Finance, Activity, Outcomes Maternity Programme Board 20 th March 2015
Maternity Tariff - Activity Table 1: Antenatal Tariff locally and nationally 2013 - 2014 Table 2: Birth Tariff locally and nationally 2013 - 2014 100% 7% 7% 13% 13% 90% 100% 80% 27% 27% 70% 90% 40% 40% 29% 29% 60% 31% 35% Intensive 80% 50% Deliveries with 40% Intermediate 70% 66% 66% complications 30% Standard 60% 47% 47% and co- 20% morbidities 10% 50% 0% 40% HUH 2013 HUH 2014 National National 71% 71% 69% Deliveries 65% 2013 2014 30% without complications 20% and co- Table 3: Postnatal Tariff locally and nationally 2013 - 2014 10% morbidities 100.0% 1.0% 0.0% 0.8% 0.8% 0% 90.0% 22.0% 21.0% HUH 2013 HUH 2014 National National 35.0% 35.0% 80.0% 2013 2014 70.0% 60.0% Intensive 50.0% 40.0% Intermediate 78.0% 78.0% 64.2% 64.2% 30.0% Standard 20.0% 10.0% 0.0% HUH 2013 HUH 2014 National National 2013 2014
Maternity Tariff - Spend Table 4: 2013/14 Spend Table 5: 2014/15 Forecast Deliveries without CC £4,197,179 Deliveries without CC £4,631,420 Deliveries with CC £3,255,667 Deliveries with CC £3,175,957 AN Standard £2,436,422 AN Standard £2,521,368 AN Intermediate £3,298,187 AN Intermediate £3,335,725 AN Intensive £1,825,072 AN Intensive £1,837,583 PN Standard £853,029 PN Standard £835,883 PN Intermediate £293,460 PN Intermediate £291,840 PN Intensive £23,631 PN Intensive £11,640 Total £16,622,124 Total £16,201,939 * Additional revenue comes from other CCGs such as Waltham Forest
GP Ante/Postnatal Service Table 6: Finance forecast for GP Confederation contract 2014/15 2014/15 YTD Budget YTD Actuals Full-Year Full-Year Forecast Annual Non-Recurrent Funding at Month 11 at Month 11 Forecast (Under)/Overspen Budget (£000's) (£000's) (£000's) d (£000's) (£000's) Antenatal Local Enhanced Services 596 546 239 261 (335) Total Non-Recurrent Funding 596 546 239 261 (335) Table 7: GP Confederation Antenatal Activity Qtr 1, 2, 3 Table 8: GP Confederation Postnatal Activity Qtr 1, 2 , 3 Actual spend Qtr 1, 2, 3 £57,920 Actual Spend Qtr 1, 2, 3 £ £96,200 530 860 846 519 520 840 825 510 820 500 800 490 780 Qtr 1 Qtr 1 480 760 Qtr 2 Qtr 2 734 465 464 470 740 Qtr 3 Qtr 3 460 720 450 700 440 680 430 660 Antenatal activity Postnatal activity
Births & Deliveries 1 Table 9: City & Hackney deliveries at the Homerton 2012/13 to 2014/15 400 350 300 250 200 150 100 50 0 April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December 2012/13 2013/14 2014/15 Per annum: 2012/13 – 3281; 2013/14 – 3480; 2014/15 – 2543 to date
Births & Deliveries 2 Table 10: City and Hackney deliveries at other maternity units UCLH Whittington Barts Health Other Providers Royal Free 100 2 90 7 1 2 11 2 2 2 2 1 80 1 1 4 10 10 5 1 3 11 10 9 3 6 8 8 11 6 1 6 10 9 6 2 1 2 10 6 11 70 3 10 5 1 3 4 4 4 8 12 10 8 8 8 7 9 9 7 Percentage share 7 9 1 13 10 12 15 7 4 4 3 11 1 60 6 10 24 28 20 6 5 2 7 1 2 2 21 7 2 4 17 7 7 7 15 26 24 27 13 18 20 6 7 9 5 21 20 19 28 22 3 50 13 17 6 9 17 8 23 17 18 9 22 13 16 40 20 17 17 15 30 56 49 48 41 47 42 43 43 47 46 44 41 46 43 33 38 39 37 35 40 43 37 42 20 30 34 38 40 40 35 32 29 29 29 10 0 January February March April May June July August September October November December January February March April May June July August September October November December April May June July August September October November December 2012/13 2013/14 2014/15
Births & Deliveries 3 Table 11: Trends in births at Homerton and other units 4000 3500 3480 3391 3000 3281 2500 Homerton 2000 Other Units 1500 1000 952 892 500 855 0 2012/13 2013/14 2014/15 (forecast)
Births Projections Table 12: Birth Data & Projections Actual Last 10 Years Last 5 Years GLA GLA Forecast Forecast Annual 2023 Annual 2023 (central + (SHLAA plus 2003 2008 2013 Increase Projection Increase Projection NPP) NPP) City and Hackney 4,323 4,485 4,500 0.40% 4,683 0.07% 4,532 5,119 5,150 Newham 5,102 5,963 6,267 2.08% 7,700 1.00% 6,923 7,507 7,605 Tower Hamlets 3,940 4,230 4,608 1.58% 5,390 1.73% 5,470 5,536 6,077 Barking and Dagenham 2,594 3,619 3,796 3.88% 5,555 0.96% 4,177 4,318 4,251 Havering 2,366 2,787 3,004 2.42% 3,815 1.51% 3,490 3,427 3,478 Redbridge 3,376 4,013 4,591 3.12% 6,242 2.73% 6,010 5,151 4,947 Waltham Forest 3,770 4,582 4,721 2.27% 5,909 0.60% 5,012 5,102 4,869 Total NEL 25,471 29,679 32,264 2.39% 39,294 0.84% 35,614 36,160 36,377 Increase 7,030 3,350 3,896 4,113 Births may increase in City and Hackney by as much as 650 over the next eight years.
Public Health Outcomes Table 13: Antenatal assessment by 12 weeks + 6 days Table 14: Breastfeeding prevalence 6-8 weeks 82.0% 81.3% 84.0% 80.7% 81.0% 83.5% 83.5% Quarter 1 80.0% 83.0% 2013/14 79.0% 82.5% 82.4% 82.3% 78.0% 82.1% 82.0% Quarter 2 81.8% 77.0% 76.3% 81.5% 2013/14 76.0% 81.0% 75.0% Quarter 3 80.5% 2013/14 74.0% Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 2013/14 2013/14 2013/14 2013/14 2014/15 73.0% Table 15: % women who were smokers at time of delivery Table 16: Uptake of flu vaccine by pregnant women 2013/14 42.0% 6.0 39.8% 5.4 40.0% 5.1 5.0 4.9 4.7 4.4 38.0% 4.0 35.9% 36.0% 3.0 33.2% 34.0% 2.0 32.0% 1.0 30.0% 0.0 28.0% Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 2013/14 2013/14 2013/14 2013/14 2014/15 C&H Rate London Rate England Rate
Maternal/Neonatal Mortality Maternal mortality • 5 maternal deaths between July 2013 and February 2015 Table 17: Neonatal & infant mortality 2011-2014 Neonatal mortality 2011 2012 2013 2014 Pre-term intrapartum deaths <5 6 7 <5 Term intrapartum deaths <5 <5 Pre-term stillbirths 23 25 32 39 Term stillbirths 11 6 Totals 39 42 40 38 Table 18: Neonatal morbidity – Sis Table 19: Rates of mortalities per 1000 births 2011-13 10 Unexpected admissions to NICU for term babies (SIs) 8.8 9 7.6 8 7.1 2012-13 16 7 5.8 5.7 2013-14 8 5.5 6 4.9 City and Hackney 5 2014-15 11 4.1 3.9 4 London 3 England 2 1 0 Stillbirth rate Perinatal Infant mortality mortality
Patient Experience 1 Family & Friends Test Response rates Table 20: FTT Response rate pre October 2014 Table 21: Response rate % post October 2014 (Four questions asked) (combined question results) 20% 25.00% 18% Response rate FFT-Antenatal 16% 20.00% 14% Response rate 12% 15.00% FFT- Intrapartum 10% 8% 10.00% Response rate 6% FFT-Postnatal Hospital 4% 5.00% 2% Response rate FFT-Postnatal 0% Community 0.00% Oct-14 Nov-14 Dec-14 Jan-15
Patient Experience 2 Table 22: Response rate by FFT questions Table 23 : FTT recommendation scores Dec 2014 25.00% 100% 20.00% 100% 99% 15.00% 98% Oct-14 97% 97% Nov-14 96% 10.00% 96% Dec-14 95% 95% Jan-15 5.00% 94% 93% 0.00% 92% Response rate Response rate Response rate Response rate FFT-Antenatal FFT-Birth FFT-Postnatal FFT-Postnatal FFT-Antenatal FFT-Birth FFT-Postnatal FFT-Postnatal Hospital Community Hospital Community Table 24 : FTT comparison of recommendation rates locally, regionally and nationally HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION BARTS HEALTH NHS TRUST TRUST England London Maternity - November 2014 Response Rate % Recommend Response Rate % Recommend Response Rate % Recommend Response Rate % Recommend Antenatal Care - 93.1% - 100.0% - 95.5% - 93.9% Birth 11.3% 95.1% 4.2% 100.0% 22.1% 96.8% 19.6% 94.4% Postnatal Community Provision - 96.6% - 0.0% - 97.0% - 97.2% Postnatal Ward - 86.4% - 91.0% - 93.0% - 90.4%
KPIs and CQUINS Table 25: Update on GP Ante/post natal service process KPIs Each practice has a named GP lead for Maternity provision and a In place named Midwife Evidenced by practice list of names for lead GPs Each practice has an agreed protocol with their named midwife In development regarding: 1) regular practice meetings / review of current caseload 2) how urgent communication is managed, 3) clear documented clinic times / access information (for both practice and midwife staff) for patients Confederation to work with the Homerton Hospital to create a service In development – through level agreement that will outline these areas and ask the Federation to Homerton / CCG / negotiate and implement these. Confederation meetings Homerton Maternity CQUIN : 70% continuity for low risk women for antenatal care Reporting in 2014/15 quarter 4.
Maternity Dashboard Please see separate excel spreadsheet
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