Women’s prison develops a perinatal and maternity care pathway for vulnerable women in the judicial system, improving access to clinical and mental health support services

Outline:

The specialist perinatal service for vulnerable women in the judicial system at HMP Low Newton has been initiated as a result of identified inequalities in existing service provision. This service ensures increased capacity to manage the custodial perinatal caseload and develop and implement a Multi-Agency Maternity care pathway with the aim of ensuring equivalence of care and improving perinatal outcomes for this population. (Ref: Corston report 2016, Birth Charter 2016). Increased Midwifery service provision ensures a proactive approach to care needs and improved access to clinical and perinatal Mental Health support services within the prison.

Actions:

National and local drivers for change support the changes, from the current evidence available (Ref:Better Births 2016, NHS England Guidance on equality and Health Inequalities –legal duties 2015) and from Coroner’s recommendations in response to a perinatal death in custody at Low Newton.

A lack of clarity in relation to multi agency communication, documentation, care planning and lack of accountability in care provision were identified. This evidence advocates the revision of prison perinatal services.The project term was initially twelve months to develop the collaborative maternity care pathway and local HMP Midwifery caseload management.The process involved:

• Recruitment of specialist midwife to manage the project.

• Familiarisation, mapping, induction to the HMP setting and setting up of stakeholder group.

• Development of a multi-agency pathway, weekly peri natal MDT meeting, Prison Perinatal care protocol and associated documentation

• Increased Midwifery capacity and Mental Health support, and related resources in HMP setting

• Workforce consultation and awareness training. Cost of transfers out for routine care will be offset by increasing ante natal services within prison. Such as the planned provision of CTG reviews in healthcare HMP Low Newton

Challenges:

• Limited timescales to familiarise with HMP processes achieve activities as per Gantt chart and provide sustainable frameworks, should funding cease at twelve months.

• Communication/information sharing problematic due to limited access to electronic agency specific systems.

• Initial MDT and Stakeholders defined through consultation and awareness sessions with Obstetric,Paediatric, Midwifery, Public Health, Offender management teams, HM Prison Healthcare providers.

• The Specialist Midwife ensures a coordinated approach, linking HMP and CDDFT policies and care pathways and addressing workforce development needs.

• Service users are invited to evaluate care and suggest service improvements.

• Stakeholders informed through meetings and minutes as well as a bimonthly, midterm and 12 monthly reports and support of HMP Governor via Local Delivery Board Maternity care representation.

Evaluation through:

• Audit to measure the achievement defined activities within the pathway.

• Setting of review dates to monitor the maternity care pathway and the HMP perinatal care protocol.

• Service user feedback forms.

• Attendance at Stakeholder forums to achieve feedback on the care pathway.

• Regular workforce consultation.

• Designing of a bespoke parenting support and education with the potential of academic evaluation.

Results:

Cost of transfers out for routine care, offset by increasing access to services within prison.

• Reduced impact on mental health. Improved Maternal/infant health outcomes, proactive care planning, increased multi-disciplinary support.

• Long term maternal and child health benefits and related cost savings e.g. The provision of Breast milk through lactation plans when mother and baby are separated. (Ref: Breast Feeding - 21st Century. TheLancet 2016) Early evaluation via resident feedback suggests that the MDT approach is beneficial due to consistency inperi natal care givers. Approximately 28 women 2016/17 on the perinatal pathway in HMP Low Newton.

Spread:

• Continuation of project will ensure continued workforce consultation and awareness training across HMP and Maternity teams maintaining accountability, monitoring and strengthening services.

• The HMP midwife will continue to link HMP peri natal services and County Durham and Darlington Foundation trust services and the identified Stakeholders.

• Presentations to Obstetric, Midwifery and Paediatric forums and HMP teams regionally and nationally will raise service profile.

• Development of a clinical network for sharing of best practice to design regional models including bespoke parenting support courses.

• Commencement of Midwifery Student placements in HMP settings. Capacity of HMP Midwife to extend skills and increase in house clinical care.