1. Birmingham Women’s Hospital 37 th Annual Clinical Report April 2009 – March 2010 Simon Grant Consultant in Obstetrics & Fetal Medicine

2. My background…. Consultant in Obstetrics & Fetal Medicine Southmead since 2005 Member NICE IPC GDG 2005-7 Consultant in Obstetrics & Gynaecology Treliske 2000-5 Subspecialty training in Maternal Fetal Medicine Birmingham Women’s 1996-9 Research Southampton 1993-5

4. Southmead - BWH Large district general hospital compared to long- standing university unit Full range of obstetric care except specific maternal complications & two fetal medicine procedures (proximal regional referral centre) Some limitations of gynaecology activity at both Developing against established research environment Unusual situation in Bristol

5. SMH – BWH: deliveries SMH 07/08 BWH 07/08 SMH 08/09 BWH 08/09 SMH 09/10 BWH 09/10 Hospital 5,0507,2515,2267,1835,5295,907 Birth Suite 5106215711,184 Home 2099420910519280 Maternity DAU Other Unknown Total 5,7697,3456,0567,2856,2927,171 % Hospital 87.586.387.982.3 % Birth Suite 8.810.39.116.5 % Home Births 3.63.53.11.1

6. SMH – BWH: mode of delivery % SMH 07/08 BWH 07/08 SMH 08/09 BWH 08/09 SMH 09/10 BWH 09/10 SVD 6561.56260.159 Forceps 57887 Ventouse 75.5766 Breech 10.5 10.2 1 Elective CS 812.5 811 9 Emergency CS 14131514.5 16 Multiple births Twins 108125132140 Triplets 2322

7. SMH – BWH: Gynaecology SMH 07/08 BWH 07/08 SMH 08/09 BWH 08/09 SMH 09/10 BWH 09/10 New outpatients 739315,490703016,170 Follow-up outpatients 796623,367854825,379 Elective inpatients18971311173511771613 Elective day cases 18332566207124132027 Emergencies 16941464163714361613 BCRM/BWH ACU BCRM IVF/ICSI egg collections 1009 BWH ACU treatment cycles 900

8. Scope of the report Clinical Governance Maternity Gynaecology Neonatology Clinical Support Genetics Infection Control R&D, Education Patient Experience

9. Clinical Governance (1) Intranet & document management system allows digital storage of & access to guidelines & policies; facilitates update of documents; Challenges: ease of access to on-line documents often printed anyway for “near-patient use” rate limiting step for update of documents is the process of production

10. Clinical Governance (2) NHSLA Standard 2 considerable achievement what was prior level? admirable commitment to reassessment against future standards Achievement of standards increasingly challenging is it time to reassess the system? BJOG December 2010

11. Maternity (1) KPIs 80% bookings before 12 weeks 75% women with named midwife 75% continuity of carer by 2 midwives continued increase in breastfeeding rate smoking cessation referrals (identification of intrauterine growth restriction)

12. Maternity (2) First trimester combined screening for aneuploidy current “gold standard” for screening can it be offered at the same level as in the private sector? funding staffing training capacity FASP accreditation/oversight

13. Maternity (3) Community scanning midwife sonographers dating & growth scans CoGs study improved identification of growth restriction Resources?

14. Gynaecology (1) Very high level of activity Target achievement Infection control a continued success Successful ACU with successful pregnancy rates in line with national standards Wide range of sub-speciality activity Urogynaecology Colposcopy Gynae cancer EP/AGA PAG Menopause MASE

15. Gynaecology (2) Assisted Conception Unit Multiple pregnancy rate reduced from 28% to 13% With no impact on overall pregnancy rates Significant decrease in complications of ovarian stimulation: Reduction in abandoned cycles from ~12% to 0- 3% Apparently significant reduction in cases of ovarian hyperstimulation

16. Gynaecology (3) Outpatient gynaecology Not “just” ambulatory hysteroscopy, but includes: Menstrual disorders PMB Hysteroscopic sterilisation OP endometrial ablation Coil retrieval & contraceptive advice Investigation and treatment of reproductive problems Innovative Leadership – national & wider Research

17. Neonatology New premises – overwhelming effort Joint working with BCH for neonatal surgical patients Clinical information system Increasing nursing staffing numbers First submission of data to the National Neonatal Audit Project Active contribution to unit’s research effort

18. Clinical Support (1) Radiology & Ultrasound In-house & direct access gynae US service to GPs 6.5% increase in activity from 2007/8 41% increase in activity over 5 years up to 2009-10 Obstetric US: 4.8/delivery (3.1/delivery @ SMH)

19. Clinical Support (2) Laboratory specialities – maintained accreditation while dealing with increased workload & staffing issues Anaesthetics: Epidural rate increased but still below national average; Regional analgesia satisfaction rates maintained; Complication rates continue to decrease

20. Clinical Support (3) Genetics: continued increase in staffing to address workload; Meeting RTT targets. Infection Control: CQC inspection; 7 th year of lack of any mandatory surveillance infections.

21. Research & Development High level of stability long established University department Maintenance of staff & funding tenured academic posts support staff High level of activity 105 studies in progress, or in start-up, at the end of March 2010 High rate of publication 173 publications listed in report

22. “New challenges” – review 2004 More focussed research strategy? Recruitment to major trials? Recruitment to specialities Maternal morbidity Neonatal morbidity IUGR? Gynaecological follow up

23. Challenges Complaints environment First trimester screening implementation NHSLA/CNST standards Financial environment Reorganisation of NHS – GP commissioning

24. Annual Clinical Report 2009-10 Extremely busy unit High levels of clinical activity in all areas Achieving most externally set standards Innovative Thriving research environment