1. Maternity Framework Antenatal Access Target and Outcome Measures Data Theme Work Stream Women and Children’s Health Information Programme Lindsay Mathie Project & Information Manager Etta Shanks Senior Information Analyst

2. Proposed Target – Current Situation Antenatal Access Target - Data from Scottish Morbidity Record 02 (SMR02) Key components –The record is submitted by 6 weeks following the end of the month of discharge –‘Date of Booking’ field (will be Mandatory from 1 st April 2012) –‘Gestation at Time of Delivery’ field (Mandatory) –Using both these fields ‘Gestation at Time of Booking’ can be calculated

3. SMR02 Submissions In October 2010 ISD notified all Health Boards of the definitional enhancement to ‘Date of Booking’ –the ‘Date of history taking appointment’ as recorded on the ‘Demographic information and EDD’ page in SWHMR Pregnancy Record page 2

4. Why we need to pursue these actions with SG support? Submission backlogs across Scotland (for the last 3 months of data available) Aug 20113,349 Sep 20113,782 Oct 20114,479

5. All Health Boards Number of SMR02 records submitted by the target date of 6 weeks following the end of the month of discharge

6. Quality Of the SMR02 forms submitted in 2010, and where all necessary fields were completed, we could derive a figure for 82% completion of ‘Date of Booking’ A large number of records have been with ‘not known’ An example: Gestation at booking calculated in NHS Fife (9%), NHS Forth Valley (30%) and NHS Shetland (38%) SMR02 Data Quality Project in 2009 identified: –In some sites date of booking be recorded in SWHMR but not transferred to SMR02 –Findings and recommendation fed back to hospitals (a web report is available) ISD can provide reports and analysis to help support you in managing your local performance – what information would be useful for you?

7. Proportion of patients booking <= 12 weeks gestation, 2010, by Health Board of Residence

8. Proportion of patients booking <= 12 weeks gestation, Scotland, 2010, by SIMD Quintile

9. Provisional Figures Please contact ISD for copy of figures nss.isdmaternity@nhs.net

10. Developing a Set of Quality Measures for Maternity Care in Scotland

11. Policy Aims Improve early access to antenatal services to support mothers-to-be to breastfeed, improving maternal and infant nutrition, reduce harm from smoking, alcohol and drugs, and improve healthy birth weight.

12. Proposed measures Access, HEAT Target At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 –Data currently recorded on SMR02 Check that all units are recording properly Encourage prompt completion of SMR02 Monitor data and set up routine analysis and reporting (quarterly)

13. Proposed Outcome Measures Examples… Breast feeding Maternal and Infant nutrition Smoking Alcohol & drugs Improvement in birth weight Continuity of Carer

14. Institute for Healthcare Improvement Framework (adapted) Measure title and Source (rationale) Type of measure (outcome/process etc) Why do we need it? Definition Exclusions (e.g. where it would be inappropriate) Stratifiers (e.g. age, deprivation, ethnicity, disability etc) Data collection method Analysis and presentation

15. Other Initiatives Implementation of Patient Management Systems National Screening Initiatives –Pregnancy –Newborn –Universal Hearing Screening –Congenital Anomalies Child Health Screening –Childhood Immunisations –Breastfeeding –Child Healthy Weight Other targets, indicators and initiatives –Alcohol & Drugs –Sexual Health –Patient Safety –Smoking Cessation –Stillbirth & Caesarean section groups –Scottish Woman Held Maternity Record –Scottish Birth Record and Neonatal systems –Older Peoples Agenda –Mental Health incl. Child and Adolescent Mental Health

16. The way through the complexity Find the right balance: –What we want to measure –What is measurable Are we already measuring it? –What makes sense in analysis e.g. sufficient numbers –What the service will tolerate

17. ISD’s role Engage data providers and other stakeholders Assure the measure makes sense Tease out all the relevant definitions Work out how to get the data Collate the data Analyse and help to interpret resulting information

18. How will we get there….. Agree scope, plan and timescales by end of March 2012 Project to run until March 2016 Governance - including principles, deliverables & outputs, plans for communication & engagement Agree development and phased implementation approach with stakeholders Define and agree the Measures with stakeholders