The Health and Adults Scrutiny Sub-Committee meeting on Tuesday 20 February 2024 focused on critical issues within maternity services and primary care access in Tower Hamlets. Residents shared deeply personal and often distressing experiences with maternity care, highlighting systemic failures in empathy, communication, and provision of care, particularly for women from Black, Asian, and Minority Ethnic (BAME) backgrounds. The committee also received updates on efforts to improve GP access, including addressing workforce shortages, enhancing digital services, and ensuring equitable care for all residents, especially vulnerable individuals.

Maternity Services in Tower Hamlets

The meeting heard powerful testimonies from residents Momina Begum and Farhana Anjuman regarding their experiences with maternity services at the Royal London Hospital. Both women described instances of dismissive staff, pressure to undergo medical interventions against their wishes, and a lack of adequate support during and after childbirth.

Momina Begum recounted being pressured into insulin for gestational diabetes and later being told not to push during labour, despite her body signalling it was time to deliver. She also highlighted instances of staff appearing to avoid responsibility, particularly during night shifts. Farhana Anjuman drew a stark contrast between her experiences in Italian hospitals, where she received compassionate and extended care after the birth of her first two children, and her experience at the Royal London Hospital, where she felt abandoned and unsupported after a premature birth. She noted that staff dismissed her requests for assistance and that night staff were unhelpful.

Karen Wint, CEO of Sister Circle, presented an overview of her charity's work supporting women with complex needs, including refugees and asylum seekers, who are more likely to experience poor healthcare. Sister Circle's 'Maternity Mates' programme, funded by the borough a decade ago, trains local women to support pregnant individuals referred by Barts Health. While this programme has improved experiences, concerns about poor care persist. Wint commended Barts Health for their ongoing learning and education programmes for health professionals but stressed that all women should receive the same quality of care.

Irantzu Perez Arribas, Head of Programmes at Sister Circle, detailed findings from interviews with 13 women, identifying key concerns around resources, culture, and care. Recommendations included ensuring continuity of care with a single midwife, improving clinical handovers, and adopting a more holistic approach. Specific suggestions included reducing unnecessary inductions, enhancing postnatal care, providing better breastfeeding support, and fostering greater kindness and empathy from staff. The use of technical jargon, particularly for women with limited English or hearing impairments, was also identified as a barrier.

Further discussions revealed that while Barts Health is increasing language support, pregnant women need to be better informed about its availability. Members noted that despite staff shortages, a consistent level of compassion should be shown, and that a lack of funding and professionalism has led to disproportionate maternity provision. The importance of recruiting and training more midwives and nursing staff to understand the anxieties of expectant mothers was emphasised. Residents were encouraged to voice concerns early. The need for cultural sensitivity and responsiveness to BAME mothers, especially those with language barriers, was highlighted, with a call for annual cultural awareness training for health professionals. Continuity of care was deemed crucial for meeting the complex needs of pregnant women. Feedback regarding women with disabilities indicated mixed responses, with particular concern for those with hearing impairments.

Lisa Dinh, External Relations Manager at Barts Health NHS Trust, confirmed that colleagues from the Trust would attend the next sub-committee meeting on 18 April 2024 to discuss clinical concerns and that a written brief addressing service delivery and patient concerns would be submitted.

GP - Out of Hours Service and Primary Care Access

Dr Roberto Tamsanguan, Tower Hamlets Primary Care & Clinical Lead, and Jo-Ann Sheldon, Head of Primary Care, provided an update on improving access to primary care. They highlighted challenges including rapid population growth, high patient turnover, workforce shortages, and the ongoing impact of the pandemic on telephony and face-to-face services. Data from the GP Appointments Data Dashboard (GPAD) showed a significant increase in both telephone and face-to-face appointments.

Initiatives to improve access include encouraging patients to use the NHS app for test results and waiting list information, promoting self-referrals to bypass GPs, and the 'Pharmacy First' initiative, which allows community pharmacists to prescribe for common conditions. Modern telephony with call-back services, enhanced staff training, and improved links between primary and secondary care are also being implemented. The Additional Roles Reimbursement Scheme (ARRS) is being expanded to include physician associates to alleviate pressure on GPs.

Dr Khyati Bakhai, GP and Tower Hamlets Primary Care Development Lead, shared findings from an 'Improvement Week' patient survey. While staff interaction was rated highly, patients experienced difficulties with lengthy telephone waiting times and overwhelmed administrative teams. The survey indicated that booking appointments, whether via telephone or e-consult, was both the most positive and most challenging aspect of accessing services. Efforts are ongoing to reduce telephone waiting times and improve the patient experience through a more holistic approach.

Members were informed that further awareness is needed to change perceptions of physician associates, who can help address GP shortages. The N6 network, serving approximately 70,000 residents, is providing adequate appointments despite population density. Plans for new GP practices are underway, with a building programme to be submitted for review. The importance of a holistic approach to patient contact modes was emphasised, with a commitment to prioritising vulnerable patients requiring home visits. The council was asked to help communicate to residents that GP teams now comprise a wider range of trained clinicians beyond just doctors.

Malcolm Thomson, Chief Operating Officer for Tower Hamlets GP Care Group, presented an overview of the Out of Hours (OOH) service, which sees around 1,500 patients monthly and has been rated 'good' by the CQC. The service is accessible via 111 and offers telephone, face-to-face, and home visit consultations. Independent GPs undergo regular clinical audits and safeguarding training, with pharmacists also conducting monthly audits on prescribed medications.

Performance and patient satisfaction are continuously monitored, with patients encouraged to provide feedback. A patient experience team will conduct further surveys to understand residents' experiences with the OOH service. The service aims to ensure efficient and effective care through qualified, competent, and compassionate staff, though recruiting OOH GPs can be challenging. Integration with primary care is facilitated through electronic discharge notes and shared care plans.

Concerns were raised about the potential for a lack of empathy and compassion from some staff, with a commitment to further training and development to address this. The two-hour response time target for 111 calls was acknowledged as a potential source of stress for patients who may not require such urgent attention, creating a demand and capacity issue. The importance of clear communication to residents about the diverse roles within general practice teams was stressed, and the council was invited to collaborate on disseminating this information.

Decisions Made:

• Maternity Services: It was resolved that a written brief highlighting specific measures to address service delivery and patient concerns would be brought back to the sub-committee at the next meeting on 18 April 2024. The presentation was noted.
• GP - Out of Hours Service and Primary Care Access: It was resolved that a written brief from Primary Care on the building programme for practices in the borough would be submitted to the sub-committee. A brief overview on the number of surveys conducted in borough practices would also be brought to the sub-committee. The presentations were noted.