Exploring the barriers and opportunities to improve maternity safety with staff on the frontline
Victoria Vallance, Director of Secondary and Specialist Care, discusses how engagement with frontline NHS maternity staff has informed our inspection approach and is being used to support improvements in care.
For most women, pregnancy and birth are a positive and safe experience. But sadly, that is not the case for everyone, and the safety of maternity services has been subject to increasing scrutiny.
The Care Quality Commission’s (CQC) inspections of maternity services nationally have found many units that are providing good care, and we know that’s what staff want to be able to deliver every time. But there remains a variation in the quality and safety of maternity care across the country and a need for greater support to help services put the systems in place to make safety a top priority.
The findings of recent reviews and reports — including our own report on safety, equity and engagement in maternity services — show the same concerns emerging again and again. The quality of staff training, poor working relationships between obstetric and midwifery teams, and a lack of robust risk assessment all continue to affect the safety of maternity services. Those issues pose a barrier to good care, that is compounded when the voices of frontline staff and women using services are not listened to or acted on.
Building on our maternity work to date, we recently brought together staff from NHS trust maternity services across England to discuss the challenges that they face and seek their views on what needs to change to overcome them.
At the event we heard first-hand how staff are working in exceptionally demanding circumstances. They described how staffing pressures, a drive to meet targets, and insufficient funding are all factors that are directly impacting on their wellbeing and their ability to implement safety improvement programmes and ensure high-quality care. We also heard about the importance of culture, staff feeling safe and supported to speak up, and that close, trusting and respectful multi-professional teamwork is crucial.
Not only did the event provide a safe space for staff to share their concerns and reflect honestly on the challenges they feel are holding back service improvements, but it also served as a forum to discuss what practical action is needed to make a difference now.
A view shared by many staff was that ensuring the availability of multidisciplinary team training would be incredibly beneficial in supporting safety improvements and in building stronger team relationships. Simulation scenario training for all professionals in the maternity team, more secondment opportunities to enable cross-system learning, and the introduction of a new national standard for team training and team building were all suggestions put forward.
There were also ideas about how to develop team skills and use the workforce more flexibly by maximising the role of Maternity Support Workers to increase capacity amongst more senior staff or those with specific expertise. Additionally, better support for students such as bursaries and buddying schemes was proposed as a way of improving staff retention.
What was apparent throughout the discussion was the overwhelming desire of all involved to provide the best care possible. Colleagues welcomed the various national initiatives that have been introduced to help strengthen safety but felt that closer alignment between them would give services and staff a clearer direction and help focus their improvement efforts.
And there was learning for CQC in terms of our oversight role. We have an obvious part to play in identifying and acting on concerns and calling for action where we find poor care or risks to people using services or staff. But we are also uniquely placed to directly support improvement by sharing what we see is working well as a way of enabling positive change. This dissemination of good practice is something that colleagues at the roundtable event told us they want CQC to do more of and we recognise it is an area where we can have a beneficial impact.
From this summer we will be prioritising our operational resources to ensure we and others have an up to date and accurate view of the quality and safety of maternity services nationally through an inspection programme that will focus on supporting improvements at both a local and national level. The insight shared at the roundtable event is being used to shape the assessment framework for these inspections, which will have a strong emphasis on listening to the voices of women using services and the staff providing them.
We will be reporting on our inspection findings individually. But our ambition is to use what we learn from the programme as a whole, together with the insight from the roundtable, to support frontline staff in their delivery of care. We are committed to doing all we can to accelerate safety improvements, facilitate wider learning across services and influence action from national partner organisations where it is needed to alleviate the current challenges that staff face.
Through a concerted and collective effort and a reframing of the dominant narrative to one that is focused on what good care looks like, we have an opportunity to step up the pace of change, prevent future tragedies from occurring and ensure that women and babies get consistently safe and compassionate care every time.