New findings from our national maternity inspection programme
Carolyn Jenkinson, Deputy Director of Secondary and Specialist Healthcare, shares the latest findings from our national maternity inspection programme to help enable wider learning across the sector.
As I begin this blog, I’d like to take the opportunity to outline my personal commitment to ensuring our work on maternity delivers much needed support and tangible learning for trusts. I’m proud to work closely with colleagues on our national maternity inspection programme, who continue to observe staff going above and beyond for women and people using maternity services and their families. Despite this, we know that many are still not receiving the safe and quality care that they deserve.
In our last maternity blog, we highlighted emerging concerns around triage, communication and leadership; issues which we have continued to see in our recent inspections. As we reach the halfway point of the programme, this blog explores our latest findings, highlighting good practice to enable trusts to learn from one another and make vital improvements.
Translation and interpretation services
It has been positive to see examples of units supporting women, birthing people and their families whose preferred language is not English. While staff often report being able to use and access translation services, some units have introduced initiatives that go a step further in addressing language barriers. Following a review of its interpretation services, Bradford Royal Infirmary introduced online video interpreter services and is working towards making it clear which staff are bilingual, using badges to indicate this.
At Peterborough City Hospital, we saw that women and birthing people had access to a digital wellbeing information pack and were encouraged to use QR codes displayed across maternity areas to access information leaflets, surveys and the maternity website. Information on the website could be translated into other languages. The service also used electronic devices for virtual translation services during clinics.
Learning from demographic data and feedback
Throughout the programme, we have been exploring what trusts are doing to tackle health inequalities. Our inspections have shown that providers are not routinely recording demographic data on people using their services who are involved in clinical incidents. We first raised concerns about this in our Safety, equity and engagement in maternity services report, as it was not always clear whether services were using data on ethnicity to review outcomes, learn from incidents and personalise care. Trusts that are still not collecting this data are missing an opportunity to understand why certain populations in their area are more likely to have a poorer experience of care.
We’ve been encouraged to see trusts making good progress in this area. At Bradford Royal Infirmary, leaders monitored outcomes and interrogated data to identify the impact of ethnicity on outcomes. This learning was shared with teams to help improve care. For example, recommendations were made for increased scanning for Pakistani women after data revealed they have a higher risk of having Small for Gestational Age (SGA) babies.
While demographic data is vital to understanding and addressing inequalities for people using maternity services, other trusts are using feedback from people from a wide range of ethnic groups to tackle these challenges. For example, staff at Milton Keynes Hospital sought to understand the needs of their local population by proactively seeking feedback from different members of the community. The service had a strong focus on engaging people whose voices are seldom heard and gathered views from a range of women and birthing people to improve service delivery. As part of a community project, the foetal medicine lead at the trust supported GPs to tackle health inequalities in pre-conceptual and antenatal care, looking at areas such as long-term conditions, maternal health and wellbeing.
At Chelsea and Westminster Hospital, leaders and staff actively and openly engaged with women and birthing people to plan and manage services. Here, people could share their experiences through surveys, complaints and through the local maternity voices partnership (MVP). The MVP also co-produced a ‘Muslim Mums memo card’ that outlined important rituals and aspects of care, as well as a labour information booklet and decision aid tool.
Obstetric staffing
Recommendations in the Ockenden report state, “there must be a minimum of twice daily consultant-led ward rounds and night shift of each 24-hour period. The ward round must include the labour ward coordinator and must be multidisciplinary. In addition, the labour ward should have regular safety huddles and multidisciplinary handovers and in-situ simulation training.” While it has been encouraging that all units inspected so far in the programme have adjusted consultant cover to meet this recommendation, we are concerned that the cover model is often fragile, and the rotas are reliant on every consultant being available. While funding was provided following the Ockenden report, it was not enough to meet the demand from trusts.
This precarious position is compounded by pressure on consultants to take on additional roles without the necessary support in place. We’ve seen consultants having to cover registrar rotas and extra on-call shifts to meet the needs of their service. In other instances, lead clinicians had to submit business cases to justify the need for additional consultants, a task that could be carried out by a business manager. Perhaps most worryingly, many trusts do not have any frameworks in place to safeguard the wellbeing of consultants who are working well above their hours.
Services that are succeeding in this area are recruiting to a workforce plan, not recruiting when the obstetric workload is unmanageable. By considering how best to use the skills of their specialists and providing the right level of operational support, maternity units can allow their obstetric staff to fulfil their leadership role and focus on caring for women and people using their services.
Board-level support
We have seen that maternity services which are closely supported by their organisational board have been empowered to make improvements. The quality of this relationship can have a significant impact on how the trust progresses towards its vision and provides better care for the local population.
Croydon University Hospital had a non-executive director (NED) who was internationally recognised for their expertise in reducing women’s health inequalities. The NED was a maternity safety champion who talked to us about the problems facing the service, notably those related to recruitment, retention and ensuring that women’s perspectives were promoted. It was also positive to learn that Peterborough City Hospital now has a NED attached to the maternity service, helping to facilitate communication from ‘floor to board’.
As a system we need to work together to recognise and reduce health inequity. During this programme we are looking at how as a regulator, we can be better at capturing evidence that relates to equality, diversity and inclusion in relation to safety. We strive to play our part in reducing health disparities by using experiences and evidence to inform and develop our approach to regulation.
We will continue to share findings as our national maternity programme progresses and the next update will feature in our annual State of Care report later this year. Our commitment to improving outcomes in maternity will continue throughout and beyond this programme. We look forward to hosting the Healthcare Safety Investigation Branch’s (HSIB) maternity and newborn safety investigation programme later this year. We will also be working with THIS Institute on an evaluation of our national maternity inspection programme. The evaluation project will be an important step in helping shape our approaches to inspecting, analysing, and supporting safety culture in maternity services in the future.
