Maternity units have been told they must act now on 15 separate areas to improve the care and safety for mothers and babies. A damning report into services at one hospital trust has highlighted a number of areas which need "immediate and essential action" across the country.
Areas such as safe staffing, escalation and accountability, clinical governance and robust support for families have all been included as “must dos” for all units by maternity expert Donna Ockenden. They cover 10 key areas.
The call comes in a 234 page document into care at The Shrewsbury and Telford Hospital NHS Trust. It looked into cases involving 1,486 families between 2000 and 2019 and reviewed 1,592 clinical incidents where medical records and family consent was gained.
It found 201 babies and nine mothers "could have survived" if they had received better care. That trust was also handed 60 local actions for learning, in light of care received by 1,486 families.
However it also identified key areas which other trusts need to look at. Here are the 15 "immediate and essential actions" covering 10 key areas according to the report.
1: Financing a safe maternity workforce
NHS England must commit to a multi-year investment plan to ensure the provision of a well-staffed workforce. Appropriate, minimum staffing levels must be agreed nationally, and locally, with these staffing levels adhered to.
2: Essential action on training
Sufficient protected time must be allocated for training across all maternity specialisms including routine refresher courses as well as multidisciplinary team training, particularly in emergency drills.
3: Maintaining a clear escalation and mitigation policy when agreed staffing levels are not met
Escalation should go to the senior management team, the Board, the patient safety champion and local maternity system(LMS). The Midwifery Continuity of Carer model must be suspended across all Trusts unless they can demonstrate staffing meets the minimum requirements. It should not be reinstated until robust evidence is available to support its reintroduction.
4: Essential roles for Trust Boards in oversight of their maternity services
Boards must work with their maternity departments to develop a process of regular reports and reviews to ensure improvement plans and actions take place. Every trust should have a patient safety specialist dedicated to maternity services.
5: Meaningful incident investigations with family and staff engagement and practice changes introduced in a timely manner
All investigation reports must use language that is easy for families to understand and lessons from clinical incidents must form the basis of a multidisciplinary training plan. A change in clinical practice must be evidenced by six months after an incident has occurred.
6: There must be mandatory joint learning across all care settings when a mother dies
A joint review panel must include representations from all clinical settings which were involved in the mother’s care. Post-mortem examinations must be conducted by expert pathologists in maternity and all learning must be introduced into clinical practice within six months of the investigation concluding. Investigations when a mother dies must be timely and treated as urgent and vital rather than families having to chase up trusts for conclusions as we have seen.
7: Care of mothers with complex and multiple pregnancies
Care must be provided by specialists who are familiar with managing complex pregnancies and multiple pregnancies. Where these specialisms are not found within a trust there must be early discussions with a nearby unit that has that expertise.
8: Ensuring the recommendations from the 2019 Neonatal Critical Care Review are introduced at pace
Maternity and neonatal services must continue to work towards a position of at least 85 per cent of births at less than 27 weeks gestation take place at a maternity unit with an onsite NICU and that appropriately trained consultants and staff are available 24/7.
9: Improving postnatal care for the unwell mother
All trusts must develop a system to ensure consultant review of all postnatal readmissions, and unwell postnatal women, including those requiring care on a non-maternity ward and staffing levels must be appropriate in order to deliver this.
10: Care of bereaved families
Bereavement services must be available everyday of the week, not just Monday to Friday and staff must be trained to takepost-mortem consent. All trusts need to ensure they have a system for follow-up appointments for families who have been bereaved.
At a press conference on Wednesday morning, Ms Ockenden said: “It is absolutely clear that there is an urgent need for a robust and funded England-wide maternity workforce plan starting right now, without delay, and continuing over multiple years. This is essential to address the present and future requirements for midwives, obstetricians, anaesthetists, neonatal teams and equipment, and all the associated staff working in and around maternity services. Without this very significant multi-year investment, maternity services cannot provide safe and effective care for women and babies."
Ms Ockenden said there needs to be a focus on addressing the issue of doctors and midwives leaving the workforce. “Clearly if midwives and doctors continue to leave our maternity services and we do not improve working conditions for maternity teams, there is very little benefit in continually recruiting more staff,” she said.
Ms Ockenden added: “Only with a robustly funded, well-staffed, and well-trained workforce can families and Government be able to expect consistent delivery of safe and compassionate maternity care locally and across England.”
Ms Ockenden said the final report spans the period from 2000 to 2019, but said she is “deeply concerned” that families continue to contact the review team in 2020 and 2021 raising concerns about the safety of maternity care they have received at the Shrewsbury and Telford Hospital NHS Trust. “Some of these recent families contacted us with reports they wanted to share with us.
"We haven’t been able to include them fully within the review but what we have seen is that the themes within their reports seem to echo concerns we have previously seen during this review. Seeing these repeated themes is a cause for grave concern. It is clear that there are a number of areas of maternity care where the Shrewsbury and Telford Hospital NHS Trust still has significant learning to undertake."
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