Maternity Services Inquiry

The King’s Fund report, Safe Births: Everybody's business, sets out the findings of a year-long independent inquiry into the safety of maternity services in England. It draws three general conclusions.

• Most births in England are safe, but some are less safe than they could and should be.
• Safety is the responsibility of each and every member of the teams involved in delivering or supporting maternity services. This means not just midwives and obstetricians, but anaesthetists, support staff, managers and trust boards.
• ‘Safe teams’ are the key to safe maternity services.

The inquiry report gives practical recommendations in seven key areas.

1. Safe maternity teams

Doctors and midwives sometimes have different approaches to maternity care and communication between professionals is not always smooth. To deal with difficulties around communication, leadership and management, ‘safe’ maternity teams need:

• to be clear about roles and objectives within the team
• strong and effective leadership
• clear and agreed procedures for communication.

2. Staffing for safety

There need to be enough staff to provide safe care, and enough staff with the right skills.

• Safe teams need the right staff in the right place at the right time. Without the right management systems in place, more staff won’t necessarily mean safer care.
• Maternity units should regularly review their capacity and level of demand for their services. This will help them make sure they employ enough staff with the right mix of skills, and that enough staff are available to cover the busiest periods.
• The Department of Health and other national bodies should provide simple, effective tools to help managers deploy staff effectively in real time.

3. Training for safety

Safe teams need members with the right skills, training and resources to enable them to work effectively as individuals and as a team.

• Teams that work together should train together. Training should take place on the labour ward rather than on away-days. It should be a key part of the job, not an optional extra.
• All maternity staff should be given simulation-based training, to assess clinical, communication and team skills in a single exercise (ideally it should be carried out on the wards).
• Training on safety awareness should be included in mainstream professional education.

4. Guidance on safe practice

Safe practice must be based on evidence about what interventions work, and when. It should be clearly set out in guidelines and protocols.

• There should be one set of evidence-based guidelines that are backed by all relevant organisations, including the National Institute for Health and Clinical Excellence (NICE).
• They should include short summaries and one-page protocols that can be easily understood by all staff.
• All staff should be trained to use these guidelines and protocols, and their implementation should be regularly audited.

5. Using information

Many staff spend considerable amounts of time gathering and processing information for reporting and other purposes. But the issue is more about getting the right information and using it to help maternity teams assess and improve their own work.

• Teams need manageable amounts of information about their own performance. They also need information about national performance that they can use as a benchmark for their own performance.
• Trust boards should make sure that their maternity teams collect and use a limited amount of reliable information that deals with key aspects of safety.
• Until there is an effective national information system in place, maternity teams need simple systems for capturing information on safety that are designed, implemented and maintained locally.

6. What trust boards need to do

NHS trust boards are responsible for patient safety. Every board meeting should start by looking at how their trust is performing. Information on the safety of maternity care should be a key part of a ‘balanced scorecard’ of key performance indicators.

Boards should:

• prioritise safety, making sure that staff and patients know it’s a priority too.
• educate board members about issues around safety in maternity services
• set up safety committees or other structures to collect information on safety and bring it to the board
• do regular ‘walkrounds’ of maternity units to get a fuller picture of the key safety issues locally. There should be a full review of reported safety incidents
• recognise that improving safety in maternity services is a business imperative rather than a ‘nice to have’. Lapses in safety may be an important factor in patients exercising their choice and choosing to go elsewhere in what is an increasingly competitive market.

7. What national structures need to do

There are a number of national bodies concerned with safety of health care, and particularly maternity services. But their roles and how they relate to each other are not always clearly understood, even by those working in them.

• Standards for safety in maternity care should be set and monitored by just one body – the Healthcare Commission (which became the Care Quality Commission in April 2009), taking advice from others.
• Existing standards should be streamlined to a more manageable set of standards that are most critical to safety.
• Strategic health authorities and others working on maternity care at regional level should provide specific support to trusts that are being merged or restructured (‘reconfiguration’).
• The Department of Health should make sure that financial incentives promote safer maternity care, and should encourage commissioning and patient choice as the main levers for improvement.