Maternity staff working hard to improve safety but barriers remain, according to new report

Maternity professionals are doing more to ensure safe care is delivered reliably to mothers and babies, but there are still significant barriers impeding their progress, according to a new report published today by The King's Fund.

The report is based on the outcome of a series of regional events held with midwives, obstetricians and risk managers as part of the Safer Births initiative* and which explored their views on the challenges facing maternity units in improving the safety of services.

Ensuring safe services was the highest priority for staff across the four regions involved – Yorkshire and the Humber, North East, North West and London. The report reveals many examples of innovative local practice with maternity professionals developing better ways of working, improved handovers, joint training and user-friendly summaries of clinical guidelines. However, many of the teams reported major barriers that were preventing their progress, including:

  • a lack of staff - this was of greatest concern to most teams, particularly with a rising birth rate;
  • recruiting and retaining staff, especially midwives with more than a couple of years' experience;
  • poor communication between staff from different disciplines or different units particularly during transfer;
  • a lack of leadership, both within maternity units and at board level of NHS trusts.

Although there are significant challenges facing maternity services, teams were able to see that many solutions did not depend on having greater resources or more staff, but on better deployment of limited resources, stronger leadership within units and across professional disciplines, and more effective teamworking. There were local examples of innovative best practice, such as joint training of teams from two different trusts between which transfers are made.

Other solutions identified by the teams included:

  • new ways of deploying staff, such as case loading or flexible rostering across labour ward and community teams;
  • developing support roles to take on new responsibilities;
  • aligning shift patterns so that midwives and obstetricians attend the same, multidisciplinary handover;
  • joint training to improve teamworking and clinical outcomes – this was seen as crucial and a number of trusts had revamped their skills and drills training to make sure everyone knew what to do in an emergency;
  • and supporting clinical staff to put guidelines into practice.

Dr Anna Dixon, Director of Policy at The King's Fund, said:

'This report shows that maternity professionals are introducing new ways of working that should improve the safety of care provided to mothers and babies. We are seeing progress and an appetite locally for change - there are many examples of local innovation where solutions focus on making the best use of existing resources to deliver safe care. Yet frontline staff who took part in our events also identified obstacles they face in providing the safest possible care. They told us that they want to be able to exchange ideas and good practice with other trusts and that they need practical advice on how to improve safety, tailored to their local circumstances, not simply more guidance.'

Dr Kevin Cleary, Medical Director at the National Patient Safety Agency, said:

'The views expressed by maternity professionals in this report highlight some of the most important factors we know are crucial in embedding a safety culture in health care organisations. Along with reporting patient safety incidents these include the need for openly and constructively sharing information, fostering effective teamwork and demonstrating that patient safety is a top leadership priority. The NPSA is working closely with our partners in the Safer Birth initiative to ensure maternity teams receive practical patient safety tools that can easily be tailored to local circumstances.'

The events marked the first stage of the Safer Births initiative – a service improvement programme set up by The King's Fund and national and local NHS partners to help frontline professionals improve the safety of maternity services. The partners are: the Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, Centre for Maternal and Child Enquiries, NHS Litigation Authority and National Patient Safety Agency. The Safer Births initiative will shortly announce details of a major new improvement network to improve the outcomes of care during labour and birth for women and babies.

The initiative follows a number of reports, guidance documents and reviews over the past few years that have identified the challenges for maternity services. These include the 2008 report of the independent inquiry commissioned by The King's Fund, Safe Births: Everybody's business, and the Healthcare Commission's review of maternity services, Towards Better Births. Both reports identified similar areas in need of improvement, including staffing, information, training and communication.

See more from our Safer Births programme

Notes to editors: 

  1. For further information or interviews, please contact The King's Fund press and public affairs office on 020 7307 2585 or 020 7307 2603. An ISDN line is available for interviews on 020 7637 0185.
  2. *The Safer Births initiative is a partnership between The King's Fund, Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, Centre for Maternal and Child Enquiries, NHS Litigation Authority and National Patient Safety Agency. It aims to improve the safety of maternity services by supporting frontline professionals.
  3. The report is available to download at www.kingsfund.org.uk/saferbirths. It sets out the findings from three regional events involving heads of midwifery, lead obstetricians and risk managers. Across the three events, held in York, London and Wigan, 71 trusts were involved out of a total of 73 in the Yorkshire and the Humber, North East, London and North West strategic health authority regions. Overall about 40 per cent of participants were midwives; 20 per cent were obstetricians; and 20 per cent were managers or risk managers. Most teams came from consultant-led units.
  4. The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.
  5. The Royal College of Midwives (RCM) aims to promote and advance the profession of the midwife. The RCM represents the vast majority of the UK's midwives and is one of the world's oldest and largest midwifery organisations, and celebrated its 125th anniversary in 2006. It is also a trade union. For more information visit the RCM website at www.rcm.org.uk
  6. The Royal College of Obstetricians and Gynaecologists (RCOG) is dedicated to the study and the advancement of standards in women’s reproductive healthcare.  It does so through publishing working party reports, scientific opinions and clinical guidelines and works closely with other professional organisations and healthcare agencies.  It is also involved in postgraduate medical training and the continuous professional development of consultants.  For more information, please visit www.rcog.org.uk.
  7. The Centre for Maternal and Child Enquiries (CMACE) is an independent charity. Its mission is to improve the health of mothers, babies and children by carrying out confidential enquiries and other related work on a UK wide basis and widely disseminating the results.
  8. The NHS Litigation Authority (NHSLA) is a Special Health Authority responsible for handling negligence claims made against NHS organisations in England. In addition to dealing with claims, the NHSLA has an active risk management programme to help raise standards of care in the NHS. The Clinical Negligence Scheme for Trusts (CNST) is a risk pooling scheme administered by the NHSLA which handles all clinical negligence claims made against NHS organisations where the incident took place on or after 1 April 1995. Maternity claims account for around 50% of the value of all CNST claims. The costs of CNST are met by contributions from NHS organisations. The CNST maternity standards apply to NHS organisations providing labour ward services and are used by the NHSLA to assess the management of risks. NHS organisations achieving the standards receive a discount from the maternity element of their CNST contribution. www.nhsla.com.
  9. The National Patient Safety Agency is an Arm’s Length Body of the Department of Health. It encompasses three divisions; the National Research Ethics Service, the National Reporting and Learning Service and the National Clinical Assessment Service. The NPSA’s vision is to lead and contribute to improved, safe patient care by informing, supporting and influencing healthcare individuals and organisations. For more information visit: www.npsa.nhs.uk.