MATE RNI T Y
constant issue over the last few years. Our perspective at the CQC is that we expect providers to have adequate staff to provide safe care. Where they do not, we will insist that they find those staff, but we recognise that many units have difficulty recruiting.” The report emphasised that staff
shortages have been a persistent problem. Health Education England calculated that the NHS remains short of 1,932 midwives and a recent RCM survey indicated that, 8 out of 10 midwives (83% of those surveyed) reported that they did not believe that there were enough staff on their shift to be able to provide a safe service.
While the Government advised the Health and Social Care Committee that there were now 4.8% more obstetricians and gynaecologists on maternity units than there were in 2019, evidence from the Royal College of Obstetricians and Gynaecologists (RCOG) has suggested that numbers still need to increase by 20%. NHS Providers estimates this would require an extra 496 consultants working in Obstetrics and Gynaecology.
The Health and Social Care Committee stated that “appropriate staffing levels are a prerequisite for safe care, and a robust and credible tool to establish safe staffing levels for obstetricians is needed.” There is already such a tool for calculating staffing levels for midwives, called ‘Birthrate Plus’. However, the Health and Social Care Committee acknowledged that the development of a tool to calculate workforce requirements is only a first step towards ensuring safe staffing.
Those running maternity services report that even when ‘Birthrate Plus’ is used to assess staffing needs, Trust boards often refuse to fund the necessary expansion in midwifery posts.
Gill Adgie, regional head, Royal College of Midwives (RCM), commented: “We know… that if a head of midwifery needs 30 more midwives in a service based on Birthrate
Plus, when she goes to the Trust board with a business case, it is quite often knocked back.”
Funding Funding was identified as a significant issue that needs to be addressed as a priority, in the report. The Health and Social Care Committee said that it welcomed the Government’s recent increase in funding for the maternity workforce but added that when the staffing requirements of the wider maternity team are taken into account (including anaesthetists to provide timely pain relief), a further funding commitment will be required to deliver safe staffing levels. It recommended that the budget for maternity services be increased by £200- 350m per annum with immediate effect. In addition, the Department of Health and Social Care should work with RCOG and Health Education England to consider how to deliver an adequate and sustainable level of obstetric training posts, to enable Trusts to deliver safe obstetric staffing over the years to come. This work should also consider the anaesthetic workforce.
Training
While 93% of Trusts are meeting the training objectives, set out in the Maternity Incentive Scheme, only 8% of units across the UK are meeting the very highest standards of training, as set out in the ‘Saving Babies Lives Care Bundle’. Evidence submitted to the Health and Social Care Committee suggested that implementation of training remains ‘variable’. In particular, insufficient staffing is not only impacting the number of healthcare professionals available to deliver care for mothers and their babies but also the ability of staff to participate in vital training. The Health and Social Care Committee recommended that a proportion of maternity budgets should be ringfenced for training in every maternity unit and that NHS Trusts should report this in their annual Financial
and Quality Accounts. It should be sufficient to cover not only the provision of training, but the provision of back-fill to ensure that staff are able to both provide and attend training.
Culture of blame
The Committee highlighted issues around the lack of compassionate support for families when things go wrong and a failure to learn from mistakes. Central to this was a prevailing ‘culture of blame’. The Committee stated: “For those delivering maternity care, the adversarial nature of litigation promotes a culture of blame instead of learning after a patient safety incident. Alternative approaches are already in place in other countries where the use of a threshold of ‘avoidability’ rather than ‘negligence’ to award compensation has helped to tackle the debilitating culture of blame, accelerate learning and provide timely support to patients and their families. We believe that adopting such an approach is an essential next step in shifting the culture in maternity services away from blame to one of learning.”
It described the rising costs of maternity
claims, without sufficient learning and outdated mechanisms for calculating compensation, as ‘unsustainable’.
Screening
The Committee also went on to highlight the importance of screening to improve safety for mothers and babies. During pregnancy all women have a scan at 12 and 20 weeks. However, the Committee highlighted the fact that there is a body of opinion that an additional routine scan in the 3rd trimester could improve outcomes for babies. Professor Gordon Smith, professor of obstetrics and gynaecology at the University of Cambridge, told the Committee that introducing a routine scan at 36 weeks could allow for the detection of breech pregnancy earlier, preventing emergency C-sections or high-risk breech vaginal deliveries. He also explained that while midwives routinely performed palpation to determine whether the baby was headfirst or otherwise, that procedure detected only between 50% to 70% of non-cephalic presentation. In March 2021, the UK National Screening Committee considered the addition of a 3rd scan for breech presentation and described the evidence as ‘promising’. There is also scope for improvement in screening for Group B Streptococcus (GBS) – the most frequently identified cause of severe infection in newborns. On average, at least one baby a week in the UK dies from GBS infection, and 70 babies a year are left with lifelong disabilities as a result of contracting meningitis or sepsis in their first days of life. In 2017, updated guidelines stipulated
SEPTEMBER 2021
WWW.CLINICALSERVICESJOURNAL.COM l 35
▲
©Nenov Brothers -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
