The Royal College of Obstetricians and Gynaecologists (RCOG) supports the key recommendations of the Healthcare Commission (HCC), made in the report Towards better births, a review of maternity services in England. The report stems from a large scale review of maternity services, undertaken in 2007, that examined care from the start of pregnancy through to the postnatal transfer of the patient from a midwife to the health visiting services.
The initial results were released in January 2008 and showed significant variation in the standards of care in Trusts across the country. It was noted that for those Trusts that rated fair or less well performing, this did not reflect unsafe services but often poor central data collection and complexities of case mix. Work has already begun across England to improve services in areas where Trusts rated poorly.
The review found that staffing issues remain a significant factor in the delivery of maternity services and states that consultant obstetrician staffing levels on the labour ward did not reach that recommended by their professional body. It has been noted by the HCC and the RCOG that this may be due to other programmed activities such as gynaecological care, which means consultants are unable to do more labour ward work. An important measure can be found in Safer Childbirth which recommends appropriate consultant presence on the labour ward.
Appropriate numbers of staff underpin a safe and quality service. The RCOG has recommended and requested increased consultant obstetrician and midwifery numbers for some time. With the introduction of the Working Time Directive (WTD) in August 2009, it is even more imperative that staffing is at an appropriate level. The WTD will reduce the total working time of trainee doctors to 48 hours per week with significant impact on Trusts. It is essential that consultant staffing is increased to ensure the best training opportunities and supervision for junior doctors and that appropriate numbers of senior staff are available, day and night to provide quality and safe services.
The RCOG has been working in conjunction with the Royal College of Paediatrics and Child Health (RCPCH) regarding the WTD and has produced a report, Children’s and Maternity’ Services in 2009: Working Time Solutions, which assesses the challenges being faced by Trusts and explores possible solutions.
The College is involved in ongoing work to constantly improve maternal and gynaecological standards of care. Since information was gathered for the review, a number of key guidelines have been released by the RCOG and in collaboration with other Royal Colleges. These documents can act as an auditable instrument for commissioners, Trusts, clinicians and also patients regarding standards of care and organisation of services.
Standards for Maternity Care, Report of a Working Party and Standards for Gynaecological Care, Report of a Working Party were published on 02 July 2008 and provide robust, auditable standards of care for women from preconception to menopause. Standards for Maternity Care, a collaboration between the RCOG, and the Royal Colleges of Anaesthetists (RCOA), Midwives (RCM), and the RCPCH, includes 30 individual standards covering the different stages of motherhood. Standards for Gynaecological Care was produced by the RCOG and comprises of 20 individual standards across the specialty.
The RCOG’s Maternity Dashboard, released in January 2008, is a clinical performance and governance score card that serves as an effective tool for units to monitor clinical activity, staffing, outcomes and patient satisfaction. The main purpose is to monitor safety through clinical governance on a continuous basis, so that action can be taken immediately when services are over-stretched or below target. The RCOG advises that each unit should have a designated person responsible to ensure accurate recording and maintenance of maternity data.
Safer Childbirth (produced jointly by the RCOG and the RCOA, RCM and RCPCH) was published in October 2007 and recommends standards for the safe organisation of labour and birth, including extensive guidelines to assess required staffing numbers. The HCC report highlights the need for improved working relationships across the maternity disciplines; similarly, underpinning Safer Childbirth is the essential need for good working relationships between a multi-disciplinary maternity team of midwives, obstetricians, anaesthetists, paediatricians, as well as support and managerial staff.
The RCOG would urge the Government and Trusts to make use of the above tools and standards to monitor and improve safety and quality of maternity care and to ensure that women can enjoy the choice of care that they have been promised. The College looks forward to working with the HCC, the Department of Health, fellow Royal Colleges and other organisations to further improve maternity care in the UK.
10 July 2008