The RCOG welcomes the King’s Fund report and acknowledges that improvements can be made to our maternity services. In some cases, these changes need to be implemented at a multi-disciplinary level, while in others, systemic problems need to be tackled before further progress can be made.
As noted in the report, the rising birth rate, the increase in pregnancy complications in the general population because of changes in lifestyle or caring for a diverse population and the effects of the Working Time Directive (WTD) mean that a range of solutions are required to ensure that NHS maternity services continue to be safe and high quality services are provided to women.
The Department of Health has promised £330m (over 2008 – 2010) to prop-up maternity services but these funds need to be ring-fenced at trust level so that maternity units receive the financial support they need. Clinical Directors and Heads of Midwifery need to work with NHS managers to ensure that these funds are first secured, then appropriately allocated.
The RCOG recognises that finding appropriately trained staff was deemed to be a barrier to progress. Currently, many maternity teams across the country are examining rota redesign, the use of locums, the forming of maternal and neonatal networks and a restructuring of some services to meet the challenges. However, there is still a need to recruit more midwives to provide one-to-one midwifery care to women throughout their pregnancy and the need for more consultant presence in the labour ward to ensure round-the-clock care. The successful implementation of the WTD means that we can no longer expect doctors in training to provide acute maternity care and the NHS must explore innovative solutions to develop a consultant-led service so that trusts can achieve compliance.
As noted in the Safer Childbirth recommendations; multidisciplinary teamworking, adequate staffing, clearly defined roles and good communication channels are key to good clinical practice and essential to efficient delivery of the service. The RCOG agrees with the finding that the close working relationship between midwives, obstetricians and other healthcare professionals are needed to provide better continuity of care in our hospitals. This should include joint training and handovers.
On the topic of leadership, the NHS Constitution enshrines the principle of the continuous professional training and development of doctors. New requirements in medical revalidation will also ensure that doctors’ knowledge and skills are updated in order for them to remain fit-to-practise. Such programmes and opportunities exist but doctors need to be supported by their trusts to undertake these activities. Much good work is done outside hospitals (such as contributing to government and Royal College working groups) and doctors should continue to be encouraged by their trusts to be actively involved in these as the experience gained is invaluable to their roles within their trusts.
The RCOG is pleased to note how two-thirds of participants at the regional events have adopted clinical dashboards in their trusts. This is a crucial forward-planning tool originally developed by the RCOG to help trusts manage risk. The RCOG is currently working on an electronic version of the maternity dashboard that will be available to all trusts free-of-charge when it is ready. The RCOG would like to remind the NHS of its Standards for Maternity Care report which provides doctors and service commissioners with audit indicators so that safe services can be provided from pre-conception through to parenthood.
Professor Sir Sabaratnam Arulkumaran, RCOG President said, “Careful resource allocation is important, and as the King’s Fund report demonstrates, in a time of financial difficulty, many trusts are looking at innovative ways to ensure that money is well spent. You can pour money into the system however what is fundamental is not what you buy but how you go about planning your services when funds are tight.
“The RCOG has been a key player in this process alongside colleagues in the RCM and we recognise that there is more work to be done.
“Ultimately, our shared goal is to ensure that good quality care is provided to pregnant women and their babies. The way forward is to ensure that high standards are maintained in our maternity services and we will work with the Department of Health and King’s Fund to get these messages across.”
The RCOG looks forward to the next phase of the Safer Birth initiative involving 12 multidisciplinary maternity teams across England over 18 months to develop safety tools and share best practice.
For more information on the King’s Fund Safer Births initiative, click here.