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Royal Colleges respond to the latest findings from the NMPA

News 11 July 2019

  • The latest NMPA report provides a snapshot of NHS maternity and neonatal services in England, Scotland and Wales
  • Improvements have been made since the last report, but variation in the availability of services and facilities still remains across the country
  • More work needs to be done to ensure services are safe and personalised for women and their families, say Royal Colleges

The National Maternity and Perinatal Audit (NMPA) is a large evaluation of NHS maternity and neonatal services in Britain.

Launched in 2016, the NMPA uses timely, high quality data to evaluate a range of care processes and outcomes. It aims to identify good practice and areas for improvement in the care of women and babies looked after by NHS maternity services.

It is a led by the Royal College of Obstetricians and Gynaecologists (RCOG), in collaboration with the Royal College of Midwives (RCM), the Royal College of Child Health and Paediatrics (RCPCH), and the London School of Hygiene & Tropical Medicine (LSHTM).

Today the NMPA publishes its second organisational report which maps services, staffing and facilities across all hospital trusts and health boards as of January 2019.

It shows how maternity and neonatal services have changed since the last survey in January 2017. It also outlines where these services have improved and where further work is needed to meet national guidance and recommendations.

All 151 eligible trusts and health boards that provide on-site care for women during pregnancy and childbirth in Britain were included in the audit. In total, 130 trusts in England, 14 boards in Scotland, and 7 boards in Wales took part.

Among the key findings include:

Services

  • Smoking cessation and weight management support is available at 72% and 45% of trusts and health boards respectively – no improvement since 2017.
  • A higher number of trusts and health boards participate in a perinatal mental health network – this has increased from 70% to 93% in England, from 43% to 79% in Scotland, and from 71% to 86% in Wales.
  • Access to community perinatal mental health teams increased from 72% to 91% of trusts and boards, and to specialist perinatal mental health midwives from 72% to 91% of 151 trusts and boards. Availability of psychiatrist clinics increased from 37% to 58% of maternity sites with an obstetric unit.
  • 83% of maternity sites with a neonatal unit provided transitional care – keeping mothers and babies together and avoiding unnecessary neonatal unit admission – and this has risen from 64% in 2017.
  • Maternity sites with a dedicated multi-disciplinary cardiac clinic increased from 18% to 25%, with a greater geographical spread in England and Scotland than in 2017.
  • Access to electronic maternity records improved for community midwives, with 66% of trusts and boards reporting access at any location and 90% at midwives’ community bases. But still only 19% reported that women could access their own electronic record, and the number of GPs with access decreased from 29% to 21%.

Staffing

  • While 87% of obstetric units reported gaps in their obstetric middle grade rotas, compared to 89% in 2017, the number that required locum cover remained the same at 83%.
  • 85% of sites reported that at least 95% of women had one-to-one midwifery care in established labour, compared to 84% in 2017. But only half (51%) of maternity sites reported that all women received one-to-one care in established labour, compared to 54% in 2017.


The report also provides a breakdown of birth settings, such as obstetric units co-located with an alongside midwifery unit, and facilities such as private bathrooms, available to women and their families.

Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said:

“With more than one in ten women experiencing mental health problems during pregnancy and in the post-natal period, it is highly encouraging to see a significant increase in women being able to access to specialist mental health services. 

“However, it is extremely disappointing to see no improvement in accessibility to specialist services on weight management and smoking cessation. Funding cuts to local public health budgets are unacceptable and investment in these services will not only support women to be as healthy as possible before, during and after pregnancy, but give their babies the best possible start in life, and save money in the long term by preventing future health problems.

“We are also disappointed that only one in five pregnant women have access to their electronic maternity records. This is a backwards step and Trusts must take steps to address this urgently and give more women autonomy over their own healthcare.

“The report highlights that workforce challenges persist among the obstetrics and gynaecology profession, while demands on maternity and neonatal services grow. We hope the findings from this latest report will help to ensure the workforce is equipped and supported to deliver the highest levels of care to women and their families across the country.”

 

Gill Walton, Chief Executive of the Royal College of Midwives, said:

“The results suggest that maternity and neonatal service provision is improving in a number of important areas as well as facing ongoing challenges, particularly around unwarranted variation.

“The RCM is pleased to see that maternity services are making continuous and considerable efforts to improve and implement recommendations from recent reviews and initiatives.

“There has also been a welcomed increase in services across the UK offering homebirth which ultimately improves choice for women.”

 

Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, said:

“The expansion of perinatal mental health support is particularly welcome news. A mother’s mental health can have an enormous impact on her children, particularly during the early years, and so it is right to expand provision so that more pregnant women can consult mental health professionals and specialist midwives.

“It is disappointing to see the lack of improvement in the availability of smoking cessation and weight management programmes, and simply not good enough that only one in five trusts gave women access to their own electronic maternity records.

“Good maternal health is vital for children’s well-being, and so all women must be appropriately supported throughout pregnancy, birth, and postnatally. Support services have been put under immense pressure in light of recent public health funding cuts, and so we urge an immediate moratorium on any further cuts so that pregnant women and their children can access the treatment and support they deserve.”


Mrs Ngawai Moss, Member of the NMPA Women and Families Involvement Group, and Chair of the NMPA Clinical Reference Group, said:

“The findings from this report enables us to view maternity care based on fact, so we can be confident, ambitious and targeted in our goals to improve future outcomes for women and their babies. There is a woman behind every number and each one has had a different experience. This report captures and harnesses these encounters into something really powerful that enables us all to have a positive impact on maternity and neonatal services for women and their families.”


Note to Editors

For media enquiries, please contact the RCOG press office on +44 (0)20 7045 6773 or email pressoffice@rcog.org.uk

The report is available on the NMPA website.

Further data from the report on birth settings:

  • A slight increase in number of maternity sites with an obstetric unit, co-located with an alongside midwifery unit, rising from 67% to 71%, but regional variation exists.
  • The number of freestanding midwifery units went down from 95 to 91, while the long-term closures of these units increased, with a further eight closed for births from several months to more than a year.
  • Freestanding midwifery units decreased from 63 to 61 in England; from 18 to 17 in Scotland; and from 14 to 13 in Wales.
  • All trusts and boards offered homebirths.


An alongside midwifery unit is a maternity unit where midwives have primary responsibility for care during labour in women at low risk of complications and which is located on the same site as an obstetric unit so it has access to the same medical facilities if needed.

A freestanding midwifery unit is a maternity unit where midwives have primary responsibility for care during labour in women at low risk of complications and which is not located on the same site as an obstetric unit. If complications develop, women will be transferred to an obstetric unit by ambulance.

An obstetric unit is a maternity unit where care is provided by a team of midwives and doctors to women at low and at higher risk of complications.

 

About the NMPA 
The NMPA is a unique collaboration and audit that aims to produce high-quality information about NHS maternity and neonatal services which can be used by providers, commissioners and users of the services to benchmark against national standards and recommendations where these exist, and to identify good practice and areas for improvement in the care of women and babies.
For more information, visit: www.maternityaudit.org.uk 

About the RCOG
The Royal College of Obstetricians and Gynaecologists (RCOG) is a medical charity that champions the provision of high-quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision. ​www.rcog.org.uk

About the Royal College of Midwives
The Royal College of Midwives (RCM) is the only UK professional organisation and trade union dedicated to serving midwifery and the whole midwifery team. The RCM has a vital role in disseminating information about professional midwifery practice, and in ensuring that there is a recognised UK-wide platform for sharing good practice. This includes professional and clinical guidance and information, online resources, reports on service provision, and conferences and events. www.rcm.org.uk

About the Royal College of Paediatrics and Child Health
The mission of the Royal College of Paediatrics and Child Health (RCPCH) is to transform child health through knowledge, innovation and expertise. The RCPCH aims to improve outcomes through research, standards, quality improvement and policy, in the UK and globally, and to ensure the voice of children, young people and families in its programmes. The RCPCH is responsible for the postgraduate training of paediatricians in the UK and provides access to multidisciplinary educational programmes. www.rcpch.ac.uk