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Safety must be the driving force behind every decision say maternity Royal Colleges

News 15 December 2020

Putting themselves front and centre in the efforts to make the UK the safest and best place to give birth, the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) are proposing a bold and ambitious vision for maternity services.

It comes in a joint written response to the Health and Social Care Select Committee maternity safety inquiry.  Dr Edward Morris, President of the RCOG and Gill Walton, Chief Executive of the RCM gave joint oral evidence to the inquiry today.

Setting up a national maternity improvement centre to improve maternity safety is at the centre of the Colleges’ joint vision.  The RCOG and RCM see the centre bringing together fragmented elements of maternity care and taking on a range of initiatives to drive and improve learning and focus care where it is most needed. The centre would also organise national maternity specific staff training, such as improved fetal monitoring training, and develop information for pregnant women and those planning a pregnancy. 

The Colleges stress that ensuring the safest possible care will need investment in maternity services, including increasing workforce numbers to address the serious shortage of midwives and obstetricians.They also call for maternity services to receive regular funding to enable professionals in maternity teams to undertake vital safety training together, and for future funding to be more flexible so that bespoke training programmes can be developed to meet the specific contexts and needs of each trust.

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:

“The most important thing is that maternity services across the UK provide the best possible care for women and their families. Sadly, we know that for various reasons – such as those tragic experiences of families in the Ockenden review – failures in care do happen and women and their babies are the ones that pay the price.

“We believe introducing a centre dedicated to improving maternity safety will significantly improve the system in the UK. Reducing risk needs a holistic approach that both targets the specific challenges of fetal monitoring interpretation and strengthens organisational functioning, culture and behaviour – all of which will be key priorities for the centre.

“We reiterate our call for maternity services to be funded properly, giving staff the resources and support they need. Stretched and understaffed maternity services affect the quality and safety of care provided to mothers and babies, and restricts the choices available to women.”

Gill Walton, Chief Executive of the RCM, said:

“Reports on failing and failed maternity services, like the Ockenden report published last week, have shown consistently, similar problems that led to damaged mothers, damaged babies and deaths.  We have all got to work together to stop this happening and put safety right at the top of the agenda from where it must never move.  It must be the driving force behind every decision made in maternity services, from the midwives and maternity support workers at the front line through trust chief executives to the highest levels of government. Safety also needs the right numbers of staff, in the right place, and whose skills are regularly updated with the right training. This means investing in staff and in services, which is investing in safety.”

In its evidence the Colleges also stress the critical importance of tackling poor and dysfunctional working relationships in maternity teams. This has been a persistent factor in failing maternity services, and on the safety and quality of care.

Both organisations also call for urgent action on leadership within maternity services, saying midwifery must have a voice at the highest levels. Central to this is appointing a director of midwifery to work alongside the clinical director for obstetrics to represent maternity services at Trust Boards’

The safety of maternity was a significant concern for midwives in a recent RCM survey with over 80 per cent saying they did not feel they had enough staff to provide a safe service, and 4 out of 10 (42%) saying half of shifts are understaffed. A third said there are very significant gaps in most shifts.