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Lucy Crawford takes a look at the latest CQC survey on UK maternity services, published last week, and reviews whether it is showing any real progress on patient safety.
Since the Royal College of Obstetricians and Gynaecologists (RCOG) report was published in 2008 (Standards for Maternity Care), there has been a continued drive to improve maternity services and patient experience across the NHS.
With almost 700,000 births in the UK in 2015, it is a service that sees great demand so it is important to take stock and look at both successes and the improvements that still need to be made.
The most recent Care Quality Commission 2017 maternity survey (looking at births across hospitals in February 2017) draws a number of interesting conclusions.
On the surface, the report seems very optimistic about the future of maternity services. When compared to the 2015 survey, it suggests improvement in areas such as:
Whilst I agree that, overall, women have reported a positive experience of the maternity services, I am of the view much more needs to be done. 10 years on from the 2008 report, are we really much further forward?
The June 2008 report set out 30 “standards” ranging from antenatal care in the community,
labour & delivery, postnatal support through to training and reporting safeguarding concerns. Each standard is subdivided with more specific goals to achieve.
Clearly, to go through each standard and look at how we are doing in 2018 would be a mammoth task. However, my attention was drawn to a couple of points that are worth exploring further.
The survey completed was fairly basic and the answers limited to “yes – sometimes – no” or similar. It therefore clearly can never tell the complete story of a mother’s journey through pregnancy. For instance, whilst 50% of women thought their midwife was aware of their previous medical history (a small improvement from the previous survey) concerningly, 50% of women thought this was only the case sometimes, or worse not at all. Would you feel comfortable with any medical professional ‘sometimes’ knowing your medical history?
Similarly, whilst two-thirds of women thought they were always given sufficient information in hospital and explanations were clear (a 4% increase on the previous survey), one third of women thought this only the case sometimes or not at all.
It is my view providing sufficient information to patients, no matter what their medical circumstances, should always be a priority. For a third of women to not have this is completely unacceptable.
One of my other main concerns is about communication between midwives, hospital staff and patients. I represent a number of families where English is not their first language and often they require an interpreter to fully understand the medical background.
The 2008 report highlighted the importance of ensuring provision for translation and interpretation by an independent person, not a family member. My experience representing clients is that this is simply not readily available in all areas and it is clear patients are not always having risks and benefits fully explained in a language they understand. From my experience, it can be a postcode lottery and areas with a higher non-native English speaking population are falling short of the expected standards.
It is difficult to say whether shortfalls have improved, as the 2017 report of course only shows answers of those who completed and returned the questionnaire. In some age demographics such as 16-18 years, only 13% of people responded and even in the most responded group, it was still well under 50%. Similarly, certain demographics had a very low reply rate such as Asian ethnicity where only 27% of women responded.
The survey has other significant limiting factors. The 2008 RCOG report has a focus on supporting families who experience bereavement, stillbirth or early neonatal death. It highlights the need for maternity services to offer culturally specific policies and support as well as offering post-mortem examination and ensuring this is reported to the lead clinician within 6 weeks.
Given the importance of this, I therefore cannot understand why the 2017 survey excludes all women whose baby has died or who have had a stillbirth. Maternity services should be taken as a whole, and we should not just cherry-pick areas to look at.
Whilst I agree there has been some incremental improvement in a number of areas, particularly in relation to consistency in community midwifery, we are still falling short of the standards promised over 10 years ago. Also, there seems to have been a concerted effort to ignore areas that would clearly shed a poor light on progress.
Overall, the 2017 survey should be seen as a disappointment for those expecting real change, or at least a proper review of those we expect to deliver our children safely.