Maternity care in UK varies – Healthcare Commission review

The Healthcare Commission has ranked one in four NHS maternity services as “best performing” in a national review published today, but the comparative review, the most comprehensive assessment ever of maternity services in England, also found significant variations in the quality of care across the country.

The Commission ranked 22% of maternity services as “fair performing” (32 trusts) and 21% as “least well performing” (31 trusts). Some 26% of trusts were “best performing (38 trusts) and 32% were “better performing” (47 trusts).

The Commission launched the review in response to concerns about maternity services. It has published three investigations into maternity units and this area of care makes up one in 14 of referrals to its investigation unit on safety grounds.

In the absence of formal standards, the review set performance benchmarks for maternity for the first time, taking into account guidance from the National Institute for Health and Clinical Excellence (NICE) and the National Service Framework for Maternity Services. Trusts can use these to measure improvement and the Commission will conduct a follow-up review to check on progress.

Trusts in the north of England performed relatively well, while trusts in London performed most poorly. In the north, 33 out of 44 trusts were “better performing” or “best performing” (75%), while 19 out of 27 London trusts were “least well performing” (70%).

Anna Walker, the Commission’s Chief Executive, said: “There have been serious concerns about maternity services. That is why we have carried out a wide-ranging review. We have assessed 148 trusts providing maternity services against a comprehensive range of issues that women and clinicians tell us are important.

“We have deliberately made the experience of women central to this review. The care given to women during pregnancy, birth and the time just after giving birth is extremely important to both the mother and the baby. It can have lasting negative effects if not handled correctly.

“Being put in the least well performing category does not mean that a service is unsafe. If we believed any unit to be unsafe, we would take immediate action to ensure patients were protected. We would not hesitate.

“The purpose of the review is to encourage improvement and get all trusts performing to the standard of the best. We will repeat the assessment so that trusts have the opportunity to demonstrate improvement.

“Overall, it is positive that more than half of trusts were in the best or better performing categories. But those trusts that were least-well performing should as a matter of urgency take steps to improve and we shall be checking that they do so.

“One reason that some trusts performed poorly is because they did not supply the full data. Trusts cannot know how good their services are without monitoring this key information. They must be able to collect and use information to improve care for women. We hope that this review will help ensure that this occurs.

“The review raises real concerns about performance in London. There are a number of factors that may have influenced these results, such as lower staffing levels and the mobility and mix of the population. But London trusts need to rise to these challenges. We and NHS London will do all that we can to support this. Where this involves NHS foundation trusts, Monitor will oversee the required actions.

“We know that patients want comparative information about individual hospital services. This review gives that to expectant mothers for the first time.”

The review, carried out in the summer 2007, assessed all 148 trusts providing a full maternity service in England. It covers clinical effectiveness and women centred care, as well as the efficiency and capability of services.

The review looked at the period from when a woman first contacts a maternity service to her final contact with a midwife, usually around 10 days after a birth.

It used 25 indicators, ranging from the type of scans women receive to staffing levels and the number of times a woman has contact with a midwife after going home. The review drew on a survey of over 26,000 mothers as well as data collected from trusts. Indicators drawn from the survey include women’s experience of the cleanliness of units and whether they felt supported to breastfeed.

The Commission is publishing individual reports for each trust, highlighting their scores and areas for improvement. Every trust that was “least well performing” will have to produce an action plan, which the Commission will check.

Strategic health authorities (SHAs) will monitor implementation of the action plans for non-foundation trusts. For NHS foundation trusts, Monitor will ensure that recommendations are implemented. Where insufficient action is taken, Monitor can consider exercising intervention powers.

In London, the Commission said that antenatal and postnatal care tended to be consistently poorer ? the quality of care around the time of birth was mixed.

The review found, for example, that in London a higher percentage of women reported not receiving the recommended number of antenatal checks. This may be because they had to wait longer to be fully assessed and booked for maternity care.

The Commission added that trusts in London needed to provide greater continuity where women are getting different aspects of their care from different trusts.

Nationally, the review highlighted a significant weakness in the quality and availability of data. In all, 103 trusts were unable to provide full data and this had an impact on their score. Of these, 57 trusts had scores restricted by lack of data on a single indicator, while six trusts had scores restricted by lack of data on five indicators.

Source: Healthcare Commission, UK

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