Maternity Safety: Mind the Gap 2021
In 2015 Baby Lifeline sent out a Freedom of Information request to all Trusts to obtain a better understanding of the training that was being provided in maternity services throughout the UK in an effort to improve outcomes. In October 2016 they published their first “Mind the Gap” report setting out the gaps in training which had been identified across the Trusts. They followed this up with a second “Mind the Gap” report in November 2018 in order to review training across maternity services and assess the progress which had been made. On 23 November 2021 they published their third “Mind the Gap” report.
In 2018 the report identified issues with retention of maternity staff with 1 in 3 Obstetric Registrars leaving before completing their training and the Royal College of Midwives reporting that for every 100 students, 1 midwife would go on to practice in the NHS. They also identified that issues with staffing were the key barrier to training at that time. Another barrier identified was in respect of appropriate funding for training. It was noted in the report that 3 in 4 baby deaths and injuries were preventable with better care and that training needed to be targeted at key areas. They identified a gap in key areas of evidence based best training and practice. They concluded that the Saving Babies’ Lives Care Bundle had been poorly implemented with 60% of Trusts reports training in at least one element but less than 8% of Trusts reporting that they had adopted all of the training elements. The recommendations of the report at that stage were to immediately re-instate the Maternity Safety Training Fund and to develop national guidelines for training in maternity services across the UK.
Mind the Gap 2021
In March 2021 NHS England and Improvement committed to investing £95 million in order to increase the maternity workforce and improve training and development programs.
Baby Lifeline have now produced their third “Mind the Gap” report. The report deals with the progress made in respect of training in maternity services and the impact that the Covid pandemic had on maternity services during 2020/21. The report identified 5 key areas:
Retention of staff
It is noted that retention of staff remains a significant issue with a third of obstetricians leaving the profession. It also refers to the survey published by the Royal College of Midwives in October 2021 which warned that over half of those surveyed had expressed an intention to leave the NHS in the next year.
Barriers to training
It also found that over the last year almost all maternity services (97%) have experienced barriers to training, an increase from the previous report. Clearly one barrier was in respect of a lack of interactive training during that period. However, the report also found that inadequate and insufficient IT systems and inadequate staffing were also having an impact on the ability of staff to access appropriate training.
Training in respect of avoidable death and harm
The report found that the training being offered in respect of avoidable deaths and harm was “patchy”. While there had been a general increase in the provision of training, less than a quarter of maternity services were providing all of the training required and while two thirds were dealing with general topics relating to safety as part of their training, only 3 Trusts were providing training on detailed aspect of safety and training as specified in the guidance.
Racial and social disparities
One other issue which was not considered in the previous reports but which was identified in the 2020 MBRRACE report (published in January 2021) was in respect of racial disparities in relation to maternity care with Black, Asian, and mixed ethnicity women significantly more likely to die than their white counterparts. The MBRRACE report also identified that women living in the most deprived areas were almost three time more likely to die than those who lived in the most affluent areas. The latest “Mind the Gap” report found that 1 in 4 Trusts do not consider the needs of the local population when considering training. The report recommends that Trusts should use local population data to determine clinical and social risk factors and determinants of health, which should then guide their training priorities.
Finally the report found that across Trusts there were variations in relation to the information being recorded and the degree of detail being used to record information. They found that the lack of a standard process to collect and store data on training in maternity services made it difficult to measure the impact of quality improvement initiatives nationally and they advocate a standardized approach across Trusts.
It is clear that appropriate, high quality, evidence based training is a vital part of the process in order to improve maternity outcomes, the consistency of maternity services throughout the UK and improve patient safety. It is also clear that there continue to be significant issues with the training that is being provided throughout the country and the ability of staff to access appropriate training. Maternity services are already under significant strain and the Covid pandemic has exacerbated those existing pressures. The impact of Covid on maternity services was also considered in our previous blog ‘Has COVID-19 led to an increase in stillbirths in the UK?‘ While this indicated that the numbers of stillbirths during the pandemic did not increase significantly, we did not see the significant reduction in stillbirth rates which had been a trend in the previous years. In addition there was no data available in respect of neonatal deaths or non-fatal birth injuries and so the true impact of Covid on maternity outcomes could not be seen.
While the government has committed to investing £95 million in order to increase the maternity workforce and improve training and development programs, retention among maternity staff continues to be poor with many citing understaffing and concerns about safety in maternity services as reasons for wishing to leave the profession. The latest “Mind the Gap” report concludes that further funding is required to improve staff retention and training and ultimately to improve maternity services.
We are frequently instructed by families who have concerns about poor standards of maternity care. If you are concerned about maternity care which you or your family have received then you can speak to a member of the team who will be happy to provide you with advice.