Teams across the country are piloting risk-minimising practices for maternity services to help avoid mishaps and litigation, says Rebecca Fitzpatrick

The safety of maternity care in England has been highlighted by high profile cases. NHS maternity services are under increasing pressure to improve safety standards, against the backdrop of rising populations in some areas, and the European working time directive.

The NHS Litigation Authority, National Patient Safety Agency, Royal Colleges of Midwives, Obstetricians and Gynaecologists and the King’s Fund have all raised concerns.

Some trusts are implementing new working at consultant level to address concerns and meet national guidance.

Below average

National guidance is set out in Safer Childbirth - minimum standards for the organisation and delivery of care in labour, issued in 2007. It recommends that maternity units dealing with up to 4,000 births per annum should provide 40 hours per week of consultant presence.

For units with over 4,000 births a year, the recommendation is 60 hours delivery suite consultant presence, by April 2010. The guidance recommends that out of hours consultants on the on-call rota should live within a 30-minute call-out range.

Safe Births: Everybody’s Business - an independent inquiry into the safety of maternity services in England, commissioned by the King’s Fund in 2008, and the Clinical Negligence Scheme for trusts make similar recommendations.

In 2008 the Healthcare Commission published its review of maternity services in England, assessing clinical effectiveness, women-centred care, efficiency and capability of services, and reviewed data about medical staffing.

A key finding was that in some trusts staffing levels were well below average and consultant obstetricians did not spend the time recommended by their professional body on labour wards.

Legal consequences

The implications for patients, staff and trusts can be catastrophic when things go wrong, particularly in the field of litigation, inquests and where trust systems can be shown to be consistently failing without remedial action being taken, increasing the possibility of corporate manslaughter investigations.

It is increasingly important that trusts and commissioners can demonstrate they have ensured adequate systems are introduced to meet national targets. It is equally important that implementation of systems is adequately communicated across trusts and monitored

With rising birth rates in some areas, 12 maternity teams across the country are working together intensively with the King’s Fund as part of a pilot project. The aims of the network are to improve outcomes of care during labour and birth for mothers and babies. The project also focuses on team working and communication, staffing and training, leadership and the use of information.

It is widely acknowledged that risk may be minimised if there is senior on-site presence on maternity units for a greater proportion of the week. Stockport Foundation Trust, which is involved in the pilot, was the first maternity unit in Greater Manchester to introduce a resident consultant model.

The trust has appointed additional consultant obstetric and gynaecology posts, which have an overnight and resident aspect rather than the normal requirement for those consultants to be on call out of hours within a 30-minute radius of the hospital they work in. Consultants at the trust have been asked to change working practices to provide additional evening on-site presence.

Early signs are that these changes have seen benefit to both patients and trusts, although the overall results will not be available for some time. l

Top tips

  • Provide practical advice to staff on how to improve safety, tailored to local circumstances
  • Audit and monitor impact of any changes carefully
  • Invite and consider carefully patient and staff feedback to see if changes are working
  • Work in partnership at all stages with commissioningprimary care trusts and local strategic health authorities
  • Exchange ideas and good practice with other trusts
  • Ensure a coordinated approach to service improvement across trusts and regions, to secure consistency