Maternity services ‘overwhelmed with reporting requirements’, warns DHSC group

The Department of Health and Social Care set up the “independent working group” on neonatal and maternal care to oversee its response to Donna Ockenden’s spring 2022 inquiry report into Shropshire maternity services; and was then asked to do the same for key recommendations from Bill Kirkup’s report later that year on failings in East Kent.

The group is led by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists and made up of representatives of maternity staff.

It was asked particularly to look into advising on two Kirkup recommendations: first, on improving standards of professional behaviour and “embedding compassionate care”, including asking royal colleges and others how this can be done. Second, charging the royal colleges and others “with reporting on how teamworking in maternity and neonatal care can be improved, with particular reference to establishing common purpose, objectives, and training from the outset”.

However, a recent report from the working group, to the DHSC, released under the Freedom of Information Act, suggests the staff groups are arguing there is little scope to introduce more change.

They said in the April report: “There [is] little capacity across the system for further recommendations [for improvement] currently…

“Maternity leaders have reported that services are overwhelmed with reporting requirements into many different portals and that this burden is at risk of restricting improvements taking place.”

The report goes on to suggest that some recent national “target [driven] policies” aimed at improving care had in fact – alongside pressure on capacity and funding – made things worse. It said: “Frontline staff having had the opportunity to fully discuss the impact these may have on service capacity and the need for operational change. The impact on home life balance may also have been underestimated.”

Last week NHS England patient safety director Aidan Fowler suggested too much time and resource was being spent on “burdensome” inquiries to investigate failings in the system.

And in November, several NHS leaders warned maternity services in particular were being hamstrung by a lack of clear standards and direction from government and regulators.

Dr Kirkup’s 2022 report declared it had given only a “limited number of key themes and recommendations” to avoid adding to what he acknowledged was “the already difficult – if not impossible – task of making sense of those that already exist”. Most of its recommendations were aimed at government, regulators, and staff/professional groups.

His report also said lack of capacity and staffing was not a factor in all the failures at East Kent.

And one of the parents involved in the East Kent maternity scandal told HSJ in response to the independent working group: “It is appalling to see they here effectively deny 200+ families’ testimony, and the senior clinicians who investigated what happened in their cases, and seek instead to use this as a way of making the agenda their own.

“Women and their families need the royal colleges to face up to what the report reveals about the behaviour of their members, to come to terms with it, and address it. If not, then how can we have any faith in them at all.”

The parent said the royal colleages had put forward “no urgent, concrete proposals for change”.

A series of other reports from the independent maternity working group, also obtained through a Freedom of Information Act request and shared with HSJ, also make it clear it rasied concerns last year about implementing the immediate and essential actions from the Ockenden review.

The DHSC would not comment, citing pre-election restrictions, and referred HSJ to the Conservative party, which has not responded.

In a joint statement the RCM and RCOG said: ”Part of the IWG’s remit has been to listen to maternity staff and bring their voices back to the working group to better inform system change. The role of the RCM and RCOG on this group is not to provide recommendations but rather advice, and to also share examples of good practice.

 “The IWG agrees with the DHSC in recognising that the recommendations in the Ockenden report and Bill Kirkup’s ‘Reading the Signals’ report are wide reaching and very much require a system change.

 “The recent IWG ‘report’ was a summary of the initial scoping rather than a final report. This scoping exercise was undertaken within the twelve weeks of the group’s initiation and involved the gathering of frontline maternity staff feedback on systems that prevent the delivery of safe and compassionate maternity care and issues that often hamper multi-disciplinary training.

 “Both the RCM and RCOG remain committed to working with our members and partner organisations to improve UK maternity safety and to support improvements that drive positive change in maternity services, for those using them but also for the staff that work in them.”

 Updated 27 June with response from the RCM and RCOG