A Case for Investing in Maternity Healthcare Professionals
On the 18th April we met with Secretary of State for Health and Social Care, Jeremy Hunt, to discuss the importance of investment in maternity healthcare professionals. In attendance we had a select group from our Multi-Professional Advisory Panel; Professor James Walker, Professor Julie Jomeen, Bernadette McGhie, Dr William Parry-Smith, Judy Ledger, and Sara Ledger.
In the meeting we outlined the importance of sustained political and financial investment in quality CPD training for maternity healthcare professionals, and its role in reducing preventable deaths, injuries, and costs in maternity care. We stipulated that urgent action is required to make improvements to neonatal death and stillbirth rates, staff retention, the rising cost of clinical negligence claims, as well as avoiding unnecessary interventions and costs to the NHS. The full report and supporting documents presented are at the bottom of this page.
Progression and Standardisation Rather Than Repetition of the Same Mistakes
Maternity care reviews and enquiries over the past few decades have made the same recommendations to improve practice year-on-year, demonstrating a persistent lack of sufficient investment in the solutions. Of note is the recurring recommendation of “multi-professional training” in key areas of harm, and in general within maternity teams.
We also know from multiple MBRRACE-UK reports that there is an apparent “post code lottery” relating to neonatal deaths and stillbirth rates which is not actually due to socioeconomic disparity; suggesting that this is in some part due to difference in practice and resource across maternity units. In addition, recent reports have stated that the number of preventable deaths is between 75-80% of those investigated.
Baby Lifeline courses, since their inception, have directly responded to reports and enquiries by providing affordable and geographically accessible multi-professional training in key identified areas. We believe that regular local and external training has a key part to play in standardising care, improving the skills of the frontline staff, and boosting morale and consequently staff retention.
In our meeting with the Secretary of State, we emphasised how maternity teams across England had benefitted from the Maternity Safety Training Fund, and that our delegates had expressed their gratitude for being given the opportunity to attend high-quality training in work time, and not at their own expense; something which will undoubtedly improve morale and practice, and consequently impact on care given to mums and babies.
How Do We Know Current Training is Effective?
We know from the ‘Mind the Gap’ research carried out by Baby Lifeline and the University of Hull, in which we investigated the training gap between NHS Trusts in England, that training varies widely across Trusts. Budgets for training, in particular external training, were lacking or non-existent, and the quality of in-house training was not robustly assessed or, in some cases, assessed at all.
We informed the Secretary of State that the quality of assessment of national training, and the quality of current training is a barrier to change. The group emphasised the need for rigorous assessment and evidence-base of maternity training provision; stating that often training is seen as a “tick-box” exercise with professionals feeling underwhelmed, under-confident, and under-invested in.
A Role for External Training
We have found at Baby Lifeline that delegates have benefitted from our training being expert-led, highly relevant to practice, and in an inter-Trust and inter-professional environment. Delegates reported that training with their colleagues in different specialities, and from different regions and hospitals, led them to revolutionise certain areas of practice within their own units.
In addition, we asked our delegates last month about the impact that the training had on them and their practice; and themes in the responses stated that they had more confidence in practice, that the training had supported teamwork and communication, and there was a call for further provision amongst colleagues.
“Education and training is not genuinely valued in the NHS – this is clearly demonstrated by the lack of resources that are devoted to this. I cannot find venues for teaching, have had to personally buy AV equipment for training, and am constantly having to cancel study days when short of staff in the clinical area. Don Berwick talks about truly learning from experience, Jeremy Hunt has committed to addressing safety issues in maternity; and an absolute prioritisation of education and training is the absolute key”
– A delegate from Baby Lifeline study day
In conclusion, Baby Lifeline expressed that there is an urgent need for continued funding and provision of high-quality maternity CPD training in the UK, as well as a robust evaluation of training provision; this is demonstrated by reports year-on-year with the same recommendations, huge regional differences in mortality rates, and 75-80% of recorded incidences being still preventable. The Maternity Safety Training Fund, administered by HEE, was a great start but it must continue to see tangible national benefits. As demonstrated by our feedback, outcomes, and demand for courses, there is a quantifiable advantage to providing relevant, high-quality, responsive training; the value is not only financial, but also crucial to improving the care for mums and babies, as well as supporting the healthcare professionals caring for them.
The Department of Health. Confidential Enquiry into Stillbirths and Deaths in Infancy. 3rd Annual Report, 1 January–31 December 1994. s.l. : The Department of Health, 1996.
Draper ES, Kurinczuk JJ, Kenyon S (Eds.) on behalf of MBRRACE-UK. MBRRACE-UK 2017 Perinatal Confidential Enquiry: Term, singleton, intrapartum stillbirth and intrapartum-related neonatal death. The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester: Leicester, 2017.
Magro, Michael. Five Years of Cerebral Palsy Claims. s.l. : NHS Resolution, 2017.
BN, Manktelow, et al. MBRRACE-UK Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from January to December 2014. s.l. : Leicester: The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester. , 2016.
Manktelow, Bradley N, et al. MBRRACE-UK: Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from January to December 2015. s.l. : Leicester: The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester, 2017.
NHS Resolution. Annual Report and Accounts 2016/17. London : NHS Resolution, 2017.
NHS Litigation Authority. NHS Litigation Authority: Report and Accounts 2013/14.: NHS Litigation Authority, 2014.
NHS Litigation Authority. 10 Years of Maternity Claims. London : NHS Litigation Authority, October 2012.
NHS England. National Maternity Review: Better Births. s.l. : NHS England, 2016.
The Royal College of Obstetricians and Gynaecologists. Each Baby Counts. London : The Royal College of Obstetricians and Gynaecologists, 2015.
Wadephul, F, et al. Mind the Gap: An Investigation into the Training Gap Between NHS Trusts in England. 2016
Full Report and Supporting Documents