Maternity services: what we are doing to improve
We want to provide the highest quality, safest care and best experience to every woman and baby in our care.
We have staff who are kind, caring and compassionate, and who want to deliver exceptional care together for every person who needs us - and that remains our aspiration.
We also recognise and understand our issues and so we know that, at this moment, we do not get that right for every person, every time.
We have acted with openness and honesty when we have got things wrong and proactively requested and welcomed reviews into our services - which are now helping us to learn more quickly and make changes.
These reviews from the Health and Care Safety Investigations Branch, or ‘HSIB’, and NHS England Maternity Support Team have been hugely valuable in sharing recommendations that we can use to improve what we do, and have also helped us to prioritise some issues we were already aware of.
We want to:
- Be fully compliant against all national safety measures.
- Embed recommended changes from the recent reviews of our service.
- Make our communication with families better, so that you feel properly listened to and that we act on what you are saying.
- Do some focused work on the culture within our units, so that we create the best possible environment for our teams to do their job of caring for you.
- Strengthen our monitoring processes that track progress on the things we have said we will do, including how we make sure we have learned and made changes when something has not gone well.
A lot of work is underway already to help us get there. We will use this space to share publicly what we are doing and to provides updates on our progress.
What we are doing
- Put in more staff: We have recruited more than 25 newly qualified midwives who will start in the autumn, and a further 12 midwives will be joining the nine already newly with us through ongoing international recruitment. We have invested £6m in maternity services since 2019 that has funded additional doctors, midwives, and sonographers. Since February, we have also invested some additional funding to help us put in new roles like a dedicated fetal-wellbeing lead midwife and family liaison coordinator, there to provide dedicated wellbeing support to families. We have also strengthened our leadership with more matrons, including a public health matron to help us make sure we offer a service that reaches all parts of the population we serve.
Being proactive: We check our safety metrics thoroughly, and if we see something that doesn't look right we are proactively investigating it. As an example, our perinatal mortality rate is currently above the national average. While this can be for a wide number of reasons, we want to be sure there are no trends that we do not already know about, so we have commissioned additional resource to support an internal review to look into this.
Improving our systems: We have invested £1.6m in a dedicated electronic patient record for maternity services. An advanced digital system like this means staff can access your maternity records more easily, and you will be able to view information about your pregnancy and care plan in real-time too. We hope to start deploying this later in 2023.
Using the best software to monitor your baby: We have invested £250k in ultrasound software that automates and maps the scan measurements for babies we are closely monitoring the growth of during pregnancy.
Changing how we work: We are doing some work to look at how we can best utilise our clinic capacity, and are hoping to put in additional theatre capacity to support elective c-sections. We are also reviewing how we use our staff to make sure we have the right number of staff, at the right skill-mix, on duty to deliver the best care.
Looking at who does it best: We are proactively visiting other NHS trusts, including those who are addressing challenges or have significantly improved their services, to see what we can learn from them.
Making long-term plans: We are committed to having a clear plan for both our Samuel Johnson midwife led unit and our homebirth service by September 2023, which are currently paused due to staffing pressures.
Protecting what we already do well: While we know there are improvements to make, we need to make sure we keep doing the things that we do well. As one example, we will protect our Continuity of Carer teams, who provide care to our most vulnerable women.
Supporting research trials which can support better outcomes: Research can help improve quality of care not just here at UHDB, but for women and babies everywhere. We have already been involved in research trails for things like: routine testing for Group B Streptococcus; a Smoking Nicotine and Pregnancy 2 trial, which looks at interventions on smoking cessation in late pregnancy; an investigation into the role of previous in-labour caesarean section in future preterm birth risk; and protection against invasive Group B Streptococcus disease.
Looking after our staff: We want to make sure every member of our team is supported and can contribute to our service, so we are putting some culture development work in place to build on existing good practices and help teams to create the best possible working environment with one another.
We are committed to continuing on this journey at pace, to listen, to improve, and to make positive changes.
Check back for regular updates on our progress and improvements.
As part of our ongoing commitment to openness and transparency with our patients and the public, we have chosen to publicly publish the reviews into our maternity services that we requested.
NHS England maternity services diagnostic report
We invited the NHSE Maternity Improvement team to do a review of our maternity services, to help support our improvement journey and key areas for focus.
The NHSE review was undertaken by a multi-disciplinary team in January 2023, and consisted of on-site visits at Royal Derby Hospital (RDH) and Queen's Hospital Burton (QHB).
Following the review, we were advised that we did not meet the criteria to be a part of a national intensive support programme, however we have asked that we receive support on an informal and voluntary basis from the national team to support our improvement journey.
The review provided a great deal of feedback and opportunities for learning, and progress on these findings is being monitored through our governance processes.
Maternity learning review, published February 2023
In February 2023 we published the report findings from an independent maternity learning review > we requested. The Trust - taking lessons from national reports that have highlighted the need for openness to learning from incidents - asked the NHS Derby and Derbyshire Integrated Care Board to commission an independent review into seven maternity incidents that took place at Royal Derby Hospital between January 2021 and May 2022.
The cases over this 16-month period sadly related to three maternal deaths and four maternal collapses; all seven cases had already been individually investigated, but allowing an independent team to review them collectively was designed to give the Trust and the families involved assurance that all possible learning had been identified.
Although the review did not find any common themes that impacted on the outcomes for all the women involved, there has been learning for us an organisation which we have taken very seriously, and the recommendations are invaluable in helping us further improve safety and the experience of women under our care.