Continuing to improve maternity services in Shropshire

24 March 2017

Simon Wright, Chief Executive at The Shrewsbury and Telford Hospital NHS Trust, looks at the Trust’s work in improving Maternity Services 

How does the NHS help families when the most tragic of events happens…a baby dies?

Honesty, compassion, kindness, support, humanity and learning must surely all feature strongly in any response.

Our maternity services have been on a journey since 2009. Whilst we have supported more than 40,000 mums in giving birth to their babies safely, sadly not every outcome has been a happy one.

There have been, sadly, some mums who have had unexpected deaths during or shortly after labour. In every tragic case we have made the learning public; our Maternity service and hospital Trust Board have looked at the circumstances to see how we can learn and, in so doing, make our services even safer.

With the publication of the Saving Babies’ Lives report of 2009 we looked at how we could reduce perinatal deaths. Between 2009-2015 there has been a fall in the UK perinatal death rate. Whilst we are in line with the national average more needs to be achieved to continue this downward trend.

Across the whole of the UK, one of the largest areas of error within midwifery and obstetrics is the misinterpretation of cardiotocographs, also known as CTGs (foetal heart monitoring).

We have had avoidable deaths in our service where foetal monitoring was not routinely recorded, so we have supported midwives to go on training over two days on master classes in this area and purchased new software and hardware which will allow us to review CTG traces remotely whist a woman is in labour. This regular ‘fresh eyes’ approach has been shown to reduce the chance of the tracing being misread by using additional reviewers without disturbing the mum in labour.

In addition we have trained our staff in the use of ‘Dawes-Redman’ antenatal CTG analysis. We have purchased specific CTG machines which use specially developed software to assist doctors and midwives in interpretation of CTG.

We need to also think about how we respond to obstetric emergencies. We are one of only three departments across the West Midlands to be recognised as a PROMPT training centre. PROMPT is an evidence-based multi-professional training package for obstetric emergencies. It is associated with direct improvements in perinatal outcome and has been proven to improve knowledge, clinical skills and team working.

Dr Edwin Borman, our Medical Director, said: “The neonatal department at SaTH has been among the first in England to commence targeted training – in conjunction with West Midlands Ambulance Service and Neonatal Transport Services alongside experienced midwifery teams – to optimise the identification, stabilisation and transfer of sick or potentially sick newborn babies from our Midwifery Led Units and home births.

“The course has received excellent feedback, has recently included ambulance and midwifery staff from Wales and the wider West Midlands, won the Staffordshire, Shropshire and Black Country Newborn Network Innovation Award in 2016, and been presented at national meetings hosted by the British Association of Perinatal Medicine.”

Our Trust Board has been rightly concerned about this and is ensuring progress is being made, which it is.

We are a rural county and need to support choice for our mums and support their wishes to have their babies near to or in their own homes whilst recognising the potential of low-risk babies quickly becoming high-risk at this complex, and sometimes frightening, time. That is why, with Commissioners, we are entering dialogue with our public about how we deliver these services in the future.

We have sought to ensure our Maternity Services are much more open and engaging when it comes to dealing with complaints and concerns about the care in our hospitals and how we support families on the very rare occasions when things do, sadly, go wrong.

Dr Borman said: “In recent years we have made significant improvements in the governance processes within Maternity Services. Serious Incident Root Cause Analyses (RCA) are led by Consultants and Senior Midwives and often involve external organisations. We also perform thematic review of Serious Incidents (SIs) to capture system wide learning.”

Many families need to know what has happened and we have developed our investigation process to involve the families affected. Trying to get this balance right is hard and we will not always get this right but we genuinely want to be open and transparent and invite families in to share our learning and understanding about what happened including where human mistakes occur.

National League tables have seen SaTH faring poorly on openness and transparency and our reporting culture. We acknowledge this and the importance of culture in creating a climate where staff, and mums and dads, feel able to speak up when they are worried and that all incidents are reported so we can take the learning and improve.

Our efforts has seen the reporting of incidents increasing and the safest hospitals in the world all cite this as an important marker on the journey to become the safest and kindest organisation you can be.

We can never allow complacency to occur and, as such, we have been working with Human Factors training used by the airline industry after the terrible crashes in the 1980s to learn and establish safety first principals and behaviours.

The Trust Values define how we want every one of our 5,500 people to come across (the importance of this was recognised by 99% of our staff in the latest national NHS Staff Survey). We have been running Values in Practice sessions with our people across our Women and Children’s services (and beyond), including our Midwife Led Units, illustrating how we ensure our Values are evidenced in everything we do.

We are working with our own Transforming Care Institute to help establish in every member of staff and every situation a clear ‘Patient First’ mantra. Since starting this work in 2015 we have seen more than 7,000 safer patient journeys and over 1,700 staff have joined with us in embracing this philosophy. In the relatively short time that I have been Chief Executive here at SaTH, I have been very impressed by the attitude and willingness of the staff to learn and improve.

So how are we doing in the eyes of the public? We have seen a greater than 50% reduction in instances where communication was seen as an issue in any complaint to the service. Over 92% of women said they felt they were treated with respect and dignity at all times, showing steady year-on-year improvements.

We cannot and will not be complacent. Cultural change requires constant vigilance and our Board has set our direction and we are moving forward every year evidencing these improvements and, most importantly, hearing from our mums and children about the improvements they have seen, felt and experienced.

How are we helping families at this most difficult and tragic of times? By opening our organisation up to external scrutiny through inviting NHS England, the Care Quality Commission (CQC), Healthwatch Shropshire and Healthwatch Telford & Wrekin, Independent Expert Midwifery reviews, the Department of Health and the Midwifery Local Supervising Authority to look at any and every aspect of our service and how we fare.

They have all independently confirmed we have a good, safe service. We have lessons to learn, as every maternity service in the NHS has. Our clinical performance is better than the national average but clearly we want to be outstanding. We are working very hard to build a learning culture and recent visits by local media into our services are perhaps the best way to shine a light on our progress.

Sarah Jamieson, Head of Midwifery, said: “It is our firm belief that our service provides safe care for women and their babies. This is supported by the findings of a number of reviews that have taken place since 2013 and through on-going learning and improvement work.

“Just this week, local media spent all day with us with a lot of very positive comments about our Maternity services.”

The NHS is a wonderful gift to us all and SaTH wants to protect this and build services we are all proud of and believe in. More than a decade of challenge faced by Shropshire and Telford & Wrekin health services will not disappear overnight, but incremental steps like the introduction of our Transforming Care Institute – working in partnership with Virginia Mason Institute – Leadership Academy, Values in Practice and promoting Safest and Kindest whilst creating the healthiest population we can, all set our course, support our people and engage with the population we serve to deliver the outcomes we all want to provide.

If anybody has any questions, concerns or experiences to share about SaTH’s Maternity Services please call our Patient Advice and Liaison Service (PALS) on 01743 261691 or 01952 641222 Ext 4382. More information is also available on our website at https://www.sath.nhs.uk/patients-visitors/advice-support/pals/