Programme for maternity services

As part of its work to promote improvements in healthcare, the Healthcare Commission assesses maternity services to check that they meet the required standards in a range of areas. The Commission also has a statutory duty to safeguard and promote the rights and welfare of children, from pregnancy onwards.

Programme for maternity services

The standards and guidance against which the Commission assesses NHS maternity services include:

the National Service Framework for Children, Young People and Maternity Services (particularly Standard 11)
NICE guidance
Matternity Matters
recommendations of the National Screening Committee
Royal College publications, e.g. Safer Childbirth

We also regulate maternity services provided by independent healthcare organisations against the Department of Health’s National Minimum Standards.

In 2007 the Healthcare Commission carried out a comprehensive programme of work related to maternity services. Our aim was to build up a comprehensive picture of maternity care in England. In addition to running our own projects, we will be collaborating with other organisations to minimise the burden for those who contribute to our inspections. This page gives an overview of our planned activities.

Review of maternity services

In 2007 the Healthcare Commission conducted a detailed review of maternity services throughout England. At the beginning of the process we developed a set of indicators that will enable health professionals and the public to make benchmark comparisons between individual maternity units. We used existing datasets where possible, complemented by bespoke data collection from individual units where necessary. The results of surveys of staff and the reported experiences of women using maternity services were also used in the review.

We consulted with a wide range of stakeholders about the set of indicators in April 2007. Data collection took place between May to October 2007. Scored results, trust by trust, were published in January 2008 with a natonal report “Towards Better Births” published in July 2008.

Trust by trust results of the review of maternity services

More information on the review of maternity services

Towards better births - A review of maternity services in England

This report gives a detailed analysis of the results of our maternity review, drawing conclusions and making recommendations to help improvement. The review drew information from trusts delivering maternity services, a survey of their staff, and one of the largest surveys of women ever undertaken.

Click here to read the press release

Towards better births - A review of maternity services in England (pdf 1726kb) (opens new window)

Maternity for Managers and Clinicians

On 10th July 2008, in parallel with the launch of “Towards Better Births” the Healthcare Commission hosted a free conference specifically aimed at Maternity/trust managers and commissiooners of maternity services. The conference was oversubscribed and 20 speakers on the day set the context for improvement in maternity services, by celebrating innovation and sharing examples of good joint working.

Details of the presentations can be found here

Links to NHS Litigation Authority (NHSLA)/ Clinical Negligence Scheme for Trusts (CNST) Assessment

The purpose of this statement is to clarify the links between the Healthcare Commission (HC) scored assessment in its maternity services review and NHS Litigation Authority (NHSLA) levels in its Clinical Negligence Scheme for Trusts (CNST) maternity standards.

Joint statement by the Healthcare Commission and NHS Litigation Authority (pdf 31kb) (opens new window)

Survey of maternity service users

As part of its 2007/2008 National Patient Experience Survey Programme, the Department of Health asked the Healthcare Commission to organise a trust by trust survey of women’s experiences of maternity services. The survey, which built on the NPEU’s “Recorded Delivery” national survey, provided acute hospital trusts, primary care trusts and the public with women’s views of their experience of maternity services.

Results from the survey are posted on our website and contributed to our national review of maternity services (see above).

Results of the women’s survey of maternity care (xls 112kb) (opens new window)

More information about the national trust based maternity survey

Audit of neonatal care

Supported by the Department of Health, the Healthcare Commission has commissioned a national audit of neonatal care, and a further two years funding has been agreed. This initiative is in response to the recognised need for auditing of national standards to inform good clinical practice in this area. Led by the Royal College of Paediatrics and Child Health, the project aims to demonstrate the feasibility of a national neonatal auditing process and to design an audit that will lead to improvements in care and outcomes for patients across England and Wales.

More information on our audit of neonatal care

Investigations

To date the Healthcare Commission has published three investigation reports related to maternity services:

August 2006: Investigation into 10 maternal deaths at, or following delivery at, Northwick Park Hospital, North West London Hospitals NHS Trust, between April 2002 and April 2005. The investigation report provides a detailed account of the factors and circumstances contributing to the deaths, which will enable other maternity units to learn from the systems failings identified and to ensure that they have risk management systems in place to prevent similar occurrences.

July 2005: Review of maternity services provided by North West London Hospitals NHS Trusts. This report of our first investigation into services at Northwick Park Hospital provides clear recommendations about organisational structure, resourcing, systems and behaviours that all maternity units can learn from. Many trusts have used this report as the basis for their own assessment work; our national review of maternity services (see above) will show the extent to which they have done so.

June 2004: Investigation into maternity services provided by the Royal Wolverhampton Hospitals NHS Trust at New Cross Hospital. This investigation was launched in October 2003 following four serious incidents at the trust’s maternity services.

Healthcare Commission investigation reports

In July 2005 Sir Ian Kennedy, Chairman of the Healthcare Commission, warned of growing evidence that some maternity services "are not as good nor as safe as they could be". The Commision had in the previous two years analysed three investigations of maternity units with high death rates which triggered the launch of the maternity service review work in 2007.

Press release on Sir Ian’s comments about maternity services (published 18 july 2005)

The annual health check

As part of our annual health check, the boards of NHS trusts are required to make a self-assessment and public declaration on the extent to which their organisation has met the Department of Health’s core standards. The Commission checks these self-declarations against a wide range of surveillance information, including information on maternity services.

We call this "screening". Three times a year we run internal reports, collating our data and monitor these for anomalies or changes. Any significant areas of concern may provoke local contact with the trust for clarification of the background.

We are continuously seeking statistically valid organisational data to enhance our knowledge of the care provided by maternity units. If your organisation has data you think would be useful, we would be grateful if you would share it with us. For more details, please email the maternity services team at:
maternity@healthcarecommission.org.uk

More information on the annual health check

Regional Operations Teams

The Healthcare Commission’s Regional Operations Teams work at the local level, building relationships with healthcare organisations, healthcare professionals, partners, patients and the public. This includes liaising with those involved in maternity care and being alert to new examples of good practice or issues that may require further exploration. Our Regional Operations Teams also have close links with the Healthcare Commission’s Complaints Team.

Complaints

The Healthcare Commission is responsible for independently reviewing complaints about NHS healthcare in England that have not been resolved by trusts at the local level (second-stage complaints).

Complaints about maternity services make up a small but significant proportion of the complaints that are referred to us for independent review. We find that we need to refer back to trusts a higher proportion of complaints about maternity services than for other areas of care. This will usually be because the explanations provided have not been adequate and more local work is needed. Any clinical issues raised in complaints are looked at to identify trends and similarities, both within and across trusts.

More information about complaints about healthcare

Interventions

As part of our investigative function, we sometimes carry out an intervention into a trust's services instead of an investigation, if we consider that this will be the most appropriate, practical way of bringing about sustainable improvements. Our summary of an intervention explains why we decided to intervene rather than to investigate. An intervention in Newham University Hospitals NHS Trust was published on 26th September 2007 and the summary of our findings is available by clicking on the link below.

Click here to find out more about our summaries of interventions

Further information

If you would like more information about the Healthcare Commission’s programme of work for maternity services, please email:

maternity@healthcarecommission

Healthcare providers

Programme for maternity services