Review of maternity services 2007

Maternity services account for about 600,000 births in England each year. In recent years they have become a cause for concern as we have investigated potentially serious issues affecting maternity services at three separate trusts and found worrying similarities in the problems identified – mainly relating to poor staffing practices and shortages of staff.

During 2007 the Healthcare Commission undertook a review of maternity services focusing on whether trusts provide a high quality, value for money maternity service. An introduction to the review for trusts is provided in the document below.

Introduction to the review (pdf 179kb) (opens new window)

All relevant NHS trusts in England that are involved in intrapartum maternity care were included in the review, as well as trusts providing maternity services in Wales.

Scored Assessment

Published individual trust reports provide an overview of the scoring methodology applied.

Go to trust reports

For a more detailed explanation click on the link below.

Service Review Scoring Methodology (pdf 77kb) (opens new window)

For a summary of all trust results click on the following link:

Maternity Services Review Organisation Results (xls 112kb) (opens new window)

How we conducted the review

The review was based on three main sources of data:

• a web-based maternity questionnaire completed at trust level
• a voluntary web-based supporting questionnaire for maternity staff to complete at each trust, which will not form part of the scored assessment
• a trust-level survey of women who have recently given birth

We also used national datasets that provide useful information on maternity services.

The review covered the care provided from when women first access maternity services, having become pregnant, to their sign-off by the midwife - usually around 10 days after the birth.

It included:

• general care provided by trusts to women, such as the provision of tests and screening, antenatal appointments, birth choice options and postnatal care
• policies and outcomes for specific groups of women, in particular:
  - services in place for women with diabetes
  - services in place for women experiencing mental health issues
  - delivery methods and outcomes for births involving twins, breech presentations and women that have had a previous caesarean section birth
• value for money issues such as number and use of staff

The review included the transfer of babies to neonatal units, including details of admission thresholds and transfer times into neonatal units. However it did not cover issues regarding the operation of these units.

Data Collection: The guide that supported the data collection can be access through the link below:

Review of Maternity Services 2007 Guide to Data Collection (pdf 402kb) (opens new window)

Printer-friendly versions of the data collection forms can be downloaded from the links below:

Maternity review trust questionnaire V1 (Section 1 and 2) (xls 194kb) (opens new window)

Throughout the review we maintained a list of frequently asked questions for the trust questionnaire. These include responses to questions raised during the pilot phase which are replicated in the data collection guide. Frequently asked questions can be accessed through the link below:

Review of maternity services trust questionnaire - Frequently asked questions (Updated 17 July 2007) (pdf 172kb) (opens new window)

Trusts also had the option to include a Survey of Staff as part of the review.

Number of staff survey responses by trust at the close of the review on 10th October 2007 (pdf 29kb) (opens new window)

Copies of the questions by staff group are provided below for information:

Review of maternity services staff survey: Obstetricians version (pdf 123kb) (opens new window)
Review of maternity services staff survey: Midwives version (pdf 131kb) (opens new window)
Review of maternity services staff survey: Support Workers version (pdf 83kb) (opens new window)
Review of maternity services staff survey: Other Staff version (pdf 78kb) (opens new window)

The survey of women who have recently given birth was being undertaken as part of the patient survey programme and the following link provides a copy of the questionnaire that was sent to women.

Survey of Women's Experience of Maternity Care (opens new window)

Reporting our findings

The period for collecting data ran from 11 May 2007 to 10 October 2007. In November, we provided a summary report to trusts, including details and rationale for all the scored indicators relating. Trusts had two weeks to check that the indicators had been properly calculated with the data they supplied (ratification) and to raise any extenuating circumstances that might change their scores. Scores for all trusts were published on our website in January 2008.

Trust by trust results of the review of maternity services

A national report summarising the main messages from the review was published in July 2008.

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

Contacts for further information and help

The Service Review Team (AHP) at the Healthcare Commission is running this review. If you have any questions or comments on the review, please send an email to acutehospitalportfoliohelpline@healthcarecommission.org.uk or call 02074480812

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