Major weaknesses found in maternity systems

10 Jul 2008

The Healthcare Commission has urged trusts to invest in maternity information systems in a report that identifies major weaknesses in services for pregnant women and new mothers.

The outcome of a two-year review of maternity services in England, launched after a series of inquiries at trusts, identifies a lack of good maternity information services as a “major weakness” that needs to be addressed.

It says that although trusts are required to provide data sets on hospital activity and outcomes for mothers and babies to the Clear Net system, the information was “found to be missing for many trusts” when it was checked for the review.

Trusts also struggled to provide data requested by the Healthcare Commission for its inquiry. Only 60% of trusts said they had a maternity information system that met the requirements of NHS Connecting for Health.

A further 23% said they had a system that was not compliant: and 17% said they had no maternity information system at all. Even when trusts had systems, the review found they were limited.

More than half (55%) covered only intrapartum care, or labour and birth, and just 15% covered the whole patient journey from antenatal to postnatal care. Many trust staff reported that their systems were not inadequate or badly maintained.

“All trusts should invest in a suitable maternity information system covering both community and intrapartum care,” the report concludes.

The review looked at maternity care at 150 trusts in England and carried out a survey of more than 5,000 maternity staff and 26,000 mothers.

It found that most women had a favourable view of hospital maternity services, although the number rating their care as good or better ranged from 96% at one trust to just 67% at another.

Perceptions of antenatal and postnatal care were less good. And the report identifies weaknesses in staffing and teamwork that have been identified in earlier investigations, suggesting trusts are not learning from failure or best practice.

In particular, it found that staffing levels were low, that doctors and midwives were failing to attend courses and training, that there was poor continuity of care, poor communication, and inadequate numbers of beds and bathrooms on labour wards.

"There is no doubt that the report contains some tough messages,” said Healthcare Commission chair Sir Ian Kennedy. “There is clearly more to be done to improve the quality of clinical care as well as the experiences of women.

“I don't ever again want to be reading another report into high death rates at a maternity unit. I don't want our investigators to be again describing to a young family what happened to their mum."

The report contains seven key recommendations, with a checklist for action by managers.

Link

Towards Better Births – a review of maternity services in England

Reader's Comments

Staff not IT

elaine.wakeham@aaw.nhs.uk

11 Jul 08 12:50

When I worked in an acute trust it was the staff not the IT systems at fault. Most midwives did not believe that entering birth details onto a system was part of their job and the information that came out was just terrible. The amount of women who apparently had a caesarean without an anaesthetic was interesting to say the least.

Still staff but also IT

15 Jul 08 11:32

I am currently working at a Trust where NCRS is installed and used for maternity as well as a maternity departmental system to cover the clinical detail not recorded on NCRS. Just like the previous poster stated, many of the midwives do not consider it to be part of their duty to record data on either system, although some do so from time to time. But despite the frustrations this causes me (part of my role is to get these women to use these systems) I can sometimes sympathise because the systems are appalling. The NCRS one is so user-unfriendly that it is a hindrance, the departmental system is full of bugs and inconsistencies and, although following the workflow, demands the same information be entered multiple times ... and we can't get any data out of it.

I cannot agree ....

15 Jul 08 11:38

I must disagree wholeheartedly with the last comment - in my experience, if you involve the midwives and other clinical staff from the very beginning, they will buy into what is trying to be achieved. Even the die-hard anti-IT midwives, who, believe me, are resident in every Trust, will eventually come round to the benefits of a good IT system within Maternity. Any implementation is reliant - 1 upon a good system in the first place, which for me has to be E3 from Euroking and 2 upon a credible and very patient midwife to act as the champion for the system.