The Trust is working closely with some of England’s leading maternity experts and with our health regulators to ensure that we have done - and are continuing to do – everything we can to make rapid improvements to maternity care and to learn the lessons from past failures.
On this page we list some of the improvements we have already made and are making to our maternity services but we are determined to be open and transparent about the further improvements we need to make and while we have made some improvements, there is no doubt that more needs to be done.
In summary, in recent years we have:
- Brought on board a new leadership team
- Recruited more staff
- Increased consultant presence on the labour wards
- Improved staff training
- Revised our policy for recruiting and supervising temporary and junior doctors.
In 2020 we introduced ‘centralised cardiotocographic monitoring’ (CTG monitoring) which allows babies’ health during labour to be displayed on monitors in the labour ward and viewed by consultants elsewhere in the hospital or on call. This means staff can immediately be alerted to a potential problem and on call doctors are able to provide expert opinion straight away, wherever they are.
We introduced an innovative smartphone app to provide mothers with easy-to-access pregnancy information at the touch of a button. The MOMA maternity app was developed in response to feedback from mothers-to-be and has been designed to help expectant mothers and their families through pregnancy. It features general information about pregnancy, a confidential appointments calendar, maternity leaflets, important contact numbers, and videos, including a tour of East Kent maternity units and at the CQC inspection in August 2018 was cited as an outstanding innovation.
However, we recognise that the pace of change in our maternity service has not been as rapid as it should have been. We are determined to ensure that all necessary improvements now take place quickly and that learning is fully embedded.
As we continue to improve maternity services, we will engage closely with our maternity voices group, with Healthwatch and with the families affected by poor performance over the past few years. Our aim is to ensure that the Trust is embedding learning in a long-term, sustainable manner.
The list of other improvements that have been made to maternity services in East Kent includes:
- The move to a clinically led care group specifically focussed on maternity care, with a Director of Midwifery and a Clinical Director, supported by new site-based leads
- The appointment of a new clinical skills facilitator and labour ward leads for obstetric anaesthesia and neonatology
- The appointment of two bereavement midwives and the establishment of bereavement suites at both Ashford and Margate
- The appointment of two new Foetal Wellbeing midwives
- A review of staff rotas to ensure an extra labour ward co-ordinator on every shift
- A revised policy for recruiting and supervising temporary and junior doctors
- Improved clinical standards for obstetric care on the labour ward
- Multidisciplinary teaching at simulated emergencies and training with a focus on communication, team working, recognition of the deteriorating patient and escalation skills
- Foetal monitoring competency assessment in place as part of the annual mandatory study programme
Recent changes to improve our service
Improved staffing
Following a successful recruitment campaign in 2020, we are now able to offer a 24-hour consultant presence at our busy acute maternity unit at William Harvey Hospital, Ashford. This makes the hospital one of the first non-tertiary centres in the country to move to consultant-led care. At QEQM, additional consultants mean an extended consultant presence on site until 10pm.
Eleven senior midwifery posts have been introduced to ensure there are two senior staff members on for every shift; one to co-ordinate the labour ward and another to carry out any required operational duties. As well as safer outcomes this role aims to support safe and appropriate decision making which will impact on decisions around caesarean sections, appropriateness and timeliness of induction of labour, early recognition of deterioration, and appropriate transfers from the Midwifery Led Units.
In 2021, the Trust invested further in midwifery staffing following a detailed workforce review. This has resulted in recruitment of additional community and hospital midwives, and specialist midwife roles to support implementation of national recommendations and strengthen the midwifery leadership team.
New maternity triage unit
A new maternity triage unit opened at William Harvey Hospital in 2021, which offers a purpose-built 24/7 assessment area where women who are at least 16 weeks pregnant can get checked if they have any concerns, or where they can get advice and treatment.
Listening to and involving families
We have listened to staff and families and worked with our maternity lead Governor and Maternity Voices Partnership to co-produce a strategy to significantly improve how we support and listen to families.
‘’Your Voice is Heard’’ has 11 feedback methods that families can use during and following pregnancy. It describes how we will use that feedback and involve the people that use our services to make changes. Our aim to hear from more than 6,000 people who use our maternity services every year so we can act on their feedback.
It includes a “6 week After Care” service which will be offered to everyone on discharge from hospital, and their birthing partners, starting in May 2022. Six weeks post-delivery they will be contacted and asked what went well and where improvement was needed.
We strengthened our maternity triage units in August 2021 by introducing a dedicated telephone triage midwife on both sites, so that a qualified, clinical person answers all calls from women. The units offer 24/7 assessment for women who are at least 16 weeks pregnant.
In January 2022 we also appointed two patient experience midwives, in addition to our specialist bereavement midwives.
Listening to staff
Our culture and leadership programme is aimed at building relationships and multi-disciplinary team work, across our different hospitals and between maternity and neonatal services and includes vision and values workshops, staff drop-in sessions, a leadership development programme as well as opportunities for teams to learn together.
In March 2022 a full-time Freedom to Speak Up Guardian dedicated to maternity started in post. There are two lead-consultant “safety champions” in Women’s Health and Neonatology and Lead Professional Midwifery Advocates. Our Maternity Champions, including the Chief Nursing and Midwifery Officer visit the maternity departments weekly.
The maternity quality improvement programme’s focus includes safe staffing, learning from complaints and ensuring appropriate monitoring when women report reduced fetal movements. It is part of the Trust-wide We Care programmewhich is based on an internationally recognised improvement approach and aligns our strategy and goals across the Trust. It is designed to empower staff to make improvements by supporting them with the knowledge, tools and systems for managing improvement.
We have added a new mentorship programme to our established development programme for new consultants. We are also working with the Faculty of Medical Leadership and Management to embed leadership standards as part of our medical appraisal process, to strengthen the skills of our consultants.
We have also held externally facilitated workshops for our obstetricians based around the 2021 RCOG “Roles and responsibilities of the consultant providing acute care in obstetrics and gynaecology”. These focus on developing a shared understanding of roles, teamwork and behaviours and an agreement to uphold this approach.
Improving staffing
In September 2021 a business case for £1.6m was approved by the Trust Board following a detailed workforce review with investment in both core and specialist/leadership midwifery positions as well as support staff to release midwifery time.
This, alongside national funding, resulted in an additional 22 community and hospital midwives joining the Trust in 2021. International recruitment is being explored. Approximately 23 student midwives are also expected to qualify and start in post in September and October 2022. In addition, we are recruiting 10 senior and specialist midwives, as well as infant feeding support workers.
This recruitment will fill all vacant posts and means we can manage effectively when staff are absent due to maternity and sickness.
To support safe and appropriate decision-making around caesarean sections, appropriateness and timeliness of induction of labour, early recognition of deterioration, and appropriate transfers from the Midwifery Led Units, there are two senior staff members on duty for every shift; one to co-ordinate the labour ward and another to carry out any required operational duties. Further work is ongoing to strengthen the escalation guidance, aligned to the Regional Mutual Aid policy.
We are also working closely with the Kent and Medway Medical School to create academic links that will drive excellence and will also help us to develop a sustainable workforce.
We introduced 24-hour consultant presence on the wards at our busy unit at William Harvey Hospital, Ashford in 2020, making the hospital one of the first non-tertiary centres in the country to move to consultant-led care. At QEQM, consultant presence was extended on site until 10pm, although consultants regularly remain on site 24/7.
In early 2020 we restructured to create a new care group dedicated solely to women’s health, led by a clinical director.
Learning from serious incidents and improving safety
To strengthen the quality and speed of investigations and understanding and learning from incidents, we have improved the way our serious incidents are acted on, including a new process for notification of SIs and their investigation and oversight in the first 72 hours.
We have introduced the HSIB Systems Engineering Initiative for Patient Safety (SEIPS) training for staff. The Trust Board undertook an awareness session in SEIPS training in February 2022.
An Executive SI panel is chaired by the Chief Nursing and Midwifery Officer, who with the Chief Medical Officer and Director of Quality Governance, provide oversight and an opportunity for challenge and debate around complex cases and ensure immediate safety actions have been taken.
Learning from serious incidents is discussed at the Maternity and Neonatal Assurance Group and reported to the Quality and Safety Committee, and directly to the Board of Directors every quarter.
We are currently making improvements for pregnant women who attend our emergency departments with non-pregnancy related health concerns so that every pregnant woman is referred to maternity triage where an assessment is undertaken by a midwife or obstetrician.
In February 2022 we introduced Uterine Artery Doppler scans for women who have been assessed as at risk of having growth restricted babies. These scans help guide the care and management of the baby during the pregnancy including frequency of further scans and antenatal appointments and safest time for delivery.
We introduced a dedicated preterm clinic in March 2021, with a lead Obstetrician and midwife, for women identified at risk of preterm labour and to improve triage day care.
The Trust introduced centralised CTG monitoring in 2020, which allows fetal heart monitoring during labour to be displayed on monitors in the labour wards’ midwifery stations and enables CTG traces to be viewed by consultants elsewhere in the hospital or on call, so staff can immediately be alerted to a potential problem and on call doctors will be able to provide expert opinion straight away, wherever they are.
The Trust faculty of learning provides human factors, fetal monitoring and emergency obstetric training, as well as state-of-the-art simulation training.
