In the years following the CQC Inspections in 2014 and 2015 the Trust has a made a significant number of improvements to its maternity service and we are now 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 the main improvements we have already made to our maternity services but, as our Chief Executive Susan Acott has made clear, “we are determined to be open and transparent about the further improvements we need to make to our maternity service and we are equally clear that 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 addition, we are now introducing ‘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 have also introduced an innovative smartphone app, developed by clinicians at East Kent Hospitals, to provide mothers with easy-to-access pregnancy information at the touch of a button. The MOMA maternity app 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.
The app was developed in response to feedback from mothers-to-be who told midwives they wanted the right information, at the right time, at their fingertips. They also said they were less likely to read paper leaflets because they didn’t always carry them when they were out and about. At the CQC inspection in August 2018 the MOMA app 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.
At the start of 2020, we:
· Set up a Board sub-committee, chaired by an external senior clinician, to review the actions we have taken since we commissioned the independent RCOG review into our service in 2015 and to ensure we are complying with national safety standards.
· Began receiving support from the NHS Maternity Support Programme, including support from a Director of Midwifery at a Trust rated ‘Outstanding’ by the CQC and a Consultant Obstetrician and a Consultant Paediatrician, to work with us to make rapid and sustainable improvements to our service.
· Commissioned an external review of the data available on our maternity services today, to see how it compares with maternity services across the country.
· Set up an improvement and learning programme in midwifery, paediatrics and obstetrics which includes seven elements overseen by a panel chaired by an external obstetrician. The elements are:
- To review the RCOG report and assess progress
- To review the current scope of the BESTT programme and assess progress
- To establish a process for implementing, embedding and assuring the Coroner’s recommendations arising from the Harry Richford inquest
- To review obstetric and paediatric medical job plans
- To review Serious Incidents, Root Cause Analyses and actions arising, to ensure that new complaints and re-opened complaints are treated consistently and ensure lessons are learned
- To undertake a data review
- To review Paediatric Emergency Department cover and oversight.
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 improvements that have been made to maternity services in East Kent since the CQC inspection of 2014 includes:
- Leadership changes with a new Head of Midwifery appointed in 2018 supported by two site-based deputies and a new clinical lead for obstetrics appointed in 2019 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
- Improved job planning with consultants present on labour wards for at least 70 hours per week
- 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
- An improvement in the “midwife to birth” ratio from 1:32 to 1:28
- The introduction of an innovative smartphone app, developed by clinicians at East Kent Hospitals, to provide mothers with easy-to-access pregnancy information at the touch of a button.
- Improved clinical standards for obstetric care on the labour ward
- The BESTT improvement programme launched in 2017 with 10 safety actions in five separate workstreams
- Introduction of ‘centralised cardiotocographic monitoring’ (CTG monitoring) which allows babies’ health during labour to be displayed on monitors in the labour ward and viewed by consultants on call.
- 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
- The introduction of a newsletter for discussion and sharing with staff that focuses on key maternity themes and learning
- Weekly labour ward risk meetings to which all staff are invited
- HSIB reports available on each labour ward in hard copy and available electronically.
Recent changes to improve our service
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.
Continuity of care home birth team
We launched our continuity of carer home birth team (Team Aurora) in November 2020. This means women have the same team looking after them during their pregnancy, birth and after the birth. Evidence shows this leads to better outcomes and safety for the woman and baby, as well as offering a more positive and personal experience.
The second continuity of carer team at East Kent Hospitals will launch in Ashford at the end of March. This will support women throughout their pregnancy journey, whether they choose to have their baby at home or in hospital.
We are working to provide geographically based continuity of carer teams throughout east Kent.
New 24-hour maternity triage unit at William Harvey Hospital
We are in the final stages of building works for the new maternity triage unit at William Harvey Hospital, due to open in March 2021.
The unit will offer 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. It will be staffed by a dedicated team.
- For more information on plans for maternity services in east Kent, please see our Strategy for Excellence in Maternity Care, which is available here, together with a summary document.