Westminster Health Forum

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Maternity services in England - safety, tackling inequalities, learning from the pandemic, and next steps following the Ockenden Review and the NHS LTP

Morning, Thursday, 6th May 2021


***Full-scale policy conference taking place online***

This conference focuses on next steps for maternity services in England.


Areas for discussion include:

  • the Ockenden Review and the NHS Long Term Plan - progress and outstanding issues in meeting recommendations and ambitions relating to maternity care
  • care during COVID-19 - adjustments in delivery, lessons learned, and possible directions for post-pandemic maternal care and recovery of services
  • health inequalities - looking at priorities for how they can be addressed and improving support
  • key issues for innovation, safety and regulation

The discussion is bringing together stakeholders with key policy officials who are due to attend from the DHSC; the Department of Health, NI; and the Health Inspectorate Wales


The agenda

  • Developments in maternity services, and policy priorities going forward
  • Delivering maternity services during the pandemic - the impact of heightened COVID-19 risk factors on care, patient choice and maternal mental health, and lessons learned and priorities for service recovery
  • Supporting vulnerable families and delivering community care during the pandemic
  • Tackling health inequalities in maternity - community care, outreach, and child health and development
  • Innovation and service improvement in maternity care

    • Widening the evidence-base around pregnancy medicines, and assessing where innovation is most needed
    • Improving efficiency, digitisation of maternity records, and enabling increased personalised care plans
  • Priorities for regulation of maternity services, and improving standards and safety
  • Moving safety forward in maternity services - institutional culture, learning from mistakes, and improving inspection outcomes
  • Next steps for improving care and safety in maternity services

Areas for discussion

The Ockenden Review and the NHS Long Term Plan - progress and outstanding issues in meeting ambitions relating to maternity care:

  • the impact of the pandemic - and re-targeting of resources, and how resources, staff, and capacity for innovation can be boosted post-pandemic to ensure the goals of the Plan can be reached

Care during COVID-19 - adjustments in delivery, lessons learned, and possible directions for post-pandemic maternal care and recovery of services, looking at:

  • the experience of maternity - the impact of social distancing, and other measures, factors and trends during the pandemic, including:
    • antenatal appointments - pregnant women attending without their partners, and how it may have affected support, wellbeing and rates of complications during labour
    • perinatal and post-natal mental health - the quality of remote support in lockdown
    • domestic abuse - with NHS England research finding 15-30% of domestic violence beginning during pregnancy, and with growing rates of domestic abuse seen during lockdown
  • what can be learned - opportunities for taking forward the experience of practical adjustments to inform possible improvements to:
    • keeping maternity units safe
    • allocation of resources, funding and staff - following warnings of workforce burnout by healthcare leaders, increased pressure on services, and recommendations in the Ockenden Report
    • support for staff wellbeing
  • patient choice - looking at possible impacts of recent limitations and options for policy and future practice for safeguarding both safety and patient choice, in the context of:
    • rising cases of free-birthing - and demand for independent midwifery during the pandemic, and patient preferences going forward
    • insurance issues - options for resolving those complications affecting the independent midwifery sector
    • instilling trust - between patients and healthcare professionals, discussing best practice to enable both personal choices and safe birthing

Health inequalities - looking at priorities for improving support:

  • support outside hospital settings - community care provision during the pandemic, the digital divide and ensuring access to remote support, and the impact of resource levels and capacity
  • outreach to ethnic minority communities - following concern about provision of advice about COVID-19 to members of communities with a prevalence of low English-language skills, and priorities for better tailoring communication and for ensuring adequate levels of appropriately trained staff
  • ethnic minority inequality - following the MBRRACE-UK report and subsequent inquiry launch, understanding the reasons and priorities for improving ethnic minority maternity care
  • child health and development - joining up local services for supporting children from disadvantaged families, improving data-sharing and providing targeted support, and policy priorities for improving working conditions and staff retention in the early years sector

Safety and regulation

  • institutional culture
    • how can blame cultures be addressed to tackle concerns around hindering the ability of healthcare institutions to learn from mistakes and priorities for improvement
    • the NHS People Plan and what it means for the maternity workforce
    • supporting maternity staff in danger of suffering burnout during the pandemic
  • regulation - policy priorities for improving the outcomes of inspections on safety in maternity units, in areas such as:
    • improving teamwork and the use of multi-disciplinary training
    • strengthening leadership
    • reducing variation in quality of care
    • ensuring investigations are consistently carried out to ensure learning from mistakes
    • addressing the disconnect between ward and board

Innovation

  • digitised records - progress so far towards the goals set out in the Long Term Plan and ensuring accessibility to women, including those from disadvantaged backgrounds
  • pregnancy medicines:
    • priorities for widening the evidence base on the safety of drugs used by pregnant women
    • how can innovation and development around pregnancy drugs be supported and moved forward, following the lack of progress highlighted by Birmingham Health Partners
    • the impact of the recent wider policy drive to boost R&D

A scan of relevant developments

  • the Ockenden Review - examining cases of neglect at the Shrewsbury and Telford Hospital NHS Trust, and making system-wide recommendations for safety at maternity units, such as:
    • improving collaboration between local trusts, and ensuring serious incident investigations have regional oversight
    • ensuring that pregnant women are truly listened to in relation to maternity services
    • providing multidisciplinary training for staff working together
    • risk assessment for all women at every antenatal contact
    • funding - Chris Hopson, Chief Executive of NHS Providers, has told MPs on the Health Select Committee to request more funding for maternity wards after recommendations by the Ockenden Review, with over £400m recommended
  • New NHS maternity leadership training to address Ockenden Review recommendations - DHSC announcing training for staff across 126 NHS trusts and in 44 Local Maternity Systems
  • The NHS Long Term Plan - with commitments on maternity care such as:
    • reducing maternity-related mortality - achieving 50% reductions in stillbirth, neonatal mortality and maternal mortality by 2025
    • personalised care - for most women to receive continuity of carers during pregnancy, birth and postnatally by early this year
    • reducing health inequalities - women from ethnic minority and deprived groups to receive continuity of care by 2024, as well as the offering of specialist support for ending smoking
  • Safety of maternity services in England:
    • the Health and Social Care Select Committee’s inquiry following investigations at a range of hospital trusts, and also looking at possible changes to clinical negligence and litigation processes to improve safety, and how blame culture affects learning from incidents
  • Group B Strep Support charity investigation - highlighted that only 13% of trusts are testing for Group B Strep in line with PHE and RCOG guidelines
  • support for pregnant women from ethnic minority and at-risk groups:
    • NHS boosts support for pregnant black and ethnic minority women - with research by MBRRACE-UK showing that the likelihood of being admitted to hospital with COVID-19 is significantly higher for Black and Asian pregnant women than for those who are white
    • Racial injustice in maternity care: A human rights inquiry - supported by the charity Birthrights, it will aim to evaluate the reasons for poorer maternity health outcomes for ethnic minority patients, currently calling for evidence
    • The DHSC Health and Wellbeing Fund - £7.6m for 19 three-year projects targeting mothers from ethnic minority communities or deprived localities, seeking to tackle health inequalities around early development, nutrition and pre and post-natal mental health
    • NHS England recommendations for minimising additional risks from coronavirus to women and babies from ethnic minority backgrounds:
      • lowering the threshold for admitting and reviewing cases of at-risk pregnant women
      • tailoring communications when reaching out to pregnant women from ethnic minority groups
      • taking into account vitamin D, especially where darker or covered skin may be associated with higher risks of deficiency
      • ensuring that risk factors for all women are recorded by all providers
  • New focus on babies' and children's health as review launches - led by Early Years Health Adviser Andrea Leadsom MP:
    • aiming to inform the Government’s levelling up policy agenda by examining barriers such as socio-economic factors impacting early development
    • seeking to reduce health inequalities during the first 1,000 days of life
  • reduced access of birth partners to antenatal appointments and the birth - the But Not Maternity open letter organised by Pregnant Then Screwed and signed by MPs and others highlighting adverse impacts, including higher levels of anxiety and complications during labour
  • Statement on the Withdrawal of Professional Indemnity Insurance - IMUK putting forward concerns around self-employed midwives having no longer been legally permitted to assist in childbirth following the withdrawal of their professional indemnity insurance (PII), due to complications caused by COVID-19 and Brexit
  • Birmingham maternity experts call for urgent action on pregnancy 'drug drought' - from Birmingham Health Partners, citing one new drug specifically for pregnant women having been developed in the last 30 years and that less than 30% of drugs used during pregnancy come with information on their safety implications when used by pregnant women

Policy officials attending:

Our forums are known for attracting strong interest from policymakers and stakeholders. Places have been reserved by the Department of Health and Social Care; the Department of Health, NI; and the Healthcare Inspectorate Wales.


Overall, we expect speakers and attendees to be a senior and informed group including Members of both Houses of Parliament, senior government officials in this area of public policy, together with other stakeholders from across the health sector, including industry representatives, research and development organisations, executive agencies, regulators, the independent and third sector, patient groups, manufacturers, law firms and consultancies, academics and think tanks, and reporters from the national and specialist media.


This is a full-scale conference taking place online***

  • full, four-hour programme including comfort breaks - you’ll also get a full recording and transcript to refer back to
  • information-rich discussion involving key policymakers and stakeholders
  • conference materials provided in advance, including speaker biographies
  • speakers presenting via webcam, accompanied by slides if they wish, using the Cisco WebEx professional online conference platform (easy for delegates - we’ll provide full details)
  • opportunities for live delegate questions and comments with all speakers
  • a recording of the addresses, all slides cleared by speakers, and further materials, is made available to all delegates afterwards as a permanent record of the proceedings
  • delegates are able to add their own written comments and articles following the conference, to be distributed to all attendees and more widely
  • networking too - there will be opportunities for delegates to e-meet and interact - we’ll tell you how!

Full information and guidance on how to take part will be sent to delegates before the conference



Keynote Speaker

Gill Walton

Chief Executive, Royal College of Midwives

Keynote Speakers

Baroness Cumberlege

Independent Chair, National Maternity Review, NHS England

Lynne Reed

National Lead, Family Nurse Partnership and Parenting Programmes, Nursing, Maternity and Early Years Directorate, Public Health England

Elizabeth Duff

Senior Policy Advisor, National Childbirth Trust

Gill Walton

Chief Executive, Royal College of Midwives

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals, Care Quality Commission

Speakers

Dr Denise Chaffer

Director of Safety and Learning, NHS Resolution

Dr Christine Ekechi

Consultant Obstetrician & Gynaecologist, and Co-Chair, Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists

Clotilde Abe

Co-Founder, FiveXMore and Co-Chair, St Thomas’ and Lambeth Maternity Voice Partnership

Helen Hughes

Chief Executive Officer, Patient Safety Learning

Dr Clea Harmer

Chief Executive, Sands