Maternity services: what we are doing to improve

We want to provide the highest quality, safest care and best experience to every woman and babies in our care.

We have staff who are kind, caring and compassionate, and who want to deliver exceptional care together for every person who needs us - and that remains our aspiration.

We also recognise and understand our issues and so we know that, at this moment, we do not get that right for every person, every time.

We have acted with openness and honesty when we have got things wrong and proactively requested and welcomed reviews into our services - including from the Care Quality Commission (CQC) - which are now helping us to learn more quickly and make changes.

We have put a programme of work in place that will help us to:

  • Be fully compliant against all national safety measures.
  • Embed recommended changes from the recent reviews of our service.
  • Make our communication with families better, so that you feel properly listened to and that we act on what you are saying.
  • Do some focused work on the culture within our units, so that we create the best possible environment for our teams to do their job of caring for you.
  • Strengthen our monitoring processes that track progress on the things we have said we will do, including how we make sure we have learned and made changes when something has not gone well.

A lot of work is underway already to help us get there. We will use this space to share publicly what we are doing and to provides updates on our progress.


 12 months on: a letter from our senior team on improvements in our maternity service

Dear parents, parents-to-be and families,

We continue to make big changes across our maternity and neonatal services at Queen's Hospital Burton and Royal Derby Hospital, and in the community, to provide safer care to the women, birthing people and babies in our care.

We have a kind and compassionate workforce who dedicate their working lives to helping our patients, we are committed to making things better and we care about getting this right, for the people accessing our services now, or in the future.

To help us deliver on this commitment, last year we developed a Maternity and Neonatal Improvement Programme (MNIP). This is a strong action plan based on feedback from our communities, and safety recommendations from the Care Quality Commission (CQC) and Healthcare Safety Investigations Branch (HSIB) > , which is now known as the Maternity and Newborn Safety Investigations programme.

We know that we have not always got everything right for every family. We know what our issues are and we continue to face our challenges with openness and honesty, by welcoming external reviews and proactively asking for support to assist us with making our services safer, including through the Maternity Safety Support Programme, led by NHS England >.

We regularly meet with other NHS hospital trusts. Some are further along in their improvement journey and we can learn from their experiences to help us make informed decisions and work efficiently.

W e are now a year into the journey and our quality and safety measures are improving, which shows we are providing safer care to women, birthing people and babies.

All NHS maternity services are assessed against some key safety measures, and we are now consistently seeing improvements in our compliance rates:

'Ockenden' essential actions - our compliance has improved from 40% to 69%.

Saving Babies Lives, improving from 33% in September 2023 to 64% in July 2024, with an ambition to improve to 100% compliance.

Below we have shared a summary of the areas we have been focusing on to help make care safer for you and your baby, and to improve the experience you have with us as a family. We are making good progress, and you have our absolute commitment that we will continue to move at pace to make more improvements happen.

Please continue to share your feedback, whether than be by contacting our  Patient Advice and Liaison Service (PALS) >, by replying to the text message surveys or directly to our staff who provide you care. We are fortunate to have engaged patients and families who provide feedback and it helps us target our improvement work at the things that matter most to you. And if you have any questions for us, please do not hesitate to reach out.

 Sarah Noble , Interim Director of Midwifery

Mary Montgomery , Divisional Medical Director

Guy Tuxford , Divisional Director for Women's and Children

Gwen Hatton,  Divisional Nurse Director

 
 Download 'The Maternity and Neonatal improvement programme journey so far' infographic [pdf] 202KB >

What we have done to make care safer for you

  • Recruited more staff - we have boosted staff numbers across obstetrics, anaesthetics, maternity, neonatal, theatres and imaging (where you go for scans). We have an additional 32 newly qualified midwives across Derby and Burton joining us in a few months and are actively recruiting more experienced midwives too. We have one of the best staffed maternity services in the Midlands with kind, caring and compassionate staff who are committed to making a difference to your pregnancy journey and birth experience.

  • Following a new national standard for fetal monitoring -  all maternity staff have completed a training programme on a best practice, evidence-based approach to fetal monitoring. This means we have a single consistent approach to monitoring babies before they are born and since this focused piece of work, we have seen fewer hypoxic-ischaemic encephalopathy (HIE) cases, a condition caused by a lack of oxygen to the brain before or shortly after the birth. We have also appointed a dedicated fetal wellbeing lead midwife to give dedicated attention to this work.

  • Managing a bleed after birth- we are now using a nationally developed process which is considered best practice for reducing major bleeding after birth. It identifies women at risk of bleeding and provides a more consistent measure of blood loss allowing us to respond quicker when someone is bleeding abnormally. This means where possible we can try and avoid someone needing a blood transfusion.

  • Improving our induction pathway - at Royal Derby Hospital, we now have dedicated induction side rooms and at Queen's Hospital Burton we have a private examination room that will be used during intimate examinations. We are also reviewing how our inductions are booked and managed to reduce the time you wait before an intervention.

  • Wireless telemetry -  wireless telemetry means you can have continuous monitoring while in labour and still be mobile, creating a more comfortable environment for you to birth. This is now available in the labour wards at Queen's Hospital Burton and Royal Derby Hospital.

  • Reviewing scan capacity and delays -  to help us understand why delays happen we have completed a review to look at whether current capacity (available clinic slots) meets demand (the number of patients requiring care). This will shine a spotlight on where the issues are that we need to tackle next.

  • Neonatal transitional care - after birth, some babies require more frequent observations, this is called neonatal transitional care, and some babies require anti-biotics. We are creating transitional care spaces within our post-natal wards, which will mean babies will soon be able to receive this support within our maternity units, keeping families together.  
  • Electronic access to your maternity notes -  we now have a single electronic patient record system across all of our maternity services which means wherever you access care at UHDB, our clinical teams will have instant access to your notes. It also has a patient online portal and app where you can read your notes, input your own messages, track weekly development through your pregnancy and view some test results. To find out more about this, visit our Badget Notes page >

  • Supporting you through pregnancy and beyond - we have strengthened our partnerships with key voluntary sector organisations including the Family Hubs and Connected to identify how we can better work together to support women, birthing people and their families during pregnancy and as they transition away from maternity or neonatal care. We also work closely with Maternity and Neonatal Voices Partnerships (MNVPs) in Staffordshire and Derbyshire. You can contact the MNVPs to share anything about our service:

o   ddicb.derbyshirematernityvoices@nhs.net (Derbyshire)

o   sasot.mnvp@nhs.net (Staffordshire)

  • Home birth service opening in October - women and birthing people with a due date after 6 October 24 can now consider a homebirth as we are now able to provide a consistent, safe service to support people who want to birth in this way. If you would like to know more about a home birth please speak to your community midwife.

  • We have improved communication and engagement with families -  we have people who have used our services involved in our improvement journey and a Patient Safety Partner, who has firsthand experience of our services and acts as an independent voice, representing our communities formally on the programme. We have also started a series of community conversations with the public, in partnership with our MNVPs, and the first event was held in June in the community.

  • A good safety culture -  as well as improving the experience for our families, we want to improve the experience of our teams too. We know that a good safety culture is one that involves value, respect and civility. Our frontline colleagues, including midwives, support workers and consultants, have worked together to develop a shared set of behaviours and values for everyone to sign up to.

What we have already done to improve your care

  • Investing in staff: Since August 46 new midwives have joined our teams, which means we have one of the best staffed midwifery teams in the Midlands. We have also recruited into new leadership roles to help provide more senior support to our people, and are recruiting more doctors in obstetrics and anaesthetics.
     
  • Changing how we monitor babies during labour: We have reviewed the guidelines and tools we use to monitor babies during labour and we will soon be moving to a new, 'gold-standard' process that helps our teams better track and respond to any changes to your baby's heart-rate during labour. This makes care safer for you and your baby, as the new process is more personalised rather than using the same approach for all babies during labour. We will be rolling out the training on this new process to our staff soon - when everyone is fully trained, we will start using this new system.
     
  • Changed how we measure any bleeding during and after birth: We have put a new process in place for how we risk assess, monitor and manage women and birthing people for post-partum haemorrhage, which is when someone has heavy bleeding after giving birth. We now use a new process that measures any blood loss throughout childbirth much more consistently, so we know as soon as someone is bleeding abnormally. This means we can take steps to stop any abnormal bleeding earlier and try and avoid someone needing a blood transfusion.
     
  • Making sure our staff always stay up to date with their training: We have changed how we track our staff training. We check staff can still do important skills, like how they monitor your baby during labour, at least once a year, to make sure all staff are experienced, knowledgeable and confident. In fetal monitoring as one example, we have increased our compliance to above 87% (the standard is 90%), and we are on track to reach 92% by the end of April. Staff are not allowed to do these skills while caring for you unless they have passed their training though - so you can be assured everyone looking after you is fully trained in what they are doing for you and your baby.
     
  • Listening to women, birthing people and their families: We have been engaging with people at Family Hubs in Derby to hear how they want to be involved in and communicated with about their care, and the Chairs of the Maternity and Neonatal Voice Partnerships (MNVPs) in Derbyshire and Staffordshire are involved in some of our improvement work to act as 'critical friends'. We have also welcomed a Patient Safety Partner, who is a member of the public with personal experience of our service, to one our improvement project groups. If you are interested in joining us as a Patient Safety Partner, we would love to hear from you >
     
  • Supporting our staff: We are running some workshops with staff across our maternity and neonatal services to look at our culture and how we work together - including on how we can together challenge any behaviours that are not in line with our values or those of the NHS.
     
  • Improving our systems: We have invested £1.6m in a dedicated electronic patient record for maternity services. An advanced digital system like this means staff can access your maternity records more easily, and you will be able to view information about your pregnancy and care plan in real-time too. Work has started on the deployment - with full roll-out expected in June this year.
     
  • Using the best software to monitor your baby: We have invested £250k in ultrasound software that automates and maps the scan measurements for babies we are closely monitoring the growth of during pregnancy.
     
  • Looking at who does it best: We are proactively visiting other NHS trusts, including those who are addressing challenges or have significantly improved their services, to see what we can learn from them.
     
  • Making long-term plans: We are committed to having a clear plan for both our Samuel Johnson midwife led unit and our homebirth service, which are currently paused due to staffing pressures.
     
  • Supporting research trials which can support better outcomes: Research can help improve quality of care not just here at UHDB, but for women and babies everywhere. We have already been involved in research trails for things like: routine testing for Group B Streptococcus; a Smoking Nicotine and Pregnancy 2 trial, which looks at interventions on smoking cessation in late pregnancy; an investigation into the role of previous in-labour caesarean section in future preterm birth risk; and protection against invasive Group B Streptococcus disease.


We are committed to continuing on this journey at pace, to listen, to improve, and to make positive changes.

Check back for regular updates on our progress and improvements.

Reports

As part of our ongoing commitment to openness and transparency with our patients and the public, we have chosen to publicly publish the reviews into our maternity services that we requested.

Perinatal Mortality Review Report, November 2023

In 2023 we commissioned a piece of work to collectively review cases of stillbirth and neonatal loss at our hospitals between January 2020 and March 2023. 

This is because, across that time, our data was showing that we were experiencing more stillbirth and neonatal losses than expected, and that we were an outlier against the national average. 

Every baby loss is a tragedy and while some cases are, very sadly, unavoidable, we wanted to look collectively at the cases to make sure there were no themes we had not already identified, or additional changes we could put in place to improve care. Although every case was investigated individually at the time, we also wanted to look at the care we gave to the mother and baby again, as well as the processes we followed at the time.

The review highlighted some concerns, particularly around our compliance with national guidance and how we involved and supported families following a loss. It also highlighted  cases where we could and should have done better, and areas where we had the opportunity to make care safer and improve the experience for families. We remain deeply sorry to the families who we let down at that time.

We accepted the recommendations and have acted on them. 

The report found that 20 families had not been involved in the review process that we undertake when a baby sadly dies. After receiving the report, the Trust identified a further four families, giving a total of 24. This should not have happened, and we have proactively contacted those families to personally apologise and to answer any questions or concerns they might have. 

Many of the wider themes in the review were similar to those highlighted in other reports from around the same period, including from the Care Quality Commission (CQC), and these now form part of our wider Maternity and Neonatal Improvement Programme > 

We have made significant improvements to our maternity and neonatal services, and are providing safer care than we were 18 months ago, with better outcomes for mothers and babies. 

Our compliance against national maternity safety standards has improved and we have invested in more staff, training and equipment and are involving families in the changes we are making. 

While we have made progress, we are not complacent, and our teams remain focused on delivering safer, personalised and professional care to every family using our maternity services now and in the future.

If you have any concerns about this report or want to speak to us, please reach out. Please contact our Patient Advice and Liaison Service (PALS) >,  or speak directly to our staff if you are already under our care. 

Download UHDB Perinatal Mortality Thematic Review, Jan 2020 - Mar 2023 [pdf] 16MB

Please note: we have chosen to publish this report as part of our commitment to openness and transparency with local people; however small amounts of information in the report that could be considered personal or identifiable information has been redacted (removed) to protect the identities of those involved.

NHS England Maternity Services Diagnostic Report

We invited the NHSE Maternity Improvement team to do a review of our maternity services, to help support our improvement journey and key areas for focus.

The NHSE review was undertaken by a multi-disciplinary team in January 2023, and consisted of on-site visits at Royal Derby Hospital (RDH) and Queen's Hospital Burton (QHB).

Following the review, we were advised that we did not meet the criteria to be a part of a national intensive support programme, however we have asked that we receive support on an informal and voluntary basis from the national team to support our improvement journey.

The review provided a great deal of feedback and opportunities for learning, and progress on these findings is being monitored through our governance processes.

Download NHS England Maternity service review diagnostic report [pdf] 12MB (opens in new window) >

Maternity learning review, published February 2023

In February 2023 we published the report findings from an independent maternity learning review > we requested. The Trust - taking lessons from national reports that have highlighted the need for openness to learning from incidents - asked the NHS Derby and Derbyshire Integrated Care Board to commission an independent review into seven maternity incidents that took place at Royal Derby Hospital between January 2021 and May 2022.

The cases over this 16-month period sadly related to three maternal deaths and four maternal collapses; all seven cases had already been individually investigated, but allowing an independent team to review them collectively was designed to give the Trust and the families involved assurance that all possible learning had been identified.

Although the review did not find any common themes that impacted on the outcomes for all the women involved, there has been learning for us an organisation which we have taken very seriously, and the recommendations are invaluable in helping us further improve safety and the experience of women under our care.

Download UHDB Independent thematic report by Healthcare Safety Investigation Branch (HSIB) - February 2023 (opens in new window) [pdf] 2MB