Maternity services: what we are doing to improve
We want to provide the highest quality, safest care and best experience to every woman and baby 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.
April 2024: Update for parents, parents-to-be and families
Dear parents, parents-to-be and families,
We wanted to share the latest update with you on the work we have been doing to change and improve our maternity and neonatal services here at UHDB. We are absolutely dedicated to making the changes both you and we want to see - and you have our absolute commitment to doing so.
We know that we have not got this right for every family in the way they deserve in the past. You may have heard about some truly tragic cases from 2021 and 2022 in the news lately where we let those families down in the worst way possible. For that, we remain truly sorry.
That is why we are absolutely determined to make changes. While we have much further to go, those changes are already making a difference to the care you will receive with us today.
In the last few months we have been focusing on some key safety areas, like how we monitor you and your baby, and how we make sure you are safe if you have an unexpected bleed during or after labour.
Alongside this we have been investing in multiprofessional training to make sure that every team member is up-to-date with important safety learning. We have strengthened the processes for ensuring all our staff are knowledgeable, confident and up to date with training and education. We know this leads to safer care and is one of the things reflected back to us by the Care Quality Commission in their most recent inspection.
We know that staff that train together perform better together in the workplace. In March, we improved our compliance for the 1 day multi-professional 'fetal monitoring training' to 90% of our teams (up from 85% in December). We have worked hard on Practical Obstetric Multiprofessional training ('PrOMPT') training too, this is a national programme that maternity staff attend togther. It is about human factors and how we work together as a team to reduce the likelihood of human error as well as ensuring we respond appropriately to obstetric emergencies, and in March we reached 86% for this. Whilst this improvement is really positive, we aren't complacent and in the last month we recruited to some new, senior education roles to help us go further.
As mentioned above, we have also done some focused improvement work on improving the experience and management of women who bleed unexpectedly after birth.
We are now using a new nationally developed process that 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.
Behind the scenes we have also been working to get ready for our new electronic patient care record (EPR) which is expected to go live in June. This new system helps us to improve safety as it means staff can access your maternity records more easily. It will also allow you to view information about your pregnancy and care plan in real-time from home too.
As well as improving the experience you have, we want to improve the experience of our teams too. In March we ran some staff workshops 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. We know that a good culture means a safer culture.
Our 46 new midwives who have joined us since August have settled in well, and have been a really welcome addition to our team. This now gives us one of the best-staffed units in the region and allows our teams to better provide the safe and compassionate care they strive for.
We also want to involve you in our work, as we know hearing from and listening to you will help to make sure we make the right changes for you. We have welcomed a Patient Safety Partner >, who is a member of the public with personal experience of our service, to our Maternity Improvement Programme, and their input is making a huge difference, for which we are really grateful.
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'. If you want to get in touch with the MNVPs to share anything about our service, you can do so at ddicb.derbyshirematernityvoices@nhs.net (Derbyshire) or sasot.mnvp@nhs.net (Staffordshire).
You are also welcome to talk to us - you can reach out to your community midwife or named consultant, or our Patient Advice and Liaison Service (PALS) at: telephone 01332 785 156; text 07799 337 500; or email uhdb.contactpalsderby@nhs.net. We will ensure that any feedback you want to share is listened to and, importantly, is acted upon.
We are making progress but we absolutely know that we must go further. You have our commitment and determination that we will continue to do so. We have a team of compassionate, caring people who want to do their best for you.
We will continue to approach our challenges with openness and honesty and we will continue to share updates on our progress with you. We'll share another update with you in May.
You have our absolute commitment that we will keep working at pace to listen, improve and make the further changes that both you and we want to see.
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
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.
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.