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Lack of frontline training on stillbirth prevention care bundle

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Mothers and babies are at risk because of a lack of training for frontline maternity staff with less than 10% of trusts following official training guidance, according to a new report.

The report by maternity Charity Baby Lifeline found only a minority of trusts and health boards in the UK have adopted training recommendations in the Saving Babies’ Lives Care Bundle, which was launched by NHS England as part of efforts to prevent stillbirths.

“It is beyond disappointing that the provision and uptake of such training remains as poor and as patchy”

Bill Kirkup

Based on findings from a Freedom of Information request, the report reveals poor attendance at training sessions, with staffing shortages and sickness absence among the main reasons for people not showing up.

It also shows huge variations in annual spending on maternity training with budgets for 2017-18 ranging from just over £1,000 at one trust to more than £370,000 at another – with the level of spending apparently unrelated to the size of the service.

In a foreword to the report, Dr Bill Kirkup, former chair of the Morecambe Bay investigation into failings in maternity care, described the poor take-up of multi-disciplinary training revealed in the report as “beyond disappointing”.

The research saw a FOI request sent out to all 157 trusts with maternity services in all four UK nations in July this year, with responses received from 140 – 89%.

“Those whose calling is to keep mothers and their babies safe deserve our full support to achieve that goal”

Robert Francis

Overall, the report shows the amount of maternity training has increased across the UK since Baby Lifeline’s last report on maternity care in 2016 – especially when it came to areas emphasised in recent reports, such as “human factors” training.

However, the research also reveals virtually no consistency in the way maternity training is prioritised, provided, funded, assessed and attended.

It found just 7.9% of trusts provided all the training elements in the Saving Babies’ Lives Care Bundle, which includes training in foetal monitoring and smoking cessation.

When training is available, attendance is often patchy, the report shows. Just 38% of trusts reported more than 90% of staff attended mandatory training. One trust said less than a quarter of staff showed up.

Midwives were the staff group with the highest rate of attendance by far with more than half of trusts reporting rates of more than 90% and about a quarter at more than 95%.

“There is a clear difference between what is said is being done and what is happening”

Judy Ledger

The report found the biggest barriers to attending training were staffing and sickness absence with 81% of trusts reporting staffing issues prevented people from attending scheduled training sessions, while 61% said sickness was to blame.

“Trusts also reported staff having to return to clinical practice from training sessions because of raised acuity, in order to maintain patient safety,” said the report – titled Mind the Gap: An Investigation into the Maternity Training Gap Between NHS Trusts in the UK.

When it came to providing training in the first place, 74% of trusts cited staffing as an issue while 62% said there were financial barriers.

Several respondents commented on the challenges in getting enough staff from different disciplines together to create a multi-professional learning environment.

There were wide variations in the topics covered in training. While most trusts provided training in emergency skills and safeguarding vulnerable children, more than one in five said they did not provide training on co-morbidities in pregnancy and managing high risk pregnancies.

Despite the high rate of operative interventions, the topic provided by the fewest trusts was care of women following operative interventions, while about a quarter did not provide training in bereavement care.

“We’re calling for this to change, and for training to be standardised, mandated and properly funded”

William Parry-Smith

Trusts were asked about the type of training they regarded as mandatory, as well as whether different professionals undertook training in key subjects together.

Unsurprisingly, emergency skills drill was the most likely mandatory topic to be attended by multiple professionals together, followed by recognition and management of severely or critically ill women and maternal life support.

Interpersonal and human factors training was not attended together in almost one fifth of trusts where it was mandatory for more than one professional group.

There was variation in how often key topics, such as sepsis, and learning from risk were provided to a multi-professional audience in these trusts.

The Morecambe Bay investigation stressed the importance of close and effective teamwork when it came to ensuring safe maternity care.

Dr Kirkup, who said the report should be “required reading for trust boards and for all concerned with maternity care”, said he was particularly disappointed to see gaps in multi-professional training.

Bill Kirkup

Bill Kirkup

Bill Kirkup

“It is effective in improving care, including safety and outcomes, and must remain a priority as long as unnecessary and avoidable harm persists,” he wrote.

“It is beyond disappointing that the provision and uptake of such training remains as poor and as patchy across the country as this report indicates,” he added.

The report also includes a foreword by Sir Robert Francis QC, who led the inquiry into Mid Staffordshire care scandal and now chairs Healthwatch England.

He said he had seen the “terrible price” price paid by children and families affected by obstetric incidents.

“The impact on staff can be devastating as well. Those whose calling is to keep mothers and their babies safe deserve our full support to achieve that goal,” he wrote.

“Ensuring these hard-working and dedicated people are fully-trained and equipped to deal with every eventuality is key,” said Sir Robert.

Judy Ledger, founder and chief executive of Baby Lifeline, said the report provided a stark picture of the amount and type of training actually being done by frontline maternity staff.

“It highlights the training actually delivered in the last financial year rather than showing the intentions of trusts to provide it,” she said.

“The report shows there is a clear difference between what is said is being done and what is happening,” she noted.

She warned the government would fail to achieve its goal of halving stillbirths, neonatal deaths and maternal deaths by 2025 unless training was mandated and properly funded.

“Our report shows that the one-off £8.1m in funding the government gave to trusts for maternity training in 2017 has had an impact, but it was a drop in the ocean,” said Ms Ledger.

“At the very least, the reduction of one negligence case through proper training would be a life and money saved,” she said.

The report cited figures from NHS Resolution, showing the NHS faced maternity-related clinical negligence claims totalling £2.1bn in 2017-18 compared with the £1.9bn per year spent on delivering babies.

Registrar obstetrician and gynaecologist and Baby Lifeline trustee, Dr William Parry-Smith, maintained this was “nothing short of a national scandal”.

“We’re calling for this to change, and for training to be standardised, mandated and properly funded,” he said.

“The focus needs to be on ensuring maternity staff across the country are consistently given the opportunities they need to be prepared to save lives,” he added.

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