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Maternity services show ‘limited improvement’, finds patient survey

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The expectations of women receiving maternity care has fallen short, according to the latest annual survey on the area for the Care Quality Commission, which highlights issues in continuity of care, choice in antenatal and postnatal services and access to help and support after giving birth.

In the sixth survey of its kind, the regulator measured the responses of over 17,600 women who gave birth in February 2018, to help NHS providers to better understand the experiences of women using maternity services.

“It is particularly disappointing to see that scores for questions about postnatal care remain poor”

Nigel Acheson

Findings from the study, which involved 129 trusts, uncovered ”limited improvement” in women’s experiences between now and the last time women were surveyed in 2017, and shows that in some areas women’s experience has declined.

For example, over a quarter of women (28%) reported they did not see the same midwife for their antenatal checks though they would have liked to and only 15% said the midwives who cared for them during labour and birth had been involved in their antenatal care – the same as 2017.

In addition, the results show a downward trend for women reporting they had been visited at home after giving birth, from 95% in 2013 and 2015, to 94% in 2017 and now 93% in 2018.

In terms of home visits, almost a quarter (24%) of women surveyed said the midwife or midwives they saw at home did not appear to be aware of their medical history, this is up from 23% in 2017 and 22% in 2015.

A slight increase in the proportion of women stating they would have liked to have seen a midwife “more often” after they went home, was also noted. In 2018, 23% of women said this, compared to 21% in 2017.

“I hope that trusts will make full use of their individual survey results to identify where changes can be made”

Nigel Acheson

However, not all results were negative. The survey highlighted that several areas of maternity care continue to show positive results and found that many women had a good experience, particularly in relation to interaction with staff, access to midwives and emotional support during pregnancy.

Most respondents (82%) stated that during antenatal check-ups the midwives they saw “always” listened to them. While this is unchanged from 2017, it is up from 79% in 2015 and 2013.

Also remaining the same as last year, 88% of women said they were “always” treated with respect and dignity during labour and birth. This was, again, slightly up from 2015 (86%) and 2013 (85%).

With a slight increase in 2018, more women (68%) said they were asked how they felt emotionally during their antenatal care, up from 64% in 2017 and 57% in 2015.

It was also found that 97% of women reported that during pregnancy, they had a telephone contact for a midwife or midwifery team. Of those who tried to contact them, 73% “always” got the help they needed – these results have remained stable over time, noted the CQC.

A separate CQC report, also published today, which looks at “outliers” among the survey results, highlighted that there were no trusts flagged as “much better than expected”.

Nevertheless, there were nine trusts that had overall performance rated as “better than expected”. These were:

  • City Hospitals Sunderland NHS Foundation Trust
  • East Lancashire Hospitals NHS Trust
  • Harrogate and District NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Northern Lincolnshire and Goole NHS Foundation Trust
  • Northumbria Healthcare NHS Foundation Trust
  • Salisbury NHS Foundation Trust
  • The Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Wirral University Teaching Hospital NHS Foundation Trust

However, five trusts were categorised as “worse than expected”. They were:

  • Barts Health NHS Trust
  • Heart of England NHS Foundation Trust
  • Mid Yorkshire Hospitals NHS Trust
  • North Middlesex University Hospital NHS Trust
  • University College London Hospitals NHS Foundation Trust

Furthermore, one provider – Basildon and Thurrock University Hospitals NHS Foundation Trust – was categorised as “much worse than expected” when all questions were analysed simultaneously, said the CQC.  

Commenting on the survey, Nigel Acheson, the CQC’s deputy chief inspector of hospitals and lead for maternity, said he was pleased to that many women were experiencing “high quality care and treatment” in maternity care.

He said: “This is a testament to efforts and dedication of staff working hard to provide care for pregnant women and new mothers across the country.

“The survey reveals a number of positive results, with support during antenatal check-ups and partner involvement showing encouraging upward trends,” he added.

“It is worrying that some areas are progressing very slowly, standing still or indeed going backwards”

Sean O’Sullivan

However, Mr Acheson also highlighted that in “other areas women’s experiences continue to fall short”.

“It is particularly disappointing to see that scores for questions about postnatal care remain poor – information provision, emotional support and communication after birth are all highlighted as areas where experiences could be improved,” he said.

“Similarly, ensuring greater continuity of care for women through the whole maternal journey is an area where trusts need to focus their attention,” he added.

Mr Acheson stated: “It is vital NHS trusts listen to and work with those who use maternity services to fully understand what is working well and what might need to improve.”

”I hope that trusts will make full use of their individual survey results to identify where changes can be made to ensure consistent and high-quality care for the benefit of all women and their families,” he said. “This is of huge importance if we are to realise the ambition of the NHS long term plan.”

Sean O’Sullivan, head of health and social policy at the Royal College of Midwives, said: “It is very encouraging to see the steady improvement in many areas of maternity care, and we know the government are working hard to improve our maternity services.

“But it is worrying that some areas are progressing very slowly, standing still or indeed going backwards,” he said. “Continuity of care is crucial to ensure safe and high quality care, yet many women are not getting the continuity of carer they want and need.”

He added: “The RCM has been highlighting the gaps in postnatal care for many years and this remains another area of concern, including the support women get for mental health issues. We must see a real focus at government and local level to improve this.”

The full results for England, as well as individual results for each trust are available on the CQC’s website.

Other findings from the CQC survey:

  • More women in the 2018 survey (71%) said their partner or someone else close to them could stay with them as much as they wanted during their stay in hospital (69% in 2017 and 63% in 2015)
  • Over two-thirds of women (68%) in 2018 said they were not given a choice about where their antenatal check-ups would take place, however, this proportion has declined gradually over time (from 71% in 2013 and 69% in 2015 and 2017)
  • Over three-quarters of women (77%) reported that they were never left alone during the birth of their baby at a time when it worried them. This is unchanged from 2017 but has improved from 74% in 2013 and 2015
  • In 2018, fewer women felt that they were ‘definitely’ given enough information about their own physical recovery (57% in 2017 falling to 53% in 2018) or about any emotional changes they might experience (59% in 2017 and 56% in 2018) after the birth
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