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New ratings show 75% of CCGs failing on maternity care

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Almost 75% of clinical commissioning groups are failing to provide the expected standards of maternity care in England, new NHS England ratings show.

CCGs in England have been given an overall rating based on four improvement indicators published by NHS England – patient choice, experience, maternal smoking, and neonatal mortality rates.

“Hopefully these ratings will be used to help CCGs learn from the best”

Cathy Warwick

Eleven CCGs were reported as having “greatest need for improvement” with another 144 needing some improvement. Only one, West Kent CCG, was labelled as “top performing” with another 53 rated as “performing well”.

The ratings showed significant variation in neonatal mortality and stillbirth rate per 1,000 births, with 13.2 infant deaths per 1,000 in North Kirklees and just 1.8 in Bracknell and Ascot. The national average was 7.1 per 1,000 births

In addition, the ratings showed only 65.4% of women across all CCGs felt they had a choice of maternity services, with even the best performing CCG in this category perceived as offering choice to just three-quarters of women

There was also a variation of almost 20% in how women rated their experience of maternity services, ranging from 69.8 per cent for women in Tower Hamlets, to 87% for those within the Bath and North East Somerset CCG area

“These figures starkly highlight areas where improvement is needed”

Elizabeth Duff

Meanwhile, there were 11 regions where more than 20% of women were smoking up to their due date, with Blackpool, Swale and North East Lincolnshire the worst CCG areas

The new maternity ratings are one of six “clinical priority areas” that CCGs will be rated on as part of a CCG improvement and assessment framework by NHS England.

Speaking at the Conservative Party conference earlier this month, health secretary Jeremy Hunt referred to the new system as being like “Ofsted ratings” – the well known process by which schools are rated.

A spokesman for NHS England said: “The data will help CCGs self-assess more effectively and target areas which need improvement, and NHS England will be offering a comprehensive support package to enable that improvement to happen.”

However the CCG improvement and safety framework for 2016-17 said it was “designed to supply indicators for adoption in [sustainability and transformation plans] as markers of success”.

Professor Cathy Warwick

Professor Cathy Warwick

Cathy Warwick

With maternity seen as an area of contention in the country-wide STPs, it is unclear how these ratings will impact on future service reconfiguration.

Commenting on the ratings, Professor Cathy Warwick, chief executive of the Royal College of Midwives, said: “This is a significant amount of data which the RCM will need to consider carefully.

“I do, however, welcome the openness and transparency in publishing these ratings,” she said.

She described the ratings as a “positive step” that could help women to be informed about the quality of services in their local area and “empower them” to make more informed decisions about their care.

“Hopefully these ratings will be used to help CCGs learn from the best and to improve quality where that is shown to be needed. There is of course already a great deal of work going on to implement the recommendations of the National Maternity Review in England. It will be important that improvements emerging from this process feed into that work if we are to ensure learning across the whole system,” she said.

“I am concerned about the number of services requiring improvement, and about the variations in care and outcomes for women and their babies, shown in areas such as stillbirth rates. Poorly performing services need to be addressing this variation very urgently. I do also recognise also that some of this is older data and that improvements may have been made since then,” said Professor Warwick.

National Childbirth Trust

New ratings show 75% of CCGs failing on maternity care

Elizabeth Duff

She added: “Services are though up against huge cost savings being demanded from the government, whilst also facing rising demands on their services, leaving them too often under resourced and under-staffed. This is not just about learning from each other to ensure all are performing well, it is also about resourcing services adequately.”

Elizabeth Duff, senior policy adviser at the National Childbirth Trust, said: “We’re pleased to see NHS England is delivering on its commitment to be more transparent about CCGs’ performances and this is a positive step forward.

“These figures starkly highlight areas where improvement is needed. For example, it is very disappointing that in some parts of the country barely half of women get the maternity care of their choice,” she said.

“Parents shouldn’t use these figures alone to decide where to have a baby,” she said. ”They are baseline ratings which don’t take into account every aspect of care.”

Worst performing CCGs

CCGMaternal smoking rate at delivery (2015-16 Q3)Neonatal mortality and stillbirth rate per 1000 births (2014 ONS Extract)Women’s experience of maternity service score out of 100 (CQC Maternity Survey 2015)Choice’s in maternity services - score out of 100 (CQC Maternity Survey 2015)Overall  rating
South Warwickshire CCG 7.9% 9.8 72.1 56.1 Greatest need for improvement
Slough CCG 8.1% 8.1 72.5 58.7 Greatest need for improvement
South Gloucestershire CCG 10.7% 7.6 75.0 61.0 Greatest need for improvement
Milton Keynes CCG 10.8% 7.2 72.9 57.6 Greatest need for improvement
East Riding of Yorkshire CCG 14.7% 5.6 72.5 57.7 Greatest need for improvement
Wolverhampton CCG 15.8% 10.3 75.1 59.6 Greatest need for improvement
Bradford Districts CCG 18.2% 10.6 79.2 66.9 Greatest need for improvement
Nottingham City CCG 18.8% 12.4 78.6 67.7 Greatest need for improvement
Durham Dales, Easington and Sedgefield CCG 21.2% 5.9 80.3 60.7 Greatest need for improvement
South Tees CCG 22.3% 6.4 76.6 56.6 Greatest need for improvement
Hull CCG 22.5% 10.7 81.1 66.5 Greatest need for improvement

Best performing CCG

CCGMaternal smoking rate at delivery (2015-16 Q3)Neonatal mortality and stillbirth rate per 1000 births (2014 ONS Extract)Women’s experience of maternity service score out of 100 (CQC Maternity Survey 2015)Choice’s in maternity services - score out of 100 (CQC Maternity Survey 2015)Overall  rating
West Kent CCG 10.1% 4.1 83.6 69.1 Top performing
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