A culture of “silo working” and a “lack of respect” between midwives, obstetricians and other healthcare professionals has been revealed in an independent review of maternity services in England.
The review found problems with communication, handovers and disagreements about how to handle situations, such as the transition to specialist care.
“Do I think dysfunctional relationships are sometimes a problem in the provision of healthcare? That is a problem we can only address if we recognise it”
The need for improved working relationships between staff groups – including with health visitors, nurses, neonatologists, GPs, paediatricians and anaesthetists – was highlighted by both midwives and obstetricians who submitted evidence to the review.
Such “cultural tensions” should be tackled through improved multi-professional education and training, during both undergraduate teaching and throughout the careers of health professionals, they told the review panel.
The review, chaired by Baroness Julia Cumberlege, was commissioned last year by NHS England partly in response to another major review, the investigation into University Hospitals Morecambe Bay NHS Foundation Trust, following a number of maternal and baby deaths at its Furness Hospital.
The investigation at Morecambe Bay found “serious and shocking” failures at almost every level of the system, including “extremely poor” working relationships between some midwives, paediatricians and obstetricians.
Today’s report on services across the country, called Better Births: Improving outcomes of maternity services in England, called for barriers between midwives, obstetricians and other professionals to be broken down.
Morecambe Bay apologies for failings but claims it is improving
Multi-professional learning should be a “core” part of all pre- and post-registration training for midwives and obstetricians, so that they “understand and respect each other’s skills and perspectives”, it said.
National workforce and training body Health Education England should fund the training through post-registration education in 2016-17, with employers taking over the responsibility from that point onwards, said the report.
Each year, it said 5% of all maternity staff should be taught in a “train the trainer” scheme, which will cost around £2m a year.
Meanwhile, the report added that the Nursing and Midwifery Council and the Royal College of Obstetricians and Gynaecologists should review education requirements to ensure multi-professionalism was promoted and that there were shared elements of learning on courses.
When asked if poor working relationships similar to those found at Furness Hospital were identified across the country, review vice chair Sir Cyril Chantler said: “I would like to think there aren’t too many Morecambe Bays.
Review warns of ‘lack of respect’ between maternity staff
“But if you asked me as a doctor, do I think dysfunctional relationships are sometimes a problem in the provision of healthcare – as in the provision of any service – I would say that is a problem which we can only address if we recognise it. Part of the themes of our report is to ensure we do recognise it,” he said.
The report makes a series of recommendations for the NHS, government and other bodies such as regulators, based on seven themes.
These are to ensure personalised care for the mother, to provide continuity of care, safer care, better postnatal and perinatal mental health services, improved multi-professional working, more provision and commissioning of services across boundaries, and reforms of payment systems for maternity services.