Baby Lifeline is a unique national charity with the aim that every pregnant person and their baby receives the safest and best care. It does this by providing equipment, developing and providing training and conducting research.
As multi-professional training is a central recommendation to improve safety and care in maternity, Baby Lifeline's most recent report, Mind the Gap, surveyed training provision at maternity services across the UK in the last financial year. It found significant and detrimental gaps as well as variability across UK organisations. The full report and supporting materials can be downloaded from the Baby Lifeline website (Ledger et al, 2021).
Information was gathered from the frontline in maternity via a Freedom of Information request in May 2021, and the comprehensive survey asked about the prioritisation of training topics, attendance rates, barriers and amount spent on training in the last financial year (2020/21). This information was then directly compared with recommendations by national reports aimed at reducing avoidable harm and deaths in maternity.
Maternity training suffered during the pandemic
The COVID-19 pandemic had a huge impact on maternity services in the financial year 2020/21, and despite exceptional efforts by practice development teams, training nationally has suffered. Maternity teams received less training, money spent on training nearly halved and more barriers to the provision of training were identified.
‘It has been an immensely difficult year to deliver safe, practical and optimum training. The pressure of providing the best training possible without compromising staff safety has been challenging.’ Respondent to the Mind the Gap survey
The 2021 Mind the Gap report examines the latest data on training provision in maternity services across the UK in the financial year 2020/21
Gaps and variability in training relating to avoidable harm
There were significant gaps in training related to known causes of avoidable harm for mothers and babies. Only four out of 10 organisations provided the relevant training in risk recognition/assessment (frequently identified as a leading cause of avoidable baby deaths and injuries). Less than one third of organisations provided training in how to manage heart disease, although heart disease is the leading cause of deaths in pregnant/postnatal mothers (Knight et al, 2021).
There were also shortfalls in training relating to the NHS (2021) priorities on achieving equity and equality. A quarter of maternity services did not consider the the needs of the local population, fewer than a third of services provided training in cultural competency and there was variation in training in elements of severe and multiple disadvantage and complex social factors. Only one organisation provided training in all relevant areas in the NHS England guidance.
There were also gaps in training where specific guidance exists. Although there was an increase in the percentage of UK organisations that provided training outlined by the Saving Babies' Lives Care Bundle (NHS England, 2019) – from 8% to 22% – this figure still remains low. Similarly, only three organisations indicated that they provided all aspects of training as specified in the NHS Resolution (2021) Maternity Incentive Scheme, which financially rewards organisations taking action to improve maternity safety.
Barriers to training increased
Almost all organisations identified barriers to attending or providing training (97%), and there were more identified than in the 2017/18 financial year (Ledger et al, 2018). Although the most frequently identified barrier was the pandemic, key barriers to training from 2017/18 were still prevalent in 2020/21, including funding, venue restrictions and staff shortages. These need serious and immediate action.
Training gaps highlighted in the last report (Ledger et al, 2018) have become worse, and innovation and proper investment in the maternity workforce have never been more important. Services are not being given the right infrastructure to support the demands of improvement and transformation work mapped to the national ambition of halving stillbirths, neonatal and maternal deaths and brain injuries (Gov.uk, 2015).
Calling for change
Mind the Gap (Ledger et al, 2021) provides vital insight into gaps into maternity training that, if addressed, may help to reduce avoidable harm and increase staff morale. The report urges the UK government to provide:
- Dedicated and targeted funding for the direct costs of training, including support for staff backfill
- Investment in systems and infrastructure to allow training to take place. This is particularly important in light of the pandemic, as much training has moved to a virtual setting
- A solution to the workforce shortage that is plaguing maternity services (NHS Digital, 2021).
Responses to Mind the Gap
The report was launched on 23 November and has been well received by the maternity safety community.
‘Training is central to making maternity services as safe as they can be…While we're pleased to see recent additional funding for maternity services, it's essential that professionals get the time to learn as well as the time to care. Training needs to reflect the demands of modern maternity services and play a part in tackling health inequalities. Our new Future Midwife standards will help as they continue to embed across the UK.’
Verena Wallace, senior midwifery advisor at the Nursing and Midwifery Council (2021)
Examples of excellence and innovation
As well as identifying gaps in training, Baby Lifeline was pleased to receive responses demonstrating the innovative ways in which staff navigated pandemic restrictions and other pressures in order to provide training in 2020/21.
‘Topics were covered as part of the weekly skills sessions and also as part of our “education bus” programme. The education bus is effectively a trolley which is wheeled round the unit by topic experts or members of the education team. They discuss different topics, give out leaflets and information and give staff the opportunity to ask questions.’
Respondent to the Mind the Gap survey
Further examples of excellence and innovation from staff in maternity services across the UK can be viewed on the Baby Lifeline website.
The report launch was accompanied by a free-to-attend webinar where experts including Dr Bill Kirkup CBE, Sascha Wells-Munro, Alison Talbot, Sandra Igwe and Dr Kirsty MacLennan joined the head of research and development at Baby Lifeline, Sara Ledger, to discuss best practice in maternity training. The webinar was recorded, and the charity welcomes those who are interested in maternity safety to catch up.