An appraisal of the East of England ‘sixty supportive steps to safety’ tool
Universally, maternity care is particularly susceptible to risk. In England, the safety of maternity services has been the subject of many recent enquiries, leading to media scrutiny and concerns regarding safe outcomes and positive maternity experiences. During 2020–2021, an increased number of maternity units in the East of England were placed on the national Maternity Safety Support Programme, indicating that enhanced regional support was necessary. To establish exactly what support was required, both as a region and for individual maternity units, a tool was developed and launched April 2021: the ‘sixty supportive steps to safety’. This framework was intended to provide support to maternity units, so that the maternity quadrumvirate, the local maternity and neonatal system, the trust board and the integrated care board could have confidence and assurance that their maternity services had identified any required areas of improvement. Completion of the framework also enabled units to complete the tool, as well as to showcase and share best practice across the region.
Maternity care is particularly susceptible to risk and, in England, the safety of maternity services has been the subject of recent enquiries. The Ockenden (2022) report on maternity services at the Shrewsbury and Telford Hospital NHS Trust was published in March 2022, followed by the Kirkup (2022) independent report of maternity and neonatal services in East Kent in October. Both reports indicated that the pace of change to meet maternity safety regulations, and ensure sustained safe maternity and neonatal care, needs to be accelerated.
These national reports identified that a poor safety culture can lead to poor outcomes, having a devastating impact on women, pregnant people, babies and families. It also impacts the wellbeing of staff who provide care, which can potentially affect individual and/or team performance, and can lead to increased sickness absence, further exacerbating the safety issue.
The national Better Births report (NHS England, 2016) set out an ambition to reduce the rates of stillbirth, neonatal death, maternal death and brain injury in babies, that occur during or soon after birth, by 50% by 2025. Although good progress has been made towards this goal, further work is needed. As of January 2020, 38% of maternity services were rated ‘requires improvement’ by the Care Quality Commission (2020) in the safety domain. Services that receive this rating are entered onto the national Maternity Safety Support Programme, indicating that they require additional support.
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