CQC publishes report on safety, equity and engagement in maternity services

The Care Quality Service Commission (CQC) has released a report on maternity care in England.

Highlighting concerns about variations in quality and safety, the publication – entitled ‘Safety, Equity and Engagement in Maternity Services‘ – was published in September.

While the report recognises the good level of care that many maternity units across the country are providing, it also puts leadership, risk oversight, team working, culture, and engagement with the local population, under the microscope.

Although, keen to stress that it does not reveal a “national picture” across all maternity services, due to the small sample size, the CQC does say that “issues we have highlighted in our previous publications continue to cause concern”, such as staff not having the right skills or knowledge, poor working relationships, poor risk assessments, and not learning from when things go wrong. The body added that it’s “concerned that many of the issues raised in our report may be occurring in other maternity services”.

In a foreword, setting out its reasonings for the report, the CQC states: “In most cases pregnancy and birth are a positive and safe experience for women and their families. This is the outcome that everyone working in maternity services wants every time, for every woman.

“But when things go wrong, we need to understand what happened, and whether the outcome could have been different. The death or injury of a new baby or mother is devastating and something that everyone working in the health and care system has a responsibility to do all they can to prevent.”

Based on nine maternity inspections carried out between March and June 2021, as well as interviews and engagement with organisations and campaigns that represent women and their families, the document also adds that, “safe, high-quality maternity care is not an ambitious or unrealistic goal. It should be the minimum expectation for women and babies.”

A particularly important area that is also addressed by the report are the inequalities in outcomes for Black and minority ethic people. The report notes that: “We must also be honest about the inequalities that exist for some people. Women from Black and minority ethnic groups have poorer experiences of care and face additional risks. 

“While maternal deaths are rare, maternal mortality rates are significantly higher than for women from Black and minority ethnic groups than for women from White groups. Addressing inequalities in access and tailoring maternity services to best meet the needs of the local population is a critical area for action and something that good services are prioritising.”

To underline this, the CQC shares its “further evidence of poorer maternity outcomes for Black and minority ethnic women” through its “analysis of Hospital Episode Statistics data on readmission rates per 1,000 deliveries from January 2018 to December 2020”. This shows a “consistent trend of Black women having the highest rate of readmission to hospital during the six-week postpartum period.”

Among the findings of note within the publication are that its “ratings data shows that the improvement in the safety of maternity services is too slow,” with the latest figures from July 2021 showing that 41 per cent of services “are rated as inadequate or requires improvement”, while a combined 59 per cent are currently rated as good or outstanding – although the report does allow that during the pandemic its “inspections have been focused on those services where we have the biggest concerns.”

The CQC has also set out a list of recommendations for maternity services and wider system partners, to help address the issues raised in the report. These ‘next steps’ include:

  • Leadership – boards urged to take ‘effective ownership’ of the safety of maternity services, including ensuring ‘high quality, multidisciplinary leadership and positive learning cultures’ and that staff feel free to raise concerns.
  • Voices and choices – making sure that ‘all women and their families have information and support that allows them to make choices about their care’. This is recommend to include ‘listening to individual women and fully explaining choices’ in an accessible way.
  • Engagement – local maternity systems instructed to ‘improve how they engage with, learn from and listen to the needs of women, particularly women from Black and minority ethnic groups’, and to make sure that targeted engagement work is ‘appropriately resourced’.
  • Data and risk – services and systems are directed to use the ethnicity data that they collect to ‘review safety outcomes for women from Black and minority ethnic groups’ and to ‘take action in response to risk factors’, including by working with Black and minority ethnic women to ‘personalise care and reduce inequality of outcomes’.

On the report, Ted Baker, CQC’s Chief Inspector of Hospitals, said: “We know that there many maternity services are providing good care, but we remain concerned that there has not been enough learning from good and outstanding services – or enough support for that learning from the wider system.

“We have seen good progress in some services, but we must now accelerate the pace of change across all services to prevent future tragedies from occurring and ensure that women and babies get consistently safe care every time.”

The CQC has also put out a call for comment and feedback. You can read and shares your views on the document, here.