Working together: what lessons from maternity care can teach us about doing things differently
Opening the NHS Confederation Conference session, Working together: what lessons from maternity care can teach us about doing things differently, Charlie Massey made the following remarks -
Over the last few days, we’ve heard a lot about the enormity of the challenges thrown up during the pandemic, and how grateful we need to be to the thousands of healthcare professionals who have continued to provide fantastic care.
Amidst the pandemic, babies have continued to be born, and mothers have continued to need care. And in the vast majority of scenarios, our maternity services have provided world-class care to women and their families.
But we also know that this is not universally the case. Maternity is a particularly complex area of medicine, requiring seamless teamwork across disciplines. And when things go badly wrong, the human cost is absolutely tragic.
It’s also an area of medicine that has markedly worse outcomes for women from ethnic minority backgrounds.
Recent reviews tell us that there are some recurrent themes when things go wrong.
Firstly, we see significant challenges within the workforce.
For example, our data tells us that obstetrics and gynaecology (O&G) trainees say they experience more bullying, are more likely to switch to other specialties, and feel less well supported than trainees working in other specialties.
It’s also a profession that loses more of its newly appointed consultants than others. And where specialty and associate specialist (SAS) doctors feel more bullied working in O&G than they do in other specialties.
And it’s an area of medicine where doctors from ethnic minorities feel much less well-supported than their white counterparts.
Culture and leadership are also frequent themes. This manifests itself in a lack of honesty, poor clinical governance, and poor teamwork between the different professions. And too often it leads to missed opportunities to learn, and a failure to spot problems at an early stage.
Unfortunately, these issues are not unique to maternity, and there are wider learnings and reflections to consider.
A critical issue is how we as regulators can use our data better to provide insight, intelligence and support. But we must do so in a way that feels more joined up from the perspective of a provider. Complex challenges require a more system-wide and co-ordinated approach, with more of a mentality to fix things before harm occurs.
We also need to address the challenge of providing workplaces that are genuinely more supportive and more inclusive for all of our colleagues, especially those from ethnic minorities.
And we need to improve the support we and others give to providers to deliver the clinical governance and leadership that are needed in maternity services and elsewhere.
I want to finish with some reasons to feel hopeful about the progress that is and can be made.
First, data and insight. I’m excited by the work we are doing with the NMC and CQC to create a shared data platform. Our hope is that by pooling our data, we will be better able to spot issues earlier, and work with others to support providers in addressing those issues and challenges that we identify.
Second, we need to recognise and replicate where things are working well. The pandemic has been enormously challenging, but has also led to numerous examples of better leadership and better teamwork. Our own data told us that around 60% of doctors reported improvements in team-working during the first phase of the pandemic. We need to sustain that, and think about how we can use this period of recovery and renewal from the pandemic to embed those successes.
Third, I sense a much stronger determination to tackle inequalities within the workforce. We must follow through – this is not just a moral imperative, but one that is fundamental to providing excellent patient care and getting the most out of all of our workforce, as we look to the significant challenges that lie ahead.
And finally, although it may sound rather technocratic and self-serving, the government’s commitment to make legislative change to give professional regulators more autonomy in setting their rules will allow us to be much more focused about what we do. And, I hope, invest more of our time and resources in our “upstream” activities.
Ultimately, we all want the same thing – safe, open cultures where people feel able to raise concerns and learn from them. We all want early intervention that prevents harm before it occurs. And we all want babies and their families to have the best possible experience of maternity care.