Mums Say NHS Maternity Services Are Good In Biggest Ever Survey, UK

Mothers have praised the good quality of care provided by NHS maternity services in a survey published today (Tuesday) by the Healthcare Commission.


But the results also highlight specific areas of concern and wide variations between trusts in responses to questions about postnatal care, communication, food and cleanliness.


Responses came from 26,000 women who gave birth in January and February 2007, making it the largest survey ever of maternity experience.


The Commission has chosen to throw the spotlight on maternity services because its investigations have highlighted instances of poor quality care.


It is carrying out a national review of this area of care that will culminate in a comprehensive assessment of services nationally and locally. Early next year all trusts will be ranked on a four-point scale from "excellent" through to "weak".


The survey, which will contribute to the national review, represents the voice of women using these services. The watchdog is also gathering information on clinical outcomes and value for money.


The proportion of women surveyed who said their care was "excellent","very good" or "good" was 89% during pregnancy, 90% during labour and birth, and 80% after the birth. The Commission said that these are positive overall results.


Looking at the three stages of care, positive survey results included:


Antenatal care:


- 91% of women said they saw a health professional about their pregnancy as soon as they wanted

- 90% of women said they had the name and telephone number of a midwife they could contact during pregnancy


Care during labour and birth:


- 92% of women said they "definitely" or "to some extent" got the pain relief they wanted

- 82% of women said they were always spoken to in a way they could understand


Postnatal care:


- 88% of women said they had a postnatal check-up four to six weeks after the birth

- 76% of women saw a midwife as much as they wanted


However women's responses were less positive in the following areas:


Antenatal care (Note that antenatal and postnatal care may or may not be provided by the same trust where women have their baby. Primary care trusts, GPs and community midwives also have a role to play.)


- 43% of women said they were not given a choice of having their baby at home, as NICE guidelines suggest. Responses ranged from one acute trust where only 8% of women said this was not offered to another where 76% were not given this option. This may not be the direct responsibility of the acute trust.


- 36% of women said they were not offered NHS antenatal classes, which trusts were asked to do in the government's National Framework for Children, Young People and Maternity Services. Fourteen per cent of those were first time mums and 76% had previously had a baby. Responses ranged from 11% of all women at one acute trust saying they were not offered NHS classes to 67% saying this at another.















During labour and birth


- 26% reported being left alone during labour or shortly after giving birth at a time that worried them. This suggests midwives may not be adequately reassuring women when they have to leave the room - NICE guidelines say women should not be left alone except for short periods. Looking at labour alone, 9% of women at one trust said they were left alone at a time that worried them, while 33% said this at another. In 18 out of the 148 trusts, more than 20% of women said they were left alone during labour at a time that worried them.


- 57% of women gave birth either lying (30%) or lying with their legs supported in stirrups (27%). The most recently published NICE guidance encapsulating best practice recommends that for normal births women should be discouraged from having their baby in this position. At one trust, 44% reported using stirrups, but only 11% at another. Only 13% of women reported their babies were born using forceps or a vacuum cap - these are medical reasons that may require a women to give birth lying.


- The vast majority of women said they were treated with kindness and understanding but beneath this there were variations. At some trusts this was barely an issue while at one trust 18% of women said they were not treated with kindness and understanding.


Postnatal care


- 19% of women said the food in hospital was "poor". Seventy seven per cent said they had the right amount of food but 23% said they had had too little. At one trust only 6% of women said they had too little, 46% at another. There were 21 trusts where more than 30% of women said they did not get enough food.


- 22% of women said they would have liked to have seen a midwife more often after birth and 22% said their midwife did not discuss feeding their baby with them during pregnancy.


- 8% of women said their hospital room or ward was "not very clean" or "not at all clean" while 18% said this of the toilets or bathrooms. At one trust 63% of women said the toilets and bathrooms were "not very clean" or "not at all clean", while at other trusts only 4% of women said this.


Anna Walker, Healthcare Commission Chief Executive, said:


"We have had well publicised concerns about some maternity services. So now is a good time to carry out a thorough review of the quality of care women are getting. A critical piece of that jigsaw is the views of women. This survey represents their voice.


"Overall women are clearly positive about maternity services. But the results do highlight specific areas of concern and wide variations with issues including postnatal care, communication, food and cleanliness.


"We expect trusts to make full use of their individual results and the opportunity to compare with others. These results show us that many trusts provide very positive services for women. Trusts with less positive results need to learn from the good performers."


The maternity survey was coordinated on behalf of the Commission by the Picker Institute Europe.


Early next year the Commission will publish detailed results of its comprehensive review of maternity services which will include data on outcomes, facilities, resourcing, staffing levels and costs. These survey results will feed into this review.


Trusts are expected to use the results of this survey, and the assessment they receive next year from the maternity service review, to help them focus on areas where improvement is needed.


More information about the survey of NHS maternity services


Notes:


This report builds on a national survey of women's experiences in NHS maternity units published in March which was carried out last year by the The National Perinatal Epidemiology Unit (NPEU) and supported by the Healthcare Commission.


The Healthcare Commission survey extends the findings collated by the NPEU by providing localised results of women's experience's in maternity units at a trust level.


Information on the Healthcare Commission


The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.


Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.


The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

Healthcare Commission