Wednesday, 3 April 2013

Maternity Services

20% of all litigation claims in England involve maternity care and these represent 61% by value. Thus the RSCH belongs to the CNST (Clinical Negligence Scheme for Trusts). This scheme routinely assesses maternity units to ensure they comply with best practice thereby ensuring patients are safe and the likelihood of claims is low.  There are 4 levels of achievement: zero, 1, 2 and 3. Levels 2 and 3 are the highest and involve a gruelling assessment every 3 years. RSCH's maternity unit has just been assessed and has achieved the highest Level 3. This is not only excellent for mothers and babies but also means that the hospital receives the maximum insurance premium discount.

Part of the assessment checks that the midwife to mother/birth ratio is appropriate.

The Royal College of Midwives  and the Royal College of Obstetrics and Gynaecology both recommend a ratio 1:28. However they also recommend that hospitals should determine the ratio appropriate for them by using the Birthrate Plus toolkit into which data about type and volume of work and case mix etc. are fed with the output being the recommended ratio for safe and effective care.

The CNST assessment expects the ratio to be as determined by Birthrate Plus. If it is not then there has to be a plan in place to achieve it otherwise Level 3 would not be awarded.

I have made Freedom of Information requests to the major hospitals in Surrey to ascertain what there midwife to mother/births ratios are/have been over the last 12 months and their plans in the context of the RCM and RCOG recommended 1:28 or Birthrate Plus appropriate levels.

RSCH has been between 1:34 and 1:41 during 2012 against a Birthrate Plus appropriate level of 1:30. The Trust recognises that this is not satisfactory. A Business case for improvement has been accepted and the appropriate ratio of 1:30 will be achieved by 2014 – recruitment is underway.

For Frimley Park the Birthrate Plus appropriate level is 1:31. Through 2012 the level has been in excess of this: the Chief Executive has decided on a level of 1:33. There is a plan to work to 1:31 by 2015.

At Ashford and St Peters the ratio as of March13 was 1:31. They seek to reduce this to "national requirements" over the next 3 years.

St Heliers state that over the last 12 months they have always complied with the RCM's recommended ratio of 1:28.

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