Learning to Manage Health Information Measuring the Quality of Maternity Care Professor Suzanne Truttero Midwifery Advisor Department of Health 18 th March 2009

Quality of Maternity Services “The maternity and newborn groups [SHA Clinical Pathway] were clear that women want high quality, personal care with greater choice over place of birth, and care provided by a named midwife.” High Quality Care For All (June 2008)

Maternity Matters (April 2007)  ‘The priority for modern maternity services is to provide a choice of safe, high quality maternity care for all women and their partners’.

Triangulation of Quality Indicators Workforce Consumer satisfaction Activity & clinical outcomes

Operating Framework 2009/2010 Maternity & Neonatal  Access to care  Type of antenatal care  Place of birth  Place of postnatal care  Improve experience  Sufficient workforce  Healthcare Commissions findings

Health Inequalities Infant Mortality Rates  Born in Pakistan 10.2 per 1,000 live births  (Double the overall infant mortality ratio)  Born in Caribbean 8.3 per 1,000 live births  (63% higher than the national average)  Aged under 20: 7.9 per 1,000 live births  (60% higher than for older mothers aged 20-39)  Sole parent 6.7 per 1,000 live births  (36% higher than among all births inside marriage)

Standards for Maternity Care  800 existing standards – 50 publications  30 standards that follow the maternity care pathway  Existing standards should be distilled into a smaller number that are critical to safety (Kings Fund 2008)  Audit indicators for each standard – clinical & organisational  ‘NHS Evidence’ role of NICE (High Quality Care For All)

Confidential Enquiries

Guidance & Recommendations

Public Service Agreements  Women should have a full assessment of needs, risks and choices by the 12 th completed week of pregnancy (Ensure Better Care For All October 2007)  Prevalence of breastfeeding at 6-8 weeks (Improve the health and wellbeing of children and young people April 2008)

Maternity Inquiry (Kings Fund) 1.What are the main problems relating to the safety of maternity services 2.How can the safety of maternity services be improved 3.What are the barriers to achieving these improvements

Safe Births: Everybody’s Business Recommendations  Use of balanced scorecard by Trust Board for high-level information of Trusts business  Detailed ‘dashboards’ – outcomes, activity, workload, staffing levels, training, intervention rates, near-miss incidents, risk incidents and complaints.  Supplemented with staff and patient surveys

Tools for Improvement – The Pathways  Keeping first pregnancy & labour normal  VBAC (vaginal birth after caesarean)  Elective caesarean section

The Productive Maternity Ward

Healthcare Commission Review (2005) & Investigation (2006)

Maternity Scorecard ‘The dashboard shows you what is happening & leads you to why’.

Maternity Balanced Scorecard  Customise  Activity – casemix/capacity  Workforce – capacity/skillmix  Clinical indicators - thresholds  Traffic light system  Data source 

NHSALSA New Maternity Standards  CNST  1 st April 2009  5 standards  Number of criterion

500 missed opportunities intrapartum-related deaths  Maternity scorecard piloted nationwide to assess & improve standards of care in maternity services  NPSA intrapartum scorecard specifically on safety of intrapartum care – automated scorecard  NPSA retrospective casenote review of all intrapartum related deaths  NPSA project testing 2 safety bundles

National Screening Programme  Information to parents  Screening choices  Screening Timeline

Consumer satisfaction

The Information Centre definition of ‘normal delivery’  ‘Measurement of the process not outcome’  Women whose labour starts spontaneously, progresses spontaneously without drugs, and who give birth spontaneously Exclusions:  Induction, epidural or spinal, GA, instrumental, C/S or episiotomy

Maternity Care Facilities  New publication  Environment  Care pathway  Models of care  Triage  Maternity day care

Maternity Dataset  995 items of data  30 maternity services currently piloting dataset 

Measuring the Quality of Maternity Care  Contemporary information and data  Development of ‘Clinical Dashboards’ to support clinical teams  Commissioners involve clinician groups in strategic planning and service development to drive improvements in health outcomes  Use of tools and toolkits to measure the quality of care  Information from tools to inform commissioning