Care Quality Commission
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Most comprehensive review of maternity services ever carried out

Best and least well performing services ranked in first national benchmarking study
 
The Healthcare Commission has ranked one in four NHS maternity services as 'best performing' in a national review published today (Friday 25th January).
 
But the comparative review, the most comprehensive assessment ever of maternity services in England, also found significant variations in the quality of care across the country.
 
The Commission ranked 22% of maternity services as 'fair performing' (32 trusts) and 21% as 'least well performing' (31 trusts). Some 26% of trusts were 'best performing' (38 trusts) and 32% were 'better performing' (47 trusts).
 
The Commission launched the review in response to concerns about maternity services. It has published three investigations into maternity units and this area of care makes up one in 14 of referrals to its investigation unit on safety grounds.
 
In the absence of formal standards, the review set performance benchmarks for maternity for the first time, taking into account guidance from the National Institute for Health and Clinical Excellence (NICE) and the National Service Framework for Maternity Services. Trusts can use these to measure improvement and the Commission will conduct a follow-up review to check on progress.
 
Trusts in the north of England performed relatively well, while trusts in London performed most poorly. In the north, 33 out of 44 trusts were 'better performing' or 'best performing' (75%), while 19 out of 27 London trusts were 'least well performing' (70%).
 
Anna Walker, the Commission’s Chief Executive, said: "There have been serious concerns about maternity services.  That is why we have carried out a wide-ranging review. We have assessed 148 trusts providing maternity services against a comprehensive range of issues that women and clinicians tell us are important.
 
"We have deliberately made the experience of women central to this review. The care given to women during pregnancy, birth and the time just after giving birth is extremely important to both the mother and the baby. It can have lasting negative effects if not handled correctly.
 
"Being put in the least well performing category does not mean that a service is unsafe. If we believed any unit to be unsafe, we would take immediate action to ensure patients were protected. We would not hesitate.
 
"The purpose of the review is to encourage improvement and get all trusts performing to the standard of the best. We will repeat the assessment so that trusts have the opportunity to demonstrate improvement.
 
"Overall, it is positive that more than half of trusts were in the best or better performing categories.  But those trusts that were least-well performing should as a matter of urgency take steps to improve and we shall be checking that they do so.
 
"One reason that some trusts performed poorly is because they did not supply the full data. Trusts cannot know how good their services are without monitoring this key information. They must be able to collect and use information to improve care for women. We hope that this review will help ensure that this occurs.

"The review raises real concerns about performance in London. There are a number of factors that may have influenced these results, such as lower staffing levels and the mobility and mix of the population. But London trusts need to rise to these challenges. We and NHS London will do all that we can to support this. Where this involves NHS foundation trusts, Monitor will oversee the required actions.
 
"We know that patients want comparative information about individual hospital services. This review gives that to expectant mothers for the first time."
 
The review, carried out in the summer 2007, assessed all 148 trusts providing a full maternity service in England. It covers clinical effectiveness and women centred care, as well as the efficiency and capability of services.
 
The review looked at the period from when a woman first contacts a maternity service to her final contact with a midwife, usually around 10 days after a birth.
 
It used 25 indicators, ranging from the type of scans women receive to staffing levels and the number of times a woman has contact with a midwife after going home. The review drew on a survey of over 26,000 mothers as well as data collected from trusts. Indicators drawn from the survey include women’s experience of the cleanliness of units and whether they felt supported to breastfeed.
 
The Commission is publishing individual reports for each trust, highlighting their scores and areas for improvement.  Every trust that was 'least well performing' will have to produce an action plan, which the Commission will check. 
 
Strategic health authorities (SHAs) will monitor implementation of the action plans for non-foundation trusts.  For NHS foundation trusts, Monitor will ensure that recommendations are implemented. Where insufficient action is taken, Monitor can consider exercising intervention powers.
 
In London, the Commission said that antenatal and postnatal care tended to be consistently poorer - the quality of care around the time of birth was mixed.
The review found, for example, that in London a higher percentage of women reported not receiving the recommended number of antenatal checks. This may be because they had to wait longer to be fully assessed and booked for maternity care.
 
The Commission added that trusts in London needed to provide greater continuity where women are getting different aspects of their care from different trusts.
 
Nationally, the review highlighted a significant weakness in the quality and availability of data. In all, 103 trusts were unable to provide full data and this had an impact on their score.  Of these, 57 trusts had scores restricted by lack of data on a single indicator, while six trusts had scores restricted by lack of data on five indicators.
 
 
 
Later this year the Commission will publish a detailed national report on the service review giving deeper analysis and recommendations.
 
NHS maternity services are responsible for about 600,000 births in England each year
 
About the review
 
This review builds on the Healthcare Commission’s survey of mothers who gave birth in February 2007 and information provided by trusts to provide an assessment of the services in place and outcomes for women.
 
The indicators used in the review are designed to assess services that all trusts would normally be expected to deliver.
 
Please note that percentages for numbers of trusts in each category add up to 101% due to rounding.

Each trust is ranked in relation to one another on the following scale:
 
  • Least well performing - The group of trusts relative to others that is scoring at the lowest end of the performance distribution.  There is evidence that they lag behind in a range of key areas and need to improve. It does not mean that the trust is providing care that is unsafe.  If we have concerns that a trust is unsafe, we do not hesitate to use our powers of enforcement by, for example, carrying out investigations
  • Fair performing - The group of trusts which is scoring at this level in the distribution of performance should benefit from improvement for one or more of the key areas covered in the review.
  • Better performing - The group of trusts scoring at this level demonstrated good performance in some key areas which was better than many other trusts, but where there is scope for improvement in some areas.
  • Best performing - The group of trusts scoring at this highest level performed better than most other trusts in a range of key areas.
Information on the Healthcare Commission
 
The Healthcare Commission is the health watchdog in England. It checks 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.
 

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