The role of CQC in advancing maternity care Professor James Walker - - PowerPoint PPT Presentation

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The role of CQC in advancing maternity care

Professor James Walker

National Professional Advisor (Maternity) CQC 5th April 2017

Examining maternity services

About CQC: Our purpose The Care Quality Commission is the independent regulator of health and adult social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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Our model of regulation

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Register Monitor, inspect and rate Enforce

Independent voice

We register those who apply to CQC to provide health and adult social care services We monitor services, carry

• ut expert

inspections, and judge each service, usually to give an

• verall rating,

and conduct thematic reviews Where we find poor care, we ask providers to improve and can enforce this if necessary

We provide an independent voice on the state of health and adult social care in England on issues that matter to the public, providers and stakeholders

RCOG/RCM NICE MBRRACE Better Births Morecambe Bay Mid Staffs Monitor, inspect and rate Against Standards and Recommendations provided by the professional and national bodies as well as from reports

• not a standard setting body
• an inspection service
• regulates on whether the accepted

standards are met.

• data collected from trusts
• on-site inspections with a team of

inspectors and specialty advisors

• sometimes planned, sometimes not

Definitions of our five domains

Safe - you are protected from abuse and

avoidable harm

Effective - your care, treatment and support

achieves good outcomes, helps you to maintain quality of life and is based on the best available evidence.

Caring - staff involve and treat you with

compassion, kindness, dignity and respect.

Responsive - services are organised so that

they meet your needs

Well-led - the leadership, management and

governance of the organisation make sure it's providing high-quality care that's based around your individual needs, that it encourages learning and innovation, and that it promotes an

• pen and fair culture.

Definitions of our five domains continued..

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Outstanding The service is performing exceptionally well. Good The service is performing well and meeting our expectations. Requires improvement The service isn't performing as well as it should and we have told the service how it must improve. Inadequate The service is performing badly and we've taken action against the person or organisation that runs it.

What do the overall ratings mean?

• Findings from our first round of

hospital inspections

• First focussed national

analysis

• 136 acute non-specialist
• 18 specialist trusts
• More detailed understanding
• f the NHS at trust and

individual core level than ever before The state of care in NHS acute hospitals report

Spotlight on maternity and gynaecology Services provided to women that relate to gynaecology and pregnancy including the planning and/or prevention of pregnancy;

• Ante and post-natal services
• Labour wards
• Community services
• Theatres (both obstetric and gynaecology)
• Termination of pregnancy

A snapshot of maternity services

The snapshot tells us..

The good news:

• 2/3 of trusts are either good or outstanding
• Examples of excellent practice found

The not so good news:

• An area of concern;
• National shortages of midwives and obstetricians
• Lack of one to one care
• Excessive use of locum and bank staff
• Lack of profile of maternity within trust
• Concerns about safety
• Poor leadership and lack of team working

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What do we know from our five key questions? - Safety

• Some excellent practice found however;
• safe levels of staffing and one-to-one care

during labour not being achieved.

• 5% rated as inadequate
• 2% were rated as outstanding
• Midwives working with lack of support and

supervision

• Lack of overview of care – good bits/bad bits

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What do we know from our five key questions? - Effectiveness

• Saving lives – the average maternity unit saves 35

women’s lives each year

• Guidelines followed but inconsistent training
• Supportive with pain relief a normality, but less so with

complications

• Choices are offered, not for home birth (midwife led)
• Outcomes generally good but varied
• Few outstanding units
• Looking beyond the guidance
• How can we make it better?

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What do we know from our five key questions? - Caring

• This is a caring profession, staff treat women with dignity

and respect

• Positive feedback from patient interviews
• Most feel involved in their care
• Most have good outcomes and are positive about their

experience

• Outstanding units provide high level of care when things

go wrong

• Bereavement midwives as a support for the family not

the hospital

• Often sessions provided only – not dedicated full time

midwife

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What do we know from our five key questions? - Responsive

• Services are organised so that they meet your needs
• No inadequate - 2% outstanding
• Good care pathways covering all eventualities
• Escalation policies (awareness and willingness)
• Calling a man/woman who can
• Border issues
• Between services
• Between professionals
• Potential fragmentation of the services is a risk and a

worry for the future – needs proper oversight

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• Strong comprehensive safety system
• Continually monitors outcomes, focuses on
• penness, transparency and learning when

things go wrong

• Safety thermometer results – 100% achieved

since December 2014

• Outcomes good and the service frequently

performed than trust own targets

• Great work being done to reduce stillbirths and

admissions to the Special Care Baby Unit and Neonatal Intensive Care Unit

• High levels of multi-disciplinary team working

within service and with external partners

Outstanding practice

St Richard’s Hospital, West Sussex

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• Time spent is not rushed and care delivered with

kindness, which extended to whole family

• Fully informed and involved in choices
• Feedback actively sought
• Protocols in place for women with complex

social needs taken into account with specialist midwives

• Information in different formats and translation

services for local population groups

• Efforts to engage hard-to-reach community

members and public engagement outstanding

Outstanding practice

Cossham Hospital, Bristol

Clinical dashboards

• Most maternity services used a clinical dashboard to

monitor patient outcomes

• not standardised
• Some used this information to drive a culture of

continuous improvement, but many did not

• Poor outcomes were explained away as a reflection of

the characteristics of the population served and not as a spur for improvement

• Case mix
• Less than a third of the difference between units is

due to case mix

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Learning culture

• a learning culture in which errors are reported and

investigated is key to delivering a safe service

• some staff behave passively about safety and see it as

the role of senior management to tell them what to do

• others do take reporting seriously and report incidents

when they see them

• but they feel discouraged when they get no

feedback

• Need leaders and champions at all levels

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What do we know from our five key questions? – Well-led

• Leadership of the service is linked closely to how safe a

service is – strong risk management culture

• Reflects on the safety culture within the unit
• Poor multi-disciplinary cultures undermine the quality

and safety of the service

• Effective multi-disciplinary team working is essential
• Good services are run jointly with head of midwifery and

a lead obstetrician

• Staff concerns are listened to and shared between

teams

What do trusts do with the results?

Between inspection of all 136 acute non-specialist and 18

specialist trusts;

thirteen trusts improved five deteriorated

• CQC are encouraging and driving improvement

through recommendations

• Local inspection teams supporting the learning

process

How do we encourage improvement?

• We benchmark how trusts are doing
• Our expert teams give feedback on where

improvements can be made

• We learn about what good looks like and share

best practice and innovation, with other trusts

• We support trusts to improve their service
• We use our independent voice in support of

maternity services

The next phase of regulation

How we propose to update our approach and our assessment framework to reflect the changing provider landscape There will be two consultations on these changes: one in Winter 2016/17, and another in Spring 2017

more integrated approach that enables us to be flexible and responsive to changes in care provision more targeted approach that focuses on areas of greatest concern, and where there have been improvements in quality greater emphasis on leadership, including at the level of

• verall

accountability for quality of care closer working and alignment with NHS Improvement and other partners so that providers experience less duplication

NHS trust inspections – what we are proposing to change

Changes to KLOEs and inspection methodology

• Focus our inspections where we

have the greatest concerns or services that might have improved

• Develop our local relationships

with providers, with Healthwatch and local and regional public

• rganisations
• Accommodate new models of care
• Align our approach with NHS

Improvement to avoid duplication

Consultations on our proposed changes to inspections

NHS Improvement consultation on Use of Resources and ‘well-led’ has also now been closed

20 December 2016 – 14 February 2017

New care models and complex providers Cross sector changes to assessment frameworks Updated guidance for registration of learning disability services Changes to Hospitals inspection methodology

Spring 2017

Changes to Adult Social Care inspection methodology Changes to Primary Medical Services inspection methodology Changes to registration Clarifying guidance on Fit and Proper Person Requirements Regulating place-based models of care How we rate large and complex providers

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Thank you

www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Professor James Walker, National Professional Advisor (Maternity) CQC