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

Examining maternity services The role of CQC in advancing maternity care Professor James Walker National Professional Advisor (Maternity) CQC 5 th April 2017 1

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. 2

Our model of regulation Monitor, Independent Register inspect Enforce voice and rate We register Where we find We provide an We monitor independent those who services, carry poor care, we voice on apply to CQC out expert ask providers the state of to provide inspections , to improve and health and adult health and and judge each can enforce social care adult social this if service, usually in England on care services to give an necessary issues that overall rating , matter to the and conduct public, thematic providers and reviews stakeholders 3

Monitor, inspect and rate Against Standards and RCOG/RCM Recommendations provided by the professional and national NICE bodies as well as from reports • not a standard setting body MBRRACE • an inspection service • regulates on whether the accepted Better Births standards are met. • data collected from trusts Morecambe Bay • on-site inspections with a team of inspectors and specialty advisors • sometimes planned, sometimes not Mid Staffs

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 .

Definitions of our five domains continued.. 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 open and fair culture .

What do the overall ratings mean? 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. 7

The state of care in NHS acute hospitals report • Findings from our first round of hospital inspections • First focussed national analysis • 136 acute non-specialist • 18 specialist trusts • More detailed understanding of the NHS at trust and individual core level than ever before

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 4 The not so good news: 32 • An area of concern; 59 - National shortages of midwives and obstetricians - Lack of one to one care 4 - Excessive use of locum and bank staff • Lack of profile of maternity within trust • Concerns about safety • Poor leadership and lack of team working

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

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? 13

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 14

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 15

Outstanding practice • Strong comprehensive safety system • Continually monitors outcomes, focuses on openness, 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 St Richard’s Hospital, West Sussex 16

Outstanding practice • 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 Cossham Hospital, Bristol 17

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 18

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 19

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 20

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 closer working more targeted more greater and approach that integrated emphasis on alignment focuses on approach that leadership , with NHS areas of enables us to including at Improvement greatest be flexible the level of and other concern , and and overall partners so where there responsive to accountability that providers have been changes in for quality of experience improvements care provision care less in quality duplication There will be two consultations on these changes: one in Winter 2016/17, and another in Spring 2017