Staffing shortages force NHSE to abandon safety target

NHS England has this week told trusts it is abandoning a patient safety target ‘until maternity services in England can demonstrate sufficient staffing levels’ to meet it.

The Midwifery Continuity of Care model was designed to ensure expectant mothers would be cared for by the same small team of midwives throughout their pregnancy, labour and postnatal care. It was a key recommendation of 2016’s Better Births review of English midwifery services.

NHSE’s chief midwifery officer for England Jacqueline Dunkley-Bent championed the policy and guidance on its implementation was issued in October.

However, in her report on the care failures at Shrewsbury and Telford Hospital Trust’s maternity department, Donna Ockenden said the MCoC model should be suspended until more evidence was gathered about its effectiveness and there were enough midwives to meet minimum staffing requirements.

Ms Ockenden said patient safety had been “compromised by the unprecedented pressures that CoC models of care place on maternity services already under significant strain”.

In response, NHSE said MCoC services said should be adequately staffed, but refused to suspend the model, stating it was still part of its plans for interventions to meet national maternity safety ambitions, including reducing stillbirths and neonatal deaths.

It stated that the intention was still that it would become “the default model of care”.

In August, HSJ reported that at least 82 trusts suspended or paused rollout of the MCoC model because they did not have enough staff.

This week Professor Dunkley-Bent and NHSE chief nurse Dame Ruth May have written to all trusts to say that rolling out the MCoC model across the country is no longer a priority.

The letter says: “In light of the continued workforce challenges that maternity services face, there will no longer be a target date for services to deliver [MCoC] and local services will instead be supported to develop local plans that work for them.”

The letter explains that trusts which “can demonstrate staffing meets safe minimum requirements can continue existing MCoC provision”.

It adds that “trusts that cannot meet safe minimum staffing requirements for further rollout of MCoC, but can meet the safe minimum staffing requirements for existing MCoC provision, should cease further rollout and continue to support at the current level of provision or only provide services to existing women on MCoC pathways and suspend new women being booked into MCoC provision.”

Trusts that “cannot meet safe minimum staffing requirements” must “immediately suspend existing MCoC provision and ensure women are safely transferred to alternative maternity pathways of care”.

In bold lettering, Professor Dunkley-Bent and Dame Ruth state: “Trusts are not expected to deliver against a target level of MCoC, and this [policy] will remain in place until maternity services in England can demonstrate sufficient staffing levels to do so.”

The letter also reveals that NHSE “will publish a national delivery plan for maternity services this winter which will bring together actions for maternity services, including next steps for improving continuity across all professional groups.”