System-wide change needed to improve maternity care in Northern Ireland – review

By Jonathan McCambridge (PA)

System-wide change is urgently needed to radically improve maternity care in Northern Ireland, an independent review has found.

The review was led by Professor Mary Renfrew and makes a series of recommendations to transform services across all settings and ensure better outcomes and experiences for women, babies and families.

Her report said that many women and their partners had described “unacceptable experiences” which contributed to “physical and emotional harm, sometimes causing long-lasting distress”.

Health Minister Mike Nesbitt has responded by announcing that a new maternity and neonatal partnership will be established to drive forward improvements in care.

The report, Enabling Safe Quality Midwifery Services and Care in Northern Ireland, was commissioned by the Department of Health following a coroner’s court hearing into the death of a baby during birth in March 2017.

Christine McCleery’s son Jaxon McVey was born dead at the Royal Victoria Hospital after she was transferred from Lagan Valley Hospital.

Prof Renfrew said her review has found both “serious weaknesses and real strengths” in the current provision of midwifery and wider maternity care for mothers and their babies.

She said: “It proposes an ambitious evidence-based plan to transform maternity services for all women, babies and families and to improve safety and quality and tackle inequalities across Northern Ireland.

“It includes requirements for the safe provision of community midwifery units and home births, regional strategic developments to support staff and ensure safe, quality and equitable care and services, improved data and monitoring, and building for the future.

“Key requirements include acceptance by senior leaders that radical change is needed, together with investment that reflects the level of need.

“At the heart of the changes must be a new relationship with women, families and communities, with an enabling environment for all staff and students, and better informed, better implemented monitoring, commissioning and governance.”

Prof Renfrew added: “Many women and their partners who engaged with the review described a range of unacceptable experiences during their maternity journey which contributed to physical and emotional harm, sometimes causing long-lasting distress.

“Many midwives and interdisciplinary colleagues described working in circumstances where they could not give the quality of care that they knew was needed.

“The voices of the women and families and of the staff who spoke so openly, often at the cost of re-experiencing their trauma and harm, must result in the outcome they all hope for – a better experience for women, babies, and families in the future.”

Prof Renfrew’s report includes 32 recommendations for action.

These include:

– A shared strategic vision for safe, quality midwifery and wider maternal and newborn services in Northern Ireland with a regional framework for action.

– A reconfigured relationship with women, families and communities, ensuring respectful personalised care for all and a genuine voice in shaping services.

– A consistent, region-wide, evidence-informed approach to planning, funding, standards, provision, monitoring, and review of maternity and neonatal services.

– Improving clinical, psychological, and cultural safety and equity for women, babies and families across the whole continuum of care and in all settings.

– Changing the prevailing work culture to implement an enabling environment for all staff and managers, including ensuring midwives are represented at senior management levels, tackling silo working, and developing an open learning culture at every level of the system.

Mr Nesbitt said: “My department is committed to continuing a major programme of work on improving maternity and neonatal safety across Northern Ireland.”

He added: “The new maternity and neonatal partnership when established will be tasked with implementing a consolidated regional action plan including the overseeing of action on recommendations from Professor Renfrew.

“This will only be properly effective through a multi-disciplinary approach that keeps women and babies at the centre of everything we do.

“Maternity services in Northern Ireland have undoubtedly been under intense pressure, not least in relation to staffing.

“The same, unfortunately, can be said for services right across health and social care.

“I want to make very clear that improving maternity and neonatal services is an immediate area of focus for my department and for me personally.

“Professor Renfrew has found both serious weaknesses and real strengths in the current provision of midwifery and wider maternity care for mothers and their babies.

“We need to both build on these strengths and systematically address the weaknesses.

“This report has highlighted traumatic experiences faced by some women, which I acknowledge and deeply regret.

“It also underlines the pressures on midwives and wider clinical teams within maternity and neonatal services.”