Safety – it’s everyone’s business

By Executive Director Midwife Birte Harlev-Lam and Director for Professional Midwifery Dr Mary Ross-Davie on 17 September 2021 Maternity Services Midwifery Safety Maternity Safety Report

On World Patient Safety Day, Executive Director Midwife Birte Harlev-Lam and Director for Professional Midwifery Dr Mary Ross-Davie reflect on what the RCM is doing to support improvements in maternity safety.

There is an often-quoted (and often misquoted) phrase: The standard you walk past is the standard you accept. This sentiment has been applied to healthcare settings, particularly during the inquiry into standards of care at Mid Staffordshire NHS Foundation Trust. And it can equally be applied to standards of safety in maternity services.

While we are rightly proud that the UK is one of the safest places in the world to give birth, sadly that isn’t everyone’s experience. Too many women are traumatised by their experience, too many women and babies suffer physical harm and too many families leave hospital with empty arms and broken hearts. Midwives, MSWs, obstetricians, the whole maternity team must work together to make maternity services safer for everyone. And so must policy-makers.

Today is World Patient Safety Day – and while we all agree that pregnant women are not patients, safety is safety for every service user, regardless of what we call them. Because safety is everyone’s business: every one of us has a role to play, and that includes us as the RCM.

Our dual role as both trade union and professional association gives us a unique opportunity to raise questions and provide workable answers. We lobby policy-makers, both civil servants and politicians, to address the midwifery workforce crisis, that has been only worsened by the pandemic. We highlight the crisis not only in training and recruiting new midwives, but also in retaining those we have. We know that an exhausted, overworked and dispirited workforce won’t make the best, safest decisions or provide compassionate care. Where midwives work in toxic cultures that focus on blame rather than learning from adverse events, where they don’t feel safe to ask questions or escalate concerns and where they can’t hope to get a break, they are far more likely to make mistakes and to leave the profession for good. A workforce that is appropriately rewarded and resourced, as well as being treated fairly is a workforce that will deliver on safety and quality in maternity care.

Maternity services rely on a multi-disciplinary teams (MDTs) that communicate well, respecting our different roles and expertise. The RCM is modelling this behaviour, working with partners, including the Royal College of Obstetricians & Gynaecologists (RCOG), to develop programmes that are rooted in the reality, rather than the theory, of maternity services.

Over recent years, these programmes have included Each Baby Counts Learning & Support and OASI, as well as newcomers the National Centre for Maternity Care, with RCOG and pregnancy charity Tommy’s, and the Avoiding Brain Injury in Childbirth (ABC) collaboration with RCOG and THIS Institute. An important aspect of each of these projects has been ensuring that they have the time to bed in, so that any evaluation is meaningful. A failure to do this is not only a waste of money, it also adds to the fatigue of ‘initiative-itis’ that we are all depressingly familiar with in the NHS.

Now more than ever, we need maternity teams to be given time to engage with these programmes – and by that we mean actually engage, rather than being done unto. When we have a stake in the outcome, we are more likely to participate in the build, and that’s what we have embedded in all of our safety-related programmes. Our programmes are shaped by midwives and other maternity staff working clinically, as well as those knowledgeable about policy development and research. Their input is vital to ensure what we produce and recommend is actually deliverable at a local level, is scalable depending on where you work and reflects the reality of delivering maternity care.

While all of these programmes have the aim of making maternity care better and safer, we are mindful that too many of them are rooted in tragedy. Our Solution Series, for example, was created in the wake of Donna Ockenden’s interim report into poor outcomes for both women and babies at Shrewsbury & Telford Hospital Trust. The series reflects on particular aspects of the interim report’s findings – including human factors, the role of leadership and the need to nurture positive cultures – offering tools to benchmark your own workplace and reflections on how improvements can be made. As well as our i-learn modules on the Ockenden review, human factors and leadership, we are also offering a range of online workshops addressing issues around positive workplace cultures and building practitioners that have the confidence to escalate concerns – if you would like to book a workshop for your local team, please get in touch with your local RCM regional officer.

Of course, all the initiatives and programmes and toolkits in the world won’t help solve the workforce crisis being felt in every part of our maternity services. Which is why, alongside these positive collaborative programmes, we continue to make the case for more investment in recruitment and retention, in better estates and better training for the whole team.

Safety is everyone’s business and we all have a role to play.