Ockenden: what next?
It is now over four months since the Ockenden report into maternity services at Shrewsbury and Telford Hospital NHS Trust was published. On the day of its publication, Sajid Javid, the then Health Secretary, accepted the report on behalf of the Government and promised swift action: “so that no families have to go through the same pain in the future.”
The RCM welcomed the report and pledged to work with the Government and NHS England to listen and learn from the experiences of women and families and of staff at the Trust. We also made clear that the recommendations – referred to in the Report as Immediate and Essential Actions (IEAs) – could not be implemented without a significant increase in spending on maternity services and in the recruitment and retention of maternity staff.
So, today, are we any clearer what the Ockenden review means for maternity services? What is clear from the tone of her report, and from everything Donna Ockenden has subsequently said, is her support of midwives and maternity support workers (MSWs). She understands the pressure maternity staff are under, due to a decade of underfunding and staffing shortages, and she knows the impact this is having on morale. She acknowledges that the RCM has been raising these issues for years but that no-one in authority has been listening.
Her solutions – a proper NHS workforce plan, a multi-year fully funded settlement for maternity services, a focus on the physical and psychological safety of staff – are all ones that the RCM shares and will continue to advocate. Donna Ockenden, who will be joining our annual conference in October, is very much on the side of maternity staff just as she is on the side of women and families.
Slow progress has been made in meeting the review recommendations, and we know that some people have attempted to place the blame for this at the RCM’s door, and that of the Royal College of Obstetricians and Gynaecologists (RCOG). This is both unfair and misleading. The RCM and RCOG have neither the authority nor the levers to implement the deep rooted, systemic changes that are advocated by the Ockenden review.
What we can and will do, as asked by the Secretary of State, is act as a critical friend to those who do have responsibility to fund and implement the recommendations. We support the recommendation that ‘Department of Health and Social Care (DHSC) and NHS England (NHSE) NHS Improvement must now commission a working group independent of the Maternity Transformation Programme (MTP) that has joint RCM and RCOG leadership to make plans to guide the MTP around implementation of these IEAs and the recommendations of other reports currently being prepared.’
We have been in discussion with DHSC and NHSE about the terms of reference for the group and the resources required to enable it to fulfil its remit. While it would not be right to conduct these negotiations in public, and we are aware that the process has taken some time, we are hopeful that sufficient progress is being made to enable the Independent Working Group to be up and running within the next month.
We will use our influence to argue for the implementation of the IEAs as the Ockenden review intended, rather than being misinterpreted or implemented in a piecemeal fashion:
- Midwifery services should not be put under pressure to reinstate continuity of carer teams if they have insufficient staff to do this safely. This position is unambiguously outlined in the Ockenden review. It is incumbent on national organisations, Local Maternity Systems, Trust Boards, and local managers to ensure that this is adhered to.
- Services must also be able to continue to use established and reputable workforce planning tools. One of the Ockenden IEAs was a call to review the feasibility and accuracy of Birthrate Plus. While we support this recommendation, we continue to support the value and robustness of Birthrate Plus and would want to ensure that any review is objective and informed. Accordingly, we have recommended that the review should be undertaken under the auspices of the Independent Working Group. In the meantime, we are pleased that NHS England has made clear their continued support for Birthrate Plus and the need for services to continue to use the methodology.
- The Ockenden review is clear that staff must be able to raise concerns if necessary, and, in addition to our Standing up for High Standards guidance, we will be reinforcing our support to midwives who raise concerns about the safety or quality of care.
Above all, the Ockenden review must not become another set of recommendations sent out to an already over-stretched system, with the expectation that staff and managers will find a way to implement them on top of their existing responsibilities, with existing resources. There must be substantial investment in staff recruitment, retention, and training, as recommended by both the Ockenden review and the House of Commons Health and Social Care Select Committee, in its report into the safety of maternity services in England.
The RCM will use its collective voice to amplify the case for change. We will use our networks to spread best practice and gain evidence of the opportunities and hurdles. And we will use our experience and expertise to support the entire system, from policy makers to individual clinicians, all of whom have a role to play.
This is a watershed moment for everyone involved in maternity care and we must work together to deliver the positive change that women, families, and staff deserve.