Baby Lifeline's 'Mind the Gap' report says gaps in maternity training are putting mothers and babies at risk

Maternity charity, Baby Lifeline’s report, Mind the Gap 2021: An Investigation into Maternity Training for Frontline Professionals Across the UK (2020/21), says gaps in maternity training in NHS hospitals are putting mothers and babies at risk.

The charity is calling for immediate action to support maternity units to provide training for staff, to make births safer. The report says proper investment in the maternity workforce has never been more urgent and urges the government to commit funding to ensure the correct level of training is delivered with enough staffing for training to take place.

However, the report also emphasises that, ‘the deficit should not be paid by families. Investigations and maternity reports detail the same causes of avoidable harm, and it is an overdue courtesy to those who have suffered to learn lessons quickly and effectively. This cannot be done without proper investment in resources for training, as well as a sufficient workforce.’ 

The charity remind the government that, ‘it should not be optional for the NHS to provide professionals with the resources and tools to feel safe and valued in their jobs, and to give the best care to women, birthing people and their babies”.

What is Baby Lifeline’s ‘Mind the Gap’?

Baby Lifeline is a UK charity which works with NHS professionals to promote safe care for pregnant women and newborn babies.  Its ongoing ‘Mind the Gap’ research looks at NHS training for maternity professionals, having regard to current themes in maternity safety and the causes of birth-related injuries for mothers and babies, or injuries which lead to their death. Mind the Gap 2021 examines the training that was delivered to maternity staff in 2020/21 based on data from 124 NHS trust maternity providers who responded to  Baby Lifeline’s Freedom of Information requests.  

What does Baby Lifeline’s 2021 Mind the Gap report say?

Maternity professionals are not receiving enough training

Training has been a key recommendation for improving maternity safety in countless investigations into birth-related avoidable harm and maternal and baby deaths. However, Mind the Gap 2021 found that NHS trusts are delivering less training, and spending only half as much on maternity training, than they were in 2017/18. Baby Lifeline believe that gaps in maternity training are putting mothers and babies at risk.

Most NHS trusts fail to comply with NHS requirements and recommendations to  reduce avoidable harm

The report shows that most NHS organisations are failing to comply fully with maternity training requirements set out by NHS schemes designed to reduce avoidable harm. Despite 97% of English NHS trusts saying that the requirements of NHS Resolution’s Maternity Incentive Scheme  (which financially rewards trusts that are taking action to improve maternity safety) are a training priority, only three organisations followed the scheme’s guidance fully in providing maternity training. Similarly, fewer than a quarter of maternity services complied fully with the training requirements of the Saving Babies’ Lives Care Bundle.

When Mind the Gap compared actual maternity training provision during 2020/21 with the safety themes identified by HSIB, NHS Resolution, Each Baby Counts and other investigations they found:

• Fewer than 4 out of 10 NHS trusts provided recommended training in risk recognition and assessment before and during labour, or in recognising women at risk of premature birth, or when planning the place of birth. Fewer than half provided recommended training in risk assessment and management of pregnancies at risk of restricted fetal growth.
• Training in emergency skills and drills was provided by all trusts, but the topics covered within that training varied. For example, training was provided for uterine rupture in 49% of trusts, but impacted fetal head was only covered in 29% of trusts.
• Training relating to labour and delivery varied, with only 28% providing training in induction and augmentation (boosting) of labour, 40% training in instrumental/assisted delivery, and 45% complying fully with recommended training for fetal monitoring in labour.
• 99% of trusts provided training in newborn (neonatal) life support but only 63% covered positioning for neonatal skin-to-skin contact, and 60% covered neonatal hypoglycaemia.
• A third of trusts provided training in fetal and newborn serious infection risk, but only 9% covered group B strep (GBS), 5% herpes simplex virus (HSV) and 6% cytomegalovirus.
• The proportion of NHS trusts offering maternity training in post-operative care has halved since 2017/18, even though the RCOG requires specific expertise and training to be given for operative procedures, and 29% of deliveries in 2020/21 were caesarean sections.
• NHS trusts’ training priorities did not match the key causes of maternal deaths. Significantly less training was given in high-risk pregnancies and co-morbidities (other health conditions in pregnancy, such as cardiac disease and obsesity) which are known to cause stillbirth, maternal or fetal death.
• 60% of mothers need anaesthetic during delivery and both the Ockenden Report and the Royal College of Anaesthetists (RCoA) recommend that obstetric anaesthetists are involved in multi-professional training. The report found that obstetric anaesthetists had to attend training in maternal life support in 80% NHS trusts, and emergency skills and drills training in 87% trusts, but attended training in antenatal and birth-related risk assessment in only 5% of trusts.
• Training in learning from adverse events was offered to staff in 7 out of 10 trusts but was mandatory for only 38%.  Topics covered in the training varied, with 57% covering incident reporting, 46% covering duty of candour, and family engagement in incident investigations covered in only 36%. Despite NHS Resolution calling for more rigorous training for all staff who carry out serious incident investigation, only 32% of NHS trusts provided this training.

NHS trusts are still failing to address equality issues

Despite evidence from MBRRACE-UK showing the disproportionately poor outcomes for mothers and babies from the most deprived areas, and from Black, Asian and mixed ethnic groups:

• More than a quarter of NHS trusts failed to consider their local population’s needs when prioritising maternity training.
• Only 1 in 5 included scenarios where English is not a woman’s first language in their emergency skills and drills training,
• Less than a third of trusts included identification of clinical signs in Black/Brown skin in their emergency skills and drills training.
• Only one maternity service trained their frontline maternity staff in all topics prioritised by NHS England’s Equity and Equality guidance.

Response to COVID-19 pandemic

Mind the Gap found that most NHS trusts adapted their maternity training in response to the COVID-19 pandemic:

• 9 out of 10 trusts included COVID-19 emergency in their emergency skills and drills training.
• Only 2 in 5 provided training relating to blood clots.

However, training was less interactive, often without any evaluation of its impact on clinical outcomes, and more than a third of trusts did not give tailored training to staff who were moved to work in a different maternity area from their usual role.

Years of chronic under-funding more to blame than impact of COVID-19

The COVID-19 pandemic had a significant impact on maternity services, but the pandemic exposed existing gaps and structural issues which have been caused by chronic under-funding over many years. The pandemic did not cause these problems, but widened existing, detrimental gaps that years of chronic under-funding, staff shortages and lack of resource have created.

Almost all maternity services (97%) reported that they faced barriers to providing maternity training, including staffing shortages  (reported by 72% of organisations), lack of venue availability and restrictions, and inadequate IT systems which affected online training. Over two-thirds of maternity services had difficulty providing multi-professional training, mostly from staffing pressures and COVID-19.

Urgent investment needed by government

Baby Lifeline’s Mind the Gap 2021 report emphasises that these gaps will not close unless there is change but funding for maternity safety training has declined since 2017/18.  To allow the maternity workforce access to all the training that they need and deserve, the government must provide targeted funding for the costs of training, investment in the systems and infrastructure needed for training to take place and a solution to the staffing shortage that currently threatens maternity services.

Mind the Gap emphasises that families should not be paying the price for the gaps in maternity safety training. Proper investment in the maternity workforce is long overdue and has never been more urgent.

If you or your child have suffered severe injury as a result of medical negligence and you would like to find out more about making a claim, you can talk to one of our solicitors, free and confidentially, by contacting us here.