NHS maternity services in England

Under pressure?  NHS maternity services in England | Kelly, E. & Lee, T | Institute of Fiscal Studies

Admission to hospital to give birth is the single largest cause of admission to NHS hospitals in England. In common with many NHS services, providers of maternity care are reporting pressures from increased demand, staffing shortages and programmes to improve the quality of care. How units respond to these challenges carries important implications for the health of mothers and babies, and the finances of NHS Acute Trusts.

This briefing note reviews the evidence on the long-run pressures faced by maternity units. While the number of maternity cases has remained largely constant since 2010, the case mix continues to change, with women giving birth later in life and with more complex health conditions. There are implications for MUs if this evolving case mix of mothers requires more care in terms of staffing or other resources.

Full briefing available here

A-EQUIP midwifery supervision model

The model supports a continuous improvement process that builds personal and professional resilience, enhances quality of care and supports preparedness for appraisal and professional revalidation | NHS England

The ultimate aim of using the A-EQUIP model is that through staff empowerment and development, action to improve quality of care becomes an intrinsic part of everyone’s job, every day in all parts of the system.

With the help of midwives, the Local Supervising Authority national taskforce and the projects Editorial Board, ‘A-EQUIP Operational Guidance’ has been developed.

The guidance is in four parts:

  • Part one describes the impact of the legislative change on midwifery regulation and the changes to midwifery supervision
  • Part two describes the A-EQUIP model and its benefit to midwives and users of maternity services
  • Part three has a clinical focus. Case studies show how the model can be deployed to support staff working in clinical and non-clinical roles and the benefits of the model to the multidisciplinary team
  • Part four provides guidance for:
    • Midwives and providers of maternity services and describes key actions for maternity providers
    • CCGs
    • HEIs

Full guidance can be found here

Rudeness in paediatric care

Ward Platt, M. Archives of Disease in Childhood. Published Online: 24 February 2017


‘Who is that rude man? He must be someone important.’ The man referred to was a very self-important associate medical director, well known for his lack of common courtesy. My colleague’s remark held another grain of truth, too: the ability to be rude, and for this to go unchallenged, is clearly associated with hierarchy. If you are someone important, you can get away with behaviours that would not necessarily be tolerated in another context. But rudeness can also arise between equals and from patients (or parents). It can be corrosive in a workplace where there are plenty of other stress factors, and may even have implications for patient safety.

There have been two recent papers relevant to rudeness in paediatric care, both from Riskin et al.1 ,2 The first of these, a randomised controlled trial, involved a standardised simulation in which both diagnostic and procedural skills were assessed for quality. There were clear group differences between the arms of the trial exposed and not exposed to mild professional rudeness: diagnostic and procedural performances were both adversely affected.

Read the full correspondence article here

The experience of providing end of life care at a children’s hospice

McConnell, T. & Porter, S. BMC Palliative Care. Published online: 13 February 2017


Background: More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children’s hospice.

Conclusions: Service and policy initiatives should encourage open, informal peer/organisational support among the wider children’s palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children’s hospices and hospital settings.

Read the full article here

Evidence-based Practice in Action: Ensuring Quality of Pediatric Assessment Frequency

McDonald,K. & Eckhardt, A.L. Journal of Pediatric Nursing. Published online: December 12 2016

Purpose:Optimal frequency of head-to-toe assessment in hospitalized pediatric patients is unknown. An alteration in head-to-toe assessment frequency was proposed at a Midwestern regional hospital. The purpose of this descriptive study was to evaluate patient safety and staff satisfaction following a change in head-to-toe assessment frequency.


Conclusions: The change in head-to-toe assessment frequency did not impact patient safety, but had a positive impact on nurse satisfaction. Following the study period, the unit policy was changed to reflect the new evidence based head-to-toe assessment interval. Further research is needed with a larger, more diverse sample of pediatric patients and pediatric nurses.

Read the full abstract here

Moral distress: an inevitable part of neonatal and paediatric intensive care?

Field. D. et al. Archives of Disease in Childhood. doi:10.1136/archdischild-2015-310268

The paper by Prentice et al reports a systematic review of moral distress occurring in neonatal and paediatric intensive care units. This term, which may be unfamiliar to many readers, has been defined as the anguish experienced when a health professional makes a clear moral judgement about what action he/she should take but is unable to act accordingly due to constraints (societal, institutional or contextual).2 In a situation of moral distress, the health professional can see, from their point of view, that there is an ethically correct action but is powerless to act, a situation that will be familiar to all those who work in neonatal or paediatric intensive care teams.

Moral distress is not a new phenomenon, although the scenarios where it arises may have changed due to developments in society’s beliefs and the healthcare system and dramatic improvements in technology. Perhaps the most clear UK example of how the views of society at large have changed in this context over time comes from the trial of Dr Leonard Arthur (https://en.wikipedia.org/wiki/Leonard_Arthur; accessed 21 March 2016). In 1981, Dr Arthur, a paediatrician based in the English Midlands, was tried for attempted murder following the death of a newborn baby with Down’s syndrome whom he had prescribed ‘nursing care only’ and sedatives.

Read the full comment article here

Read the original research article here