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NPfIT maternity workshop, 17 April 2008

Introduction

Held on 17 April 2008, at 20 Cavendish Square, London, the aim of this workshop was to bring together nominated practicing midwives and present them with an up-to-date briefing from the three Programmes for IT and to publicise current activity within these regions to create valuable engagement opportunities.

Each of the three Programmes for IT are hosted by the strategic health authorities (SHAs) and have a Local Service Provider (LSP).

Discussion forum

Following presentations from each of the Programmes for IT, the final session of the workshop focused on a group discussion. National Clinical Lead for Nursing, Susan Osborne, introduced the session and stressed how important it was for delegates to take the information and key themes discussed on the day and feed this back to their trusts and colleagues.

Many midwives came to the workshop with very particular and individual needs and so we structured the group discussions around this. Each person in the room, including those who had presented, had a chance to talk about how helpful they found the event and raise individual queries.

Discussion topics and feedback

System management

Some trusts do not all have 24/7 support or adequate administrative support. The examples given were of systems running on apparently inadequate servers. There were concerns in some units that data entry takes an inappropriate amount of the clinician's time - one of the midwives said: "In a recent ward-based study the midwife was timed as spending an average of 12 minutes at mother's bedside and one hour at the computer".

Another concern was with the skills of the midwife, or midwives, attempting to manage the IT systems from implementation to go live and beyond.

It was concluded that, ideally, a dedicated system manager-midwife with set agreed role, excellent communications skills and minimum basic IT skills, with access to training in clinical system management and experience in training up clinical staff from varied backgrounds would be appointed.

Other long term skills of auditing and management of clinical information and basic data extraction/analysis will enable the units to respond to requests for statutory and local reports on activity and for quality management.

Standardisation

This was the recurrent theme throughout the day and the general consensus of the group was the overwhelming need for an agreed and nationally mandated maternity dataset. This data is required to satisfy a number of organisations, royal colleges and processional bodies, including:

  • The Health Care Commission
  • Audits to support Clinical Negligence Scheme for Trusts
  • Royal College of Obstetricians and Gynaecologists
  • Local Supervising Authorities – 'supervisors of midwives'
  • Dr Foster
  • Confidential Enquires into Maternal and Child Deaths
  • Antenatal Screening Audit
  • Local and national statistics (monthly activity returns for coding and payment by results)
  • Trust business activity
  • Local and national research and audits
  • Organisational e.g the West Midland Perinatal Institute

The pressing need for the standardisation of reports, letters and forms was also voiced by the group. Examples included:

  • Notification of birth
  • Risk assessment and booking - first visit with maternity services
  • Antenatal screening
  • Social services referrals, African Well Woman services
  • Collaborative care, for example:
    • Simple: diabetes in pregnancy etc
    • Complex: management of pregnancy with Brittle Asthma, HIV or Cystic Fibrosis.
  • Referrals to and from primary care.

Benefits Realisation Exercise

Requests were made for a benefits realisation exercise to assist trusts in formulating their original business cases, basic requirements and to define current best practices in maternity systems, modules and solutions.

Local supervisors of midwives

Representation the 'supervisors of midwives' discussed how they could benefit from being involved more as a group to help inform and advise midwives.

Risk management and risk issues

With respect to Existing

There are also some units that still only have access to a combination of paper and individual databases, plus the Interim Solution (INNS), to apply for the NHS number for babies - (the NN4B project went live in England on 22 October 2002 to apply for an NHS number for a newborn baby close to birth).

Most of these existing systems are not spine compliant, but successfully apply for NHS numbers every day using them. These systems are providing the statistics and evidence that allow maternity units to function.

To sum up, there are risks associated with using many different systems, definitions and protocols within the primary, secondary and tertiary health care communities. The group recognised these points and were subsequently impressed with the options the National Programme for IT solutions could offer.

However, they were also keen to stress that the existing systems should not been forgotten and that 'the baby should not be thrown out with the bath water' so to speak. For example, the group did not want to lose the data already collected and used to commission care and provide evidence for quality care for a system only in the early days of functionality and they feared this may lead to waiting unspecified lengths of time for the full releases to become available.

Conclusion

This event provided a unique opportunity for NHS Connecting for Health (NHS CFH) to listen to senior clinical midwives and their concerns.

The challenge from them is to make the available NHS CFH systems and services as good as the existing systems whilst providing support and advice that enables the midwives and obstetricians and their maternity units, to provide the best possible care. Another key message was the need for NHS CFH to encourage effective engagement with the appropriate clinical staff by opening communications, arranging visits and disseminating useful information.

In order to build on the knowledge shared at this event, there needs to be further NHS CFH activities, focus groups, site visits, open channels to provide feedback and regular communications in the midwifery and nursing press. This will improve our levels of engagement. The informatics group at the Royal College of Midwives also has the potential to be a very useful tool.

As National Clinical Lead for Midwifery, I pledge to develop my own networks to improve communications, meet with appropriate individuals in the Nursing and Midwifery Council and Royal College of Midwives, and place regular articles in circulations such as the Chief Nursing Officer’s bulletin and Royal College of Midwives publications.

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