Hundreds of staff working in maternity, obstetric and neonatal teams throughout the Oxford AHSN region have shared their experiences on the NHS frontline caring for mothers and babies during the first phase of the Covid-19 pandemic.
They have helped paint a detailed picture of the impact of this unprecedented period of rapid learning and significant change. The survey generated many useful insights, with lots of the learning applicable to other areas of health and social care.
A total of 868 questionnaires were completed by staff working in all the NHS trusts with maternity and neonatal services in Berkshire, Oxfordshire, Buckinghamshire, Milton Keynes, Great Western Hospital, Swindon, and Frimley Health in July and August. Responses were received from all staff groups.
Results of the survey have been collated into this report which maps against nine key themes covering a wide range of issues including visiting, remote consultations, communication and risk assessments for personal protective equipment (PPE).
Eileen Dudley, Oxford AHSN Patient Safety Manager, who coordinated production of the report, said: “I hope its findings inspire a spirit of working collectively as a region to deliver the best care for women, babies, families and staff during the challenging months ahead.”
Changes in service delivery and the impact on mothers, babies, partners, families and staff were all considered in the report which acknowledges the significant efforts made by trusts to respond to service user feedback while managing rapidly changing guidance.
The report says: “The impact of the pandemic gave a certain freedom to decision making and an opportunity for rapid cycles of innovation and change … if a change … didn’t work or had unintended consequences it was possible to either stop it or try a different change with speed.”
Almost three-quarters (73%) of those who completed the questionnaire agreed or strongly agreed that it was easier to make changes.
The report highlights that in the early stages of the pandemic there had been limited opportunity for dialogue between trusts and scope for shared learning. Local units were addressing identical issues and facing similar challenges and sometimes had to manage those in different ways to find local solutions to local problems. Despite the varying local responses, there was consistency in the feedback from staff on areas requiring improvement.
The report supports coproducing services, increasing collaboration across organisations to share best practice more effectively, reduce regional variations and maintain quality and safety through future waves of the pandemic and recovery.
Key factors in enabling the introduction of innovations which were identified by respondents included national focus and priorities, positive attitude, less bureaucracy, agile working, communication and leadership, a sense of urgency and fewer distractions. Many of these enablers should be possible in more ‘normal’ times too.
One positive change highlighted was the implementation of a pathway to dispense postpartum contraception in hospital which has eliminated the need for an additional GP visit. Other changes, including outpatient neonatal (baby) intravenous antibiotics and screening for gestational diabetes, may require more evaluation and analysis of clinical outcomes and economic benefits before being adopted routinely.
The report was written by Dr Lauren Morgan, of Morgan Human Systems, working with colleagues from all six trusts in the Oxford AHSN region providing maternity and neonatal services.