London quality standards and better births: Improving maternity outcomes

London quality standards (LQS)

The London Quality Standards (LQS) for acute emergency and maternity services were originally published in 2012. The drivers for their development were threefold:

• Recognition that recommendations from many reports highlighting shortcomings in quality and safety were rarely implemented.
• Concerns from Royal Colleges that many trainees were insufficiently supervised and were working beyond their experience.
• Growing awareness of differential mortality rates between weekday and weekend admissions.

The standards aimed to address these issues. Compliance would ensure consistent delivery of consultant care throughout the week. They represent the minimum that patients should expect to receive in London’s hospital services. The work engaged many professionals, patients and the public. They were debated in the Clinical Senate Forum on many occasions and finally endorsed.

Developments since LQS publication

Since publication, however, there have been a number of national service reviews, including those addressed within LQS such as the national Urgent and Emergency Care Review and Better births: Improving outcomes for maternity care in England.

• A number of questions have arisen in this context, and need further discussion:
• How do the London Quality Standards align with national review recommendations?
• How have they been implemented and what has their impact been to date?
• Does clinical consensus remain the same?
• Are there additional areas of practice that the SCNs have identified where standards are needed?
• Are the standards influential in developing sustainable transformation plans?
• Given the importance of ‘parity of esteem’ have we paid sufficient attention to incorporating standards relating to mental health?
• What legality do the standards have?

Refreshing collective clinical thinking

The forthcoming meeting of the Clinical Senate Forum will provide a timely opportunity to refresh our collective thinking, particularly in the context of the NHS Right Care programme and the development of Sustainable Transformation Plans.

Of special importance is the national maternity review, and the positioning of maternity services as a priority. Much of the Forum will be given over to consideration of work undertaken by the London Maternity Strategic Clinical Network (SCN) with a view to advising CCGs where the focus should lie.

The London Maternity SCN has undertaken a substantial amount of work alongside commissioners in the last few years, supporting improved quality and outcomes for mothers and their babies. The national review has highlighted the growing complexity of many pregnancies, and yet, in contrast to the agreement reached by London Senate members, seems dismissive of the need for comprehensive consultant cover for labour wards.

Conversely, the national review makes recommendations that span the whole pathway of maternity care, including perinatal mental health, whereas LQS focused mostly on care in labour and delivery.

Issues to consider

• How should London respond to the outline vision?
• What good practice can be shared?
• What further steps could be taken to address perinatal mental health?