Closed petition Review triage procedures used by NHS maternity wards

The Government should review how maternity wards triage patients, with a view to mandating a standard risk assessment based system for maternity and triage; assessing every patient within 15 minutes and prioritising care based on urgency, should be implemented.

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Upon arrival at triage I was not seen for 40 minutes. I was not assessed for a further 1 hour and 5 minutes, then my CTG was not reviewed for an hour. I believe a lack of risk assessment and all of these delays were the reason for my son's death. If the hospital had used standard risk assessment based system my baby's death could have been prevented. Similar cases could be prevented if risk assessments are done properly and sooner.

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Government responded

This response was given on 26 January 2021

NHS England and NHS Improvement are reviewing improvements to maternity triage processes in local services with the Royal Colleges with a view to publishing new clinical guidelines.

Read the response in full

We are very sorry to read of your experience and the tragic death of your son.

We recognise that, unlike mainstream emergency medicine, there is currently no nationally standardised triage system within maternity for women who attend for unscheduled appointments.

As a result, a lack of appropriate clinical prioritisation can have consequences for safety as women who need urgent care may be seen after those with minor concerns.

There have been local developments in relation to triage systems. Midwives and obstetricians from Birmingham Women’s and Children’s NHS Foundation Trust and researchers working on the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) maternity theme at the University of Birmingham, have co-produced The Birmingham symptom-specific obstetric triage system (BSOTS), which is well evaluated and has been implemented in 25 maternity units in the UK and a further 30 units have received training.

The system is based on established triage systems in emergency medicine and uses an assessment with clinical prioritisation of the common reasons that present within maternity triage. An initial standardised assessment of each woman identifies her presenting condition, key clinical symptoms and physiological indicators. Symptom-specific prioritisation algorithms use this information to define the level of clinical urgency using a four-category scale; green (non-urgent), yellow (requires further assessment), orange (priority) and red (emergency).

An initial evaluation of the implementation of this system suggests increases in the numbers of women seen within 15 minutes of arrival, reductions in the time spent waiting for assessment and the interval between attendance to medical review for those requiring it. Numbers of women who re-attended, and when they were next seen by maternity services suggested validity and improved safety. The system had excellent inter-rater reliability and midwives felt it improved safety for mothers and babies and the organisation of the department.

The Royal College of Obstetricians and Gynaecologists (RCOG) works to improve health care for women and sets standards for clinical practice, as well as the training curriculum for doctors practising in this specialty. NHS England and NHS Improvement (NHSEI) have been in discussions with the RCOG about the issue you raise, and on the work conducted in Birmingham, and will seek to take improvements forward once the appropriate clinical guidelines have been published.

In addition, NHSEI has written to all NHS Trust and Foundation Trust Chief Executives and Chairs setting out the immediate response required of all Trusts providing maternity services and next steps to be taken nationally following the publication of the ‘Ockenden Report - Emerging Findings and Recommendations from the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust on 10 December 2020.

The letter acknowledges that despite considerable progress having been made in improving maternity safety, there continues to be too much variation in experience and outcomes for women and their families.

The letter instructed Trusts to confirm the steps they are taking to implement the full set of the ‘Immediate and Essential Actions’ set out in the Ockendon Report and 12 urgent clinical priorities from the IEAs by 21 December 2020. Individual responses from Trusts will form part of the presentation and discussion at the NHSEI Public Board in January 2021 when the report, and immediate and longer-term actions will be considered.

Department of Health and Social Care

Government launches public survey on a new Women's Health Strategy

The Government has launched a public survey, to help decide on what should be included in its new Women’s Health Strategy for England.

They want to hear from women of all ages and backgrounds about their healthcare experiences. This will help the Government consider possible changes to NHS services.

The survey is open to anyone aged 16 or over.

Share your experiences with the Government here, by 30 May:

Specifically, the Government wants to hear views on the following themes:

  1. Placing women’s voices at the centre of their health and care
  2. Improving the quality and accessibility of information and education on women’s health
  3. Ensuring the health and care system understands and is responsive to women’s health and care needs across the life course
  4. Maximising women’s health in the workplace
  5. Ensuring research, evidence and data support improvements in women’s health
  6. Understanding and responding to the impacts of COVID-19 on women’s health

Find out more about the Strategy, and the issues the Government wants to hear about in its survey, here:

Read the full Call for Evidence here:

What is the Women's Health Strategy?

The Government has promised to develop a new Women's Health Strategy. The Strategy will aim to improve the health and wellbeing of women across England, and ensure NHS services in England are meeting women's needs.

In Scotland, Wales and Northern Ireland, health services are the responsibility of the devolved Governments, so the Strategy will only apply to England.

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The consultation is being run by the Department for Health and Social Care (DHSC), the Government Department responsible for the NHS and oversight of social care in England.

Find out more about DHSC:

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Read the full report:

The report finds that improvements in maternity services have been too slow, and recommends urgent action to address staffing shortfalls in maternity services.

Among its recommendations, the Committee has said that the Government should:

  • Introduce a target to end disparities in maternal and neonatal outcomes
  • Immediately increase the annual budget for maternity services by at least £200-350 million
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  • Take urgent action to address staffing shortfalls in maternity services

The Government will respond to the Committee's report in the coming weeks.

The Committee has also published an evaluation of the Government’s progress against its policy commitments in the area of maternity services in England, which was produced by an Expert Panel selected by the Committee.

Read the Expert Panel's evaluation here:

What is the Health and Social Care Committee?

The Health and Social Care Committee scrutinises the work of the Department of Health and Social Care and its associated public bodies. It examines government policy, spending and administration on behalf of the electorate and the House of Commons. It's a cross-party committee and is independent of the Government.

Find out more on their website:

You can get updates on their work by following the Committee on Twitter:

This is a ‘select committee’. Find out how Select Committees work:

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This will be a general debate. General debates allow MPs to debate important issues, however they do not end in a vote nor can they change the law.

The debate will start at 9.25am and last for up to an hour and a half.

Watch the debate:

You'll be able to read a transcript of the debate a few hours after it happens:

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During this debate MPs talk about their own and other's experience of baby loss, which you might find distressing.

Watch the debate

Read the transcript

What is a Westminster Hall debate?

Westminster Hall is the second chamber of the House of Commons. Westminster Hall debates give MPs an opportunity to raise local and national issues and receive a response from a government minister. Westminster Hall debates are general debates that do not end in a vote.

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