Government initiative may highlight regional disparities in care provided to women who suffer a postpartum psychosis

A government initiative to find out new mothers’ views on the quality of the care they have received may highlight the regional disparities in care provided to women who suffer a postpartum psychosis.

Every woman who gives birth is to be asked to rate how the NHS looked after her, as part of a new government drive to improve the quality of maternity care, according to a report by Denis Campbell published in The Observer. [on 29 Dec 2012 – FYI]

All 700,000 women a year who have a child will get the chance to give feedback on how doctors, midwives and nurses cared for them, during one of the most stressful periods of their lives. The ratings will be then published as a way of encouraging hospitals and birth centres to ensure women get high-quality care.

Confirming the plan to the Observer, health minister Dr Daniel Poulter, who still works part-time as an NHS obstetrician at a London hospital, said it was part of the move to introduce a "friends and family test", under which patients will be asked if they would recommend the care they have received to their loved ones. "This will introduce scrutiny and transparency into the quality of maternity care women receive," said Poulter.

"It will bring under the spotlight the satisfaction and quality of care that mothers feel they have received at that particular maternity unit, whether that's an obstetric unit in a hospital or a birthing centre where midwives are in charge. The idea is that hospitals really listen to what women say. If the feedback says that local women wouldn't recommend it as a place to give birth and that there are concerns about that unit, then that's a very strong lever to encourage or force improvements in care," he said.

The "friends and family test" will first be brought in for all patients who arrive in A&E or are admitted as acute cases from April. They will be asked: "How likely is it that you would recommend this service to friends and family?"

Mothers, though, are to be asked more detailed questions, or to rate the care they have received at different stages throughout their pregnancy. The areas will include how they were treated by antenatal staff during their labour and how they were counselled over key tasks in the days after birth, such as learning how to breastfeed and any emotional support they may have received.

The feedback will cover a woman's entire experience of the NHS, from when her 12-week scans confirms the pregnancy to the help she gets if she ends up suffering postnatal depression, and support from community midwives after she returns home.

The Royal College of Midwives, Department of Health and the new NHS Commissioning Board, which will assume responsibility for running the health service from April, are devising exactly what questions should be asked, how and when. The new scheme will be tested in early 2013 in four hospitals, including St Thomas's in central London, which already use questionnaires to collect mothers' opinions. It will then be introduced from October at all 150 hospital trusts which provide maternity care.

Cathy Warwick, chief executive of the RCM, which represents the 30,000 midwives in England, agreed that the move would help women decide where to give birth. "It will lead to women choosing places where they believe they will get high-quality care or go for a home birth or to a midwife-led unit, if these are rated positively by women. Last year's birthplace study showed that women with low-risk pregnancies were more satisfied if they had a home birth or used a midwife-led unit than an obstetric unit", said Warwick.

Sally Russell, a co-founder of the Netmums website, welcomed the move. "What prospective parents want to know is about the experience others have had, not just the facts and figures around quality of care", she said.

Mothers should be asked for feedback when they are being discharged or soon after they get home, as they may feel reluctant to be honest while still being cared for in case that affected their treatment, Russell added.

The feedback will inevitably highlight the ongoing shortage of midwives, which the RCM warns is hindering the efforts by the NHS to properly look after the growing number of women giving birth during a decade-long baby boom, added Russell.

But Poulter said that midwives and other maternity staff should not be anxious. "From working in maternity care myself, I welcome feedback from women and their families. As a doctor or midwife you want to know if you can do better. You need to know that", he said.