A new report by the Royal College of Obstetricians and Gynaecologists  into maternity services has found differing levels of maternity care across England.

The report, ‘Patterns of Maternity Care in English NHS Hospitals 2011/12’, emphasises the wide variation in practice and outcomes among maternity services in England. The report presents a series of indicators that can be used to compare the performance of English maternity units, and is the first of what will be an annual review into maternity services by the RCOG.

The survey presents a number of key findings. For example, among women giving birth for the first time, there was a two-fold difference between hospitals with the highest and lowest rates of induction of labour (17% compared to 38%), emergency caesarean section after induction of labour (20% to 40%) and instrumental delivery (16% to 32%).

RCOG has expressed concern about such disparities as it could suggest that not all women are getting the best possible care, or that NHS resources are not being used in the most efficient way.

However, the report’s authors caution against over-interpreting the findings. Some of the observed variation could be due to differences in the quality of the data submitted by hospitals, and differences in patient characteristics that were not possible to control for.

Dr David Richmond, RCOG Vice President (Clinical Quality) said: “This work represents a first step towards the development of a balanced suite of indicators that could be used by maternity services to monitor local obstetric care and improve quality of care.

“The initial set of indicators suggests wide variation in both practice and outcomes between maternity units which is a source of concern for the specialty as we cannot be sure that every woman is getting the best possible care.

“It highlights that specialist-delivered care must expand so that for women with complex obstetric needs – which may only become apparent during labour – care can be provided by trained clinicians 24 hours a day and 7 days a week.

“There is a need to improve the completeness and consistency of routine maternity data and we hope that this report will act as a stimulus for clinicians and units to improve their data collection activity which will ultimately lead to improving the quality of patient care.”

Commenting on the findings, Mervi Jokinen, Practice & Standards Development Advisor at the Royal College of Midwives, said:  “It is innovative and gives professionals working in maternity services useful comparative data of current variations in performance. Such data encourages maternity professionals to look at the way they are working and to consider how they can improve the services they provide for women. 

“The report is open and transparent about its limitations which should drive all involved in maternity care to improve data collection and agree on universal data definitions. 

“We will be looking at the report carefully and considering how the RCM can help to ensure that women receive the same quality of care and the best possible outcomes wherever they deliver.”

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