Summary
This Independent Report led by Professor Mary Renfrew was commissioned in May 2023 by the Department of Health (DoH) Northern Ireland (NI). It forms part of a broad programme of work to receive assurance on the safety of maternity and neonatal services for the population of NI. It resulted from two related developments:
- A request from the Coroner for Northern Ireland that the Department of Health NI take action to investigate her concerns following an inquest into the death of a baby that raised questions about care in Freestanding midwifery led units (MLUs). In the inquest report the Coroner identified a number of practice and system failings and shortcomings including the management of shoulder dystocia, fetal macrosomia (the baby being large for gestational age), and raised maternal body mass index (BMI). At the time of the inquest, all Freestanding MLUs in NI were closed. The Coroner found that a comprehensive review of the number of staff, experience, training, and policies should be conducted by the DoH, in the event of these Units reopening in the future. In response to this request, the Permanent Secretary asked the Chief Nursing Officer (CNO) for NI, along with the Midwifery Officer, to instigate an inquiry into the issues highlighted by the Coroner.
- Several other reports, both local and national, concerning the safety of services for pregnant women, new mothers, and babies required consideration of the wider health service context that influences midwifery and maternity care and services.
Content
In summary, the report advocates for the following changes:
- A shared strategic vision for safe, quality midwifery and wider maternal and newborn services in Northern Ireland with a regional framework for action.
- A reconfigured relationship with women, families and communities, ensuring respectful personalised care for all and a genuine voice in shaping services.
- A consistent, region-wide, evidence-informed approach to planning, funding, standards, provision, monitoring, and review of maternity and neonatal services.
- Improving clinical, psychological, and cultural safety and equity for women, babies and families across the whole continuum of care and in all settings.
- Changing the prevailing work culture to implement an enabling environment for all staff and managers, including ensuring midwives are represented at senior management levels, tackling silo working, and developing an open learning culture at every level of the system.
- Supporting midwives to provide quality midwifery care and services across the whole continuum of maternal and newborn care, with investment in community as well as hospital services, and increasing midwives’ influence over the safety and quality of care and services.
- Better oversight through improved accountability, monitoring, evaluation, and research.
- A unified approach to education and training of all staff, including leadership development - especially for midwives - and capacity building for the future.
Department of Health: Enabling safe quality midwifery services and care In Northern Ireland (22 October 2024)
https://www.health-ni.gov.uk/publications/enabling-safe-quality-midwifery-services-and-care-northern-ireland
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