Sands & Tommy’s Policy Unit: Better board oversight needed to save babies’ lives (7 November 2023)

Summary

Trust boards’ regular oversight of the quality and safety of maternity and neonatal services has been the subject of successive inquiries and reviews. In this report, the Sands and Tommy’s Joint Policy Unit review publicly available board papers and minutes for seven NHS Trusts in England. They analyse whether the information presented to boards, the process for review, and actions taken enabled boards to deliver effective oversight over the safety and quality of maternity and neonatal services.

Content

The review highlights the following policy and practical needs:

• The need for clearer guidance on the minimum metrics required by boards, which should include any new measures identified by the Maternity and Neonatal Outcomes Group to provide an early warning of service quality and safety declining.
• Better ward-to-board communication is required to contextualise data and findings. They state that this requires integrating more insights from Clinical Service Leaders in reports to the board to contextualise the metrics presented, as well as board members’ engagement with wards and staff.
• Reports to the board should include reviews over a longer time frame.
• Review current systems and processes in each Trust and whether they allow boards to have meaningful oversight over the quality and safety of services. They make the case that there is a need to review the meeting frequency and/or length to ensure sufficient time for meaningful scrutiny or to delegate this scrutiny further, alongside improved transparency of committee-level discussions.
• Transparent reporting of the issues discussed outside of public board meetings, such as at sub-committee level.
• The need to review the extent to which the maternity incentive scheme in its current form incentivises transparent reporting of performance issues so that they can be addressed in a timely way. It states that there is a risk that the boards and services focus on demonstrating compliance with the scheme rather than supporting the improvements in safety.
• Clarity over the role of Local Maternity and Neonatal Systems in oversight of quality and safety and the implications for Trust boards’ responsibilities.