< Previous | Contents | Next >

A Framework for maternity services in Scotland

Information and communication

This section endorses the absolute requirement for maternity services to address the information needs of women according to their needs. It also reflects on the quality of consistent information required by professionals and managers to provide a safe, efficient and effective service.

Local Action

• NHS Boards should use the data collated by the Common Services Agency's Information and Statistics Division in planning and providing local services;
• NHS Trusts should make sure that robust data collection mechanisms are in place;
• NHS Trusts should make sure that data from current practice is used to inform service development.

Local Action

• NHS Boards should provide education and training in consumer participation for lay/user representatives on Maternity Services Liaison Committees;
• Maternity Services Liaison Committees should make sure that women's views are recognised and reflected in the planning, provision and auditing of services;
• NHS Boards must have mechanisms in place for local consultation that incorporate the recommendations in "Designed to Involve: Public Involvement in the new Primary Care Structures" and which also include effective feedback;

• NHS Boards should use the results of consumer consultation in planning and delivering services.

Local Action

• All professionals must make sure that they communicate with women, and their families, in an open, friendly, courteous manner. They must make sure that they are fully understood and take account of the needs and wishes of women and their families;
• NHS Trusts must make sure that professionals provide full and consistent information before carrying out clinical procedures in order to obtain and document consent;
• All professionals must be educated and trained in communication skills, with particular emphasis on management of continuing care;
• NHS Trusts should have in place measures to provide high standards of verbal and written communication. These standards should be regularly audited.
• All professionals should be educated and trained in how to communicate bad news in the most sensitive and compassionate way possible;
• NHS Trusts should have in place policies for supporting parents who are bereaved including miscarriages, stillbirths, neonatal and infant deaths. NHS Trusts should have appropriately trained staff to support these parents;
• In life and death decisions concerning neonatal babies, care staff must work as a team to foster a practice of open communication. The consultant, as team leader, has a special responsibility to communicate sensitively;
• All professionals must communicate with each other in a way that provides successful teamwork and inter-professional respect;
• NHS Boards in isolated communities should consider using user-friendly Telemedicine services for professionals in order to provide support and reduce isolation in remote communities;
• NHS Boards in remote and rural areas should actively encourage professionals to use video conferencing as an alternative means of updating and maintaining skills.

Views

I felt I could ask them everyday questions - that was important because I didn't want to get myself down or upset about little things. (Lay Focus Group)

At that point nobody really did speak to me. To be fair I do remember asking a lot, is she okay, is she okay? And they didn't answer me. And then I was crying. They said to me she was fine. I just thought that she had died, it was just awful. (Lay Focus Group)

I didn't know whether or not the baby was alive. They just forgot to say something. (Lay Focus Group)

I felt 2 of the midwives just read off the notes, they didn't tell me information, I had to ask. Only one of them remembered me and took an interest. She came to see me when I was in labour. (Lay Interview)

It was a bit confusing, they didn't let me know what was going on. But I know they had the baby's best interests and that's why I didn't complain about it at the time. (Lay Focus Group)

Local Action

• All services and agencies caring for women of reproductive age must develop clear channels of communication with women and their partners. They must make sure that referral mechanisms are robust, and they must give priority to confidentiality and Data Protection guidance;
• Evidence based information and education should be available in various formats to suit individual needs. For example, UK Online "Having a Baby", translation and interpretation services, information in different community languages, tape/video/braille formats and publications such as the MIDIRS informed choice leaflets;
• The Health Education Board for Scotland pregnancy book "Ready Steady Baby" should be given to each woman by midwives or GPs at confirmation of pregnancy to help inform her decision making;
• NHS Trusts should make sure that advocacy services are readily available to all women and their families should they wish to comment on, or complain about any element of their care.

Local Action

• A unified, multi-professional, woman-held maternity record should be developed and implemented throughout Scotland;
• A standardised national record should incorporate result reporting and discharge information;
• NHS Trusts should encourage women to contribute to their notes if they so wish;
• NHS Trusts must make sure that record keeping is an integral part of care. Documentation of every episode of care must be recorded by the professional in good time, and dated and signed with a legible signature;
• NHS Trusts should make sure that clear information is given to women locally about how they can obtain a copy of their maternity record.

Views

Everything was written down so anybody I saw knew about me. (Lay Interview)

It mattered that he hadn't read my file. (Lay Focus Group)

It's a complete stranger that you're seeing and you've got to go through everything again. (Lay Focus Group)

All the different people I saw just read your notes and asked the same questions but there was no sense that they knew you. It's important that they know you and what has been happening. (Lay Interview)

It's the one you're meant to carry everywhere and everybody's meant to fill it in and nobody does. So I don't see the point of having them. I thought the whole point of them was so that everybody knew exactly what was going on with your child. But the only people that fill them in is your midwife. (Lay Focus Group)

The main problem in our area is seen as being the lack of information at the base. If the woman has taken all the information away with her, then there's nothing left at base. The solution to that would be to have an electronic patient record system. (Professional Focus Group)

Further Work to be undertaken

• NHS Trusts should review existing communication tools and training mechanisms, implement change and put in place an audit programme;
• The Information and Statistics Division of the Common Services Agency and the General Register Office should carry out work to address Scotland-specific future population projections, to include deprivation category projections. Their report should highlight implications that revised population projections may have for maternity services;
• The Scottish Executive Health Department, in conjunction with Information and Statistics Division should set up a Maternity Services Information Forum to review all aspects of information and data collection relating to maternity care and neonatal services in conjunction with the Child Health Information Group;
• The Scottish Executive Health Department should set up a multi-professional working group to develop a national standardised woman-held maternity record. This may eventually employ smart cards or other electronic systems;
• The Remote and Rural Areas Resource Initiative should consider maternity services as a specific project under the Scottish Telemedicine Initiative.

< Previous | Contents | Next >