Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework
Abstract Background The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a...
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-06-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09669-0 |
| _version_ | 1827917049550077952 |
|---|---|
| author | Sarah Neal Lucy Stone Gill Moncrieff Zoë Matthews Carol Kingdon Anastasia Topalidou Marie-Clare Balaam Sarah Cordey Nicola Crossland Claire Feeley Deborah Powney Arni Sarian Alan Fenton Alexander E P Heazell Ank de Jonge Alexandra Severns Gill Thomson Soo Downe |
| author_facet | Sarah Neal Lucy Stone Gill Moncrieff Zoë Matthews Carol Kingdon Anastasia Topalidou Marie-Clare Balaam Sarah Cordey Nicola Crossland Claire Feeley Deborah Powney Arni Sarian Alan Fenton Alexander E P Heazell Ank de Jonge Alexandra Severns Gill Thomson Soo Downe |
| author_sort | Sarah Neal |
| collection | DOAJ |
| description | Abstract Background The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts. Methods We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care. Results The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured. Conclusions The COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care. |
| first_indexed | 2024-03-13T03:23:13Z |
| format | Article |
| id | doaj.art-772dd28a64c04ee5b686b8f79fa44263 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-13T03:23:13Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-772dd28a64c04ee5b686b8f79fa442632023-06-25T11:12:30ZengBMCBMC Health Services Research1472-69632023-06-0123111810.1186/s12913-023-09669-0Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 frameworkSarah Neal0Lucy Stone1Gill Moncrieff2Zoë Matthews3Carol Kingdon4Anastasia Topalidou5Marie-Clare Balaam6Sarah Cordey7Nicola Crossland8Claire Feeley9Deborah Powney10Arni Sarian11Alan Fenton12Alexander E P Heazell13Ank de Jonge14Alexandra Severns15Gill Thomson16Soo Downe17Department of Social Statistics and Demography, University of SouthamptonFaculty of Medicine, Health & Life Sciences, Swansea University Medical School, Swansea UniversityReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central LancashireDepartment of Social Statistics and Demography, University of SouthamptonReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central LancashireReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central LancashireReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central LancashireReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central LancashireMAINN Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central LancashireNursing, Midwifery & Palliative Care, Methodologies Division, King’s College LondonSchool of Justice, University of Central LancashireSchool of Medicine, University of Central LancashireNewcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation TrustMaternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of ManchesterDepartment of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit AmsterdamLancashire And South Cumbria Cardiac NetworkMAINN Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central LancashireReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central LancashireAbstract Background The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts. Methods We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care. Results The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured. Conclusions The COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care.https://doi.org/10.1186/s12913-023-09669-0COVID-19Maternal health servicesMidwiferyCrisesCase studyOrganisational evaluation framework |
| spellingShingle | Sarah Neal Lucy Stone Gill Moncrieff Zoë Matthews Carol Kingdon Anastasia Topalidou Marie-Clare Balaam Sarah Cordey Nicola Crossland Claire Feeley Deborah Powney Arni Sarian Alan Fenton Alexander E P Heazell Ank de Jonge Alexandra Severns Gill Thomson Soo Downe Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework BMC Health Services Research COVID-19 Maternal health services Midwifery Crises Case study Organisational evaluation framework |
| title | Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework |
| title_full | Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework |
| title_fullStr | Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework |
| title_full_unstemmed | Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework |
| title_short | Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework |
| title_sort | assessing safe and personalised maternity and neonatal care through a pandemic a case study of outcomes and experiences in two trusts in england using the aspire covid 19 framework |
| topic | COVID-19 Maternal health services Midwifery Crises Case study Organisational evaluation framework |
| url | https://doi.org/10.1186/s12913-023-09669-0 |
| work_keys_str_mv | AT sarahneal assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT lucystone assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT gillmoncrieff assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT zoematthews assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT carolkingdon assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT anastasiatopalidou assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT marieclarebalaam assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT sarahcordey assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT nicolacrossland assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT clairefeeley assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT deborahpowney assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT arnisarian assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT alanfenton assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT alexanderepheazell assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT ankdejonge assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT alexandraseverns assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT gillthomson assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework AT soodowne assessingsafeandpersonalisedmaternityandneonatalcarethroughapandemicacasestudyofoutcomesandexperiencesintwotrustsinenglandusingtheaspirecovid19framework |