Read standard 5: High-performing and functioning teams

Maternity standards
Healthcare Improvement Scotland

Standard statement

Maternity care is delivered by high-performing and functioning multidisciplinary teams.

Rationale

Maternity care should be delivered by highly-trained staff working within a multidisciplinary team.3 NHS boards have responsibilities under The Health and Care (Staffing) (Scotland) Act 2019 and associated statutory guidance to ensure appropriate staffing levels, skill mix, effective workforce planning and clear lines of accountability.

NHS boards are legally required to ensure that all clinical staff, including maternity staff, maintain their relevant professional registration. Staff must uphold the professional standards expected by their regulatory body and NHS Scotland.

Staff should work collaboratively across organisational and professional boundaries.1, 3 NHS boards should ensure staff are clear about their roles and responsibilities and are enabled to work within their skills, competencies and scope of practice. This supports effective multidisciplinary team working and facilitates collaboration.

Staff should be enabled to participate in relevant national programmes of work, including the Scottish Patient Safety Programme and national networks. They should also have opportunities to engage in research and evaluation, contribute to the development of evidence-based tools and guidance (including national work such as guidance development groups) and share learning across services. Staff should also be supported to practice innovation in their teams and maternity services and to engage in improvement approaches and tests of change that promote safe, effective and person-centred care.

Core mandatory training is essential to ensure staff maintain the skills required for safe and effective practice. Scottish Government and Healthcare Improvement Scotland emphasise the importance of core training in fetal heart monitoring and the management of obstetric emergencies, enabling staff to recognise deterioration and respond promptly to complications. NHS boards should have robust systems to deliver this training and monitor uptake and completion. Where gaps or risks are identified, NHS boards should develop and implement targeted improvement plans.

Training and support should be provided to enable effective communication within and between teams, including at care transfer points and during handovers. Effective communication underpins safe multidisciplinary team working and helps ensure that any concerns relating to the delivery of maternity care are escalated promptly and appropriately.1 Multidisciplinary training supports a shared understanding of staff roles and responsibilities, enhancing team dynamics, communication and culture. Local, regional and national training can provide opportunities for shared learning, innovation and effective practice. This should include training that enables staff to understand and respond to the factors that matter to women during their maternity care.

NHS boards should ensure that staff have protected time and appropriate resources to attend both mandatory and role-specific training.

NHS boards should ensure a healthy and supportive working environment to optimise the wellbeing and performance of all staff.23 This includes having policies and procedures in place to identify and minimise vicarious trauma. The provision of clinical supervision and restorative supervision are essential components of training, professional development and emotional wellbeing. Opportunities for mentoring, peer support and multidisciplinary learning and development should be available to all staff.

Maternity staff should have time for learning and reflection, support for innovation, access to restorative breaks and mechanisms to provide feedback to their senior leaders in a psychologically safe way.3 Effective and visible clinical leadership is critical in supporting staff and fostering a positive culture (see Standard 3).

NHS boards that offer clinical placements to students should ensure these placements support the development of the knowledge, skills and experience required to deliver safe, effective and high-quality maternity care. Where possible, placements should provide opportunities for students to observe a range of women’s experiences of physiological labour and birth.3

Criteria

5.1

NHS boards have multidisciplinary workforce plans to support the delivery of safe and high-quality maternity care. These plans should:

  • detail the appropriate skill mix and numbers of suitably qualified and competent staff
  • address recruitment, retention and succession planning
  • clearly define roles and responsibilities across teams
  • reflect service delivery models, for example, partnership working with island boards or regional centres
  • implement the Health and Care (Staffing) (Scotland) Act 2019.
5.2

NHS boards have oversight and assurance of staffing and workforce data, including:

  • staffing levels, including predicted and actual absence levels
  • skill mix
  • staff recruitment activity
  • staff training and continued professional development (CPD)
  • professional registration and revalidation
  • access to, and uptake of, clinical supervision.
5.3

NHS boards review staffing and workforce data to:

  • identify trends and gaps
  • understand the impact of workforce gaps, skill mix and staff shortages on the safety and quality of care
  • develop improvement plans.
5.4

NHS boards enable staff wellbeing by ensuring staff (and students, where appropriate) at all levels:

  • feel able to raise concerns and escalate staffing risks in ways that support their wellbeing and psychological safety (see Standard 3)
  • have time for learning and reflection
  • can access restorative breaks
  • can access both clinical and restorative supervision
  • can access psychological support, if required.
5.5

NHS boards ensure all clinical staff delivering maternity care are:

  • appropriately registered with their professional regulator or body
  • supported to meet revalidation requirements, including collecting and submitting evidence.
5.6

NHS boards ensure effective multidisciplinary working across all maternity services through:

  • good communication and collaboration within, and between, teams
  • joined-up decision making
  • accurate documentation and effective information transfer
  • identification of, and support from, relevant clinical professional leads
  • values-based, person-centred and trauma-informed leadership at all levels
  • multidisciplinary education and training, where appropriate
  • regular education and simulation training focused on local safety priorities.
5.7

NHS boards ensure that maternity staff work within defined clinical and professional competencies and:

  • understand their (and their colleagues’) roles and responsibilities in delivering safe and high-quality maternity care
  • respect the professional competencies, contributions and decisions of all members of the multidisciplinary team
  • recognise when to seek specialist advice, second opinion or further clarification where needed.
5.8

NHS boards ensure that training and education plans cover:

  • competencies and proficiencies for all maternity staff, including specialist roles and students
  • core mandatory training, in line with local and national guidance
  • identifying, addressing and reducing health inequalities
  • person-centred and trauma-informed practice
  • effective team working and communication, including handovers
  • CPD
  • improvement methodology
  • opportunities to support the development of standards, pathways and guidance
  • evaluation and research activities.
5.9

NHS boards provide time and resources for staff to access and attend CPD and multidisciplinary training and education. Training and education resources are:

  • quality assured and accredited, where appropriate
  • underpinned by local or national professional standards, frameworks and guidance
  • informed by systematic reviews of learning needs
  • evidence based and informed by good practice
  • delivered across a range of training mediums, including online learning
  • appropriate to staff roles, responsibilities and workplace setting
  • informed by feedback and the lived experiences of women.
5.10

NHS boards ensure that women are supported by skilled and competent staff, who are enabled to:

  • be compassionate and take time to understand and respect each woman’s experience, wishes and personal outcomes
  • respond to the individual needs of the woman and her baby, including offering extended appointments if needed (see Criterion 4.7)
  • communicate effectively and respond appropriately to different communication or language needs
  • access and use appropriate communication or language support, including translators and interpreters
  • understand and respect the rights of women and their babies
  • support women to uphold their and their baby’s rights
  • support women to improve their and their baby’s health.

Students should be supported to develop and consolidate these skills throughout their clinical practice placements.

5.11

NHS boards ensure that staff have the time and resources to deliver high-quality, person-centred and trauma-informed care and support.

5.12

Staff in leadership, supervisory and mentoring roles have the appropriate skills and knowledge to:

  • create psychologically safe environments and apply trauma-informed approaches within their teams and services
  • manage and support staff effectively, including providing coaching, supervision and assessment
  • embed reflective practice to support continuous learning, insight and improvement
  • support students effectively, including providing high-quality teaching, supervision, assessment, feedback and learning opportunities.
5.13

Staff are supported to provide honest and open feedback to their colleagues and leaders to help strengthen reflective practice and peer learning.

5.14

NHS boards ensure staff can assess workplace policies and support services that:

  • encourage and support joy at work
  • enable them to feel confident and supported in their clinical judgement and decision making
  • promote their general health and wellbeing
  • identify and minimise the impact of vicarious trauma, including after pregnancy or baby loss
  • address any professional or emotional challenges they may experience.
5.15

Staff are supported to participate in local and national improvement work and are enabled to:

  • use evidence-based improvement tools and approaches appropriately
  • undertake tests of change and to safely apply innovation in their teams and maternity service
  • engage actively in national improvement programmes.

What does this standard mean for...

What does the standard mean for women and their babies?

  • Your care will be provided by staff and teams who work well together and are knowledgeable and skilled.
  • You will be listened to and supported to make decisions by well-informed staff and teams.
  • You can be confident that the maternity service will have the right staff available to deliver your care.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting, are enabled to:

  • understand their roles and responsibilities within a multidisciplinary team
  • hold and maintain the appropriate registration to practice
  • safely raise concerns and are supported to do so by compassionate and visible leadership
  • have time and resources to develop and expand their knowledge, skills and competencies
  • receive support for their own health and wellbeing
  • participate in improvement approaches, tests of change and practice innovation.

What does the standard mean for the NHS board?

NHS boards:

  • provide clear leadership and oversight of staffing and skill mix to ensure continuity of care, support and carer in line with the Health and Care (Staffing) (Scotland) Act 2019
  • have workforce resilience plans and implementation monitoring that reflects local service delivery models
  • ensure staff have the time, resources and support to participate in education, training, reflective practice, supervision and CPD
  • support staff and multidisciplinary teams through effective, values-based and trauma-informed leadership
  • promote multidisciplinary team working through training and supporting effective communication, including care handovers.

Benchmarking and measuring performance

 

Criteria

Examples of what meeting this standard might look like

Please note this list is not exhaustive and examples may vary according to the size and scale of the service or NHS board or delivery model

5.1

Application of the common staffing method and use of workforce planning tools, for example, maternity staff level tool.

5.2

Workforce resilience plans, such as mutual staffing, cover arrangements during sickness absence and training.

5.3

Regular review of staffing levels and appropriate escalation processes implemented.

5.4

Feedback, such as iMatter, that staff feel safe and supported to raise concerns and risks.

5.5

Professional registration and revalidation reports.

5.6

Accurate document and effective information transfer between teams.

5.7

Feedback from staff, such as annual appraisals, that they feel respected by colleagues.

5.8

Agreed training plans outlining core and mandatory competencies.

5.9

Access to regional events, for example, larger NHS boards providing training for island boards.

5.10

Feedback from women, such as through Care Opinion, that they felt supported by compassionate and supportive staff.

5.11

iMatter reports and staff feedback.

5.12

Evidence of leadership training and development pathways and frameworks.

5.13

Staff huddles and reflective sessions.

5.14

Proactive provision of a range of appropriate measures to ensure prevention of vicarious trauma, chronic stress and burnout and reactive measures to support staff when needed.

5.15

Evidence of tests of change and practice innovation..

 

Editorial Information

Last reviewed: 23/03/2026

Next review date: 23/03/2031

Author(s): Maternity standards development group.

Author email(s): his.standardsandindicators@nhs.scot.

Approved By: Maternity standards development group

Reviewer name(s): Maternity standards project team.