Improving clinical safety and workforce visibility in community midwifery
How Swansea Bay University Health Board strengthened oversight, reduced the risk of missed care, and enabled proactive decision‑making across community maternity services
Summary
Swansea Bay University Health Board delivers community midwifery services across a geographically diverse region, supporting women and families through home visits, clinics, and a freestanding birth centre. Like many NHS organisations, the service was managing complex workloads in a safety‑critical, high‑risk clinical environment using paper records, spreadsheets, and informal handovers, which limited visibility, increased administrative burden, and introduced avoidable clinical risk.
By implementing RLDatix eCommunity, Swansea Bay UHB has established a single, real‑time view of community midwifery activity, workload, and staffing capacity. Over 60 midwives and maternity care assistants now use the platform to manage referrals, visits, and follow‑up care, supported by live acuity‑based reporting and integrated rostering.
The result has been improved oversight of clinical risk, a reduction in missed and delayed care, fairer workload distribution, and stronger evidence to support both daily operational decisions, continuity of care and longer‑term workforce planning.
The Challenge: fragmented systems and growing clinical risk
Prior to implementation, community midwifery teams within Swansea Bay UHB were operating with different, site‑specific systems for managing workload and patient visits.
In Neath Port Talbot, work was coordinated through paper‑based workbooks, with multiple sheets per day documenting patient details, visit reasons, and allocated midwives. These records relied on individuals manually carrying visits forward. In Swansea, midwives used their own diaries, with work handed over through phone calls or voice messages. Although workbooks were later introduced, the process still depended on paper records being consistently updated.
Rhiannon Griffiths, Community Midwifery Matron, explains:
“We would often see visits being missed because records weren’t being updated for whatever reason. There was a general recognition that the system wasn’t working.”
In practice, this meant workload visibility was limited, and clinical risk was often identified retrospectively rather than proactively. Missed or delayed visits were difficult to detect in real time, and senior staff had no single view of caseload, acuity, or available capacity across the service.
Finding the right solution
When Mandy Wilson joined Swansea Bay UHB as Workforce Systems Effectiveness Manager, she partnered with Rhiannon to support rolling out the E-community project, that had been previously identified by Swansea Bay University Health Board, as a solution that could reduce clinical risk while also addressing inefficiencies in workload coordination.
Their priority was a system that could reflect the realities of community midwifery practice, where continuity of care, autonomy, and unpredictable demand are central, while also providing clearer oversight of staffing and activity.
“It’s a complex picture, so we needed a solution that would simplify our existing system,” says Rhiannon.
Following selection of eCommunity, the team took a phased implementation approach. This allowed staff to build confidence gradually, supported by tailored training, Q&A sessions, and refresher opportunities.
“For us, it was really about how we were implementing timelines, timeframes and delivering training,” Mandy explains. “We worked closely with the RLDatix project manager and focused on building confidence step by step.”
From the outset, the team was clear that the purpose of the system was to support safety and improve visibility across the service.
Outcomes Achieved
Stronger clinical risk management and daily oversight
eCommunity now provides real‑time visibility of caseload, patient acuity, and staffing capacity across community midwifery services. This information is used daily within multidisciplinary safety huddles alongside the obstetric unit.
Live Red, Amber, Green (RAG) status reporting enables senior leaders, ward managers, community managers, governance, and safeguarding teams to prioritise high‑risk patients and make informed decisions at the start of each day.
“We know exactly how many red, amber, and green calls we have,” says Rhiannon. “That’s very significant when it comes to keeping patients safe.”
This represents a shift from retrospective awareness of risk to proactive, data‑informed decision‑making.
Reduction in missed and delayed care
Previously, transferring information between paper records and informal systems created opportunities for work to be lost or overlooked. Missed visits were often identified only after incidents occurred.
With eCommunity, all patient contacts and outstanding activity are centrally recorded, tracked, and automatically carried forward where required. Outstanding tasks remain visible to the wider team, significantly reducing the likelihood of missed or delayed care and improving coordination during unplanned or urgent demand.
Improved workforce visibility, fairness, and responsiveness
Integration with e‑rostering provides a single, unified view of workforce activity across geographical clusters. Senior clinicians can now see, in real time, who is working where and where capacity exists.
“For the first time, our Band 7s can see digitally who’s working where,” says Mandy. “Before, it was paperwork or phone calls. Now it’s all in one place – faster, clearer, and more reliable.”
This visibility supports rapid redistribution of workload when priorities change and enables safer responses to urgent referrals or unexpected demand.
The map feature provides greater visibility of community midwives and maternity care assistants working across the community, supporting lone working practices and helping teams identify a colleague’s last known location if welfare concerns arise.
Transparency of workload has also improved perceptions of fairness among staff, helping to reduce stress associated with uneven task allocation.
Strengthened continuity of care and patient relationships
Continuity of care has always been central to community midwifery at Swansea Bay. eCommunity brings together appointments, visits, and follow‑up activity into a single view and, through its integration with the existing e‑rostering system (Optima), it helps link women with known midwives across their care. This supports greater continuity throughout the maternity pathway.
Over 2,000 records have now been transferred into the system, allowing care plans to be tailored more effectively to individual needs and supporting a more consistent and personalised experience for women and their families.
Rhiannon explains the impact:
“Community midwives strive for continuity, because they’ve built that relationship with the mum and the family throughout the pregnancy. It has impacted continuity in a positive way across all our clusters.”
Clearer evidence for service planning
The inclusion of maternity clinic activity within eCommunity revealed previously unrecorded workload. Initially, it appeared there was spare capacity because this time was not being consistently logged.
Now that midwives are able to record these hours, Swansea Bay UHB has a clearer and more accurate picture of demand and capacity. This visibility allows establishment levels to be justified more effectively and supports improved workforce visualisation across community services.
“We want to build a full picture of demand and capacity,” says Mandy Wilson. “It’s about being proactive, not reactive and getting the best outcomes for our patients.”
This improved visibility supports both day‑to‑day decision‑making and longer‑term workforce planning.
Why continuity of care matters
Widely recognised maternity guidance highlights the importance of continuity of care as a foundation for safe, personalised and coordinated maternity services, particularly in community settings where effective information sharing is critical. Swansea Bay’s approach reflects these principles by using digital visibility to support continuity across the maternity pathway.
Looking ahead
The next phase of the journey focuses on using real‑time data from eCommunity to inform leadership decisions, resource planning, and long‑term strategy across community maternity services.
“Better visibility leads to better decisions, which leads to better care,” says Rhiannon. “That’s what it’s all about.”
Advice to other NHS organisations
Both Mandy and Rhiannon emphasise the importance of clinical engagement, phased implementation, and having the right digital infrastructure in place.
“There was a learning curve,” says Mandy, “but you get out what you put in. to date we have found this system to be supportive for our community midwifery team. It was definitely worth it.”
For more information or to book a demo, visit: RLDatix eCommunity