Five safe, sustainable and productive staffing improvement resources

NHS Improvement has published five safe, sustainable and productive staffing improvement resources in the areas of maternity services, adult inpatients in acute care, district nursing services, learning disability services and mental health.

2017 survey of women's experiences of maternity care

This CQC report finds that overall women reported positive experiences of maternity care over 2017 and  there were small incremental improvements in results across almost every question. Whilst there have been general improvements overall, the results highlight the need for better communication and greater patient choice.

Implementing better births: continuity of carer

This guidance from NHS England sets out how local maternity systems can improve their services so that women experience continuity in the clinicians providing their maternity care.

An uncommon approach: four organisations selected to replicate health and social care interventions

Four organisations have each been awarded £145,000 by the Health Foundation to replicate successful health and care interventions using social franchising and licensing techniques. Social franchising and licensing are methods to replicate and scale interventions that have not yet been used widely in health care in the UK.

The projects are:

Scaling and replicating IRIS through social franchising

Lead organisation: IRISi

IRIS is a successful general practice-based training, support and referral programme that improves the identification and support offered to people with experience of domestic violence and abuse (DVA). One in four women and one in six men will experience DVA during their lifetime, with DVA against women being more frequent and more severe, with long-lasting effects that also have an impact on children. IRIS will be replicated through social franchising so that the programme can be implemented more widely, and more people can be supported. IRISi, a social enterprise set up to house the programme, will support other sites to engage commissioners, and recruit and train staff.

Replicating Pathway’s homeless health hospital team model to towns and cities experiencing significant homelessness

Lead organisation: Pathway

Homeless patients attend emergency departments four times more often than the general population, are admitted eight times more often and stay three times as long. Ten hospitals have implemented Pathway’s integrated care model ensuring that homeless patients admitted to hospital have access to the health care they need and support to recover. Pathway will use social franchising or licensing to replicate the model in places with significant homeless populations that would benefit from adopting it.

Scale up, replication and licensing of the PINCER intervention

Lead organisation: The University of Nottingham

In a recent study, prescribing errors were identified in 5% of prescription items, with one in 550 items containing a severe (potentially life threatening) error. This equates to around 1.8 million serious prescribing errors in English general practices each year. PINCER is a successful pharmacist-led information technology intervention for reducing common medication errors in general practice prescribing, and has been incorporated into national guidelines to support medicines optimisation. PINCER will be replicated in GP surgeries across the country; helping them to protect patients at risk of errors, and reduce medication-related hospital admissions and deaths.

Developing a licensed, social franchising model for regional hubs to roll out effective local multi-professional maternity training

Lead organisation: PROMPT Maternity Foundation

The PRactical Obstetric Multi-Professional Training (PROMPT) programme has been associated with a significant reduction in the number of babies with a low oxygen level at birth and also babies born with a permanent nerve injury following difficulties with their shoulders. Through social franchising and using a regional hub system, it is hoped that this improved implementation model will ensure that PROMPT training may be associated with the same improvements in outcomes across the country.

The new projects are currently subject to contracts being finalised.

The investigation of stillbirth

This House of Commons briefing discusses the way that stillbirth is investigated at present and the government announcement about independent investigations in future.

MBRRACE-UK Perinatal Confidential Enquiry: term, singleton, intrapartum stillbirth and intrapartum-related neonatal death

This report finds that the rate of term, singleton, intrapartum stillbirth and intrapartum-related neonatal death has more than halved since these deaths were last reviewed nationally in 1993. This represents a reduction of about 220 intrapartum deaths per year. It concludes that despite the fall in the mortality rate these deaths remain an important group for concern because, in the vast majority, the mother was directly receiving maternity care when the baby died or when the event in labour or birth occurred which led to the baby’s death.

A rapid resolution and redress scheme for severe avoidable birth injury: government summary consultation response

This consultation response document summarises the views received through the 12-week Consultation on rapid resolution and redress scheme for severe birth injury, launched in March 2017.

Over 200 unique responses were received, from a range of stakeholders, including: family members with personal experience of birth injury; the organisations that support them; and frontline clinical and legal professionals.

New maternity strategy to reduce the number of stillbirths

The government has announced a new maternity strategy to reduce the number of stillbirths as part of plans to make the NHS the safest place in the world to give birth.

Families who suffer stillbirth or life-changing injuries to their babies will be offered an independent investigation to find out what went wrong and why. Full-term stillbirths will be investigated by coroners.

Stillbirth risk is doubled if pregnant women sleep on their backs in third trimester

New research published in BJOG: An International Journal of Obstetrics and Gynaecology suggests that the risk of stillbirth is doubled if pregnant women sleep on their backs during the third trimester.

The Midlands and North of England Stillbirth Study (MiNESS) is the largest study of maternal sleep position and risk of stillbirth. It looked at 291 pregnancies that ended in stillbirth and 735 women who had a live birth.

The findings suggest women who go to sleep on their back - known as the supine position - have a 2.3 fold increase in risk of late stillbirth (after 28 weeks of gestation) compared with women who sleep on their side.

National Maternity and Perinatal Audit Clinical report 2017

The National Maternity and Perinatal Audit (NMPA) has published a major clinical report that identifies areas of good practice and opportunities for improvement in the care of women and babies in maternity services across Britain.

While the vast majority of women have a safe birth, and despite on-going improvements in the safety of maternity services, findings show that variation exists in a number of clinical processes and outcomes in maternity care. Some of the variation found will be due to differences in data quality, completeness and the risk profile of women being seen in different units.

Tissue pathway for histopathological examination of the placenta

This tissue pathway from the Royal College of Pathologists aims to provide guidance on the range of indications for referral of aplacenta for histopathological examination and minimum standards for pathologists undertaking placental examinations. Variations to the standard pathway for singleton placentas, relating to pregnancies from multiple gestations, are also included. Please note that products of conception (1st trimester) have been included in the tissue pathways for gynaecological pathology.

Under pressure? NHS maternity services in England

This briefing finds that NHS maternity units are more likely to close towards the end of the week and during holiday periods due to low staffing levels. It reviews the evidence on the long-run pressures faced by maternity units from changes in the number of maternity admissions and the case mix.

While the number of maternity cases has remained largely constant since 2010, the case mix continues to change, with women giving birth later in life and with more complex health conditions. There are implications for maternity units if this evolving case mix of mothers requires more care in terms of staffing or other resources.

‘Vaginal seeding’ birth trend could do more harm than good, say experts

The potential benefits of vaginal seeding do not outweigh the risks, according to a group of doctors who reviewed the available evidence published in BJOG: An International Journal of Obstetrics and Gynaecology.

Vaginal seeding is the practice of exposing babies born by caesarean section to their mother’s vaginal fluids in order to expose them to bacteria that may help to build their immunity against some chronic conditions, such as asthma and allergies. This involves taking a swab of vaginal fluid and applying it to the baby’s eyes, face and skin after birth.

Maternity care must not become further polarised

Bill Kirkup on the storm that has erupted following the royal college decision to withdraw its guidance on promoting normal birth Maternity care must not become further polarised

Last week, the Royal College of Midwives removed its guidance on promoting “normal” birth. That has been followed by an exchange of claims and counter claims in the press and in social media.

National maternity and perinatal audit: organisational report 2017

This report finds large increase in midwife-led units co-located with obstetric units, increasing birthplace choice for pregnant women but also describes variation in availability of staff, facilities and services.  The National Maternity and Perinatal Audit (NMPA) is the largest evaluation of NHS maternity and neonatal services undertaken in Britain. It aims to help maternity and neonatal services to identify good practice and areas for improvement in the care of women and babies.

Gathering feedback from families following the death of their baby: A resource to support professionals in maternity care

Many parents who have experienced bereavement want to offer feedback to ensure lessons are learned and good practice is shared. The Maternity Bereavement Experience Measure questionnaire and supporting resource is designed to seek feedback from bereaved parents where a baby or babies have died during pregnancy or shortly after birth. It should also enable commissioners and providers to collect and understand women’s insight from all communities, cultures and ethnic groups to help explore where local improvements may be needed.

Each baby counts - 2015 summary report

Three quarters (76%) of cases of stillbirth, neonatal death and brain injury during childbirth might have had different outcomes with different care, according to a report by the Royal College of Obstetricians and Gynaecologists. The conclusion is based on a review of cases that underwent local review in 2015

Teamwork in maternity units key to reducing baby deaths and brain injuries during childbirth

A detailed analysis of all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015 has identified key clinical actions needed to improve the quality of care and prevent future cases, reveals a summary report from the Royal College of Obstetricians and Gynaecologists’ (RCOG) Each Baby Counts initiative.

Maternity Services Monthly Statistics, England - January 2017, Experimental statistics

This is a report on NHS-funded maternity services in England for January 2017, using data submitted to the Maternity Services Data Set (MSDS).

As part of this month's publication, NHS Digital is also publishing an analysis of delivery method by Robson group. (Robson groups are 10 population groups used to classify births based on information relating to women's labour and previous birth history.)

Maternal feeding practices and children's eating behaviours: A comparison of mothers with healthy weight versus overweight/obesity

Appetite, Volume 116, 1 September 2017, Pages 395–400. doi.org/10.1016/j.appet.2017.05.033

This study aimed to explore differences between mothers with healthy weight versus overweight/obesity in a wide range of their reported child feeding practices and their reports of their children's eating behaviours. Mothers (N = 437) with a 2-6-year-old child participated. They comprised two groups, based on their BMI: healthy weight (BMI of 18.0–24.9, inclusive) or overweight/obese (BMI of 25.0 or more). All mothers provided demographic information and completed self-report measures of their child feeding practices and their child's eating behaviour. In comparison to mothers with healthy weight, mothers with overweight/obesity reported giving their child more control around eating (p < 0.001), but encouraged less balance and variety around food (p = 0.029). They also had a less healthy home food environment (p = 0.021) and demonstrated less modelling of healthy eating in front of their children (p < 0.001). There were no significant differences in mothers' use of controlling feeding practices, such as pressure to eat or restriction, based on their own weight status. Mothers with overweight/obesity reported their children to have a greater desire for drinks (p = 0.003), be more responsive to satiety (p = 0.007), and be slower eaters (p = 0.034). Mothers with overweight/obesity appear to engage in generally less healthy feeding practices with their children than mothers with healthy weight, and mothers with overweight/obesity perceive their children as more avoidant about food but not drinks. Such findings are likely to inform future intervention developments and help health workers and clinicians to better support mothers with overweight/obesity with implementing healthful feeding practices and promoting healthy eating habits in their children.

UHCW Research:Caroline Meyer