Saving Lives, Improving Mothers’ Care Report

Saving lives, improving mothers’ care: lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017-19
National Perinatal Epidemiology Unit 11 November2021

• This report finds that pregnancy remains safe in the UK, with the overall maternal death rate showing a slight decrease. Among 2,173,810 women who gave birth in 2017-2019, 191 died during or up to six weeks after pregnancy, and 495 during or up to one year after their pregnancy. However, the findings show a continued inequality in the mortality rates for women of different ethnic backgrounds, ages and socio-economic circumstances.

Ethnic and Socio-economic Inequalities in NHS Maternity and Perinatal Care for Women and their Babies
National Perinatal Epidemiology Unit 11 November2021

• This report describes inequalities in maternity and perinatal care for women and their babies in England, Scotland and Wales during the period 1 April 2015 to 31 March 2018. Using routinely collected data, care and outcomes experienced by women and babies using NHS maternity services are measured and stratified by ethnicity and by Index of Multiple Deprivation (IMD), a proxy for socio-economic deprivation. 
• The results demonstrate differences in outcomes of maternity and perinatal care among women and birthing people, and their babies, via comparisons between those living in the most deprived and the least deprived areas in Great Britain, and in those from ethnic minority groups versus white ethnic groups.

Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study

Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study
The Lancet 1 November 2021 DOI:https://doi.org/10.1016/S0140-6736(21)01595-6

• Analysis of data compiled by the National Maternity and Perinatal Audit (women with a singleton birth between 1 April 2015 and 31 March 2017) indicate that socioeconomic and ethnic inequalities were responsible for a substantial proportion of stillbirths, preterm births, and births with fetal growth restriction in England. The largest inequalities were seen in Black and South Asian women in the most socioeconomically deprived quintile.

Equity and equality: Guidance for local maternity systems

Equity and equality: Guidance for local maternity systems
NHS England 6 September 2021

• Based on the five health inequalities priorities in the 2021/22 Planning Guidance​, this will help Local Maternity Systems align their Equality and Equality Action Plans with Integrated Care Systems health inequalities work​. The guidance includes an analysis of the evidence, interventions to improve equity and equality, resources, indicators and metrics.

Maternity high impact area: Reducing the inequality of outcomes for women from Black, Asian and Minority Ethnic (BAME) communities and their babies

Maternity high impact area: Reducing the inequality of outcomes for women from Black, Asian and Minority Ethnic (BAME) communities and their babies
PHE December 2020

Part of: 
Supporting public health: children, young people and families
Documents to help local authorities and providers commission and deliver maternal and child public health services from preconception up to 24 years.

Safer staffing guides from NHS Improvement

Safer Staffing improvement guides.
NHS Improvement 30 January 2018

• NHS Improvement has published a series of safer staffing improvement guides.
• Safe staffing in learning disability services - A guide to help standardise staffing decisions for learning disability services in community and inpatient settings.
• Safe, sustainable and productive staffing in mental health services - Improvement resource to help standardise safe, sustainable and productive staffing decisions in mental health services.
• Safe, sustainable and productive staffing in maternity services - Improvement resource to help standardise safe, sustainable and productive staffing decisions in maternity services.
• Safe staffing for adult inpatients in acute care - A guide to help standardise staffing decisions in adult inpatient wards in acute hospitals.
• Safe, sustainable and productive staffing in district nursing services - Improvement resource to help standardise safe, sustainable and productive staffing decisions in the district nursing service.

STP Quick Guides

STP Quick guides - STP aide-mémoires
NHS England May 2016

• These quick guides are designed to help local leaders work together in tackling the big system questions, and build on existing efforts to make progress on some of the most challenging priorities. 
• Each guide starts by setting out what success would look like in 2020, and gives suggestions about how areas could approach implementation. 
• Includes:
• Introduction to the aide memoires
• Cancer
• Diabetes
• Digital
• Estates
• Learning disabilities
• Maternity
• Mental health
• New care models
• Personalisation and choice
• Prevention
• Primary care
• Safety
• Supporting people to manage their own health, wellbeing and care
• Urgent and emergency care and 7 day hospital services

NHS England Board meeting, 31 March 2016 - Highlights

NHS England Board meeting, 31 March 2016

Highlights by Anne Gray, Knowledge Officer Arden & GEM CSU

Video will be available here: https://www.youtube.com/playlist?list=PL6IQwMACXkj0U7BzZm4AxeykK5OgnS2sl

Agenda

• Item 1: Board meeting agenda
• Item 2: Minutes of meeting held on 25 February 2016
• Item 3: Chief Executive’s Report
• Item 4: NHS England business plan 2016-17
• Item 5: Transforming Maternity Services – implementing the national maternity review
• Item 6: NHS England Corporate and NHS Performance report 
• Item 7: NHS England Finance Report
• Item 8: [Greater Manchester Health and Social Care Devolution] The Journey So far (paper from Sir Howard Bernstein)
• Item 8b: Greater Manchester Health and Social Care Devolution [Internal Delegation arrangements]
• Item 9: Managing Conflicts of Interest 
• Item 10: Delegation of Primary Medical Services Functions
• Item 11: Emergency Preparedness Resilience and Response
• Item 12a: Commissioning Committee Report to the Board
• Item 12b: Investment Committee Report to Board
• Item 12c: ARAC Report to the Board

Highlights

Better Births - FYFV National Maternity Review

National Maternity review: BETTER BIRTHS Improving outcomes of maternity services in England: A Five Year Forward View for maternity care
NHS England 23 February 2016

• While the review found that quality and outcomes of maternity services have improved significantly it found meaningful differences across the country. 
• The report highlights key priorities to drive improvement and ensure women and babies receive excellent care wherever they live and suggests that a number of pilot sites are established to test these ideas.

Extensivists focus on patients likely to need NHS care in Tameside interated care plan

Tameside Hospital NHS Foundation Trust contingency planning team final report
Monitor 17 September 2015

• Report from the Contingency Planning Team appointed by Monitor to review and develop further a joint plan by Tameside Metropolitan Borough Council and NHS Tameside and Glossop Clinical Commissioning Group to better join up health and social care across the area.
• The suggested new care model is based on the wider health and social care system and suggests a number of innovations. These include the development of new care professionals called ‘extensivists’. Extensivists are specialists who focus on the patients most likely to require NHS services. In addition to specific training they will have extensive experience in looking after patients with complex medical conditions and will complement and work alongside GPs.
• Five key elements of the new care model:
• Preventative and proactive care: keeping people well and independent for as long as possible. 
• Integrated urgent care service: the development of a single service to deal with people who are in social crisis or seriously unwell. 
• Planned care: responsibility for the wellbeing of the patient is shared by a single team, from home to hospital and back home again.
• Maternity care: wait til outcome of the Cumberlege Review of maternity services 
• Hospital specification: in the new model every resource, including the hospital, is brought together around the four elements of care above
• The main report includes a description of each element, how it was developed, who was involved and implementation plans.
• Estimates of costs and impact on the existing deficit as well as set up costs are included.

Kirkup report highlights failure of lead commissioner arrangements

Morecambe Bay Investigation report
Department of Health, 3 March 2015

• The Morecambe Bay Investigation looked at the maternity and neonatal services in University Hospitals Morecambe Bay NHS Foundation Trust.
• Covering January 2004 to June 2013, Kirkup Report concludes the maternity unit at Furness General Hospital (FGH) was dysfunctional with serious problems in 5 main areas:
• Clinical competence of a proportion of staff fell significantly below the standard for a safe, effective service.
• Poor working relationships between midwives, obstetricians and paediatricians. 
• Midwifery care became strongly influenced by a small number of dominant midwives whose ‘over-zealous’ pursuit of natural childbirth ‘at any cost’ led at times to unsafe care.
• Failures of risk assessment and care planning resulted in inappropriate and unsafe care.
• Grossly deficient response from unit clinicians to serious incidents with repeated failure to investigate properly and learn lessons.
• CCGs had not inherited a service specification from the PCTs and the absence of lead commissioning arrangements inherited from PCTs was found to have resulted in  lack of effective communication between commissioners and performance issues being missed.

Strategic clinical networks model

Single operating model for Strategic Clinical Networks
NHS CB, 12 November 2012

• The new model set to be in place by April 2013 brings together management support and clinical leadership for mental health, dementia, neurological conditions, maternity and children, cancer and cardiovascular services.

Commissioning maternity services

Commissioning Maternity Services - A Resource Pack to support Clinical Commissioning Groups
NHS Commissioning Board, July 2012

• This Maternity Resource Pack sets out a framework for the commissioning of the discrete set of maternity services provided by acute trusts – essentially obstetric and midwifery care across the antenatal, intrapartum and immediate postnatal periods.