More rigorous investigating needed to improve maternity safety

My Post (16)Coroners could be given powers to investigate stillbirths and help improve maternity safety, Health Secretary Jeremy Hunt has said. Currently, coroners only have jurisdiction to investigate deaths of babies who were alive at birth. The announcement comes after a recent report showed that three-quarters of birth-related deaths or brain injuries might have been avoided (Royal College of Obstetricians and Gynaecologists (RCOG), 2017).

Hunt also revealed that independent investigations are to be offered to families who suffer stillbirth or life-changing injuries to their babies. The Healthcare Safety Investigation Branch will look at 1000 cases each year to find out what went wrong and why, and encourage system improvements that will lead to fewer deaths and injuries in the future.

Health Secretary Jeremy Hunt said:

‘The tragic death or life-changing injury of a baby is something no parent should have to bear, but one thing that can help […] is getting honest answers quickly from an independent investigator. Too many families have been denied this in the past, adding unnecessarily to the pain of their loss.

‘Countless mothers and fathers who have suffered like this say that the most important outcome for them is making sure lessons are learnt so that no-one else has to endure the same heartbreak. These important changes will help us to make that promise in the future.’

Alongside the devastating impact of death or serious injury to mother or child at birth, maternity incidents dominate the NHS’ litigation expenditure. Half of the £1 billion negligence claims the NHS paid out in 2016/17 were in maternity services, largely due to the high value of claims arising from brain injuries at birth (NHS Resolution, 2017).

The Government’s maternity safety plans will also see its ambition to halve the number of stillbirths and deaths among neonates and mothers brought forward from 2030 to 2025 (Department of Health, 2017), saving an estimated 4000 lives.

The rate of premature births is also hoped to fall from 8% to 6% by 2025.

Gill Walton, chief executive officer and general secretary at the Royal College of Midwives (RCM), said:

‘Midwives are in a unique position to help achieve this, as they are the one healthcare professional whom all women will see during their pregnancy and birth, and therefore have a clear role in ensuring care is coordinated, safe and, most importantly, personal.

‘Much has been done already through an array of initiatives to improve the safety of maternity care, and this revised strategy will give everyone involved in maternity care the opportunity to reflect on past successes and focus on key areas where more still needs to be done.’

The RCOG ‘Each Baby Counts’ programme has used local investigations into stillbirths, neonatal deaths and brain injuries to inform national data and identify lessons learned across maternity services. One-quarter of local reports were deemed inadequate by the RCOG, with many NHS institutions listed as not sufficiently investigating incidents and learning from mistakes in their maternity services.

Commenting on the proposals, Professor Lesley Regan, RCOG president, added:

‘We are delighted that the Government has agreed to expand the RCOG’s Each Baby Counts programme, which has been hugely successful in securing the trust of both the midwifery and obstetric communities, with 100% of Trusts involved in providing maternity services engaging in this important work.

‘We are committed to sharing the expertise we have gained […] and our understanding of the complex interplay of factors that lead to stillbirths, neonatal deaths and brain damage during term labour, to work with partners such as NHS Improvement to expand the work and reach of the Maternal and Neonatal Safety Collaborative and the Healthcare Safety Investigation Branch as they undertake their investigations.

‘Expansion of the national strategy to include a focus on preterm birth and brain injury will likewise help provide a more complete picture of maternity safety, strengthening our evidence base to help us deliver ever more effective care’.

References

Department of Health. Safer Maternity Care: The National Maternity Safety Strategy— Progress and Next Steps. London: The Stationery Office; 2017

NHS Resolution. Annual report and accounts 2016/17. London: The Stationery Office; 2017

Royal College of Obstetricians and Gynaecologists. Each Baby Counts: 2015 Summary Report. London: RCOG; 2017

Taken from British Journal of Midwifery, published February 2018.

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New techniques at pilot sites to improve bereavement care for parents

Adobe Spark (1)A new pathway has been launched to improve the quality of care for parents who have lost a baby. The National Bereavement Care Pathway (NBCP) seeks to offer individualised, safe and sensitive care for parents and families at all stages of pregnancy and baby loss up to 12 months.

Led by Sands, the stillbirth and neonatal death charity, it has been produced in collaboration with a core group of charities and professional bodies, comprising the Institute of Health Visiting, the Royal College of Midwives, NHS England, the Royal College of Obstetricians & Gynaecologists, the Royal College of Nurses, Neonatal Nurses Association, Bliss, Antenatal Results & Choices, The Lullaby Trust and Miscarriage Association. It also has the support of the Department of Health and the All-Party Parliamentary Group on Baby Loss.

The first wave of 11 pilot sites has been rolled out across the UK to coincide with Baby Loss Awareness Week and includes Wirral University Teaching Hospital NHS Foundation Trust, Liverpool Women’s NHS Foundation Trust, and Hull and East Yorkshire Hospitals NHS Trust. The sites were chosen to be ‘representative of geography, capacity and specialism’, and will trial the use of new materials, guidelines and training for professionals to help improve the care that bereaved parents receive.

The latest figures show that in 2015 there were over 2,500 infant deaths (that is, deaths under 1 year of age) in England and Wales, with stillbirths and deaths of infants under 7 days accounting for around 6.5 deaths per 1,000 total births (Office for National Statistics, 2017).

Clea Harmer, chair of the NBCP Core Group and CEO of Sands, comments: ‘I am delighted that we have so many enthusiastic partners across the country who want to work with us in improving bereavement care for parents when a baby dies.

‘As a collaboration, we were inundated with offers of support and I am excited by the potential impact that the pathway will have in these 11 sites, in the first instance. We  look forward to learning from their experiences before wave 2 begins and the wider rollout later next year.’

A spokesperson for the Institute of Health Visiting says: ‘The Institute is pleased to be one of the key partners in the project group working to deliver a National Bereavement Care Pathway for England, with the support of the Department of Health and All-Party Parliamentary Group for Baby Loss.

‘We are really keen to support the project group with identification of community health providers [which employ health visitors] that are willing to be included in the second pilot phase. This will ensure that the pathway offers clear, consistent guidance to health visitors and enable them to work confidently alongside parents, providing compassionate and parent-centred care to those affected through use of the pathway.’

Sue Cooper is the bereavement midwife at Hull and East Yorkshire Hospitals NHS Trust. She highlighted the important role that bereavement midwives play in providing support for parents who have lost a child:

‘Losing a child is an incredibly difficult experience and something that no parent should ever have to go through,’ Cooper says. ‘If they do, however, it’s important that we, as health professionals, are able to provide the right advice, information and support for bereaved parents.

‘The quality of care and the empathy shown to parents at a time when they are struggling with a whole range of different emotions is crucial, and our role in guiding bereaved parents through this difficult time is not to be underestimated. How we care for bereaved families when their baby dies can have long-lasting effects. Good care can’t remove parents’ pain and grief, but it can help them through a devastating experience.

Cooper is hoping bereavement care in Hull and East Yorkshire will improve as a result of being one of the pilot sites on the new pathway: ‘We’re really pleased to have been chosen to pilot the new care pathway,’ she says. ‘We’re not only hoping to improve the care we personally provide for bereaved parents, but it will mean a lot to know that what we do here in Hull and East Yorkshire will go on to shape and improve services provided for others right across the country.’

Since the project was initiated, it has engaged with over 200 professionals and 60 parents, completing a gap analysis of current pathways, guidance and research. A number of pregnancy and baby loss pathways have been created, with input from members of the NBCP Parental Advisory Group, which shared their stories to help inform the pathway.

Cathy Warwick, chief executive at the Royal College of Midwives, says: ‘This is important work because it is about giving bereaved families better care following the sad loss of a baby and we need to get it right. Learning from parents and the results of the work at the pilot sites will mean care can be better tailored to meet the needs of families.’

According to Carmel Bagness, Royal College of Nursing’s professional lead for midwifery and women’s health, it is the responsibility of healthcare staff to support bereaved parents: ‘The loss of a baby is an absolute tragedy and it is up to healthcare staff to provide the best care possible for bereaved parents and families,’ she says. ‘This pathway could really help to improve the care they receive during this difficult time. We hope this pilot is just the first step towards better care throughout the country for parents and families suffering from this terrible loss.’

Caroline Lee-Davey, Chief Executive of Bliss, adds: ‘Bliss is proud to be partnering on this project to improve bereavement care for pregnancy and infant loss. We know that being supported in the right way can help grieving parents and families at this heart-breakingly difficult time, and we look forward to working with the pilot sites to deliver consistent, high-quality and parent-centred care.’

A second wave of pilot sites is planned for April 2018, with a national rollout expected later in October.

References

Office for National Statistics. Childhood mortality in England and Wales: 2015. London: ONS; 2017.

Taken from Journal of Health Visiting, published November 2017.

Ambulance staff strike in dispute over pay

Ambulance staff were among the thousands of health workers who took part in a strike over pay on 13 October.

Workers from seven trade unions took part in the strike, which lasted from 07:00 to 11:00 BST in England.

Unions and managers had met in advance of the strike to ensure essential services were maintained, with military and police personnel helping ambulance services where needed.

Despite ambulance services developing backlogs, priorities were given to life-threatening cases.

The dispute came as ministers in England have awarded NHS staff a 1% increase in pay, but only for those without automatic progression-in-the-job rises.

The independent NHS Pay Review Body recommended a 1% rise across all pay scales, but ministers claimed this was an ‘unaffordable’ cost.

The unions involved in the strike included Unison, Unite, GMB, UCATT, the Royal College of Midwives, the British Association of Occupational Therapists, and Managers in Partnership.

Christina McAnea, head of health at Unison, said the offer in England was a ‘disgrace’.

‘The fact that so many unions representing a range of NHS workers are taking action or preparing to join future actions should send a clear message to the government,’ she said.

Taken from Journal of Paramedic Practice, published 20 October 2014.