Improving Perinatal Outcomes Maternity Perspective Sarah Winfield Maternity Clinical Lead Y&H Maternity Clinical Network

Maternity Transformation Programme Established to: Ensure implementation of the vision and recommendations set out in Better Births by 2021. This means: Supporting local transformation Ensuring delivery of national actions Support the Secretary of State’s ambition to reduce the rate of stillbirths, neonatal and maternal deaths and brain injuries by 50% by 2030.

7 Themes of Better Births

CCG Improvement and Assessment Framework 2016/17 Maternity is identified as one of the six vital clinical priorities along with cancer, MH, LD, diabetes and dementia. Independent panel chaired by Baroness Julia Cumberlege. CCG IAF provides a perspective on the effectiveness of commissioning of maternity services and allows NHS England to target the support needed to assist CCGs and local maternity systems to improve. The 2016-17 baseline maternity assessment has been designed to align with a number of the key themes from Better Births Four indicators have been selected which provide a broad representation of the various aspects of the maternity pathway: Neonatal mortality and stillbirths Maternal smoking at time of delivery Women’s experience of maternity services Choices in maternity services In future years, a more comprehensive assessment will be undertaken, drawing on wider measures and qualitative information. Full details can be found at: https://www.england.nhs.uk/mat-transformation/maternity-iaf/

Local Maternity Systems Establish Local Maternity Systems to design and deliver maternity services across boundaries: by March 2017 local commissioners and providers should work collaboratively to establish an LMS that is coterminous with the STP Footprint by October 2017 the LMS should have established a shared vision and a local maternity transformation plan to implement Better Births by 2020/21.  

1 NHS England (North) Sustainability & Transformation Plan Footprints Northumberland, Tyne and Wear Durham, Darlington and Tees, Hambleton, Richmondshire and Whitby Coast, Humber and Vale South Yorkshire and Bassetlaw West Yorkshire Greater Manchester Cheshire and Merseyside Lancashire and South Cumbria West, North and East Cumbria 9 2 5 3 8 6 4 7

What should LMS plans include? Plans to implement the vision in Better Births will need to include delivery of the following by end 2020/21: Improving choice and personalisation of maternity services so that: all pregnant women have a personalised care plan all women are able to make choices about their maternity care, during pregnancy, birth and postnatally most women receive continuity of the person caring for them during pregnancy, birth and postnatally* more women are able to give birth in midwife-led settings (at home, and in midwife led units)* Improving the safety of maternity care so that by 2020/21 all services have: made significant progress towards the ‘halve it’ ambition of halving rates of stillbirth and neonatal death, maternal death and brain injuries during birth by 50% by 2030 are investigating and learning from incidents, and are sharing this learning through their LMS and with others fully engaged in the development and implementation of the NHS Improvement Maternity and Neonatal Quality Improvement programme * Evidence will be gathered from early adopters and other leading systems to consider whether more specific national ambitions should be put in place for these measures during 2017. Local Maternity Systems are asked to begin to define and plan to meet local ambitions in these areas.

Implementing Better Births: Links with Neonatal Care Maternity services cannot work in isolation and are inextricably linked to neonatal services Ensure effective integration with neonatal care Neonatal ODNs will be able to help LMSs deliver seamless services LMSs should be responsible for including all providers of maternity and neonatal care Neonatal ODN recommended to be members of the LMS boards and work in close co-operation Improve elements of care pathways to improve outcomes, including neonatal care

Implementing Better Births: Chapter 13 - Neonatal Care Ensure a joint policy on care for women where there is an anticipation for the need for NICU All women at high risk of extremely preterm labour (23-26 weeks) are delivered in a centre with a designated NICU, unless prior exemption has been sought LMSs need to work with neonatal teams to ensure capacity Ensure a clear policy to offer screening to those at high risk of delivery and therefore transfer, and the use of antenatal steroids and intrapartum magnesium sulphate to provide for improved outcomes

MBRRACE-UK Report Recommendations include: Conduct local review (red & amber Trusts) Investigate individual stillbirth and neonatal deaths using a standardised process and independent multidisciplinary peer review NHS England provide targets to aspire to for stillbirths, neonatal deaths and extended perinatal deaths Stillbirths and neonatal deaths 22+0 to 23+6 gestation to be reported to MBRRACE-UK for international consistency Provide data on stillbirths and neonatal deaths, report to MBRRACE-UK and provide accurate statutory data Improve on coding for cause of death based on CODAC Post mortem to be offered to all stillbirths and neonatal deaths and all placentas to be submitted for histology

Reducing Stillbirths: Current work in Y&H Implementation of Saving Babies Lives Care Bundle across all 13 maternity services. Implementation of Y&H Stillbirth and Bereavement Care Recommendations in all 13 maternity services. Collection of quarterly stillbirth data as part of the Y&H Maternity Dashboard. Stillbirth Peer Review Group - Development of a Stillbirth Peer Review Process. Awaiting National standardised review tool – currently being developed by NPEU. Pilot sites to be requested over summer 2017.

Actions Neonatal ODN members of all 3 LMSs in Y&H Support improvements to multidisciplinary working Continue to collect data for improvement: Maternity Services Dataset National Maternity Perinatal Audit MBRRACE-UK Maternity Dashboards – Y&H - National in development RCOG Each Baby Counts Local data Approve and implement a stillbirth peer review process Support the implementation of a national standardised perinatal mortality review tool