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NHS plan will see roll out of care bundles to reduce stillbirths

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NHS leaders have pledged to roll out care bundles across every maternity unit in England in 2019, as part of its goal to reduce stillbirths, maternal and neonatal mortality and serious brain injuries by 50%.

They also said an expanded version of the care bundle will be implemented in 2020, under a new blueprint for the development of the health service in England.

“The prevalence of pre-term birth is increasing, and more focus on pre-term mortality is needed”

NHS Long Term Plan

The NHS Long Term Plan, published yesterday, includes a chapter on care quality and outcomes that outlines ideas and strategies for further progress in maternity and neonatal services.

As previously reported by Nursing Times, the launch of the Saving Babies’ Lives Care Bundle (SBLCB) in 2015 forms part of NHS England’s aim to halve the number of stillbirths, neonatal and maternal deaths in the UK by 2025.

In its new long-term plan, it has been announced that the care bundles, which NHS England reports to have reduced stillbirths in maternity units by 20%, will be rolled out in every maternity unit across the country this year.

The plan also claimed it will be supporting maternity services to fully implement an expanded SBLCB in 2020, with a publication on it due this year.

Regarding the expansion, it stated: “The prevalence of pre-term birth is increasing, and more focus on pre-term mortality is needed to achieve substantial reductions in overall perinatal mortality rates and meet our national ambition.”

The SBLCB was first launched by NHS England in March 2015 and focuses on key measures to reduce stillbirths which include: smoking in pregnancy, improved identification and monitoring of small babies, boosting awareness of foetal movements and effective monitoring during labour.

The expanded SBLCB “will include a focus on preventing pre-term birth, which will minimise unnecessary intervention and define a more holistic approach to risk assessment during labour, alongside further improvements to cardiotocography monitoring, and reductions in smoking during pregnancy”, said the plan.

“It is very encouraging to see maternity front and centre of this plan”

Gill Walton

The long-term plan also explained that NHS England will “encourage development of specialist pre-term birth clinics across England”, in order to help care for women with heightened risk of pre-term birth, including younger mothers and those from deprived backgrounds.

It added that the SBLCB “will also encourage clinically appropriate use of magnesium sulphate – estimated to help reduce the number of pre-term babies born with cerebral palsy by up to 700 per year”.

Dr Bill Kirkup, honorary president of the charity Baby Lifeline and former chair of the inquiry into care failings at Furness General Hospital, said: “Full implementation of the bundle would make a significant impact in reducing the number of stillbirths.”

The long-term plan goes on to highlight that recommendations from the National Maternity Review: Better Births, which was published in February 2016, are being implemented through local maternity systems.

“These systems bring together the NHS, local authorities and other local partners with the aim of ensuring women and their families receive seamless care, including when moving between maternity or neonatal services or to other services such as primary care or health visiting,” the stated.

It said: “By spring 2019, every trust in England with a maternity and neonatal service will be part of the National Maternal and Neonatal Health Safety Collaborative,” while noting every NHS organisation involved in providing safe maternity and neonatal care now has a named “maternity safety champion”.

Through the champions, it said the NHS was “supporting a culture of multi-disciplinary team working and learning, vital for safe, high-quality maternity care”.

In terms of safety, the plan then goes on to highlight how the NHS should continue to improve how it learns lessons, specifically highlighting the work of the Healthcare Safety Investigation Branch and the development and adoption of the Perinatal Mortality Review Tool.

It stated: “The NHS will continue to improve how it learns lessons when things go wrong and minimise the chances of them happening again. The Healthcare Safety Investigation Branch reviews all term stillbirths, early neonatal deaths and cases of severe brain injury in babies, as well as all maternal deaths.

“A Perinatal Mortality Review Tool is now used by all maternity providers, supporting high quality reviews of the circumstances and care leading up to and surrounding each stillbirth and neonatal death,” it added.

“Full implementation of the bundle would make a significant impact in reducing the number of stillbirths”

Bill Kirkup

As part of the 10-year plan, NHS leaders have also pledged for pregnant women to be offered the same midwife throughout their care, as part of efforts to boost continuity of care and deliver more personalised care plans for pregnancy.

It said the aim for 2019 was that “20% of pregnant women will be offered the opportunity to have the same midwife caring for them throughout their pregnancy, during birth and postnatally”. 

The plan added: “We will continue to work with midwives, mothers and their families to implement continuity of carer so that, by March 2021, most women receive continuity of the person caring for them during pregnancy, during birth and postnatally.”

According to the plan, “women who receive continuity of carer are 16% less likely to lose their baby, 19% less likely to lose their baby before 24 weeks and 24% less likely to experience pre-term birth”.

“This will be targeted towards women from BAME [black, Asian and minority ethnic] groups and those living in deprived areas, for whom midwifery-led continuity of carer is linked to significant improvements in clinical outcomes,” it added.

As reported on Monday by Nursing Times, the first ever role of a chief midwifery officer has also been created as part of the 10-year plan. The move has been welcomed by the Royal College of Midwifery.

Meanwhile, the plan has also revealed a redesign and expansion for neonatal critical care services to improve the safety and effectiveness of services and experience of families”.

As part of this move, NHS England announced that the neonatal nursing workforce would be developed, meaning extra neonatal nurses and expanded roles for allied health professionals.

It also added that, from 2021-22, care co-ordinators would work with families within each clinical neonatal network across the country to help families become more involved in the care of their baby and invest in improved parental accommodation.

Reflecting health and social care secretary Matt Hancock’s interest in technology, the maternity plans also detail NHS England’s aims to expand the roll-out of maternity digital care records.

Digital records are currently being offered to 20,000 eligible women in 20 accelerator sites across England, with the figure set to rise to 100,000 by the end of 2019-20, according to the NHS Long Term Plan.

“By 2023-24, all women will be able to access their maternity notes and information through their smart phones or other devices,” the plan claimed.

On another note, health service leaders said they will also “improve access to postnatal physiotherapy to support women who need it to recover from birth”.

According to NHS England: “Physiotherapy is by far the most cost-effective intervention for preventing and treating mild to moderate incontinence and prolapse.”

The plan stated: “We will ensure that women have access to multi-disciplinary pelvic health clinics and pathways across England via referral.

“Clinics can also provide training and support for local clinicians working with women, such as GPs and midwives,” it added.

In addition, the plan noted that maternity services that do not deliver an accredited, evidence-based infant feeding programme, such as the Unicef Baby Friendly Initiative, will begin the accreditation process in 2019-20 under the long-term plan.

It claimed that, for England, only 57% of babies were currently born in an accredited “baby friendly” environment, adding that the nations breastfeeding rates compare unfavourably with other countries in Europe.

The plan said: “There is substantial variation between parts of England, with 84% of children breastfed at 6-8 weeks in London compared to 32% in the North East.”

Commenting on the NHS Long Term Plan, Gill Walton, chief executive and general secretary of the RCM, said: “It is very encouraging to see maternity front and centre of this plan.

“This is an ambitious plan and good leadership will be needed to implement it, in midwifery and in other health professions,” she added, welcoming in particular the creation of the new chief midwifery officer role.

But Ms Walton, who said she looked forward to working with the government and other health organisations to make the plan a “reality”, warned that there was currently a “gap between the ambitions for our maternity services and the reality on the ground”.

“This plan adds yet more aspirations, but we need to know how the government will bridge this gap and give us the services they have promised,” she said, drawing attention to funding and workforce issues.

Royal College of Midwives

New chief executive takes over at midwives’ union

Gill Walton

She noted: “There are some commitments in the plan to postnatal care, yet this is an area that has long been underfunded. It is therefore vitally important that sufficient funding is made available and that we have the right numbers of midwives and other staff in place.

“It is not just about a shortage of midwives, but also a shortage of other health professionals which can impact on midwives,” she said. “The whole system has to be staffed adequately otherwise the system falls down.”

The new 10-year plan for the health service was published at 12pm on Monday, after being delayed since the end of last year – reportedly due to the chaos around Brexit.

The blueprint sets out how the £20.5bn annual budget increase for the health service, which was promised last summer by prime minister Theresa May, will be spent.

Ahead of its full publication, some of the main aims and innovations set to be included in the plan were revealed in bite-size chunks over the festive period and in a more comprehensive statement yesterday by NHS England.

As well as maternity care, children’s services, cancer care, mental health and heart disease were all highlighted as being set to benefit, along with funding boosts for community care, digital technology and prevention.

The last time a 10-year strategy document was drawn up covering the whole health service in England was the NHS Plan, which was published in 2000 by the Labour government under Tony Blair.

  • More details on the NHS Long Term Plan can be found on a website created by NHS England along with the document itself.
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