Maternity care in England is being transformed, so that women and babies receive safer, more personalised care (National Maternity Review, 2016). Most women have good outcomes and positive experiences (Department of Health and Social Care (DHSC), 2017): the stillbirth rate has fallen by 16% from 2010–2016, and the neonatal death rate has fallen 10% from 2010–2015. Compared to other European countries, however, the UK ranks 19th out of 28 for neonatal mortality. This is a drop of 12 places since 1990, according to the World Health Organization (WHO) (2017), so there is still more to be done.
The ambition set by the DHSC to halve the number of stillbirths, brain injuries, and maternal and neonatal deaths that occur during or soon after birth by 2025 (DHSC, 2017) remains a national priority that requires a concerted, co-ordinated effort from leaders and managers, midwives, obstetricians, neonatologists, support staff and care commissioning groups.
A need to move further faster
Despite improvements in outcomes and experiences, reports by MBRRACE-UK (Knight et al, 2016), the Each Baby Counts Programme and NHS Resolution show that errors continue and that differences could have reduced mortality or morbidity.
Furthermore, perinatal mortality rates continue to vary across England, ranging from 3.2–9.6 per 1000 births in 2015 (Office for National Statistics, 2015). While some difference is expected, variation in the uptake and implementation of best practice is not acceptable.
New initiatives to improve safety
The publication of the new national maternity safety strategy (DHSC, 2017), sets out measures to make and sustain changes. These include changes to the NHS Improvement Hub, improving mental health services, and developing a new tool to review perinatal mortality.
NHS Improvement
The NHS Improvement Hub will be developed to provide information to help care providers learn from when things go wrong. This will help to spread learning and best practice, and benefit system leaders, including local, regional and national Maternity Safety Champions and the Improvement Managers who have been identified for the Maternal and Neonatal Health Safety Collaborative (MNHSC).
Improving mental health services
Specialist perinatal mental health services will be improved so that, by 2020/21, 30 000 more women will be able to access appropriate, specialist mental healthcare in the community and in inpatient Mother and Baby Units closer to home. This is significant, given that the direct deaths from suicide have more than doubled, from 6 deaths in 2009–11 to 14 in 2012–14 (Knight et al, 2016).
Reviewing perinatal mortality
A national, standardised perinatal mortality review tool to improve the quality of investigations will enhance the quality of incident reviews, aiming to reduce the chances of repeat mistakes. The new tool aims to achieve this by supporting:
Clinical negligence scheme for Trusts
NHS Resolution will launch the clinical negligence scheme for Trusts (CNST), a new initiative that aims to reward good practice. Trusts will be required to comply with specific criteria, which will result in a CNST discount. Where full compliance cannot be demonstrated, Trusts will be eligible for a smaller discount, if they use the funds to increase compliance.
Standardising investigations
A new approach to investigating term stillbirths, neonatal and maternal deaths and serious brain injuries will be led by the new Healthcare Safety Investigation Branch (HSIB). Other measures include support for bereaved families, rapid resolution and redress, coroners' investigations into stillbirths, the MNHSC and Each Baby Counts Learn and Support (DHSC, 2017).
All provide further opportunities to improve the outcomes and experiences of women, babies and their families.