1
Introduction
This paper is a
response to the National Assembly for Wales Health and Social Care
Committee’s follow-up on its inquiry into stillbirths in
Wales.
The response has
been prepared by Public Health Wales’ 1000 Lives Improvement
Service.
Evidence is
provided on recommendations one, two, four, five and eight of the
“One day Inquiry into Stillbirths in Wales” (National
Assembly for Wales, 2013) - the recommendations on which the 1000
Lives Improvement Service has some responsibility.
2
Background
The 1000 Lives
Improvement Service used to host the Transforming Maternity
Services Mini Collaborative. The Collaborative was established in
March 2011 with the overall aim of improving the experience and
outcomes for women, babies and their families within Welsh
maternity services. The Collaborative came to an end on the 31
March 2104
The Collaborative,
in turn, established the National Stillbirth Working Group (NSWG)
in March 2012. The work of the NSWG was fully funded by 1000 Lives
for the financial year 2013/14.
Following the
Health and Social Care Committee’s “One day inquiry
into stillbirths in Wales” held in February 2013, the NSWG
was tasked with supporting the implementation of recommendations
one, two, five and eight of the report.
At the time, the
NSWG was leading work on the implementation of the following
nationally agreed interventions:
- Standardising
the management of reduced fetal movements
- Implementing
customised growth charts
- Increasing
post-mortem consent
- Local
perinatal review
At the time that
the Transforming Maternity Services Programme came to an end, on 31
March 2014, the NSWG produced two reports summarising its work:
- Progress
Report (March 2014)
- Increasing the
Consent to post mortem following stillbirth in Wales (March
2014)
These reports are
submitted to complement this response.
3
A Maternity Network for Wales (recommendation 4)
Following the
Committee’s recommendation that “the Welsh Government
scope the viability of establishing a maternity network to drive
the standardisation of care across Wales”, the Welsh
Government undertook the scoping.
In June 2013 the
Quality and Safety Sub Group of the Welsh Government’s
Maternity Strategy Implementation Group recommended that the
purpose of a maternity network in Wales should be:
- Ensuring
similarly high quality standards across the whole of Wales with
similar, but not necessarily identical, guidelines and
pathways
- Collation of
information across Wales for the purposes of audit, benchmarking
and improvement of outcomes
- Sharing
lessons learned widely across Welsh maternity services
- Enabling all
those involved in women’s health to interact more freely,
learning from each other and supporting each other
In March 2014, the
Health Minister wrote to the Director of the 1000 Lives Improvement
Service requesting that the service set up and run the Maternity
Network.
3.1
Network manager
The first task was
to appoint a network manager. A full time, permanent manager,
Claire Roche, was appointed and commenced in post on 21 July 2014.
Claire is a midwife who has worked in three different health boards
in South Wales, most recently as a Senior Midwifery Manager in
Aneurin Bevan Health Board.
3.2
Clinical lead
A clinical lead
post has been established to provide clinical leadership within the
network. This post was aimed at consultant obstetricians. The
clinical lead will work in partnership with the network manager.
Claire Francis, a consultant obstetrician in Cardiff and Vale UHB
has been appointed and wiill provide half a day per week to the
network for a fixed term of one year (after which the role will be
reviewed). She is due to start on 5 January 2015.
3.3
Steering group
A steering group
is being convened and is scheduled to meet on 26 January 2015. The
steering group will be multi-professional and aims to represent all
organisations involved in the provision of maternity services in
Wales. It will include health boards, the educational sector, the
Welsh Government and women who use the services. The steering group
will have the responsibility of ensuring that the network has clear
priorities and objectives, focusing on patient safety and quality
as well as the experience of women and their families.
The themes of the
Strategic Vision for Maternity Services in Wales (Welsh Government,
2011) will be a key driver for the work of the Maternity
Network.
3.4
National Stillbirth Working Group (NSWG)
The National
Stillbirth Working Group (NSWG) is being re-established as a sub
group of the Network and will be the highest priority for 2015. The
first meeting is planned for January 2015, as soon as the Clinical
Lead commences her post. The group will meet quarterly during the
year with an additional meeting planned for the first quarter to
develop momentum.
Membership of the
group has already been reviewed by the Network Manager and Clinical
Lead with a particular focus on ensuring that there is
representation from all health boards. The Heads of Midwifery and
Clinical Directors for Obstetrics in each health board have been
contacted and asked to identify who will represent their
organisations.
There will also be representation on the NSWG
from the Welsh Government, the All Wales Perinatal Survey and
Paediatric Pathology. Women and families will be represented by the
SANDS (Stillbirth and Neonatal Death Society) organisation.
The NSWG will be chaired by the Chief Nursing
Officer for Wales, Professor Jean White. The Network Manager will
meet with the CNO regularly during the period for which she chairs
the group, ensuring that she is fully briefed and updated before
meetings and during the intervening periods between meetings.
Prior to the meeting in January, all Heads of
Midwifery and Clinical Directors for obstetrics will be asked to
complete a self assessment for their organisations of the progress
made against the interventions agreed nationally (Appendix 1). This
will enable a thorough assessment to have been undertaken that will
inform the NSWG.
4
Perinatal Pathology Sub–Group (recommendation 8)
The Perinatal Pathology Sub-Group of the NSWG
has been reconvened to address the recommendation that:
“... the
Welsh Government publish a detailed plan of how it proposes to
tackle the problem caused by the low rate of post-mortem for
stillborn babies. The plan should include:
•
details of how
training will be delivered to Health Professionals in order that
they are better equipped to raise this very difficult issue with
grieving parents
•
details of what
improved information will be developed for parents so that they are
able to make more informed decisions
•
assessment of
the actions needed to improve the provision of perinatal
pathology.”
The sub-group will meet on Friday 5 December
2014 to assess progress in health boards with the consent training
package.
All Heads of Midwifery and Clinical Directors
for Obstetrics have been contacted and requested to nominate a
representative from their Health Board to attend this meeting. The
Cellular Pathology Services Manager of Cardiff and Vale UHB will
attend in addition to representatives from SANDS.
5
Public awareness and information (recommendations 1 and 2)
The NSWG has ensured that there is a good
representation of women (service users) in its membership. The
views and opinions of those who have used the service and, in
particular, have experienced the loss of their baby are essential
to informing this work.
Since being in post, the Maternity Network
Manager has had regular contact with the SANDS organisation. She
attended the Stillbirth Public Health Messaging Task and Finish
Group meeting in London on 23 September hosted by SANDS as the
representative for Wales. Phillip Banfield, a consultant
obstetrician from BCUHB, was also present. The aim of the meeting
was to bring together representatives from across the UK so that
feedback could be provided from SANDS on their project exploring
public health messages relating to stillbirth.
The team shared the learning from their
engagement with both women and midwives. Of particular interest
were the messages that women felt were important depending on their
experiences. Women who had experienced a stillbirth wanted to be
given as much information as possible. Women who had not had this
experience were more reserved about the information they would want
to receive. In particular, they did not want to be told anything
that they did not have control over, for example being in a
deprived or vulnerable group of women.
The proposed narrative and design of a patient
information leaflet was shared with the group. It was reviewed and
comments were made.
Since the meeting, communication has continued
between the devolved nations of the United Kingdom. A draft
consensus statement on reducing the risk of stillbirth was
circulated in November 2014. The Maternity Network Manager shared
it with the Welsh Government and the Heads of Midwifery and
Clinical Directors for Obstetrics to coordinate a response from
Wales. The response to the Department of Health was submitted on 23
November 2014.
The Maternity Network will continue to engage
with this national work to develop public health messages as a
matter of priority to ensure that all expectant parents receive
adequate information about stillbirth and its associated risks.
The NSWG will also ensure that the key
messages are shared with clinicians so that they can be given to
women while the leaflet is being developed. Written information
alone will not be as effective as well informed clinicians who are
confident to deliver the messages.
6
Women who deliver more than thirteen days after their due date
(recommendation 5)
The Transforming Maternity Services
Mini-Collaborative Welsh Initiative for Stillbirth Reduction
Progress Report (March 2014), acknowledged the challenge of
reviewing women giving birth more than thirteen days after their
expected date of delivery.
The collaborative identified that the numbers
of women were very high and, through cross reference of data sets,
found that information was inaccurate. The report explained that
this was a reflection of the available maternity information in
Wales and the lack of a Welsh national data set. It suggested that
this would need to be explored further beyond the timeframe of the
collaborative.
The issue will now be addressed by the NSWG.
It will be a specific item for health board self assessments and
will be on the agenda of the January 2015 meeting.
7
Conclusion and way forward
The Transforming Maternity Services
Mini-Collaborative (March 2011 -March 2014) assisted health boards
to agree interventions to be implemented with the aim of reducing
stillbirth rates in Wales.
The Maternity Network will now take
responsibility for facilitating and supporting health boards to
work collaboratively to achieve this shared aim.
A permanent Maternity Network that is not time
limited will strengthen partnerships between health boards, the
Welsh Government, education providers, Royal Colleges, third sector
and of course the women and families who use the services.
While the NSWG will specifically focus on the
continued work required to progress the interventions in the Welsh
Initiative for Stillbirth Reduction driver diagram (Appendix 1),
other work streams of the network will also contribute to this
work.
The network will address quality and patient
safety. The Network Manager and Clinical Lead are keen to address
the issue of having a national Maternity Dashboard and for each
Health Board to have a dashboard that reports on the same
parameters. Having a baseline in Wales that avoids variation in the
way data is reported will be the first and crucial step to take
forward a national approach to risk reporting, the identification
and avoidance of harm, reduced variation and management in
maternity services in Wales. The Network Steering Group will be
asked to consider this issue when it meets in January 2015.
8
References:
Welsh Government (2011) “A Strategic
Vision for Maternity Services in Wales” www.cymru.gov.uk
Welsh Government (June 2013)
“Welsh
Government Maternity Strategy: Report from Quality
and Safety Sub-Group” www.cymru.gov.uk
Welsh Government (July 2013)
“A Maternity Network for Wales: Scoping Paper”
www.cymru.gov.uk
