Maternity safety – Updates from NHS Resolution and HSIB

On 26th March NHS Resolution and HSIB both issued important updates for those working within maternity trusts.

NHS Resolution – the Maternity Incentive Scheme during COVID-19

NHS Resolution has helped ease the burden on maternity trusts during the COVID-19 outbreak by suspending aspects of the reporting required under the Maternity Incentive Scheme (MIS) until 31 August 2020. The reporting period for MIS actions will be extended and will run from 1 September 2020 to 30 April 2021, although these dates are subject to review. Revised guidance will be provided to trusts directly.

The 10% uplift to CNST contributions will not be collected from April 2020 for the year 2020/2021.

Trusts are still asked to apply the principles of the ten safety actions, to report perinatal deaths to MBRRACE-UK and eligible cases to NHS Resolution’s Early Notification team in the usual way. Advice on prioritisation of reports to MBRRACE is included in the full announcement.

HISIB National Learning report

The Healthcare Safety Investigation Branch (HSIB) has published a national learning report (NLR) summarising the themes identified from maternity investigations undertaken between April 2018 and December 2019.

HSIB investigates maternity incidents that meet the criteria for the Each Baby Counts programme and also maternal deaths, replacing the previous use of trust internal investigations. Over 1,000 investigations have been initiated since April 2018 and 425 have either been completed or finalised (subject to factual accuracy review).

The NLR identifies eight themes that have emerged following completion of investigations. They are, in summary:

1. Early recognition of risk – This relates to the re-evaluation of maternal risk level in response to events occurring during pregnancy, including changes in maternal health and multiple episodes of reduced fetal movements. HSIB found that there could be a lack of follow up in terms of test results and referrals to specialist services, and that maternity staff needed to ensure that all measurements of fetal size were plotted on a chart so that potentially higher risk cases could be identified. This provides an opportunity for the choice of delivery setting to be reconsidered.  
2. Safety of intrapartum care – This theme considers the advice provided to mothers in the early stages of labour, usually over the telephone. The report makes recommendations for cases where early clinical attendance upon signs of labour is important, and when the ‘4cm rule’ should not be applied.
3. Escalation – Clinicians seeking support from a more experienced colleague should be empowered to do so directly, in the absence of complex processes or hierarchy. ‘Fresh eyes’ reviews must be aware of the potential for confirmation bias.
4. Handovers – There must be adequate time and resource to carry out safe patient handovers, between shift changes, teams or during escalation of care.
5. Larger babies – The risks associated with the delivery of large babies should be discussed with mothers to ensure that choices are fully informed. Staff should have training to ensure that they can anticipate potential adverse events and prepare for them.
6. Neonatal collapse alongside skin-to-skin contact – In some cases, due to exhaustion or sedation, mothers were not able to see or reposition their baby in the immediate postnatal period. The NLR therefore emphasises the importance of staff actively assessing the child for subtle changes that could indicate compromise in the first few minutes after delivery.
7. Group B Strep – The identification and escalation of care for babies who show signs of GBS infection following birth could be missed. The report emphasises the importance of ensuring that mothers are aware of a positive GBS test, to avoid delays in the administration of antibiotics.
8. Cultural considerations – Misunderstandings between parents and staff were more common in some ethnic groups, and the report notes that a generally assessed good understanding of English may not mean that all aspects of a discussion regarding care can be understood. The report considers the use of translation services and cultural expectations or perceptions that can impact on care.

HSIB will be publishing further guidance and NLRs to expand on the learning relevant to these themes in due course.

If you would like to discuss this or any of the initiatives on maternity safety, please contact your main contacts: Andrew Leslie (Maternity and Early Notification scheme lead) or Rebecca Hunt.

For further updates and other articles discussing the impact of the coronavirus please view our coronavirus hub.