4.1 Closure of the programme
There was a mixed set of feelings relating to the closure of the programme, with a number of interviewees stating that they felt a sadness at Each Baby Counts closing and a subsequent concern about the work being forgotten or lost.
That said, there was a balanced number of responses feeling that the programme has run its course, that the rates of outcomes identified in the original ambition of the programme have not been reducing as was hoped and that now work should be concentrating on how to implement the findings and change practice instead of continuing to report on the same issues.
“I feel very sad [about Each Baby Counts closing]. I feel it’s going to leave a big hole. It’s been a project that’s been highly respected by organisations.” (Governance Midwife)
“I think it has run its time. You can’t keep collecting the data and observing the same problem. The most important thing now is that we turn it into action and implementation and then it will really have made a difference, and that’s the most important part of these programmes, the impact.” (Director of Safety and Learning, NHS Resolution)
For many of the interviewees, one of the greatest ‘gaps’ being left by the closure of Each Baby Counts is the impact on the devolved nations. The work of HSIB is continuing the legacy of Each Baby Counts to some degree in England, but Scotland, Northern Ireland and Wales will need to consider their options for continuing this type of work in their respective nations. The small number of cases in these countries was identified as a potential issue, which reflected the added value brought by the UK-wide approach of Each Baby Counts.
Reporting to Each Baby Counts has often been seen as a duplication of effort and as just one more initiative in an ever-growing landscape of maternity safety programmes. For many, this repetition (particularly with the lack of new findings emerging) was frustrating – having to report the same or similar cohorts of babies to three or four organisations was seen as time-consuming and unnecessary. The future of work like this needs to take into account other existing and upcoming programmes and really strive for streamlining and the coalescing of intentions.
“Important to reduce the amount of players in that space and then widen their influence in this sphere.” (Consultant Obstetrician and Gynaecologist)
4.2 Future priorities
Further suggestions for future work of this type were focused on the implementation of the Each Baby Counts recommendations. For many, there has been a value to a programme like this being in existence and that, having brought these issues to the national agenda for maternity safety, work needs to be done to carry on the legacy and further drive towards improving outcomes.
“Keeping a programme going in itself keeps people thinking and keeps people alert to events [...] just the fact that something is ongoing can improve outcomes.” (Consultant in Neonatal Medicine)
“I don’t think we can let this area of harm go [...] I would not want to see in 5 years’ time that nobody remembers EBC.” (Head of Maternity and Neonatal Safety, NHS England and NHS Improvement)
Suggestions for future work were not abundant, but some offered thoughts around exploring the international research context of similar work and what could be learned from others working in this area. More widely, concerns around who would be responsible for continuing the Each Baby Counts legacy, for implementing and evaluating the findings, developing training and learning packages from the thematic findings, and ensuring that the quality of the local reviews continues to improve are all areas that could be a focus of future strands of work from Each Baby Counts.
“We’re all trying to solve the same problem, so what is the international research around about what works?” (Director of Safety and Learning, NHS Resolution)
“Going forward [...] what do we do with the learning, what learning packages can we develop, how can we implement them because the College has that clinical credibility and clinical know-how. I would want to see that EBC maintained a unique presence and a link with the College.” (Head of Maternity and Neonatal Safety, NHS England and NHS Improvement)
Finally, one of the overarching findings from this qualitative work is the sense that, on the whole, the maternity profession – including all disciplines involved in the care of women giving birth – are striving to improve care and outcomes. Committing time and investing energy in maternity safety programmes such as Each Baby Counts, often with no financial incentive and no resource or time allocation, demonstrates the keenness of these professions to ensure that babies do not die or acquire harm during the process of labour and birth. For the families affected by these outcomes, this work does not go unnoticed, but the impetus to continue to improve and make these vital changes cannot be left to break down, essentially leaving families questioning what changes have been made as a result of their and many others’ previous heartbreaking experiences.