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NMPA newsletter, December 2016

Welcome to the first NMPA newsletter. The National Maternity and Perinatal Audit (NMPA) is a new large scale audit of the NHS maternity services across England, Scotland and Wales.

Feature: NMPA Midwifery LeadershipTina Harris Senior Clinical Lead for Midwifery

I am Tina Harris, the Senior Clinical Lead for Midwifery on the National Maternity and Perinatal Audit (NMPA).  I work with the audit team one day a week.  The rest of the time, I work as a midwifery educator and researcher at De Montfort University in Leicester. My research interests include practice variation, a key driver for the audit’s work. 

I am really excited about the potential the audit has to help us all understand practice variation better. 

Currently, we know what happens in our own units, and we can benchmark ourselves nationally on key markers such as caesarean section rates.  However, we know that up and down the country, midwives assiduously collect large amounts of information about the women we care for, their history, their delivery and their babies.  We have limited ways at present of using this data to see if what happens down the road or across the country is different from what happens in our own units. 

The audit will use this data, which is already available, to answer questions and provide more sophisticated information about service provision and variation.  For example, by linking mothers to babies we will be able to see whether babies have different rates of being admitted to a neonatal unit.  This will allow units to investigate why they have a low or high rate and see if changes should be made. 

The first task of the audit is to conduct an organisational survey, which maternity units across England, Scotland and Wales will be receiving in January 2017.  I am particularly excited that we will be mapping out both midwifery-led and highly specialist services, which will show what choices are available to women when planning place of birth, and where specialised services are concentrated. 

As a midwife for almost 35 years I am delighted to bring my expertise in practice, education and research to this highly important, HQIP funded initiative, to provide national audit data to support quality improvement for mothers and their newborn babies.  This project, with equal input from both midwifery and obstetrics, represents a unique opportunity to evaluate and improve maternity and newborn care. 

Get to know the NMPA team

There’s a small, dedicated team of people based at the RCOG who work on the NMPA. If you email or call them with a query, they will endeavour to get back to you as soon as possible. Here they are and this is what they do:

NMPA team

  • Hannah Knight is the NMPA programme manager. She’s almost always available by email or phone to answer any queries you might have.
  • Andrea Blotkamp and Jen Jardine are our clinical fellows for midwifery and obstetrics respectively. We like to call them the ‘engine’ of the audit – they provide day-to-day clinical support to the team and support the audit’s development in all sorts of ways.
  • Lindsey Macdougall is our data manager. She will be keeping tabs on data collection, answering queries about data transfer and making sure that we strictly comply with the regulations for data confidentiality.

The team is supported by three senior clinical leads, Dharmintra Pasupathy (obstetrics), Tina Harris (midwifery) and Jane Hawdon (neonatology), as well as academics from the London School of Hygiene and Tropical Medicine who have expertise in national audits and service evaluations (Jan van der Meulen, Ipek Gurol-Urganci and David Cromwell).

Since the NMPA began in July 2016, the team has been busy setting up the programme and preparing for the start of data collection. 

In our next newsletter we’ll introduce you to the NMPA Clinical Reference Group, who oversee and advise on everything we do.

Coming soon: NMPA Organisational survey

NMPA Organisational survey The NMPA will start with an organisational survey to ensure that we can put the findings from the clinical audit into context. For example, the presence and designation of a neonatal unit could have an impact on the complexity of the women giving birth at a unit, as would the availability of some specialist services.

As all Trusts and Boards across England, Scotland and Wales are expected to participate, the survey will provide a unique opportunity to map out available services and to enable maternity services and commissioners to compare like with like. In combination with the clinical audit findings, the survey will also provide insight into the possible impact of organisational factors on variation in practice and outcomes.

We would like to express our gratitude in advance for the invaluable help of each maternity service.

The organisational survey will take place during January and February 2017. All Heads/Directors of Midwifery (HoMs) will be sent details to complete the survey online. The survey is aligned with previous national organisational surveys of maternity services, updated in the light of the national maternity review and current standards and guidance.

The survey will consist of questions about the trust/health board as a whole and questions specific to the different maternity units within each trust/health board. It will include questions about unit types, bed numbers, available services and aspects of care. Questions are tailored as much as possible to each organisation and according to responses. We will also make use of existing data where possible (such as national workforce datasets and Safe Staffing data) to minimise the time needed to complete the survey.

To facilitate completion of the questionnaires, the HoMs as main respondents will be able to forward their survey link and log in details to colleagues such as obstetric or neonatal lead clinicians or midwife-led unit leads. These can then complete relevant questionnaires or sections. A printable version of the questionnaires will also be available to help gather some of the information required prior to completing the online questionnaires.

The NMPA team can be contacted with any questions or issues via, with ‘Organisational survey’ in the subject line.

Electronic Maternity Record Systems – what you’ve told usElectronic Maternity Record Systems map 

We’d like to say a big thank you to the HoMs at all NHS trusts/health boards who took part in our survey about electronic maternity record systems. You helped us to achieve a 100% response rate.

The purpose of the survey was to determine which electronic maternity record systems were in use in English and Welsh trusts/health boards to help inform our approach to data collection. The existing national datasets in Scotland (SMR-02 and SBR) already contain the information needed for the audit, so we won’t be collecting data from local systems in Scotland.

The survey found that in total there are 247 sites providing intrapartum care across the 141 trusts/health boards in England and Wales. Each trust/health board has between 1 and 7 sites. Of these sites, 118 are obstetric units with alongside midwifery led units, 55 are obstetric units only and the remaining 74 are freestanding midwifery led units.

Of the 137 trusts/health boards who gave us details of their maternity record system, all but 2 have an electronic system of one kind or another. The map shows the location of each NHS trust/health board, and the electronic maternity record system in use*. There are 4 trusts/health boards with their systems still marked as “Unknown”: these are currently being followed up because we need some more information from them.

View the interactive Electronic Maternity Record Systems map.

*Two trusts have separate sites using different electronic maternity record systems: Frimley Health NHS Foundation Trust and the Royal Free London NHS Foundation Trust.

Electronic Maternity Record Systems graph