Dr David Richmond, President of the RCOG, writes...
This year has been both rewarding and challenging for the RCOG. The principles of always putting the patient first, continually promoting a culture of zero harm, and improving patient safety need to be embedded in everything we do. We have therefore been continuing to position ourselves as leaders of the profession, advocating on behalf of women while always ensuring that quality standards in education, training and service provision are maintained.
At the beginning of the year the Kirkup Report of the Morecambe Bay Investigation highlighted failings in the provision of care to women and their babies. Tragic mistakes occurred over a period of ten years, with devastating consequences for babies, mothers, fathers and their families. We all have lessons to learn from this report and must view it as a blueprint for positive change in the future. The RCOG has committed wholeheartedly to improving safety in maternity care through working with others to implement the report’s recommendations. We have already been instrumental in promoting much closer multidisciplinary training, emergency skills and drills and outcome measurement with the Department of Health, Health Education England and other Royal Colleges.
We are leading NHS England Women’s Health Patient Safety Expert Group (WHPSEG), and continue to develop gold standard clinical guidance based on best practice to support our Members and Fellows in putting patient safety first. Over the last year alone fifteen new or revised guidelines have been published alongside patient information leaflets and videos.
In addition, the College has set up a UK Board to take responsibility for O&G issues such as revalidation and greater responsibility for advising trained doctors on professional issues. The Board will be responsible for the communication and implementation of the College’s work on clinical quality to UK members and also for listening to the voices of our Fellows and Members via an annual census, regular membership surveys, focus groups and specific membership research. From this we will be able to make recommendations for future RCOG work.
The RCOG’s own Working Party report ‘Safer Women’s Healthcare’, to be published next year, will focus on revising the standards for gynaecological and maternity care, while the Each Baby Counts initiative has been set up to review all incidents during term labour which result in stillbirth, neonatal death or severe brain injury, with the aim of reducing incidents by 50% by 2020. A preliminary report is due in 2016.
I also sit on the NHS England National Maternity Review chaired by Baroness Cumberlege. This major review of maternity services in England aims to modernise care for women and babies, and will be published early next year. Its main focus will be on how to achieve improved team working, promote the importance of inter-professional cooperation, reduce avoidable harm, improve both the physical health and mental wellbeing for the mother, the baby, and her family, and promote informed choice of care. A similar Scottish review has begun, with Prof Alan Cameron (Vice President, Clinical Quality) representing the RCOG.
Earlier this month, MBRRACE-UK published its annual confidential enquiry into maternal mortality. While there is good news that the number of maternal deaths is falling, the rates of death from indirect causes, such as epilepsy, heart disease and cancer, remain high and may have been prevented with better care. It is particularly saddening that around one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems and one in seven of the women who died in this period committed suicide. New guidelines from NICE, currently under consultation, along with RCOG Green-top Guidelines on topics such as thromboembolism, will provide evidence-based recommendations to help prevent these tragedies.
For me, the problem is not necessarily the evidence underpinning the guidance, it’s all about the implementation. Using the deaths from thromboembolism as an example, half were antenatal and half postnatal. Half of those were following caesarean section and in about 50% of the cases RCOG guidance had not been followed. It’s that recurrent theme which requires greater effort. Clearer pathways to timely specialist care must also be developed.
The findings of MBRRACE-UK’s report into perinatal mortality also showed an overall improvement in the rates of stillbirth and neonatal deaths; however, it is clear that we still face a challenge of further reducing the number of perinatal deaths, as well as addressing the existing variation of perinatal mortality rates across the UK. The Perinatal Confidential Enquiry, published in November, further highlighted missed opportunities and where better care may have improved the outcome.
In November, the Government announced its plan to reduce the rate of stillbirths, neonatal and maternal deaths and severe morbidity in England by 50% by 2030. This is something that the RCOG supports and it fits closely with our Each Baby Counts programme.
The Chief Medical Officer for England published her annual report last week, with a sole focus on women’s health. Key areas where improvement is needed have been identified such as pre-conception health, prenatal screening and perinatal mental health. For older women, the impact of menopause and pelvic floor dysfunction leading to urinary or faecal incontinence have at last been recognised as a national concern. The report also discusses incidence and mortality from ovarian and cervical cancer. It calls on the RCOG to audit treatment and survival trends in ovarian cancer and to ensure that subspecialty training in gynaecological oncology provides a basis for the reduction in mortality from this disease.
For some time we have been advocating a life-course approach to women’s health, promoting prevention rather than intervention, and placing women at the centre of their care throughout their life. Pregnancy is a window of opportunity to maximise health gain for the mother but equally for her fetus and baby in later life. The challenges of reducing health problems and deaths in mothers and babies due to contributory factors such as maternal obesity, poor diet and nutrition, lack of physical activity, high levels of alcohol consumption, smoking and poor sexual health are a ticking time bomb that must be addressed via education and support that we, working closely with our clinical colleagues and key stakeholders, can help to provide.
On the global stage the MRCOG, as popular as ever, is evolving with the ‘Part 3’ beginning next year. The Advanced Fellowship Programme (AFP) is being piloted overseas to mirror the successful Advanced Training Skills Modules (ATSMs) we have in the UK. Projects such as those in Uganda (Kitovu) and the expanding and highly successful Leading Safe Choices in Tanzania and South Africa are extremely exciting. The latter in particular is likely to grow further with other bids for funding being submitted.
I come to the end of my three-year tenure in September. A new team of Officers will be elected during May and July, but first we must implement the changes recommended by the Governance and Representation Working Parties, particularly surrounding the election of the President. I have intimated the proposals previously and will issue resolutions in early January for us all to vote upon at a General Meeting in mid-February.
It has been a pleasure and an honour to be your President and I am looking forward to 2016. The energy and enthusiasm is just as strong as the day I started, new ideas and new projects seem to appear on a weekly basis!
I wish everyone a happy festive period and a healthy and prosperous New Year.