Professor Tim Draycott, Vice President at the Royal College of Obstetricians and Gynaecologists writes...
When the Each Baby Counts (EBC) programme started in October 2014, our ambition was to reduce the number of stillbirths, neonatal deaths and babies born with severe brain injury related to complications during term labour.
This was an extremely important undertaking, highlighting how each baby in our report had a significant, life-changing effect on the women, their families, and also maternity staff. It is vital that we learn as much as possible from these births, so we can collectively work on improving maternity care for all.
The final report
This programme is now ending, and our 2020 final progress report published today will be our last. I think it is clear from the data that while progress has been made in certain areas, there are still too many avoidable stillbirths, baby deaths and brain injuries occurring during term labour in the UK.
This latest report will be the fifth in its series, and focuses on our analysis of care provided for mothers and babies born in 2018 and the lessons the system can learn. We have also provided a retrospective summary and review of the five years of the programme.
One of the most positive findings of the last year, and indeed the programme, has been that more parents were invited by the Trust of birth to contribute to the local review of their care, with a rise of 20 per cent from 2017 to 2018. This improvement is vital to good care, and the EBC programme was the first to both surface and measure this. It is crucial that parents are given the choice to be involved with options for different models of involvement to share their perspective.
It is disappointing that over the five years of the programme, we have not seen the reductions in avoidable stillbirths, baby deaths and brain injuries related to term labour that we had hoped for.
Ultimately, our ambition remains that no family should experience an outcome that, with best care, may have been different, and we should reflect on the programme to learn from and spread the positive elements.
Reflecting on the programme and looking ahead
We have sought feedback and reflections from reviewers and reporters, as well as stakeholders and organisations across the maternity safety landscape, with a focus on the intentions, impact and legacy of EBC, as well as the limitations and any potential vacuum left by the closure.
Of those interviewed, there was great positivity. Many highlighted that the EBC programme has successfully raised the profile of maternity safety and ‘gave a voice’ to our cohort of babies. EBC also established family involvement as an essential part of reasonable care.
Many participants also identified that EBC programme definitions have been adopted by other national initiatives, including the Early Notification Scheme at NHS Resolution and Healthcare Safety Investigation Branch (HSIB).
However, although identifying issues and making cogent recommendations are important, outcomes will not be improved without action, and more work is needed around implementing previous EBC recommendations.
These data will be useful in designing future programmes of work, and moving forward, we are addressing these issues: working to improve leadership and culture, implementing practical changes to improve electronic fetal heart monitoring, and using a positive deviance lens to understand what makes maternity units safe.
As this programme ends, the important work of investigation and reporting will be the responsibility of HSIB in England – but it is crucial that funding is provided for EBC programmes in the devolved nations.
We urge the UK Government to remain committed to its national ambition to halve the rates of stillbirths, neonatal and maternal deaths, and intrapartum brain injuries by 2025. The recent investigations at individual Trusts, and the publication of the interim Ockenden report, have to be a watershed moment for maternity services, with the entire health system recommitting itself to challenging safety issues head on. Reducing risk needs a holistic approach that targets the specific challenges of fetal monitoring interpretation and strengthens organisational functioning, culture and behaviour.
All maternity units across the country want to provide the highest quality of care for women and their babies, and programmes like EBC are a key part of that ambition. Future programmes would usefully aggregate care incidents into archetypes, produce tools to improve care, and implement and scale best care models.
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