Developing and assessing implementation of world-class guidelines will help us to drive up the quality of women’s health care. This is at the very heart of our work, along with our Invited Review service and the projects being carried out by the Lindsay Stewart Centre for Audit and Clinical Informatics.
Each Baby Counts
Our national quality improvement programme to reduce the number of babies who die or are left severely disabled as a result of incidents occurring during term labour published its first report. This highlighted the need to improve the quality of local investigations into incidents during labour and to improve communication with families when incidents occur. Our next report will be published in June 2017.
New guidelines from NGA
We’re delighted with the early success of the National Guideline Alliance (NGA), one of two centres set up to produce guidelines on behalf of the National Institute for Health and Care Excellence (NICE). The new centre, which has taken the College into new areas of cancer, mental health and social care, represents significant growth in the RCOG as a centre of expertise and knowledge.
Quality care for women
Healthcare professionals can only deliver a safe service if they have safe staffing levels in both maternity and gynaecology units. That was one of the recommendations from our major report ‘Providing Quality Care for Women: Obstetrics and Gynaecology Workforce’. Published in November 2016, the report identified key workforce challenges and made recommendations to ensure those working in the specialty are supported to deliver high-quality, safe care. All units need to ensure a locally agreed safe and sustainable solution to address workforce issues to manage care in both obstetrics and gynaecology.
Lindsay Stewart Centre expands
Our Lindsay Stewart Centre for Audit and Clinical Informatics has continued to expand its work in 2016. The centre is now recognised for health service evaluation, the publication of national clinical indicators and clinical audit in obstetrics and gynaecology. As well as the Each Baby Counts project, it has also made significant progress in its other major projects such as the Obstetric and Anal Sphincter Injury (OASI) Care Bundle project and the National Maternity and Perinatal Audit.
Obstetric Anal Sphincter Injury (OASI) Care Bundle Project
With the number of women suffering from severe perineal tears increasing, the aim of this project is to provide a package of interventions designed to reduce the number of severe tears during labour through an increase in the use of standardised prevention practice. In this project, a collaboration with the Royal College of Midwives, local clinical champions from 16 sites are being trained to implement the bundle. The local champions will train their colleagues in techniques to reduce third- and fourth-degree tears. The evaluation of the Care Bundle’s implementation outcomes has begun via site visits and focus groups, with multiple contributors including the local champions, clinicians and women.
Clinical Indicators Project
In April 2016, we published 18 maternity indicators that can be used to compare the performance of English NHS trusts on a new website: indicators.rcog.org.uk. This work has now been subsumed within the National Maternity and Perinatal Audit which commenced in July.
Similar projects are now under way in benign gynaecology and gynaecological cancer.
In July 2016, the College was delighted to be awarded a £2 million contract by the Healthcare Quality Improvement Partnership to deliver the new National Maternity and Perinatal Audit (NMPA), in partnership with the Royal College of Midwives, Royal College of Paediatrics and Child Health and the London School of Hygiene and Tropical Medicine. For the first time, this audit will evaluate the quality of care received by women and newborn infants in order to identify good practice and areas for improvement in the care of women and babies looked after by NHS maternity services in England, Scotland and Wales.
The outputs from the audit will allow healthcare professionals, NHS managers, commissioners and policy makers to examine the extent to which current practice meets guidelines and standards and to identify areas for improvement.
We published 17 pieces of clinical guidance
The College brought in over £2.5 m from external grants and tenders to carry out quality improvement projects in the UK
We published 18 indicators for maternity care that can be used to benchmark services
“It would have made such a difference if, in the first few hours, someone had said ‘It is rare for a term baby to be born in such a poor condition, therefore we are going to conduct a review. We would like to involve you as much as possible’.”
Nicky Lyon Co-founder of the Campaign for Safer Births
Each Baby Counts
“Finley’s death could have been prevented”
Mel Scott supported the Each Baby Counts programme by talking about how she lost her son Finley during labour.
“I’m so pleased and grateful this RCOG campaign exists. I lost my own son Finley during labour in 2009, so I thought Each Baby Counts would be a valuable project to support as I’m now really passionate about reducing stillbirth.
“Finley’s death could have been prevented. Key opportunities to save him were missed. I was put on a monitor when I got to the hospital as there was meconium in my waters and we now know that the first cardiotocography trace was suspicious. I was 41+4 weeks when I went into labour and it was recognised that the opportunity to talk to me about the need for induction, and the risks of not accepting it were missed. There were also delays in a doctor seeing me due to the busy labour ward and queries over whether a different outcome may have occurred had I had one-to-one care on the labour ward.
“While no-one can say that Finley would have survived, having doubts about the path that my labour took is distressing to me. I wish that everything that could have been done had been done and I want to try to ensure fewer women go through this terrible experience.
“I really welcome the first report from the Each Baby Counts programme and two of the key messages which are that when something goes wrong a robust review is carried out and that parents are aware of the review and can participate if they want to.
“There was an investigation into why Finley died, but we weren’t allowed to contribute and weren’t given the results of that investigation. We had to go down the legal route and it took four years for us to find out about all the errors and the things that could have been done differently.
“We still weren’t able to go to court, so we went back to the hospital and five years after Finley’s death they opened an investigation that we were allowed to be part of. It’s really important as it gives parents a chance to contribute their concerns and helps them towards healing. Parents often say they knew something was wrong and this isn’t something that would be picked up as part of a review of the clinical notes.
“The focus on communication during labour is also important. When I was in labour with Finley, I had to call the midwife back to look at Finley’s heart rate dropping because they didn’t stay with me. It was really difficult to get my concerns heard and responded to.
“There needs to be improvements in these areas and projects like Each Baby Counts are so important in helping to make this happen.”