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Angela Hayes, is a Nurse Fellow and Project Lead at The Centre for Sustainable Healthcare. In this blog, she tells us more about the Green Maternity Challenge and draws on three case studies to highlight it’s success in delivering low carbon, equitable and safe maternity care: local screening for newborn developmental hip dysplasia supporting breast-feeding reducing health-inequalities for Albanian-speaking women. Background With births totalling over 673,000 in 2022, maternity services contribute significantly to the overall carbon footprint of the NHS, and therefore, to the environmental crisis. Pregnant women and infants are particularly vulnerable to climate change, which exacerbate existing health complications. Women from ethnic minorities or disadvantaged backgrounds are disproportionately affected so significant health inequalities persist. The Green Maternity Challenge was delivered in partnership with the Centre for Sustainable Healthcare, The Royal College of Obstetricians and Gynaecologists, The Royal College of Midwives and The Sustainable Healthcare. It aimed to: address the environmental impact of maternity care improve health outcomes create a more sustainable, equitable healthcare system. Nine clinical teams in the UK were chosen and supported by CSH to develop a Sustainable Quality Improvement project (SusQi) and measure its impact. Examples of impact Local screening for newborn developmental hip dysplasia - Orkney Due to geographical limitations, access to advanced equipment and specialist care and skills can be limited. Presently, families need to travel to Aberdeen with their newborns for the Ultrasound Newborn Screening for Hip Dysplasia. This has the potential to negatively affect clinical outcomes for patients, particularly those from peripheral areas such as Orkney Island, due to increased travel time and delay in travel owing to unpredictable weather, longer waiting periods and inconvenience to families. Local screening programmes can reduce waiting times and increase access to healthcare. It can also allow for early management and intervention in newborns. A team in Orkney introduced local screening facilities for newborn developmental hip dysplasia and eliminated the need for travel to the mainland. The programme has created increased job satisfaction for staff and reduced stress, travel and delays for patients. The environmental savings projected are around 22,500 miles and costs savings rising to £17000/year. Supporting breast-feeding - Great Western Hospitals NHS Foundation Trust Breastfeeding is important because it improves the long-term health of both mothers and babies. Between 74-86% of birthing people start breastfeeding in the first 48 hours. Around 8% stop breastfeeding by the time they go home from hospital and a further 20% stop during the first two weeks at home. There are several reasons for this, but a lack of infant feeding support is a major contributor. Lack of support also contributes to 5-20 mothers and babies a month requiring readmission for jaundice, weight loss and tongue tie. Staff on the post-natal ward at the Great Western Hospitals NHS Foundation Trust hoped to improve breast-feeding rates through the implementation of daily feeding support groups. They demonstrated improvements in effective person-centred care, staff satisfaction and patient confidence. With breast-feeding rates up by 5%, they projected yearly savings over £4600, reductions in re-admissions and outpatient appointments, and environmental savings equivalent to driving almost 5000 miles. Reducing health-inequalities for Albanian-speaking women - Kingston Vulnerable groups such as migrants and ethnic minorities, face various barriers in accessing healthcare, and as a result, face poorer clinical outcomes. One such example is that of Albanian speaking women in Kingston. Comprising of 1% of all maternity care bookings at Kingston (as compared to the 0.2% national population), Albanian women face various challenges such as language barriers, asylum seeking status, poor socio-economic status, lack of support, histories of human trafficking and sexual abuse, and pre-existing mental health conditions. They are also subject to discrimination and culturally insensitive care. All these factors contribute to underutilisation of healthcare services, limited access to high quality care, concerns about confidentiality as well as lack of faith in healthcare system. Delay in getting timely and appropriate care can lead to poorer health outcomes, often necessitating more intensive and resource heavy treatments. The Olive Clinic in Kingston & Richmond midwifery team arranged for an interpreter to support their ante-natal clinic for Albanian-speaking women to support them during and after pregnancy. Impact studies are yet to be measured but qualitative data shows encouraging results from women and midwives. Summary There are many more examples and case studies but these three particularly highlight how green initiatives can be aligned to patient safety improvements to make sure every newborn and every child receives safe care. With projected annual savings of £860,669, and carbon savings equivalent to 778,978 disposable nappies, they made a huge impact on sustainable and equitable maternity. Share your insights Do you have insights to share around balancing patient safety with sustainability? What are the challenges and opportunities? Contact the editorial team at [email protected] to share your ideas.

Join this webinar on “Safe Birth and Neonatal Care – Strengthening Healthcare Systems for Every Newborn” on 13 June 2025, from 3:00 to 4:00 IST. This webinar aims to address system-level gaps in maternal and newborn care in India. The session will bring together healthcare professionals, policymakers, and patient advocates to discuss referral mechanisms, care standards, and strategies to improve outcomes for mothers and newborns. Focus Area: Safe care practices for newborns and children. Strengthening referral systems and delivery care. Reducing preventable maternal and neonatal deaths. System-level recommendations for safer healthcare. Join us to be part of this critical dialogue on advancing patient safety for every newborn and child. Register

In this interview, Chris McQuitty, a clinical fellow at the Maternity and Newborn Safety Investigation (MNSI) programme, talks us through a new patient safety tool. COMPASS (Culture of Organisations and its iMpact on PAtientS’ Safety) is currently being piloted to help understand the impact organisational culture may have on patient safety in maternity settings. The tool was designed by Chris and Nicki Pusey, Maternity Investigation Team Leader at MNSI. This blog is part of our World Patient Safety Day 2025 series - Safe care for every newborn and every child. Why was COMPASS developed? COMPASS was created based on work carried out by the Patient Experience Library who conducted a literature review of over 10 years’ worth of avoidable harm enquiries, which included the reports on the maternity services at East Kent and Morecambe Bay. The work has been collated into a report called ‘Responding to Challenge’¹. The review demonstrated that poor organisational culture is a recurrent theme in avoidable harm, with significant impact on patient safety. Their work highlights how organisational culture remains challenging to quantify and articulate which hampers external bodies’ ability to provide insight to providers. Through our safety investigations it became evident that MNSI did not have a way to record and analyse cultural observations in a structured and evidence-based format. This inhibited us from feeding back our observations to organisations to help them see how their organisational culture might be impacting on patient safety. What are the aims of COMPASS? We developed COMPASS for two key reasons: To provide MNSI staff with a standardised process to record observations around organisational culture, empowering MNSI staff to articulate their observations to trusts in a structured and evidence-based manner rather than based on personal experience or individual interpretation of certain situations. To highlight to trusts areas where their organisational culture is contributing positively to patient safety, and areas where enhancing their focus will support and improve safer care to be delivered. There is already significant work being done to help trusts to improve culture and leadership within maternity services, and COMPASS is a tool designed to complement this by focussing on how organisations respond to and learn from patient safety events. How is COMPASS being used? COMPASS is currently being piloted in partnership with 12 NHS trusts in England and is due to finish at the end of May. MNSI staff are using COMPASS to gather observations about organisational culture that may have impact on patient safety, in a structured manner that reflects the findings from the ‘Responding to Challenge’ report. The findings are then collated and reviewed to determine how frequently these types of observations are occurring so we can assess the overall level of impact to patient safety that may be occurring within each of the specific areas. These findings are then shared with trust leadership teams to flag areas that may require attention or focus to improve safety and organisational culture and also highlight observations of culture that have had a positive impact on patient safety. What is next for COMPASS? After the pilot, and with the help of feedback from both MNSI staff and trusts who piloted the report, we hope to: Adapt the COMPASS tool to match the needs of both MNSI and organisations we work with to maximise the impact of the tool. Showcase the positive impact COMPASS has had on patient safety within maternity and newborn services. Share our learning through the development of COMPASS and explore how this can be utilised in other sectors to improve patient safety across healthcare. If feedback suggests that the tool is of value to both MNSI and trusts, we may seek to use COMPASS on a regular basis to help share our insights into organisational culture with trusts to help improve patient safety. How can people find out more? Introducing COMPASS: A new safety tool to help understand the impact of culture on patient safety MNSI has launched a new patient safety tool COMPASS Red Flag Tracker – a tool to help recognise the red flags for harmful healthcare cultures by the Patient Experience Library References 1. The Patient Experience Library's Responding to Challenge report April 2025 Do you have a safety tool or project to share? Are you implementing a change that has had a positive impact on patient safety? Could you share your insights, tools and knowledge to help others? Or perhaps you are at the start of the journey, seeking ways to address a patient safety issue that you've identified. Comment below (sign up for free first) or contact our editorial team at [email protected] to tell us more.

Ambulance services play a pivotal role in ensuring the safety of mothers and their newborns during urgent and emergency situations. These services act as the frontline responders, providing immediate care and facilitating timely transport to appropriate healthcare facilities. World Patient Safety Day, observed annually on 17 September, serves as a global platform to raise awareness about patient safety and encourage collaborative efforts to reduce harm in healthcare settings. The theme for 2025, 'Safe care for every newborn and every child', underscores the critical importance of safeguarding our youngest and most vulnerable patients from preventable harm. In the UK, ambulance services play a pivotal role in ensuring the safety of mothers and their newborns during urgent and emergency situations. These services act as the frontline responders, providing immediate care and facilitating timely transport to appropriate healthcare facilities. Their contributions are multifaceted, encompassing emergency childbirth assistance, neonatal transfers and the management of obstetric emergencies. In addition, many women and families will use the 999/111 service throughout the childbearing continuum, often using these services as a gateway to accessing maternity care. A recent review of Maternity and Newborn Safety Investigations (MNSI) highlighted that 6 in 10 independent investigations that met the criteria for MNSI involved the ambulance service. Out-of-hospital births, though relatively rare, present unique challenges for ambulance clinicians. Intrapartum care accounts for approximately 0.05% of emergency medical services' caseload, with only about 10% of these cases resulting in deliveries managed by ambulance staff. This limited exposure can lead to a decline in obstetric clinical skills, potentially impacting patient care. To address this, continuous training and simulation exercises are essential. For instance, the London Ambulance Service has developed a bespoke communication tool to support midwives in out-of-hospital settings, ensuring effective communication during the transfer of women or babies in emergencies and delivers bespoke mandated emergency training to its frontline clinicians. Such initiatives enhance the preparedness of ambulance clinicians to manage emergency deliveries safely; however, these are not standardised across services. Challenges and areas for improvement Despite their critical role, UK ambulance services face challenges that can impact maternal and neonatal safety. Incidents of delayed response times have been reported, leading to tragic outcomes. For example, a three-day-old baby named Wyllow-Raine Swinburn passed away after an eight-minute delay in answering a 999 call and a 31-minute wait for the ambulance to arrive. Although the delays were not deemed the direct cause of death, they highlighted inefficiencies in the emergency response system. In other cases, the lack of effective training for ambulance clinicians impacted upon the management of a time critical breech delivery, with tragic consequences. Such cases underscore the need for systemic improvements, including better resource allocation, enhanced training and the implementation of robust protocols to minimise delays in emergency response. Collaboration between ambulance services and midwifery teams is essential for improving outcomes in maternal and neonatal emergencies. The development of communication tools and training programmes exemplifies efforts to standardise information exchange during emergencies, thereby reducing the potential for errors and delays. Furthermore, ambulance services are increasingly recognising the importance of specialised roles focused on maternity care. For instance, paramedics with additional training in neonatal and maternity care can provide more comprehensive support during emergencies. Susie, a paramedic with the Northwest Ambulance Service, highlighted her passion for improving maternity care within the ambulance service, emphasising the importance of continuous professional development in this area. Conclusion As we observe World Patient Safety Day 2025, it is imperative to acknowledge and support the vital role of UK ambulance services in safeguarding mothers and their newborns during and following pregnancy. Continuous training, effective communication tools and collaborative practices are essential to enhance the safety and quality of care provided. By addressing existing challenges and building on successful initiatives, we can move closer to the goal of ensuring safe care for every newborn and every child from the very start. Further reading Exploring the pre-hospital setting for the emergency care and transfer of neonates: the role of UK ambulance and neonatal transport services Displaced risk. Keeping mothers and babies safe: a UK ambulance service lens An exploration of maternity and newborn exposure, training and education among staff working within NWAS Disparities In Access to the Northwest Ambulance Service during pregnancy, birth and postpartum period and its association with neonatal and maternal outcomes World Patient Safety Day 2025