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  1. Content Article
    "How could we have predicted this outcome better in you?"  This was one question that has lingered with me since the Summit, raised by Dr Helen O'Neill. Why this question in particular? Because, if we are able to gain a deep understanding of the factors that contribute to good or bad outcomes, we will be better placed to assess individual risk and adapt practice to make sure all women receive safe, culturally sensitive and equitable care.  In this blog, I look at this question in relation to four key themes that came up throughout the day: listening personalised care embracing digital solutions improving data and knowledge representation Listening  Actively seeking and welcoming insights from those with lived experience or most affected by a healthcare service seems common sense, and yet is remains poorly embedded. Hearing and elevating the voices of patients and collaborating for safety was touched on many times throughout the day.  Kate Brintworth, Chief Midwifery Officer for NHS England talked early on about the need to listen more to women, reflecting that maternity services had not done this well enough to date: "We need to step out of the space of being the 'expert' and become the partner." This was echoed by others, who also highlighted the negative responses women can get when speaking up or advocating for themselves and their body. A barrier often caused by bias, racism, stress and a paternalistic clinician-patient power imbalance. Seeking ways to involve yourself as a patient in research design, data collection and advocacy was strongly encouraged. Get yourself a seat at the table and bring others with you, one speaker said. Tokenism will not work. The only way to understand what makes women feel safe or unsafe is to ask them. The only way to understand the barriers they have faced in accessing safe care is to ask them. These insights are vital in understanding outcomes.  Personalised care We heard many times throughout the day from people advocating personalised care. Holistic care that responds to need, vulnerability and the whole person. Care that enables deeper understanding and improved outcomes. Care that takes time and resource to get right.  One midwife attendee questioned whether the medical model was meeting the needs in maternity services. She talked openly about how the current system stunts her ability to provide much needed personalised care.  Dr Christine Ekechi talked about the rate of stillbirths and how it has increased for the first time in 8 years. She reflected that there is a growing anxiety in patients and staff about the care that can be provided. This, she said, is contributing to a fragmented relationship between the two.  Embracing digital solutions Opportunities to use digital health solutions to improve outcomes and patient experience were also talked about.  Professor Basky Thilaganathan spoke about a trial in 26 UK hospitals of a medical 'device' called Tommy’s Pathway which uses a dual-facing approach to engage both clinician and patient. The aim of this Clinical Decision Support Tool is to ensure that whatever your ethnicity, your outcome would be the same.  We were asked by his fellow panellist to reflect on that for a few moments.  To really let it sink in.  Whatever your ethnicity. Your outcome would be the same.  It could be a huge leap forward for maternity safety and health equity.  But barriers to embedding tools like this, despite evidence of their success elsewhere, were noted. Largely being attributed to bureaucracy. The need for digital advances to be translated into healthcare provision faster was discussed. However, questions were raised around the feasibility of this when our day-to-day healthcare IT systems seem so woefully inefficient, outdated and a constant drain on staff time.  If health tech solutions were found that could improve patient safety, questions also have to be asked about how accessible they are. If they are available to patients to buy privately, you are potentially widening disparities. We need to find a way to make digital solutions cheap and accessible to everyone... whilst protecting patient data. Improving data and knowledge After an in-depth discussion around menopause and menstruation, panellist Dr Nighat Arif summed it up beautifully, "We just don't know enough".  This lack of knowledge around women's health is a reflection of a system that was built on the white, male body and it plays out in many ways. Gynaecology waiting lists are long, with 1/3 women waiting up to three years before getting a diagnosis. Women undergoing IUD and hysteroscopy procedures are too often enduring severe pain and left with long term trauma and there is little understanding as to why pain experiences differ so much. When asked what an abnormal period is, Dr Arif said, " We don't actually know what a normal period is".  Staff need data, both qualitative and quantitative, to update and improve their practice. This requires funding. It means commissioning research that is co-designed with women. It means employing a critical eye over how statistics are presented to ensure the messaging is accurate and health inequalities are uncovered. Dr Mariya Kalgo talked about the dangers of 'correcting for race' when presenting data. How this can skew the findings to show that something is not a safety issue when in fact it is.  Representation The importance of representation in healthcare and the role it can play in outcomes was a topic that came up throughout the day. Panellists Dr Arif and Dr Aziza Sesay talked about their public facing work and the positive responses they have had to seeing a woman in a hijab talking about menopause, or a woman sharing information on 'how to check your vulva' that includes images of a Black vulva. One woman had written to Dr Sesay having seen this, to thank her for the video as it had led to her getting diagnosed and treated for cancer.  Representation can lead to better outcomes. We also heard about the value in being able to culturally relate to a patient as a clinician, to understand concerns, responses and needs within different contexts. To be able to deliver care in a culturally sensitive way that ensures the patient feels comfortable accessing the system to seek help and advice without judgement or bias.  Final thoughts To understand the factors that contribute to good and bad outcomes we need to start by listening better to women. This is true of the GP's consultation room, research design and digital developments.  Patients need to feel informed and empowered to question things. Staff need quality data, based on lived experience to evidence their practice. They also need the tools and resources to enable them to understand individualised risk and the time to provide personalised care.  Women's health has been the poor relation for too long. The stark statistics showing poorer outcomes for Black women and their babies in maternity care highlight an urgent need to co-design research and policy with those most likely to experience baby loss and complications.  Conversations shouldn't just include these voices, they should be led by them. 
  2. News Article
    Derby and Burton’s maternity services are now among the “most challenged in England”, requiring national involvement to boost improvements. The University Hospitals of Derby and Burton NHS Foundation Trust joins 31 other NHS trusts across England which are now under closer scrutiny aimed at improving the quality of maternity services. A report from the trust details that it asked to be added to the national NHS England Maternity Safety Support Programme (MSSP) "voluntarily". Midwifery and obstetric improvement advisors have now been allocated to the trust to spend two days a week on the trust’s sites and also to provide “virtual” assistance. A letter to Stephen Posey, the trust’s chief executive, sent by Sascha Wells-Munro, the deputy chief midwifery officer for NHS England, details that the organisation’s addition to the national support programme comes after a number of concerning reports – not just its request. It references the Healthcare Safety Investigation Branch report, published in February, which highlighted the cases of seven women and their babies between January 2021 and May 2022, with three mothers and a baby dying and four mothers suffering extreme consequences. Read full story Source: Derbyshire Live, 13 September 2023
  3. News Article
    Leaders of two maternity services have been told to take urgent action, after inspectors found understaffing and declining levels of care, despite safety warnings from midwives. Maternity services at University Hospital North Durham and Darlington Memorial Hospital have been downgraded from “good” to “inadequate” in Care Quality Commission reports, published today. The CQC noted a “concerning deterioration” in the care the two services provided, despite midwives telling managers they felt the service was unsafe. Sue Jacques, chief executive of County Durham and Darlington Foundation Trust, which runs the hospitals, said the CQC’s findings would be taken “extremely seriously”. The reports also said staff reported “feeling ‘frozen out’ or that their concerns were ignored by leaders” and that staff felt “‘continuity of carer’ was the trust’s main focus, despite depleted safe staffing levels, skill mix, and staff being pulled in to cover acute areas on a frequent basis”. Last year, trusts were told not to pursue continuity of carer models – which were previously championed by NHS England – unless they had adequate staffing levels to do so safely. Read full story (paywalled) Source: HSJ, 15 September 2023
  4. Content Article
    Recommendations The report makes a number of recommendations, including calls to: support external clinical input into the rigorous review of all stillbirths and neonatal deaths across the UK, to identify learning and common themes related to clinical care and service provision, delivery and organisation. ensure healthcare providers adopt and use the BAPM Perinatal Optimisation Pathway, to improve preterm outcomes. continue to develop and implement targeted action, at national and organisational levels, to support the reduction of direct and indirect health inequalities. review perinatal pathology services as a national priority, and ensure equity of access to all modalities of post-mortem examination.
  5. News Article
    Women are being "failed at every stage" when it comes to maternity care, say campaigners, as they call for more support for those experiencing traumatic births. Mumsnet found 79% of the 1,000 women who answered their questionnaire had experienced some form of birth trauma, with 53% saying it had put them off from having more children. And according to the snapshot of UK mothers, 44% also said healthcare professionals had used language implying they were "a failure or to blame" for what happened. Conservative MP Theo Clarke is leading calls for more action after her own experience, where she thought she was "going to die" after suffering a third degree tear and needing emergency surgery. Now, she has set up an all party parliamentary group on birth trauma. She said: "[It is] clear that more compassion, education and better after-care for mothers who suffer birth trauma are desperately needed if we are to see an improvement in mums' physical wellbeing and mental health. "It is vitally important women receive the help and support they deserve." Chief executive of Mumsnet, Justine Roberts, said the trauma had "long-lasting effects", adding: "It's clear that women are being failed at every stage of the maternity care process - with too little information provided beforehand, a lack of compassion from staff during birth, and substandard postnatal care for mothers' physical and mental health." Read full story Source: Sky News, 15 September 2023
  6. News Article
    A trust facing a police investigation into one of the NHS’s largest ever maternity scandals is no longer rated ‘inadequate’ by the Care Quality Commission in its well-led and maternity domains. Nottingham University Hospitals Trust was rated “inadequate” for its leadership and maternity services during inspections in 2021 and 2022, following serious care failings exposed by staff and patients during this period. The Nottinghamshire police confirmed last week they were opening an investigation. But the regulator noted improvements after its well-led and maternity inspections which took place in April and June. The well-led rating has gone up from “inadequate” to “requires improvement” and maternity services at both hospitals have also gone up to “requirements improvement”. Greg Rielly, CQC deputy director of operations in the Midlands, said: “During this inspection, we saw a team that consistently led with integrity who were open and honest in their approach.” However, he stressed that while the culture across the trust was improving, some staff still didn’t feel able to raise concerns without fear of retribution. “Leaders were aware of this and were working to create a workplace that is free from bullying, harassment, racism, and discrimination so we hope to see an improved picture soon,” he said. Read full story (paywalled) Source: HSJ, 13 September 2023
  7. News Article
    A police investigation is to be launched into failings that led to dozens of baby deaths and injuries at a hospital trust. The maternity units at Nottingham University Hospitals (NUH) NHS Trust are already being examined in a review by senior midwife Donna Ockenden. The review will become the largest ever carried out in the UK, with about 1,800 families affected. Nottinghamshire Police said its decision to investigate followed discussions with Ms Ockenden. Her team is looking into failings that led to babies dying or being injured at Nottingham City Hospital and the Queen's Medical Centre. Chief Constable Kate Meynell said: "On Wednesday I met with Donna Ockenden to discuss her independent review into maternity cases of potentially significant concern at Nottingham University Hospitals NHS Trust (NUH) and to build up a clearer picture of the work that is taking place. "We want to work alongside the review but also ensure that we do not hinder its progress. "However, I am in a position to say we are preparing to launch a police investigation. "I have appointed the Assistant Chief Constable, Rob Griffin, to oversee the preparations and the subsequent investigation." Read full story Source: BBC News, 7 September 2023
  8. News Article
    Staffing shortages are likely to restrict the use of a beneficial painkiller in birthing suites, even once its use has been recommended by national guidance. Research by HSJ suggests that just over half of trusts are already offering remifentanil to women in labour, although some are having to restrict its use due to lack of staffing. Responses to freedom of information requests from 108 trusts revealed 55 offered remifentanil during labour in 2022-23. Recent draft National Institute for Health and Care Excellence guidance on intrapartum care, published in April, suggested healthcare professionals “consider intravenous remifentanil patient-controlled analgesia” in obstetric units. This is partly because it reduces the likelihood of forceps or ventouse being required compared to intramuscular pethidine (an opioid commonly used in labour). However, the drug is not yet mentioned in official NICE guidelines and the opioid’s use in labour is currently off-label (its more common licenced use is alongside anaesthesia in surgery). A Royal College of Anaesthetists spokesperson said the use of drugs off-label “is extremely common in obstetrics given that drug trials do not often include pregnant women”. Read full story (paywalled) Source: HSJ, 1 September 2023
  9. Content Article
    September 2023 - World Patient Safety Day, Patient Safety Partners, Patient Safety Strategy, improving patient safety culture, the International Dysphagia Diet Standardisation Initiative (IDDSI), checking medication. patient-safety-newsletter-september2023.pdf August 2023 - patient safety investigations, managing human & animal bites in UTCs/MUIs, weight settings for mattresses, Bournemouth Guidelines standardised training tool to support safe manual handling, cross system relationships. patient-safety-newsletter-august2023.pdf July 2023 - Medical Devices Roadshow, end of life care audit, SCFT Patient Safety Day, speaking up, Patient Safety Partners. patient-safety-newsletter-july2023.pdf June 2023 - Learning disabilities care bags, Heel Pro boots, Palliative Care for People with Learning Disabilities (PCPLD), “No reply, missed or deferred visits (Adults) procedure” policy, clinical audit and CQUINS. patient-safety-newsletter-june2023.pdf May 2023 - aSSKINg Framework, Freedom To Speak Up update, Patient Safety Partners recruitment, missed fractures, supporting staff with patient handling, staff safety. patient-safety-newsletter-may2023.pdf April 2023 - Intentional non-adherence in the context of ART, PSIRF, Patient Safety Partners, blocked catheters, patient moving and handling training. patient-safety-newsletter-april2023.pdf March 2023 - GripAble for upper limb rehabilitation, Mindray C2 AEDs, recruitment for Patient Safety Partners, Clostridium difficile infection, Bivona tracheostomy tube, therapy dogs. patient-safety-newsletter-march2023.pdf February 2023 - Patient feedback, Trust's Patient and Public Voice Policy, Patient Safety Partners, safe wheelchair risk assessment, referral to prolonged jaundice clinic. patient-safety-newsletter-february2023.pdf January 2023 - Dementia friendly ward, National Audit for Inpatient Falls (NAIF), investigation training, CQUINS, ePMA, Health Visitor teams. patient-safety-newsletter-janaury2023.pdf December 2022 - Supporting hydration (HCSW Innovation Idea project), deteriorating patient thematic review, investigation training, checking the right saline, Professional Nurse Advocacy, Medical Device Safety Lead. patient-safety-newsletter-december2022.pdf November 2022 - Reducing the use of fall alarms, wound photography, defining levels of assistance when moving patients, Duty of Candour. patient-safety-newsletter-november2022.pdf October 2022 - Reminiscence Interactive Therapeutic Activities RITA systems, pressure ulcers on heels, post falls checklist, importance of carers care plans, Datix and LfPSE. patient-safety-newsletter-october2022 (1).pdf September 2022 - World Patient Safety Day, ordering and fitting mattress toppers, PSIRF, Sussex interpreting services, risk assessment to prevent pressure sores. patient-safety-newsletter-september2022.pdf August 2022 - Thematic review to discuss falls on the unit, Duty of Candour requirement, reporting a pressure ulcer on Datix, UTC and learning disability health facilitation team table top, care home matrons. patient-safety-newsletter-august2022.pdf July 2022 - Collaboration with the IC24 Roving GP service, critical limb ischaemia, Genius 2 and 3 thermometers, implementing the Patient Safety Strategy, introducing Professional Nurse Advocates and Patient Safety Learning's hub. patient-safety-newsletter-july2022.pdf June 2022 - New visual fluid chart tool, bruising in children who are not independently mobile, end PJ paralysis campaign, investigation training and the importance of personalised communication. patient-safety-newsletter-june2022 (1).pdf May 2022 - Why frailty matters’ week, audit of unstageable pressure ulcers reported on Datix and risk assessing pressure ulcer equipment. patient-safety-newsletter-may2022 (1).pdf April 2022 - ICUs engaging in recent table tops to discuss the falls prevention on the ward, paraffin fire risk leaflet, improving the environment for patients with dementia and safeguarding babies. patient-safety-newsletter-april2022.pdf March 2022 - Patients leaflet on what to expect from therapy during ICU admission and the aim of rehabilitation on the unit, falls alarm, falls in toilets and bathrooms, food fortification, project to develop better tools to monitor food and fluid intake, new or changing confusion, and the importance of end of life care. patient-safety-newsletter-march2022 (1).pdf February 2022 - Homeless Health Inclusion Team, ensuring an MDT falls review, following the no response policy, End of Life Care plan and alerts on SystmOne. patient-safety-newsletter-february2022 (2).pdf January 2022 - patient-centred care, NEWS2 on paper, ensuring safe use of Smartcards, fluid balance charts and the importance of education. patient-safety-newsletter-january2022.pdf December 2021 - a PCN Quality feedback session, the impact of student projects, safe use of wheelchairs on the ICU, the delirium alert on SystmOne and the Herbert protocol patient-safety-newsletter-december2021 (1).pdf November 2021 - hover jacks, taking photos of pressure ulcers, enhanced care assessments, an update from the deteriorating patient and resuscitation lead, and ensuring effective communication. patient-safety-newsletter-november2021 (1).pdf
  10. News Article
    Campaigners have expressed alarm at new analysis showing a sharp increase in new or expectant mothers waiting for mental health care, with one woman found to have waited 319 days for a first appointment. More than 30,000 women who are pregnant or have newly given birth are on waiting lists for mental health support, according to NHS England data analysed by Labour, with the party saying many of them were being left to “suffer in silence”. Amid rising demand for what are known as perinatal mental health services, during the period from August 2022 to March 2023 the numbers of women waiting rose by 40%. Over that same period, the numbers who accessed support also rose, but only by 8%. Read full story Source: Guardian, 4 September 2023
  11. News Article
    A woman who suffered chronic abdominal pain for 18 months after undergoing a caesarean section was found to have a surgical instrument the size of a dinner plate inside her abdomen. The Alexis retractor, or AWR, was left inside the New Zealand mother after her baby was delivered at Auckland City Hospital in 2020. Following initial investigations into the case, Te Whatu Ora Auckland, formerly Auckland District Health Board, claimed it had not failed to exercise reasonable skill and care towards the patient, who was in her 20s. But on Monday, New Zealand’s Health and Disability Commissioner, Morag McDowell, found Te Whatu Ora Auckland in breach of the code of patient rights. Read full story Source: Guardian, 4 September 2023
  12. News Article
    Tonjanic Hill was overjoyed in 2017 when she learned she was 14 weeks pregnant. Despite a history of uterine fibroids, she never lost faith that she would someday have a child. But, just five weeks after confirming her pregnancy she seemed unable to stop urinating. She didn’t realize her amniotic fluid was leaking. Then came the excruciating pain. “I ended up going to the emergency room,” said Hill, now 35. “That’s where I had the most traumatic, horrible experience ever.” An ultrasound showed she had lost 90% of her amniotic fluid. Yet, over the angry protestations of her nurse, Hill said, the attending doctor insisted Hill be discharged and see her own OB-GYN the next day. The doctor brushed off her concerns, she said. The next morning, her OB-GYN’s office rushed her back to the hospital. But she lost her baby. Black women are less likely than women from other racial groups to carry a pregnancy to term — and in Harris County, where Houston is located, when they do, their infants are about twice as likely to die before their 1st birthday as those from other racial groups. Black fetal and infant deaths are part of a continuum of systemic failures that contribute to disproportionately high Black maternal mortality rates. “This is a public health crisis as it relates to Black moms and babies that is completely preventable,” said Barbie Robinson, who took over as executive director of Harris County Public Health in March 2021. “When you look at the breakdown demographically — who’s disproportionately impacted by the lack of access — we have a situation where we can expect these horrible outcomes.” Read full story Source: KFF Health News, 24 August 2023
  13. News Article
    The United States is in the middle of a maternal health crisis. Today, a woman in the US is twice as likely to die from pregnancy than her mother was a generation ago. Statistics from the World Health Organization show the United States has one of the highest rates of maternal death in the developed world. Women in the US are 10 or more times likely to die from pregnancy-related causes than mothers in Poland, Spain or Norway. Some of the worst statistics come out of the South - in places like Louisiana, where deep pockets of poverty, health care deserts and racial biases have long put mothers at risk. Dr Rebekah Gee: The state of maternal health in the United States is abysmal. And Louisiana is the highest maternal mortality in the US. So, in the developed world, Louisiana has the worst outcomes for women having babies." A third of Louisiana's parishes are maternal health deserts – meaning they don't have a single OB-GYN, leaving more than 51 thousand women in the state without easy access to care and three times more likely to die of pregnancy related causes. Read full story Source: CBS News, 20 August 2023
  14. News Article
    A teaching trust has had its maternity services downgraded to ‘inadequate’ after inspectors found stillbirths and massive haemorrhages were not being treated as ‘serious incidents’. Maternity services at St George’s University Hospitals Foundation Trust in south London were previously inspected in 2016, when they were assessed as “good”. The Care Quality Commission (CQC) said serious incident declaration meetings at St George’s were regularly classing serious incidents as “adverse incidents”, meaning executives were not informed and there were missed opportunities for learning and development. Inspectors also found incidents such as severe perineal tears, emergency hysterectomy, and birth injuries were rated as causing low or no harm when a higher level would have been appropriate, or and sometimes downgraded from a higher rating. Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said: “We saw areas where significant and urgent improvements are needed to ensure safe care is provided to women, people using this service, and their babies. “Both staff and people using the service were being let down by leaders who failed to respond quickly, resulting in care that was unsafe, and in the delivery suite, also chaotic.” Read full story (paywalled) Source: HSJ, 17 August 2023
  15. Content Article
    Key points Maternal mental health problems are common and can be extremely serious. Timely access to effective help can make a big difference to long-term health outcomes for mothers and generations to come Integrated care systems can ensure that comprehensive and evidence-based support is provided to women and birthing people during the perinatal period Maternal mental health care must be developed equitably, adapting to the needs of groups of women with higher risk and poorer access to effective support Universal services – midwifery, general practice, and health visiting – are vital to identify needs and provide timely support Access to NHS Talking Therapies is essential for women with many diagnosable mental health difficulties during the perinatal period Specialist community perinatal mental health services are a priority for the NHS Long Term Plan and can meet the needs of women with more serious and complex conditions Adequate provision of specialist Mother and Baby Inpatient Units prevents women being separated from their babies if they need to be admitted to hospital The voluntary sector, including peer support, plays a vital role and needs to be commissioned and properly funded
  16. News Article
    Women who struggle with their mental health have an almost 50% higher risk of preterm births, according to the biggest study of its kind. The research, published on Tuesday in the Lancet Psychiatry, examined data from more than 2m pregnancies in England and found about one in 10 women who had used mental health services had a preterm birth, compared with one in 15 who did not. The study also found a clear link between the severity of previous mental health difficulties and adverse outcomes at birth. Women who had been admitted to psychiatric hospital were almost twice as likely to have a preterm birth compared with women who had no previous contact with mental health services. And women with history of mental health difficulties faced a higher risk of giving birth to a baby that was small for its gestational age (75 per 1,000 births compared with 56 per 1,000 births). The study recommends that when pregnant women are first assessed by doctors and midwives they should be sensitively questioned in detail about their mental health. One of the reports authors, Louise Howard, professor emerita in women’s mental health at King’s College London, said such screening would help identify “clear red flags for a possible adverse outcome”. Read full story Source: Guardian, 14 August 2023
  17. Content Article
    Results from the Maternity Survey 2022 that this article highlights includes: Across the maternity pathway there has been a decline in the proportion of respondents who say they can always get help when they need it. Related to the availability of staff, the provision of information and advice has also dropped. While most (82%) respondents felt they were given appropriate advice and support at the start of their labour, this is a drop from 88% in 2019 and 84% in 2021. Almost a quarter of women and people who had given birth (23%) felt that when they raised a concern during labour and birth, it was not taken seriously. There are some areas of care that have seen an upward trend across the years. One of these is the experience of discharge from hospital, where around two-thirds of women and other people who had given birth report no delay to their discharge (62%, up from 56% in 2019). The results show an improved experience around support for mental health across the maternity pathway.
  18. Content Article
    The report lists the following highlights from HSIB’s maternity investigation programme during 2022/23: During 2022/23, the maternity investigation programme completed 702 reports. This was a similar figure to previous years. At any one time there were approximately 355 active investigations. The number of investigation referrals relating to brain injury indicate a sustained decrease in babies with abnormal MRI results or neurological damage. In the last year, the programme made more than 1,380 safety recommendations to trusts and other healthcare organisations, covering various topics. Families remain central to the work HSIB undertake. HSIB contact all families who give their consent; of these 86% agreed to participate and 14% declined further participation in the investigation. As part of HSIB’s initial engagement and ongoing communication with families they have been supported with interpretation/translation services on 670 occasions. Information provided to families about HSIB investigations has been translated into 36 languages. This helps families to make informed choices about participating in investigations and provides better support to enable their ongoing involvement. HSIB’s reports, and those of other organisations such as MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK), have identified racial differences in maternity outcomes. HSIB has formed a race equality group to develop the data from investigations to analyse demographics and understand the impact of racial diversity on experiences, access to care, and outcomes. The quarterly review meetings HSIB undertake with trusts have continued to develop with greater engagement from executive-level staff, board-level maternity safety champions, and the frontline perinatal teams. By working closely with trusts, the programme has helped to increase the involvement of perinatal teams in patient safety. The programme has deepened the understanding of the role of emerging themes and how they help to identify issues in the healthcare system as a whole that contribute to the harm experienced by pregnant women/people and their families. HSIB now publish a national newsletter three to four times a year to support trusts in sharing improvements they have made in response to safety recommendations, providing learning opportunities across England and beyond. A Maternity Quality Matrix is being rolled out to trusts to provide insight into their HSIB maternity investigations over time. Feedback is received from trusts and the HSIB Maternity Quality Improvement Team continues to improve investigations and support processes. During investigations, ‘soft intelligence’ relating to the investigation is captured in a maternity observational diary, which shares concerns as well as good practices with trusts, and information about ongoing challenges. Members of the maternity team ongoingly present at regional and national meetings to share their work and findings from reports.
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