Quality and safety programme of work for Lancashire & South Cumbria local maternity and neonatal system (LMNS) 

Introduction

The National Quality Board (NQB) guidance on System Quality Groups and Shared Commitment to Quality (2021) advises that –

In Integrated Care Systems effective quality systems must serve three main aims for the Integrated Care Board, local authorities and partners:

• Timely insight and intelligence sharing into opportunities for learning and improvement, and issues that need to be addressed and escalated
• Positive assurance that statutory duties are being met, concerns and risks are addressed, and improvement plans are having the desired effect
• Confidence in the ongoing improvement of care quality, drawing on timely diagnosis, insight and learning. This includes confidence that inequalities and unwarranted variation are being addressed.

In relation to maternity services, The Ockenden Report (2020) details that the “Local Maternity and Neonatal System (LMNS) must be given greater accountability and responsibility so that they can ensure the maternity services they represent provide safe services for all who access them.” Ockenden further states that the LMNS must take on full and ongoing oversight of quality, ensuring that an understanding of the quality of maternity and neonatal services informs transformation. Alongside this, there must be clear routes of accountability with a formal, structured and systematic oversight of how their LMNS delivers its functions within the ICS.

The LMNS has a responsibility to ensure that robust quality reporting mechanisms are in place in order to discharge these responsibilities and ensure that processes are in line with emerging ICB quality structures (as outlined by the NQB).

Following the formal establishment of Integrated Care Boards on the 1st July 2022, and the statutory responsibilities of ensuring the quality and safety of services. The Local Maternity & Neonatal System (the maternity arm of the ICB) have developed and embedded a robust quality framework.

Main aims of the quality function

• To understand all relevant information for Lancashire & South Cumbria in relation to quality and safety in maternity services
• Ensure a robust governance process is in place with clear demonstration of reporting mechanisms

Also as determined by the NQB approach to quality systems:

• Create an open culture and learning system across the ICS that enables improvement across a shared understanding of needs and issues
• Take a Quality Management System (QMS) approach, defined in the Shared Commitment by the Juran Trilogy. QMSs offer a proven model for improvement, based on three functions: quality planning; quality control; quality improvement
• Move to an improvement culture to support assurance of sustained quality of care, rather than a performance management one
• Ensure a clear line of sight of quality performance, good practice, concerns, risks and mitigations from the point of care through to system leaders
• Be clear on accountabilities and responsibilities for quality
• Have a clear understanding of when to act on signals, respond together in a timely and proactive way, and address any gaps in intelligence.

How the LMNS monitors quality

Quality assurance panel

This meeting is undertaken in a bi-monthly basis and is chaired by the LMNS Associate Director.

The Quality Assurance Panel was established as a direct result of the Ockenden report and implementing a revised perinatal quality surveillance model (Dec 2020). It responsible for discharging the quality responsibilities below: 

• Overseeing quality in line with implementing a revised perinatal quality surveillance model.  
• Sharing information and learning in a structured and systematic way, working with partners to turn learning into service improvement.  
• Overseeing local trust actions from CQC inspection, CQC maternity survey’s and other independent reports/recommendations.
• Ensuring action is taken to improve the culture of maternity and neonatal services as a building block for safe, personal and more equitable care.  
• Ensuring there is ongoing shared learning and critical challenge.

Patient safety learning & oversight group

This meeting is undertaken on a bi-monthly basis and is chaired by the LMNS lead obstetrician.

The purpose of the group is to support collaboration and system learning across the four local Trusts and networks within Lancashire & South Cumbria to ensure Safety Action 1 of the Immediate and Essential actions (IEA) from the Ockenden Report (December 2020) is implemented. This stipulates safety in maternity units across England must be strengthened by increasing partnerships between Trusts and within local networks. This requirement needs to be implemented fully to ensure safer outcomes are achieved for pregnant women and babies. 

The objective of the LMNS Patient Safety Event meetings is to identify high level themes, share learning, and provide a forum for peer and system  support and review. Embedding the learning system-wide will support and strengthen the implementation of the vision and recommendations set out in ‘Better Births’ to reduce the rate of stillbirths, neonatal and maternal deaths and brain injuries by 50% by 2025 

The membership for each of these meetings includes representation from all four maternity providers, key partners from North West Neonatal Operational Delivery Network (ODN), NWAS, Maternity & Newborn Safety Investigations (MNSI) and Maternal Medicine Network. These forums are an opportunity to review and triangulate data and intelligence from various sources, so as a system we can understand where trusts are in relation the outcomes and quality metrics. Additionally, these forums provide an opportunity to identify if further support is required

Maternity incentive scheme and saving babies lives

As part of the national safety programmes of work to reduce stillbirths, neonatal deaths, brain injuries; Saving Babies’ Lives (SBL) V3 and Maternity Incentive Scheme (MIS) Year 7 compliance is monitored by the LMNS. 

On an annual basis, the LMNS undertake quarterly assurance visits with each of the Trusts to review progress and evidence, and to identify if any additional support is required in order to ensure full compliance is achieved. 

Each trust will have a minimum of 4 visits, with the option to increase as required.

Annual assurance visits

In addition to the MIS/SBL programme of visits, an annual assurance visit will be undertaken with each of the trusts. The purpose of the assurance visit is for the LMNS to have oversight and gain assurance from maternity and neonatal service providers in relation to perinatal quality and safety, priorities set out in NHS England » 2025/26 priorities and operational planning guidance  and the Three year delivery plan for maternity and neonatal services.  

The visiting team will include membership from the LMNS, Regional Maternity Team, North- West Neonatal Operational Delivery Network (NWNODN) and Maternity & Neonatal Voice Partnerships (MNVP)

Reporting and escalation

As part of the quality framework there are agreed routes of reporting and escalation; which include the LMNS Board, ICB quality & outcomes committee regional quality group and the maternity performance oversight panel, chaired by the regional chief midwife.