News from the Local Maternity System in Greater Manchester and Eastern Cheshire

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Greater Manchester and Eastern Cheshire

Local Maternity System (LMS)

Autumn Newsletter

Issue 2




Welcome to the Autumn LMS Newsletter with updates from our team members on the many workstreams underway.

Maternity Safety

Chantal Knight

Since commencing my post in December 2018 with the Greater Manchester and Eastern Cheshire (GMEC) Strategic Clinical Networks and Health Innovation Manchester my focus has been to make important links with all the maternity providers and organisations in GMEC.The importance of my work has been received with positivity and I have felt very welcomed to all the teams I am involved with, so thank you for this.

One of my main deliverables of the role is to establish a process for learning from maternity incidents and excellence across GMEC.

Sharing of learning across GMEC is vital if we are serious in our drive to improve outcomes for women and families accessing our services.

The creation of a system to provide an external reviewer to serious maternity incidents is now underway. The aim is to extract additional learning which can shared across all providers preventing harm from similar themes. We have asked for interested clinicians to join our team of external reviewers. All enquires to our dedicated email: 

And finally, today is the first World Patient Safety Day - something close to all our hearts - and below you will find some personal messages from the team at the GMEC Strategic Clinical Networks about why patient safety matters to them. 

Chantal Knight

Maternity Safety Lead

Strategic Clinician Network/Health Innovation Manchester


Learning from Maternal Deaths in GMEC

A report on maternal deaths in 2018 for GMEC has been circulated to all heads of midwifery and governance leads. It is recommended each provider looks at the organisational learning to review their systems in place with regard to:

  • What escalation pathway have you in place for referral to outside agencies for staff to follow including a target date for outcome?
  • Do you have a failsafe in place with a robust process for follow up of all blood or specimen results?
  • How do you monitor women who repeatedly do not attend (DNA) appointments across multiple specialities e.g. antenatal clinic , sonography , community midwives and general practitioners?
  • Are clinicians aware of the specialist perinatal service based at GM Mental Health Trust (Laureate House) which is available 24/7 for advice regarding risks medication and potential admission to hospital for women with mental health issues?

Further learning from MBRRACE which publishes yearly reports on maternal deaths in the UK can be found here:

The next launch event for the 2019 report will be held in Birmingham on 19th November. More details here

patient safety strategy

The new NHS Patient Safety Strategy has now been published.

Click here to see the main report but also video clips from Aidan Fowler and Suzette Woodward on the key components of the strategy



NHS Resolution Learning

Latest learning from NHS Resolution case stories is available on the following here

One case has been highlighted for maternity services. Although this case occurred in an emergency department there is learning for maternity services, particularly in relation to triage and assessment of women on arrival to maternity facilities. GMEC have seen similar cases reported where delays prior to or after triage and a poor birth outcome has occurred.

Guidance published by the National Institute for Health and Care Excellence (NICE) in 2015 entitled ‘Safe midwifery staffing for maternity settings’ outlines examples of maternity red flags, and that a red flag should be considered when there is a ‘delay of 30 minutes or more between presentation and triage’.

Therefore the following should be considered by maternity services:

• Do you have a standard for maternity triage waiting times? If yes, is this clearly displayed for maternity patients and their birth partners to see on arrival to the maternity unit?

• Are clinical and non-clinical maternity staff aware of the standard for maternity triage?

• Are maternity receptionists trained and informed of their roles and responsibilities in relation to providing information about waiting times?

• In relation to good practice, how are red flags escalated and monitored within your maternity service?


PReCePT Programme

PReCePT is a national programme (2018 – 2020) designed to reduce cerebral palsy in babies by administering magnesium sulphate (MgSO4) to mothers during preterm labour.

The data has shown a slow increase from 43% uptake in 2016 to 57% in 2018.The roll out of the national PReCePT programme and the recruitment of clinical champions has demonstrated a sharp increase and exceeded the expected national standard of 85% which is fantastic progress across GMEC.

The success of the programme has been achieved by the dedication of the PReCePT champions supporting clinicians with training and advising women of the health benefits of having MgS02 at a very difficult and stressful time, often going above and beyond the expectations of the role in personal commitment. 

Approximately 140 out of the 150 babies who were eligible across GMEC from commencement of the PReCePT programme received magnesium sulphate and evidence indicates 4 babies would be prevented from developing cerebral palsy and a life time of disability for families, as well as a reduction in expensive and extensive healthcare provision.

The PReCePT champions deserve recognition for the dedication they have shown to this mission and they have been nominated them for the Chief Nursing Officer Silver Team Award with the endorsement of Julie Cheetham (Associate Director, GMEC Strategic Clinical Networks) and Richard Preece (Executive Lead-Quality, Greater Manchester Health and Social Care Partnership).

Further updates will be included of this nomination in the next newsletter. 

A GMEC PReCePT is under creation and will be shortly shared for roll out across the region to standard best practice and assist clinicians to maximise the number of women receiving MgS02.



SCORE Survey

In conjunction with the Maternal and Neonatal Health Safety Collaborative (MNHSC), a national quality improvement programme working with maternal and neonatal services across England, 87 trusts have carried out safety culture surveys. Collectively this is the largest such survey in England and provides a snapshot of the safety culture of maternal and neonatal services, highlighting areas of strength and where improvement may be needed. Happier teams provide better care to patients and it is now accepted that good culture in the NHS is crucial to ensure that patients receive high quality care and better outcomes.

As teams work to improve systems and processes, it is important that they better understand their own culture to identify what works well and what can be improved with a collective responsibility to drive change.

Following the safety culture survey, the MNHSC has supported all Trusts with debrief sessions to begin the conversation with their staff about what action and improvement should follow.

All providers are now being actively encouraged to create their local improvement plans and initiate quality improvement projects - ultimately it is up to your team to use the results effectively.

World Patient Safety Day 17th September 2019.




Patient Safety: a global health priority

On the first-ever World Patient Safety Day on 17 September 2019, WHO will launch a global campaign to create awareness of patient safety and urge people to show their commitment to making healthcare safer.

Today is World Patient Safety Day. No one should be harmed in health care. And yet, every day, thousands of patients suffer avoidable harm while receiving care.  If you are a midwife ,doctor, nurse, pharmacist or health worker, engage patients as partners in their care. Work with the patient to create an open and transparent patient safety culture. Encourage blame-free reporting and learning from errors. Speak up for patient safety!

Patient safety is about working to prevent errors in healthcare that can cause harm to patients. Harm in this context means injury, suffering, disability or death. The errors that occur in healthcare are rarely the fault of individuals, but are usually the result of problems with the systems they work in.

wps 3




Up to 4 out of 10 patients are harmed in primary and ambulatory care settings


134 million adverse events occur each year in hospitals , contributing to 2.6 million deaths annually due to unsafe care


Up to 15% of hospital expenses can be attributed to treating patient safety failures



Clear policies, organizational leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed to ensure sustainable and significant improvements in the safety of health care.

The LMS are working across all work streams to incorporate safety as a key goal and improve outcomes for women and their families.







To endorse World Patient Safety Day, the SCNs team has been sharing its personal messages on patient safety .

Further information can be found here 

Quick link to10 facts on patient safety. 

Supporting Choice and Personalisation

The work continues to embed choice and personalisation within maternity services in GMEC. The information within the choices leaflet has been developed into an online resource together with information from each provider in order to inform women of their options for birth.

The work has been led by the Maternity Voices Partnership, ensuring that the website reflects what matters most to women and families. The website, ‘My Birth My Choice’, was launched on 20 August and continues to evolve.

The Pioneer work continues to develop in that we are exploring how we might expand the directory of services and information into a single point of access for maternity services. A working group has been established, working with the Northern Regional lead for Choice and Personalisation, Lynette Harwood. The aim of the group is to describe what a single point of access might look like, how it might be enabled using IT software providers and what it might cost. An options appraisal and case for change will be presented to commissioners in the Pioneer footprint and to the national team for consideration. It is hoped that we will be able to take this further and pilot one of the options.

Eileen Stringer

Clinical Lead Midwife    

Greater Manchester & Eastern Cheshire Strategic Clinical Networks

Continuity of Carer

mum and baby

The LMS workstream continues to gather information and data from maternity providers to measure progress against national targets. To date, the percentage of all women booked for maternity care being booked onto a continuity of care pathway is 26.35%. Providers are continuing to review their models of care against some operational challenges such as sickness & absence rates and recruitment difficulties. We are now starting to see some of the bookings from March 2019 translate into births on a continuity pathway. Further work is required to look at workforce requirements and other potential models to see if we can meet the required percentages with appropriate resources and operational changes.

Eileen Stringer

Clinical Lead Midwife    

Greater Manchester & Eastern Cheshire LMS

Pricing and Commissioning


Better Births Finance Update

Within Greater Manchester, work began on the cost implications and benefits received for role out of Better Births within the LMS foot print. Currently, we are working alongside our seven Provider colleagues and 10 CCG partners to understand what this may mean going forward. Heads of midwifery are currently working up proposals on new staffing models along with the proposed cost envelopes. We expect this to be completed some time in September. Further work is being supported with regards to both short term financial benefits and long term economic benefits alongside colleges from the GMCA within the economic team. This will be designed to test the assumptions around cost neutrality

Finally the SCNs are working alongside provider, commissioner and national payments team to understand the role out and implications of new guidelines around blended tariff for maternity. The purpose being to include some of the assumptions around cost pressures in the 2020 contracting rounds.

Craig Marshall

Finance Lead – Better Births

Greater Manchester and Eastern Cheshire LMS


Perinatal Mental Health



We held our first steering group on 12th September chaired by the SCNs' new Perinatal Mental Health Clinical Lead, Dr Sarah Jones.

Working groups are to be established to: assist in the developing of integrated pathways in all localities; development of outcomes dashboard; standardisation of obstetric liaison clinics and production of standards for the role of the specialist mental health midwife. The group was well represented by a wide range of stakeholders all engaged in improving perinatal mental health care. Newly established groups will continue looking at training/workforce and the needs of neonatal families.

The programme will be co-produced with service users, voluntary sector and/or peer support membership within all working groups.

Dr Pauline Lee (Parent Infant Mental Health Clinical Lead) continues to facilitate the delivery of commissioned training across GM.

Locality visits and  the delivery of workshops continue, to showcase an integrated perinatal and parent infant mental health whole system model, which includes: specialist perinatal mental health service (PNMH Community Mental Health Teams); improved access to perinatal IAPT; parent infant attachment service; home start/volunteer peer support programme and the roll out/support of the Dad Matters project across GM.

Jo Langton

Quality Improvement Programme Manager

Greater Manchester and Eastern Cheshire LMS

Manchester Smoke Free

jane coyne

Smoking remains the single most modifiable risk factor for infant mortality. Reducing smoking in pregnancy will positively impact child development outcomes and health inequalities. 

Nationally, a challenge has been set to reduce smoking rates in pregnancy to less than 6% by 2022, whilst increasing the choice and personalisation of service that women and their families are offered. 

In GM, we have committed to reduce smoking at delivery from its current rate of 11.9% to meet this target by the earlier date of 2021.  Our aspiration is that all babies will ultimately be born smoke free, as part of our vision to deliver a tobacco free generation within a decade.    

Smoking in pregnancy has been prioritised for immediate action as smoking in pregnancy rates have been declining too slowly and remain stubbornly higher than the England average (10.5%). The programme vision is to reduce smoking in pregnancy across and within Greater Manchester, through a standardised Smokefree pregnancy pathway which has seen investment in workforce development, equipment and a targeted intervention aimed at our highest risk population. 

The proposed scheme includes: 

System wide support for smoking cessation in pregnancy delivered via the babyClear model. babyClear is an evidence based approach, developed by the Tobacco Control Collaborating Centre (TCCC) to systematise and embed organisational change in line with NICE guidance and other policy recommendations to reduce the rates of smoking in pregnancy. It also includes a unique risk perception intervention for mums who continue to smoke at their booking scan.

A Smokefree pregnancy incentive scheme which targets a defined group of vulnerable women (teenage pregnancy, living in areas of high deprivation, living in areas of high smoking rates, smoked at point of delivery in last pregnancy) living in communities where smoking rates are highest, and who would find it hardest to maintain quitting without additional support​

Current performance has seen increases of CO screening at booking from as low as 20% in some localities to a pan GM average of 90%, increased levels of engagement with Stop Smoking services as high as 170% and four week quit rates as high as 83% (national average 28%).

Jane Coyne

Smoke-free Pregnancy Programme Manager

Manchester Health and Social Care Partnership

LMS at the NHS Health & Care Innovation Expo

Postnatal care in the LMS


The GMEC LMS presented at the NHS Health & Care Innovation Expo on 4th September, highlighting the opportunities and challenges of system-level planning. The panel included clinical leads and service user representatives. The discussion was around the journey towards the LMS, how service users have been involved, partnership working and the achievements that have resulted. There was great audience engagement, lots of questions and some inspirational words from Baroness Julia Cumberlege (pictured left) about how Better Births is here to stay!

Dr Richard Preece said about being on the panel, “It was great to share the work of teams across GMEC. When you pause and present the work you realise how much everyone’s done to improve support for mums, dads, and babies. The audience were listening closely, taking photos and notes, and writing tweets - it was really well received. Hopefully what everyone has done here will encourage others and give them ideas. It was a pleasure for me to share the stage with colleagues, but we were all very conscious that we were speaking on behalf of many others. Thank you.” 

mum and baby

Postnatal working group

The plans for improving postnatal care for women in Greater Manchester and Eastern Cheshire are gaining momentum. The postnatal working group has set its priorities, and an action plan has been approved at the Maternity Transformation Board. Task & Finish groups have been established to take the work forward. The groups will be looking at:

  • Co-production with women and their families
  • Reviewing the process for both NIPE checks, one within 72 hours and another within 6-8 weeks
  • Standardising an approach to the 6-8 week post-birth check for the mother
  • Improving breastfeeding rates
  • Communication between maternity and primary care

Colleagues across the LMS are working together to understand current service pathways and work out ways to improve them in line with the objectives.

Madha Ayub

Senior Project Manager | LMS

Greater Manchester and Eastern Cheshire LMS

Up Coming Events

Maternity Safety Event 5th November 2019 BOLTON

Join us to celebrate the fantastic work undertaken to improve maternity safety in GMEC and hear from national agencies on the latest progress. Save the date has been circulated and agenda to follow. Further details from