Question to the Department of Health and Social Care:

To ask Her Majesty’s Government whether the Care Quality Commission’s new maternity inspection framework and NHS England’s new maternity commissioning guidance will explicitly refer to the need to demonstrate how providers are actively working to reduce the much higher risks of still birth, neonatal death and clinical negligence claims among multiple pregnancies.

The Care Quality Commission (CQC) is the independent regulator of health and adult social care providers in England and has supplied the following information:

The current version of CQC’s core service framework does not refer explicitly to multiple births. CQC is currently reviewing the framework and they are working with organisations such as the Twins and Multiple Births Association to determine how best to ensure their new framework takes account of the risks associated with multiple births. As part of the existing inspection framework CQC expects maternity services to have due regard to existing advice and guidance, such as NICE Quality Standard 46 which refers specifically to multiple births and risk assessments. Going forward the CQC will expect trusts to provide evidence of their compliance with these recommendations.

NHS England has informed us that its new maternity commissioning guidance will explicitly refer to the need to demonstrate how providers are actively working to reduce the much higher risks of still birth, neonatal death and clinical negligence claims among multiple pregnancies and how it will achieve this.

The Department together with the parent’s support and campaigning organisation Stillbirth and Neonatal Death Charity (Sands) and a number of key organisations including NHS England, Public Health England, the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists are working on an on-going stillbirth prevention work programme. This work identifies key messages which can be used to raise awareness among both pregnant women and health professionals of the risk factors for stillbirths and the actions that can be taken to minimise these risks.

The new maternity commissioning guidance will make reference to stillbirth prevention work and will focus on identifying the evidence based interventions which impact on reducing stillbirths and early neonatal death.

NHS England has been working with many stakeholders on collating a package of interventions and best practice models to reduce stillbirths which will result in recommendations for clinical practice and are likely to be included in future commissioning specifications for maternity. The NHS England – led “Saving Babies’ Lives” Care Bundle brings together a number of elements likely to impact on still birth rates including:

- reducing smoking in pregnancy by carrying out Carbon Monoxide test at antenatal booking appointment to identify smokers (or those exposed to tobacco smoke) and referring to stop smoking service/specialist as appropriate;

- identification and surveillance of pregnancies with fetal growth restriction;

- raising awareness amongst pregnant women of the importance of detecting and reporting reduced fetal movement; and

- effective fetal monitoring during labour.

The commissioning guidance will refer to sufficient provision of resource to support appropriate levels of these types of surveillance within the clinical practice environment.