Public Health Prevention

Prevention is central to achieve Better Births in the North East

Both LMS boards, with the North East Association of Directors of Public Health, agreed seven ‘must-do’ priorities to improve population health within maternity services. Focussing on tobacco, immunisations, perinatal mental health, alcohol, breastfeeding, healthy weight, & making every contact count (MECC) from summer 2018, a funded LMS Prevention Lead has been leading the work with Heads of Midwifery and maternity staff to embed priorities into clinical pathways. A Prevention Practitioner has recently joined the team to add operational support. Leadership from an LMS strategic governance group has ensured work has been able to progress, addressing inequalities and developing standardised approaches to improve population health within the maternity pathway.

7 ‘must-do’ priorities

  1. Reduction in smoking in pregnancy
  2. Increase vaccination uptake in pregnancy
  3. Improve perinatal mental health
  4. Reduction in alcohol consumption in pregnancy
  5. Increase in breastfeeding initiation and at 6-8 weeks
  6. Improved management of obesity and promote healthy weight in pregnancy
  7. Increase in making every contact count

Audits/service scoping have been completed for the seven ‘must-do’ priorities using NICE guidance/ alternative evidence frameworks establishing a baseline. In October 2018, a regional LMS prevention conference was held focusing on smoking and alcohol. Audit findings and recommendations were shared so delegates could consider progression and implementing improvements. The LMS prevention coordinator has guided all maternity providers to devise locality level plans. Partnership working has been essential: maternity staff, local women, Clinical Commissioning Groups, Local Authority, voluntary sector and clinical networks.

A copy of the North East England Local Maternity Systems (LMS) System Leadership Prevention Priorities document shown above can be downloaded here.

Key work to date (November 2019)

1. Tobacco Dependency in Pregnancy

Following a regional audit, engagement event and key recommendations the most successful campaign to date is the development of a regional Tobacco Dependency in Pregnancy pathway and script. This tool has been launched in the regions Foundation Trusts and is supported by Specialist Stop Smoking Advisor and Very Brief Advice train-the-trainer courses. The work has also been endorsed by trust CEOs following the engagement of Integrated Care System Leaders.

A regional Smoking in Pregnancy Audit was conducted in May 2018 and report can be downloaded here.

2. Immunisations

Ongoing support to develop delivery of immunisations in most of the 7 FT’s acute settings has taken place which is detailed in each of the maternity plans.

3. Perinatal Mental Health

The PNIMH workstream has reviewed training needs and course availability with a strong recommendation for iHV PNIMH train the trainer cascade model. 25 ‘Champions’ were trained in May 2018 and there is plans for a further 50 Champions to be trained in Spring 2020. The work has seen improvements in referrals and accessibility to local support groups through the work of bespoke plans.

4. Alcohol in Pregnancy

A regional Alcohol in Pregnancy pathway and adapted AUDIT tool for pregnant women and training package for maternity has been developed and will be launched in 2020.

A regional Alcohol in Pregnancy audit that informed the work was completed in June 2018 and its findings and recommendations can be found here.

5. Breastfeeding

Following a regional audit and recommendations a Breastfeeding Touchpoints Pathway is also in development; raising consistency and accessibility of information and support. Key recommendations includes UNICEF accreditation across all Maternity, Health Visiting, Neonatal Units and Early Years Sectors. The breastfeeding strategy key theme is around changing culture to feeding.

A regional audit on breastfeeding was published in December 2018 and the report and recommendations can be found here.

7. Making Every Contact Count (MECC)

A maternity-specific train-the-trainer event was held in September 2019. In order to achieve the regional aim of 80% of maternity staff trained in MECC by 2020 and 100% by 2025, the LMS is promoting the use of an e-learning package. For more information please go to Making Every Contact Count.