Presentation by Mandy Townsend, Associate Director - Patient Safety Collaborative, Innovation Agency: Towards smoke free pregnancy for the North West Coast on Thursday 28 February 2019 at Haydock Park Racecourse.

1. Towards Smoke Free
Pregnancy for the North
West Coast
Local Learning Set: Mini Breakthrough Collaborative
Mandy Townsend
Sli.do - #MatNeo
Innovation Agency:
North West Coast

2. To help we have printed your
email to hand out.
Every time you swop one put an
extra in your badge
See how many you can collect:
Prize at the end
Build your network

3. “To improve the safety and outcomes of
maternal and neonatal care by reducing
unwarranted variation and provide a high quality
healthcare experience for all women, babies and
families across maternity care settings in
England”

4. • Shared learning across networks and Local Maternity
Systems
• Themes aligned to the Five Clinical Drivers
• Open to all working in maternity and neonatal services
• Involve women and families, Maternity Voice
Partnerships
• Quality Improvement
• Four events per year

5. Patient Safety
Collaborative
Innovation Agency
NHS Improvement
Local Maternity
Systems
Maternity
Strategic Clinical
Network
Neonatal
Operational
Delivery Network
NHS England
Public Health
Women & Families
Maternity &
Neonatal staff
Local
Learning
System

7. Local Learning Set
Increasing the proportion of smoke-free
pregnancies in North West Coast

8. • National expectation that we will work as a ‘system’ on
one or more of the Big 5
• Lots of work going on
• (Providers, LMSs, PHE, CCGs, Local Authorities)
• Ability to bring everyone together
• Priority area
• Data rich - on NWC dashboard
• Good evidence for potential tests of change

9. Local prevention
planning:
- Sustainability and
Transformation Plans
- Prevention at Scale
- Local Maternity
Systems
Maternity
Transformation
Programme:
Improving Prevention &
population health
workstream
(supporting women to
be fit for and during
pregnancy)
Tobacco Control
Plan, July 2017
New ambition to
reducing smoking
in pregnancy to 6%
or less by 2022.
Care Bundle
Element 1: Smoking Cessation
NICE Guidance (PH26) 8 Recommendations requiring
action across the healthcare system. Including:
• Identifying & referral (CO screening, opt-out)
• Contacting referrals & delivering support
• Meeting needs of disadvantaged pregnant smoker
• Training to deliver interventions
Smoking in Pregnancy
Challenge Group

10. The local case for
change and MatNeo QI
tools
Mandy Townsend

12. Smoking at time of delivery trend over time
15.8
14.7 14.6 14.2 13.7 13.3 12.9
12.2 11.7
11.0 10.7 10.8 10.4
22.0
21.0 21.0 21.0 20.8 20.2
19.3
18.4 17.8
16.9
15.5 14.9
0.0
5.0
10.0
15.0
20.0
25.0
Smokingrate(%)
Year
SATOD rate Adult prevalence

13. We don’t compare well with national numbers:
• 13.8% women smoking at delivery
• Some local areas with high low birth weight,
still birth and miscarriage
• A priority for our LMSs
• If we knew what to do we would already
have done it…
• Tools to help you internally and with
partners

14. By CCG Trend
England average 10.8 %
Worst 26.0 % (Blackpool)
Best Warrington 8.6%
National ambition 6.0 %

15. • Miscarriage
• Low birth weight
• Still Birth & infant death

16. Based on
• IHI
• National change package
• Local Steering group
• Local Aims
• Collect data & share data

18. Nationally agreed change package
Based on what works
Local learning set for Smoke Free
3 training days spread over 12 months
QI basics
Project plan
Zoom coaching support in between
You commit to checking data, trying the
change ideas

25. • Use MatNeo change package
• Focus on what we can do
• Improve our processes by
50%
e.g. CO monitoring
• Complements:
• PHE & local Public Health
teams
• LMS plans
• Learn & share together
• What works
• What didn’t
• Region average 13.8 %
• To achieve 50% reduction
in 1 year alone is
unachievable
• Break it up into bits
• Measure more often
• Test change ideas

26. • To improve the proportion of Smoke Free pregnancies by 31 March 2020 by
• Ensuring all women get CO monitored at booking Ensuring all women get CO
monitored at 36 weeks
• 100% of Midwives confident to give ‘Brief Intervention’ advice
• Specialist referral services able to accept 100% of referrals within 1 week
• Sli.do - #MatNeo

27. •The Method for Improvement & Driver
diagrams (Sue Hooton)
•System Thinking (Karla Rimaitis)
•The importance of Measurement in
Improvement (Sue Critchley)
•PDSA & testing your Change Ideas
(Mandy Townsend)

28. •Our Aims
1. 100% CO monitoring at booking
2. 100% CO monitoring at 36 weeks
3. 100% confidence on delivering Brief
intervention advice
•Zoom catch up dates tbc (8 weeks)
•Smoke Free Learning Set 2: 17th September
2019
•Smoke Free Learning Set 3: Feb/ March
2020
•Prize for networking challenge