Tommy’s Pathway developed to improve maternity care set for £1.8m NHS trial

Our ground-breaking clinical decision tool for identifying women and birthing people’s chance of premature birth and stillbirth is set for NHS trial, supported with £1.8 million from the National Institute for Health and Care Research, the Secretary of State for Health and Social Care has announced.

The Tommy’s Pathway: Clinical Decision Support Tool is currently in use in 4 trusts and has had 14,000 pregnant users. This new project - trialling the tool across 26 NHS hospitals around the UK - is expected to start in summer 2023, last 3 years, and involve around 39,000 women each year.   

Every year in the UK around 2,900 babies (0.4 percent) are tragically stillborn and nearly 60,000 (8%) are born prematurely, with many facing a lifetime of health issues.  

Despite 7 years of progress in reducing stillbirth numbers, data published this year by the Office for National Statistics showed an increase in stillbirths in England and Wales. This unacceptable trend must be reversed, and our team at the Tommy’s National Centre for Maternity Improvement have been working hard to develop the tools needed to do it.   

The Tommy’s Pathway enables midwives and doctors to more accurately assess each woman and birthing person’s needs during pregnancy and to personalise their care. 

Early in pregnancy, the tool is able to identify each person’s chance of preterm birth or of developing problems with the placenta which may lead to stillbirth. It supports healthcare professionals to offer care recommendations in line with national clinical guidelines for best practice maternity care, to help lessen the chance of these complications developing.   

This aims to reduce the variation in care across the NHS and ensure that each person is offered the right care at the right time, no matter where they live. 

The Tommy’s Pathway has been developed by a team of healthcare professionals at the Tommy’s National Centre for Maternity Improvement with the help of women with lived experience.   

Earlier this year, the Centre published evidence demonstrating that the algorithms used in the support tool can help reduce health inequality in Black, Asian and other minority ethnic pregnant women.  

Aiming for UK-wide NHS adoption

The new trial will be co-led by Professor Andy Judge and Dr Christy Burden at the University of Bristol in collaboration with Professor Jane Sandall and Dr Jenny Carter at King’s College London.

Professor Basky Thilaganathan, Director of the Tommy’s National Centre for Maternity Improvement, said: “We believe that our Clinical Decision Support Tool can make a significant change in the delivery and experience of maternity care. We are thrilled to be able to expand our work with this funding, and further our learning to support our aim for NHS-wide adoption.”

Kath Abrahams, Tommy’s Chief Executive, said:

“Sadly in the past year we have seen the number of stillbirths in parts of the UK rise and inequalities in access to good care widen. At Tommy’s we believe that everyone should have equitable access to good maternity care, no matter who they are or where they are based.  

“By helping healthcare professionals provide the right care at the right time during pregnancy, we hope this important new technology will help meet our goal of making the UK the safest place to give birth.”  

Andy Judge, Professor of Translational Statistics at the University of Bristol and Co-Principal Investigator of the trial, said: “This trial is an important step forward in exploring safe and effective use of the tool, to inform making it widely available in the NHS.”   

Dr Edward Morris, President of the RCOG, said: “Reducing stillbirth and preterm birth rates in the UK remains a priority. This exciting trial is a huge stepping stone towards offering more personalised care that can save babies’ lives.”   

Gill Walton, Chief Executive of the RCM, said: “Midwives play a fundamental role in identifying those women at heightened risk during pregnancy, which is why the RCM is a very proud partner in the development of the Clinical Decision Support Tool. This investment will take us a step closer to rolling this out across the country.”  

The Tommy’s National Centre for Maternity Improvement is jointly led by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives. The Clinical Decision Support Tool has been co-developed by a team of healthcare professionals from leading UK universities brought together by the Centre, including King’s College London, the University of Sheffield, the University of Bristol and St. George’s University of London, and charitable partners Mothers for Mothers and the PROMPT Maternity Foundation.   

The Tommy's Centre for Maternity Improvement welcomes expressions of interest from hospital trusts on potentially trialling the tool in the future. To discuss your interest please contact us at [email protected]