The past few years have seen the publication of some important reports that have highlighted problems with the provision of maternity and neonatal services in the NHS, including Dr Bill Kirkup’s Morecambe Bay review in 2015, his East Kent review in 2022, and the Ockenden review in relation to Shrewsbury and Telford, also in 2022. NHS England has now launched a three year delivery plan for maternity and neonatal services, which aims to respond to many of the concerns raised by those independent reviews, and by users of these services more widely.
In developing the delivery plan, NHS England talked to people who use, work in, lead or have an interest in maternity and neonatal services.
The plan is set out in a report that lists four themes, which NHS England is asking maternity and neonatal services to concentrate on: (i) listening to and working with women and families with compassion, (ii) growing, retaining, and supporting our workforce, (iii) developing and sustaining a culture of safety, learning and support, and (iv) standards and structures that underpin safer, more personalised, and more equitable care. In this article we look at some of the key points arising out of each of these themes. Each theme includes key commitments for women and families and delineates responsibilities for Trusts, ICBs and NHS England to achieve the objectives. Importantly, each theme is accompanied by an explanation on how success will be determined.
Listening to and working with women and families with compassion
There are three objectives within this theme:
1. Care that is personalised. The aim here is for women to “experience care that is always kind and compassionate” and which, amongst other things, should involve “personalised, joined-up, high-quality care right through to the postnatal period with handover to health visiting services and a GP check 6 – 8 weeks after birth”. Women should have “clear choices, supported by un-biased information and evidence-based guidelines”.
2. Improve equity for mothers and babies. This will involve NHS Trusts providing services that meet the needs of their local populations, paying particular attention to health inequalities, and collecting local data to monitor differences in outcomes and experiences for women and babies from different backgrounds, in order to improve care.
3. Work with service users to improve care. The plan advocates the use of maternity and neonatal voices partnerships (“MNVPs”) in order to reflect the view of local communities.
Growing, retaining, and supporting our workforce
As the report states, “the ambition of safer, more personalised, and more equitable maternity and neonatal services in this plan can only be delivered by skilled teams with sufficient capacity and capability”. However, it acknowledges that “NHS maternity and neonatal services do not currently have the number of midwives, neonatal nurses, doctors, and other healthcare professionals they need”. The objectives within this theme are to:
1. Grow our workforce. This will involve regular workforce planning on a local and national level, and the provision of administrative support to free up clinical time, amongst other ambitions.
2. Value and retain our workforce. The plan expects NHS Trusts to improve the experience of NHS staff in several ways, e.g. by reducing workforce inequalities, by creating an anti-racist workplace, and by offering a preceptorship programme to every newly registered midwife. NHS England will fund retention midwives during 2023/24, and will undertake various other actions, including appointing a national clinical director for neonatal services and a national neonatal nurse lead.
3. Invest in skills. The aims within these objective are that all staff are deployed to roles where they can develop and are empowered to deliver high quality care, all staff have regular training, and training should be multidisciplinary wherever practical.
Developing and sustaining a culture of safety, learning and support
There are a wide range of objectives set out under this theme, under the headings of “developing a positive safety culture”, “learning and improving” and “support and oversight”. The report confirms the responsibility of NHS Trusts to adopt duty of candour principles and describes the ways in which success in relation to this theme will be determined, i.e.:
- By listening to the people who use and work in frontline services.
- By measuring outcomes using the NHS Staff Survey, the Education and Training Survey, and the GMC National Training Survey.
The report gives a case study from the Chelsea and Westminster Hospital NHS Foundation Trust, which developed a one stop obstetric ambulatory service in response to common themes in complaints that the Trust had received, including delays in receiving care and long waits for obstetric or scan reviews. The one stop obstetric ambulatory service involves a multidisciplinary approach, with consultants, midwives, maternity support workers and receptionists working together to reduce the waiting times that were a cause of concern for patients.
Standards and structures that underpin safer, more personalised, and more equitable care
The report acknowledges that it does not seek to introduce new standards for maternity and neonatal teams, but, rather, it aims to ensure that existing best clinical practice, high quality data, and digital tools are consistently implemented. In relation to best clinical practice, the Saving Babies Lives Care Bundle, the National Maternity Early Warning Score and updated Newborn Early Warning Trigger and Track tools, and NICE guidance are listed as key guidance and tools that should be implemented consistently, while in relation to data, the plan aims for standardised data to be collected consistently, primarily through the Maternity Services Data Set. It also calls for the national maternity dashboard to be used by Trusts to benchmark services.
Conclusion
This is an important and wide-ranging plan that should undoubtedly address many of the problems in NHS maternity and neonatal services that have been highlighted in recent years. Importantly, the plan sets out the responsibilities of the various key NHS organisations (i.e. Trusts, ICBs, and NHS England itself) and the ways in which success will be determined against each of the objectives set out in the plan. This will ensure accountability and hopefully help to drive significant improvement in the care that women and babies receive from the NHS.
A link to the plan can be found here
Please contact Heather Durston-Hillyer or Ciaran Claffey if you wish to discuss this report further.
