Actions
In this briefing, we have summarised the findings from a series of interviews and roundtable discussions with trust leaders in maternity services. Drawing on these, we have identified a set of actions for government which would support trusts to improve the quality and safety of maternity services, including by reducing unwarranted inequalities in care and outcomes.
To improve the quality and safety of maternity services, alongside reducing unwarranted inequalities in care and outcomes, trust leaders are calling for action on:
Improving access
1. Provide national guidance and a framework for language and translation services in maternity services, including recognition of the specific need for out-of-hours provision. Ensure clinicians are trained appropriately to effectively utilise language and translation services.
2. Target funding towards areas with higher rates of inequalities in access (such as digital inclusion and proactive outreach measures).
Refreshing continuity of care
3. Refresh the national policy on continuity of carer to support trusts to prioritise which women (if not all) should be able to access continuity of care, with resource available to support trusts with larger cohorts of women at high risk.
Attracting and retaining staff
4. Take innovative and co-ordinated action on recruitment and retention within maternity services to close staffing and skills gaps (for example, consideration of alternative routes to midwifery training) and provide guidance for increasing the diversity and community representation of midwifery teams.
Embedding race equality
5. Demonstrate a national and system-wide commitment to tackling racism and bias in maternity services through actions including a co-produced, evidence-based and standardised framework for training in advocacy, anti-racist practice, cultural competence, and ethnicity data capture. Actions should be measurable to maintain continuous evaluation and improvement.
Co-producing with communities
6. Ensure long-term, sustainable funding of MNVPs, including clear guidance on appropriate remuneration for people involved in these roles, ensuring MNVPs have diverse representation, and mechanisms for MNVPs to hold maternity services to account on the impact and effectiveness of improvements in maternity services.
7. Co-production with women in developing policies to improve maternity services should be the default and enabled by support and adequate resource.
Unlocking funding and resource
8. Maintain priority focus on maternity at every level of the system to ensure maternity services are adequately resourced to enable both effective operational delivery and to implement long-term transformational improvements and targeted interventions to reduce inequalities.
Addressing administrative burdens
9. Streamline maternity reporting requirements, and support their appropriate resourcing, to ensure workforce skills are put to best use and better enable meaningful action to reduce inequalities and improve quality of care.
Making better use of data
10. Improve the recording and reporting of ethnicity data within maternity services by enabling data sharing through the Spine, enabling a single source of truth and sharing between primary and secondary care providers.
11. Establish co-designed engagement programmes with women at high-risk to identify and address concerns in relation to data capture and recording. Programmes should include culturally sensitive training for staff, incorporating both communication and ethnicity capture, to foster open, respectful and inclusive interactions and support collection of ethnicity data recording.
12. Enhance the national evidence base by funding research and evaluation programmes of improvement interventions within NHS trusts and foundation trusts, including embedding the learning from existing research (such as the work of the NIHR consortium addressing maternal inequalities).
Joining up patient pathways to prioritise prevention
13. ICBs should bring system and local partners (primary care, secondary care, ambulance, VCSE sector and local authorities) together to agree and set out responsibilities and outcomes for all aspects of maternity services, from prevention to perinatal pathways. ICBs should commission these services based on local need, tackling inequalities, and improving outcomes across all maternity services.
14. All Family Hubs and Women’s Health Hubs should embed maternity services within their local offer.