5. Co-production and engagement with communities

Trust leaders recognise the value of meaningful engagement with communities to understand patient concerns and to address arising issues. Engagement can also help to overcome mistrust or stigma within communities, which contributes to hesitancy in accessing services. Trusts have legal obligations for involving patients in their services and our report Co-production and engagement sets out the role of trusts in implementing engagement activities (NHS Providers, 2022e).

Some trusts have embedded a co-production approach in their development of local solutions or interventions. For example, one trust has set up a task and finish group exploring their maternity services datasets, to engage with women on the data outcomes in order to best target where further follow up and engagement with communities is needed. Another trust’s equity steering group is co-chaired by a service user, which has informed the direction of the group in shaping the organisation’s priority action areas. A number of trusts are working closely with VCSE sector organisations to deliver engagement. For example, one trust noted working closely with FiveXMore, a grassroots organisation committed to highlighting and improving black maternal outcomes in the UK. Another trust highlighted the valuable role local authorities can play in facilitating engagement and making connections between communities and providers.

One trust has employed a dedicated community support worker within the maternity team, who supports a broader network of community champions. Through this initiative, trusted individuals act as advocates and provide peer support and information to women across the community. In this example, working with individuals from shared cultural backgrounds and experiences has been effective in increasing uptake of services.

A trust leader from the mental health sector described how many perinatal mental health teams, including their own, have peer support workers with lived experience, who are included as part of both service planning but also with providing practical and emotional support to patients, which has worked well. The same trust also takes advantage of the presence of local community centres, with staff going into these centres for some clinic appointments, which has been seen to build trust and encourage engagement.

Maternity and Neonatal Voice Partnerships (MNVPs) aim to ensure that women’s voices are at the heart of improvements by providing a collaborative space for women, clinicians and commissioners to discuss innovations. Trusts reported that MNVPs are generally an effective way to engage with women, enabling them to have a say in the development and delivery of maternity care. These partnerships help to amplify the voices of those who use services, ensuring that their feedback is heard and acted upon. However, trusts acknowledged that there is local variation in the effectiveness of MVNPs. Often the resource and time women are expected to contribute to the MNVP roles is not adequately resourced or compensated. This can mean that MNVPs are not always representative of women with higher risk pregnancies, or groups that are most likely to experience inequalities. Trust leaders called for increased funding and resource for MNVPs to become more inclusive and responsive to the needs of all communities.

Trust leaders noted that engagement initiatives require sustained funding and resources to ensure long-term success. There are resource implications for trusts in terms of developing in-house expertise and skill, and for remunerating and developing the skills of women involved. Women are also more likely to be involved in engagement activities during their maternity period, but it can be challenging to maintain meaningful involvement over time.

Call to action: 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.

Call to action: Co-production with women in developing policies to improve maternity services should be the default and enabled by support and adequate resource.