6. Funding and resource

Many trusts reported financial constraints as a key barrier to the delivery of high-quality, equitable maternity care. Women at higher risk of poorer outcomes require additional support, likely through longer, face-to-face consultations, which needs increased resource to deliver. One trust highlighted that pathways and tariffs in maternity services are not representative of risk. For example, they noted that women from ethnic minority backgrounds are not classified as high risk at the point of booking, despite the national evidence highlighting poorer outcomes for this group specifically – although it was also noted that ethnic minority women might not want to be flagged solely based on their ethnicity or race.

Unlocking additional resource for supporting women at high-risk generally could enable improved quality of care. Another trust queried how local budgets are determined and whether an equitable approach would provide greater funding for areas with greater need.

In addition, funding for improvement initiatives is often short-term or time limited, which can hinder trust leaders in embedding meaningful changes into standard practice. Frustrations were raised around juxtaposition between the need for long-term strategic planning and aspirations to improve safety and reduce inequalities, against the reality of short-term funding pots which can hinder the extent to which trust leaders can act on their commitments. Some trusts reported recruitment challenges when hiring staff on fixed-term contracts for specific projects. One trust is working with its local authority to access funding streams for more strategic improvement initiatives in their area. Trusts highlighted that increased funding would allow innovative approaches to be tested and evaluated, such as working with community champions, or digital solutions for language and translation.

Other trusts highlighted the inability to meaningfully engage with women and communities without sustained funding, with specific concerns raised around the limited financial support provided to MNVPs.

The leader from a mental health trust we spoke to noted that a recommendation from the NHS Long Term Plan stated ‘care provided by specialist perinatal mental health services will be available from preconception to 24 months after birth’, an increase to the earlier expectation of support from preconception to 12 months after birth (NHSE, 2019a). This recommendation was not taken forward as funding was not provided.

Call to action: 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.