Conclusion

It is clear that there are significant opportunities to transform maternity and perinatal care to improve care for all women and their babies. Health inequalities are an important area of focus here, directly impacting the quality and safety of care by creating disparities in access, outcomes and experiences.

The trust leaders we spoke to know the enablers to delivering real and tangible change, and there is focused work already underway in trusts to improve services, tackle safety concerns and address health inequalities. We heard many examples of innovative approaches to improving care and outcomes, from the use of digital tools and data to programmes of community engagement to better facilitate access to maternity services.

However, trusts need more support from the government to continue their improvement efforts, both through increased funding and resource but also through standardised national approaches that can help reduce variations in care. Crucially, there must be a system-wide sustained effort, both in joined-up approaches to prevention and in tackling structural racism. While trusts have a significant role to play in driving forward change, they cannot do this work alone.

Through our conversations, trust leaders set out a vision for what they want maternity services to look like:

• Women are heard, seen and respected, with community champions advocating on their behalf. They are at the heart of service design and implementation, ensuring we get things right for all groups accessing services.
• Services that are equally accessible for all women, with barriers such as language and translation overcome without delays to care.
• Maternity teams that are representative of the communities they serve, culturally competent and responsive to patient needs. 
• Women are identified and supported early on in their journey, to ensure interventions are targeted and timely.
• Data is collected, analysed, shared and accessible within teams to inform decision making and quality improvements to services.
• There is a culture of improvement and innovation that underscores high-quality, safe services where all women have positive experiences and outcomes.
• Trusts are supported to work collaboratively with broader system partners, including primary care, VCSE colleagues and beyond, to cater to the holistic needs of women and families, to prevent the onset of illness and improve overall population health.
• Trust leaders and staff are freed up to focus and prioritise their work where it will be most effective in improving the safety and quality of maternity care.

These actions should be addressed as part of a coordinated, holistic and evidence-based approach to address safety concerns and persisting health inequalities in maternity, with a focus on evaluation to understand exactly how these actions have impacted quality of care, and what interventions work. Lessons learnt from tackling inequalities in maternity care could have a wide-ranging and transformational impact on work to improve safety and tackle inequalities across the NHS. 

Making these changes will require bold action from government to adequately resource maternity services to make necessary improvements. We hope that the 10YHP will provide the roadmap of how we might realise this vision. It is vital that maternity services are prioritised, as they reflect the broader challenges seen across NHS trusts and foundation trusts. Getting it right for the most vulnerable women and babies will be a measure of how successful the plan has been in creating tangible change and improving the health and wellbeing of our nation.