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Maternity care to become more ‘personalised’

National Maternity Review sets out plans

Jo Carlowe

Tuesday, 23 February 2016

Maternity services have improved over the last decade but more ‘opportunities exist’ to improve safety or care.

This is the conclusion of the National Maternity Review, published today, which calls for services in England to become safer, more personalised, kinder, professional and more family-friendly.

The NHS England commissioned review – led by independent experts and chaired by Baroness Julia Cumberlege – sets out wide-ranging proposals.

The report finds that despite the increases in the number of births and the increasing complexity of cases, the quality and outcomes of maternity services have improved significantly over the last decade. The stillbirth and neonatal mortality rate in England fell by over 20% in the ten years from 2003 to 2013. Maternal mortality in the UK has reduced from 14 deaths per 100,000 maternities in 2003/05 to 9 deaths per 100,000 maternities in 2011/13 (figures exclude coincidental maternal deaths). 

However, the review also found meaningful differences across the country, and further opportunities to improve the safety of care and reduce still births.

The framework highlights seven key priorities to drive improvement:

  • Personalised care
    • Every woman should develop a personalised care plan, with their midwife and other health professionals, which sets out her decision about her care reflecting her wider health needs.
    • It also recommends trialling an NHS Personal Maternity Care Budget. 
  • Continuity of carer  
    • Every woman should have a midwife, who is part of a small team of 4 to 6 midwives, based in the community who knows the women and family, and can provide continuity throughout the pregnancy, birth and postnatally.
    • Community hubs should enable women and families to access care close to home, in the community from their midwife and from a range of other services, particularly for antenatal and postnatal care.  
  • Better postnatal and perinatal mental health care
    • Postnatal care must be resourced appropriately. Women should have access to their midwife (and where appropriate obstetrician) as they require after having had their baby. Those requiring longer care should have appropriate provision and follow up in designated clinics
    • The report endorses the recommendation of the Mental Health Taskforce published last week for a step change in the provision of perinatal mental health care across England.
  • A payment system that fairly and more precisely compensates providers for delivering different types of care to all women, while supporting commissioners to commission for personalisation, safety and choice.
  • Safer care
    • There should be rapid referral protocols in place between professionals and across organisations to ensure that the woman and her baby can access more specialist care when they need it.
    • Teams should routinely collect data on the quality and outcomes of their services, measure their own performance and compare against others’ so that they can improve.
    • There should be a national standardised investigation process for when things do go wrong
  • Multi-professional working  
    • Those who work together should train together. Multi-professional learning should be a core part of all pre- and post-registration training for midwives and obstetricians, so that they understand and respect each other’s skills and perspectives.
  • Working across boundaries          
    • Providers and commissioners should come together in local maternity systems covering populations of 500,000 to 1.5 million, with all providers working to common agreed standards and protocols.

The report also recommends that NHS England seeks volunteer localities to act as early adopters to test the model of care set out in the report.

Baroness Julia Cumberlege, Chair of the Maternity Review said: “To be among the best in the world, we need to put women, babies and their families at the centre of their care. It is so important that they are supported through what can be a wonderful and life-changing experience. Women have told us they want to be given genuine choices and have the same person looking after them throughout their care. We must ensure that all care is as safe as the best and we need to break down boundaries and work together to reduce the variation in the quality of services and provide a good experience for all women.”

Simon Stevens, the Chief Executive of NHS England, said: “The independent review finds that quality and safety of NHS maternity services has improved substantially over the past decade, and most new mums tell us they are looked after well. But it rightly argues that the NHS could and should raise its game on personalised support for parents and their babies, better team working, better use of technology, and more joined up maternity and mental health services.”

Commenting, Cathy Warwick, chief executive of The Royal College of Midwives (RCM) and a member of the review team, said: “I hope women and everyone working in maternity services will be pleased to read this report. The RCM is most pleased that the review’s key priorities include putting women at the centre of care and believes that personalising maternity services will help to achieve this.”

Today’s report has been welcomed by the Care Quality Commission. Professor Sir Mike Richards, chief inspector of hospitals at the CQC, said: “Today’s report and CQC’s survey findings both highlight improvements in women’s experience of NHS maternity services in recent years, but also show some variation in the quality of services as an area needing to be addressed. As a result of CQC’s inspections, just over 60% of trust maternity services have been rated as either Good or Outstanding, 34% rated as Requires Improvement and 4% as Inadequate. Where we have found concerns we have told trust that improvements must be made. 

“The report makes a number of important recommendations to support improvements across the system by giving women more choice, making services safer and ensuring high quality services for all and we look forward to playing our part in overseeing their implementation.”

* Better births - Improving outcomes of maternity services in England. A Five Year Forward View for maternity care. National maternity review, 2016

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