08 / 03 / 2016
Better Births: Improving outcomes of maternity services in England
A Five Year Forward View for maternity care, February 2016
The National Maternity Review, commissioned by NHS England, aimed to survey current maternity services in England and make recommendations for improvement for services. The review conducted site visits in England and abroad, held consultations, drop-in sessions and listening events across the country. The review makes seven recommendations, which it hopes will be trialled in four sites between September 2016 and September 2018. The report also contains many case studies of organisations and local areas that are providing great neonatal and postnatal care.
The number of births in England is rising, from 566,735 in 2001 to 664,543 in 2014. Women are also giving birth later, with the average age now 30.2 years. The proportion of women who have conditions such as diabetes in pregnancy has increased, which means a higher proportion of births involve more complex care.
The Department of Health has set a target to reduce the rate of stillbirths, neonatal and maternal deaths in England by 50 per cent by 2030. The rate fell by over 20 per cent between 2003 and 2013, but is still high compared to the rest of Europe. In 2013 there were 4.3 stillbirths per thousand total births and 1.8 neonatal deaths per thousand live births in England. However the report found variation in the quality of care provided across the country.
In 2012, 87 per cent of births took place in NHS obstetric units. Although 96 per cent of trusts offered home births, only 2.4 per cent of births were at home. CQC assessments of maternity units rated seven per cent as ‘inadequate’ and 41 per cent as ‘requires improvement’. There is also variation across the country in terms of the outcomes for women and babies and the quality of the services they receive.
The review calls for:
- Personalised care – women should have a personalised care plan and use of a digital maternity tool. They suggests a ‘NHS Personal Maternity Care Budget’ which would allow women to choose the provider of their care.
- Continuity of care - every woman should have a midwife who follows her through her pregnancy and each team of midwives should have an identified obstetrician.
- Safer care – each board should have a champion for maternity services and teams should routinely collect data on the quality and outcomes of their services. A national standardised investigation process is also needed for when things go wrong.
- Better postnatal and perinatal mental health care – they call for significant investment in perinatal and post natal mental health services.
- Multi-professional working - multi-professional learning should be a core part of all pre-registration training for midwives and obstetricians and electronic maternity record should be rolled out.
- Working across boundaries - community hubs should be established creating a one-stop shop for women. They also call for clinical networks where professionals, providers and commissioners can come together on a larger geographical area.
- A payment system that fairly and adequately compensates providers for delivering high quality care to all women efficiently - the review acknowledges that different services in different areas have different cost structures and states that the money needs to follows the woman and her baby as far as possible, to ensure women’s choices drive the flow of money, whilst supporting organisations to work together.