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The key recommendations from the maternity review

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The report from the independent national maternity review, published today by NHS England, has set out seven overarching themes plus a range of recommendations designed to improve care in England.

The Better Births: Improving outcomes of maternity services in England report highlighted the following recommendations, which will now be considered by policy makers:

1. Personalised care

  • Every woman should develop a personalised care plan, with her midwife and other health professionals, which sets out her decisions about her care and is kept up to date
  • Unbiased information should be made available to all women to help them make their decisions and develop their care plan. This should be through their own digital maternity tool, which enables them to access their own health records and information that is appropriate to them
  • They should be able to choose the provider of their antenatal, intrapartum and postnatal care and be in control of exercising those choices through their own NHS Personal Maternity Care Budget
  • Women should be able to make decisions about the support they need during birth and where they would prefer to give birth – at home, in a midwifery unit or an obstetric unit – after full discussion of the benefits and risks

2. Continuity of carer

  • Every woman should have a midwife, who is part of a small team of four to six midwives, based in the community who can provide continuity throughout the pregnancy, birth and postnatally
  • Each team of midwives should have an identified obstetrician who can get to know and understand their service and can advise on issues as appropriate
  • The woman’s midwife should liaise closely with obstetric, neonatal and other services ensuring that she gets the care she needs and that it is joined up with the care she is receiving in the community

3. Safer care

  • Provider boards should have a board level champion for maternity services. They should routinely monitor information about quality, including safety, and take necessary action
  • Boards should promote a culture of learning and continuous improvement to maximise quality and outcomes from their services
  • 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 when things go wrong, to get to the bottom of what went wrong and why and how future services can be improved as a consequence
  • There is already an expectation of openness and honesty between professionals and the family, which should be supported by a system of rapid resolution and redress, encouraging learning

4. Better postnatal and perinatal mental health care

  • There should be significant investment in perinatal mental health services in the community and in specialist care, as recommended by NHS England’s independent mental health taskforce
  • Postnatal care must be resourced appropriately. Women should have access to their midwife as they require after having had their baby. Those requiring longer care should have appropriate provision and follow up in designated clinics
  • Maternity services should ensure smooth transition between midwife, obstetric and neonatal care, and ongoing care in the community from their GP and health visitor

5. Multi-professional working

  • Multi-professional learning should be a core part of all pre-registration training for midwives and obstetricians, so they understand and respect each other’s skills and perspectives
  • Multi-professional training should be a standard part of continuous professional development, both in routine situations and in emergencies
  • To support sharing of data and information between professionals and organisations, use of an electronic maternity record should be rolled out nationally
  • A nationally agreed set of indicators should be developed to help local maternity systems track, benchmark and improve the quality of maternity services
  • Multi-professional peer review of services should be available to support and spread learning

6. Working across boundaries

  • Community hubs should be established, where maternity services, particularly ante- and postnatally, are provided alongside other family-orientated health and social services
  • Providers and commissioners should work together in local maternity systems covering populations of 500,000 to 1.5 million, with all providers working to common agreed standards and protocols
  • Professionals, providers and commissioners should come together on a larger geographical area through “clinical networks”, coterminous for both maternity and neonatal services. They should share information, best practice and learning
  • Commissioners need to take clear responsibility for improving outcomes and reducing health inequalities

7. A payment system

  • The payment system for maternity services should be reformed so that it is fair, incentivises efficiency and pays providers appropriately for the services they provide
  • It should take into account the different cost structures services have, the need to ensure the money follows the woman and her baby as far as possible, the need to incentivise delivery of high quality care for all women, and the challenges of providing sustainable services in remote and rural areas
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