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Trusts must act now to deliver the maternity strategy

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Cathy Warwick provides recommendations on how to deliver the care guaranteed in Maternity Matters

The clock is ticking. NHS bodies across England have just three months before they must offer pregnant women a range of choices over maternity care, including the guaranteed choice of a home birth.

This should not come as a surprise. The Department of Health published its Maternity Matters policy in April 2007 and the need to improve maternity care provision has been inserted into the past three annual NHS operating frameworks.

The DH has had its eye on the ball. Not only did it publish Maternity Matters - a first class blueprint - but also last year it set a recruitment target for midwives and committed an extra £330m to help maternity services implement changes.

Within a decentralised NHS, the DH has pulled all the levers it can: setting an ambitious policy, and prioritising it in operating frameworks; identifying the need to recruit additional midwives; and pumping in more money.

The deadline for the implementation of the strategy is the end of this year - and the reason I approach that moment more in hope than expectation is that spending is so patchy between regions.

‘Fundamentally, what is needed is a jolt to the system - something that will make primary care trusts, acute trusts and strategic health authorities pay attention’

Take spending on maternity services as an example. Official figures confirm that in NHS South Central the amount spent on maternity services fell in each of the past two years by a total of £13m. We lodged a series of Freedom of Information Act requests recently and while money is now flowing into maternity services, it has been patchy for many years. In contrast, NHS Yorkshire and the Humber increased its spending in each of the past four years - it is up £85m over that time.

The picture is also patchy if we look at staffing levels. The recommended number of births per midwife per year is 28, a widely accepted and established benchmark, which encompasses the whole pathway of care. Despite this, the most recent staffing survey revealed that three regions - the East Midlands, East of England and South Central - all had ratios of 40 births per midwife - well above the recommended level. The North East and the North West, on the other hand, had rates of 28 and 29 respectively, proving the ratio is perfectly achievable.

So, progress varies. This inevitably raises the question as to how we can be assured that high level policy is delivered locally. Of course, local priorities depend on the needs of the population, but why should women living in one area have access to different services from women in another?

I have three recommendations to get all regions back on track to deliver the care guaranteed by Maternity Matters.

Fundamentally, what is needed is a jolt to the system - something that will make primary care trusts, acute trusts and strategic health authorities pay attention. They have the policy blueprint, they have been told that this is important, they have been set a midwifery recruitment target and they have had extra cash.

My first recommendation is that the Care Quality Commission should carry out a nationwide review of maternity services, following work by the Healthcare Commission in 2007. This would check whether trusts had progressed or fallen back on their performances.

From being a midwife in the NHS at the time, I know that the 2007 review made local decision makers pay attention to maternity care with, I believe, a positive impact. We need a repeat of that. Indeed, just such a follow up review was recommended by the Healthcare Commission in one of its last reports.

We need to know how local NHS organisations are performing. Over the past decade, more and more power has flowed down to local decision makers. With responsibility should come accountability.

This in itself is not enough. The big challenge that puts everything at risk is the economic storm and the battering that public spending is about to take as a result. Second, therefore, we need to argue for continued investment in maternity services. It may surprise you to learn that money is starting to flow into maternity care - that must continue. A flash flood does not replenish parched soil. The productivity of maternity services in coping with extra demand with limited resources is an exemplar for the NHS.

Thousands more midwives are still needed. Both the government and the opposition publicly acknowledge this. This will cost money, so investment must remain and grow.

My third recommendation is that local health services must ensure that quality indicators are in place for maternity services. Assuming that investment is made, those of us working in maternity services must ensure that that investment does indeed ensure higher quality services and expect to meet the quality targets set by commissioners.

For many women, maternity services are their first experience of the NHS. The opportunities not only to ensure women and their partners have a positive experience, but also to promote wider public health messages, to reduce the impact of inequalities on health and to ensure a positive start to family life are enormous. It is vital that we deliver on the Maternity Matters policy. Let’s hope that we are not disappointed.


Professor Cathy Warwick CBE is general secretary of the Royal College of Midwives

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