This commitment builds on our earlier vision for a modernised, woman-centred and family-centred maternity service, as outlined in the National Service Framework (NSF) maternity standard for Children, Young People and Maternity Services. This exciting vision for the future of maternity services will enable the NHS to meet the government's commitment to offer choice to every parent by the end of 2009. For maternity services this means delivering quality services , safe and accessible that are also women-focused and family-centered.
The priority of the modern maternity service is to ensure a choice of safe and quality maternity care for all women and their partners. Commissioners and providers will be able to use many elements of the health reform plan to drive improvements and innovation in the maternity services they provide. Individuals and organizations will play a key role in fulfilling the government's commitment by the end of 2009 and successfully providing the best possible maternity services.
For maternity services, this means providing safe and accessible, high-quality services that are both woman-focused and family-centred. Review of Health Inequalities PSA Target for Infant Mortality6 which highlights the role of maternity services in achieving the PSA target for infant mortality. Although many already receive this choice, the priority for modern maternity services is to offer a range of safe, high quality maternity care to all women and their partners.
If these services are available, a woman may choose to access maternity care outside her region.
Maternity Care Pathway
A standard framework for this is being developed as part of the forthcoming revised guidelines for antenatal care by the National Institute for Health and Clinical Excellence (NICE). As part of the Social Exclusion Action Plan, a model of intensive health-based home visiting will be trialled at 10 PCTs in England in 2007 and 2008, in partnership with local authorities. One of the main objectives was to reduce the number of babies with low birth weight.
Commissioners and partners must achieve a thorough understanding of demand and supply. These include identifying the characteristics of the most vulnerable and excluded local populations and determining their contacts with current maternity services (as well as identifying measures that already exist to reach those who fail to access care). Using Maternity Services Liaison Committees (MSLCs)15 or similar forums* to agree a common set of objectives for maternity services, set the service specification for maternity services and be the local voice in the production of the prospectus of PCT.
A summary of the drivers of change for reorganizing maternity services can be found in appendix B. Where NHS Foundation Trusts are planning and delivering major service changes, they should consider the PCTs' commissioning strategy as well as fulfilling their regulatory requirements19. Commissioners want to ensure improvements in services that are flexible and responsive to the needs of the local population, including the particular needs of the most vulnerable and disadvantaged women and their families.
The main element of the reorganization has been the development of the midwifery Mayday Birth Center on the grounds of the main hospital. Commissioners can set their providers challenging targets to reduce interventions as part of the contracting process. Previous reference costs for obstetrics submitted by the NHS have not always recognized the higher proportion of CNST costs falling on maternity services.
The price is set at a competitive level which is good for the commissioner but which is still profitable for the Trust due to the efficient way maternity services are run. Effective commissioning will help improve the quality of services provided and lead to improvements in perceptions of the service received. As a result, the structure of the unit was strengthened through leadership – clinical leaders were made visible and supported by senior trust staff.
WWoorrkkiinngg TTiimmee DDiirreeccttiivvee The requirements of the WTD will affect the way in which hospital maternity services are provided, as they have an impact on doctors' hours and midwifery time. The diagram shows the women and their families at the center of providing women-focused, family-centred maternity services and below are likely roles and responsibilities for each type of organisation.
Women and their
Clinical care should be regularly reviewed and poor outcomes reviewed in detail.
Families
- P Prriim maarryy C Caarree T Trru ussttss
- LLo occaall A Au utth ho orriittiieess aan nd d C Ch hiilld drreen n’’ss T Trru usstt P Paarrttn neerrss
- M Meen nttaall H Heeaalltth h T Trru ussttss
- M Maatteerrn niittyy SSeerrvviicceess LLiiaaiisso on n C Co om mm miitttteeeess
- LLo occaall SSu up peerrvviissiin ng g A Au utth ho orriittiieess ((M Miid dw wiiffeerryy))
- H Heeaalltth hccaarree C Co om mm miissssiio on n
- O Ovveerrvviieew w aan nd d SSccrru uttiin nyy C Co om mm miitttteeeess
- R Ro oyyaall C Co olllleeg geess aan nd d P Prro offeessssiio on naall B Bo od diieess
- N Nu urrssiin ng g aan nd d M Miid dw wiiffeerryy C Co ou un ncciill
- C Caarree SSeerrvviicceess IIm mp prro ovveem meen ntt P Paarrttn neerrssh hiip p
- D Deep paarrttm meen ntt o off H Heeaalltth h
Develop the local vision for maternity services in consultation with key stakeholders and local authorities and publish in the annual PCT prospectus. Commission high quality, fair, integrated maternity services as part of local networks according to local need. Liaise with the local population to ensure that maternity services are developed in line with local needs and priorities.
Work with PCTs to achieve a comprehensive and equitable provision of high-quality, responsive and efficient maternity care services that reflect local need. Ensure that high-quality, responsive maternity care is provided, including general medical services for pregnant and postnatal women. Work with PCTs and healthcare providers to agree clinical protocols and pathways within local networks and help women and their partners consider their options for antenatal, birth and postnatal care.
Ensure that the standards and activities of the local supervisory authority promote and monitor safe, high-quality care for women and their babies. Provide scrutiny and challenge around the role and integration of maternity care with local authority provided services. Support the development of curriculum requirements for postgraduate education and training in maternity care.
Enable the use of tools and improvement methods to support changes in local maternity services and facilitate the sharing and dissemination of good practice 4.16 D Deep paarrttm meen ntt ffo orr EEd du uccaattiio on n aan nd d SSkkiillllss. Ensure that the program for the development of Sure Start Children's Centers takes into account the requirements for maternity services. Maternity Matters is setting out a strategy that will put women and their partners at the center of their local maternity services.
Women and their partners will have the choice between self-referral to the local midwifery service or accessing this service via their GP. The ability to book appointments at times and places convenient for women and their partners. Reliable information to ensure that women and their partners know about the variety of choices available to them for postnatal care.
CO ON NT TIIN NU UIIT TY Y O
Maternity services must be appropriate for the 21st century and meet the needs of women and families. There is evidence that women with risk factors or complications may require expert care at any time of the day or night, and that this care may be highly specialized. Recognition of the need for an increase in the presence of consultant obstetricians on maternity wards to provide direct care to laboring women and to increase direct supervision of trainees.
Shorter working hours imposed by the WTD, which have significant consequences for maternity care, because there can be no cross-coverage from another medical specialty. Choice gives providers the opportunity to increase the capacity to provide maternity care to women from outside their region. However, it does offer the opportunity to redesign services, using existing infrastructure, that are responsive, flexible and meet the needs of the population, both as a whole and individually.
Promoting an effective skills mix within the maternity team will be critical to delivering on the government's promise of improving working conditions for midwives and other staff providing maternity care. It will be crucial to have good leadership and an open, supportive culture, together with locally developed workforce plans that enable the development of high-quality, safe and accessible maternity care. The successful development of maternity care services that can meet the expectations of women and their families requires such leadership, together with management, clinical, and user involvement.
Shorter working hours imposed by the WTD will have a significant impact on maternity services as there can be no cross-coverage from another specialty. Assessment of future workforce requirements must recognize that midwives are involved in the care of all women. Redesigning services and reallocating resources may provide an opportunity to increase consultant availability for direct patient care through all stages of the woman's journey through maternity services.
Extensive and ongoing assessments of the needs of local people will be essential. CCoonnssuullttaanntt mmiiddwwiivveess provides senior clinical leadership within maternity care and complements the role of the Head of Midwifery. CCoonnssuullttaannttss iinn oobbsstteettrriiccss aanndd ggyynnaaeeccoollooggyy are increasingly being appointed with a special interest in complementing the skills and experience of the existing team.
Maatteerrnniittyy, nneeoonnaattaall aanndd ppeerriinnaattaall mmeennttaall hheeaalltthh nneettwwoorrkkss These networks support the effective planning and delivery of a full range of maternity care services, ensuring access to quality, safe and appropriate services that meet the needs of women and their families. Woommaann--ffooccuusseedd, ffaammiillyy-cceennttrreedd The needs of the individual woman are central to the planning, organization and delivery of maternity care.
