The National Maternity Review (2016) provides a platform for innovation and transformation for the provision of maternity services. The report outlines a vision for safer, personalised, family-centred care, supported by well-led staff within a culture of continuous learning and multidisciplinary education—a culture where staff thrive and women and their families receive the best care.
Its ambitions are contextualised within seven broad themes: safer care, personalised care, continuity of carer, better postnatal and perinatal mental health care, multi-professional working, working across boundaries, and a payment system that adequately compensates providers.
Safer care
The report outlines how professionals lead services within a culture of safety and learning, working together across boundaries, ensuring timely access to the right care in the right place through rapid referral. The report recommends that there should be a lead for maternity services at provider board level, to appraise the board of the quality and safety of maternity services. There is potential for implementation of this proposal to be measured through Care Quality Commission inspection processes.
Personalised care
This ambition is centred on the needs of the woman and her family, where they receive unbiased information to make informed choices. To achieve personalised care, it is recommended that each woman will have a dynamic personalised care plan. This will include the offer of choice and decision regarding place of birth. There will be potential to measure this recommendation from the results of the patient survey.
Continuity of carer
It is proposed that a small team of four to six midwives provide care based in the community, located within a community hub. This model aims to facilitate building relationships of mutual trust and respect. Continuity of carer can be measured through the maternity survey and clinical commissioning group (CCG) framework.
Better postnatal and perinatal mental health care
The report recommends investment in mental health and postnatal services, which will improve care and outcomes for women and their families.
Multi-professional working
The report refers to breaking down barriers between midwives, obstetricians and other professionals, aiming to create a culture of efficient multidisciplinary working that contributes to safe and personalised care for women and their families. Actions required include multi-professionalism education and the establishment of a multi-professional peer review of services.
Working across boundaries
To support personalisation, safety and choice, with accessible specialist care when necessary, working across boundaries is required. The report proposes that local maternity systems with providers and commissioners should be developed, sharing best practice and protocols.
Fair payment system
Reforming the payment system will support the delivery of high-quality care to all women and support the commissioning of personalisation, safety and choice.
Achieving the ambitions of the National Maternity Review
The maternity service transformation is expected to take place over 5 years. It will require strong leadership, collaboration and partnership with CCGs and associated stakeholders, and iterative plans rooted in organisational business and financial plans. The first step should include a review of the gap between the vision outlined in Better Births and the current formation of maternity services; the findings can then inform transformational plans. Maternity providers and associated CCGs that submit successful expressions of interest to become choice and personalisation pioneers will potentially create the blueprint for future services. Plans to achieve this may include strategic and operational delivery and evaluation of:
The report shines a light on maternity services for the right reasons. The vision to transform the provision of maternity care reflects the needs of women and the opinions of health professionals, supported by foundational principles of safety. If the recommendations are implemented, the face of maternity services will be transformed. Choice and personalisation pioneers and early adopter sites will be in positions of privilege, taking the national lead on transforming maternity care, defining a blueprint for the future and inspiring other services.