Show me the money: the missing link in NHS England’s single delivery plan for maternity and neonatal services

By Sean O'Sullivan, Head of Health & Social Policy, RCM on 13 April 2023 Maternity Services RCM UK Midwives Midwifery Workforce

The much-trailed three-year delivery plan for maternity and neonatal services was finally published at the end of last month (30 March) by NHS England. The plan is intended to provide support to services in achieving safer, more personalised, and more equitable care for women and families in England. Sean O’Sullivan, the RCM’s Head of Health & Social Policy, looks at whether it succeeds in that aim.

NHS England (NHSE) has put a great deal of store in its three-year plan for maternity and neonatal services. Essentially, it aims to bring together the actions from NHSE’s maternity and neonatal programme, the NHS Long Term Plan, and the recent reviews of maternity services at Shrewsbury and Telford and East Kent. It seeks to achieve change through building in accountability throughout the system, encouraging the spread of best practice and supporting a cross-system approach to improving care.

The question is, will this plan deliver for women and families, and for the maternity workforce, where previous policies and strategies have fallen short?

There is certainly much to commend in the vision and ambition of the plan. Who would not want to see maternity and neonatal services that attain the plan’s key themes of:

• promoting safer care through listening, with compassion, to women and families;
• supporting staff to develop their skills and capacity;
• developing and sustaining a culture of safety; and
• meeting and improving standards and structures?

Dotted throughout the plan are numerous recommendations and actions, all of which are clearly designed to bring about real and lasting improvements. The RCM particularly welcomes:

• The commitment to developing a positive safety culture, underpinned by compassionate, diverse and inclusive leadership.
• The focus on personalised care to support safety, including ensuring all pregnant women are offered personalised care and support plans.
• The commitment to give women access to pelvic health services, the plan to roll out maternal mental health services and the pledge to invest in the availability of bereavement care services, seven days a week.
• The responsibility placed on NHS services to ensure the right number of staff are available, through local workforce planning, staff retention improvement plans, as well as national programmes to grow the midwifery workforce including apprenticeships, growth in student numbers and return to midwifery programmes.
• The recognition that if staff are to feel valued then they must have access to ongoing training and development opportunities and be deployed to roles where they can develop and be empowered to deliver high quality care.
• The ambition to use of digital technology to drive learning and improvement.

What isn’t always clear from the plan is how these laudable commitments will be implemented in practice.

For example, what is the timescale for ensuring that all women are being offered personalised care and support plans, bearing in mind this target has been set previously? And what support will be made available to services to deliver this ambition?

Likewise, when it comes to rolling out maternal mental health services, what, if any, consideration has been given to scaling up both the employment of specialist perinatal mental health midwives and additional training for maternity staff?

Similarly, why doesn’t the plan then specify any of the key actions that are clearly necessary to improve flexible working opportunities or to consider other options that could stop midwives from leaving?

When staffing shortages are making it so hard for midwives to access CPD (other than in their own time and with their own funds), how will it be possible to make good on the commitment to improve access to training and development opportunities?

If clinicians are to be supported to make best use of digital technology, what assessment will be made of their technological capacity and confidence? And what training will be in place to address their needs?

At the heart of these questions is our overriding concern that it is unclear where the funding will come from to turn the plan’s ambition into reality. Recommendations by both the House of Commons Health & Social Care Select Committee and the Ockenden Review would see an increase in funding of between £200m and £350m. Despite this, the commitments in this delivery plan are largely uncosted and there is little indication of the scale of investment needed and whether this will be forthcoming.

The publication of the single delivery plan makes it more vital than ever that maternity services receive a substantive and sustained increase in investment. The RCM will do all in its power to persuade the Government to come up with the funding that is so necessary for the improvements to maternity services that we all want to see.