Maternity Transformation in England

An overview of how maternity services in England are developing to become safer, more personal and kinder for the women and families using them

In February 2016, NHS England published the policy document Better Births, which set out a vision of how English NHS maternity services should develop to become safer, more personal and kinder for the women and families using them. The Royal College of Midwives was a significant contributor to the review on behalf of its members.

In response to the review, NHS England established a Maternity Transformation Board (MTB) to oversee the delivery of the policy and the 28 key recommendations that it made via the Maternity Transformation Programme. 

RCM Chief Executive Gill Walton sits on this board to represent the views of RCM members and to offer support and challenge to the programme. You can read her latest blog here.

The Maternity Transformation Board has recognised that for the Better Births vision to become reality there is a need for local leadership and action, and has asked areas of the country to come together to form Local Maternity Systems (LMS) to achieve this. 

Local Maternity Systems are there to bring together all the people who are involved in providing and organising maternity care such as; midwives, obstetricians, service users, neonatal staff, managers, commissioners, public health, educators, perinatal mental health providers and GPs.

LMS are being asked to measure their progress on reducing stillbirth, neonatal death, maternal death and brain injuries, promoting choice, continuity of carer, increasing births in midwifery-led settings and ensuring women have personalised care plans. These are called Key Lines of Enquiry (KLOE).

Maternity transformation and the RCM

The RCM has been working alongside NHS England as it has developed the vision and programme since the beginning. We have been:

  • Promoting the views of our members within the work of the programme, such as recognising the need for more midwives, and resources to successfully implement the changes
  • Influencing the work of the programme to ensure it represents positive work for the college and its members, such as the work on the Midwifery Support Worker framework
  • Supporting our staff who are implementing the programme, such as providing guidance and teaching packages on continuity of care

The Maternity Transformation Programme Workstreams and the RCM

The maternity transformation programme has split the work required into 9 areas or workstreams. These are:

This workstream is to help local areas work out what they need to do to implement the changes required in maternity services.

What is this workstream doing?

  • Helping Local Maternity Systems (LMS) come together and make robust plans for improving care. These are not statutory bodies but are an important means for services to work together in areas and share learning and improvement
  • Helping LMS develop their service users’ voices through the development of Maternity Voice Partnerships
  • Working on how services can deliver continuity of care to most women
  • Developing the idea of Maternal Medicine Networks, which enable women to access the specialist care they need in pregnancy in the right places and as close to home as possible
  • The Early Adopters programme who are parts of the country who have come together to test out lots of the key ideas of Better Births such as continuity of care
  • Asked an expert reference group to look at how to improve postnatal care
  • Overseeing the review of neonatal services and how they may need to change

How is the RCM involved?

Our regional heads and officers have offered support to every LMS in England. We have also produced lots of help for midwives to implement and measure continuity of care and manage employment issues. We have produced many resources on continuity of care. We are engaged with the neonatal review, recognising the interdependence of our services and have been a member of the postnatal expert reference group.

This workstream has many initiatives which taken together are to help maternity services:

  • Reduce rates of stillbirth, neonatal death, maternal death and brain injury during birth and be on track to make a 50% reduction by 2025

  • Reduce rates of pre-term birth

  • Ensure they are investigating and learning from incidents, and are sharing this learning through their LMS and with others.

  • Fully engage in the development and implementation of the NHS Improvement Maternity & Neonatal Health Safety Collaborative

What is this workstream doing?

Listed below are some of the key initiatives and you can find out more here:

  • Working to ensure every trust has maternity safety champions at every level of the organisation including the trust board
  • Offering every trust the chance to learn more about using quality improvement methods in all areas of maternity via the Maternity and Neonatal Safety collaborative
  • ATAIN: This is a programme to Avoid Term Admissions In Neonatal units. It is looking at four areas of neonatal care; hypoglycaemia, jaundice, thermoregulation and hypoxis
  • Saving Babies Lives care bundle: This is a series of four interventions to reduce still birth.  It includes helping women to stop smoking, improve fetal monitoring in labour, managing reduced fetal movements and monitoring fetal growth
  • CNST: Is the Clinical Negligence Scheme for Trusts which all maternity services pay into. Trusts were able to pay less this year if they could show that they met 10 criteria for safety which included looking at training and planning numbers of staff
  • HSIB: Healthcare Safety Investigation Branch is a new organisation who are have been asked by the secretary of state to conduct investigations into the most serious incidents in maternity. They are trying to understand the causes of incidents from a system wide perspective and support the families and staff involved

How is the RCM involved?

We are sitting on all the key working groups that support these initiatives to ensure our members views and concerns are represented and heard. Such we were influential in making sure labour-ward coordinators were seen as crucial to improving safety through the changes to CNST. We are partnering with the RCOG to deliver a package of Learning and Support for Trusts to implement the learning from the Each Baby Counts programme.  We have launched our Blue Top Guidelines of evidence based midwifery care in labour.

One of the key messages of Better Births is that women want services that are personalised and kind, where they have  genuine choice based informed by unbiased information.

What is this workstream doing?

  • Started a Pioneer Programme which brought together groups of commissioners and providers to test ideas such as working across boundaries, introducing new providers into maternity care and Personal Maternity Care Budgets known as PMCBs
  • Produced decision aids to help midwives discuss decisions about place of birth

How is the RCM involved?

We are members of the group working with the pioneers and have offered advice and support to the programme. Our education team led the group that produced the decision aids for women on choosing places of birth.

There was a consistent message to the Better Births team that mental health services for women needed to improve.

What is this workstream doing? 

  • There have been two waves of perinatal mental health funding to support service improvement including funding new Mother and Baby Units
  • Improved monitoring of services and consulting with service users and stakeholders

How is the RCM involved?

The RCM has been campaigning for many years for improvements to perinatal mental health services for women and midwives as well as contributing to a role framework with the maternal mental health alliance (MMHA) and NSPCC.

‘…for all staff to be supported to deliver care which is woman-centred, working in high performing teams, in organisations which are well led…promote innovation and continuous learning, and break down organisational and professional boundaries’

What is this workstream doing?

  • Produced a maternity transformation workforce strategy
  • Developed a MSW career and competency framework
  • Supported implementation of the new model of clinical supervision A-EQUIP
  • Worked with Health Education England on recruiting more sonographers

How is the RCM involved?

The RCM is an active and vigorous campaigner for improvements to the pay and conditions of its members securing 3,000 more student midwives, supported by our reports on the State of Maternity Services. We have been key to shaping the workforce strategy in which the government acknowledges England needs more midwives to carry out the transformation programme. We have published guidance on apprenticeships and as long term advocates and supporters of MSWs, are leading the MSW career and competency framework and developing a midwifery career framework.

This workstream is looking to develop a national set of indicators to allow LMS to track, benchmark and improve the quality of maternity services.

What is this workstream doing? 

  • Helped trusts improve their reporting of data to the Maternity Services Data Set (MSDS) so we can build a national data set to research, monitor and improve care including monitoring how well continuity of care is being delivered to women and families. This will be available to all clinicians working in maternity services
  • Developed Clinical Quality Improvement Metrics to start that process
  • Reviewed how service gain and use feedback from women and families – Ipsos MORI report

How is the RCM involved?

We are sitting on all the key working groups that support these initiatives to ensure our members views and concerns are represented and heard. 

NHS Digital are leading this workstream that seeks to empower individuals to care for themselves, improve outcomes and experience and support clinicians to be enabled to deliver care and reduce costs.

What is this workstream doing? 

  • It has conducted a Digital Maturity Assessment with all maternity services to see what the system needs to develop electronic personal records for all women
  • Started to develop an outline of what a Digital Midwife role looks like
  • NHS Choices is now NHS.UK and has redesigned its maternity pages with service users
  • Developed standards for healthcare records with PRSB (Professional Records Standards Body)
  • Developed standards for interoperability – making sure systems can speak to one another

How is the RCM involved?

We are sitting on all the key working groups that support these initiatives to ensure our members views and concerns are represented and heard. We are contributing to the expert digital midwives group and PRSB and in working with NHS.UK on the website content have initiated introductions to particular trusts to ensure representation of the midwifery voice as well as seeking women’s voices from under-represented groups.

Better Births was clear that the payment system for maternity services should be reformed to fairly and adequately compensate providers and support commissioners to commission for improvements. 

What is this workstream doing?

  • Reviewing the payment system for Fetal Medicine Services
  • Supporting commissioners on how providers work together to share the tariff when they share the care of a woman
  • Given specialist support to improving how services report activity and get paid

How is the RCM involved?

The RCM is an active member of the maternity pathway payment group that is leading these changes. It has responded to several consultations to ensure midwives and women’s voices are heard, particularly in relation to payment for differing types of care. We have given advice on making sure payments take into account the complex social needs of women.

This workstream is working to reduce health inequalities so everyone gets the right care, support and information to give their new family the best start in life.

What is this workstream doing?

  • Maternity Action were commissioned to report on reducing health inequalities for low-income women
  • Public Health England are supporting a number of initiatives in the wider system such as supporting breastfeeding and uptake of flu vaccinations
  • Planning to support smoking initiatives of the safety workstream (workstream 2) and offer further support to LMS

How is the RCM involved?

The RCM has long recognised the importance of public health and the enormous contribution that midwives make. We have led the Health Inequalities and ‘Stepping up to Public Health’ campaigns, and work with several charities and Maternity Action to secure the right support and care for the most vulnerable women using maternity services. We have campaigned against violence towards women and girls and we have published a new position statement on infant feeding, to give midwives the confidence to help women make the right choices for them. 

This workstream is working to reduce health inequalities so everyone gets the right care, support and information to give their new family the best start in life.

This workstream is aiming to implement the findings of the neonatal critical care review that looked at all neonatal services in England. 

What is the workstream doing?

  • Asking services to look at their own activity and staffing data to understand how they can plan to improve care
  • Asking plans to be focussed on workforce, capacity and improving parents experience
  • Reviewing how neonatal care is paid for specialised commisioning
  • Ensuring that Neonatal Operation Delivery Networks (ODNs) and Local Maternity Systems (LMS) work together

How is the RCM involved?

This is the newest of the transformation workstreams and the RCM is currently a member of the programme board that will be responsible for delivering the changes.  We are there to represent our members views and concerns and ensure that they are heard.

Find out more about how the RCM is involved with national policy here.