Maternity services have been identified as a priority of the NHS Long Term Plan by Theresa May and were described by the Department of Health (DHSC) as ‘wide-ranging’ and ‘new’. But these two attributes have been challenged by health researchers on social media. So how accurate are they?
Maternity elements of the Long Term Plan include: expansion of the workforces (many of the different disciplines involved are mentioned including neonatal staff, who are also promised a ’major redesign’); greater continuity of carer to be assured in models of midwifery practice; accelerated moves towards digitalisation of records for mother and baby; accredited infant feeding programmes in every area; and a reiteration of the previous Secretary of State’s commitment to reducing deaths of mothers and babies around the time of birth.
These could well be designated as wide-ranging and also fit well with the expected themes of planning under Health Secretary Matt Hancock, who has made clear his focuses on workforce, digitisation and prevention. But ‘wide-ranging’ is not quite ‘comprehensive’ – and there do appear to be a few gaps left among some otherwise excellent plans and initiatives.
How much of the Long Term Plan for maternity is ‘new’? NHS England’s latest maternity policy review produced the ‘Better Births’ report in 2016, and this initiative kicked off a major implementation programme now in its third year. Clearly the plan would be expected to pick up many of the recommendations of Better Births and take them further forward, so more innovation was not necessarily a great expectation. Having said that, there are some specific clauses in the Long Term Plan that begin to address some of the areas that haven’t been well covered in the Maternity Transformation Programme so far.
Physiotherapy for pelvic health in postnatal women is a great move that will help many mothers – but this addition needs more around it about the holistic care of new mothers who may be experiencing multiple physiological and psychological issues that can be treated effectively IF they are identified and diagnosed in a timely way. Postnatal care from midwives, health visitors and GPs must be given greater priority; be better co-ordinated and less fragmented; and be carried out face-to-face, not over the phone. Around 80% of maternal deaths happen in the postnatal period so the safety ambition cannot be achieved until this neglected area of care is radically improved.
Another greatly welcome new offer is access to perinatal mental health services for fathers of new babies or partners of new mums. We’ve known for some time these parents are at risk of depression, anxiety and even PTSD and to ensure the good start for babies’ lives that is at the heart of the NHS plans, both parents should be supported to optimum wellbeing and confidence in their new role.
The Long Term Plan has a specific section titled ‘Stronger NHS action on health inequalities’ and this is to be welcomed with open arms. But will the action be ‘strong’ enough to address in absolute terms the appalling statistic, published by MBRRACE-UK in November 2018, that five times as many black women die around childbirth than white women? Asian mothers also have a higher death toll, and the babies of most mothers from ethnic minority groups have a higher risk of death just before or after birth. The plan alludes to these findings – and pledges more targeted continuity of carer for families in disadvantaged communities – but seems to fall short of serious and specific action on behalf of those most vulnerable to tragic outcomes.
There is a great deal in the plan that has been well identified and makes sense, aligning with the current evidence of need. Congratulations are in order for all that has been proposed – and more accolades will hopefully be due when the plans are actually in place. Gaps nevertheless remain in strategies for postnatal care, improved experience for black and Asian families and elsewhere.
The fast-tracking of digitisation plans are long overdue and this is undoubtedly right. Women’s digital records will help them ‘make choices … in a more convenient way’, apparently. But if a healthy woman then chooses an out-of-hospital setting for the birth (as specifically recommended by NICE guideline), will there be a freestanding midwifery unit or a home birth practice to help fulfil her choices? In spite of an emphasis elsewhere in the LTP on moving services out of hospital premises, it seems a missed opportunity not to have promoted these safe, effective and local services.
It is also disappointing to note little about further research in the maternity arena. There are unanswered questions about the effectiveness of some interventions in practice and the underlying reasons for their increased use in recent years. Pouring money into neonatal intensive care, for example, is absolutely right – to care properly for the babies who need it – but why are so many separated from their mothers and sent to NICU? If they are critically ill, what has caused this? If they are not, was the judgement on the move appropriate?
And why are so many women regarded as needing ‘intermediate’ or ‘intensive’ levels of care in pregnancy and birth, yet are discharged from hospital ASAP after the birth and sent home as if they can recover from the birth and look after a newborn when they have been treated like a seriously sick woman for the past few months?
There is much to welcome in this new plan. But DHSC and the NHS must direct some thought toward the even longer-term direction of maternity that will get the right level of care to mothers and babies, where and when – and from whom – they need and want it.
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