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Better Births and the Best Start: Implementing the English and Scottish maternity strategies

Jacque Gerrard, Director England & Mary Ross-Davie, Country Director for Scotland
27 June, 2017

Better Births and the Best Start: Implementing the English and Scottish maternity strategies

Maternity Transformation in England: One year and more after Better Births

It’s hard to believe that a year and more has passed since the publication of Better Births. A lot has happened in that time but yet there is still so much to do in terms of piloting, testing and implementation as per the recommendations.

The Maternity Transformation Programme Board (MTPB) which Cathy Warwick sits on is meeting regularly and has received feedback from the workstreams.  Local Maternity Systems (LMS) have now been set up across the 44 STP footprints in England. Feedback from the regional maternity boards indicates that good progress is being made in forming LMSs however there are a few locations, largely in south west and eastern England, where they have yet to be established.

The Stakeholder Council which is a representative group that enables stakeholders to influence and contribute to the MTP by scrutinizing its work is chaired by Baroness Cumberlege and meets every two months.

Continuity of Carer
As the work progresses, there is no doubt that continuity of carer is seen as one of the most challenging aspects of Better Births.  The main work that is being done seeks to understand both the resource requirements and the impact of continuity of carer on the working lives of midwives. The  RCM are pleased that NHSE have established a continuity of carer sub-group with Cathy Warwick and Rupa Chilvers on it.  An expert advisory group has also been set up and the first meeting is taking place in the next few weeks.

The Early Adopters are currently moving forward with their plans and here is a brief overview of some of their work so far. Three key points from each Early Adopter have  been highlighted in this blog but important to note they are all doing much more.

Birmingham and Solihull known as BUMP have plans to:
• Develop continuity of carer from pregnancy through to handover to health visiting.
• Explore  sites for their Community hubs and ‘hublets’  
• Enhance multidisciplinary team working with linked obstetricians

Surrey and the Heartlands are planning to:
• Develop a single point of access and  look at their electronic records.
• Improve the maternity pathway and widen choice and personalisation for women Develop their community midwifery care and improve continuity of carer by exploring models including caseloading and home birth teams.

Cheshire and Merseyside plans for improving and personalising care for women include:
• A central booking system which will be a ‘single point of access’.
• A named midwife and consultant (if required) for each woman.
• Development of pilot ‘pop-up’ MLUs.
NW London is building on progress already achieved in maternity to date. They have taken significant steps already to:

• Ensure women have continuity of carer
• Increase the number of women who have a named midwife
• Focus on developing  further continuity of carer teams by agreeing common antenatal and postnatal care pathways, and aligning trust catchment areas with community services


Somerset is planning to improve continuity of carer with a focus on the most vulnerable women.
They also plan to:
• Have a named midwife lead
• Work in small multi-disciplinary teams
• Improve postnatal and perinatal mental health care

North Central London is making progress in their plans to:
• Focus on community-based maternity care in community hubs
• Co-locate  with social care, health visitors, perinatal mental health and general practice
• Relocate  hospital services to the hubs to enable joint midwifery, obstetric clinics, phlebotomy and ultrasound services

Dorset plans include:
• Improving  postnatal care including the 6 week post natal check up
• Keeping mother with their baby together for minor common medical interventions or treatment
• Focussing on improving continuity of carer, including obstetrician and neonatologist where appropriate

Photo shows Bumps Early adopters with Baroness Cumberlege at a workshop earlier this year.

Next blog we will be updating you on the workstreams and the Choice and Personalisation pioneers.

The Best Start: Implementation of Scotland’s maternity and neonatal strategy gets underway

Scotland’s review of maternity and neonatal services, called the ‘Best Start’, was published in January 2017. You can read it here:   http://www.gov.scot/Publications/2017/01/7728

The review sets out a five year vision for maternity services in Scotland, which the RCM has welcomed.  The RCM welcomed the review recommendations as they are based on high quality research evidence and lots of engagement with maternity staff and families all over Scotland throughout 2016. 

The Scottish Government has now set up the Best Start implementation board and we met for the first time on Friday June 9th 2017. The Board is chaired by Jane Grant, Chief Executive at NHS Greater Glasgow and Clyde, who chaired the review itself.   Midwives are well represented on the Board with Ann Holmes, Chief midwife; Gillian Morton, Director of Midwifery from NHS Forth Valley; Justine Craig, Head of Midwifery NHS Tayside; Kate Kenmure, Head of Midwifery, NHS Shetland; Susan Key, Associate Director at NHS Education for Scotland, Professor Mary Renfrew from University of Dundee and NMC, along with myself from the RCM.  Midwives are joined by obstetricians, senior NHS executives, Directors of Nursing, service user organisations, neonatologists and neonatal nurses.  The Board will meet every 3 months to oversee the implementation process.  It was agreed at this first meeting that four working groups will be set up to lead the more detailed work: 


1. Continuity of carer and local delivery of care
2. Workforce and education
3. Perinatal service development (neonatal and maternity, obstetric services)
4. Information and data.


The process to identify the pathfinder boards will be underway soon, but in the meantime there is lots of work that can start in all boards looking at how to develop services to meet the recommendations.  Boards will also be asked to undertake a baseline assessment of their service to identify how near or far they currently are in terms of meeting the recommendations.


Three ‘Best Start’ regional events are being held by the Scottish Government, and I would really encourage RCM members to attend one:

Glasgow – Golden Jubilee, Clydebank Friday 23rd June 09:00 – 12:00 (+VC)
Edinburgh – New Royal Infirmary, Wednesday 28th June 13:30 – 16:30
Aberdeen – Robert Gordon University, Monday 3rd July 12:30 – 15.30

You can book to attend through Eventbrite: https://www.eventbrite.co.uk/e/the-best-start-maternity-neonatal-care-in-scotland-regional-event-glasgow-tickets-34228579603


Photo from the best Start implementation board meeting:

 

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