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The NHS Long Term Plan

Gill Walton
9 January, 2019

The NHS Long Term Plan

The Government has finally published the NHS Long Term Plan, the purpose of which is to guide how the NHS in England develops over the next decade. You can find more information about the Plan at https://www.longtermplan.nhs.uk/

We are encouraged to see that maternity care has been placed front and centre in the Plan. The Plan maintains the commitment to the Maternity Transformation Programme (MTP) and the key pledges around continuity of carer for most women by March 2021 and halving the rates of stillbirth and neonatal and maternal deaths by 2025. In addition there are a number of important new aims for maternity, such as targeting continuity of carer at women from BAME backgrounds and other vulnerable groups, increasing access to perinatal mental health services and new smoking cessation pathways for mothers and their partners. There is also an increased focus on digital solutions, including enabling 100,000 women to access their maternity record digitally from 2019/20, with expansion to the whole of England by 2023/24.

The proposals for maternity care have to be seen in the context of some important system-wide changes, including the suggestion that MTP will be implemented in conjunction with a new Children and Young People's Transformation Programme, which will oversee the delivery of the children and young people commitments in the Plan. In addition, there is a strong emphasis on all parts of the system working together, with more shared decision making between commissioners, providers, GPs and local authorities.

The RCM has given a qualified welcome to the Long Term Plan. There are some very good, sensible and ambitious proposals within the Plan and we have particularly welcomed the commitments to improve prevention services, reduce health inequalities, renew and build on the commitments within the Maternity Transformation Plan as well as the new five-year jobs guarantee for newly qualified midwives. The announcement of the new post of Chief Midwifery Officer is timely as implementing the Plan will depend on good leadership, in midwifery and other professions.

We do have a number of caveats about the Plan. Firstly, while the scale and ambition of many of the aims and pledges is laudable, there is far more in the Plan about what needs to happen and a lot less on how these changes will actually be implemented. The absence of the long-awaited Green Paper on Social Care leaves open important questions about how the commitments around prevention and tackling inequalities in the Plan can be squared with continuing cuts to local authority public health budgets. Similarly, the absence of a comprehensive workforce implementation plan is a major flaw and makes it hard to judge just how realistic some of the commitments are, when we don't know how these will be supported by strategic workforce planning.

Getting funding right will be absolutely essential if we are to achieve progress in implementing key elements of the Plan as they related to maternity care. For example, we will be asking the Government about commitments to increased funding for postnatal care given that this is an area that has been historically underfunded. Similarly, we will be making the case that implementation of prevention measures, such as smoking cessation, need to be supported by employing more specialist midwives with a public health role who can then develop smoking cessation services.

It will also be important to ensure that we have the right number of midwives and maternity support workers in place to support these ambitious changes. We welcomed last year's commitment to increase midwifery training numbers by 3,000 over the next four years. We now need to see evidence that the Government will make good on this pledge.

What will now be important is to understand and visualise how the elements of the Plan that relate to maternity services translate into the experience of women, babies and their families.

Overall we believe the Plan is an important step forward, but there is much to do if it is to become a reality. We are looking forward to working with the Government and the NHS to make it happen.

Take a look at the NHS Long Term Plan here

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It is great to look beyond the immediate challenges we face on a daily basis working in healthcare. I often wonder though whether we are avoiding the elephant in the room. We are getting sicker as a race and in maternity care this is very apparent. Young people in their prime presenting with underlying conditions that make pregnancy a high risk event. I am not sure how but we need to wake ourselves up to how irresponsible we are with our health and be honest about the mess we have got ourselves into.