A new vision for Wales

By Vicky Richards on 08 July 2019 Welsh Government Maternity Services

The Welsh government has launched its Vision for maternity services in Wales. After two years of work, involving women and their families, midwives, other NHS professionals, Health Boards, community and voluntary groups, the Vision and its five pillars of quality care are finally here. Health Minister Vaughan Gething AM, in his statement to the Welsh Assembly introducing the Vision, said  the ‘Vision provides us with the route map to deliver high quality and safe services which secure improved health and wellbeing for mothers and babies in the short, medium and long term.

The voices of women are clear, with the Vision heavily influenced by the surveys of women and their experiences, as well as clinical leaders. Women can expect to get to know their midwives,  be listened to, have choices of birthplace, have a clear point of contact when something goes wrong, more postnatal visits and know their clinical information is stored digitally, to avoid having to tell their stories over and over again, as their midwife will have access to it at their fingertips.  There are specific recommendations about her access to evidence-based information, allowing her to make the right decisions for her and her family, and co-producing an individualised care plan with her midwife.

The second part of the Vision statement at the start of the document talks about NHS staff, much like the English Better Births report. We are so heartened to see another strong stance from a UK government that the wellbeing of staff is critical to the quality of care for women and babies, and that the government will ‘promote a positive culture of learning from excellence in care and reflection and learning from adverse outcomes.’  The Welsh government’s approach is multi-pronged: leadership programmes from Academi Wales to build our future leaders; preceptorship and mentoring at all levels; new workplace behaviour champions to encourage a supportive environment; and ensuring maternity staff have access to continual professional development and embed leadership skills into practice, at all levels.  We’ve been concerned for some time that access to CPD is being curtailed, and some members are doing training in their own time. We will be holding the Welsh Government and Boards to account for this strong commitment to training for our members to grow and develop in their roles.  We are especially happy to see a firm commitment to getting the right number of midwives in post, as the Vision says all Health Boars must ensure that staffing levels are Birthrate+ compliant.

The communication and collaboration needed across professions is a key theme of the vision, with the different professionals working as teams, with shared culture, aims and language. This idea of multi-professional teams will be embedded in midwifery and clinician education in undergraduate and postgraduate settings, as well as ensuring a seamless handover from midwife to GP and Health visitor after the maternity care period ends.  

The Vision comes after the publication of the investigation report into maternity services at Cwm Taf, and there are strong recommendations on safety, being one of the five core themes the Vision is structured around. The Welsh Government will standardise the process of review and shared learning from maternal and perinatal morbidity and mortality incidents across Wales, and create a new All-Wales Maternity Performance Indicator dataset  which will help inform a national quality improvement strategy. New fora will be set up to represent each Board and the professional groups, to advise Welsh Government on national priorities for maternity care. The Government has also make specific commitments on caring for women with additional neds, picking up on the findings of the MBRRACE-UK report, by ensuring ‘high quality universal, enhanced and targeted services are in place including access to evidence based psychological therapies and specialist Mother & Baby Units to reduce separation when a woman requires additional treatment’. Board will identify quality improvement leads in maternity services that will support local teams in reviewing data and undertaking service improvement.

Like the other nations in the UK, the impact of the research into continuity can clearly be seen here in this vision. Wales’ approach to Midwifery Continuity of Care (MCOC) is a buddy system, like that being implemented in Scotland, with the primary midwife coordinating the woman’s care and navigating the pathways into other perinatal services she might need. The Welsh government has pledged to set up a multi professional working group to support continuity of carer models across Wales to explore and develop a feasibility model of continuity of carer across the whole maternity pathway. The RCM will work in partnership with this Group to make sure that midwives are supported and enabled to work in this new model of care.

The Vision too recognises that women’s health is not only determined by what midwives and the NHS can do for her, but is socially determined. The Well-being of Future Generations (Wales) Act 2015 places obligations on Welsh bodies to make Wales a safe space to grow, learn, work, both now and in the future, in recognition that place has a huge impact on the sustainability of the nation as a whole. The Vision recognises that the first 1000 days of life are crucial to setting people on a healthy path for the rest of their lives.  Boards will work with Public Health Wales on specific programmes to reduce obesity, smoking, improve maternal mental health and breastfeeding support, and we look forward to seeing in more detail what these collaborations will result in for midwives and women.

As the Minister says, the Vision is only the first step – and it is now up his government, Welsh Boards, RCM members, and all of the NHS in Wales, to make the Vision a reality. We will be working hard in the coming months to support or members learn about the Vision, make positive change and support the whole maternity team in brining the Vision to life.