Better Births 3 years on: reflections on what matters most

By Gill Walton on 22 March 2019 Better Births Initiative

On March 7th 2019, NHS England celebrated the three-year anniversary of the launch of the maternity policy document ‘Better Births’ in Manchester, see here. Attending this event made me reflect on how hard maternity services have worked, and how far they have come in the last three years. It was also an opportunity to think about what challenges remain as services move further into implementing the asks from Maternity Transformation Programme (MTP).  The MTP is a big programme, with nine workstreams that are generating lots of initiatives to try and improve care, improve women’s experiences and improve clinicians working lives and which you can read more about here and in March’s issue of Midwives Magazine.

One of the day’s most important messages is the need for collaborative working to really make a difference.  From the implementation of a new way of working, to reflecting on being on the receiving end of an ‘inadequate’ CQC rating, to starting to understand how to improve neonatal care, those who were making real progress with the challenge of improving their services were those who were working really closely with our colleagues from all parts of the maternity journey. I was so pleased to see this as we have been talking about this at the RCM for a long time, with our closer working links with the RCOG and leading the development of the ‘One Voice’ initiative that brings all of us concerned about maternity together to create a unified voice to drive positive change.

Positive change was certainly on display with lots to celebrate as services really showed the difference they can make to women.  And within that celebratory atmosphere there was plenty to take away, not least the importance of listening, right at the start of any new project or episode of care to the voices of women and families. It is really clear to us that if we get that right, we will get everything else right. 

This was poignantly illustrated in two women’s stories of birth, one of which described the wish to avoid hospitals and intervention, and one which sought comfort and reassurance in hospitals, and being close to testing and intervention. Both women expressed from their point of view what they needed to feel safe giving birth, and this was not something to be defined by anyone else other than the women themselves.  It was a great reminder of how important the personalisation of care is if women are to have safe and happy experiences of birth.

We also all know that safe care depends on the workforce who give it and Manchester saw the long-awaited launch of Health Education England’s Maternity Workforce Strategy – Transforming the Maternity Workforce see here. Which for the first time has looked in depth at ALL the staff involved in the provision of maternity care.  This echoed the key themes of the day; that we need to put people first and focus on what works best for women and families and the staff who support them.

Some of the ways outlined in the strategy included; enabling a flexible and adaptable workforce through investment in education and training for both new and current staff; providing broad pathways for careers in the NHS and widening participation in NHS jobs so that people from all backgrounds can contribute and benefit; ensuring the NHS and other employers in the system are inclusive modern model employers; and ensuring that service, financial and workforce planning are intertwined, so that every significant policy has workforce implications thought through and tested. 

The RCM will be sitting on several of the implementation programme boards to ensure that these ideas are transformed into reality for our members as we can see that these are exactly the issues that need to be taken into consideration in all aspects of maternity care including with Continuity of Carer.  Services have put so much effort in over the last two years to improve continuity for women, and I really enjoyed listening to their stories of success in Manchester.  However, at the RCM we are also very aware that it is not easy, and that the right conditions need to be in place for success to follow and be sustained.  That is why we recognise that for all those involved there will absolutely need to be continued investment and support for this work, whether you are a midwife charged with leading change or midwife considering changing how they work.

And that leads me to my final reflection that, key to all this work, whether it is a quality improvement project, or redesigning a service it is all about the people.  We need to care for women and care for staff, we need to listen to women and listen to staff and we need to take their insights and concerns seriously.  Without this we cannot hope to effect really positive change, as many speakers said ‘writing the guideline was just the start and then we really started listening and learning’.  Change in healthcare can be complex and sometimes daunting but if we listen to one another and work together we can be confident that we will make a real difference to the women and families in our care.