Maternity transformation in England: an update

By Gill Walton on 17 July 2018 Maternity Services

We are now well and truly into the implementation phase of the Maternity Transformation Programme (MTP) in England. Since the publication of Better Births in 2016 and throughout the last two years, the RCM has always tried to engage positively with maternity transformation, whilst also acting as a critical friend to those charged with implementing MTP.

At a strategic level, I attend the meetings of the MTP Programme Board. This is a very important meeting for ensuring there is clear feedback from our members as to the impact of maternity transformation as well as being part of the board’s decision making.

We also attend the national stakeholder council, which brings together charities, professional bodies, academics, and NHS clinical and managerial practitioners to influence and scrutinise MTP. And we are represented on eight of the nine national workstreams, which oversee work on issues such as safety, choice and personalisation, the workforce, local transformation, payment systems and digital services.

At a local level, the RCM is keen to ensure that there is midwifery engagement with Local Maternity Systems (LMSs), the bodies that are responsible for planning and delivering the transformation of local services. To this end we have contacted every LMS to give them our perspective on maternity transformation, to offer our support to work with them and to put them in contact with their local RCM Regional Officer.

Whether at strategic, workstream or at local level, our approach to maternity transformation is based on our ability to:

• Promote those elements of the transformation programme where the outcomes clearly benefit women and their families, and where recommendations are underpinned by robust evidence.
• Support our members in achieving change, by developing products and resources and through advice and guidance from our officers and representatives.
• Influence the way that maternity transformation is delivered, by lobbying for the right level of resources to be invested in maternity services and for all maternity staff to be given proper support and development.

Continuity of carer

Take continuity of carer, perhaps the recommendation in Better Births that is proving to be the most challenging and which is the cause of some anxiety amongst our members. The RCM supports the aspiration of ensuring more women receive continuity of carer, which is known to increase women’s satisfaction with their care and to ensure better outcomes are achieved. In order to help members in delivering this aspiration, we have produced a range of resources including an i-learn module, advice on the employment relations implications of continuity policies and training sessions for consultant midwives in supporting local implementation.

We have also commissioned work, on behalf of NHS England, from Birthrate Plus on a report that offers advice on determining the right number of midwives needed for continuity teams and the core service and from Professor Jane Sandall CBE who is developing an evaluation framework for implementing continuity of carer. Both of these resources are close to completion and should be available soon.

The RCM will continue to work with national and local decision-makers for the successful implementation of continuity teams; we have never shied away from saying that this cannot be achieved without sufficient staff and proper investment. So we will be issuing advice to managers and members to the effect that maternity services should always ensure that they have safe staffing levels and are able to provide women with one-to-one care during labour and birth, before they embark on developing continuity models.

Workforce

The RCM, along with our friends in the RCOG, has worked tirelessly to draw attention to the need to improve the recruitment and retention of maternity services staff; we regard this as an essential prerequisite to making maternity transformation happen. The Government’s announcement of plans to train 3,000 more midwives over the next four years is a big step in the right direction and vindication of our campaign to tackle the midwifery staffing shortage in England.

However, these additional midwives won’t qualify until 2022 and we also know that training extra midwives only solves half the problem; action is also needed to support the current midwifery and MSW workforce. So while we have welcomed the Government’s pledge to recruit more midwives, we will use our position on the MTP workforce workstream to lobby for action both to ensure that these new training places are commissioned but also for measures to improve the retention of midwives and MSWs, such as enabling staff to work more flexibly. Over the next year we will be monitoring progress and holding the Government to account, should the promise of more midwives fail to materialise.

Safety

Safety should underpin everything we do and the RCM has a huge role to play in influencing the safety agenda, particularly as it relates to maternity transformation. We are actively engaged in many of the initiatives that comprise the MTP safety workstream. These include:

• The Perinatal Mortality Review Tool, which three quarters of maternity providers have started to use.
• Maternity Safety Champions, who have published their first newsletter and launched a Maternity Safety Champions hub.
• The Maternal and Neonatal Health Safety Collaborative learning sets, which are focusing on clinical improvements relating to, among other things, smoking cessation, diabetes and hypoglycaemia.
• The Health Safety Investigation Branch, which will investigate 1000 neonatal deaths and all maternal deaths in England.
• The Atain IV scheme work streams and roadshows.

Together with the RCOG and NHS Improvement we are currently working on a programme to support the national safety agenda by focusing on clinical leadership and staff support when things go wrong.

Other workstreams

The other MTP workstreams remain active with meetings taking place on a monthly basis:

• The data and information workstream is overseeing work on making the Maternity Data Viewer more comprehendible and accessible and on testing the Maternity Services Data Set, before it goes live next year.
• The work of the digital technology workstream is concerned with better utilising digital technology for the benefit of women and families. Issues under consideration include: assessing the ‘digital maturity’ of maternity providers and the digital needs of the workforce; how to ensure the accuracy and accessibility of data; and training staff in the use of eHealth Records.
• The National Maternity Pathway System Payment Group is reviewing the financial sustainability of birth centres and revising the postnatal tariff.
• The prevention workstream is taking forward a range of initiatives covering issues such as smoking cessation, maternal health weight and preconception health planning.

Conclusions

This is a brief snapshot of the latest developments regarding maternity transformation in England and what the RCM is doing to engage with and influence the programme. As the pace of change intensifies, I would like to hear from you about your expectations (and anxieties) relating to maternity transformation and your experience of what is happening with your local services. You can write to me at gill.walton@rcm.org.uk.