Exploring NHS England’s three-year neonatal and maternity roadmap

NHS England has released a roadmap which details how they will seek to improve maternity and neonatal care over the next three years.

A diverse range of stakeholders have supported the development of this plan, including women and families who are using (or have used) maternity and neonatal services, members of the maternity and neonatal workforce, service leaders and commissioners, NHS systems and regional teams, and representatives from Royal Colleges, charities and other organisations.

The latest strategy comprises three themes for driving change and innovation across maternity and neonatal care.

Theme one: listening to and working with women and families with compassion

The strategy acknowledges that “listening and responding” to women and their families is an essential aspect of delivering safe, high quality care. Personalised care is one of the central ways NHS England hopes to achieve this, giving people more choice and control over their delivery of care.

The plan states a commitment to increase funding in order to “better align neonatal cot capacity” over the next three years – as well as investing in other crucial areas such as bereavement services, ensuring they are available seven days a week for women and families experiencing loss.

NHS England will ensure that local maternity and neonatal voice partnerships (MNVPs) have a robust infrastructure needed to be successful – placing the user’s voice “at the heart of service improvement.”

The plan also outlines a commitment to targeting health inequalities, by tailoring services to meet the needs of their local populations; this will include access to interpreter services and the adherence of the Accessible Information Standard across all maternity and neonatal settings.

Co-production with service user representatives such as MNVPs will ensure all groups within communities are heard, paying particular attention to minority and undeserved cohorts or those experiencing health inequalities.

An example of trusts working together to achieve this outcome is The Seeking Sanctuary Clinic in Berkshire West – a specialist maternity clinic developed in 2021 from co-production between Royal Berkshire NHS Foundation Trust maternity team and Berkshire West public health team. The clinic helps vulnerable women and families such as asylum seekers, refugees and people who have been trafficked access vital services and information around sexual health, pregnancy and neonatal care. Whilst the project is still in an evaluation phase, NHS share that feedback has been very positive with more than 50 families supported so far.

Theme two: growing, retaining, and supporting the workforce

NHS England will endeavour to relieve pressures facing the current maternity and neonatal services by investing in recruitment across the workforce.

They will utilise evidence-based tools endorsed by NICE or the National Quality Board, aligning local and national strategies to support recruitment and better meet the needs of local populations.

The strategy also shares how NHS England will collaborate with the Royal College of Obstetricians and Gynaecologists to support the development of an obstetric workforce planning tool, which will be published in 2023/24.

The plan emphasises the importance of ensuring that all staff feel valued and included at every stage of their career; they will aim to create a safe and inclusive culture in which staff feel empowered and supported, ensuring equal opportunities for everyone.

Another action listed in the roadmap is for the NHS to undertake an annual training needs analysis in order to make training available to all staff, in line with the core competency framework. Multi-disciplinary training will be encouraged where possible to optimise team working and ensuring all staff have the opportunity to develop their skills.

One example of these ambitions being put into action can be found at The Chelsea and Westminster Hospital NHS Foundation Trust, where a a ‘one stop obstetric ambulatory service’ has been established to improve triage management. Since launching the service, waiting times have been significantly reduced, staff report that they feel more supported and 80-90 percent of women are seen within 15 minutes of arrival – which exceeds the national KPI.

Theme three: developing and sustaining a culture of safety, learning, and support

Developing a positive safety culture is one of the key objectives outlined in the plan; ensuring there is a “shared commitment to safety and improvement at all levels.”

NHS England will work to facilitate this ambition, by enabling “effective coordination, rapid mobilisation, and supportive communication based on agreed principles.” This will enable teams to escalate concerns and fairly address any issues related to conduct or conflict between healthcare professionals.

Maintaining “effective, kind and compassionate processes to respond to families who experience harm or raise concerns” is another fundamental ambition. Trusts will be expected to act alongside maternity and neonatal leaders on complaints, audits, outcomes data, feedback from the Maternity Voices Partnerships and incident investigations – learning from what has gone well.

The plan also talks about “good oversight” and having “clear systems in place that promote timely escalation and intervention before serious problems arise.” The perinatal quality surveillance model will ensure concerns are identified and addressed early, maintaining an “ethos of open and honest reporting” on the safety and quality of experiences across all services.

According to the plan, trusts will work with the Maternity Voices Partnerships to develop complaints processes and – at board level – “listen to and act on feedback from staff, including Freedom to Speak Up data, concern raised and suggested innovations”.

Theme 4: standards and structures that underpin safer, more personalised, and more equitable care

NHS England has identified a need for clear standards and structures across maternity and neonatal teams in order to support best practice for women and families.

By 2024, an updated version of the Saving Babies Lives Care Bundle will be published, which comprises a package of intervention to reduce stillbirth, neonatal health, preterm birth and neonatal brain injury.

The NHS will also look to publish refreshed data by 2024, recording standard that allow for the collection of “more meaningful standardise data” that can be used to improve care. Additionally, trusts will be encouraged to learn from research and evaluation as set out in the National Maternity Research Plan, available on the FutureNHS platform.

The plan details a final objective to better utilise digital technology to improve maternity and neonatal services. The main ambitions are to ensure women have access to their records and can interact with their digital plans to support informed decision-making.

All clinicians will be supported to make best use of digital technology with “sufficient computer hardware, reliable Wi-Fi, secure networks and training.” Alongside this, integrated care boards will be expected to create and implement a digital strategy and, where possible, “procure on a system-wide basis to improve standardisation and interoperability.”

One way the NHS is achieving this goal is through the Ask A Midwife service – a social media messaging service managed by midwives, which allows users to “make timely and informed decisions about their maternity care.” The service gives women and families the opportunity to ask questions and gain feedback around birthing options, appointments, pregnancy and caring for a new-born baby.

Going forward, NHS England will develop facets of a digital personal child health record with service user-facing tools to support neonatal and early years health by March 2025.

To read more about NHS England’s maternity and neonatal strategy, please click here.