Improving maternity services across North Central London
Better Births Programme
In 2016 NHS England published a set of recommendations to improve maternity services across England based on a systematic review of the evidence, and consultations with NHS staff, professional bodies and user groups. The review found that, whilst strides have been made to improve the quality and outcomes of maternity care over the last decade, work still needs to be done to ensure consistency in the care women and their families receive. At its heart the review highlighted the need to make maternity services more personal and family friendly by centering care on the needs and choices of women and their families.
Bringing together commissioners from North Central London (Barnet, Enfield, Haringey, Camden and Islington CCGs), and hospital maternity services delivered by North Middlesex, Royal Free, UCHL and Whittington Health Trusts, North Central London was identified as one of seven pilot areas to trail women-centred approaches to maternity care. UCLPartners support the network in delivering these improvements and evaluating progress
Over the last two years North Central London (NCL) Better Births has focused on:
•providing personalised care by accommodating the specific needs of individuals, and offering choice throughout pregnancy, birth and postnatally;
•establishing community hubs with care delivered by a small group of midwives in the antenatal and postnatal period;
•developing a single point of access to maternity services by standardising the process for booking antenatal care, and developing a website to provide a centralised source of information for women and their families; and
• encouraging greater collaboration between different services and professionals.
Engaging women and their families
A key part of this work has been the engagement of women and families in order to place their needs, experiences and expectations at the centre of a new and more responsive system. NCL Better Births has been keen to engage with a greater diversity of women, including those whose views are not well represented by existing service user groups.
In order to improve representation, a diverse group of 15 women who have recently used maternity services, were recruited as Patient and Public Voice Partners. The group was trained in participatory appraisal, a community action research method, and have, over a five month period, engaged with parents in order to gather their experiences of, and priorities in re-shaping, maternity services in North Central London.
In the summer of 2018 all 15 Patient and Public Voice Partners were trained to use the Positive Appraisal (PA) ‘tools’, to reflect upon ethics, behaviour and attitudes, and to practice their facilitation and listening skills. The three PA team roles, including facilitator, note taker and anti-saboteur were introduced. Based on local knowledge, the group were able to identify suitable community venues and groups to engage parents in the research.
In September 2018, the group came together for another training session where they presented their initial findings to each other and the NCL Better Births team. The group then had the opportunity to facilitate conversations with staff from NCL Better Births, using PA tools, to develop a deeper understanding of the areas that they would like to explore in more detail during the second phase of research.
UCL Partners have written a blog to describe the work so far. The research is now complete and the participatory action research report has now been published . An event was held in April 2019 to share the findings. The outcomes of the Better Births Programme including the patient feedback gathered in the participatory action research is intended to help us shape maternity care across NCL. The group will continue to be involved with the Maternity Voices Programme.