Government Response to the Quality of Maternity Services

Geoffrey Simpson-Scott, Partner
Geoffrey Simpson-Scott
Partner, Head of Medical Negligence

We’re continuing to look at the government’s response to the report put together by the Health and Social Care Committee (HSCC) in July this year. The final section of the report sets out recommendations under the heading Providing Safe and Personalised Care for all Mothers and Babies. This includes the Continuity of Care model, targeting disparity in maternal care, choices at birth and measuring of Caesarean Section rates.

We’ll talk through the recommendations laid out in this section as well as the government’s response and our opinion on them.

Final Recommendations and Our Opinions On the Government's Response

Recommendation 12 - Ensuring anyone delivering Continuity of Care gets the right training and are competent, (particularly in relation to ethnic minorities where there are the biggest gaps)

We’re pleased the government has accepted this recommendation and that NHS England and NHS England Improvement (NHSEI) recognises that professionals working in maternity care should be competent.

Local maternity services will complete a Training Needs Analysis updating midwives’ clinical skills. This allows midwives to care for mothers-to-be through their whole pregnancy and deliver the Continuity of Care model equally across diverse ethnicities and deprived communities.

Health Education England (HEE) are working with NHSEI to offer a Continuity of Care training package for 2021/22 that supports midwives and wider staff (including obstetricians, midwife leaders and managers).

Better training should lead to fewer mistakes which will have a positive impact on women and their babies.

Recommendation 13 - Ending disparity in maternal and neonatal outcomes for all ethnicities

The government has accepted this recommendation in part but has said the NHS won’t set a hard target for reduction in disparity because the additional social factors that impact health are outside of NHS control.

Instead, they will focus on a ‘life course approach’ identifying areas for health intervention before women get pregnant. The new Office for Health Improvement and Disparities (OHID) will use this approach to target health disparities across all social and minority ethnic groups.

There are plans to use data collected on the most deprived 20% of the local populations and other identified minority groups to target improvements in key areas.

The adoption of Placental Growth Factor (PIGF) based tests will be supported to identify pre-eclampsia, which is most prevalent in black women, so the right treatment can be given sooner.

Recommendation 14 - Improving choice over whether to have a vaginal birth or not and ensuring that they are fully informed about safe birth options

The government has accepted this recommendation in part, but they are not being entirely clear about how they this will make this happen.

They have acknowledged the importance of prioritising personalised care in maternity services, which includes the implementation of the iDecide digital platform. This helps women with informed consent on their treatment and that personalised care will be in in place by March 2022.

The ‘Re:Birth Project’ is essential to deal with the language used by maternity professionals to mothers. The project will help to ‘name’ different types of birth, and make sure all professional use the same language.

It’s crucial that the government prioritises women and allows them to be clear about what their options are and are fully informed. We urge them to move forward with all of these recommendations as soon as possible.

Recommendation 15 – End penalties for high Caesarean Section rates

The government accepts this recommendation and agrees that maternity units should not be measured on high Caesarean Section rates. Instead, C-section rates must be measured more intelligently.

Concerns around offering a C-section to woman affecting their unit’s stats should never be there – the decision should solely be a medical one. Removing these measures should help remove these concerns.

But there are no time scales in place as to when this will happen. We urge the government to put this in place as soon as possible.

Although there’s a long way to go, there are some positive signals that change is coming. We will be monitoring the situation closely and look forward to hearing more around the implementation and timings of when this will all take place.

Our Final Thoughts

Although there’s a long way to go, there are some positive signals that change is coming. We will be monitoring the situation closely and look forward to hearing more around the implementation and timings of when this will all take place.