Maternity improvement resource

We had very clear feedback from our maternity workshop that providers and stakeholders want us to share more of the good practice we find on our inspections.

We analysed the inspection reports from the National maternity inspection programme and want to share the good practice we found in relation to improving healthcare equity. It is not exhaustive. But we hope that services can use the examples and get in touch with the trusts if they wish to learn more.

Meeting language and communication needs

Liverpool Women’s NHS Foundation Trust - Liverpool Women’s Hospital

The Non-English-Speaking Team (NEST) provided care for those women and families who did not speak English. The trust hosted an antenatal clinic using translation services with midwifery and consultant support, and home visits could be arranged. Information was provided in the woman’s own language so they could make the right choice for them and their baby.

Reviewing clinical outcomes with a health inequalities lens

Leeds Teaching Hospitals NHS – Leeds General Infirmary

The service was focused on reviewing health outcomes to improve health equity in maternity services. The service completed a 12-month review of stillbirths and a 5-year review of stillbirth by maternal ethnicity to understand if disparities existed. The consultant midwife for health equity and an obstetric registrar led work on an audit of reduced fetal movements which highlighted disparities in the presentation of different cohorts of women for reduced fetal movements. Following the review the service worked with the MVP to set up focus groups with local Black African women to ensure advice on reduced fetal movements was accessible and inclusive.

The trust employed a Deputy Chief Midwifery Information Officer. The trust was the first organisation to create such a senior role for a digital midwife. The service had created a Maternity Health Inequalities Dashboard to review maternity data through a population health management lens reviewing social profiles and medical complexity across the city. The service used data from the dashboard to inform a business case for increased funding for gestational diabetes clinics due to increased prevalence of gestational diabetes. Data from the dashboard was also used to target smoking cessation advice across 7 high prevalence smoking areas in Leeds.

 

North Bristol NHS Trust - Southmead Hospital

The service had a lead consultant obstetrician for equality and diversity who had examined outcomes reported nationally for still birth and neonatal deaths and looked for themes around health inequalities. This had led to project work with specific communities to break down barriers and improve outcomes for them.

Working with local stakeholders to reduce health inequalities

Warrington and Halton Teaching Hospitals NHS Foundation Trust - Warrington Hospital

The trust demonstrated outstanding practice in relation to the commitment to the equality and equity agenda, working in collaboration with external stakeholders such as, people who use the service, Warrington Borough Council and integrated care boards. This had led to improvements in the offer available in the local communities and in people’s homes.

Specific pieces of work had been carried out to address the barriers faced by the community the trust served.

The service had established an antenatal and postnatal clinic in a hotel which was housing asylum seekers in the local area, to reduce barriers to accessing care and support some of society's people who are (or might be) made vulnerable or in vulnerable circumstances..

The service created communication cards for non-English speaking women to support them in communicating their communication needs.

The service provided care packages of essential items for parent and baby, to support women in need, working closely with local charities.

North Bristol NHS Trust - Southmead Hospital

The service focused on improving maternity care for women in local prisons. Here, complex care midwives developed ‘separation boxes’ specific to the needs of women with some contents that could return to prison with them. The service also worked with the prison catering department to ensure pregnant women received more nutritious meals and prison staff took part in unexpected birth scenario training.

Liverpool Women’s Hospital NHS Trust - Liverpool Women’s Hospital

The trust was hosting and supporting the C-GULL – Children Growing up in Liverpool research programme. The programme focused on improving the health and wellbeing of children and their families within the Liverpool City Region. It will trace the lives of over 10,000 local families to understand more about what influences the health and wellbeing of children and their families living in the region.

Using Data to improve outcomes

North Cumbria Integrated Care NHS Foundation Trust - Cumberland Infirmary

The service used refugee pathway links with other regions to enable and promote care of women and babies for refugees and refugee communities. Data analysts in the trust had worked with public health colleagues to identify key vulnerable and refugee groups in the area and leaders used this information to help plan service delivery to improve access to these groups, addressing health inequalities in their population.

Specialist roles

Milton Keynes University Hospital NHS Foundation Trust - Milton Keynes Hospital

The maternity service recognised and ‘…’ the additional challenges the women and families who accessed the service faced, particularly around health inequalities, co-complexities and co-morbidities. As a response to these challenges, the service had created more specialist roles to support women in the hospital and community to improve the outcomes and experiences of the women.

Manchester University NHS Foundation Trust - Wythenshawe Hospital

The service ran 24-hour access mental health support and had a specialist midwife for mental health to support both staff and women, who carried out psychosocial assessments of women to identify risks of harm and suicide.

North West Anglia NHS Foundation Trust- Peterborough City Hospital

The trust had appointed an equality, diversity, and inclusion midwife to care for the diverse population and hard to reach community including the local females’ prison to improve patient outcomes.

Improving access

Liverpool Women’s Hospital NHS Trust - Liverpool Women’s Hospital

The service used charitable funds to fund several initiatives to meet the basic needs of women who were vulnerable. For example, they accessed funding for SIM cards for women who were digitally excluded. They issued food vouchers to women in need.

George Eliot Hospital NHS Trust - George Eliot NHS Hospital

The service offered information about bus routes, reimbursement schemes as well as free parking on-site to women who might have missed appointments and disengaged from the service due to the costs of transport.

Leeds Teaching Hospitals NHS Trust

One trust had made a video with local women including asylum seekers who shared their experiences and the impact of genuinely personalised, culturally competent care:

Lewisham and Greenwich NHS Trust - University Hospital Lewisham

The MNVP worked closely with local Muslim groups to improve bereavement facilities. Muslim support packages offered by the trust included prayer beads, anointing oils and shrouds and a list of Muslim funeral directors

Training staff

University Hospitals Bristol and Weston NHS Foundation Trust – UHBW Bristol Main Site

Senior leaders at the service attended the ‘Black Maternity Matters’, a 6-month anti-racism education and training programme. It examined a range of topics, including unconscious biases and the role of the individual in perpetuating unsafe systems of care for Black women.

Communication

Portsmouth Hospitals University NHS Trust - Queen Alexandra Hospital

As part of a learning disabilities and neurodiversity project, the service produced a maternity passport to support people with a learning disability. The passport was produced with a service user and staff group from the learning disability team in the local community. The service also had plans to develop easy read birth plans and post-natal plans.

The service had also recognised the impact of staff behaviours on communication and worked to embed principles from the ‘civility saves lives’ campaign, which aims to ‘raise awareness of the power of civility in medicine’.