What does the Government’s 10-year Health Plan for England mean for the Maternity Services?

The Government’s 10-year health plan for England ‘Fit for the Future’, launched in July 2025, is the outcome of the large-scale ‘Change NHS’ consultation that began in 2024. AIMS participated in this consultation both by producing our own submission about the changes we wanted to see in the maternity services AIMS suggestions for the maternity services in the Government's 10-year Health Plan and by hosting a community engagement workshop attended by a mix of midwives or former midwives, birth workers, birth activists and representatives of charities in the maternity sector Change NHS Community Engagement workshop feedback.

The key thing AIMS wanted to see included in the 10-year plan was a renewed commitment to the Better Births recommendations and vision. Our specific priorities are:

• Continuity of Carer to become the standard model of maternity care with a rollout strategy that that prioritises those at most risk of poorer outcomes

• Choice of birthplace including community-based birth centres and support for homebirth as well as hospital-based birth centres and obstetric units in all areas.

• Community hubs providing not only antenatal and postnatal maternity but family health and social services. AIMS would like these to be ‘women’s health hubs’ providing services for women’s whole life course, and integrated with support for community-based births.

• Physiology-informed maternity services with a focus on salutogenesis (the promotion of health and wellbeing) as well as the current pathogenic focus on detecting or avoiding risks.

• Equity of access to care including the provision of information in formats accessible to the individual, and the availability of qualified translators/BSL signers.

• A strategy to address the chronic shortage of midwifery staff.

So how well does the new strategy deliver for maternity care?

Few of the things on our ‘wish-list’ are mentioned specifically, though the strategy goes some way to address some of them. Perhaps not surprisingly, given the recently announced National Maternity Review, the plan lacks an overarching framework for making maternity services ‘fit for the future’. However, there are a number of specific initiatives relating to maternity care. Many of these are welcome, but much will depend on how effectively they are developed and implemented.

One of the potentially most valuable is the proposal to introduce “a neighbourhood health centre in every community… a ‘one stop shop’ for patient care and the place from which multidisciplinary teams operate”. This is similar to the model of Community Hubs recommended in the Better Births report, and offers the potential for a much greater proportion of maternity care to be provided close to where women live. It should also facilitate the delivery of Continuity of Carer and homebirth support by a local community midwifery team. However, the fact that the strategy says “We will begin establishing NHCs in the places where healthy life expectancy is lowest” implies a recognition that it will not be possible to implement this model nationwide for some time.

We can speculate that it might even be possible for some maternity screening services such as ultrasound scans to be delivered in these neighbourhood settings - though if this were to be the case, it would be essential to ensure that suitably qualified staff were also available to provide support and information about options in the event of an adverse finding.

On the question of staffing we are pleased to see a commitment to “help nursing students overcome financial obstacles to learning, including reducing delays to reimbursement for their Placement travel”. We are concerned that there is no specific mention of the needs of midwifery students. The broader issues around recruitment and retention seem to be left to the ‘Professional Strategy for Nursing and Midwifery’ being developed by the Chief Nursing Officer for England. We believe that there needs to be clear guidance on adequate staffing levels (such as Birthrate Plus) and transparency about actual levels versus targets for each Trust.

We also welcome the requirement for “all students to have a high quality experience in neighbourhood and community settings and social care.” Hopefully this will mean future midwives having experience of Continuity of Carer and physiological births in community settings.

Much of the strategy is focused on the use of digital tools. Whilst these offer potential benefits, AIMS is concerned about equity of access. The plan appears to rely on women (and all staff) having internet access, a smart phone and the digital literacy to use such services. There must be alternative means of access and support to meet the needs of those that are unable or reluctant to use digital services. There also needs to be adequate training and support for all staff to help them use the new tools effectively. The cost and time required for this should not be underestimated.

A new 'Single Patient Record' intended for the whole NHS is to be rolled out in maternity first. This is meant to ensure that all healthcare staff have access to the full range of information about an individual and can offer “seamless care”. It’s also intended that patients should have access to all the information in the record and be able to add their own information, though it’s not clear how this would be done. There is a reference to “clinically validated wearables” and later to the NHS App.

This initiative could be very helpful in enabling women to see and if necessary correct the records of their maternity care and ensure that their preferences and decisions are documented and communicated to all their carers. It should avoid the need for women to repeat potentially distressing experiences to multiple people, and help to avoid the mistakes in care that can arise if staff are ignorant of key information. It is an ambitious aim, and we have to hope that the development of the system will be more effective than previous attempts to develop IT systems for the NHS.

A range of new services are envisaged to be available through the NHS App including ‘My Choices’ to provide data on available service providers. This has the potential to give women information to help them make decisions such as choosing their birthplace. If it is able to include user experience feedback it might act as a driver to services to improve their care.

Another tool ‘My Companion’ is intended to help patients “articulate their health needs and preferences confidently” and provide them with information. It will “support translation, so that everyone can engage with their healthcare in their first language.” This sounds like a potentially valuable service - but again, only for those women with the technology and confidence to use the NHS App. The strategy promises that “Inclusion will be designed into the NHS App by default” with information tailored to meet the needs of people from different backgrounds. These are essential requirements, but the value of these services will still depend on people being able and willing to use an App in the first place.

For any of these digital services it will be essential to ensure adequate safeguards for privacy and data security. Some maternity service users could be reluctant to share personal information knowing that it could be seen by a wide range of healthcare staff, and may fear it being shared with other agencies such as social services.

Referencing the various maternity and other scandals, the strategy promises "a new era of transparency, a rigorous focus on high-quality care for all and a renewed emphasis on patient and staff voice". Developing systematic collection and publication of patient reported outcome measures (PROMs) and patient reported experience measures (PREMs) "for maternity care will be our earliest priority". This includes plans for "implementation of a new PREM that enables all women and families to provide feedback on their care from summer 2026 onwards." AIMS has long called for greater transparency, and a system for monitoring of women’s maternity experiences is to be welcomed as long as the resulting measures are made available in a clear, easy to interpret and accessible formats. This needs to go alongside transparent reporting of the statistics on care and outcomes that matter to maternity service users, and we call on all Trusts to co-produce and publish these.

Another new tool is the Maternity Outcomes Signal System (MOSS) which is planned to be in place across trusts from November. This will use "near-real time data to indicate higher than expected rates of stillbirth, neonatal death and brain injury" in the hope of identifying potential issues with care. This may be helpful if it proves to be an accurate way of signalling problems, but only if there is external scrutiny and holding of Trusts to account for taking appropriate corrective action.

Conclusions

The strategy includes a number of measures that, if they can be developed and implemented effectively, have the potential to improve maternity care and outcomes. AIMS is particularly hopeful about the benefits of Community Hubs, though we fear it may be a long time before enough of these can be developed to make care truly accessible. The recent experience in Northern Ireland is that lack of funding seems to be hindering implementation of the recommendations in the Renfrew Report for developing community hubs. Will England be any more successful in the current economic climate?

On their own these initiatives are insufficient to support the radical transformation that is needed to create a maternity service that is truly ‘fit for the future.’ Whether the National Maternity Review will do so remains to be seen.

There seems in this strategy to be a reliance on technology to solve problems rather than addressing the issues of culture, behaviour and attitudes within the maternity services that have so often led to serious failures of care. Will having women’s comments recorded in a Single Patient Record or tracking of patient reported outcomes and experience measures lead to all women being listened to, respected and supported in their decision-making? We can but hope.