AIMS Campaigns Update, December 2022: Continuity of Carer – challenging times, but we’re still moving forward

As ever, this quarter has been a busy one for AIMS campaigners working on our flagship campaign: the call for a universal relational model of midwifery care to be in place throughout the UK. This update focuses on what we’ve been working on recently in England. It is an open access update, but produced especially for all AIMS members, whom we are keen to hear from as we seek to progress this campaign.

As many readers will be aware, Continuity of Carer is the service reconfiguration policy that has been firmly in place in England since early 2016, when the Government accepted the recommendations of Better Births, and the Maternity Transformation Programme was created in NHS England to lead on policy delivery. AIMS is privileged to sit on the Stakeholder Council for this Programme, and we have been keen since 2016 to retain a key oversight of national implementation activity around the realisation of ‘relational care for all’ (or ‘a midwife for me and my baby’).

We have spent some time this year reflecting on implementation progress. There have surely been ups and downs along the way, but it’s clear that much good and sustainable work has been done, both at the national level and also in some areas of the country. But progress, even before the Covid pandemic hit, was insufficient and patchy. So the key questions for us now, looking forward, are:

• What have we learnt from this initial Better Births implementation period?
• How can we use this learning to move forwards?

We were therefore pleased to see that an evaluation of the implementation to date has been commissioned by NHS England. We worked to highlight this opportunity to the research and evaluation sector over the summer, so that we were assured that the invitation to tender for this work was widely known. We have already been in contact with the team now leading the evaluation at City, University of London, to offer them some initial ideas about where they might look for the evidence and key contextual information, and to support their intention to ensure evidence is collected from a wide range of stakeholders. We look forward to their report next Spring, as a key contribution to moving ahead well with the implementation of this policy.

Not so welcome, perhaps, was the announcement by NHS England that national targets for the universal implementation of this policy are being paused given the extreme workforce pressures being experienced in the maternity services and the wider NHS.

Nevertheless, national support for research and evaluation work to support this policy continues, as does a firm focus on the implementation of relational care under the CORE20PLUS5 programme.This is essentially the priority equity rollout strategy as also outlined in the NHS Long Term Plan, and some extra money is available to Trusts for this purpose.

We are also starting to think about how all Trust CEOs might be persuaded to recognise that this policy is essential to their delivery of a safe, equitable and personalised maternity service. It’s been interesting to reflect that achieving this buy-in does not necessarily require interim national targets, but certainly does depend on national support to demonstrate the benefits and facilitate the change process.

In terms of third sector and community collaboration, AIMS also continues to work closely with other charities and service users in support of the continuity of carer policy. I am pleased to report that the Charities’ and Service Users Maternity Continuity of Carer Network set up for this purpose is gaining strength, and that members of the Network recently recommitted themselves to continuing our work together in 2023. It was a pleasure, alongside Mary Newburn, to be able to introduce the Network to an international audience at a conference in September. At the beginning of December, I took the opportunity to brief colleagues at the Association for Radical Midwives (ARM) about both the Network and the latest AIMS thinking, and to hear some excellent updates from other speakers involved in the roll-out of this policy. Finally, to reach a wider audience of midwives, I have been working with colleagues in the Network to prepare an article which will introduce the Network and our work to readers of The Practising Midwife.

Meanwhile, in the face of a raft of continued shocking news about our maternity services’ ability to offer safe, equitable and personalised care, and the large number of outstanding recommendations for improved maternity services - from reports recent and not so recent, including those relating to individual services - NHS England put out a survey in November seeking views on how they might ‘refresh’ their maternity activity focus. The idea is to bring together the various areas for action, to ensure that ‘asks’ of local services are streamlined, to reduce the bureaucratic burden. We should therefore expect to see a ‘single delivery plan’ as a result of this work in early 2023. AIMS has been assured that the Better Births recommendations - which include of course those relating to continuity of carer - will remain a key part of that plan.

In response to the key ‘single delivery plan’ survey question, ‘what is our priority?’, I spoke up in favour of Continuity of Care, and the Campaigns Team thought it worth sharing my text. Please take a read of it and let us know what you think of this latest argument in our campaign to see continuity of carer as the foundation for transformational change in the maternity services. Does it resonate with you? If not, how would you continue to make the case for relationship-based care? It’s so crucial that political support for this policy is maintained over the coming months and years. In addition to AIMS action at the national level, what do we each need to discuss with our local communities, including local councillors, MPs, Trust CEOs and other key decision makers, to make them really listen to our plea and support our call for the implementation of relational care as quickly as possible?

Thank you for reading, and please do feel welcome to get in touch and tell us what you’d like to see covered in future campaign updates. We’d love to hear from you.

Jo’s response to a question in the Maternity Transformation Programme’s recent ‘refresh’ survey

“What is my priority? Continuity of carer.

The introduction of whole-pathway relational care for all women - as repeatedly called for by those most invested in maternity service improvement, its users - will be the game changer in the maternity services.

It will function as an engine for quality improvement, enabling safety on the basis of equitable personalised care:

• as a flexible service delivery mechanism, it will ensure greater equity in maternity outcomes, addressing the ‘inverse care law’ that is too frequently seen and which is simply unacceptable in the context of taxpayer funded [public] health service.

For each woman and family, a ‘continuity midwife’ will become the 'key account holder'. With this structure properly in place, and supported by the whole organisation, the highly skilled continuity midwife, with the support of both the immediate and wider multidisciplinary team, will be able to:

• Offer truly personalised care, based on a solid foundation of relationally-enabled mutual respect and trust
• Advocate for service users, keeping them safe as they do so; and
• Properly see and bring to the system's attention those elements of the service requiring quality improvement.
• Support service users navigate a sometimes complex multi-disciplinary maternity service, where additional support is necessary

This is the transformational change demanded for decades by service users, and agreed as Government policy most recently following Better Births in 2016. We’ve learnt much over the last seven years about how to implement this policy, with some good progress made in some areas. The evidence base demonstrating improved outcomes is growing. We’ve seen how it can be the solution to staffing crisis, not the problem, offering midwives who’ve experienced it a more satisfying job and work/life balance.

Now it’s time to see a determined focus on Continuity of Carer being delivered for every family using the maternity services, in all areas of England. A postcode lottery on this one is not acceptable. The cost of not making this service transformation, across a range of outcomes, is simply too high for us to accept.”