Implementing Continuity of Carer in England

Key national milestones in the implementation of Better Births’ call for continuity of carer in the maternity services: a resource list

By AIMS, September 2022

AIMS has long campaigned for a transformation of the maternity services across the UK, to include the implementation of a model of care that places relationships at its heart, notably via ‘a midwife for me and my baby’. This model of care, now being called ‘continuity of carer’ or ‘midwifery continuity of carer’, was central to the 2016 report of the National Maternity Review, Better Births. Since the publication of Better Births in 2016, AIMS has been following closely national level implementation activity, including the publication of national documents of relevance. One of our volunteers has compiled this resource list for our own use and we share it now on our website for others who are interested.

Please let us know if you can help us with extra items for this list, or if you see anything in need of correcting, by emailing us at Thank you!


February: Better Births published; report of the National Maternity Review, a 5 year forward view





March: general implementation guidance for Local Maternity Systems

(c. 44 across England) for the implementation of Better Births published by NHS-E, including key pointers wrt CofCer implementation eg it was suggested that LMSs reflect on ‘[whether there is] a local ambition for how women will receive continuity of the person caring for them during pregnancy, birth and postnatally and …clear and credible plans for implementing it.’


NHS England » Implementing Better Births: A resource pack for Local Maternity Systems

December : specific CofCer implementation guidance published by NHS-E

NHS England (2017). Implementing Better Births: Continuity of Carer: ‘This document provides practical guidance to Local Maternity Systems on how to improve their services so that women experience continuity in the clinicians providing their maternity care.’


NHS England » Implementing Better Births: Continuity of Carer


November: Measuring Continuity of Carer: A monitoring and evaluation framework.


Measuring Continuity of Carer: A monitoring and evaluation framework - RCM

December: maternity continuity of carer implementation included in national annual operational planning and contracting guidance


NHS Operational Planning and Contracting Guidance 2019/20



January: NHS-E Long Term Plan; focus on phased rollout to address racial and socio-economic inequalities

“In maternity services, we will implement an enhanced and targeted continuity of carer model to help improve outcomes for the most vulnerable mothers and babies. By 2024, 75% of women from BAME communities and a similar percentage of women from the most deprived groups will receive continuity of care from their midwife throughout pregnancy, labour and the postnatal period.” (2.28)

“Continuity of carer teams are being developed and launched across the country – with the aim that in 2019, 20% of pregnant women will be offered the opportunity to have the same midwife caring for them throughout their pregnancy, during birth and postnatally. These teams will deliver more personalised care plans for pregnancy. We will continue to work with midwives, mothers and their families to implement continuity of carer so that, by March 2021, most women receive continuity of the person caring for them during pregnancy, during birth and postnatally.” (3.13)


NHS Long Term Plan » The NHS Long Term Plan

March: inclusion of Continuity of Carer in standard contract between NHS-E and local Trusts, 2019/2020

“3.13 Where the Provider provides maternity Services, it must:

3.13.1 fully implement the Saving Babies’ Lives Care Bundle by no later than 31 March 2020 and thereafter comply with it, and

3.13.2 use all reasonable endeavours to achieve the Continuity of Carer Standard by 31 March 2020 and demonstrate its progress to the Coordinating Commissioner through agreement and implementation of a Service Development and Improvement Plan.”



February: NHS Resolution (updated in March) includes CofCer implementation progress in the Maternity Incentive Scheme, Year 3.

This focussed on Trust level action planning - with regular Board level oversight - with the ask refreshed in October 2020 following a pause due to the pandemic


NHS England » Saving Babies’ Lives Version Two: A care bundle for reducing perinatal mortality

March: another clear national endorsement of CofCer as a key safety initiative, via text in the Saving Babies Lives Care bundle update: it noted that CofCer was outside the remit of bundle but referenced it as an important safety intervention alongside the bundle


NHS Standard Contract 2020/21 Service Conditions (Full Length)

March 2020: Standard national contract includes provision on CofCer implementation


Maternity incentive scheme – year three

September: Appointment of National Clinical Lead for Continuity of Carer



March: inclusion of Continuity of Carer implementation condition in national NHS contract

“3.13 Where the Provider provides maternity Services, it must

3.13.1 comply with the Saving Babies’ Lives Care Bundle,

3.13.2 use all reasonable endeavours to achieve the Continuity of Carer Standard by 31 March 2022 and demonstrate its progress to the Coordinating Commissioner through agreement and implementation of a Service Development and Improvement Plan; and

3.13.3 put in place an action plan, approved by its Governing Body, describing, with timescales, how it will implement the immediate and essential actions set out in the Ockenden Review and must implement this action plan diligently, reporting on its progress to its Governing Body in public and to the Co-ordinating Commissioner.”


NHS Standard Contract 2021/22 Service Conditions (Full Length)

July: Publication of Health and Social Care Select Committee’s report of their inquiry into Maternity Safety, including an Expert Panel Report set up to evaluate Government progress on delivering four commitments on maternity services, including continuity of carer:


‘Blame culture’ in maternity safety failures prevents lessons being learnt, says Committee

link to expert panel report:

Expert Panel: evaluation of the Government’s commitments in the area of maternity services in England

September: Government response to Health and Social Care Select Committee report


The Government’s response to the Health and Social Care Committee report

October: further implementation guidance published by NHS-E; updated guidance, setting out building blocks for implementation, including key focus on safe staffing (whatever the model of care)


Delivering Midwifery Continuity of Carer at full scale | NHS England

March: Annual contract between NHS-E and maternity service providers again includes Continuity of Carer implementation provision



April: new high level CofCer guidance via letter from NHS-EI, in response to Ockenden Report concerns about staffing and CofCer implementation (note: some de-implementation seen as a result)

NB: June deadline for all Trusts to refresh implementation plans, to allow for regional and national oversight: “In line with the maternity transformation programme, trusts have already been asked to submit their MCoC plans by 15 June 2022. In doing so, they must take into account this IEA in ensuring that safe midwifery staffing plans are in place.”


OCKENDEN – Final report | NHS England

May: NHS Resolution Maternity Incentive Scheme includes CofCer once again, this time focussing on data reporting quality and action planning (in line with NHS-E ask) towards full-scale delivery by March 2024


Maternity incentive scheme – year four

August: NHS-E launch call for bids for the independent evaluation of the implementation programme, contract value £110k


We hope that this page is of interest, especially to our colleagues in the maternity services improvement community.

The AIMS Campaigns Team relies on Volunteers to carry out its work. If you would like to collaborate with us, are looking for further information about our work, or would like to join our team, please email

Please consider supporting us by becoming an AIMS member or making a donation. We are a small charity that accepts no commercial sponsorship, in order to preserve our reputation for providing impartial, evidence-based information. You can make donations at Peoples Fundraising. To become an AIMS member or join our mailing list see Join AIMS

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.

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