Making sense of maternity service recommendations

By Jo Dagustun, Senior Campaigns Volunteer

As readers grapple with the latest set of national recommendations and actions from Donna Ockenden's Nottingham report, Valerie Amos’s National Investigation, and now James Mackay’s communication of NHS England’s 10 Point Plan, this reflection piece suggests a new approach for dealing with recommendations for action, whether they be recommendations calling for the prioritisation of existing asks or new asks. For without such a robust process, there is as much chance that these and future recommendations will indeed sit on a shelf, be poorly implemented or be implemented to ill effect, as have so many recommendations before them.

Whatever the likely value of new recommendations, it is important to remember that they come against a backdrop of many hundreds of recommendations from previous reports and investigations. Stakeholders have no confidence that all existing recommendations have yet been properly considered, checked against appropriate research evidence and/or NICE guidance, and acted on appropriately. This is a situation that has been left unresolved for too long, leaving system leaders exposed, staff confused and families furious, and failing to lead to the radical improvement that our maternity services need. NHS England's creation of a 'recommendations register' was a welcome contribution and long overdue, but is not in itself sufficient to address the problem.

I have two linked suggestions:

First - and I was pleased Valerie Amos calls for this too (her recommendation 4, bullet point 3, page 18) - we need to develop an open and accessible compendium of national expectations of all NHS Trusts offering maternity services. This would be a clear and transparent ‘digital book’ containing an overview of and routemap through every action that Trusts need to take, including the resources they need and standards they should meet, to run a maternity service. This would become a core resource for service leaders, service users and service regulators. It would serve as a key reference point for the question of whether service provision is or isn’t being delivered;

and second, to build on this - anyone making recommendations for service improvement should ensure that they demonstrate clearly how each new recommendation relates to this compendium, with clarity on whether (a) they have identified an issue that is already in the compendium but that isn’t being delivered, in which case action should follow, or (b) a new issue. If it is a new issue, then we have a potential addition to the Compendium. That should trigger a robust process to consider it, bringing to bear a good understanding of the relevant evidence base, of existing relevant elements of the Compendium, and of the likely consequences of such a change, including unintended consequences.

This simple new approach would require the people and organisations who review services or make proposals to consider their recommendations and proposals in the context of the Compendium, and I believe would in that way improve the quality of new recommendations. It would also help to underpin swift appropriate policy-making and effective implementation.

As well as supporting change in this way, the compendium in itself would bring its own benefits:

• systems leaders would be required and enabled to identify, monitor and report on any gaps in local service delivery, including those that are most important to women and families, not just the ones on which they themselves prefer to focus;
• women and families using the services would be clearer about what they can expect. The current confusion about whether to expect service offers in line with NICE guidelines would come to an end;
• regulators would have a new transparent template for their work.

I believe that such an approach, founded on the key principles of transparency and openness, is vital, if the maternity services are to both learn/ improve and regain the public's confidence/trust that they are willing and able to do so.

For AIMS, I have made representations previously on this issue, in my role as a member of the NHS England Stakeholder Council. I feel that I have been fobbed off for too long, without a decent explanation of why this approach wouldn’t represent an improvement over how we work currently.

Certainly, if already implemented, it would be a more straightforward task to review the 100+ recommendations that have come in over the last ten days.

Let's get the Compendium in place - no mean feat in itself - and put it to work, for women, for families, and for everyone who works in the maternity services!

Jo Dagustun

On behalf of the AIMS Campaigns Team

Jo Dagustun is the AIMS representative on the Charities and Third Sector Expert Reference Group, which is intended to support the Department of Health and Social Care Maternity and Neonatal Taskforce. Jo is also the AIMS member of the NHS England Maternity and Neonatal Stakeholder Council, previously known as the Maternity Transformation Stakeholder Council, originally set up to support the implementation of the previous National Maternity Review, Better Births.