Maternity transformation - where are we?

Is maternity improvement possible without service transformation? AIMS says no, and calls for work over and above the NHS-E Three Year Delivery plan, to get the necessary transformation back on track

AIMS is sad and disappointed to note that there is no longer an NHS-E team with the phrase 'maternity transformation' in its title (see NHS-E's bulletin of July 25, 2023). Throughout the development of NHS-E's Three Year Maternity and Neonatal Delivery Plan, we received reassurance from NHS-E that this new short term plan is intended to help Trusts address immediate problems, such as staffing levels, whilst paving the way for the transformation set out in Better Births.

As such, AIMS understood that the Plan would be a remedial plan of action, setting out clearly the part that various stakeholders must play to get us to where we need to be in order to deliver the Better Births transformation agenda. In other words, a plan to restore the fundamentals in readiness for relaunching transformation. We wish it well, whilst noting, as in the case of a true chicken and egg dilemma, that its key aims are perhaps more likely to be enabled by the maternity transformation it is intended to precede.

But the Plan itself is worryingly silent on the essential longer term transformation vision. Instead, it seems to suggest that we can effect sustainable improvement in the maternity services through a series of discrete initiatives and tools, most of which are already in place, without implementing that complete and fundamental rethink - set out in Better Births - about how we deliver services, based on a relational model of midwifery care delivered within our own communities, where community hubs bring together the support we need: wrapping services around us.

To be meaningful, the 3 year plan must be underpinned by an ongoing focus on the longer-term vision. We ask: where is that focus?

Let's be clear. The lack of progress with transformation isn't a COVID issue. COVID has certainly complicated the work programme, but the pace of implementation of the maternity transformation agenda as set out in Better Births, in the four years before COVID, was already disappointingly slow. We understood this to be in good part related to the lack of capacity - perhaps even lack of will - for change across Trusts, as well as maternity staff shortages. We had hoped for recognition that ‘maternity transformation’ needs to be viewed as a change management process, and for the Plan to draw on the extensive literature about how to manage such a process effectively.

We welcomed as a step towards this change management process the national leadership capacity building programme put in place by England's first Chief Midwifery Officer, Jacqueline Dunkley Bent, aimed at improving leadership capacity both through the creation of NHS-E regional chief midwifery teams (later joined by regional obstetric leads) alongside leadership development programmes for NHS Trust maternity teams.

We understand that such initiatives take time to deliver; we are hopeful that - thanks to that programme - we are now in a stronger position to effect the Better Births transformation. Not least, good leaders should know how to create working environments that are attractive to staff, as well as how to gain buy-in at all levels to the radical changes in organisation, systems and working practices that true maternity transformation requires. The evaluation of that development programme, now being commissioned, will help us pinpoint next steps.

In addition, the as-yet-unpublished rapid evaluation of the implementation of Continuity of Carer across England, delivered to NHS-E some months ago, should offer further understanding of the challenges and enablers, and help with the design of the transformation programme going forward.

And with all of that learning under our belts and underway, let's get on with planning and preparing for transformation. Maybe too there are some areas of the country, with effective management in place, who can lead the way? Let's bring them into the conversation.

Women and their families deserve maternity services that are not only “safe, personal and equitable” but also “kinder, professional and more family friendly” as called for in the Better Births vision. For that, maternity transformation is needed. Instead, with the deletion of the word transformation from the lexicon of maternity improvement in England, AIMS is left wondering if there is indeed any clear vision of transformation left. And for those of us with in-depth knowledge of the harm repeatedly wrought on women and their families by the maternity system, reaching back for many decades, that's a bitter pill to swallow.