There is no plan B: continuity, accountability, and maternity reform

The evidence collected from women and staff all points in the same direction: a system that feels fragmented, inconsistent, and, at times, unsafe. Women describe not being listened to, struggling to get help, and encountering multiple professionals who do not know them or their history. Too many of the tragic outcomes identified in maternity reviews over the years have resulted from a failure to listen to the mother or to act on her concerns. These are not isolated failures. They are systemic, and they reflect how maternity care is organised.

If we are serious about addressing these problems, we need to be equally serious about the solution. AIMS has long argued - across its policy work, campaigns and publications - that a model of care of community-based midwifery Continuity of Carer is not simply one improvement among many, but a key structural reform.

Drawing on decades of advocacy and the experiences of women and families, we have consistently made the case that care built around ongoing relationships - with a known midwife or small team, rooted in the community and spanning pregnancy, birth and the postnatal period - is the only model of care capable of delivering truly safe, equitable and personalised maternity services.

If this, then, is Plan A, we must also confront a difficult truth: there is no meaningful plan B.

The Care Quality Commission’s maternity surveys underline the reality women are describing. In 2023, only just over half of women said they could always get help when they needed it after birth, and a quarter reported being left alone at a time when it caused them concern. More recent results show that, despite some improvements, problems with access to advice, being taken seriously, and continuity persist across the pathway. Crucially, the same data show that women who experience greater continuity are more likely to feel listened to, involved in decisions, and supported when they need it.

As AIMS has repeatedly highlighted, this is not a problem of individual professionalism or commitment. It is a consequence of a system that fragments care across multiple teams and settings, and in doing so fragments both relationship and responsibility.

Community-based midwifery Continuity of Carer directly addresses this structural flaw. It restores the relationship-based care that AIMS has consistently argued is foundational: enabling trust, recognition of change over time, and meaningful communication. It creates continuity across settings, linking community, home and hospital care through a consistent midwifery team. It reduces the risks that arise at points of handover, where information, concerns and accountability are most easily lost.

As part of this model of care, a “key account holder” is created in the form of the continuity midwife. Too often, women and families are left to coordinate their own care, repeating information, navigating services, and chasing responses. Our proposal shifts that burden back where it belongs: onto the system. It offers a single point of responsibility across the pathway, helping to ensure that care is joined up and that concerns do not fall through the gaps.

Community-based Continuity of Carer provides relational continuity: being known, heard and supported over time. As KCL researcher Professor Jane Sandall said recently in introducing a new evidence summary, "...knowing your midwife, and having your midwife know you, may be one of the most powerful safety interventions maternity services have”. We have reproduced a section of that new evidence summary in an annex to this note - see the full report for a fully referenced version.

The key question now facing the Government is not whether Plan A is needed. The evidence - from women, from professionals, from national data, from research, and from longstanding advocacy by AIMS - already tells us that it is. The question is whether the Government is prepared to adopt a policy of community-based Continuity of Carer as a core structural reform, and to commit to the conditions required to deliver it in practice.

Full-pathway community-based midwifery Continuity of Carer is the clearest route to safer, fairer and more personalised care. The alternative is not another model waiting in reserve; it is simply more of the same. There is no Plan B.

Jo Dagustun
On behalf of the AIMS Campaigns Team
22nd July 2026

Further reading: AIMS position paper

Annex: How do researchers think that a community based Continuity of Carer model of care works?

Extract from Sandall, J., Burton, S., De Backer, K., Easter, A., Fernandez Turienzo, C., Khan, Z., Rayment-Jones, H., & Vowles, Z. (2026). Continuity of Midwife Care: The Safety Critical Golden Thread

Mechanisms of action

It has been argued that neither management nor informational continuity can compensate for the lack of an ongoing relationship over time. Continuity contributes to service user’s [sic] perceptions of having a trusted care provider who knows their social and medical history and harnesses an expectation that a known provider will care for them in the future, lessening stress and anxiety. This longitudinal aspect develops a trusting relationship between women and their midwives. It enables midwives to work to their full scope of practice across women’s care journeys, improving their ability to identify women’s individual needs and providing a safety net.

Suggested mechanisms of effect in maternity and primary care literature include care providers taking greater responsibility, improved trust, confidence in the care provider, feeling safe to disclose concerns or risk factors, reduced stigma and discrimination, and improved engagement, access, and referral. Continuity of care may also lead to enhanced co‐ordination or navigation of care, greater advocacy, timely follow‐up of test results, and greater adherence to treatments and multidisciplinary guidelines. It may also provide more opportunities for social support from multidisciplinary services, families, and the local community, timely care, earlier help‐seeking, opportunities for early prevention, escalation of concerns, and diagnosis of complications to facilitate management and intervention.