There is a very palpable change in maternity at the moment or at least I think so. A real shift in views and a change of gear. I believe this was in evidence when I was fortunate enough to attend a London Clinical senate forum on 21st April, the first devoted entirely to maternity services. I was honoured to be speaking briefly about #MatExp amongst many illustrious people both speaking and in the audience and I would like to share some personal highlights that both made me think and made me optimistic that there is a change underway.
Baroness Cumberlege started the morning with the National Maternity Review. I have heard her speak before but the concept of personalised care wrapping services around a woman with continuity through the pathway cannot in my view repeated too many times. There are as we know many practical organisational and financial barriers to this at present and the importance of leadership encompassing trustworthiness, competence, reliability and honesty was strongly emphasised.
As co-chairs of the London Maternity Strategic Clinical Network (SCN) the baton passed to Professor Donald Peebles & Donna Ockenden to give an overview of the work undertaken by the SCN in the last 2 years and to introduce some of the work in more detail. Donald set us a challenge to consider how we translate clinical networks that are currently mainly acute provider based into maternity systems with a broader far more integrated approach. Amongst more detailed presentations Jane Sandall presented compelling evidence about the impact of continuity on outcomes & Liz Mc Donald chair of the London Perinatal Mental Health Clinical Network presented both the enormous impact of perinatal mental health and the huge disparity in care across London.
Next we had a panel session with David Richmond (RCOG) and Cathy Warwick (RCM) on their views on the London Quality standards (LQS). These were process based standards e.g. midwifery staffing ratios & consultants’ hours of presence developed 5 years ago to drive improvement, the maternity section being part of a wider piece of work across London health care including emergency care standards. David Richmond spoke of ‘asking what do women want and what makes a difference to them?’ as well as a discussion of the immense workforce challenges facing the specialty. Cathy Warwick spoke of the importance of multidisciplinary culture and gave a lovely cake shop story analogy for women’s choice. If you go into a chocolate cake shop and have a piece of chocolate cake you will say you were satisfied as this was the only choice, however if you had known there was lemon drizzle cake in a shop down the road you may have wanted that and not been pleased with the chocolate cake and annoyed you were not aware of the alternatives. We agreed that the LQS still had purpose in driving improvement but need modification. A discussion flowed on the importance of outcomes rather than process and that we need to move from quantitative to qualitative outcomes. Process can be useful to drive change but should not be the be all and the end all. We talked about the need for different measures for satisfaction as what we currently have is not adequate and the importance of relationship based care.
At one point a question from the audience came as to how women are involved in driving improvement in maternity services across London and what is their role in the implementation of the Maternity Review. The answer was of course that there is far more to do but I was proud that it was also acknowledged that #MatExp both though ‘Whose Shoes’ workshops and virtually is evidence of women starting to drive the change as true collaborators and leaders.
I was the final speaker of the morning and although I was asked if I would like to switch and speak slightly earlier to me this seemed the most appropriate way to finish the meeting. I stood up and spoke to explain: #MatExp Maternity Experience is not the fluff or the afterthought, it is the beginning, the foundation of the future. True multidisciplinary team work and co-production is enshrined in the Health & Social care act, Francis, Kirkup and now the NHS Maternity Review. #MatExp bringing together the grassroots voices of women, families and health care professionals with the energy and enthusiasm for improvement is the future. Join in!
There is an enormous quantity of work ahead to do but it is clear that the work of the London SCN is very much along the right lines in terms of the NHS Maternity Review and the direction of travel. I had never been to a meeting with some many influential people where there was a genuine desire to undertake a wholescale change in maternity services and towards a very much more holistic person centred approach. I left with a real sense of hope and opportunity. On top of this the announcement last week by NHS England of a Maternity Transformation Board make me certain. The future of maternity services is here for the taking so we’d better grab it with both hands. The time to act is now, let’s hope we can do it justice!