Putting maternity on the main stage

A woman cradles her pregnancy bump

One year on from the launch of the Better Births vision, the Chair of NHS England’s Maternity Transformation Programme updates on the progress being made:

The NHS England Maternity Transformation Programme Board was created in June 2016 to drive the implementation of Better Births, ensuring maternity services across England provide more personalised, safe and supportive care.

I was incredibly honoured and privileged to be invited by Simon Stevens to Chair the Board. It felt like the moment for maternity services to step up and take the opportunities of a refreshed vision, together with priority status and associated funding, to make a real difference to society.

This is because for me, transforming maternity services is about so much more than a nine-month event, with some post-natal care. It’s fundamental to every family and every community. If we get care right during pregnancy, birth and early years, we set up the next generation to thrive. There can be no greater cause.

Key to our transformation is honesty about what we are not getting right, such as:

  • We are not consistently delivering the care that women want
  • We are sometimes not organised in a way that gives us the best chance of ensuring the very best outcomes for women and babies
  • In some areas care has become de-personalised and over-focused on process, so that we have lost the connection with the individual woman
  • Although giving birth in England has never been safer, we still have higher rates of mortality than some other countries
  • And we face some challenging cultural issues, as evidenced by Bill Kirkup’s report on Morecambe Bay.

This is why personalisation and safety are the two golden threads running through everything we are doing in the Maternity Transformation Programme – and I firmly believe they are two-sides of the same coin.

Personalisation includes:

  • Care plans developed with women
  • Continuity of carer so women know their midwife
  • Offering meaningful choice across and within services
  • Community hubs to access a range of support, including post-natal mental health
  • Understanding the need for preventive services, such as smoking cessation

Safety involves:

  • Individual maternity units to link up and create Local Maternity Systems
  • Planned, safe and sustainable care
  • Sharing data and information – about the things that are going right and the things that are going wrong
  • Maternal and neonatal quality improvement programme bringing together midwives, obstetricians and neonatologists
  • Reviewing all stillbirths and perinatal deaths to a consistent methodology to feed into a national system for analysis and learning.

All of which are enabled by strengthening the workforce, our IT systems and fair financing.

However, whilst we can take national enabling action, this ambitious vision can only be delivered by local transformation, and we already have systems leading the way.

Seven Early Adopters have been chosen and are now working hard to plan for and test the ways of working envisaged in Better Births, in order to improve services. Specific innovations include providing a single point of access for women in maternity services, a community hub model of care, and a single maternity record, accessible by women and healthcare professionals.

The Personal Maternity Care Budgets are being piloted by seven Maternity Choice and Personalisation Pioneers, which have been selected to test ways of deepening and widening the choices available to women.

44 Maternity Providers have commenced the Maternity and Neonatal Quality Improvement Programme with a range of safety projects currently getting underway, led by midwives, obstetricians and neonatologists working in triumvirates.

The rest of the country is following closely behind. All Local Maternity Systems will be formed by the end of March, and will have plans in place to deliver the vision of Better Births locally by the end of October 2017.

I am incredibly proud of the start we have made in the year since the publication of Better Births, and I have been humbled by the passion, determination and commitment of so many of the people I have encountered along the way. But I am also feeling cautious. We still face many challenges as we move from the planning phase into much broader implementation.

Key to this is tackling the reality that we in maternity often find we are talking only among ourselves. We have to come together, to take our story out of the side-room and onto the main stage where we belong.

The Better Births’ vision is transformational. As with most things that are worth doing, this transformation will not be achieved without hard work, innovation and, in some cases, upheaval. We will need to think differently about the way we do things. Achieving the vision is as much about creating a lasting ethos of greater collaboration as it is about system design. This will require a cultural shift in many places and organisations, and also for many of us as individuals.

The momentum continues to build. We need to capture that energy and work together to drive the transformation we know is needed for women and babies. Together we can build maternity services we can all be even more proud of, and give the very best start to the next generation.  This is our time.

Sarah-Jane Marsh

Sarah-Jane Marsh is National Director of Urgent and Emergency Care and Deputy Chief Operating Officer for NHS Engalnd.

Sarah-Jane joined NHS England in January 2023. Previously she was Chief Executive of Birmingham Children’s Hospital for over 13 years, achieving an Outstanding CQC rating, before integrating with Birmingham Women’s in 2017 to create Birmingham Women’s and Children’s, the first such organisation in Europe.

In 2020, in response to the Covid-19 pandemic, Sarah-Jane was asked to become Director of Testing at the newly formed NHS Test and Trace and during 2021 she Chaired the National Health and Social Care Discharge Taskforce. Sarah-Jane has also led the NHS England Maternity Transformation Programme, the NHS England Children and Young People’s Transformation Programme, and the Genomics England New-born Screening Programme.

In 2022 Sarah-Jane received a CBE for her services to leadership in the NHS and an honorary professorship from the University of Birmingham in recognition of her contribution to science and research.

Her passions are exceeding the expectations of patients and citizens, while supporting leaders from all backgrounds to achieve their full potential.