Maternity Care in Wales: A 5 year

vision for the future (2018 – 23) Karen Jewell

Nursing Officer – Maternity and Early Years, Welsh Government

‘The foundations for health and well-being start

in pregnancy. From heart disease to obesity,

educational achievement and economic status,

the months before and the years immediately

after birth are crucial to the life chances of the

mother, her child and her family’

Marmot 2010

KEY DRIVERS FOR CHANGE

PRUDENT HEALTHCARE IN WALES

(The Bevan Commission 2015)

Achieve health and wellbeing with the public, patients and

professionals as equal partners through co-production;

Care for those with the greatest health need first, making the

most effective use of all skills and resources;

Do only what is needed, no more, no less; and do no harm.

Reduce inappropriate variation using evidence based

practices consistently and transparently.

• Children to be given the best start

in life from very early years.

• Thriving communities built on a

strong sense of place.

• Valuing our environment.

• Investing in growing our local

economy.

• Reducing inequality and a greater

value on diversity.

• A stronger citizen voice and active

participation in decision making.

• Celebrating success, valuing our

heritage, culture and language.

ADVERSE CHILDHOOD EVENTS WALES

http://www.aces.me.uk/in-wales/

Five Key Themes

Prosperous and Secure

Healthy and Active

Ambitious and Learning

United and Connected

Priority Areas

Early Years

Housing

Social Care

Mental Health

Skills and Employability

Prosperity is not just about material wealth – it is about every

one of us having a good quality of life, and living in strong,

safe communities

PARLIAMENTARY REVIEW :THE QUADRUPLE

AIM (2018)

4 core aims:

1. Improve population health and wellbeing through

a focus on prevention

2. Improve the experience and quality of care for

individuals and families

3. Enrich the wellbeing, capability and engagement

of the health and social care workforce

4. Increase the value achieved from funding of

health and care through improvement,

innovation, use of best practice, and eliminating

waste

A HEALTHIER WALES (2018)

Five key aims:

• The health and social care system will work together to

provide seamless care. Local services will share best

practice and scale up local solutions

• Services will be provided closer to the community and more

provision of early intervention services to stop people

becoming ill

• To get better at measuring what really matters to people to

inform future service provision

• To make Wales a great place to work in health and social

services and invest in new technologies which will make a

real difference to services.

• To make our services work as a single system, we need

everyone to work together.

The Lancet 2014

AIM: 45% OF WOMEN WILL HAVE THE OPPORTUNITY

TO COMMENCE LABOUR IN A MIDWIFERY LED

SETTING

National maternity review 2015 NHS Five year forward view for maternity care.

BIRTH PLACE STUDY

The Birthplace cohort study compared the safety of births planned in four settings: home, freestanding midwifery units (FMUs), alongside midwifery units (AMUs) and obstetric units (OUs).

The main findings relate to healthy women with straightforward pregnancies who meet the NICE intrapartum care guideline criteria for a ‘low risk’ birth.

DEVELOPING THE VISION

WHAT WOMEN AND MIDWIVES WANT

FINDINGS OF MIDWIVES SURVEY

Current midwifery-led guidelines were found to restrict the proportion of women who could

safely start their labour in a midwife-led unit.

55% of midwives reported that they did not feel equipped to support and facilitate women’s

choices if this falls outside of the recommended guidance.

In the event of a woman requesting care outside guidance, 27% of midwives would refer to a

consultant midwife or obstetrician for further discussion and birth-choice planning.

Midwives frequently complained that there are insufficient numbers of midwives available to

fulfil clinical requirements.

Community-based midwives requested that systems should be developed to allow hospital-

based staff to support obstetric units during times of high acuity.

77% of midwives wished to see the provision of continuity of carer to include the intrapartum

period.

Many midwives expressed concern that a buddy system—whereby each woman receives care

from two to three midwives in the antenatal and postnatal periods—could not be delivered

within current staffing establishments and employment arrangements.

If full-continuity models covering the antenatal, intrapartum and postnatal period cannot be

supported, then antenatal and postnatal continuity should be given priority.

Inflexibility over the required timing of newborn screening was regarded as a factor that

disrupts current continuity of carer in the postnatal period.

ENGAGEMENT EVENTS

OVERALL AIM OF NEW VISION

Our vision for maternity services in Wales is to ensure that:

‘Pregnancy and childbirth are a safe and positive experience, and parents are supported to give their child the best start in life.’

High performing multi professional teams will deliver family-centred care within Health Boards which display strong leadership within a culture of research and development, continuous learning, best practice and innovation.

KEY THEMES OF NEW VISION

Family Centred Care

Women will receive personalised care planned in

partnership with them and will reflect their

choices and health needs.

Continuity of carer

Women will experience continuity of care

and carer across the whole of their

maternity journey.

KEY THEMES OF NEW VISION

Safe, effective care

Women will receive safe, effective care,

with risk, intervention and variation

reduced wherever possible.

Skilled multi professional team

Women will receive care from multi-professional

teams, with access to specialist services

when required.

KEY THEMES OF NEW VISION

Sustainable quality services

Women will receive maternity services which

are sustainable and the highest

quality possible.

PLANNING & IMPLEMENTATION

Maternity and Neonatal network worksteams

Key Issues: Once for Wales Approach

Learning from best practice

Responding to service feedback

Data and Information

Monitoring and Evaluation

STEP CHANGE

LETS BE BRAVE – BE PART OF THE CHANGE