Our objectives

We want birthing people to know how to access our services which means making sure we are available in places we are needed.

Every family may not have access to the information and support required to make informed choices about their care while pregnant throughout their maternity journey and this is especially true of people from minority ethnic backgrounds and people living in deprived areas.

The Better Births report recommends having community hubs for maternity services situated with family-orientated health and social services. These hubs can act as a “one stop shop”, providing fast and effective referral services to the right expert where required.

We have already started this work by recruiting maternity core connectors to improve our engagement with community partners. We will also work with the Croydon family hubs initiative to ensure early access to maternity care is a key priority.

Examples of some of our actions

• Ensure early access to information on maternity care and support is available to all families in minority ethnic groups and those living in deprived areas.
• Ensure the Baby Buddy app is easily available to all families with digital access.
• Ensure personalised care and support plans (PCSPs) are available in different languages and formats, including hard copies for those without digital access.

What does success look like?

• Increase in uptake of the Baby Buddy app
• Increase in the number of Maternity Community Core Connectors at a local and system level– service users who will champion maternity services.
• Increase in early maternity bookings among women from minority ethnic backgrounds and those living in deprived areas.
• Increase equality of access to maternal medicine pathways.
• Reduction in Did Not Attend (DNA) rates for women and birthing people from minority ethnic backgrounds and those living in deprived areas.
• Increased user feedback and evidence of co-production.

We need to be listening more to our women and birthing parents so we can identify issues with the pregnancy early and be proactive.

It is important that we understand the experiences of marginalised people who have used maternity services so we can improve our services and provide a safe environment. This means listening, especially when things go wrong and then acting on what we hear.

Language barriers can make it harder for people to engage with us so we must make sure we have translations services available so everyone has a voice.

We need to

• Ensure there are accessible forums for service users to share their voices.
• Ensure service user voices are relayed back to staff routinely.
• Ensure each trust prioritises the availability of translations services.
• Ensure women, birthing people and their families play an important role in co-producing services and programmes.
• Ensure growth of the Maternity and Neonatal Voice Partnership (MNVP).

What does success look like?

• Increased membership of all our MNVP groups with increased representation of the local population.
• Maternity Community Core Connectors are embedded in the community.
• All maternity units have an effective translation service for those with language barriers.
• A thriving database of engaged minority ethnic women and birthing people and those living in areas of deprivation.
• Increased number of personalised care plans.

We will increase the number of people accessing our prevention programmes, ensuring continuity of care.

It is so important that servicce users maintain a good level of health before, during and after pregnancy. This sets the foundation for good pregnancy outcomes and lifelong healthy behaviours. It is also important to manage long-term physical and mental health conditions and address complex social needs.

We are focusing on preventing pre-term births, which will minimise unnecessary intervention as well as reducing smoking during pregnancy.

In addition we are establishing Maternal Medicine Networks so that those with acute and chronic medical problems have timely access to specialist advice and care at all stages of their pregnancy.

Continuity of carer teams will be in place, where possible, to ensure the same midwife is seen throughout pregnancy, during and after birth.

We need to

• Increase up take of continuity of carer in women from minority ethnic backgrounds and those living in deprived area.
• Reduce the number of pregnant people who smoke.
• Encourage uptake of higher doses of Vitamin D for people from minority ethnic backgrounds.
• Ensure women and birthing people from minority ethnic backgrounds and those living in deprived area have equitable access to Maternal Medicine Networks.

What does success look like?

• Increase in smoke free pregnancies.
• Increase uptake of Continuity of Carer pathways.
• Increase in minority ethnic groups and those in deprived areas accessing Maternal Medicine Networks.
• Stronger relationships between maternity and mental health services.

We will look at how we provide services for people with protected characteristics including those with disabilities, from the LGBTQ+ community as well as minority ethnic backgrounds and those from deprived areas.

It is important that we consider other protected characteristics beyond race when trying to reduce health inequalities.

Other factors might include socio-economic background, sexuality or disability and we need to improve the data we capture for these groups so we can provide a more sophisticated analysis of the inequalities a person might face, especially if they have more than one protected characteristic.

We need to

• Work with maternity units to ensure consistent data metrics are monitored.
• Undertake gap analysis of protected characteristics.

What does success look like?

• Protected characteristics included on maternity dashboards.
• Undertake analysis of existing datasets.
• Ensure each Trust’s Public Sector Equality Duty (PSED) policy is read and noted.

We want to create a safe culture where we learn from mistakes and challenge each other.

Maternity services must be high quality, they must also be safe and this means having safe staffing levels, monitoring and escalation measures in place.

South West London is a safe place to give birth however we can continue to improve by learning lessons when things go wrong which minimises the chance of them happening again. LMNS Serious Incident meetings take place quarterly with the Healthcare Safety Investigation Branch.

We need to

• Ensure serious incidents are shared with the LMNS.
• Ensure serious incident learning is captured and shared with all staff.

What does success look like?

• Lessons are routinely logged and reviewed.
• Learning is captured on a lessons learnt log.
• Serious incidents across the system are reviewed regularly.
• Scrutiny of serious incidents information against ethnicity and deprivation data.
• Increase in the number of positive events reported at system level.
• Improved clinical outcomes and reported experience.

We will collect and use data better to have a greater understanding of our women and birthing people and their experiences and therefore provide an improved service.

Data capture around ethnicity and deprivation is currently unreliable which makes it difficult to understand whether what we are doing is improving outcomes.

Effective use of data is central to tackling health inequalities. For example; recording ethnicity and postcode data at booking helps us understand how health outcomes vary by geographical area and ethnicity. We can then identify and prioritise those groups.

NHS England wants maternity care to continue to improve ethnicity data collection and recording and we have already developed a maternity dashboard to capture data and monitor activity across the system.

We need to

Monitor Local Maternity and Neonatal Systems data to continuously improve the data quality of ethnicity coding.

What does success look like?

• Ensure South West London Digital Strategies are embedded across the system.
• Ensure the maternity dashboard is active and fully functioning.
• Ensure all South West London maternity units are fully compliant with the maternity services data set (MSDS) which is the NHS’s administrative dataset used by providers of maternity care in England for clinical purposes.
• Ensure all Trusts have recruited a digital midwife.
• Ensure all midwives are trained on how to ask a person’s ethnicity and ensure this is documented on the Maternity Information System correctly.

We will look at how we can increase support for our staff and improve their wellbeing.

We know that where an NHS workforce is representative of the community it serves, patient care and the overall patient experience is more personalised and improves.

Workforce Race Equality Standard (WRES) data shows that people from ethnic minorities are significantly more likely to be nurses, midwives and health visitors compared to their representation in the population, yet they are under-represented in senior roles.

It is also important that we have enough staff and that they are well trained which reduces incidents. We want a culture where incidents are reported and all staff learn from errors.

We need to

• Provide training opportunities for maternity staff.
• Encourage midwives to sign up to Capital Midwife, a London-wide scheme to support midwives.
• LMNS to monitor anti-racism framework activity at the trusts.
• Consider a Making Every Contact Count (MECC) staff training opportunity.
• Listen, act and motivate staff.
• Recognise and reward performance.
• Embrace culture change.

What does success look like?

• Training is routinely available to all staff especially staff from minority ethnic backgrounds.
• Development opportunities accessed by all staff groups.
• Reduction in the gaps in minority ethnic groups in Band 7 roles and above against background proportion of staff.
• Health Equity and Racial Disparity (HEARD) campaign from Croydon is adopted across the south west London LMNS.