karen jewell nursing officer maternity and early years ...€¦ · prudent healthcare in wales (the...
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Maternity Care in Wales: A 5 year
vision for the future (2018 – 23) Karen Jewell
Nursing Officer – Maternity and Early Years, Welsh Government
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‘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
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KEY DRIVERS FOR CHANGE
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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.
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• 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.
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ADVERSE CHILDHOOD EVENTS WALES
http://www.aces.me.uk/in-wales/
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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
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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
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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.
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The Lancet 2014
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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.
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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.
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DEVELOPING THE VISION
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WHAT WOMEN AND MIDWIVES WANT
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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.
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ENGAGEMENT EVENTS
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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.
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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.
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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.
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KEY THEMES OF NEW VISION
Sustainable quality services
Women will receive maternity services which
are sustainable and the highest
quality possible.
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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
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LETS BE BRAVE – BE PART OF THE CHANGE