Maternity services liaison committees (MSLCs): a consensus statement from NCT, RCM and RCOGOur shared views on the importance of engaging with women and their partners in the planning and monitoring of maternity services and the role played by MSLCs

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Key recommendations

We recommend that MSLCs:

• Continuetoexist,undertheauspicesofanappropriatebodyinthelocalhealthstructure.

• Continuetobethemainmeansofgivingserviceusersaninfluenceovermaternitystrategyanddeliveryoftheservice.

• Areprovidedwitharing-fencedbudgettomakesurethattheycanmeetregularlyinsuitablesettings,andthatchairsandmembershavetheappropriatetrainingandsupport.

• Continuetoactasstrategicadvisorygroupsthathelpcreateandmaintainhighqualitymaternityservices,definedasthosewherewomenandtheirpartnershaveasafetransitiontoparenthoodandanexperiencethatispositiveandlife-enhancing.

• Areconstitutedasatpresentandchairedorco-chairedbyalayuser.

• Continuetohaveresponsibilityforcreatingmechanismstoelicitandcollatebothqualitativeandquantitativeinputfromusers.

Introduction

“No decision about me, without me”1

“Womenandtheirpartnerswantasafetransitiontoparenthoodandtheywanttheexperiencetobepositiveandlifeenhancing.Qualitymaternityservicesshouldbedefinedbytheabilitytodoboth.”2

Asusersoftheservice,womenandtheirpartnerscanmakevaluablecontributionstothedesignandprovisionofmaternitycare.Fornearly30years,MaternityServicesLiaisonCommittees(MSLCs)havebeenthemeansbywhichserviceusershavebeenabletomakethosecontributions.Theyhaveanexcellenttrackrecord:maternityserviceshavechangedtomeettheexpressedneedsofwomen,andtheirpartnersandbabies,morethananyotherservice.Thisisdue,atleastinpart,totheuniqueapproachofMSLCs,andtheirconsensual,multidisciplinaryethos.

ThestructuregoverninghealthcarecommissioninginEnglandhasrecentlychanged,castingintoquestionthecontinuingroleofMSLCs,whichweresetupunderadifferentcommissioningstructure.ThisconsensusstatementsetsoutthereasonswhywebelieveMSLCsshouldcontinuetoexistunderthenewstructure,andwhyweregardthemasthebestmeansoffulfillingtheobligationsofthenewcommissioningbodiestolistentotheviewsofserviceusers.Webelievethatthenewstructure,withitsemphasisonuserinvolvement,providesagoodopportunitytostrengthentheroleofMSLCs.

AlthoughthestatementhasaparticularfocusonEngland,wehavetakenintoaccountuserinvolvementpoliciesandguidanceaboutMSLCsfromallfourcountriesoftheUKinmakingourrecommendations.Scotland,WalesandNorthernIrelandallhaveslightlydifferentcommissioningstructures,butMSLCsplayanimportantroleineachofthosestructures,andwebelievethattheyshouldcontinuetodoso.

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MSLCswereintroducedin1984,asawayofprovidinganeffectivechannelforusersofmaternityservicestoinfluencethelocalprovisionofmaternityservices.EachMSLC,whichmeetsatleastfourtimesayear,iscurrentlymadeupofrepresentativesfromthefollowinggroups:

• Users(localpeoplewhohavehadababyrecentlyorwhoareexpectingababy)

• Thelocalprimarycaretrust(PCT)

• Maternityhealthcareprofessionals,suchasobstetricians,midwives,neonatologists,healthvisitorsandGPs

• Voluntarygroupsrepresentingpregnantwomenandnewparents,suchasNCT

TheroleoftheMSLCistomakesurethatthebodythatcommissionsmaternityserviceslistensto,andtakesaccountof,theviewsandexperiencesofboththeusersandprovidersofthoseservices.Asaresult,MSLCs,sincetheirinception,haveplayedanimportantpartinshapingthedeliveryofmaternityservicestomeettheneedsofusers.

UnderthechangesandnewarrangementsforcommissioningofmaternityservicessetoutintheHealthandSocialCareActEngland2012,6PrimaryCareTrusts(PCTs)havebeenfullydisbandedandClinicalCommissioningGroups(CCGs),formedprincipallyofgroupsofGPs,willtakeovermuchofthecommissioningofhealthcareinEngland.WhilstresponsibilitywillsitwithCCGs,theNHSCommissioningBoardwillsetanationalframeworkforqualityandchoice,andwillrequireCCGstoworkcollaborativelytoensurethisisdelivered.

Singlecommissioninggroupsof250,000populationsgeneratingonly3000pregnanciesperyearwillprobablybetoosmalltocommissionthefullrangeofmaternal-fetalmedicineandhigh-riskserviceseffectively.Themostefficientmodeltoadoptisafederatedone,inwhichaleadcommissionertakesresponsibilityforlocalnegotiationswiththemainproviders.Commissioninggroupswithinafederationwillneedtojointlyagree,attheoutset,theprinciplesunderpinninglocalarrangements,whichshouldinclude(amongothers):

• Outreachtovulnerablewomenencouragingthemtoengagewiththeservices

• ContributingtotheJointHealthandWellbeingStrategy3

TheNHSCommissioningBoard’srequirementsareforamaternity servicethat:

• Isflexible,appropriateandaccessibletoallwomen

• Isprovidedinaccordancewithevidenceandbestpractice

• Reflectslocalneedsandpriorities

• Seeksandactsonfeedbackfromwomenandtheirfamilies7,5

Strategic clinical networks

Thenewcommissioningstructurealsoseesthecreationofstrategicclinicalnetworks.Theseareorganisationsthatenablegroupsofhealthprofessionals,hospitalsandotherprovidersandcommissionerstoworktogethertomakeimprovementsintheirlocalarea,eitherinaparticularpathwayorforaparticulargroup ofpatients.

Thestrategicclinicalnetworksaredesignedtoimprovelocalaccountability.Theywillbeexpectedtoinvolvepatientsandthepublicbysupportingrobustengagementprocessesthatwillinformthestrategicdevelopmentofservices.

BecauseMSLCshavebeensosuccessful,therearegoodreasonstokeepthemintheirexistingform:

• MSLCsplayauniqueroleinthehealthservice.WhilematernityservicessharemanyofthechallengesfacedbyotherNHSservices,thesectorisuniqueforthreereasons:amaternityepisodestartswithonewomanandherpartner,andendswithafamilyofthreepeopleormore;themajorityofwomenandbabiesreceivingcarearenotill,butfitandhealthy;andtimingofactivityisunpredictable–itcannotbedemand-managedorcontrolledthroughreferrals.Thereforethedesignandprovisionofthistypeofcarecannotbesupportedbygenericpatient/userrepresentationorfeedback.3

• Effectiveengagementwithusersofservicescanhelptodeliverinclusiveandsuccessfulcommissioning.Aservicesupportedbyawell-functioningMSLCwillbeaccessibleandattractivetowomen,trustedandvaluedbyexpectantandnewparents.Meaningfulengagementisabout

Fourstrategicclinicalnetworkswillbeestablishedimmediately,oneofwhichwillcovermaternity&children.Othersmayfollowatalaterdate.

Thestrategicclinicalnetworkshavealreadybegunclarifyingtheirworkplanandshouldbesettingupaseriesofmeetingstoagreethedetailedmechanismsbywhichtheywillengagewithpatientsandthepublic.TheexistingMSLCsineachareateamshouldbeinvolvedinthisprocess.

Healthwatch

ThenewcommissioningstructurewillseethecreationofHealthwatch,alocalindependentconsumerchampionforhealthandsocialcarethatgivescitizensandcommunitiesastrongervoice.

HealthwatchwillhaveaseatonthenewstatutoryHealthandWellbeingBoards.ItsrolewillbetomakesurethattheviewsandexperiencesofserviceusersaretakenintoconsiderationwhentheJointStrategicNeedsAssessment(JSNA)isbeingundertakenandtheHealthandWellbeingStrategy(HWBS)isbeingdeveloped.ClinicalCommissioningGroupswillneedtotaketheJSNAandHWBSintoconsiderationwhendecidingoncommissioningpriorities.8

HealthwatchwillcarryforwardthefunctionsofLocalInvolvementNetworks(LINks)withsomeadditionalfunctionsandpowers.9 BecauseMSLCshavehistoricallyhelpedinformdecision-makingincommissioningmaternityservices,theroleofLINkshasbeentofocusontheneedsoftheelderlyandpatientswithlong-termmedicalconditions.Ourviewisthat,becauseHealthwatchtakesforwardthehistoricfunctionsofLINks,itisnotcurrentlyinagoodpositiontorepresenttheneedsofpeoplewhousematernityservices.

Specialised services

Previously,specialisedservices,whichtreatpatientswithrareconditions,werecommissionedbyPCTs.Underthenewcommissioningstructure,theywillbedirectlycommissionedatanationallevelbytheNHSCommissioningBoard.

Thespecificationforeachrelevantspecialistserviceincludesaparagraphsettingouttherequirementsinrelationtospecialistmaternalcare.Whentheyplantheircommissioningformaternalcare,CCGswillneedtomakesurethatthecommissioningincludesspecialistcarefromprovidersdeliveredwithinadedicated,multi-disciplinaryservicestaffedbyamaternal

establishingrobust,userfriendlyandsustainablemechanisms,notaboutone-offactivities.4

• TheMSLCremitistobeamultidisciplinaryindependentadvisorygrouptothecommissioners.5Itisnotausergroup–thesuccessofMSLCsderivesfromtheirroleasadiscussionforumforavarietyofpartiesinvolvedinmaternityservices.Theyenabledifferentviewstobedebatedandfortheresultingconsensustobefullyintegratedintodecision-makinginaneffective,timelyandappropriateway.

• MSLCshavebroadsupportfromallpartiesinvolvedinmaternityservices:midwives,obstetriciansandusers(see‘Intheirownwords’onpage11).

AhistoryofpoliciesaffectingMSLCsisgivenintheappendix.

medicinespecialist,aphysicianandsupportingmulti-disciplinaryteam.

Friends and family test

Thechangestothecommissioningstructureareinformedbyacommitmenttomakingservicesmorepatient-centred.ThemandatetotheNHSCommissioningBoardrequirespatientstohaveapositiveexperienceofcare.EverypatientwillbeabletogivefeedbackontheircareintheformofaFriendsandFamilytest–thiswillbeasimplequestionsuchas,‘Howlikelyareyoutorecommendthisservicetofriendsandfamilyiftheyneededsimilarcareoftreatment?’ThetestwillbeintroducedforusersofmaternityservicesfromOctober2013.ThedataderivedfromthistestcanbeusedtoinformMSLCdiscussionsanddecision-making.

The role of MSLCs – and why we need them

MSLCs and the new commissioning structure in England

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WebelievethatMSLCsrepresentthebestmediumforprovidingavoiceforusersofmaternityservices,andwerecommendthatCCGs,HealthwatchandHealthandWellbeingBoardsexploretheroleMSLCscanplaywithintheirlocality.Thediagramoppositeshowshowwethinkthefourorganisationalroleswouldfittogether.

How MSLCs fit into the new structure in England

TomakesurethatMSLCsareeffective,theyshouldincluderepresentativesfromthekeycommissionerandproviderbodiesrelevanttomaternity.ThesebodiesshouldacknowledgethepivotalroleoftheMSLCanddemonstrateclearlinesofcommunicationandaccountabilityinrelationtotheMSLCwithintheirowntermsofreference.Maternityexperienceevolvesallthetime,andisdependentonboththeshapeofservicesandonthesituationsofwomenandtheirfamilies.Forthatreason,constantfeedbackisneededfroma diverserangeofcurrentserviceusers.

Bylisteningtoserviceusers,andlinkingtheseviewswithwell-informed,evidence-basedinputfrommoreexperienceduserrepresentatives,healthprofessionalsandcommissioners,MSLCshaveanimportantroletoplayinthecommissioningandprovisionofwomen-centred,high-qualitymaternitycare.AllcommissionersinEnglandshouldbemakingarrangementstoimplementaphilosophyof‘Nodecision aboutmewithoutme’,usingtheMSLCas a model.7,3

Department of Health

NHS Commisioning BoardAllocatesresources,overseesCCGs,developscommissioningguidelines.Supportsclinicalnetworks.Isresponsiblefor

neonatalcarecommissioning.

Public Health EnglandResponsibleforhealth

improvement

Local Authorities HostdirectorsofPublicHealth.

FundandholdlocalHealthwatch(formerlyLINks)toaccount.

Clinical Commissioning Groups (CCGs)

Holdbudgetsandcommissionservicesfromvariousproviders.

NHS Commissioning Board LocalAreaTeam

User/parent/ community groups

MSLCAdvisesCCGs.Gathersviewsofserviceusers.

HasstronglinkstoMaternityServiceProviders,StrategicClinicalNetworks,HealthandWellbeingBoardsandlocalHealthwatchregardingJointStrategic

NeedsAssessmentandHealth&Wellbeingstrategydevelopment.

Commissioning Support Service (CSS)

SupportsCCGsin deliveringcommissioning.

Note:ThestructuresinWales,Scotland,NorthernIrelandandtheChannelIslandshavenotchanged.

Health and Wellbeing Boards Co-terminouswithlocalauthorities,theywillscrutiniselocalhealthprovision.Willleadonpublichealthinitiativessuchasteenagepregnancy,smokingcessation.Theyhaveadutyto

ensurecommissioningofhealthandsocialcarejoinupatlocallevel,basedonproperassessmentofneedsandjointstrategies.

GP PracticesAllGPpracticesmustbe

membersofCCGs.

Providers Hospitalobstetricunits,midwiferyledunits,homebirthservices.

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whentheyspeaktoparents.Thewalkersmeetwithanamedmidwiferymanagertoreceiveabriefingaboutanyclinicalissuesthatmightimpactonthevisit.Userrepresentativesmeetthewomenandtheirpartners,withtheiragreement,withoutstaffmemberspresent.Feedbackfromtheone-to-oneor(sometimes)groupdiscussionsintheclinicalareasvisitedcanbediscussedimmediatelyattheMSLCmeeting.‘Walkingthepatch’feedbackisconsideredahigh-priorityagendaitem.

Commentsfromwalkersinclude:

‘Fantastic to meet mothers in the early postnatal period or antenatally to hear about their experiences first hand.’

‘Good opportunity to meet a truer cross section of the community.’

ManyMSLCshavenowadopted thisactivity.

Tell Your Story and Make a Difference

InHove,theMSLChassetupaparents’groupthatallowstheparentrepresentativesontheMSLCtomeetseparatelyeverytwomonthstodiscussissuesinmaternitycare.TheyagreetheissuestheywouldliketoraiseatthenextMSLCmeeting,andagreewhichoftherepresentativeswillattendthemeeting.

Lunch,travelexpensesandchildcare areprovided.

Using Social Networks to Build a Following

BrightonandHoveMSLCusedagrantfromaDepartmentofHeathfundinginitiativeintheareatodevelopanonlineinformationhubforantenatal,birthandpostnatalservices.Thelaychair,HannahSherlock,obtainedspecialistone-to-onetrainingfromasocialmediaconsultancyabouthowtobuildandmaintainasimplewebsite,createaFacebookpageandbuildafollowingonTwitter.Historicallyithasbeenachallengetoencourageabroadrangeofparentsfromdifferentcommunitiestogetinvolved,butbyusingsocialmediatheyhopetoreachawideraudience.PostingviewsonFacebookonlytakesacoupleofminutes,andismuchlessofacommitmentthangivingupafewhourstoattendacommitteemeetingorfillinaconsultativeresponse.TheviewsfromsocialmediaarethenfedintodiscussionswithprovidersandcommissionersattheMSLCmeetings.HannahSherlockisnowsharinghernewlyacquiredskillswithotherMSLCswithinSussex.

How MSLCs work: someexamplesofgoodpracticeBelowaresomecasestudiesdemonstratinghowMSLCsareableto respondeffectivelytotheneedsofserviceusers.

Talkback: A Strategic Approach To Working With Maternity Service Users

FollowingareviewofuserinvolvementwithinthelocalmaternityserviceinStockport,theMSLCdevelopedastrategicapproachtobuildingthecapacityofserviceuserstoworkwithcommissionersandproviders.Talkbacksessions,fundedbythePCT,werearranged,aimedatgivingmaternityserviceusersanopportunitytofeedbacktheirexperiences.Theseincludedspecificsessionstargetingseldom-heardgroupssuchasteenagers,fathersandMuslims.Over100parentssharedtheirexperienceswithlocalmidwiveswhosolicitedanswerstothefollowingquestions:

• Whatwentwell?

• Whatcouldhavebeenbetter?

• Doyouhaveanysuggestionsforimprovingourservices?

Thiswasthensharedwithstaffandlocalserviceuserswhohadindicatedtheywouldliketobefurtherinvolved.Asaresult,theTalkbackgroupwasformed,withapproximately12membersateachmeetingfromamailinglistof40.TheMSLCwasthenreinstated,withserviceusersforming75%ofthemembership.TheMSLClaychairattendsMaternityServicesBoardmeetings.

InanarticleinPractising Midwife,consultantmidwifeDebbieGarrodwrote,‘Thecontributionofserviceusersinmovingourserviceforwardisinvaluable.Theymakedecisionsthatmatter.’10

In Your Shoes

APCTcommissioningmanagerinNewhamrecruitedafacilitatortorunaneventataninnerLondonChildren’sCentre,toprovideanopportunityforlocalwomentosharetheirstorieswithmidwives.ItwasalsoachanceforlocalwomentofindoutwhatanMSLCisandhowuserinvolvementcouldimprovelocalmaternityservices.

Interpreterswereonhandforfourdifferentethnicgroups(Bengali,Somali,ChineseandPolish),andlunchwasprovided.Theeventwasattendedby39people,includingtheheadofmidwiferyandnumerousmidwivesfromthelocalhospital.Eachwomanwasgivenanopportunitytotellherbirthstorywithoutinterruptionfor10minuteswhileothersinthesmallgrouplistenedtoeachstory.Thegroupwasthenaskedtohighlightthreethingsthattheylikedaboutthematernityservicesandthreethingsthatneededsomeimprovement,andtogethercomeupwithsomesuggestionsforthose

improvements.Discussionbetweenthewomenandthemidwiveswasverylively.

Afterlunch,auserrepresentativefromthelocalTowerHamletsMSLCcametotalkaboutwhyshebecameauserrepresentative,howtheMSGworks,andhowtheusergroupinTowerHamletshadinfluencedchangesinmaternitycarethroughtheMSLC.PeopleinterestedinjoiningtheproposednewlocalMSLCweretheninvitedtogivetheirnamestothePCTcommissioningmanagerandtosuggestdifferentwaysinwhichtheyfelttheycouldbeinvolved.Givingpeoplearangeofoptions,orevenaskingthemtosuggesthowtheymightwanttobeinvolved,offersagreateropportunitytoengageawiderangeofwomenthanaskingthemtofillinaquestionnaireorattendameeting.

Walking the Patch

WalkingthePatchwasanideaoriginallydevelopedbyprofessorofmidwiferyJacquelineDunkley-Bent,headofmidwiferyeducationatLondonSouthBankUniversity,andHazelJones,formerjointchairoftheMSLCatGuysandStThomas’sNHSFoundationTrust.11‘Walkers’areuserrepresentativeswho,onehourbeforeanMSLCmeeting,visitwomenandtheirpartnersonthepostnatalwardsandsometimesinantenatalclinicsandbringtheirviewsdirectlybacktothecommittee.Theyhaveaguidancesheettohelpthem

Tower Hamlets MSLC Project

In2008,TowerHamletsPCTcommissionedSocialActionforHealth,acharitybasedinEastLondon,toengagelocalmothers,especiallyfromtheSomaliandBengalicommunities,toinvolvethemintheirMSLCandconsultthemabouttheirexperiencesofusinglocalmaternityservices.Womenwereengagedthroughanexistingconsultationprocesswithlocalpeople,knownashealthguides.Thesehealthguidesessionswereonehourlong,withupto20people,andfacilitatedbyworkerstrainedtorunsessionsinBengali,Somali,Turkish,Gujarati,Urdu andCongolese.

Thesessionsrecruitedmorethan30interestedwomenfromanumberofdifferentcommunitiesincludingChinese,NigerianandIndian.NinewomenwereselectedtorepresentthesecommunitiesatMSLCmeetings.AnNCTVoicestrainingworkshop,designedtopreparepeopletoworkeffectivelyaspartofacommittee,washeldforcommissioners,healthprofessionalsandthenewuserrepresentativesbeforethefirstMSLCmeeting.(Thisworkshopisshowninthephotographbelow.)

TheMSLCwaslaunchedatapubliceventattendedby91localpeople.ADVDhasbeenproducedwithuserrepresentativesinforminglocalwomen,intheirownlanguages,abouttheMSLCandhowtheycangettheirviewsheard.

Between2009and2011,acollaborationbetweentheMSLCandamothers’networkcalledtheMothersSupportGroup(MSG)resultedin10communityengagementsessionscarriedoutinseveraldifferentlanguagesincludingBengali,Chinese,Somali,LithuanianandUrdu.

TheMSG,nowmadeupof53womendrawnfromthesesessions,aimstocreateasupportivenetwork,developingconfidenceforlocalwomentoattendandspeakupatMSLCmeetingsaswellasincreasingawarenessofhowtheservicesoperate.

Women’sstories,usergroupreflectionsandlocalsurveyswereusedtobringaboutchangetoanaspectoftheservicesthathadconcernedmanywomenfromethnicminoritygroups–thatofstaffattitude.Theirviewswerefollowedupbyaconsultantmidwifewhoworkedoninfluencingmidwivesthroughsupervision,encouragingthemtoreflectontheirbehaviouranditsimpactonwoman’sexperiences.Thisworkresultedinareductioninthenumbersofcomplaintsandincreasedsatisfactionwiththematernityservices.

The way forwardUnderthenewcommissioningstructure,theroleplayedbyMSLCswillbemoreimportantthanever.Below areourrecommendationsforhowMSLCscanbestrengthenedandmaintainedatbothlocalandnationallevel.

Local recommendations

To get the best out of your local MSLC:

• ReviewtheroleofyourlocalMSLCandexplorenewmechanismsforeffectivelyworkingtogetherwithinthecommissioningstructures.

• Celebrateandbuildonpast MSLCsuccesses.

• Highlighttheirroleandstatus andestablishsoundcommunicationlinkswithincurrentandnewlydevelopingstructuresforcommissioningmaternityservices.

• ReviewtheirmembershiptotakeaccountofthelocalpopulationinlinewithHealthcareCommissionindicatorsforsuccess(seeappendix).

• Reviewtheeffectivenessoftheiruserengagementmodelsand,whereappropriate,drawonbestpracticetodevelopthese.Inparticular,findwaysofsolicitingtheviewsofthosefamiliesnewtotheUK,non-Englishspeakers,oldermothers,teenagers,fathers,disabledwomen,womeninprisonandotherfrequentlyoverlookedgroups.

• Reviewanddevelopthelinkswiththelabourwardforumorotherrelevantclinicalforumsornetworks.

National recommendations

• AttentionshouldbepaidtothewayinwhichMSLCscanbeintegratedintoanyfuturematernitynetworksorotherpotentialnewstructuresdevelopedforcommissioningservices.

• Guidelinesregardingpaymentofexpensesforserviceusersshould bestrengthened.Theabilitytomakepromptpaymentofexpensesislikelytoimprovetheinvolvementofserviceusersfromdisadvantagedbackgrounds.

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• ‘Iwouldn’twanttolosetheMSLC.Itispartofthewaywework.Itisamoreefficientwayofworkingindevelopingservicesandchangingpractice.Toloseitwouldbearetrogradestep.’ Head of midwifery and former LSA Midwifery Officer

• ‘Asacommissionerofmaternityservices,IhavefoundtheMSLCtobeaninvaluableresourceintermsofdrivingforwardchangeandserviceimprovement,anditformsakeyelementofthePCT’sgovernanceframeworkinrelationtomaternityservices.TheMSLCofferscommissionersofmaternityservicesavitallinktothepeopleaccessingandusingtheservicesforwhichtheyareresponsible.Realandeffective

user-ledengagement,throughthemultidisciplinaryteamthatformstheMSLC,providesbothcommissionersandproviderswithaforumfordebatinglocalmaternityservices.’ Maternity Services Commissioner

• ‘Ijoinedthecommitteeasawayoftryingtogivebacksomethingtothecommunityandhelpingtoimprovethecareforusersofmaternityservicesat…...[Hospital].’User representative

• ‘Involvingpatients/serviceusersallowsaccesstoexpertisethatcliniciansandmanagersdonothave,asnotonlydoserviceusersbringtothetabletheirunique,individualexperienceofhavingusedaspecifichealthservicebutalsoawiderangeofotherexperiences

andexpertisefromtheirownworldofwork.Serviceuserstendtohaveanoverallviewofhowawholepathwayofcareworksratherthanjustseeing,thesometimes,isolatedaspectsofcarethatindividualhealthprofessionalsareawareof.Theyareabletohighlighttheimpactofcareonfamilylife.’Healthcare Commission

• ‘MyroleontheMSLCistorepresenttheBlack&MinorityEthnicCommunitybyhighlightingissuesthatareinthecommunitywhichwouldberelevanttotheMaternityServices. User representative

Appendix: LegislationandguidanceonMSLCs fromtheUKhealthadministrationsandother healthbodiesTheDepartmentofHealthGuidelinesforMSLCs,producedforEnglandandlargelyadoptedforMSLCsinNorthernIreland,ScotlandandWales,clearlyidentifyMSLCSasplayinganimportantroleinadvisingonandmonitoringallaspectsofmaternitycare.Despitechangesofgovernment,policiesandsystemssincetheywerefirstintroducedin1984,thereisnoreasontosupposethatMSLCsareneededanylessnow.

A2007reviewofmaternityservicesinEnglandbytheHealthcareCommissionstatedthatPCTshaveadutytoensurethatMSLCsareinplaceandfunctioningproperlyiftheyaretomeettheirobligationofengagingstakeholderstoimproveservices.ThereviewputinplacefourindicatorstomeasurethesuccessoftheMSLCs:

• Atleast40%ofcommitteemembersareuserrepresentatives.

• AtleasttwominoritygroupsarerepresentedoneachMSLC.

• AtleastfourMSLCmeetingsareheld ayear.

• MSLCstosharerecommendationswithtrustboardorappropriatesubcommitteeatleastonceayear.12

Despitetheabundanceofpolicydrivinghealthservicestoinvolveusers,the2008reportTowardsBetterBirthsfoundamixedpicturewhenitcametothefunctioningofMSLCs.13Themajorityoftrusts(72%)hadcommitteesthathadmetatleastfourtimesinthepastyear,butonly41%oftrustsreportedsharingrecommendationsfromtheircommitteewiththetrustboard.WhilemostMSLCshaveaboutfouruserrepresentatives,seventrustsreportedhavingnouserrepresentativesontheMSLC.

Wheretheyareacknowledgedasvaluableandsupportedbycommissioners,theyoperateeffectivelyandcanhaveakeyroleintheplanning,monitoringandimprovementofhighquality,women-centredmaternityservicesintothefuture.Inotherlocalitiestheyneedreviewingandstrengthening.CurrentlywehaveauniqueopportunitytorenewmaternityserviceuserengagementandtheroleandremitofMSLCsforthefuture.

Inthe2010consultationdocument,LiberatingtheNHS:Commissioningforpatients,thecoalitiongovernmentfullysupportstheprinciplesofuserengagement,and states the need to:

• PutpatientsattheheartofeverythingtheNHSdoes.

• Focusoncontinuouslyimprovingthosethingsthatreallymattertopatients-theoutcomeoftheirhealthcare.

• Empowerandliberateclinicianstoinnovate,withthefreedomtofocusonimprovinghealthcareservices.14

Northern Ireland

NorthernIrelandguidelines,issuedinMay2009,statethatmaternityservicesneedtobeappropriate,acceptableandaccessibletothelocalpopulation.15Forthisreason,usersneedtobeinvolvedintheserviceimprovement,planningandmonitoring ofservices.

AllMSLCmembersshouldrecognisethepositivecontributionthatserviceusermemberscanmake.Theyshouldstrivetoensurebroadrepresentationandimprovetheireffectivenessthroughtheprovisionofsupportandtraining.ThismayincluderepresentationfromthePatientandClientCouncilbutshouldnotberestrictedsolelytotheirinputandshould,wherepossiblereflectthenatureanddemographyofthechildbearingcommunity.

IneachHealthandSocialCareTrust(HSCT)offeringmaternityservices,theremustbeaneffectivemultidisciplinaryMaternityServicesLiaisonCommittee(MSLC),wherecommissioners,providersandusersofmaternityservicesbringtogethertheirdifferentperspectives,toplan,monitorandimprovelocalmaternityservices.WherethereismorethanoneMaternityUnitwithintheTrusts,theTrustwiththeCommissionerwillneedtodecidethenumberofMSLCs.

Scotland

TheScottishHeathCouncilpublishedagoodpracticedocumentin2011highlightingtheresultsofvariousreviewsofUserInvolvementinMaternityServices,goodpracticeandmakingaseriesofrecommendationsforinvolvingwomenmoreeffectivelyinimprovingtheircare.16

WhilstacknowledgingtheroleoftheMSLCsinthepast,thereportalsohighlightedsomeoftheconstraintsofthiswayofworking,inparticulartheissueofnotalwaysengagingwiththe‘seldomheard’groups.ItsuggestsavarietyofdifferentmechanismsofengagementthatNHSBoardscould alsoutilizewhileemphasizingkeymessagesofaccessibility,meaningfulandsustainedengagement:

• Boardsshouldencouragetheuseoftoolswhichencouragewomentoprovidefeedbackduringhospitalvisitsor

treatmentmakinguseofwhatthewomencalled‘statictime’.

• Boardsshouldencourageuseofnewtechnologiessuchassocialnetworkingsitesandvirtualmeetingroomswhilerecognisingthatnoteveryonehasaccesstoweb-basedresources.

• Boardsshouldconsiderworkingmorecloselywiththirdpartyagenciessuchasexistingparentandcommunity,employmentoreducationgroups.

• BoardsshouldconsiderhowexistingNHScontactwithmaternityserviceuserscouldbeusedtowidenparticipation,suchasthroughhandheldrecordsandappointmentorreferralletters.

TheyconcludethattheintroductionofaParticipationStandard,coveringpatientfocus,publicinvolvementandrelatedgovernanceissues,shouldsupportthenecessaryculturechangewithinNHSScotlandtosupportsustainableinvolvement.

Wales

TheStrategicVisionforMaternityServicesinWalesstatesthatmaternityservicesshouldbedeliveredinpartnershipwithwomenandtheirfamilies,playingacentralroleinplanninganddevelopingmaternityservices,includingaddressingareasofweaknessandmonitoringprogress.17

MSLCsshouldhavemembersthatrepresentalltheprofessionalswhocomeintocontactwithwomenandtheirfamiliesduringthetransitiontoparenthoodandonethirdofmembersoftheMSLCshouldbeuserrepresentatives.Avarietyofmeansmaybeusedtoinvolvepeopleandfindoutabouttheirexperiencesandconcerns,includingengagementwithdifferentcommunitiesandvoluntarysectorgroups,usingformalandinformalmethodstogatherevidenceandfeedback.InWales,headsofmidwiferyarecurrentlyexploringwaystoeffectivelystrengthenuserinvolvementinmaternityservicemonitoringandplanningthroughdevelopmentofMSLCsacrossWales.

In their own words serviceusersandhealthprofessionals

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7. NCT,RoyalCollegeofMidwives,RoyalCollegeofObstetriciansandGynaecologists.MakingsenseofcommissioningmaternityservicesinEngland-someissuesforClinicalCommissioningGroupstoconsider.Availablefrom:www.rcm.org.uk/EasySiteWeb/GatewayLink.aspx?alId=207370

8. HumphriesR,BuckD,HenwoodM,etal.DevelopingaJointHealthandWellbeingStrategy:frameworksforaction.TheLondonHealthandWellbeingPartnershipSupportProgramme.Availablefrom:http://www.kingsfund.org.uk/publications/articles/joint-health-and-wellbeing-strategy-guide

9. DepartmentofHealth.Modernisationofhealthandcare.WhatisHealthwatch?Availablefrom:http://healthandcare.dh.gov.uk/what-is-healthwatch/

10. GarrodD.Talkback:astrategicapproachtoworkingwithmaternityserviceusers.Pract Midwife 2012;15(4):18-20.

11. Dunkley-BentJ,JonesH.MaternityServicesLiaisonCommittee(MSLC)‘walksthepatch’toreflecttheviewsofusers.Availablefrom:http://www.rcm.org.uk/midwives/in-depth-papers/maternity-services-liaison-committee-mslc-walks-the-patch-to-reflect-the-views-of-users/

12. HealthcareCommission.State of healthcare 2007: improvements and challenges in services in England and Wales.London:TSO;2007.Availablefrom:http://www.official-documents.gov.uk/document/hc0708/hc00/0097/0097.pdf

13. HealthcareCommission.Towards better births: a review of maternity services in England. London:CommissionforHealthcareAuditandInspection;2008.Availablefrom:http://archive.cqc.org.uk/_db/_documents/Towards_better_births_200807221338.pdf

14. DepartmentofHealth.LiberatingtheNHS:commissioningforpatients.Aconsultationonproposals.Availablefrom:http://www.cuh.org.uk/resources/pdf/cuh/structure/foundation_trust/consultations/commissioning_for_patients.pdf

15. DepartmentofHealth,SocialSecurity&PublicSafety.GuidelinesforMaternityServicesLiaisonCommittees(MSLCs).Availablefrom:http://www.dhsspsni.gov.uk/guidelines_for_maternity_services_liaison_committees__mslcs__may_2009.pdf

16. ScottishHealthCouncil.Good practice in service user involvement in maternity services: involving women to improve their care.Glasgow:ScottishHealthCouncil;2011.Availablefrom:http://www.maternityservices.scot.nhs.uk/wp-content/uploads/MaternityServicesAction.pdf

17. WelshGovernment.A strategic vision for maternity services in Wales .Cardiff:WelshGovernment;2011.Availablefrom:http://wales.gov.uk/topics/health/publications/health/strategies/maternity/?lang=en

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AcknowledgementsOurthanksgotothemanypeoplewehaveconsultedinthepreparationofthisstatement.

DeniseBoulter–aNorthernIrelandCommissioner

ElisabethBuggins–ChairofBirminghamWomen’sHospitalandformerlyChairofBirminghamandtheBlackCountryStrategicHealthAuthority

MaxineBullen–ProjectLeadonMSLCsacrossSussexGeoffBurgess–SeniorNetworkProgrammeManager,SussexManagedClinicalNetworks

AshleyBrooks–PatientandPublicEngagementandPatientInvolvementCo-ordinator,SouthWarwickshireCCG

ElizabethDuff–SeniorPolicyAdviserNCT

GinnyEdwards–ServiceImprovementandKnowledgeManagementLead,HealthandWellbeingBoardImplementation,SocialCare,LocalGovernmentandCarePartnershipsDirectorateattheDepartmentofHealth

JanetFyle-ProfessionalPolicyAdviser, RoyalCollegeofMidwives

SineadHughes–PatientandPublicInvolvementLeadSouthernTrust,NorthernIreland

AnnJudges–formercommissioningmanagerofMaidstonePCT

LisaMarch–HeadofQualityLeicester,Leicestershire andRutlland

HeatherMellows–FRCOGProfessionalAdvisertotheDepartmentofHealth

JillMorrell–PublicCommunicationsLeadat CareQualityCommission

PaulaMurphy–HammersmithandFulhamLINksaHealthWatchPathfinder

HelenO’Dell–AssociateChiefNurse,WomenandChildren’sDirectorateandHeadofMidwifery,BrightonandSussexUniversityNHSTrust

LesleyPage–PresidentofRoyalCollegeofMidwives

JamesRansome–CommissioningManager,Kent

JessicaRead–LSAOfficer,NHSLondon

HeadsofMidwiferymeetinginWalesJuly2012– personalcommunication

DavidRichmond–VicePresident,RoyalCollegeofObstetriciansandGynaecologists

NicolaStevenson–PolicyResearcheratNHSConfederation

MelanieThwaites–AssistantDirector,ChildrenandFamiliesTeam.Leicester,LeicestershireandRutland

SylviaTidy–ChairofShadowHealthandWellbeingBoard,EastSussex

DrSuzanneTyler–StrategicMaternityLead,NHSSouthofEngland

JeremyTaylor–ChiefExecutive,NationalVoices

DavidWells–CHIMATDeputyDirectorandLocalNetworklead(http://www.chimat.org.uk/mslc)

JudithWright–DirectorofPublicHealth,WestSussexCountyCouncil

Chairs of several MSLCs:

PhilippaBennett–Chair,WestEssexMSLC

CynthiaClarkson–ExperienceduserrepLothianMSLC

LouiseGriew–Chair,SouthWarwickshireMSLC

RichardHallett–Chair,CrowboroughBirthingCentreMSLCandCoChairofEastbourneMSLC

GitteLindberg–Chair,Plymouth,WestDevon,EastCornwallandtheSouthHamsMSLC

AlisonLedward–Chair,MidSussexMSLC

HannahSherlock–Chair,BrightonMSLC

SeanaTalbot–Chair,SouthernMSLCNorthernIreland

CatherineTugnait–JointChair,HillingdonMSLC

Author GillianFletcherMBE–NCTVoicesco-ordinator

RegisteredCompanyName:NationalChildbirthTrust Registeredaddress:AlexandraHouse,OldhamTerrace,Acton,LondonW36NH.RegisteredCompanyNo:2370573 RegisteredCharityNo(EnglandandWales):801395 RegisteredCharityNo(Scotland):SC041592

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