Report published on women’s satisfaction levels with maternity care in Wales

Most women are satisfied with maternity care in Wales with services generally meeting an appropriate standard, says a report published this week by the Auditor General. But the report also highlights some specific problems including the way that labour is managed in some trusts and dissatisfaction with support for infant feeding.

The report includes a survey of new mothers and although many women questioned were satisfied with their experience, a significant minority felt they were not always treated with dignity and respect or kindness and understanding.

Antenatal care generally meets good practice guidelines, but some women do not receive enough check-ups and there is generally low attendance at antenatal classes. The report also shows that women in some trusts tend to receive too many scans whilst trusts are not yet offering the most up-to-date screening for Down’s syndrome.

The way labour is managed in some NHS trusts gives rise to concern. A significant minority of women felt they were left alone and worried during or shortly after labour and some trusts could do more to prevent unnecessary Caesarean sections. Women were least satisfied with the postnatal phase of care, with over a third of women being unhappy with the quality of support they received for infant feeding.

The report calls for the Assembly Government to develop an overall strategy for maternity services in Wales. This would help the planning of maternity services which is currently being undermined by the lack of a clear vision and poor information about the cost and quality of care.

The strategy would also provide a comprehensive source of guidance aimed at removing some of the specific problems with maternity services, such as the failure to meet recommended staffing levels in some trusts and the low level of staff training in many trusts.

The report called Maternity Services makes a number of recommendations for improvement, by calling on:

• the Assembly Government to develop a comprehensive strategy for maternity services, highlighting good practice and offering guidance on local service planning
• new local health boards to assess staffing requirements for delivering safe and high quality services
• local health boards to make sure that all maternity staff receive the necessary clinical training
• local health boards to review their training programmes to ensure that there is sufficient focus on the principles of respect, well being, choice and dignity
• the Assembly Government, in partnership with the NHS in Wales and other key stakeholders, to agree a standard set of data that is routinely collected, monitored and used to support service improvement.

RCOG reports on older mothers

In response to growing concern over the rising incidence of later maternal age in the UK, the RCOG convened a Study Group to meet to discuss the issues. Research shows there is a growing trend in the UK for childbearing to occur at a later time in women’s lives and the RCOG says there is an urgent need for better public information on the issues surrounding later maternity.  The RCOG report that whilst women should be supported, rather than constrained, in their life choices, both women and society need to be aware of the possible problems that older mothers may encounter.
 
RCOG reports that later maternal age is an emerging public health issue and organisations such as themselves, NICE and the Centre for Maternal and Child Enquiries (CMACE) must work together with the Department of Health to tackle these new challenges. 

Research into impact of independent midwifery care published

The British Medical Journal this week published research comparing care provided by independent midwives with maternity care within the NHS. The research compared a wide range of ‘outcomes’ including whether mothers started labour spontaneously, whether their birth was spontaneous, without forceps, ventouse or caesarean section,  where drugs were used for pain relief, and breastfeeding rates. It found that women who used an independent midwife (i.e. a midwife registered with the Independent Midwives Association) were more likely to start labour spontaneously, have an unassisted vaginal birth, use fewer pain relieving drugs and were much more likely to establish breastfeeding.
 
For women with a straightforward pregnancy the stillbirth and neonatal death rate was similar to that for women having their baby with NHS care. There appeared to be more baby deaths among women who had a more complex pregnancy with an independent midwife. Unfortunately the methodology used was unable to compare accurately the women having care with an independent midwife with those using NHS services. Although the sample was matched in terms of age, previous children, year of birth and socioeconomic status there are likely to be many other ways in which the two groups differ, including different beliefs and preferences, making it difficult to make meaningful comparisons.

Government commitment on child poverty to be enshrined in law

The Government has published a landmark child poverty bill that enshrines in law a duty to eradicate child poverty by 2020 – so that all children have the best start in life and have the opportunities to flourish. The cross departmental bill requires Government to reduce poverty so families on low income do not get left behind. It puts duties on local authorities, and partner organisations like the NHS and Police to work together at local level to lift children out of poverty. It also requires Government to report to Parliament each year on progress and creates a new expert Child Poverty Commission to publish advice and encourage progress.

500,000 children have been lifted out of poverty already and measures currently in train are expected to lift around a further half a million children out of poverty. The target for relative poverty requires the UK to go further than the best currently being achieved in Denmark, Finland and other European countries.

In summary the UK-wide Bill will:

• Establish four income targets to be met by 2020, which will define the eradication of child poverty; Relative poverty: Less than 10 per cent of children living in relative low income poverty by 2020 (i.e. in households with less that 60 per cent of the median income); Material Deprivation: Less than 5 per cent of children living in combined material deprivation and low income (i.e. in households with less than 70 per cent of median income); Persistent Poverty: percentage of children living in relative poverty for three out of four years (target level to be set by the end of 2014 as data are currently unavailable); Absolute low income: less that 5 percent of children living in families with an income below an absolute threshold.

• Require the Government to publish a UK child poverty strategy, which must be revised every three years. The strategy will set out the policies that will put in place to meet the targets.  There will also be a requirement for Scottish ministers and Northern Irish ministers to publish child poverty strategies and the establishment of a child poverty Commission to provide advice on the development of the child poverty strategies.

• Require the Government to publish annual progress reports. Place duties on local authorities and other local delivery partners to work together to tackle child poverty, conduct a local needs assessment, produce a child poverty strategy and take child poverty into account in the production and revision of their Sustainable Communities Strategies.

The Government is also announcing the pilot areas that were selected for an innovative scheme which gives local authorities the opportunity to draw up individual plans to tackle local child poverty issues and the areas to benefit from targeted accommodation support for teenage parents.

‘Take Up the Challenge’, the report from the Take Up Taskforce outlines how local services can help poor families to take up their financial entitlements, illustrated by examples of local approaches that are having a real impact. Increasing the take up of benefits and tax credits is an important part of the Government’s strategy, and is particularly important to help vulnerable families through a time of economic uncertainty. This report will help local authorities and partners meet the requirements of the Bill.

Details on the Child Poverty Bill and the Take Up Taskforce’s report can be found at http://www.dcsf.gov.uk/ecm/childpoverty

There are currently 42 Local Authorities running pilots.

HMRC Outreach Pilot: The HRMC Outreach pilot tests whether providing tax credit advice in Children’s Centres will assist in the take up and best use of tax credits for families, ensuring that families in poverty are claiming all that they are entitled to claim to better support them. The HMRC-led and funded pilot began in five Children’s Centres in Preston and Newham in May 2008 has been extended, from April 2009, to 100 Children’s Centres in the West Midlands, NW Lancashire and London areas.

Work Focused Services Pilot: This pilot, led by DWP and DCSF is testing whether placing JobCentrePlus (JCP) advisors in Children’s Centres, along with additional support aimed at getting more people into employment .It was launched in 10 Local Authorities and 30 Children Centres in January 2009 and early anecdotal evidence is showing that parents are making good use of the service and support provided in their Sure Start Children’s Centre.

Family Intervention Pilot: The DCSF has been running the successful Family Intervention Project (FIP) programme since July 2008 and in October of the same year, funding was made available for 10 local authorities to run a FIP programme specifically aimed at supporting families who experience poverty, inter-generational worklessness and other complex needs. Once fully launched, it will be operating in 32 areas with each area working with 40-60 families. It was launched in October 2008 in 10 areas which each area working with 15-20 families. 2 more projects are scheduled to be operational by September 2009.
Child Development Grant Pilots: The Child Development Grant Pilots provides incentive based programmes, aimed at encouraging hard to reach parents to engage in a number of positive activities to help lift them and their families out of poverty. The pilot will run for two years in ten Local Authorities.

Local Area Innovation pilots: In ten LAs, the Local Area Innovation Pilots give local authorities and their partners the chance to draw up new and innovative programmes to help tackle local child poverty issues. The pilots will seek to encourage movement into employment, increase the take-up of benefits and help to raise incomes through measures tailored to support the local authority.

Supported accommodation for teenage parents: In May and June 2009, seven local authorities will test how providing enhanced support for teenage parents’ housing needs can help improve outcomes for teenage parents and their children. The pilots will help to define the best ways of offering enhanced support.