Safe staffing levels are essential to the provision of safe and effective maternity care and wider antenatal support. However, recent data shows significant shortfalls in staffing for both midwives and health visitors – both key groups in supporting families during pregnancy, it says.
The report finds:
- There is significant evidence of the need for improvement in NHS maternity services, including declines in key indicators of safety and quality, and evidence of inequalities in birth outcomes and experiences of maternity care.
- Evidence also points to the need for improvement in wider antenatal services, particularly around consistent access to support
- The maternity and health visiting workforces are under significant pressure. Staffing shortfalls and rising levels of need mean many services are struggling to provide adequate care, with workforce wellbeing also suffering.
A 2023 report by the Royal College of Midwives estimates that there is now a shortfall of 2,500 midwives in England, with the workforce increasingly stretched to deliver the high level of support delivered to individuals. Meanwhile, data on health visitors from 2022 shows a ‘record low’ of 7,300 full-time equivalent health visitors, with the workforce having decreased by 37 per cent since 2015.
Against this backdrop the report highlights the work of A Better Start partnerships with case studies from the five areas that highlight a range of approaches A Better Start Partnerships have been employing to support families during pregnancy and the early weeks after birth.
The National Children's Bureau (NCB) designs and runs a programme of shared learning and development support on behalf of A Better Start, a 10-year programme funded by the National Lottery Community Fund, which operates in Blackpool, Bradford, Lambeth, Nottingham and Southend support families with babies and very young children.
The programme ‘aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life.’
Working with local parents, A Better Start partnerships are developing and testing ways to improve children’s diet and nutrition, social and emotional development, and speech, language, and communication.
The case studies are examples of direct support for families, investment in the maternity workforce, collaboration and co-production of services, integrated working approaches and 'wider systems change activities.'
The work highlighted includes:
- Lambeth Early Action Partnership (LEAP), which delivers personalised care during pregnancy to women in south London, where families experience greater inequalities than the rest of the borough
- A Better Start Bradford's personalised midwifery project using the midwife-led 'continuity of carer' model
- A Better Start Southends's perinatal mental health service delivered by health visitors, providing father-inclusive mental health and wellbeing support
- Small Steps Big Changes (SSBC) in Nottingham, which promotes father inclusive practice in services that support families from the antenatal period to the age of four
- Blackpool Better Start: Working with partners to improve support during and after pregnancy for families whose baby is at risk of being taken into care.
Frances Lyons, head of research and evidence at the NCB, said, ‘Pregnancy and the first few weeks after birth are a precious window in the lives of children. Yet research suggests that maternity services and key professionals such as midwives and health visitors sometimes struggle to provide the support that can make a real difference to babies and their families.
‘In their local areas, A Better Start partnerships are not only supporting local families to bring about improved outcomes for infants and their families but are looking to the future in terms of driving wider systems-change.'
Common areas include:
- ‘a holistic approach to family support’ drives improved outcomes
- services which have been ‘codesigned with service users’ are better placed to address needs
- ‘Building strong relationships’ between service users and those who support them are key, no matter what the service
The report points out that the pandemic and the ongoing cost-of-living crisis are having a significant impact on families and the services which support them.
It says, ‘The context within which ABS partnerships operate has therefore changed significantly since the start of funding, and many activities supporting families during pregnancy and the early weeks have had to adapt to meet changing needs.’
Lyons added, ‘At the core of the A Better Start approach is the realisation that taking a holistic approach to the needs of each baby is central to improving outcomes. Whether this is considering the wider range of where a family requires support or making sure that co-produced services work closely together in an integrated, multidisciplinary way, considering the full spectrum of a babies’ needs as well as the key people around them, can make all the difference.’
- Read the report, A better start through maternity and antenatal care, here
