Conclusions and recommendations
1. We recommend that
detailed socio-economic and ethnic data should be recorded in
a standardised way in all national datasets and that analyses
of these data should be routinely published as well as being made
available to researchers for more detailed analyses.
(Paragraph 14)
2. If maternity services
are to meet the needs of disadvantaged women, babies and families,
the evidence base on which policy decisions and service developments
are made must be expanded. We recommend that the Department commission
programmes of quantitative and qualitative research so that an
accurate assessment of the extent to which women who do not gain
full access to maternity care can be made, the reasons for inequalities
and inequities established and further action taken to address
these inequalities.
(Paragraph 22)
3. We recommend that
the Department provide PCTs and acute trusts with relevant and
timely information to enable maternity care teams to use the opportunities
and resources offered by the Government through projects and initiatives
such as Sure Start, to recruit more staff and provide specialised
services for disadvantaged women and their families. We further
recommend that the Department should ensure that best practice
be shared in relation to these centrally-funded projects. We further
recommend that the Department should ensure that best practice
be shared in relation to sustaining the work of a project after
the allocated funds have been
used. (Paragraph 40)
4. We welcome the
interim findings of the Maternity External Working Group, and
look forward to seeing the work of the sub-group appointed to
examine inequalities and access. The difference for women and
families will depend on the identification of effective strategies
and the Government ensuring that the implementation of these strategies
is achieved.
(Paragraph 46)
5. We recommend that
the Government investigate the RCM's concerns relating to the
recruitment of midwives from minority ethnic communities. Action
to promote the recruitment of midwives from ethnic minority communities
could include the identification of 'champions' from minority
ethnic communities which may help to inspire some younger people
from these communities to pursue careers in maternity
services. (Paragraph 56)
6. Any support system
for asylum seekers should provide specifically for the needs of
pregnant asylum seekers, new mothers and their babies. We recommend
that the Government take steps to ensure that pregnant women and
new mothers should not be detained for any prolonged period, and
that accommodation centres should provide a gateway to maternity
services for pregnant asylum
seekers. (Paragraph 65)
7. Better communication
between maternity and child health services and accommodation
providers during dispersal is needed to ensure that members of
maternity care teams are forewarned of the arrival of asylum seekers
who will need their services and that their test results and notes
are forwarded.
(Paragraph 66)
8. In considering
asylum seekers for dispersal special attention should be paid
to the support needs of pregnant women and new mothers since separating
them from any support network at this time could be especially
detrimental to families.
(Paragraph 67)
9. Given the high
incidence of domestic violence in pregnancy, relying on relatives
to interpret for women can be extremely dangerous. All maternity
services should ensure that the use of relatives as interpreters
does not deny women the opportunity that maternity care provides
to report domestic violence or to discuss other concerns such
as mental health.
(Paragraph 77)
10. Interpreting and
advocacy services are a vital component of appropriate maternity
care for women who do not speak English as their first language.
However, we are concerned that local service planners do not recognise
this in their budgets, and in particular that there is so little
provision for need in the community and out-of-hours in hospital-based
units. We recommend that local maternity services take steps to
ensure the development of on-site out-of-hours interpreting and
advocacy services and that better use is made of telephone interpreting
services. We further recommend that staff running antenatal classes
and undertaking postnatal visits should have access to advocacy
and interpreting services.
(Paragraph 78)
11. Ideally, interpreting
services should be provided, in the community and in the hospital,
by specialist interpreters and advocates, rather than by family
members, friends, or by other staff. However, we endorse the attempts
made by maternity care staff to find interpreters when specialist
services are not available. Bilingual and multilingual staff working
in PCTs and acute trusts should have the opportunity to develop
their interpreting skills. We recommend that the Department commission
work to develop appropriate training courses and qualifications
in interpreting for non-specialist
staff. (Paragraph 79)
12. We were also concerned
to hear of individual social workers giving mothers the general
impression that it would be easier to take a baby away and care
for him or her, rather than work with the family to keep them
together. We recognise that in extreme cases social workers do
have to recommend that babies are taken away from parents but
this experience suggests that more needs to be done to ensure
that social workers are trained to understand and respect the
sensitivities of homeless and disadvantaged families so that it
is clear that families will be kept together where this is
possible. (Paragraph 90)
13. Those responsible
for rehousing pregnant women and women with young babies should
be able to pass information on to maternity and health visitor
services where women wish for these services to be provided. Currently
methods of passing on information are inadequate and the situation
needs to be improved. We recommend that the Department should
assess the difficulties faced by low-income families who have
to spend long periods visiting their babies in Special Care Baby
Units and that the Department should then take steps to ensure
that sufficient financial support is provided so that these families
can meet travel and other
costs. (Paragraph 92)
14. We believe that
domestic violence is substantially under-reported and that the
true scale of the problem remains unknown. We endorse the RCOG's
call for further research into the prevalence of domestic violence,
and into effective models of intervention. All maternity services
need to have access to support services, to which they can refer
those who are suffering from domestic violence. All women should
have ready access women's refuges so that maternity services can
protect women who disclose domestic violence from further abuse.
(Paragraph 99)
15. All trusts should
ensure that maternity and mental health services work together
to provide proper support for women during pregnancy and the postnatal
period. We believe that the Department should give high priority
to addressing the problem of inadequate provision of mother and
baby units in some parts of the country. Mental health trusts
should appoint lead practitioners to ensure that care for these
women is properly co-ordinated.
(Paragraph 105)
16. Information that
is provided to expectant parents should be made fully accessible
to all groups of people with disabilities, including those with
physical or sensory impairments, people with learning difficulties
or long-term illnesses and people with mental health
problems. (Paragraph 116)
17. Maternity units
and services should be made accessible to all groups of people
with disabilities. We recommend that the Department set up systems
for best practice to be shared so that people with disabilities
do not have to struggle to make their views known in every area
before improvements are made. For example, the obvious success
of height-variable cots in one area should automatically be picked
up by other units. We have little confidence that this happens
now. (Paragraph 117)
18. User involvement
is vital to the effective planning of services and monitoring
of access to care. We recommend that the Department should ensure
the continuation of MSLCs in the context of NHS reforms. The role
of MSLCs in relation to the Patient Advice and Liaison Service
(PALS) and in relation to new patient forums and other mechanisms
to involve the public in health service provision needs to be
clarified. The expertise of the Commission for Public and Patient
Involvement in Health should also be used to support
MSLCs. (Paragraph 128)
19. MSLCs can be a
powerful way of involving users in planning and developing maternity
services but it is important that MSLC membership reflects the
ethnic and social diversity of the local population as far as
possible so that the needs of disadvantaged groups are accommodated.
Lay members of MSLCs should at least be reimbursed for the child
care and travel costs incurred when they attend meetings.
(Paragraph 133)
20. We were encouraged
by the work of service providers who actively sought the views
of women and families from disadvantaged groups by becoming involved
in forums established by minority communities, and we are keen
to ascertain whether this work could be replicated in other areas.
We recommend that the Health Development Agency should gather
and disseminate evidence of best practice in this area.
(Paragraph 134)
21. Because of the
particular sensitivity and importance of maternity services we
recommend that trusts should ensure that maternity care staff
and PALS officers have access to sufficient opportunities for
training with particular reference to the problems of mothers
with disabilities or mental health problems, those from minority
ethnic communities, those who live in poverty, and those from
other disadvantaged groups. If there were to be a 'specialist'
in maternity units to help such mothers, service users might not
suffer from the ignorance and prejudices of some staff that were
reported to the Committee.
(Paragraph 141)
22. We recommend that
local health services should liaise with local authorities and
other agencies to update information about traveller sites within
their areas. User representatives from local travelling communities
should be involved in planning any special measures for service
provision. We further recommend that PCTs should identify a co-ordinator
for travellers, to facilitate transfer of health records, especially
maternity records and notification of health
professionals. (Paragraph 149)
23. As part of its
work on domestic violence the Government should ensure that the
Department of Health addresses the issue in the context of maternity
services across the country. For women who have been abused and
raped, there may be particular issues which need to be addressed
in maternity services. We recommend that the Department should
take steps to ensure that special training programmes are made
available to all maternity staff across the country so that women
subject to rape and domestic violence receive
appropriate care. (Paragraph 153)
24. We recommend that
all maternity services should consider recruiting healthcare assistants
from minority ethnic communities, and developing training programmes
so that these assistants can provide advocacy support for women
and families.
(Paragraph 159)
25. All health professionals,
including PALS officers, who become involved with a disabled mother
who is either planning to become pregnant, receiving fertility
treatment or who is already pregnant, should know how and where
to obtain specialised information about the problems with pregnancy,
delivery and baby care associated with particular impairments.
(Paragraph 163)
26. In order to provide
an appropriate level of care for disadvantaged women and families,
health professionals should have ready access to expert information,
and to sources of further support. We recommend that the Health
Development Agency should collate available research and evidence
on work with disadvantaged groups, and create a central database
of voluntary organisations working at local and national
level. (Paragraph 164)
27. We recommend that
local maternity services should appoint a lead health professional
to ensure that women and families who have needs specific to physical
or mental health, or social circumstances are provided with appropriate
services. The role should involve liaison within a multi-disciplinary
health and social care team, provision of care for individual
women, advice on plans and policies within units, co-ordination
of advocacy and interpreting services, including British Sign
Language, and training and support for colleagues.
(Paragraph 173)
28. Maternity teams
which have developed community-based continuity of carer schemes
for women from disadvantaged groups, have been successful in improving
access to maternity care and in achieving positive health outcomes
for mothers and babies. We recommend that providing continuity
of carer schemes for women from disadvantaged backgrounds should
be a particular priority for maternity services.
(Paragraph 178)
29. Although the use
of woman-held notes does not address the problem of identifying
and reaching those women who do not make any contact with maternity
services, they are a valuable way of passing on information which
may be crucial to the provision of appropriate care for women
from transient populations and for women who see a variety of
health professionals during their maternity care. Given the concerns
expressed by witnesses during our first inquiry in relation to
maternity care records, and to the Electronic Patient Record (EPR)
in particular, we recommend that the Department should clarify
whether the EPR will affect the use of woman-held notes and how
it will be adapted to facilitate provision of appropriate services
for disadvantaged women and their
babies. (Paragraph 182)
30. Provision of support
for smoking cessation and for breastfeeding represent two interventions
which can improve a woman's experience of maternity care, and
the long-term health outcomes for women and babies. Women from
disadvantaged groups may need specialist support in these areas.
We recommend that health visitors and midwives undertake training,
and that they work closely with peer groups and volunteers, to
provide this support. We further recommend that the Health Development
Agency issue guidance to PCTs on best practice in smoking cessation
and breast feeding support for women from disadvantaged groups.
There should be a flexible approach to the transition to care
provided by health visitors, to allow mothers to work with whichever
health professional they feel is best placed to support
them. (Paragraph 191)
31. We recognise the
potential of midwives, and of maternity services, to play an expanded
role in promoting public health. However, maternity care staff
must have access to appropriate levels of training and support
if they are to be effective in this role. We recommend that the
Department should facilitate the implementation of the proposals
in Making a Difference by making a detailed assessment of the
training and support needs of staff who provide maternity
care. (Paragraph 197)
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