Local maternity and neonatal system - North East London Health & Care Partnership

The North East London Local Maternity and Neonatal System (NEL LMNS) is a partnership of organisations, women and their families working together to deliver improvements in maternity services in North East London.

The NEL LMNS supports all the maternity units in our seven North East London boroughs – City and Hackney, Tower Hamlets, Newham, Waltham Forest, Barking and Dagenham, Redbridge and Havering – bringing together all the people, services and organisations who are involved in providing and organising maternity care such as; midwives, obstetricians, service users, neonatal staff, managers, commissioners, public health, educators, perinatal mental health providers and GPs.

Guided by local, regional and national guidelines and reports, we want to make sure all pregnant people, their families and babies are cared for in any North East London maternity units have the best possible experience.

The NHS Long Term Plan is an ambitious but realistic plan set out in 2019, aiming to give everyone the best start in life; deliver world-class care for major health problems, such as cancer and heart disease, and help people age well.

For maternity services it aims to provide wrap around care for the mother and her family to ensure every child has the best possible start in life, from birth to their transition into adulthood.

The NHS Long Term Plan for maternity care will continue to improve over the next decade; making sure safety in maternity services continues to improve, offering women more choice, and specialist support is given to mothers who are at risk of premature birth, including support to stop smoking.

Pregnant people will benefit from continuity of carer during pregnancy, which makes sure, where possible, they have the same team of midwives throughout their pregnancy and after they have given birth. In addition there is a commitment to ensure; voices are truly heard with the Maternity Voice Partnership involved in the planning and transformation of maternity services, pregnant people participate equally in all decision-making processes and are enabled to make informed choices about their care and all pregnant people and their families are treated compassionately, with kindness and appropriate language used by all staff.

Pregnant people and new parents will see increased support for those who experiences mental illness during or after pregnancy and will be able to access their maternity notes and information online and via their smartphones.

The Better Births national review of maternity services which was released in 2016 – setting out a clear vision for maternity services across England to become safer, more personalised, kinder, professional and more family friendly. It also called for staff to be supported to deliver women-centred care.

Local Maternity and Neonatal Systems (LMNS) were established across the country to provide support to maternity units to achieve more personalised, safer care, improve continuity of care and provide unbiased evidence-based information to help pregnant people make choices about their care.

The initial Ockenden Report, published in December 2020, identified themes and recommendations for immediate actions and changes across all maternity services in England.

The report identified seven Immediate and Essential actions (IEA’s) for all maternity services to be implemented, including; enhanced safety, listening to women and their families, staff training and working together, managing complex pregnancy, risk assessment throughout pregnancy, monitoring foetal wellbeing and informed consent.

The final Ockenden Report, published in March 2022, detailed further recommended actions for maternity services across England. The NEL LMNS will work with all maternity services in north east London to review these actions, work with those who use maternity services, as well as local partner organisation and user-led Maternity Voices Partnership to implement the actions, with safe, compassionate and responsive care.

LMNS’s set out how they’ll make sure that babies born in England have the best possible start in life. Our plans at NEL LMNS are consistent with the NHS Long Term Plan, Better Births and the Ockenden Report.

The National Institute for Health and Care Excellence (NICE) use the best available evidence to develop recommendations that guide decisions in health, public health and social care. Their guidelines make evidence-based recommendations on a wide range of topics. These include preventing and managing specific conditions to planning broader services and interventions to improve the health of communities. They aim to promote integrated care where appropriate. All maternity units in NEL , and the rest of the country, use NICE guidelines for maternity services.

The NHS has made four pledges to improve equity for pregnant people and babies and race equality for NHS staff in England.

Equity means that all pregnant people and babies will achieve health outcomes that are as good as the groups with the best health outcomes. For this, maternity and neonatal services need to respond to each person’s unique health and social situation – with increasing support as health inequalities increase – so that care is safe and personal for all.

In November 2021, the North East London Local Maternity and Neonatal System (NEL LMNS) produced a needs assessment to look at the maternity data and outcomes for women in our communities, and identified a number of clinical outcomes and experiences that were poorer for certain communities than others. The needs assessment was produced in response to the equity and equality guidance for local maternity systems, and can be viewed here.

The needs assessment forms the first part of a two-part process, with two aims for maternity and neonatal care:

Equity for mothers and babies from Black, Asian and Mixed ethnic groups and those living in the most economically deprived areas
Race equality for staff

The second part of the process was to produce a strategy and action plan to improve equity and equality for pregnant women. Through extensive engagement with our communities undertaken by Healthwatch and Maternity Mates over 1000 responses were collated to understand the experiences and expectations of the women in our care.

From this engagement, key themes were identified focused on; engagement, communication, information sharing and consent. It was evident that some difficult experiences and poor outcomes could have been different with more accessible information, stronger communication, greater cultural awareness and a trauma informed approach.

Our strategy and action plan describes our commitment to listen and work with our maternity service users and their advocates, to improve services and experiences that better meet the needs of those who use them, putting an equity lens on all we do and establishing different ways of working to ensure everyone receives safe and personalised care.

The action plan will provide direction for the maternity units in north east London, acknowledging our communities have different needs, and each maternity unit will need to develop a localised plan to fulfil these.

The full report can be viewed here, with a summary version also available, that can be viewed here.

In June 2023, the North East London Local Maternity and Neonatal System worked with Healthwatch and Maternity Voices Partnerships to understand what motivates choice when it comes to maternity care, and the demand for and nature of culturally sensitive maternity care provision in north east London.

Through online surveys and face to face interviews in antenatal clinics, children’s centres, foodbanks, nurseries and faith groups, we spoke with 403 people to hear about their experiences of maternity care and understand whether they felt they could make choices, why they chose to have their maternity care at their chosen hospital, birth centre or a home birth, and how they felt issues of cultural sensitivity and associated barriers impacted their choice.

Findings identified that we are still seeing an ongoing division in maternity experience relating to health inequality and recommendations focused on areas including: scoping of GP and self-referral structures, management of antenatal service capacity and clear information for service users on antenatal clinic waiting times, increase training for staff on cultural sensitivities and trauma informed care, improved interpreting services for those with less than conversational English, improved parking facilities for units where car in the main mode of transport and greater awareness of the nature of health inequality across North East London.

You can read the full report, with all the findings and recommendations here. Healthwatch also produced in-depth reports for each maternity unit and Borough.