What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Women and birthing people with complex social factors are less likely to access antenatal care, and are at higher risk of maternal deaths, stillbirths and neonatal deaths. This includes women and birthing people who misuse substances, recent migrants, asylum seekers, refugees, those with difficulty reading/speaking English, aged under 20 and/or who experience domestic abuse.

To ensure timely access to appropriate care, insight is needed into the current models of care for socially complex pregnancies and their effectiveness (as identified in NICE CG110). Without clarity of current provision, timeliness of access and clinical outcomes associated with the various models of provision cannot be evaluated.

This project will scope existing provision to understand how different parts of the system are currently working together to provide maternity services for women and birthing people; testing a methodology for scoping existing provision in one ICS, with potential for later scaling up across the UK.

What does your project aim to achieve?

This project seeks to improve understanding of the models of service provision (including acute, community, council and voluntary sector services) for women and birthing people who experience ‘socially complex pregnancies’.

This will include women and birthing people who: misuse substances (1), are recent migrants, asylum seekers or refugees or with difficulty reading/speaking English (2), are aged under 20 (3) and women who experience domestic abuse (4).

A better understanding existing provision for socially complex pregnancies will enable commissioners, providers and third sector organisations to:

·       Understand areas of deficit and good practice in service provision for their local population, including how well services are joined up

·       Learn from each other, and work together to develop joint services and share information in a way that would lead to continuous improvement in services for these groups of women and;

o   Improve equity of access

o   Reduce delays to care, which evidence shows are linked to improved outcomes

How will the project be delivered?

This project will involve working with local providers, social care, third sector and with patients across an ICS footprint, and will support CORE20PLUS5 priorities.

Initial focus will be upon ‘contracting’ with the local organisations to build relationships, discuss project parameters and agree participation.

In collaboration with provider organisations a scoping exercise will then be undertaken to identify maternity care provision (for the 4 identified populations) across the footprint, to include;

·       a high-level mapping of existing maternity pathways,

·       review of data collection arrangements for socially complex pregnancies

·       results of clinical audits re:CG110,

·       relevant policies and;

·       arrangements in place to provide information, support and/or referral for specialist support to women and birthing people

A national-level advisory group (principally support organisations for marginalised groups) will also provide advice on methodology. This will support both the delivery of this project, and support future replicability in other ICS’.

How is your project going to share learning?

Findings will be presented in a report for the identified ICS for shared learning, enabling improvement.

We will share learning with the Q Community with a blog, outlining the methods used and lessons learned.

As a result of this project, we will have a tested methodology for efficiently and effectively scoping existing service provision in a region – including acute, community, local authority and voluntary sector services, in a participative way. The intention is to design-in potential for later scaling up and/or application to other services.

The model developed will also provide a good foundation for the varied models of provision to be compared for effectiveness in future research, (as NICE guideline 110 outlines, further research is needed into which models are effective). We will work with an academic organisation to share our findings and contribute to further research in this area where we can.