I was recently asked by a colleague why continuity of carer had become the topic of conversation for many people working in maternity or associated with the implementation of healthcare policy. Tempted to respond immediately with enthusiasm about the benefits of continuity of carer, I responded by asking what he thought. His response was unsurprising, candid and accurate:
‘Because it's a recommendation of Better Births (National Maternity Review, 2016), and some maternity providers are finding it difficult to implement, while others seem to be getting on with it.’
Questions like these are not unusual. I am frequently asked about all things ‘continuity’ and in particular, national ambition for most women to have the same midwife caring for them throughout the antenatal, intrapartum and postnatal period, by 2021 (National Maternity Review, 2016). The depth of my response varies. In a busy clinical area, I am required to be brief, but here I can share some of the work that aims to support implementation of this important recommendation.
Work to implement midwifery continuity of carer gained pace 2 years ago, which means we are in the third year of the five-year Better Births maternity transformation programme. To support maternity providers to achieve continuity of carer, Implementing Better Births—A Resource Pack for Local Maternity Systems (NHS England, 2017a) was published. This document stated that Local Maternity Systems should create a local transformation plan, showing how they planned to achieve a number of objectives by the end of 2020/2021, including how ‘most women’ would receive continuity of carer. This was followed by the publication of Implementing Better Births: continuity of carer (NHS England, 2017b). This guidance clearly outlines the steps required for implementation of continuity of carer, and explains the definition and models of care.
Planning guidance and contractual levers
Further momentum gathered with the publication of Refreshing NHS Plans for 2018/19 (NHS England and NHS Improvement, 2018), which stated that, by March 2019, 20% of women should be booked on to a continuity of carer pathway. These results are being collated.
The 2019/2020 NHS Operational Planning & Contracting Guidance (NHS England and NHS Improvement, 2019), increases this target to 35% of women being placed on to a continuity of carer pathway by March 2020, providing it to those who face the poorest outcomes.
This goal was maintained in the 2019/20 NHS Standard Contract (NHS England, 2019), which also requires the maternity provider to agree with its commissioner and implement a Service Development and Improvement Plan, demonstrating the steps they will take during the year to increase the number of women receiving continuity of carer.
Resources that may also benefit other UK countries as they implement maternity policy are provided by the Royal College of Midwives (RCM). These include Can Continuity Work for Us? (RCM, 2017), a document designed to introduce midwives to the key concepts of continuity, the evidence and autonomous working. Following a grant from NHS England, the RCM produced an e-learning module on continuity of carer. This was supported by a webinar presented in collaboration with NHS England.
NHS England has supported Health Education England to fund continuity of carer education programmes in 2018/2019. These have helped maternity providers to implement continuity of carer with midwives who are appropriately prepared.
Further funding through Local Maternity Systems and other programmes of support continue to be provided at NHS England's regional and local levels.
Conclusion
Ongoing discussion about continuity of carer encourages positive action. Using this opportunity to learn from the past and embrace the future will allow for safer and more personal maternity care and midwifery continuity of carer must play a significant role. Fundamentally, it is a way of working that maximises the autonomous role of the midwife.