Public health prevention in maternity programme: supporting the local system
Too many children in the North East and North Cumbria Integrated Care System do not have the best start in life, and maternity care offers an early opportunity to initiate positive change. In 2018, a new model of regional public health leadership was developed to complement the developing local maternity system with a focus on prevention and reducing health inequalities. With the support of local maternity system partners, the programme set out to improve the quality of preventative intervention available to women and their families in the perinatal period. The programme focused on tobacco, alcohol, breastfeeding, reproductive health, perinatal mental health, healthy weight, immunisations and making every contact count. Through audit and co-production of regional pathways, it increased awareness, enabled greater consistency of service provision and supported quality improvement. As part of a large, evolving health and care system, the programme worked through significant challenges, such as complex leadership and governance models, prioritisation and ensuring that resources supported practice development across all local maternity services in the North East and North Cumbria Integrated Care System. Greater progress was made in areas such as reducing maternal smoking and increasing rates of breastfeeding, reflecting the critical role of local leadership. There is clear evidence of the programme's value to the local system. Ongoing evaluation and work to embed a sustainable model of delivery remain important.
In September 2018, the North East Association of Directors of Public Health and both northeast local maternity systems identified the need for a dedicated resource to support seven ‘must do’ priorities. The resource was designed to reduce health inequalities and drive improvements in population health outcomes through maternity services. Partners acknowledged the complex systems that influence these outcomes (Rutter et al, 2017) and aimed to develop a programme that would maximise the impact of consistent, evidence-based, high-quality care. The programme's priorities included reducing smoking and alcohol use in pregnancy, increasing breastfeeding, supporting perinatal mental health, healthy weight, immunisations and the roll out of ‘making every contact count’.
A local maternity system prevention lead (a midwife and health visitor with public health experience) was appointed to deliver the programme, working collaboratively with heads of midwifery, among others. The programme lead was hosted by a local authority public health team and worked to strengthen and embed priority pathways across all local maternity settings. Audits were completed for each must do area, using National Institute for Health and Care Excellence (NICE, 2006; 2010a, b; 2014) guidance and evidence frameworks to establish a baseline. Events were held to share findings and recommendations widely. The team worked closely with many local and regional colleagues from across maternity, health visiting, local authority public health teams, regional offices for tobacco control (Fresh) and alcohol (Balance), National Institute of Healthcare Research, the North East and North Cumbria Applied Research Collaboration, maternity voices partnership, universities and voluntary, community and social enterprise organisations. In addition, they regularly shared their approach and learning with other networks, local maternity systems and national organisations.
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