Despite the wide and longstanding recognition that continuity of carer reduces com plications in the childbirth continuum, in addition to increasing women's and midwives' satisfaction (Department of Health, 1993; National Insititute for Health and Care Excellence (NICE), 2016; Sandall et al, 2016a; 2016b), few women in the UK receive this gold standard of care.
The city of Bradford, in the north of England, has a population of over 500 000 (Office for National Statistics, 2012) and has some of the worst levels of social deprivation in the UK (Bradford Observatory, 2016). In 2014, Bradford was one of five areas in the UK to make a successful bid for A Better Start funding from the Big Lottery Fund. The £49 million, awarded over a period of 10 years, is being used to work with families to help them give children aged 0–3 living in three of the most socially deprived wards of Bradford the best possible start in life. The Better Start programme aims to improve:
In order to achieve these aims, Better Start Bradford is currently developing 22 projects, which include perinatal mental health peer support and community-based speech and language support for children aged ≥ 2 years old, among other programmes (Box 1).
One of the Better Start Bradford projects is a 3-year pilot of a personalised midwifery care team. This is provided by a team of six midwives (in addition to a team leader, midwifery support worker and two administrative support workers) who work in a paired ‘buddy’ system. They aim to ensure that it is the named midwife or buddy who provides 90% of all midwifery care for each pregnant woman during the antenatal and postnatal period. In some previous continuity of carer projects in which Bradford had participated, it had been recognised that high levels of midwife burnout were experienced (Collins et al, 2010; Yoshida and Sandall, 2013). Hence, the pilot does not provide hospital-based intrapartum care. The hope is that, if successful, this model of care can be rolled out across the city at the end of the pilot. The inclusion of hospital-based intrapartum care would require a more radical change to the current system, which initially may be a less attractive proposition to staff accustomed to working in the current NHS system.
Each midwife involved in the pilot has a maximum caseload of 60 women and, owing to this reduced caseload (the average caseload of a full-time community midwife in Bradford is 100–120 women), is able to offer an enhanced care package that is individualised to each woman's needs. This includes:
In addition to the project's key aims (Box 2), data will be captured such as: uptake of antenatal education; uptake of Better Start Bradford projects; maternal mental health; and duration of breastfeeding. To evaluate how successful the enhanced midwifery care has been, the data collected will be compared with the rest of Bradford.
This pilot started in October 2015 and has come across a few hurdles, including long-term sickness in the team, staff changes, the logistics of creating a new team and learning new geographical and organisational areas. However, a happy and cohesive team is in place, with a ‘buddy’ system which appears to be working effectively. The team has already observed an increase in staff job satisfaction and early indications are of an increase in the homebirth rate, breastfeeding rate and women's satisfaction with the service.
The learning from piloting this model of care is being fed into the local discussions about the National Maternity Review (2016) and, subject to the results of the evaluation, our aspiration is that it can be offered across Bradford, making the city an example for the rest of the UK.