Mental health problems during pregnancy or after giving birth are common. There can be poor long-term outcomes for parents and families without timely access to effective support and treatment. The Maternal Mental Health Alliance (MMHA) has today, launched a briefing to support Integrated Care Systems (ICSs) in England to make the most of their unique position, to ensure that all families who need support for their mental health in the perinatal period get the right level of help, at the right time, close to home.

Integrated care boards and partnerships have a statutory role in population health management. They bring together the NHS, local government, public services and civil society organisations, to explore how to improve health, reduce health inequalities and use public money wisely in the local context. Addressing mental health and wellbeing needs in the perinatal period provides ICSs with a unique opportunity to take a systemic approach in establishing good building blocks for health, for future generations.

The MMHA commissioned the Centre for Mental Health to produce a briefing to support ICSs to consider how best support can be offered. This builds on earlier work co-produced by the Institute of Health Visiting (iHV) and The MMHA to guide system’s thinking on perinatal mental health and how best practice can be further embedded (read our previous news story on this here).

The briefing encourages proactive leadership within the ICS system to ensure effective support for groups of women whose needs are less well met by existing services, including those from racialised communities, asylum seekers and refugees, single mothers, young mothers, those living in poverty or experiencing domestic abuse, LGBTQ+ parents, neurodiverse and disabled people, those who are care-experienced and those experiencing multiple adversities such as addiction, homelessness and exploitation.

Key areas for action are identified including, for universal services, the recommendation for midwives, GPs, and health visitors to ask about a woman’s mental health at all routine antenatal and postnatal appointments, as per national guidelines. Previous evidence supporting integrated mental health care with maternity and health visiting services, as both clinically effective and cost-effective, is highlighted. This proposed integrated service provision model would offer the following key support elements:

  • Screening: Asking every woman in a skilled way about their mental health to identify need
  • Assessment: Assessing the severity of women’s mental health needs and planning the most appropriate treatment in partnership with the individual
  • Treatment: Offering low-intensity treatments for common mental health problems
  • Coordination: Ensuring women receive ‘joined-up’ care and subsequent care and support as needed.

Hilda Beauchamp, Perinatal and Infant Mental Health Lead at iHV says:

“This important briefing highlights the unique opportunities that Integrated Care Boards and partnerships have to develop the universal workforce. When health visiting, maternity and GP services are adequately trained and resourced, families can be offered early, effective tailored support that can prevent problems developing or worsening.”

Further actions are included specific to NHS talking therapies, Specialist Perinatal Mental Health Services, Inpatient Services and Voluntary and Community Sector Support.

The briefing will be shared with all ICSs and we encourage you to draw attention to the publication through your local contacts and communications.


iHV submits response to the Hewitt Review consultation on Integrated Care Systems

Just before Christmas, the Government launched their consultation on the oversight and governance of Integrated Care Systems (ICSs) in England. The Secretary of State for Health and Social Care appointed the Rt Hon Patricia Hewitt to lead this review with a call for evidence to gather views from across the health and social care system, as well as from patients, the public, and the wider voluntary sector – the call for submissions closed today, 9 January.

ICSs were placed on a statutory footing on 1 July 2022, with the creation of:

  • integrated care boards (ICBs), which are statutory NHS bodies
  • integrated care partnerships (ICPs), which are joint committees formed by each ICB and the relevant local authorities in the ICS area.

ICSs bring together the NHS, local government, the voluntary, community and social enterprise (VCSE) sector, and other partners, with the aim to better integrate services and take a more collaborative approach to agreeing and delivering ambitions for the health and wellbeing of their local population.

The purpose of ICSs is to bring these partner organisations together to:

  • improve outcomes in population health and healthcare
  • tackle inequalities in outcomes, experience and access
  • enhance productivity and value for money
  • support broader social and economic development.

The iHV has submitted written evidence to this review which sets out the vital role that health visitors play in achieving these ambitions – as an infrastructure of support, and the ‘backbone of the early years… the safety-net around all families’ (WHO UNICEF UK, 2022).

Health visitors are highly skilled Specialist Community Public Health Nurses, ideally placed to act as local leaders in ICSs, working collaboratively with others to facilitate a place-based response to improve health and reduce inequalities. All families have a health visitor, and their frontline practitioner intelligence provides an important ‘early warning signal’ of the most pressing threats to the health of our youngest citizens who are often hidden behind front doors and invisible to other services.

However, our submission also highlights that ICSs are being developed in deeply challenging times for babies, children and their families, with increased levels of need and widening inequalities, alongside political and economic instability, and varied levels of healthcare performance. Health visiting faces a significant workforce shortage, with almost 40% fewer health visitors compared to 2015, and problems with recruitment, retention and career progression. Consequently, many families are not receiving the support that they need, and this is being intensified by a lack of capacity in other health and social care services who are also experiencing extreme pressures – with increased risk and detrimental impacts on child health and development.

We want ICSs to succeed. It is not too late to change direction and pursue reforms, but the situation is serious. The current rate of health visitor workforce attrition, with no national workforce plan to plug the forecasted gaps, is not sustainable and will jeopardise the delivery of England’s child health programme. The government categorised health visiting as one of six priority services in its Start for Life Vision for the first 1001 days. However, this commitment is at risk without investment and a plan to rebuild the health visitor workforce. There is also a significant risk that the current context makes it harder for the original vision of much better-integrated care across the system to be fulfilled.

More information about the objectives and scope of the review can be found in the Hewitt review terms of reference.