iHV welcomes the call from the One Voice Partnership to a county council to rethink its plan to cut £2.09 million per year from its public health budget.

In a letter to Hampshire County Council (HCC), the One Voice Partnership (which includes the Royal College of Midwives (RCM), the Royal College of Obstetricians and Gynaecologists (RCOG), Sands, and the National Childbirth Trust (NCT)) has called on HCC to re-examine as a matter of urgency the impact that the proposed budget cuts will have on women before, during and after pregnancy, and on their babies. Not only would the proposal widen inequalities yet further, but it could open the door to preventable harm to women and their babies.

The One Voice Partnership has called the HCC proposal a canary in the mine, with local government budgets across the country under significant pressure.

One Voice is also reminding all local councils of their statutory safeguarding responsibilities and the impact of any budget cuts on the wider health and social care system, including maternity services.

Furthermore, One Voice say that the introduction of non-face-to-face methods for delivering the Healthy Child Programme are currently untested and there is not enough evidence on their effectiveness as an alternative method of providing support and identifying risk and vulnerability.

iHV welcomes yesterday’s publication of PHE guidance on Care continuity between midwifery and health visiting services: principles for practice.

The PHE guidance document is designed to act as a tool to support local practice implementation and improvements in the care continuity between midwifery and health visiting services. It was developed based on a literature search of current research, an examination of current UK guidance and policy and interviewing midwives and health visitors working in Local Maternity Systems. The document provides evidence and practice examples to consider when improving quality of care through effective transition of information and collaborative practice between midwifery and health visiting services.

Alison Morton, Executive Director at the Institute of Health Visiting, commented:

“We support and welcome this new guidance from Public Health England on the care continuity between midwifery and health visiting.

“We know from our iHV annual surveys that continuity of care and building trusting relationships with parents is critical for delivering good support in the first 1001 days. Improving the quality of care for parents and their babies throughout their maternity journey, through the effective sharing of information and collaborative practice between midwifery and health visiting services, will help ensure that consistent and evidence-based information is given. Continuity of care, as well as continuity of carer (they are not the same thing), between midwifery and health visiting is crucial to ensure that health visitors provide safe and personalised care – tailored to each family’s individual needs.”

Clare Livingstone, Professional Policy Advisor at the Royal College of Midwives, said:

“This will be a valuable resource for midwives and health visitors in facilitating women to have the smoothest possible journey throughout and beyond their pregnancy. The point at which women’s care is transferred from midwives to health visitors, at around 10-14 days after the birth, is a critical point in that journey. This toolkit will support a better and more efficient handover of care, joining up the two services and ensuring care continuity for women and their babies.”

Leading health organisations have called for upgrades to England’s NHS maternity service buildings to improve care for women and conditions for staff in a letter to Health Minister Nadine Dorries today.

Women’s maternity care was significantly impacted during the pandemic, made worse by old, poorly designed buildings, according to the One Voice coalition of health organisations and the Society of Radiographers.  Many women were unable to have their partners with them because the layout of maternity facilities prevented social distancing, and would have put women, their partners and other service users at risk of catching the virus.  One Voice is calling for better design and use of space, such as having single rooms and dedicated areas for maternity clinics and scans.

Alison Morton, Acting Executive Director at the Institute of Health Visiting, commented:

“As a member of the One Voice coalition of health partners, we support this call from our maternity colleagues for upgrades to England’s NHS maternity service buildings. The government’s recent White Paper on health and social care has highlighted once again that positive outcomes are fundamentally delivered “in a place”. By improving the quality and safety of the environments in which we work, through sustained investment in “place”, we can make a big difference to the outcomes and experiences of care that we provide to families, as well as the health and wellbeing of the workforce.”

The Royal College of Obstetricians and Gynaecologists (RCOG) and The Royal College of Midwives (RCM) are hosting a webinar tomorrow (Wednesday 14 April)  for maternity staff on COVID vaccines – however, all are welcome to attend by registering via the link below.

This RCOG and RCM event is a fantastic opportunity to hear and ask questions about the latest advice, research and guidance on how to counsel pregnant women offered a COVID-19 vaccine. Vaccine hesitancy among healthcare professionals and in those with concerns about fertility or breastfeeding will also be covered.

This webinar is essential viewing anyone working in primary care and maternity services, as COVID-19 vaccines are offered to more pregnant women at higher risk of serious illness, including those with gestational diabetes.  

Wednesday 14 April 2021 19:30  21:00

Register here for – COVID vaccines, pregnancy, fertility and breastfeeding webinar

The Maternal Mental Health Alliance (MMHA), the Institute of Health Visiting (iHV),  the Royal College of Obstetricians and Gynaecologists (RCOG), and the Royal College of Midwives (RCM) are delighted the NHS Benchmarking report on Universal Perinatal Mental Health Findings was published on Friday 14 September.

Prior to this study, information on service provision and staffing of universal perinatal mental health (PMH) services was not available at a national level. The study sought to gain an understanding of the extent of PMH provision in universal services across England, supplementing an annual audit of Specialist PMH services undertaken by the NHS Benchmarking Network for NHS England.

The data collected from providers suggested that:

  • Capacity in universal services is very limited and does not provide the necessary broad base from which the Specialist PMH services can operate effectively and efficiently as a secondary care tier.
  • The provision of specialist perinatal mental health care within universal services is highly variable across England, with some areas having no, or limited, provision (obstetric & midwifery providers 61%; health visiting providers 30%).

Specialist provision within universal services is necessary to coordinate, inform and support evidence based PMH care across the whole service, and therefore offers a clear reflection of the care women are able to access. The large gap in health visiting PMH capacity was particularly evident, with 70% of providers having no specialist provision within the service.

If we are to deliver on the ambition of the Five Year Forward View for Mental Health, attention must be paid to the full spectrum of need. This report is critical because it focuses on the universal element, where the vast majority of women need to receive their care. Most recognition of mental health problems and risks, most prevention and early intervention, can only be coordinated and provided within universal services. Universal services are therefore a crucial element of the PMH care pathway at every local level and have the potential to create great savings in relation to both human and economic costs in the short and long term.

Dr Cheryll Adams, Executive Director at the iHV, said:

 “The Institute of Health Visiting warns that the real state of today’s health visiting support for mothers suffering with perinatal mental illness (PMI) may be significantly worse than that found by the NHS Benchmarking report based on data from 2016, as there have been further cuts to the workforce and the development of a significant postcode lottery of services up and down the country. Health visitors across the country nevertheless continue to strive to deliver an excellent service to children and families, and will do everything in their power to promote good family mental health.”

 Alain Gregoire, Chair of the MMHA, said:

“There has been excellent progress in funding specialist perinatal service provision across England, but we know that specialist services alone are not enough. All women in pregnancy and postnatally should have equitable access to the support, prevention and treatment they need for their mental health as much as for their physical health. This report shows that investment is essential to ensure that there are sufficient, well-trained staff across universal services so that women get the care they should expect from the NHS, and our children can get the best start in life.”

Janet Fyle, Professional Policy Advisor at the Royal College of Midwives, said:

“Whilst there is progress in some areas, there is still a lot more to do.  Our survey showed that we remain seriously short of specialist maternal mental health midwives and services to support women with mental health problems and needs in the community and in their homes. There is also a need to ensure that all midwives involved in the care of pregnant women receive adequate training, so that they can identify women with mental health problems and refer them appropriately for care and support as required.”

Dr Alison Wright, Consultant Obstetrician and Vice President of the Royal College of Obstetricians and Gynaecologists said:

“Despite maternal mental health being a key priority of the Government, this report shows the extreme pressure faced by obstetricians and psychiatrists, midwives and health visitors who provide perinatal mental healthcare. Healthcare professionals are usually the first point of contact that a woman reaches out to and we must ensure that all staff involved in the care of women during pregnancy and beyond, have the relevant education and training in perinatal mental health. Every maternity unit across the country should have in place a clearly defined care pathway for referring women to local specialised perinatal mental health services which all women can access when needed.”

Collectively, we will continue to push for equitable access to evidence based PMH care for women with mental health problems and their families through robust universal services alongside the development of specialist PMH services – women and their families need both. We support the call for all maternity and health visiting services (and GP services) to be sufficiently resourced, so that all professionals across universal services have sufficient capacity, competence and confidence to deliver top quality proactive mental health care to all families. Furthermore, we advocate that these healthcare professionals should be supported by having lead specialist professionals/Champions from within their respective professions in every organisation.

Background Information to the report

In January 2017, the NHS Benchmarking Network was commissioned by Health Education England, funded by NHS England, and partnered with the iHV, RCOG and RCM to complete a stocktake of perinatal mental health (PMH) care within maternity and health visiting services. Data collection took place from February to May 2017 and referenced the year January to December 2016. Universal PMH services in this report included obstetrics, midwifery and health visiting.

There was a high response rate from organisations across England, with numbers of responses by service type as follows:

  • Obstetric services 141
  • Midwifery services 123
  • Health visiting services 88

 In total, the following specialist practitioners were identified in the study:

  • Obstetric services = 40.8 WTE (1.3% of total obstetric capacity)
  • Midwifery services = 228 WTE (1.4% of total midwifery capacity)
  • Health Visiting services = 60.6 WTE (0.78% of total health visiting capacity)

On 12 September, The Royal College of Midwives (RCM) officially launched a series of animated films on Female Genital Mutilation (FGM).

The short animated films were developed by the RCM in collaboration with The Royal College of Obstetricians and Gynaecologists (RCOG), The Royal College General Practitioners (RCGP), survivors of FGM, NGOs and a variety local community partners.

The RCM and its partners worked closely with FGM survivors to ensure that the authenticity of the stories being told via the animations remained true to the realities of surviving FGM.

Dr Cheryll Adams CBE, executive director iHV, commented:

“FGM is embedded into the psyche of some cultures, but it is a crime against women that serves only to cause unimaginable distress and life-long suffering to its victims, destroying very many lives. The fact that so many English girls also become victims must cease, as must this practice worldwide.

The costs for necessary long-term medical care for its victims makes this much more than an individual issue, it is also a preventable public health priority. We applaud the RCM and their collaborators in making these films and urge health visitors to ensure that they have a wide audience amongst those who need to understand these issues better.

We strongly support the RCM call to action to end FGM internationally by 2030.”

All three short animations are now available to view:

The animated films will also be available soon in another four languages Arabic, French, Somali and Swahili.

The films are aimed at creating awareness around the health and physiological consequences of FGM, but also hope to cut through much of the inaccurate and misleading information circulating in the public sphere about FGM.

Importantly, each of the FGM animations ends with a ‘call to act’ on each UK Government.

The call to action includes the following:

  • To develop, implement, monitor and evaluate a National FGM Action Plan with the goal of ending FGM in the UK by 2030;
  • A commitment by all government agencies to end FGM, support survivors and share information to keep women and girls safe;
  • Provide accessible specialist health and psychological care and support services in community settings for survivors and potential victims of all age groups;
  • Education and training for the children’s workforce in their role and responsibilities for safeguarding girls and young women.

The Institute of Health Visiting (iHV) responds to the Royal College of Midwives (RCM) report ‘Every mother must get the help they need’ report published this week.  The report was inspired by the Change.org petition of Lucie Holland whose sister, Emma, died in tragic circumstances as a result of perinatal mental illness.

Dr Cheryll Adams CBE, executive director of the Institute of Health Visiting, said:

“The remarkable efforts of Lucie Holland and her family following Emma’s tragic death serve as a moral imperative for national commissioning bodies, and also for every commissioner at every local level, so that such a tragedy should never happen again. We need to broaden perceptions of mental health, so that all women and their families, and all health and social care professionals consider mental health equal to physical health.”

Lucie set up the petition in 2015 calling for better awareness and care for those affected by perinatal mental illness. Her petition received thousands of signatures and many people left heartfelt comments about their own experiences. The RCM collated and analysed all the comments to form the report ‘Every mother must get the help they need’.

Dr Adams continued:

“It is vital that all practitioners working alongside women and their families in the perinatal period are competent, confident and committed to ensuring that the right care, at the right time, is available in the right place for all women and their families. Specialist midwives and specialist health visitors should be in post at every local level as part of a comprehensive specialist perinatal mental health service offer. The Institute is committed to working in partnership with all agencies to achieve the highest standard of care all mothers and their families deserve.”

The iHV along with the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) have been involved in shaping a project, funded by Health Education England and led by NHS England Benchmarking, to collect data from maternity and health visiting services, focused on perinatal mental health provision in universal health services. This very important data will complement previous data collections within specialist mental health services, thus contributing to an overall picture of perinatal mental health provision in England.

A short data specification has been prepared and sent to all CEOs and Heads of Children and Maternity Services. This work has great potential to act as a lever for really enabling women and their families to receive the right care, at the right time, in the right place. There are organisational benefits to participating as all participants will receive a toolkit to enable local analysis and all organisation will have access to their own bespoke report detailing local positions against the national range. Data collection runs until the 24th March and reporting of the findings is due in late May.

If you require further details, please contact Jessica Walsh at [email protected].