The Southwark Maternity Commission met on Tuesday 23 January 2024 to discuss improving maternity services and addressing inequalities. The commission heard from local maternity providers and discussed issues such as ethnic disparities in birth outcomes, the importance of pre-pregnancy care, and the need for better data collection and community engagement.

Improving Maternity Services and Addressing Inequalities

The Southwark Maternity Commission convened to discuss ways to enhance maternity services and tackle existing inequalities within the borough. The meeting featured presentations from various healthcare providers, including the Local Maternity and Neonatal System (LMNS), Guy's and St Thomas' NHS Foundation Trust, King's College Hospital, and South London and Maudsley NHS Foundation Trust.

A significant focus of the discussion was the stark disparity in maternal mortality rates, with the chair highlighting that black women were 3.7 times more likely to die giving birth than white women and Asian women were 2 times more likely to die giving birth than white women. Furthermore, it was reported that 41% of Black women in Southwark experienced racism when accessing maternity services.

Representatives from the LMNS explained that maternity services are managed through contracts with various providers, which are reviewed annually. The commission was informed that updated maternity specifications would incorporate findings from extensive engagement work. The LMNS uses data provided by trusts every six weeks to monitor services, with a focus on MBRACE¹ data. Trusts identified as outliers are asked to conduct in-depth reviews. The LMNS acknowledged the need for greater collaboration with Southwark Council to support women before pregnancy and to strengthen links with local authorities and trusted grassroots organisations.

Guy's and St Thomas' NHS Foundation Trust representatives, Professor Eugene Oteng-Ntim, Clinical Director for Women's Health Services, and Gina Brockwell, Chief Midwife, identified pre-pregnancy advice and early years intervention as key priorities. They stressed the importance of making information accessible and easy to understand across partnerships. Professor Oteng-Ntim shared an example of how data analysis led to the introduction of caseload midwifery in the Aylesbury estate area after it was found that removing data from this estate significantly reduced the local mortality rate. Housing was identified as a crucial factor affecting women's outcomes, with unsuitable housing leading to longer hospital stays. Continuity of care was also highlighted as vital, with suggestions to target this in areas of higher health inequality. Practical issues such as the cost of the Congestion Charge and parking for midwives were also raised as potential barriers to continuity of care.

Dr Lisa Long, Clinical Director and Women's Health and Obstetric Consultant at King's College Hospital, emphasised the importance of optimising health before pregnancy, including access to healthy food and managing conditions like diabetes. She noted that only 6% of women at King's College Hospital currently receive continuity of care, and a sustainable model is needed to expand this. To encourage earlier access to services, King's College Hospital is improving the accessibility of its online booking form and using social media, while also clarifying that a GP referral is not required for maternity care.

Representatives from South London and Maudsley, Samantha Chong, Clinical Service Lead for community perinatal services, and Chris McCree, Parental Mental Health Lead, discussed the challenges faced by their patients, including housing and health inequalities. They noted that increased workforce capacity would enhance their ability to work in partnership and embed projects. They also highlighted the need for child-friendly resources to explain emotional wellbeing. The co-chair encouraged them to discuss potential collaborative actions with the council and submit further ideas. The trust is currently experiencing staffing issues and a lack of suitable facilities, with staff retention being a concern. A pilot for an extended perinatal period for evidence-based care for women with moderate to severe perinatal mental health difficulties, which began in August 2023, had received only one referral, with the health visiting team identified as a missing link in Southwark.

During the audience questions and answers session, a project to develop a toolkit and maternity passport for individuals with learning difficulties was mentioned. The collection of ethnicity data and inequalities was discussed, with the LMNS representative stating that data is held by NHS England and that the LMNS would investigate specific inequalities. The importance of understanding birth trauma from a user perspective was raised, and the co-chair confirmed this would be explored. The LMNS representative also noted the value of learning from 'near misses'. The engagement with ethnic groups was addressed, with panel members stating that data helps focus efforts and that community engagement, particularly with grassroots organisations, is crucial.

The chair announced that the Southwark Maternity Commission would hold six meetings in total, with the next session focusing on frontline staff. A statement from Harriet Harman MP in support of the commission's work was also read out.