Our local success in reducing the incidence of disease or systematically detecting and intervening at the earliest opportunity is dependent on maternity and perinatal services embedding public health and prevention practice into everything that we do: from policy and service development to training and supervision to the daily practice of individual practitioners to our record keeping.
Our prevention approach includes several aspects:
- Delivering equality of access via the implementation of system-wide universal models and pathways of care and standardised information-giving, to:
- Improve the health and wellbeing literacy of pregnant women and their families.
- Reduce lifestyle risks and address their causes for pregnant women and their household..
- Detect disease.
An example of this work includes the staged implementation of the in-house maternity tobacco dependency model and pathway within all of the maternity services in Lancashire and South Cumbria by April 2024, as per the Long Term Plan. This ensures that all pregnant women receive regular CO monitoring, and all those who smoke receive at the earliest opportunity brief intervention messages, speedy contact from a dedicated team and a care pathway with an enhanced level of contact offering behaviour change support and nicotine replacement therapy. This approach replaces previous models commissioned by local authorities which involved external agency referral processes, some opt-in process and disparity in the type of service offered in different localities.
- Reducing health inequities via the implementation of targeted interventions with populations who are most at risk, as identified by local data and insight and as per the CORE20PLUS5 framework. This work generally takes place at a local level: in communities and neighbourhoods or with defined groups in order to respond to locally identified health inequities, disparities in ability to access services and information, differing health needs, community aspirations and identified priorities.
An example of this work includes the Improving Culturally Sensitive Genetic Services and Literacy project in Pennine Lancashire, which focuses on Close Relative Marriage and genetic literacy within the Pakistani communities of Blackburn with Darwen and East Lancashire. Work will take place with service users, communities, practitioners within universal services (maternity services, health visiting services, GPs for example) and our partners in Voluntary, Community, Faith and Social Enterprise Sectors to improve literacy of the topic and of local referral pathways and available support services.
- Encouraging a personalised approach to meet the identified needs of each service user and their family to enable them to access all elements of their care and information.
Examples of this may include providing information in different formats, languages or medium; the use of translators; providing continuity of carer; referral to Birth Afterthoughts or Reproductive Trauma services; engaging services such as Early Help or HomeStart to provide support to attend; establishing individual’s preferences of language to be used by practitioners (for example in relation to gender identity or names of body parts (ie breast or chest; woman or person) and personalising all interactions with sensitivity to these preferences.
- Embedding a trauma informed approach to care: understanding that lived experiences may underpin lifestyle behaviours, engagement with services and how service users experience our services.
To achieve this, we will develop and embrace our enablers:
- An informed, confident and competent workforce who understand the role of public health and prevention within maternity and perinatal services and feel skilled to deliver care that embeds it as a golden thread throughout their daily practice and service planning. A culture of influencing each other, modelling behaviour, learning from each other and growing together underpins this. Standardised role-specific training and mentorship, policy and guidelines and the development of communities of practice facilitate this.
- Data that is inputted consistently and accurately at the point of care episodes so that:
- Analysis of the data can be undertaken for the wider maternity population and for defined populations within this, to identify which populations are at highest need for different public health topics and to therefore identify where targeted interventions should be focused.
- A baseline of population health can be acquired.
- Repeat analysis can identify how effective interventions. This in turn informs further developments and funding opportunities.
- Co-production with service users from population health needs enquiry to concept to planning to implementation to evaluation. Targeted engagement with communities with highest health inequities will be prioritised.
- Utilisation of our extensive partnerships, community relationships and the full NHS functions is vital. Integration of our services within the developing Family Hubs is key.
In recent years, we have chosen a manageable number of priorities based on funding availability and directives from Better Births and the Long Term Plan and we have achieved sustained, consistent action over several years:
- Infant Feeding
- Smoking in Pregnancy
- COVID-19 Vaccination in Pregnancy
- ICON and SUDC
- Perinatal and Infant Mental Health
With the publishing of https://www.england.nhs.uk/wp-content/uploads/2021/09/C0734-equity-and-equality-guidance-for-local-maternity-systems.pdf and a baseline population health needs analysis undertaken, additional priorities have been identified including:
- Postnatal referral into the NHS Diabetes Prevention Programme
- Early access to antenatal care
- Maternal nutrition and healthy weight pathways
- Culturally sensitive genetics services and literacy
- Early postnatal contraception
- Maternal medicine networks
- Support of those with complex social needs
- Enhanced Continuity of Carer models of care.
Marmot M, Goldblatt P, Allen J, et al (2010) Fair Society Healthy Lives (The Marmot Review)