We combined national metrics and local NHS, council and third sector data to help health systems understand where there are inequalities within local services.

Background

There was a national requirement from NHS England and NHS Improvement (NHSEI) for all local maternity systems to develop a maternity equity and equality audit by the end of November 2021. The aim was to understand where there are inequalities within the maternity services locally. This will be used to inform guidance to improve maternal health outcomes.

This case study looks at the Leicester, Leicestershire & Rutland (LLR) version of the maternity audit however the Midlands and Lancashire Commissioning Support Unit carried out this audit across our whole customer base.

Action

We analysed a large number of metrics:

• National metrics relating to maternity, neonatal and perinatal mental health
• Local provider data from organisations such as University Hospitals of Leicester Trust, Leicestershire Partnership NHS Trust, Leicestershire County Council and others.
• Voluntary sector data from, for example, the National Maternity Voices Partnership and others.

The audit was submitted to NHSEI as part of Stage 1 of the national requirement in November 2021.

Impact

The audit highlighted gaps in maternity services and suggested where further work was required, for example:

• Ethnic coding in the neonatal data set
• Data quality and data consistency
• Data provided to support anecdotal evidence.

Following the submission of the ‘Equity Plan’ to NHSEI, Stage 2 will be an action plan drawn up based on the analysis to improve maternal health outcomes, and will be locally focussed. The local maternity system will work with partners to develop those plans.

What the NHS is doing and how

The NHS is working to improve equity for mothers and babies and equality in experience for staff. The NHS has set out why this work is needed, the aims of this work and how the NHS will achieve its aims in two documents:

• Equity and Equality: Guidance for Local Maternity Systems. Based on the five health inequalities priorities in the 2021/22 Planning Guidance​, this will help local maternity systems align their plans with integrated care systems health inequalities work​.
• NHS pledges to improve equity for mothers and babies and race equality for staff. The four pledges help create a shared understanding of why work on equity and equality is needed, and the aims and outcomes of this work.

Scope

The guidance seeks to respond to the findings of the MBRRACE-UK reports about maternal and perinatal mortality, which show worse outcomes for those from Black, Asian and Mixed ethnic groups and those living in the most deprived areas. In doing so, consideration was given to the strong evidence highlighted in the NHS People Plan that “…where an NHS workforce is representative of the community that it serves, patient care and…patient experience is more personalised and improves”.  Therefore, the strategy recognises that improving equity for mothers and babies also requires a focus on race equality for staff.