Maternal mental health: The changes your feedback made possible
In recent years, we have seen multiple shocking systemic failures in maternity services, outlined in the Ockenden review and seen at Shrewsbury and Telford NHS Trust and East Kent Hospitals University NHS Foundation Trust, among others. These reviews highlight increasingly negative feedback on maternity services shared via local Healthwatch. Our commitment to tracking the longer-term impact of policy changes we have called for led us to carry out new research on maternal mental health.
Healthwatch England researched the issue through a national survey of 2,693 people, 42 Freedom of Information (FOI) requests to Integrated Care Boards (ICBs), NHS trusts and GP surgeries, and 20 interviews with new mothers.
Mental health care doesn’t work for many new mothers
Thank you to the 2,693 new mothers and birthing parents who shared their experiences of mental health care with Healthwatch.
Healthwatch England's report, Left Un-Checked: Why Maternal Mental Health Matters, details the findings based on your experiences and our FOI requests.
The people who completed our survey told us that:
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Six-week postnatal checks are not working well in addressing perinatal mental health for most women.
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Many new mothers and birthing parents are struggling to access the support they need for their mental health.
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There are long waits for maternal mental health referrals.
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Some GP practices are not complying with the requirement to deliver the six-week postnatal consultation.
Key findings from FOI requests
Our FOI request findings also revealed there is a gap around monitoring whether the six-week postnatal check is taking place in line with best practice guidance.
The experiences people shared with us demonstrate that policy does not always align with practice, highlighting the importance of evaluating the delivery of services to understand the quality of care that patients experience.
NHS Delivery plan: improvements for new mothers and birthing parents
Shortly following the publication of the report, NHS England released their Three-Year Delivery Plan for Maternity and Neo-natal Services.
Several key responsibilities and themes outlined within the delivery plan mirror what we have called for in our report, our wider work and what we are hearing from the public.
What we called for:
Make Integrated Care Systems (ICSs) responsible for understanding the quality of care that is being provided to the public.
Commitments in the NHS Delivery Plan:
NHS England has committed to publishing national postnatal care guidance to support ICSs with their local improvement initiatives. The plan also emphasises that ICBs should monitor and support trusts to implement care to national standards.
When: By the end of 2023
What we called for:
Improve guidance for GPs on how to carry out the 6-week postnatal check
Commitments in the NHS Delivery Plan:
NHS England plan to imminently publish new information for GPs on the 6-week postnatal check.
When: Spring 2023
What we called for:
Improve access to specialist community perinatal mental health services.
Commitments in the NHS Delivery Plan:
ICBs are to be responsibile for commissioning and implementing community perinatal mental health services to improve the availability of mental health care.
When: Ongoing
What we called for:
Listen to people and their families and place their experiences at the heart of policy decision making.
Commitments in the NHS Delivery Plan:
A high level theme in the NHS Delivery Plan is “listening to women and families with compassion which promotes safer care”. Objective 3 of the plan sets out responsibilities for services and commissioners to involve people in designing and planning of services.
When: Throughout the roll out of the plan.
Your views matter
NHS England’s commitments reflect the findings of our work and demonstrate that policymakers are considering people’s views. We were also pleased to see how the plan is underpinned by the need to focus on listening to women and their families to deliver personalised, more equitable maternity care.
Women's health continues to remain high on the national agenda, with initiatives including the Women’s Health Strategy for England and the NHS Maternity Transformation Programme supporting ongoing plans to improve maternal mental and physical health.
While these plans set out laudable ambitions to improve maternity care, we also know that maternity services have struggled with unprecedented workforce shortages and will need to be appropriately resourced to deliver on these commitments.
"I'm not saying that it [mental healthcare] wasn't available - I didn't know about it. It wasn't offered enough. It's very difficult, because I know how stretched the NHS is."
Delving deeper into new mothers’ experiences
Following up on our survey findings, we worked with four local Healthwatch to delve deeper into new mothers’ experiences of mental health. Healthwatch Bristol, Brighton and Hove, Cambridgeshire and Peterborough and Wirral each interviewed five mothers about their experiences of pregnancy and birth and their mental health throughout their perinatal journey.
We've identified three key themes:
1. Access to mental health care.
There is a lack of clear information about how to access mental health care for mothers. Even if they are able to access it, there is a lack of adequate care.
"I'm not saying that it [mental healthcare] wasn't available - I didn't know about it. It wasn't offered enough. It's very difficult, because I know how stretched the NHS is. And those midwife appointments, I'm sure they have loads of people to fit in per day, so it's not necessarily the individual that I'm frustrated at. It's the system and the process.” Interviewee
2. Continuity of care.
Many mothers mentioned a lack of continuity of care. They didn’t have the same healthcare team/ midwife throughout their pregnancy and birthing journey. All mothers interviewed who didn’t experience continuity of care thought that their experience would have greatly improved with its provision.
“And then you go to the next midwife and It'll be straight back to 0. It's almost like they didn't have the same information on the screen. And I think that felt frustrating that there wasn't that continuity of care or someone that you feel that you could trust and call or call to speak to and so that was kind of most of my midwife appointments." Interviewee
3. Agency and information
Throughout pregnancy and birth period, there was an issue of either miscommunication or a complete lack of communication, leading to mothers not being fully informed about what they were going through, sometimes meaning they were unable to make informed decisions.
“No, I don’t think that I was fully informed [about pregnancy choices], I don’t think I was particularly consulted, I just think it felt like I had to go along with whatever I was being told.” Interviewee
You can read Healthwatch England's original blog post here.
