Maternity and neonatal care - Best Start implementation: equality impact assessment

Stage 1: Framing

Results of framing exercise

As noted above, the recommendations in The Best Start are predicated on research and best practice evidence. Broad consideration of the protected characteristics under the Equality Act 2010 is recorded below.

Protected Characteristic: Age

Potential Impact:

• The Best Start addresses concerns for babies and pregnant women, their babies, and families as its primary focus. Impact on wider families may be incidental to this but is not the primary focus.
• Young parents are not addressed specifically within the recommendations but the focus on person-centred care mitigates against this, as the focus is on individualised care for each person, rather than standardised care stratified by needs profile. Recommendation 35 makes specific reference to vulnerabilities. Continuity of carer (Recommendation 1) is intended to enable the development of a closer relationship between a woman and her midwife across her pregnancy journey, which may be of particular importance for younger and older mothers, particularly, in the case of the latter, in terms of age-related risks in pregnancy.
• No recommendations within the Best Start should adversely impact the workforce directly because of age. There is the chance of an indirect impact as the age demographic of the workforce may include people with caring responsibilities.

Protected Characteristic: Disability

Potential Impact:

• The ethos of Best Start is that care is individualised around each woman and any clinical, social, physical, and psychological needs.
• Continuity of carer (Recommendation 1) is intended to enable the development of a closer relationship between a woman and her midwife across her pregnancy journey, which may be of particular importance for those living with a disability.
• Best Start aims to deliver care closer to home wherever possible, including the use of technology where appropriate.
• It is not expected that any recommendations within the Best Start should adversely impact the workforce because of disability. Any adjustments that are required currently to enable a member of the workforce to carry out their job would also be expected to be made for any change to how that job is carried out in the future.

Protected Characteristic: Sex

Potential Impact:

• As implementation of The Best Start concerns the provision of maternity and neonatal services, there are inherent differences in how men and women will be affected.
• The recommendations and the overarching ethos of The Best Start focus on establishing family-centred care, ensuring that partners feel included at all stages.
• No recommendations within the Best Start should adversely impact the workforce because of sex.

Protected Characteristic: Gender Reassignment

Potential Impact:

• Where clinical care is the key consideration, reference is made to the ‘woman’. This language recognises that biological women can achieve a pregnancy and is not intended to exclude trans men.
• No recommendations within the Best Start should adversely impact the workforce because of gender reassignment.

Protected Characteristic: Sexual Orientation

Potential Impact:

• The Best Start references partners and is intended to be inclusive of all sexual orientations and genders.
• Noted that Human Fertilisation and Embryology Authority (HFEA) confidentiality requirements preclude disclosure of pregnancies resulting from IVF/ assisted conception treatment between health professionals.
• No recommendations within the Best Start should adversely impact the workforce because of sexual orientation.

Protected Characteristic: Race

Potential Impact:

• The ethos of Best Start is that care is individualised around each woman, taking account of any additional requirements.
• No recommendations within the Best Start should adversely impact the workforce because of race.

Protected Characteristic: Religion/Belief

Potential Impact:

• The ethos of Best Start is that care is individualised around each woman which would include religious or cultural need.
• No recommendations within the Best Start should adversely impact the workforce because of religion or belief.

Extent/Level of EQIA required

As a result of the framing exercise, a full EQIA was carried out, covering the implementation of The Best Start as a whole thematically, as some of the individual recommendations are more complex and multi-faceted than others. In this way, implementation of each of the 76 recommendations is considered in a proportionate manner.

• Continuity of carer.
• Person-centred maternity and neonatal care.
• Multi-professional working.
• Safe, high quality and accessible care.
• Re-designing neonatal care and services.
• Supporting the changes.
• Wider implications.

It should also be noted that, for the implementation of recommendations which are being led locally, it is expected that Health Boards will undertake their own Impact Assessments to satisfy their local requirements. This EQIA therefore takes national implementation as its primary focus.