Maternity care survey 2018: national results

3. Context

There have been wide reaching programmes of reform to health services in recent years, which are consistent with the wider principles of Public Service Reform^[3]. This chapter provides an overview of the key developments.

This survey supports and informs all of these developments, by describing their impact from a user perspective. It is worth noting, however, that this survey relates to care experiences in 2018, during which time period some of these programmes were at the early stages of implementation.

The 2020 Vision

In 2011, the Scottish Government set out a 2020 Vision^[4] for achieving sustainable quality in the delivery of healthcare services across Scotland, in the face of the significant challenges of Scotland’s public health record, our changing population and the economic environment. All healthcare policy in Scotland drives the delivery of this Vision, which states:

By 2020 everyone is able to live longer, healthier lives at home or in a homely setting, and that we will have a healthcare system where:

• We have integrated health and social care;
• There is a focus on prevention, forward planning and supported self-management;
• Where hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm;
• Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions;
• There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

The Vision will be delivered according to three Quality Ambitions^[5]:

• Safe: There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times.
• Person-centred: Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making.
• Effective: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

A National Clinical Strategy for Scotland^[6], published by the Scottish Government in February 2016, reinforced the importance of these ambitions and called for a new clinical paradigm that incorporated person-centred approaches to care.

Scotland’s Chief Medical Officer has also articulated her vision for delivering care in this context through her Annual Reports ‘Realistic Medicine’ ^[7], ‘Realising Realistic Medicine’ ^[8] and ‘Practicing Realistic Medicine’ ^[9].  She said:

You should expect the doctor (or other health professional) to explore and understand what matters to you personally and what your goals are, to explain to you the possible treatments or interventions available with a realistic explanation of their potential benefits and risks for you as an individual, and to discuss the option and implications of doing nothing. You should expect to be given enough information and time to make up your mind. You should consider carefully the value to you of anything that is being proposed whether it be a treatment, consultation or diagnostic investigation and be prepared to offer challenge if you feel it appropriate.

Recent Changes to Maternity and Neonatal Care Policy

A strategic review of Maternity and Neonatal services in Scotland was carried out in early 2015, to place the current and future needs of women and families and person-centred, relationship-based care at the heart of redesigned services. The Review was carried out in in consultation with service users, the workforce and NHS Boards and considered current evidence and best practice when making its recommendations.

Following the review, the Scottish Government published its findings and recommendations in The Best Start: A five year forward plan for Maternity and Neonatal Care in Scotland^[10] in January 2017. NHS Boards across Scotland are now making significant progress in implementing recommendations set out in this report. Key changes include the aspiration that all pregnant women receive continuity of carer from a primary midwife, supported by a small team of midwives across their maternity journey and a new model for neonatal care that is family-centred, including the fundamental principle of keeping mother and baby together.

While some aspects of care quality will be regularly monitored through a range of methods, many important aspects of quality can only be assessed by asking those who have recently used the services to describe their experiences. The results of the Maternity Care Survey will therefore be a valuable source of evidence, helping to monitor the implementation and impact of a number of the recommendations set out in the Best Start report.

CQC Maternity Services Survey in England

The Care Quality Commission (CQC) manages the Maternity Services Survey^[11] which looks at women’s experiences of maternity care services in England. Whilst there are differences in how maternity services are managed in Scotland and England, the broader policy aspirations around quality of care remain the same. 

The most recent survey in England was also run in 2018, with results published in January 2019. Both surveys use similar methodologies, however the review of the Scottish questionnaire undertaken ahead of the 2018 survey means that there are fewer comparable questions between the surveys than in previous years.

The key findings for the 2018 Maternity Services Survey in England are:

• Overall, women reported positive experiences for many areas of their care, particularly in relation to a number of person-centred behaviours such as being listened to; understanding information and explanations; being treated with respect and dignity; and involving people that matter.
• Some questions had shown a decline compared to the previous survey in 2017, in particular questions around seeing a midwife at home after giving birth and being given enough information about their physical recovery and emotional changes they might experience.

Comparing the survey findings at a high level, women in both England and Scotland have reported overall positive experiences of maternity care services across different stages of care, particularly in relation to person-centred behaviours. However, further analysis would be required to compare the results in detail, including consideration of maternity-related demographic differences between the surveys, such as method of delivery and number of previous babies given birth to.