1. APPGM 19 th March 2012 Commissioning of Maternity Services Belinda Phipps NCT Chief Executive

2. To Commission “to order or authorise a person or organisation to do or produce something” Those who commission have authority and power: commissioning maternity care presents a challenge to use such power effectively to improve outcomes for mothers and babies

3. To do it well.. The commissioner must: Understand the wishes and needs of those who use the service Be outcome-focused – aware of evidence and good practice that brings results Monitor resources to ensure they are adequate

4. In broad terms, the desired outcome … “Women and their partners want a safe transition to parenthood and they want the experience to be positive and life enhancing. Quality maternity services should be defined by their ability to do both.” (Midwifery 2020: Delivering expectations. 2010)

5. Quality health care is … Safe Effective Woman (parent) centred Timely Equitable Cost-effective/efficient (Crossing the Quality Chasm: A New Health System for the 21st Century. IoM, 2001)

6. Why is maternity care different? Care affects both mother and baby/ies and their health/wellbeing is interdependent In most maternity cases, neither the woman nor the baby is sick or injured Poor care of mother or baby (including unnecessary intervention) can have long- term negative impact on both

7. Key points in maternity Normality – complications can arise but most births are straightforward Universality – over 80% of women give birth Continuity – a consistent style and standard of care from a small number of midwives improves outcomes

8. Birth settings The ‘Birthplace in England’ study (2011) of low-risk women has shown that birth: In any setting is generally safe Freestanding and alongside midwifery units (birth centres) are as safe as obstetric units and there is less intervention Home births are also safe for women having 2 nd or later babies but risk is slightly higher for 1 st time births ( Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400)

9. Challenges in new commissioning structure Use of ‘any qualified provider’ must not fragment care for women NHS CB to ensure standards are consistent across adjacent CCG areas The ‘user voice’ is essential in designing maternity services: promote MSLCs Maternity networks can help to offer choice of locations for all women