The Southwark Maternity Commission met on Tuesday 23 January 2024 to discuss inequalities in maternity services and hear from local healthcare providers. The commission heard presentations from the Local Maternity and Neonatal System (LMNS), Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, and South London and Maudsley NHS Foundation Trust, focusing on access, experience, and outcomes for maternity care.

Improving Maternity Services and Addressing Inequalities

The Southwark Maternity Commission convened to address significant disparities in maternity care, particularly for Black women, who are 3.7 times more likely to die in childbirth than white women. The commission heard that 41% of Black women in Southwark reported experiencing racism when accessing services. A key focus of the meeting was to understand how local healthcare providers are working to improve equality, diversity, and inclusion within their services and to implement national recommendations for safer maternity care.

Local Maternity and Neonatal System (LMNS) Submission

Jacqui Kempen, Head of Maternity for the Local Maternity and Neonatal System (LMNS), presented the system's submission. She highlighted that maternity services are not directly commissioned but are contracted with various providers, with contracts reviewed annually. The LMNS is updating its maternity specifications, informed by extensive community engagement. The system uses data, including MBRRACE[^1] reports, to identify health inequalities and has implemented an equality and equity action plan. Initiatives include community engagement projects, a pilot of maternity mates to support women, and the translation of maternity resources into various languages. The LMNS representative stressed the need for greater collaboration with Southwark Council and community organisations to prepare women for pregnancy and ensure they are aware of available services.

Guy's and St Thomas' NHS Foundation Trust Submission

Professor Eugene Oteng-Ntim, Clinical Director for Women's Health Services, and Gina Brockwell, Chief Midwife, presented the submission from Guy's and St Thomas' NHS Foundation Trust. They identified pre-pregnancy advice and early years intervention as priorities. They shared an example of how data analysis led to the introduction of caseload midwifery in the Aylesbury estate area after a reduction in mortality rates was observed when data from that estate was excluded. Housing was identified as a key factor affecting women's outcomes, with unsuitable housing leading to longer hospital stays. Continuity of care was also discussed, with the representatives suggesting it could be targeted at areas with higher health inequalities. Practical issues such as the cost of the Congestion Charge and parking for midwives were noted as potential barriers to providing continuity of care.

King's College Hospital NHS Foundation Trust Submission

Dr Lisa Long, Clinical Director and Women's Health and Obstetric Consultant at King's College Hospital NHS Foundation Trust, presented their report. She emphasised the importance of pre-pregnancy health, including access to healthy food and optimising health before conception. Dr Long noted that only 6% of women at King's College Hospital currently receive continuity of care, and a sustainable model is needed to expand this. Efforts to encourage earlier access to services include placing information in visible locations and improving the accessibility of online booking forms, with a clear message that a GP referral is not required for maternity care.

South London and Maudsley NHS Foundation Trust Submission

Samantha Chong, Clinical Service Lead for community perinatal services, and Chris McCree, Parental Mental Health Lead, presented the submission from South London and Maudsley NHS Foundation Trust. They highlighted the ongoing challenges with housing and health inequalities. Increased workforce capacity would enhance their ability to work in partnership with the council. They also noted the need to embed projects and develop child-friendly resources on emotional wellbeing. The representatives requested further submissions with ideas for collaboration. They also reported ongoing issues with staffing and facilities, with the team currently operating without a permanent base. A pilot of a 24-month extension for perinatal mental health care had received only one referral since August 2023, with difficulties in identifying the health visiting team identified as a barrier.

Audience Questions and Comments

During the audience Q&A, a project to develop a maternity toolkit and passport for individuals with learning difficulties was mentioned. Questions were raised regarding the collection of ethnicity data and inequalities, with the LMNS representative stating that data is held by NHS England and that the LMNS would investigate specific inequalities. The importance of understanding birth trauma from a user perspective was highlighted, and the co-chair confirmed the commission would explore this. The LMNS representative also added that learning from near misses is crucial. The engagement with ethnic groups was discussed, with the panel noting that data helps focus efforts and that community engagement with grassroots organisations is vital.

Closing Remarks and Next Steps

Councillor Evelyn Akoto, Chair of the Southwark Maternity Commission, stated that the commission would hold six meetings in total. The next meeting would involve speaking with frontline staff. Harriet Harman MP sent a statement in support of the commission's work.