Quality statement for maternity and neonatal services

Pregnancy and childbirth are life changing events for a woman^{[footnote 1]} and her family, both momentous and eagerly anticipated. Maternity and neonatal staff have a unique opportunity to support a woman, partner, their baby and their family. Pregnancy also represents an opportunity to support women to adopt healthy lifestyles and maximise families’ health and wellbeing across their life course, providing every child with the best start in life.

The quality and safety of maternity and neonatal (perinatal^{[footnote 2]}) services has been a focus of national policy in recent years following several independent investigations into maternity and neonatal services, with evidenced reports of failings across the UK. Despite a falling birth rate there is increasing complexity in the care provided with more women suffering from conditions such as diabetes, having an increased body mass index or suffering from perinatal mental health problems.

Women from ethnic minority backgrounds also face substantial obstacles, and there are quantifiable negative disparities in health outcomes, particularly within perinatal services. Enhancing data collection and analysis to better understand the experiences of Black, Asian, and minority ethnic women and families, as well as NHS staff have been priorities since the release of the anti-racist Wales action plan in June 2022. To guarantee inclusive policymaking, an all-Wales perinatal engagement framework has been co-developed with communities, stakeholders, and healthcare professionals to ensure the voice of service users is heard and actioned.

This quality statement builds on the 5 year vision for the future of maternity care in Wales (2019) which focused on achieving high quality maternity services in Wales. This vision was the result of many people coming together to refresh the model of maternity care, based on the current available evidence, best practice and feedback from families and frontline staff to design and further improve existing services.

As we move into 2025 and look to the future, the essence of the vision remains unchanged, our ambition is to continue to drive forward the five principles of maternity care, family centred, safe and effective, continuity of carer, skilled multi-professional teams and a sustainable quality service. At the same time, we must recognise that maternity and neonatal care is a continuum, and a joined-up approach must be utilised.

The quality attributes for perinatal care in Wales seek to support delivery of the right care, in the right place, the first time, leading to better outcomes and experiences for women, babies and their families during pregnancy, childbirth and the postnatal period.

Quality statements are being developed by the Welsh Government, aligned to the commitment in a healthier Wales (2018) to define the outcomes and standard we would expect to see in high-quality, patient focused services delivered by Welsh health boards and NHS trusts.

The national clinical framework (2021), written in response to a healthier Wales, sets out the purpose of quality statements in providing the vision for specific clinical services, underpinned by more detailed service specifications, which enable a long-term and consistent approach to improving outcomes.

In order to support the teams in maternity and neonatal units do what they do best, and deliver optimal outcomes for women, babies and their families, this quality statement provides a framework for health boards to support improvement in each unit, focusing on high quality care across Wales.

This document should be considered alongside improving together for Wales, maternity and neonatal safety support programme (MatneoSSP) discovery phase report and read in the context of broader national and local plans intended to ensure we have a clear and consistent approach to maternity and neonatal safety across Wales. Leading to improvements in outcomes and the quality of care provided to mothers and their babies whilst reducing inequalities experienced by individuals from ethnic minority and other marginalised groups.

This quality statement has undergone robust engagement, including national public and staff surveys, events and a national task and finish group. Contributions were received from leaders in maternity and neonatal care, executive and operational leaders from across NHS Wales, royal colleges, the third sector and academia.

Whilst it is recognised that a whole system approach is needed to drive transformational change, the scope of this quality statement is specific for perinatal services, the journey the mother and baby undergo from conception to discharge. However, this quality statement must not be viewed in isolation, recognising that pregnancy and childbirth are small timeframes in a life course. The quality statement for women and girls health and the subsequent women’s health plan for Wales, which supports prevention strategies, including preconception care leading to healthier pregnancies, as well as the healthy child Wales programme are important adjuncts to this document.

The quality attributes are shaped around the 12 health and care quality standards, which are intended to provide a clear framework to help plan, deliver and monitor healthcare services in Wales.

It is expected that health boards undertake a review of their current status against each of the quality attributes described in the quality statement, aligning to their local action plans for MatneoSSP. This will act as a baseline and contribute to the development of, or alignment to, existing improvement plans.

Key actions will be set by the Welsh Government and the NHS Wales Executive, aligned to the priorities identified within the discovery report. Health boards will be supported by the NHS Executive to deliver the expectations set out in this document. This will be mainly discharged through the Implementation Network for MatneoSSP and where appropriate the maternity and neonatal strategic network.

The strategic network will work collaboratively to develop a robust service specification for maternity and neonatal services in Wales with consideration of national clinical pathways, aligned to the quality attributes of other services or condition-specific groups where appropriate.

Quality attributes of perinatal care in Wales

Safe

1. Consistent use of person-centred, evidence-based pathways of care, delivered by a skilled multiprofessional workforce, supported by robust clinical governance arrangements and escalation pathways from ward to board.

2. Risk held within the service is systematically assessed, communicated and escalated within the organisation as well as through national governance systems, with appropriate measures taken to proactively reduce the potential for harm.

3. Systematic monitoring of demand and capacity information to inform service design and configuration, with consideration of acuity, complexity and specialist requirements to enable delivery in line with agreed national standards and recommended staffing ratios.

Timely

4. Systems and processes are in place for effective multiprofessional and multiagency communication across perinatal services to deliver care in the most appropriate place and time.

5. Timely, robust and evidence-based assessment is undertaken for all aspects of perinatal care in line with agreed protocols, overseen by skilled and experienced professionals to enable effective decision-making and clinical prioritisation.

Effective

6. Universal care pathways are autonomously provided by midwives to ensure a holistic approach to care, with additionality depending on the level of complexity. Women receive dedicated support from the same midwifery team throughout their pregnancy in line with the continuity of carer model.

7. Standardised reporting and multiprofessional perinatal investigation for adverse events is undertaken, with effective local and national processes in place to share learning, implement changes and reduce the risk of future harm. Openness and transparency are demonstrated in line with the duty of candour, and women, parents and families are involved throughout the investigation process.

8. Robust population health strategies are in place to promote health and wellbeing with a focus on prevention, supported by processes for providing guidance, advice and support. There are effective mechanisms for capturing, monitoring and evaluating population health data to inform quality improvement initiatives.

Efficient

9. Available resources are used efficiently and sustainably with a view to minimising environmental impact, whilst maintaining a clear focus on delivering person-centred care to maximise outcomes and experiences.

Equitable

10. Care and treatment are determined by clinical priority and delivered in an equitable way, understanding any additional care needs, with a clear focus on avoiding unnecessary variation and intervention.

11. Women, parents and families are enabled to communicate in the language and method of choice to meet their individual needs, with the Welsh language actively offered.

12. Protected characteristics, social and cultural backgrounds and additional care needs are recognised as integral to providing accessible, equitable and person-centred perinatal services.

13. Equitable access to physical and mental health advice, support and treatment throughout the perinatal journey regardless of geographical area, recognising this care may not be provided within the health board of residence.

Person centred

14. Appropriate and timely information is provided in multiple languages and formats, and women are supported to make informed decisions throughout their pregnancy, birth planning, birth and the postnatal period. A range of birth settings are available including hospital, birth centre and home birth.

15. Healthcare professionals respect and support the autonomy of women as decision-makers regarding their own care, and ensure they are made aware of their rights around consent.

16. Unnecessary separation of mothers and babies should be avoided with transitional care provision consistently available.

17. Parents are supported and empowered to be primary care givers and viewed as equal partners in all aspects of their baby’s care. A family integrated care model will be facilitated whilst babies are on the neonatal unit.

18. The all-Wales perinatal engagement framework is implemented to ensure the ideas, feedback and concerns of women, parents and families are heard and acted upon, with consistent use of person-reported experience measures, real-time engagement and co-production methods. This data is routinely triangulated with other insights, quality metrics and outcome measures.

19. Women are supported with their chosen method of feeding and receive the information and guidance required. Breastfeeding is promoted to help to reduce broader health inequalities and contribute to it being viewed as a culturally accepted norm across Wales.

20. The national bereavement care pathways are implemented to ensure equitable access to bereavement care and support for women, parents and families who have experienced death of a baby during pregnancy, birth or in the neonatal period, regardless of their geographical area.

Leadership

21. Compassionate and inclusive leadership is demonstrated, enabling transformative change in a coordinated way from ward to board, supported by clear lines of communication and escalation, with a named executive board member responsible for perinatal services.

22. Robust succession planning is in place for existing and future leaders, with equity of access to developmental opportunities.

Workforce

23. The national strategic perinatal workforce plan is implemented, ensuring appropriate multiprofessional staffing across services. Workforce information is readily available and used to support optimal staffing and planning.

24. The workforce undertakes multiprofessional training and has access to service-specific programmes of continuing professional development to ensure skills are maintained and further developed, as well as aid workforce retention and career progression.

Culture

25. Perinatal services promote a culture which embodies compassion, empathy kindness and allyship, with these values and behaviours actively embraced and demonstrated by all members of the workforce.

26. The health, wellbeing and safety of staff is prioritised at all levels of the organisation. Psychological safety is embedded and timely support is available to understood and meet the needs of the workforce.

27. A just, learning and improvement culture is fully embedded in line with service and organisational values and behaviours, and staff at all levels are supported and actively encouraged to raise any concerns in line with the speaking up safely framework.

Information

28. An intelligent suite of nationally agreed process, experience and outcome measures is systematically captured and regularly scrutinised by clinical, managerial and executive teams, with appropriate escalation and actions taken aligned to local and national assurance and improvement mechanisms.

29. Integrated perinatal digital clinical systems are adopted to inform a single national dataset and enable delivery of safe, high-quality and consistent services where data is available to support shared decision-making, inform service delivery, drive improvements and contribute to safe and person-centred care.

Learning, improvement and research

30. Women, parents, families and staff are encouraged and supported to participate in local and national perinatal research to advance knowledge and improve care, experiences and outcomes.

31. The workforce is actively engaged in delivering evidence-based local and national quality improvement initiatives which are informed by feedback from women, parents and families, as well as insights from national bodies and audit programmes, with consistent approaches to evaluation and sharing learning.

Whole systems approach

32. Collaborative working is embedded across professions, services, health boards and wider agencies involved in providing care and support, with a seamless transition between primary, secondary and tertiary care. This must include strong partnership working for regional services.

33. Integrated safeguarding systems and processes are in place with all partner organisations to ensure a holistic approach to keeping children and adults safe from violence, abuse and neglect.

Health boards should identify an executive sponsor and are expected to adopt this quality statement locally as a framework for enabling optimal care in perinatal settings. The following work should commence during 2025 to 2026: 

• develop a measurable action plan to enable delivery of the expectations set out in this quality statement, prioritising the 7 key actions described below, aligning to actions within the maternity and neonatal safety support programme
• collaborate with the maternity and neonatal strategic network and the implementation network to seek support where needed to enable local delivery of the actions

The 7 key actions are:

• All health boards are required to deploy the national digital maternity system by the end of March 2026 (quality attribute 29, MatneoSSP report page 64).
• Work in partnership with the NHS Executive to devise an implementation plan to deliver on the perinatal engagement framework commitments. Health boards must ensure they engage with women from Black, Asian, minority ethnic and other under-represented groups majority to improve outcomes by identifying barriers in access to services (quality attribute 18, MatneoSSP action 5.2).
• Ensure a baseline assessment and an associated action plan for neonatal services is developed, seeking support where appropriate to enable care to be delivered in line with the bliss baby charter principles, and commence the journey to accreditation (quality attribute 17, MatneoSSP action 7.4).
• Collaborate with HEIW to prioritise year 1 actions to ensure the perinatal strategic workforce plan is delivered, noting that this will be a phased approach (quality attribute 23, MatneoSSP action 2.1).
• All health boards are required to develop a perinatal quality surveillance dashboard with key standardised metrics that inform both network level and national oversight which in turn inform policy direction (quality attribute 28, MatneoSSP action 11.7).
• All health boards should ensure that choice of place of birth is offered to encompass all birth settings, noting that this may be in an alternative health board (quality attribute 14, MatneoSSP action 10.2).
• Ensure that 4 of the 5 bereavement pathways are ratified within year 1, with an implementation plan, to ensure a co-ordinated roll out (quality attribute 20, MatneoSSP action 13.1).

[1] The terms woman/women have been used throughout this framework as this is the way the majority of those who are pregnant and having a baby will identify. However, it also includes those whose gender identity does not correspond with their birth sex or who may have a non-binary identity. All professionals should be respectful and responsive to individual needs and individuals should be asked how they wish to be addressed throughout their care.

[2] Perinatal is the period of time from becoming pregnant and up to a year after giving birth.