A team of researchers is tracking how the shift of NHS maternity care from hospitals to local clinics and birthing centres affects mothers and babies. The National Perinatal Epidemiology Unit (NPEU) will spend five years documenting these organisational changes—including new support roles, transfers during labour, and staffing patterns—to generate evidence on what works and what does not. This matters because NHS policy is pushing maternity services into community settings without solid data on the consequences. Women may benefit from local antenatal care but then find themselves in unfamiliar hospital units for birth, potentially losing confidence during labour. Meanwhile, staff shortages and the European Working Time Directive are forcing hospitals to change skill mixes and centralise some services. If the research succeeds, it will give NHS managers and policymakers hard evidence on which service models improve outcomes for mothers and babies, which staffing arrangements are cost-effective, and how to organise care networks that reduce social inequalities. The findings could reshape how maternity units are staffed, how birthing centres are located, and how women move through the system—changes that affect every pregnant woman in England.
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BackgroundAs the future Programme of Work covers the period 2006-2010, we are aware that much of the work the NPEU will undertake in this period cannot be precisely specified at this stage as policy imperatives may change and new opportunities and priorities are difficult to predict. Therefore, the specific projects referred to in this document are mostly those that will be started early in the next Programme of Work and for which there is already a clear idea that the project is necessary and feasible. The current document assumes that all of the resources requested from the Department of Health for the proposed future Programme of Work 2006-2010 are granted. In addition, further prioritisation will take place following on-going discussions between the NPEU and the Department of Health RDD and Policy teams.Cross-cutting Theme 1: Service organisation and delivery Service provision, organisation and staffing are key inter-linked aspects of maternity care . The NSF places emphasis on the effective organisation of maternity care within managed care networks; the availability of a range of routine and specialist services; using a care pathways approach; providing choice, individualised and flexible care; the prompt transfer and treatment of mothers and babies with problems or complications; and on the skills needed in caring for women and babies.The modern NHS, led by Primary Care Trusts, seeks to offer services to consumers in localities where they live. This policy has far-reaching consequences for maternity care for consumers and providers and requires research to generate the evidence upon which to evaluate these policy changes. For example, the increasing proportion of service provision in primary-care settings is likely to decrease most women's contact with, and experience of, the hospital unit in which many of them will give birth. This may benefit women during pregnancy, but conversely may disempower them during labour. Changes in the organisation of services are occurring as a result of a number of drivers. These include policy recommendations within the NSF to improve access, equity and quality of care; shortages of traditional staff groups and the changes necessary to implement the European Working Time Directive; changing skill mix and the development of new professional and support roles; centralisation of some services; the need to maintain a local service base; and the importance of users' views about the services provided.The overall aim of this area of research is to document and evaluate some of the organisational responses and innovations in service. Areas of research under this cross-cutting theme are:" Use, location and impact of birthing centres on a range of outcomes for mothers, babies and their families, including physical, psychosocial and economic outcomes" The introduction of new support roles in maternity care " Transfers of women in labour and of women and babies postnatally" Differences in the organisation of antenatal, labour and delivery and postnatal care and care pathways through the system" The role and cost-effectiveness of early pregnancy units, fetal medicine units and specialist antenatal clinics" Staffing and skill mix in labour and delivery" The development and implementation of managed clinical networks" The role of Maternity Services Liaison Committees and their input to service planning and reviewing" Skills and training for health professionals in maternity care.Cross-cutting Theme 2: Social InequalitiesThe NSF states that "tackling inequalities is a high priority for Government and key to the NSF Programme." It is therefore appropriate that the NPEU future Programme of Work makes social inequalities a priority area and a theme that cuts across much of our proposed work.The same concerns about health inequalities run through other recently published policy documents: for example, the public health white paper "Choosing Health", the NSF for mental health, and in "Tackling health
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