Area of Research: Maternal and Neonatal Health and Care
Section 1: Summary of main strands/themes for research
This Unit will undertake research and evaluation (including social, behavioural and economic) to improve the evidence base for maternal and neonatal health and care policy. It will address key evidence gaps in the provision of safe, equitable, and personalised care. It will also focus on the use of big data and analytics to improve pregnancy and neonatal outcomes including experience of care.
The Unit’s initial work plan should include the following themes:
- Improving equity and equality – including behavioural science and cost effectiveness of interventions to improve clinical outcomes and experiences of care for women and babies of non-white ethnic backgrounds; from disadvantaged socio-economic areas; who are refugees or seeking asylum; and who are in detention (e.g., prison).
- Supporting healthy behaviours pre-conception, during pregnancy and postnatally - including behavioural science and cost effectiveness of interventions (e.g., healthy weight, smoking cessation, diabetes control, genetic counselling, managing pre-existing cardiac, neurological conditions).
- Pregnancy loss and perinatal morbidity and mortality - evidence to contribute to reducing miscarriage, stillbirth and neonatal morbidity/mortality, pre-term birth and low birth weight.
- Maternal mortality, morbidity and experience of care - evidence to contribute to understanding the effectiveness of models of care on clinical outcomes and experiences of care (e.g., reducing maternal deaths, morbidity, and near-miss events; improving services’ abilities to listen and respond to women; improving outcomes for pregnant or recently delivered mothers with medical and obstetric or social complexities, pre-existing or new mental health illness (including women in secure accommodation) or disability (including learning disability); improving clinical and bereavement care for women and families who have experienced baby loss through miscarriage, stillbirth, or neonatal death.
- Neonatal care – evidence to contribute to reducing the rate of admission of term infants to neonatal care and improving outcomes and experience of care for infants in neonatal units and for their parents and families.
- Workforce and maternity/neonatal care systems - evidence on how healthcare organisations and systems can contribute to improving outcomes and experiences of care (e.g., what constitutes safe, effective and responsive services, leadership; organisational culture; workforce numbers and structures; race equality of staff; multi-disciplinary working; education, training and career development; use of data, payment and incentive systems; and approaches to risk assessment, surveillance and management and quality improvement).
- Big data and analytics – to support the use of data by clinicians and women and families to aid informed choice and decision-making, management of care, predictive analytics, and improve cost-effectiveness of care.
For topics where there is sufficient evidence on determinants and potential impact to indicate a need for policy, the Unit is encouraged to focus on research that would support the translation of evidence into effective policy. This could include modelling or evaluating the effectiveness and cost-effectiveness of policies or interventions and identifying the ‘active ingredients’ of effective interventions.
Section 2: Details of policy context and background
NHS maternity and neonatal services provide safe, high-quality care. Since 2016, DHSC, the NHS and other system partners/stakeholders have been working to deliver the vision set out Better Births, the national ambition to halve the 2010 rates of stillbirths, neonatal and maternal deaths and intrapartum brain injuries in babies by 2025, and in Safer Maternity Care Progress Report to reduce the pre-term birth rate to 6% by 2025.
Good progress has been made with large reductions in stillbirths and neonatal deaths, but wide disparities remain with women and babies from non-white ethnic and/or disadvantaged socio-economic backgrounds having significantly worse outcomes. There are also wide disparities between services rated by the Care Quality Commission as ‘outstanding’ or ‘good’ compared to those rated as ‘requires improvement’ or ‘inadequate’. Achieving the government’s commitment to make the NHS the best place in the world to give birth relies on narrowing these disparity gaps. In addition, around 60% of the value of resolved clinical negligence claims were in obstetrics – primarily for birth-related brain damage in babies.
National reviews into maternity services in Morecambe Bay (Kirkup, 2015), Shrewsbury and Telford (Ockenden, 2020 and 2022) and currently on-going in East Kent and Nottingham highlight areas where further system improvements are required especially in terms of investment, workforce numbers and training, leadership and organisational cultures.
The breadth of the policy agenda is illustrated by key documents including, but not limited to: Better Births, the NHS Long-Term Plan, the Safer Maternity Care reports, Equity and Equality Guidance for Local Maternity Systems, and the Neonatal Critical Care Review. Applicants may also find it helpful to review the government's response to the Health and Social Care Committee report: The safety of maternity services in England, the NHS Patient Safety Strategy and the forthcoming Women’s Health Strategy.
Section 3: Justification for research topics
A research programme is required to help answer the themes set out in Section 1, in the context of the pressing policy issues set out in Section 2. These themes represent the scope of issues from which the final agreed programme will be built. Findings from this programme will provide the longer-term evidence base needed to support the Department’s key long-term goals, particularly in an environment of resource constraints.
Section 4: Other related research activity of which the Unit will need to be aware
Applicants should be aware of MBRRACE-UK (the national programme of surveillance and confidential enquiries into maternal and neonatal deaths), the Neonatal Data Analysis Unit, the Avoiding Brain Injuries in Childbirth (ABC) Collaborative, the Tommy’s National Centre for Maternity Improvement, Each Baby Counts Learn and Support and the reports from the NHS Resolution Early Notification Scheme and the National Institute for Health and Care Research (NIHR) Reproductive Health Clinical Research Network.
The unit will be expected to develop links with other Policy Research Units, for example Behavioural Science, Public Health, Children and Families, Mental Health (specifically around perinatal mental health), Health and Social Care Workforce, and Quality Safety and Outcomes.
Section 5: Other issues relevant to this programme of research
It is likely that maternity and neonatal health and care will remain a government priority long into the future. The evidence will be needed to inform policy as transformation of maternity and neonatal systems continues, to respond to new challenges such as changes in the maternal population, and periodic events such as Spending Reviews. We are keen to explore the potential for the use of big data and analytics in improving outcomes for individuals and organisations.