Gaps in service provision

Gaps in service provision

The Pathway Assessment Tool, created by the Mums and Babies in Mind project, was used to rate local services and pathways against national standards and best practice in April 2023. This tool is based on national guidelines (listed here), including NICE guidelines on antenatal and postnatal care. This review has identified strengths and gaps in local services, using scores given on a scale from 0 to 5. The scoring for the tool is as follows:

  • 0 = None of this is true in my area
  • 1 = One or two of these things are true in some areas
  • 2 = A few of these things are true
  • 3 = We are doing many of these things but we don’t know if they are working
  • 4 = We are doing many of these things and are confident in the quality
  • 5 = We are doing all of these things well

Full results of the local review are available here, but a summary is provided below:

Service or area Score (0 – 5) Key gaps
Care pathway 2
  • The clarity of care pathways varies for different levels of mental health need, with some new parents reporting that they do not understand which services are available to support them
Clinical and commissioning networks 3
  • Lack of local lead for perinatal mental health, which currently sits between mental health and maternity accountable business units (ABUs)
  • Lack of structures supporting joined up commissioning
Workforce training and development 3
  • There are some gaps in terms of workforce training around perinatal mental health, particularly for health visitors and midwives
Commissioning 2
  • A joint commissioning strategy for perinatal mental health is current under development
  • It is not always clear how services data relates to service quality or how this data can be used to inform improvements
Maternity Services (CUH) 3
  • Lack of routine information provided to parents about perinatal mental health
  • Lack of mental health support for parents who experience baby loss (services are currently in development)
  • Lack of liaison psychiatrist and psychologist
  • Geographic gaps in antenatal education (currently in development)
Maternity Services (NWAFT) 2
  • Workforce pressures have impacted continuity of care, midwife training, and provision of support for  fathers/partners after baby loss
  • Lack of psychiatrist cover for inpatients in maternity services
  • Lack of information provision about mental after discharge from maternity services (due to be put in place shortly)
General Practitioners 3
  • Further work is needed to understand how well GPs understand the perinatal care pathway
Health Visitors 3
  • Lack of training and interventions for infant mental health
Family Nurse Partnership 4
Specialist Perinatal Mental Health Services 4
Adult Mental Health Services and CAMHS 4
  • Further work is needed to determine the level of training all adult mental health professionals have around perinatal mental health, and the understanding of local care pathways in these services
Community and Children’s Services 2
  • Limited interventions promoting infant mental health
  • Provision for dads and partners is not available in all areas
Infant Mental Health 1
  • Can be difficult to determine which services provide support for infant mental health
Information for dads/partners 3
  • Geographically patchy provision for dads and partners
  • Lack of lived experience work involving dads and partners
Voluntary and Community Sector 2
  • Understanding of local pathways across this sector is patchy
  • Parents do not always know what support is available from this sector
Overall Score 3  

Table 18: Results from the services and pathways review

What do local people think?

Throughout this chapter, we had conversations with local mothers and professionals from a range of sectors in Cambridgeshire and Peterborough. This included those from CPSL Mind, the local NCT branch, the SUN Network, Child and Family Centres, local doulas, community development officers supporting service personnel and their families. The main issues highlighted in these conversations were:

  • There is a need for specialist bereavement support for parents experiencing miscarriage, stillbirth and/or trauma around birth including removal of baby from parent’s care. Organisations reported many women ask for this support and there are no specialist local services which they can be referred to
  • Poor perinatal MH often is the result of complex issues (including but not limited to financial worries, relationship problems, lack of social support, and lack of parenting skills) but it is difficult to find holistic support to address all those issues. Many community and voluntary sector organisations report that their staff and volunteers spend a lot of time supporting mothers with financial and housing issues or signpost to other support services before the parent can engage with mental health support
  • Mothers report experiencing differing mental health support from midwives and health visitors across Cambridgeshire and Peterborough. Significant differences are not observed at district level; which seems to be caused by differences in individual health professionals’ skills, knowledge and attitudes around mental health issues
  • The majority of baby weigh in clinics have been held as self-weigh in clinics with no heath professional to provide support to mothers at the clinic missing opportunities to build trusted relationships with health visitors. Many mothers report missing the informal opportunities these clinics provided to quickly ask questions around baby’s development as well as their own mental wellbeing. Mothers can struggle with the current system where they don’t personally know their health visitor and where they must make a phone call if they need support. If they already struggle with mental health issues the current system can be a barrier as it requires mothers to be proactive in seeking help.
  • Partners also reported that engaging male parents/partners in support groups or education classes has been challenging. Fathers may prefer more flexibility around timing and formality of activities due to work and other commitments. It has also been reported that the lack of male health care or support worker professionals can be a barrier as men may feel their perspective is not fully understood by female workers.

In 2021, Rosie Maternity and Neonatal Voices Partnership asked parents what was important to them when thinking about mental health support. Survey responses suggest local parents would prioritise the following:

Mental health care to become a standard, routine part of maternity care
  • parents would like perinatal health visitors and midwifes to have good awareness of mental health; mental health training to be provided for health visitors and midwives
  • continuity of care prioritised
  • careful use of language by midwives
  • lowering threshold for referral to perinatal mental health support
Improved early postnatal intervention
  • information about where to find relevant perinatal mental health information and support to be included in discharge processes
  • active identification of likely candidates for extra mental health support on postnatal wards
  • postnatal appointment as standard for anyone with a mental health history (but not necessarily a diagnosis)
Better antenatal identification of candidates for support
  • questionnaires with well-structured questions/statements handed out at booking appointment
  • support offered proactively during community midwife appointments
  • mental health should be asked about at every appointment, as per domestic safety questions, and concerns recorded and discussed further
Continued postnatal contact
  • additional postnatal appointment for mother in addition to the 6 – 8 week check
  • questionnaires with well-structured questions/statements at postnatal appointments and postnatal support groups
  • continued contact at regular postnatal intervals
Facilitate learning about symptoms, services and system
  • have all relevant information in one prominent place
  • postnatal depression should not be overly discussed at the expense of other disorders.
  • make learning about perinatal mental health standard part of NHS antenatal classes, aimed at both parents
Improved infant feeding support
    • Improved infant feeding support and more relaxed environment