What can you do to improve patient care and reduce inequalities?
As our role is focused on regulating individuals, this advice cannot address system or service level actions.
Instead, it’s focused on the actions you as an individual can take to improve care for patients, which will have a positive impact on reducing inequalities in maternity care.
These actions are not framed as additional to the day-to-day care you provide, they can be woven into the ways you tailor your care to meet your patients’ individual needs. These actions align with the good practice expectations that we already set out.
For advice on actions to take at a service level, the Equality and Human Rights Commission provide a range of recommended actions for health bodies (including Integrated Care Boards and GP practices) to tackle health inequalities, including in maternity and neonatal care.
Effective use of data
Using data can have a positive impact on all patients, especially those with protected characteristics as it means that you can design targeted interventions to meet the needs of your local patient population.
Examples of how this can be done and the impact it can have has been highlighted by several organisations, including:
- In their maternity improvement resource, the CQC highlights good practice examples for improving healthcare equity, including using data to improve outcomes.
- NHS England has produced a communications toolkit for local maternity teams to improve communications with Black, Asian and minority ethnic women. In developing a targeted communications strategy, it emphasises the importance of understanding your audience and knowing what’s best for patients in your area.
There’s a range of resources available to find out more about your local patient population.
You can also find resources about the effective use of data. These have been split by countries in the UK.
You can also find case studies from midwives about understanding communities on the NMC website.
Our professional standards
41. Medical professionals need accurate, up-to-date and accessible information to deliver good and safe care to patients. Patients need to understand how information about them will be collected, stored and used and how their confidentiality and privacy will be protected. Good information governance systems can help to achieve this and contribute to providing high quality and safe care. They can also provide valuable information to allow teams and services to improve the quality and safety of care they deliver. All medical professionals have a role to play in contributing to these systems.
Good record-keeping
A focus on good record-keeping can have a positive impact on the experience of care and outcomes of those living with social complexities, patients with mental health conditions and ethnic minority patients.
In the summary report on Saving lives improving mothers’ care 2024, MBRRACE-UK found that ethnicity, social complexities and multiple disadvantages are often poorly recorded in patient notes. They warn that inequalities will continue if patients’ individual circumstances are not recognised and considered during the perinatal period.
Without recording these things in patient notes, it may be harder for healthcare professionals that are seeing a patient for the first time to provide culturally sensitive care. It’s also challenging to take forward any interventions designed by others to enhance the patient’s care or ability to access healthcare services.
Linked to this, patients may share details with you about a previously traumatic birth or difficult past healthcare experience. As a result, adjustments may have been put in place to address these and provide reassurance. Making sure this is recorded in their notes so that the information is passed to those with direct involvement in the patient’s care can positively impact that patient’s experience.
Our professional standards
70. You should take a proportionate approach to the level of detail but patients’ records should usually include:
- relevant clinical findings
- drugs, investigations or treatments proposed, provided or prescribed
- the information shared with patients
- concerns or preferences expressed by the patient that might be relevant to their ongoing care, and whether these were addressed
- information about any reasonable adjustments and communication support preferences
- decisions made, actions agreed (including decisions to take no action) and when/whether decisions should be reviewed
- who is creating the record and when.
Tailoring care to meet patients’ individual needs
The importance of tailoring care, listening to patients and understanding their individual circumstances is emphasised across the advice we’ve provided in the communication tab. However, it’s important to highlight here that tailoring care can have a particularly positive impact on patients living with social complexities and mental health conditions, as well as ethnic minority patients.
Combining appointments and reimbursing travel
In their position statement on poverty, deprivation and women’s health, RCOG highlights that due to insecure work, the cost of travel for appointments or difficulty getting childcare can be prohibitive for some patients in accessing healthcare.
A practical action you could take to support patients in this regard is considering combining appointments so that patients don’t have to repeatedly travel in. NHS Scotland suggests considering digital options and communication tools to support patients who may live remotely and could struggle with travelling to appointments.
There are travel reimbursement schemes across the UK, which may also support patients. You can find these in our maternity useful resources.
Making sure there is continuity of carers for maternity patients
The Scottish Government and Public Health Agency in Northern Ireland promote a continuity of care model. It means that patients receive support from the same midwifery team throughout their pregnancy, which is proven to lead to better outcomes and safety for patients and their babies. The Scottish Government (Continuity of carer and local delivery of care: implementation framework) and Public Health Agency in Northern Ireland (Continuity of Midwifery Carer: Introducing Northern Ireland’s new model of maternity care) have produced guidance and resources on this.
Improving cultural awareness
Improving cultural safety will also support you to tailor patient care. NHS England has produced an e-learning tool focused on improving culture competence and cultural safety. It explores the importance of cultural safety in providing safe care. NHSE also highlights the need for healthcare professionals to be aware of key issues relating to culture and understand how this may influence a patient’s uptake of particular treatment options. Similarly, NHS Scotland has developed a Cultural humility module.
You can find case studies from midwives and a patient advocate about personalising care and cultural safety on the NMC website.
The professional standards
20. Patients may prefer to access healthcare services face-to-face or through remote consultations via telephone, video-link or online, depending on their individual needs and circumstances.8 Where different options exist, and when it is within your power, you should agree with the patient which mode of consultation is most suitable for them.
Good practice in proposing, prescribing, providing and managing medicines and devices
The importance of language
Language is important when it comes to the way patients are addressed and the language used by maternity services. A bad experience could make patients reluctant to seek healthcare. Staff need to consider the potential long-term impact on patients if those they turn to for care don’t treat them with respect.
This is particularly important to consider for transgender and gender diverse patients. There are a range of resources to support maternity services to use inclusive language:
- NHS Digital service manual provides an inclusive content style guide focused on sex, gender and sexuality.
- NHS Inform provide a style guide on inclusive language.
In line with this, when a patient shares their pronouns with you, make sure this information is passed to others involved in their care. This will have a positive impact on that patient’s experience. Our trans healthcare ethical hub page provides advice on caring for transgender and gender diverse adults and includes specific advice on confidentiality and equality.
Our professional standards
The approach and attitude of a medical practitioner can have a lasting impact on a patient. Treating patients with kindness, compassion and respect can profoundly shape their experience of care. Good medical professionals recognise that patients are individuals with diverse needs, and don’t make assumptions about the options or outcomes a patient will prefer. They listen to patients and work in partnership with them. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability.
