A Better Start

Assessing maternity vulnerability

A Better Start
  • Claire Spencer, LEAP Midwife, Guy’s and St Thomas' NHS Foundation Trust & Octavia Wiseman, LEAP Midwife, King's College Hospital NHS Foundation Trust
  • In Lambeth, a midwifery assessment tool is enabling midwives to assess the social needs of pregnant women more consistently and to refer to appropriate primary care and local community support.
Claire Spencer

The prize-winning LEAP Health Team is an innovative, multi-disciplinary team commissioned by the Lambeth Early Action Partnership (LEAP) in 2017 to explore the integration of primary care for pregnant women and their families.

Seconded one day a week from front-line jobs, our team is comprised of a health visitor, a GP and midwives from two local Trusts, overseen by a Public Health specialist. Having protected time gives us a rare opportunity to explore front-line barriers to effective inter-professional working and identify bottom-up, low-cost solutions.

One of the main projects which emerged from the Health Team’s work is the development of the Maternity Vulnerability Assessment Tool (MatVAT).

Octavia Wiseman

Our scoping work identified that, unlike other primary care disciplines, midwifery does not have a tool to classify social vulnerabilities. Tools used by GPs and Health Visitors (4-Tiers and U/UP/UPP) are not commonly used in midwifery and are not designed specifically for pregnancy. Midwives are proficient at safeguarding but there is significant variation in practice when managing vulnerable women who do not reach safeguarding thresholds.

In order to address this gap, we developed the MatVAT, a bespoke tool designed specifically for maternity using terminology which will resonate with other early years professionals as it mirrors the 4-Tier model used within safeguarding. It helps midwives classify a woman’s vulnerability (level 1-4) and maps each level to local service provision to guide care planning.

A wide-ranging consultation was undertaken in 2018 with over 40 local practitioners and commissioners, contributing to the design and development of the MatVAT.

“The advantages of the MatVAT are its applicability and ease of use, which will help take-up, and how it will inform decision-making from a public health perspective.” (Member of Lambeth Council A Better Start Committee)

Service-users who took part in a focus group about the MatVAT appreciated that the midwife’s role goes beyond clinical care:

“…when she come she's lovely, I like her. She always attend to me and the baby, she always give us leaflets, she always give us information.” (Mother)

Our vision for the MatVAT is that it will:

  • Help maternity staff classify women’s vulnerability level. This holistic assessment will take into account women and their families’ needs and assets identified during routine enquiries so it will involve little if any additional work.
  • Facilitate care planning, especially at Level 2 and 3 where the mapping to local services can support appropriate referrals.
  • Make referrals easier by giving midwives a ‘shared language’ to communicate with other disciplines.
  • Help managers and commissioners understand the level of social complexity in their local population.

In 2020 we will undertake a multi-centre pilot of the MatVAT in three London Trusts. An external academic evaluation will look at whether midwives feel the MatVAT enhances the care they provide.

Our front-line health team identified a previously unseen gap in midwifery practice and developed a local, low-cost service-improvement tool which has the potential for national implementation, fulfilling one of the remits of LEAP to lead sustainable systems change within the early years pathway.

Useful resources

Healthy Child Programme

NHS Long Term Plan

Better Births

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK. Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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