In the third year of the Fairer Start Local partnership with Stockport Metropolitan Borough Council, we focused on planning the large-scale implementation of an enhanced maternity pathway to better identify support for families. To increase collaboration and coordination between midwifery and antenatal health visiting services, we applied lessons we learned in our three pilot areas: Adswood, Brinnington and Offerton, to roll out the pathway across seven additional areas in Stockport. 

In the second year of the partnership, we co-designed and piloted a joint-visit service innovation, when a midwife and health visitor meet with a family together during the parent’s pregnancy, between 20 and 25 weeks. They use tools like the My World Assessment, Risk and Resilience Matrix, motivational interviewing techniques and joint planning to:

• holistically understand the strengths and challenges a family faces
• elevate the ‘voice of the infant’ by focusing on what they need to grow and develop
• enable families to share their priorities
• begin building trusting relationships with both practitioners earlier in their pregnancy.

The joint visit is one component of the enhanced maternity pathway, which is a wider effort to:

• identify families in need from the beginning of their pregnancy through the midwifery appointments using the Risk and Resilience Matrix where appropriate
• triage referrals to the health visiting service based on the level of need identified
• conduct either a 20-week joint visit with health visitors and midwives or a 28-week antenatal visit with the health visitor
• support practitioners with the tools, resources and processes to utilise their skills to the best of their ability
• create clear plans and pathways for the support offered by midwives, health visitors or support offered jointly by both practitioners
• ensure that the processes for identifying needs and offering support were based in holistic understanding of the family’s circumstances, and are flexible and adaptable if their situation changes. 

The implementation phase began with two focused ‘sprint days’. We convened colleagues from across midwifery and health visiting services to discuss the findings from our pilot, identify challenges and determine the next steps for implementation. Our sprint days identified the importance of having a clear process for identifying families eligible for the enhanced maternity pathway, improving digital record-keeping, and ensuring equal partnership and leadership from midwives and health visiting teams. 

Implementation plan

Together, we drafted an implementation plan with nine workstreams, each with specific objectives and indicators of progress. By agreeing on this plan together, we ensured that all stakeholders were aware of the different areas of work, who was responsible for each, and how we would achieve our objectives. 

Scheduled regular leadership meetings

To ensure all teams understood and were on track to implement the enhanced maternity pathway, we scheduled bi-weekly meetings with team leaders from both midwifery and health visiting. They helped fill gaps in understanding, created a strong foundation for scaling and ensured everyone was prepared for implementation, especially the teams not involved in the pilot phase. 

Updated resources and training materials

We updated our training materials to provide more context to the ‘spirit of the visit,’ helping practitioners understand the purpose of implementing the enhanced maternity pathway. We provided visual graphics and scenario examples for practitioners to use during training and on visits. Our revised materials, practical visit examples, peer networking sessions and support from team leaders created a solid foundation for the context and process of joint visits.

Trained all health visitors and midwives

Stockport colleagues ran mandatory training sessions for the enhanced maternity pathway for 89 health visitors and 57 midwives. These sessions were well-received and practitioners appreciated the practical examples provided and the time to practise the joint visit. We also scheduled informal ‘reflective networking sessions’ to encourage practitioners to meet again informally and discuss their experiences working on the enhanced maternity pathway.

Involving the maternity safeguarding team

Members of the midwifery safeguarding team attended training with practitioners to understand the context for the enhanced maternity pathway and joint visiting. They are now part of the process of reviewing referrals from midwives and deciding whether a family receives a 20-week  joint visit or a 28-week health visitor antenatal contact. 

Administrative support

Stockport identified administrative teams to support data entry and record sharing for the enhanced maternity pathway where appropriate. This helped free up capacity for team leads to support practitioners while ensuring the quality and consistency of the recorded information. 

Digital record-keeping

We worked with Stockport’s Business Intelligence Team to make changes to existing record-keeping systems, ensuring that eligibility for the enhanced maternity pathway, My World Assessment and joint family plan were accurately and securely recorded.

The goal of implementing the enhanced maternity pathway across Stockport is to ensure that families receive tailored support in the antenatal period so that children can have the best start in life. During our pilot, we identified that joint visiting helped improve coordination and collaboration between practitioners earlier in pregnancy. We identified operational challenges that needed to be addressed (such as record-keeping, training materials and oversight from leadership) which we used to build our implementation plan. 

To date, Stockport colleagues have achieved the following:

• trained all practitioners across 10 service teams
• the midwifery safeguarding team has started triaging all midwifery referrals to identify families who should receive a 20-week joint visit or a 28-week health visitor appointment
• practitioners have completed over 70 joint visits. 

These were our key learnings from our implementation phase:

• Team leads are responsible for their practitioners within a particular geographic area. This means they don’t often have the opportunity to learn from different areas. Scheduling regular meetings between service and team leaders provided this time, which made implementation more manageable, especially for teams that were not part of the pilot.
• Gaining buy-in from other teams, including safeguarding, business intelligence, and administrative teams, helped provide additional resources and staff time to the project.
• Health visitors and midwives noticed that digital record-keeping systems did not match their expectations of the processes they were following. By raising this concern, we fixed the digital template and provided clearer guidance and a flow chart for record-keeping to address practitioner’s feedback. 

Over the six-month implementation rollout, we worked closely with Stockport colleagues to continuously improve the delivery of the enhanced maternity pathway.