Reducing Antenatal Health Inequalities: Outcome Focused Evidence into Action Guidance

This guidance details the specific actions needed to strengthen antenatal healthcare at NHS Board and national level.





Public Health Department's work with CHPs, primary care and maternity services to carry out a rapid health needs profile of women of reproductive age for benchmarking and service planning purposes

Data required for the SWHMR is effectively and efficiently recorded, collected and systematically used for national and local audit and health profile purposes

All data required for national purposes to be returned within the agreed timescales

Boards should work towards all women accessing antenatal care services by 12 weeks of pregnancy

Audit the numbers of women booking for antenatal care by the 12 th week of gestation , including uptake by women under 20 and women living in the most deprived quintiles; high risk groups ensuring the collection of all data required by Equalities Legislation

The GIRFEC national practice model and inequalities sensitive practice is integral to assessment of need and care responses within antenatal services

Benchmark and measure whether staff have the time, knowledge and skills to work in partnership with women to assess their needs including enquiry into and collection of sensitive social data- (e.g. domestic abuse, substance misuse, poverty etc)

Benchmark and audit continuity of care and carer

A risk assessment of communication, liaison and referral processes between maternity services, primary care and other key NHS services including mental health and substance misuse services and Local Authority services is carried out

Benchmark and measure staff have the necessary skills to work in partnership with women to support them make key lifestyle changes

Ensure communication, language and translation plans are in place.

Short term (conception - postnatal phase) health outcomes of antenatal care for women and their babies in high risk groups are routinely measured

Ensure that effective audit cycles are in place to drive clinical improvement for high risk women in the antenatal phase

Benchmark and systematically measure key short term outcomes including maternal and infant mortality and morbidity data, premature birth, smoking cessation rates, breast feeding rates, drugs and alcohol use amongst high risk groups

Primary Care and other key NHS and Local Authority services ensure that women's preconceptual general health is cared for particularly those women in high risk groups

The promotion of long lasting reversible contraceptives are promoted particularly to teenagers, women with addiction problems and sex workers prior to discharge from postnatal care

Primary Care Disease register data, QOF data



THE Scottish Government will ensure that an implementation plan is developed for the Refreshed Framework for Maternity Care Services focussing on Information/data, workforce development and risk analysis of care pathways between primary care, maternity services and public health nursing

The Scottish Health Council's report regarding strengthening service user involvement with practical recommendations for capturing the experience of women from seldom heard groups will be available for NHS Boards

The Scottish Government will commission NHSQIS to update the SWHMR ensuring that it is fit for purpose

A proposal for a HEAT target measuring improvements in access to antenatal care by the 12 th week gestation for all women, including those under 20 and those living in the poorest SIMD quintiles is being developed for 2012

NHS Education for Scotland will produce a workforce development plan and knowledge and skills framework in order to support Health Boards to address antenatal inequalities

NHSQIS will develop a Vulnerable Families Pathways as a practical tool for antenatal staff working with women in high risk groups

NHS Health Scotland- is undertaking an EQIA of early years resources and will review and maintain all publications and websites for antenatal services. They will provide support for cross sector work and special interest groups via the early years network 8

NES, QIS and Health Scotland are developing a national syllabus, training and resources for antenatal education

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