Healthcare Improvement Scotland publish new maternity care standards for Scotland

ALLIANCE input and lived experience evidence help shape stronger, person-centred and trauma-informed maternity care

Healthcare Improvement Scotland has published its final Maternity Care Standards, setting out what people across Scotland should expect from maternity services. The new standards follow a public consultation, which the ALLIANCE responded to, and there is clear evidence that our feedback has helped strengthen the final version.

Our response drew on lived experience evidence from ‘Trauma, Abandonment and Isolation’, a 2023 joint research report by Engender and the ALLIANCE which captured the voices of more than 200 women about their experiences of maternity care in Scotland during the COVID-19 pandemic. While many of these accounts were pandemic specific, they also revealed long-standing systemic challenges within maternity services. Our response was further informed by experiences shared during a focus group facilitated by the ALLIANCE, on behalf of Healthcare Improvement Scotland.

One of the most significant changes in the final standards is a stronger overarching focus on accountability. There is now much clearer emphasis on what NHS Boards are expected to ensure, rather than what services should aim to promote. This is particularly evident in relation to mental health. While the draft standards focused on ‘promoting’ mental health and wellbeing the final version reflects our direct recommendation and now states that “NHS Boards ensure women and their babies can access mental health and wellbeing support that is timely, equitable, consistent and trauma-informed”. This marks a major step forward in recognising mental health as a core component of safe, high-quality maternity care, in parity with physical health. It is also supported by a stronger emphasis on staff training and practices that support early identification of poor mental health.

There has also been important improvements in how trauma is understood and addressed. The final standards take a more clearly defined trauma-informed approach, recognising that people may experience trauma at different points in their maternity journey. This has particularly been strengthened in relation to bereavement care – an area we strongly advocated to see strengthened.

This is explicitly evident with wider recognition of miscarriage within the standards, alongside explicit alignment with Scotland’s Miscarriage Delivery Framework as we proposed. NHS Boards are now required to implement and monitor this framework, representing a significant shift from the draft standards where miscarriage was less visible.

This has also translated into more practical actions. The standards have taken up our recommendation, and now set clearer expectations around environments, including removing and reducing shared spaces so the people experiencing pregnancy or baby loss are not placed alongside those receiving routine maternity care. This directly reflects what many people who had experienced loss told us about the distress caused by being in shared spaces with pregnant women and newborn babies.

Continuity of care following bereavement has also been strengthened. These standards now place greater emphasis on ensuring that people continue to receive consistent support after loss. This has also been extended to stronger recognition of the need for specialist trauma-informed care for those who have experienced loss in future pregnancies, ensuring that care is sensitive and responsive to their needs throughout subsequent maternity journeys. Importantly there is also greater recognition of the impact of trauma on staff with the standards more clearly acknowledging the need to support maternity teams who may experience vicarious trauma, reflecting our recommendation to better recognise and respond to workforce wellbeing.

There is also a stronger focus on tackling inequalities. A new dedicated standard highlights the need for maternity services to recognise and address the different barriers people face in accessing and receiving care. This reflect our call for a more explicit, system-level approach to equity, alongside a clearer rights-based framing, helping to ensure services are inclusive and responsive to individual needs.

Additionally, the standards now take a more holistic view of maternity care across the full pathway. Separate standards for antenatal, intrapartum and postnatal care replace the previous ‘core care’ grouping, reflecting out recommendation to give equal weight to all stages of the maternity journey over heightened focus on the delivery perios. Alongside this, there is more consistent inclusion of chosen care partners, with clearer expectations around their involvement in decision making, support and care processes. This represents a shift from implied involvement to a more explicit expectation of inclusion throughout.

There has also been progress on making feedback and complaints processes more accessible. In line with our recommendations, the standards now require NHS Board to provide clear information, in a range of formats, on how to raise concerns, including complaints processes that are easy to access, and understand. There is also an expectation that services demonstrate openness and transparency by publishing accessible information on feedback, complaints and learning. Together, these changes help ensure that people feel able to speak up and have their experiences heard.

We additionally advocated for improved communication on the basis that accessible information is critical to making informed decisions about maternity care. Within the final standards, communication has been strengthened overall, with greater emphasis on providing information that is accessible and tailored to individual needs. While we advocated for the introduction for a new standard on communication, the introduction of a specific substandard on accessible, responsive information is a welcome step and its placement within the ‘Principle of Care’ helps embed communication across the full pathway. However, there is still more to do. Our recommendation for specific commitments to formats such as British Sign Language, Braille and Easy Read was not take forward.

Overall, the final standards show a clear shift towards more accountable, person-centred and trauma-informed maternity care. They reflect many of the priorities raised through consultation, and critically, the lived experience shared through ALLIANCE engagement, representing a positive and meaningful step forward for maternity services in Scotland.

You can read the full consultation response via the resource links below.

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