SNEE 5 Year Maternity Equity Plan

Suffolk and North East Essex NHS Foundation Trust West Suffolk NHS Foundation Trust East Suffolk and North Essex Suffolk and North East Essex Maternity Equity and Equality Narrative

Introduction The NHS England National Maternity Transformation programme has commissioned each Local maternity and neonatal system (LMNS) to develop a five-year plan of how they will address the inequity and inequalities within our services. A framework has been provided to ensure that all systems provide detail on key areas that impact pregnancy, childbirth and early years development. This narrative document provides supporting information to evidence how Suffolk and North East Essex LMNS are going to provide equitable provision, to ensure women, families and birthing people can achieve optimal outcomes and their children have the best start in life. It follows the framework provided by NHS England. It can be read in combination with the Excel spreadsheet named ‘Suffolk and North East Essex Equity Action Plan’ which provides the detail for all mandatory sections of the plan, as well as the planned timeline for achieving the plan. Glossary of terms LMNS Local maternity and neonatal system SNEE Suffolk and North East Essex PCSP personalised care and support plans ESNEFT East Suffolk and North East Essex foundation Trust WSFT West Suffolk Foundation trust VCSE Voluntary, community and social enterprise ICS Integrated care system MVP Maternity Voices Partnership Suffolk and North East Essex Maternity Equity and Equality Narrative | 3

Priority 1 – Restore NHS services inclusively Maternity Equalities and Health Inequalities Impact Assessment In February 2022 the LMNS published its maternity equalities and health inequalities impact assessment. The ICS is supporting the development of comprehensive Equalities and Health Inequalities Impact Assessments (EHIIAs) for all major programmes such as elective care recovery, cancer and hypertension, as well as maternity. The impact assessment identifies potential impact on those with: • Protected characteristics as identified under the Equality Act 2010. • Other groups and communities that experience disadvantage, including family carers, people who are homeless, those living in deprivation or poverty or in rural areas, refugees or asylum seekers, and/or people with complex needs. The assessment will inform co-produced action planning to tackle inequalities, and will be a live document, updated as we continue to learn about our groups and communities. The template used includes an action plan with identified mitigations and priorities. Gaps in the data are to be resolved by December 2022. Engagement and involvement with the equity forum, MVP and Healthwatch will commence January 2023 with an action plan and monitoring cycle to be commenced April 2023. You can view the needs assessment here Our ICS has been successful in receiving funding for a Core20Plus Community Connectors programme. The concept of the programme is to promote community connectors. These are people who are part of those communities who are often not well supported by existing services, experience health inequalities, and who then help change these services to support their community better. This approach recognises that people and communities often know what they need and what would work, and that the NHS needs to hear from these communities The programme is being designed and delivered by African Families in the UK (AFiUK), based on their established Community Ambassador model, and drawing on their extensive contacts within numerous local ethnic minority communities. As maternity services we feature in the Core20Plus5 with our maternity community ambassadors within AFiUK. The first Core20Plus5 Connectors report April - July 2022 is published. These reports will be quarterly and will be used to shape our partnership with the VCSE groups. Health Inequality Improvement We wanted to increase support for those at risk of complications in pregnancy. This includes support for women and pregnant people from ethnic minority groups. To do this a document was created that is being used across all of the maternity units in Suffolk and North East Essex. It assures increased support for black, Asian and ethnic minority women and people, with a lower threshold for them to be seen by a clinician if they need it. This document is a standard operating procedure (SOP). The document has been shared with maternity staff in several ways, including adding it to their training days. When opening discussions around extra support for black, Asian and minority people we heard some staff were unsure how to approach the conversation. There was a fear of offence. During 2020 when the pandemic was impacting those from this community the worst, it became apparent that having the conversation was essential. Both Victoria and Corrinne reassure staff that although it may feel difficult, they need to have those conversation. 4 | Suffolk and North East Essex Maternity Equity and Equality Narrative

There have been two audits into the impact of the SOP, and there will be annual reviews. Increasing Support for Pregnant Women of Black, Asian and Minority Ethnic Background – Ipswich/ Colchester July 2022: View the Ipswich audit here View the Colchester audit here Pregnancy, birth, and ethnicity of the pregnant women admitted to hospital with COVID-19 were from ethnic minority groups 56% As we understood more about the impact of Covid-19 on people from black, Asian and minority ethnic groups we wanted to create some bespoke messages for our community. Vitamin D and folic acid Less than 1/3 of UK women take folic acid supplements in preparation for pregnancy, and within SNEE the uptake is 27% Victoria was happy to discuss health messages that include vitamin D and folic acid, especially for those with black and brown skin. These messages have been sent via a social media campaign and are accessible via a link within posters across maternity services. Victoria helped us to create a series of films discussing subjects such as the impact of ethnicity on pregnancy and birth and accessing maternity services during a pandemic. Suffolk and North East Essex Maternity Equity and Equality Narrative | 5

Health messages around the Covid vaccine are best delivered by trusted community ambassadors. Cristina is the Ipswich Roma advocate and created a film for her community. Staff awareness and information is a focus, and the challenge as a Local Maternity and Neonatal System (LMNS) has been to keep maternity staff updated on transformation projects across Suffolk and North East Essex (SNEE). As the equity work grew, we needed a central location for all the updates and information. A SNEE Padlet (online information point) for staff was created. This hosts a wealth of information for staff including all the video messages and how to find extra resources. The difference we hope to make Information, education and opening the dialogue. Disparities during the pandemic have widened, and we want targeted, bespoke messages for our communities. We have worked with local Community ambassadors/advocates and connectors, who have already built relationships of trust within their communities. We understand that not everyone plans a pregnancy, but if within the community there is easily accessible pregnancy information available that people can access, we expect to see an increase in vitamin D and folic acid uptake. We also want to ensure people know how to access an early pathway into maternity services. We hope to increase both the knowledge and the confidence of staff, ensuring they open the conversation around ethnicity and are ‘culturally curious’, which is a theme that runs throughout our work. 6 | Suffolk and North East Essex Maternity Equity and Equality Narrative

Priority 2 – Mitigate against digital exclusion SNEE ICS has a mature digital, data & technology strategy and delivery plan, operating across the whole system. The two Maternity units within SNEE – ESNEFT and WSFT, are both in the process of completing their maternity digital strategies (due October 2022). These align to the What Good Looks Like (WGLL) framework published in August 2021 by the NHS Transformation Directorate. The 7 goals of the WGLL framework are: 1. Well Led 2. Ensure Smart Foundations 3. Safe practice 4. Support People 5. Empower Citizens 6. Improve Care 7. Healthy Populations The strategies will reflect the requirement to support all service users with the appropriate tools to actively collaborate with their care planning. This will include providing access to unbiased, evidence based, and locally specific information and advice; and will encourage full engagement with responsive, individualised, plans of care as outlined within the Maternity Transformation Plan. The ICS and both hospital trusts partner with agencies across the LMNS to ensure that issues highlighted at booking, for example: English not the first language, no access to digital devices, financial issues, are addressed to ensure equitable access to maternity services for all. Following rapid adoption of Video Consultation, telephone appointments and Apps in the first wave of Covid the ICS worked with Healthwatch Suffolk & Healthwatch Essex who created the 12 Guiding Principles to address exclusion. 12 Guiding Principles to address exclusion. This methodology will be applied to the design and implementation of all new digital services for the public, as well as the adoption of best local practice. This research has allowed assessments of many of the current capabilities. Key findings are: • Digital First not Digital Only – all services are also offered as face to face. • Data collected around people and access – usage / utilisation (particularly by pseudonymised people / by characteristics) is hard to get to, siloed and often incomplete. Would be useful for trend against outcome, and with more timely data we could consider where we were ‘turning the curve’. • Most systems capture people’s communication preferences, but these aren’t shared. Some of our VCSE partners helped to mitigate against digital exclusion during the lockdown period, Ipswich Community Media provided digital devices to immigrant families so that they could access services. We want to offer face-to-face care to people who cannot use remote services, in fact all midwifery appointments across SNEE have resumed as face to face. Some obstetric clinics continue to use telephone appointments and an LMNS wide audit is commencing to review the choices on offer. Video calling is available to the obstetric team although rarely accessed. Our LMNS digital lead will review the remote offer and audit those accessing it. These will be broken down by relevant protected characteristics and postcode. Within this work our VCSE and MVP partners will be asked for service user intelligence on the impact of remote consultations and their accessibility. Suffolk and North East Essex Maternity Equity and Equality Narrative | 7

Personalised Care and Support Planning Finding ways to communicate with our pregnant community and new parents has been the focus of our LMNS. We understand there is a need for easily accessible information to help people feel confident in the choices they are making. We asked the MVP to scope digital solutions, and they fed back the results. The Mum and baby app was the preferred choice. March 2020 saw the launch of the Mum and baby app across the LMNS. This coincided with the first lockdown, and we quickly realized that the app was going to be a useful tool in communicating information to our parents. You can view the staff update here: Mum & baby app – information for staff Go to this Sway MVP service users reported that the personalised care and support plans (PCSPs) found within the Mum and baby app were comprehensive and covered all their needs. The challenge of being located digitally within an app needed to be solved, and paper copies were placed in all areas. Alongside this the PCSPs were uploaded to each trust website for people to be able to view and download on desktops. View Flipbook online Download document The maternity equity forum includes a local charity from the autistic and ADHD community. They have shared their specific health passports, and the forum agreed that this could be adapted for pregnant parents. The aim is to trial the health passports with neurodiverse parents, those with learning disabilities or those who find pages of text or English as a first language challenging. My Pregnancy Support Plan Go to this Sway Other community groups have fedback that PCSPs are not for their community. African families in the UK were asked to review the pregnancy support plan and provide feedback on its use. Joyce, the community ambassador took the plans to her community group. She reported back that the women did not want to use a birth plan. They knew how to birth, without writing it down. They did not enjoy the paper aspect of it, as their community is story based. “No paper – it has turned into a classroom!” 8 | Suffolk and North East Essex Maternity Equity and Equality Narrative

There is woman’s wisdom within the community, which is passed from grandmother to mother. Joyce explained that the grandmother wisdom cannot be overruled. As midwives we must respect the grandmother’s knowledge and find ways to honour it. If we can combine it with evidence based practice we have the perfect service. Our journey with our communities demonstrates that one size does not fit all, and PCSPs illustrate this. African Families in the UK Go to this Sway In partnership with Ipswich and East Suffolk Alliance the LMNS have secured a Personalised Care development programme ‘Making it Personal’ designed specifically for professionals working within the Maternity Pathways in Ipswich and East Suffolk. The aim of the programme is to develop vital networks and enhance pathways, services, and organisations to support those using maternity services through a powerful and meaningful personalised care approach and ethos. The programme will be delivered through a combination of practical interactive workshops, guest speakers and skills development sessions running from November 2022 to February 2023. You can view the detail of the program here The LMNS have funded 3 full days of Motivational Interviewing on 9th November 2022, 12th January 2023 and 14th March 2023. These days will be for staff and partner organisations to understand the concept of coaching conversations which will enhance their skills when discussing choices and PCSPs. Our aim is to enable clinicians and stakeholder partners to explore ways of opening choice conversations and introducing the concept of PCSPs to the families in our community. Suffolk and North East Essex Maternity Equity and Equality Narrative | 9

SNEE LMNS has Purchased a digital translation tool - ‘CardMedic’ which aims to make health information more accessible. The downloadable app is for staff use and is not aimed at replacing translation services but to be used in urgent situations when language/ communication is a barrier. CardMedic hosts an A-Z library of pre-written scripts replicating common clinical conversations and examinations between healthcare staff and patients. Staff choose the topic and display the screen to the patient to guide the clinical interaction. The content can be flexed at the point-of-care, to different languages, sign language videos and easy read. Maternity services for visually impaired people. Our equity forum was led by Kate Crofts – ICS Lead for Alliance Integration & Transformation. Kate is a blind parent and took us through some of the challenges parents experience when visually impaired. The work planned for the LMNS is to look at guidance and education for staff. Knowledge of the apps and digital options available to help families navigate into maternity services is essential. Planned work Focus group with a ‘walk through’ of maternity services led by a service user who is visually impaired. Review information formats – all maternity information to be available in digital formats that will be accessible to speech software. Maternity services for visually impaired people Go to this Sway The difference we hope to make We want all people to receive information in a way that is suitable for them, and in a way that they can access easily and understand. This will mean looking at how we approach information giving, working with and being led by our VCSE partners to improve communication. As an LMNS we have a vision. We would like to produce a central webpage that will host all of the information in a range of formats and languages that is accessible and engaging. We are working alongside system partners in the ICS to create this. Once the building blocks are in place the content will be led by MVP, Healthwatch and VCSE partners. This information will need to be accessible to all, including those without digital access. 10 | Suffolk and North East Essex Maternity Equity and Equality Narrative

Priority 3 – Ensure datasets are complete and timely We want to continually improve the data quality of ethnic coding. Ethnicity data – what we know Recording ethnicity and postcode data at booking helps us to understand how health outcomes vary by geographical area and ethnicity. Maternity services can then identify and prioritise those groups with poorer health outcomes for whom service improvements are needed. When maternity services report data to the Maternity Services Data Set (MSDS) it needs to contain a valid postcode for 95% of those booked that month. Both ESNEFT and WSFT are over 95% compliant with the ethnicity/ complex social factors and deprivation data. We receive a monthly Neonatal dashboard with data from BadgerNet neonatal database. Baby/mother and father ethnicity is recorded but is consistently less than 100%. Statistica Processing Control (SPC) charts from July 2021June 2022 showed SNEE LMNS 12 month average of recording mothers ethnicity. Father ethnicity recording was lower with an average of 63% over 12 months. Work is needed to understand why the data capture from Badgernet is low despite all birthing people and their partners being asked about their ethnicity. We have funded a lead digital midwife who will work alongside each trust to review the data collected and identify areas for improvement. The difference we hope to make We want to continue to improve the collection and recording of ethnicity data. Without robust data we cannot lead quality improvement. We would like to align all of our ethnicity data into one place, producing LMNS SPC charts to plot progress by 2023/24. Our digital lead will review the dashboards monthly. Suffolk and North East Essex Maternity Equity and Equality Narrative | 11

Priority 4a – Accelerate preventative programmes that engage those at greatest risk of poor health outcomes Understand the local population needs We want to understand the local population, the staff experience, and plan co-production activity to design interventions to improve equity for birthing women and people and their babies, and race equality for staff. The maternity equity forum The LMNS maternity equity forum was created in response to the equity analysis submitted in November 2021. We understood as we mapped our community assets that there were many communities, VCSE organisations and charites we were not working with. We extended a monthly invitation to meet, discuss equity and diversity and look towards service improvement for those from minority backgrounds. The equity forum is representative of the SNEE population from across all three alliances, and supports the coproduction of models of care that are appropriate for our service users. The forum is deliberatly community led, and although health colleagues are invited it tends to be 80% community attendance. We currently have 55 members and growing. The topic for discussion changes each month, and the chair is regularly handed to a member to showcase their work. We have created a directory which is being added to each month. Maternity staff are currently stretched to full capacity, and our aim is to offer resources that will support them to support the need of the families. You can view summaries of our equity forums here Maternity Equity Forum Go to this Sway SNEE Maternity Equity Forum Go to this Sway Responding to different communities 470 new Afghan families resettled into Suffolk Ipswich area, mostly speaking Pashto and Dari. The outreach team perform a health assessment which includes Hep B+C, HIV and syphilis and a chest clinic referral. Early smear tests and contraception are considered. They linked with maternity to discuss a streamlined pathway to enable them to refer pregnant people into. 12 | Suffolk and North East Essex Maternity Equity and Equality Narrative

A new document was created for them, with links to our padlet with 17 other languages. Communication with maternity providers included this information plus the national SOP. SNEE Afghan evacuee maternity provision Triaged by outreach system Entered onto the clinical system- health assessment – Screened for Hep B/C HIV/Syphilis/flu/Covid vaccine/ referral to chest clinic Also discussed contraception and smear test Checked by GP Introduced to mainstream primary care Referral into maternity services You can find information on West Suffolk, Ipswich, and Colchester maternity services by downloading the FREE Mum and Baby app Self -Referral into Maternity Services Colchester 01206 742369 West Suffolk 01284 713755 Community midwives Mon-Fri 09.00 – 15.00 Ipswich 01473 702666 For maternity information in 17 languages visit the Padlet Information for Maternity Staff Common languages: Pashto/Dari/Arabic/Urdu Issues to note Mental health – post traumatic stress Family pressure from those remaining Reluctant to access counselling EOE Standard Operating Procedure for Pregnant Women and Birthing People in Quarantine Facilities 30092021_East_of_E ngland_Standard_Operating_Procedure_Quarantine_Process_for_Pregnant_and_birthing_people_for_ratification_u Maternity services principles checklist for the care of pregnant women arriving from Afghanistan B0967_Afghanistan_- _A_Checklist_for_matenrity_service_providers_Sept21.pdf Contacts Amanda Wicks - Health Outreach Nurse working hours Tuesday, Wednesday, Thursday Note: Covid vaccine is probably not recorded on the national system. Flu vaccine will almost always have been received. This cohort are keen for vaccines, so please check vaccination status Inclusivity ESNEFT have created a draft guide for staff when using inclusive language. Once finalised we plan to use it as an example of good practice across the LMNS. As an LMNS we are working with the MVP and VCSE partners to look at inclusive imagery, posters and information that reflects our diverse community. Quick guide to... Inclusive language taking about pregnancy for staff DPS: 03517-22 Issue 1: August 2022 Our language • Wherever possible, we should aim to make content inclusive by changing language from ‘pregnant women may feel sick or be sick’ to, ‘you may feel sick or be sick’. • Wherever possible, we should aim to make content inclusive by changing language from ‘expectant mothers’ to ‘expectant parents’. • In situations where this is not possible, always use gender-inclusive language. For example, you can say, ‘Pregnant women and people can choose to birth at hospital or home’ rather than, ‘Pregnant women can choose to birth at hospital or at home’. Using gender-inclusive language is important, regardless of whether trans or non-binary people are known to be in the space. Our behaviour with patients • Every patient should be asked which pronouns they use as part of routine enquiry. For example, when confirming data such as name, you can ask: • “What pronouns do you use?” • “How would you like me to refer to you?” • “My name is Alex and my pronouns are she / her. What about you?” • “Can you remind me which pronouns you like for yourself?” • We should always refer to people using the pronouns and language of their choice. For some people, their pronouns may change over time, so we should be led by the way an individual refers to themself. Misgendering someone may inadvertently cause harm to trans and non-binary people, and intensify gender dysphoria.1 We’ve put together the following advice for everyone about referring to pregnancy in relation to gender. This follows best practice and national guidance about how we refer to pregnant women and people. It’s important that as an organisation we acknowledge the additional challenges that gender identity can have on pregnancy, birth and infant feeding and recognise the importance of providing inclusive, respectful care to pregnant people and their families. To help start this journey, we have developed this guide to inform your interactions around pregnancy. 1 Gender dysphoria is a term that describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity. More information can be found on the NHS website. Our LGBTQ+ Community Go to this Sway SNEE LMNS has worked closely with local LGBTQ+ charity The Outhouse. They are members of the maternity equity forum and have been commissioned by the LMNS to provide maternity specific training. We have received feedback from a transgender man and his partner who gave birth in our LMNS earlier this year. They were involved in creating a film for staff explaining some of the challenges transgender people face when birthing. You can view the film here. Suffolk and North East Essex Maternity Equity and Equality Narrative | 13

VCSE partnerships and maternity Building relationships In April 2022 SNEE LMNS financially invested in seven VCSE local organisations to support maternity services. The aim was • To build relationships of trust between maternity and communities using maternity ambassadors. • To increase engagement with maternity • To understand any cultural or religious barriers • To release capacity from frontline staff by supporting with the third sector Expressions of interest were sought, and organisations were invited to submit their bids. Seven local partners produced robust plans to support maternity in a variety of ways. Progress to date Working alongside community organisations such as African Families in the UK (AFiUK) PHOEBE, HomeStart, Youth Enquiry Service, Survivors in Transition and Ipswich Community Media (ICM) we are beginning to understand local population needs. This will not be a quick tick box exercise and we are committed to building long term relationships with the community. Each community organisation is offering dedicated links between them and maternity. They describe this in different ways – maternity community ambassadors, maternity advocates, family navigators and community connectors. Once the community links were in place we offered all ambassadors some updating and maternity information sessions. The aim was to equip the ambassadors with information to signpost into maternty and refer on if necessary. We wanted them to be able to speak confidently about maternity and understand the systems in place. The LMNS clinical lead has spent time with each organisation. What began as sessions to update the community partners has evolved into learning for maternity, and the sessions have been invaluable. The sessions have included • Listening to stories • Understanding the different maternity areas • An overview of maternity services • Who you might meet in maternity • Meeting with key staff such as health visitors, infant feeding leads and perinatal mental health midwives. • Options around birth locations • Planning births (PCSPs) • Understanding how to support the physiology of birth Alongside the face to face days there have been resources created for the VCSE partners to use. This is a central hub where they can find information on maternity services and referal pathways if necessary. You can view it here 14 | Suffolk and North East Essex Maternity Equity and Equality Narrative

Maternity ambassadors and partner update Go to this Sway PHOEBE (Promotion of Health, Opportunity, Equality, Benevolence and Empowerment) is a charity who offers specialist advice, information, casework, advocacy and support and counselling services to black and ethnic minority women and children. PHOEBE have welcomed maternity into their organisation, and we have worked very closely to build great relationships with the maternity advocates. We meet monthly and there are often 8-12 advocates, sharing experiences from their community to enable maternity to learn. These experiences and stories are fed back to the staff, you can see one here. PHOEBE maternity advocate meeting 1 Go to this Sway In July 2022 we bought our 7 VCSE partners together to share early learning, network and make plans for the future. You can see the results here Survivors in transition Survivors in Transition are an Ipswich based organisation who support adults who have experienced childhood sexual violence. We know that the pregnancy journey can be triggering for parents and are pleased to work alongside this valuable organisation. They are developing a support group for pregnant people and their partners to explore the impact the pregnancy has on them. The groups will also coproduce materials for staff to help them to support future parents who have experienced childhood sexual violence. HomeStart Suffolk and North East Essex HomeStart are a well-recognised charity with links into the community and particularly with vulnerable families. As an LMNS we have commissioned family navigators in three locations, all areas of high social and economic deprivation. The family navigators will offer home visits, telephone advice and support, signposting to other services and support for six months postnatally. They have launched weekly walkin baby beginnings groups which families can access in the antenatal or postnatal period. They will also help people to access benefits, housing, foodbanks and baby equipment. During the VCSE Network Day HomeStart and AFiUK met, shared information and made connections. This later enabled AFiUK to support a homeless mother living on the streets in Colchester. Suffolk and North East Essex Maternity Equity and Equality Narrative | 15

African Families in the UK at work Go to this Sway Youth Enquiry Service (Y.E.S.) “YES” offers support to young people facing a range of challenges in their lives, including mental health problems. They offer mentoring, support with unemployment, teen pregnancy, physical activities, and counselling, as well as support to young parents and with homelessness and housing. Support is provided with young parent groups (parent and child), attendance at antenatal clinic, positive parenting courses, issues with domestic abuse, sexual health, and teenage pregnancy prevention. During 2020 the request for support from young people doubled. YES have widened their scope as a result of the LMNS funding to help young parents (19-25 years) who have become parents. They work alongside midwives and health visitors, as well as supporting the young adults into employment, housing and stability. Ipswich Community Media (ICM) ICM work within Ipswich, supporting people from migrant families who have moved into the area. They provide an ambassador who acts as an advocate for women, explains the maternity pathway and culture within healthcare, and sources help with benefits, housing, and baby equipment. ICM have also started to deliver “English for Pregnancy” classes to help people understand the conversations that they have with the health care professionals. 16 | Suffolk and North East Essex Maternity Equity and Equality Narrative

Petals Counselling As an LMNS we commission Petals charity. This is a free counselling service to support parents who have suffered pregnancy complications, the loss of a pregnancy or the death of a baby. The 6 counselling sessions are available to all parents across the ICS who can self-refer of be referred by a health professional. Workforce Race Equality Standard (WRES) The LMNS ambition is to have a workforce which is representative of our population diversity. • ESNEFT (2021 data) workforce for Maternity & Neonatal is 673 of which 71 (or 10.5%) are from ethnic communities. • WSFT (2021 data) workforce for Maternity and Neonatal is 230 of which 12 (or 5.22%) are from ethnic communities. 10 (or 4.35%) were not stated. • WSFT Inclusion Action Plan October 2021 to October 2022 outline actions relevant to improving WSFT performance against the Workforce Race Equality Standard (WRES) or Workforce Disability Equality Standard (WDES), Gender Pay Gap (GPG) reporting or NHS People Plan. WRES standards 1-8 are included although this action plan is for the entire workforce. Maternity and neonatal data needs to be extrapolated and analysed. ESNEFT has an action plan to increase the percentage of staff from ethnic communities by 2% each year however this relates to the whole trust and does not target areas such as maternity. With support from the ICS equity, diversity and inclusion (EDI) lead and trust EDI leads and trust cultural ambassadors the workforce data will be used to identify priorities for action and inform staff engagement processes which aim to improve the experience of staff from ethnic minority groups. This work will commence in 2023 and will include pastoral support for international midwives. The difference we hope to make We hope that by working alongside our maternity partners in the VCSE sector we can offer a bespoke layer to maternity services. The community are our experts in what matters to women/people and families, and unless we understand the cultural, social and economic needs of a community we cannot meet the needs of our pregnant and birthing people. The VCSE partnership with maternity has been socialised across the ICS, and partners such as public health and alliances are supporting. Our aim is to integrate this model with alliance neighborhood teams. We see that as an ICS there is success with elderly care, bringing a range of services and partners together to support holistic care at home. Our vision is to recreate this for maternity. For the staff working in SNEE maternity services we want to ensure that workplaces and environments are places where everyone sees equality and inclusion as their responsibility and adopts a proactive approach. The LMNS is keen to introduce reverse mentoring, to support colleagues to understand the impact of working in the healthservice when coming from a deprived or diverse community. We feel this is a powerful and impactful approach to support people from all backgrounds within maternity services. Suffolk and North East Essex Maternity Equity and Equality Narrative | 17

Priority 4b – Action on maternal mortality, morbidity and experience As an LMNS we work alongside the SNEE Maternity Voices Partnership (MVP), and work particularly closely with the 3 MVP chairs. The MVP are essential in hearing and feeding back the voice of the service users. They, alongside Healthwatch, are our coproduction colleagues. H E A L T H I N E Q U A L I T I E S - T H E R O L E O F E S N E F T M V P S ESNEFT MVPs support equity strategy priorities, by the development of working methods that ensure the voices of women and pregnant people from diverse backgrounds and demographics are embedded into the delivery, and coproduction of maternity services. E S N E F T M V P I M P R O V I N G A P R E S E N C E P E E R R E S E A R C H E R S The continuation of ESNEFT MVP attendance at health inequalities workstream meetings, with an understanding of establishing direct relationships with new maternity To develop a relationship with the new Maternity and Neonatal coproduction lead. Supporting and championing the integration of the service user voice into service development work. Continue to strengthen productive working relationships with local community groups such as P.H.O.E.B.E (Ipswich) a charity with a clear objective - To offer specialist advice, information, casework, advocacy, and support services to black and ethnic minority women and children. Currently, we have three MVP members representing BME communities - A workshop is currently in the planning stages designed to focus on needs, past experiences of care, and existing thoughts relating to maternity services. BME ambassador involvement with 15 steps visit (Ipswich site). ambassadors. Community venues Children's Centres Libraries Religious buildings Community centres To strengthen relationships with the local voluntary sector and widen networking opportunities through MVP presence at community-based establishments. S H A R I N G & L E A R N I N G To recruit 'peer researchers' within the MVPs to represent diverse areas of the community. We know that individuals communicate more honestly and openly with people they trust. ESNEFT MVPs to advertise and recruit peer researchers to build monthly focus groups. Monthly meets will provide the opportunity to share feedback and strengthen communication between service users, their MVP community, and subsequently the hospital trust at which they received maternity care. ESNEFT MVPs will ensure that all learning and experiences are shared with senior leaders and at the LMNS board, to ensure the voices of seldom heard communities are involved in coproduction at every level. WO R K I N P R O G R E S S C O L L A B O R A T I V E WO R K I N G ESNEFT MVPs will continue to research, and develop relationships with key community groups. Attending existing events to improve awareness and enhance communication opportunities between families and ESNEFT MVPs. We will continue to actively participate with the LMNS Health inequalities workstream, and begin to develop relationships with current maternity ambassadors. ESNEFT MATERNITY VOICES PARTNERSHIP North East Essex chair - Rachel Chilver Ipswich & East Suffolk chair - Mel Lewis The difference we hope to make Coproduction has to be the LMNS focus, and there is always more we can achieve. Building and extending relationships with our community partners, MVP and Healthwatch is central to our success. We are recruiting a LMNS coproduction lead who will ensure these relationship develop and link our coproduction work together. 18 | Suffolk and North East Essex Maternity Equity and Equality Narrative

Priority 4c Action on perinatal mortality and morbidity Midwifery Continuity of carer (MCoC) We want to implement targeted and enhanced continuity of carer, as set out in the NHS Long Term Plan. This is when the pregnant person sees the same midwife/buddy throughout their pregnancy, birth and postnatal care. To implement this model we need to have all of our staffing roles filled, as the midwives have a smaller caseload in order to be responsive to the person’s needs, especially when they go into labour. Currently West Suffolk have two teams offering midwifery continuity of carer (MCoC). ESNEFT have no current teams. Both maternity providers have submitted plans to NHS England that provide a timeline for when teams will be rolled out. Both trusts are undergoing a staffing review with Birthrate + and are awaiting the recommendations. Both organisations are preparing the building blocks for team midwifery, with dedicated continuity leads. You can share the one-year anniversary success of teams at West Suffolk here: Although ESNEFT have no current teams, their midwifery led unit at Clacton works a team model and the staff are keen to move to full continuity. You can hear their thoughts here: Midwifery Continuity of Carer ESNEFT – sharing the plans Go to this Sway Implement a smoke-free pregnancy pathway for mothers and their partners. All pregnant people who demonstrate a positive Carbon Monoxide (CO) test at time of booking will be automatically recruited onto the SNEE NHS smokefree pregnancy pathway. They and their whole houshold will receive specialist midwife assessment and intervention, Midwifery Support Worker coaching, Nicotine Replacement Therapy (NRT), and or vaping advice to support them to be smokefree during their pregnancy and beyond. They will also receive public health messaging such as safe sleeping and feeding advice to support their child to achieve the best start in life. Suffolk and North East Essex Maternity Equity and Equality Narrative | 19

As well as advice offering treatment the SNEE pathway will be enhanced to offer behavioural support and options advice, providing a voucher at point of contact either at home or via the post. Pathways will also include maternal health advice and support for healthy eating and exercise in pregnancy. We will signpost to other services for stress & anxiety, mental health concerns and alcohol and substance misuse, and work in close collaboration with specialist midwifery teams. • 100% of pregnant people will be offered the maternity model smoking cessation pathway • 100% will be offered a smokefree assessment with the Specialist Smoking cessation midwife within 5 working days of referral. The difference we hope to make We want to see pregnant women, people and families supported by midwives they know and trust. Our difference is to build relationships, as we know this improves outcomes for families. We understand that smoking in pregnancy is the biggest modifiable risk we can influence, but that it requires support to stop. The new smoke free pregnancy pathway is an enhanced model that SNEE are proud to implement. It will be even more effective combined with care from a named and known midwife who can build a relationship and offer health advice throughout the pregnancy, birth and postnatal journey. 20 | Suffolk and North East Essex Maternity Equity and Equality Narrative

Priority 4d – Support for maternity and neonatal staff We will roll out multidisciplinary training about cultural competence in maternity and neonatal services. We began by asking the staff some questions • How do you think we should supply maternity information for pregnant people from ethnic minorities? • Do you discuss risks associated with ethnicity/skin colour with all your black, Asian, ethnic minority pregnant people? • Are you comfortable having ethnicity conversations? • Would you welcome support with having conversations around ethnicity? • Do you believe there is racism in maternity services? See the full survey and the responses here. A staff information and resource centre has been created on a Padlet and made available to all staff. This can be accessed here. Cultural competence training is currently offered in different formats across the trusts, varying from the practice development midwife delivering sessions on statutory training (ESNEFT Colchester) to e-learning sessions being offered (ESNEFT Ipswich) and Equality & diversity Training 3 yearly (WSFT). As a system we would like all staff to have received and understood cultural competence training. Current staffing capacity has led us to acknowledge the limitations of providing training. This has resulted in conversations within the equity forum and resulted in a library of eleven films aimed at increasing cultural awareness. The impact of the lived experience seen and heard in the media of film will be powerful. Each film will have further resource links where staff can signpost or access more detail. The films build on the staff survey where we understand that staff are sometimes reluctant to open the conversation for fear of offense. The theme of the films is ‘It’s OK to ask’. Each fim explores a community and has stories of a lived experience, an industry professional and a midwife. The films are focused on • The Bangladeshi community • The Roma community • Gypsy and traveller families • The Chinese community • The LGBTQ+ community • Black and African families • Refugee community • Autism and the neurodiverse community • Sensory impairment • Survivors of sexual violence • South Asian community The films will be ready for staff in October 2022. Meanwhile you can access the trailer here: The difference we hope to make We want to see pregnant women, people and families supported by midwives they know and trust. Our difference is to build relationships, as we know this improves outcomes for families. We would like to support staff working in maternity to feel confident to open the conversation on ethnicty and culture…to be culturally curious. ‘It’s OK to ask’ films are the first step in a journey between communities and maternity where we break down the barriers, explore and celebrate the difference. Suffolk and North East Essex Maternity Equity and Equality Narrative | 21

Priority 4e – working with system partners and the VCSE sector to address the social determinants of health As an LMNS we are passionate about quality improvement in maternity, and will talk discuss this at every oportunity. We attend alliance committees, personalisation boards, GP shutdown days, public health meetings and reguarly speak at the Universities, updating student midwives. We recently worked in partnership with the ICS inequalities team to offer a focus on maternity. Here we showcase maternity and equity, the importance of the first 1000 days, preconception and epigenetics. Suffolk and North East Essex Integrated Care System (ICS) 1. 1. Introduction Online event Wednesday 23 March 2022 ‘Thinking Differently Together’ about… The first 1,000 days of life: Part 1 The experience of children and families during the first 1,000 days from conception is crucial to their health, wellbeing and life chances. Even before conception, it is important to be as healthy as possible to ensure a safe and healthy pregnancy. Our independent Chair, Rachel Heathcock, East of England Local Government Association introduced the event, explaining that we would be considering a broad range of issues and diverse perspectives from preconception to birth. This event was part one of two; our second event will focus on the importance of highquality support in early life for children and their families. Our learning from both of these events will contribute to a number of areas of our strategy development so that together all our partners can give everyone in Suffolk and North East Essex the best start in life. Rachel Heathcock East of England Local Government Association challenges parenting newborn baby birth changes life feelings hospital excitement unhealthy healthy help happy major home care sad challenges parenting newborn baby care changes life feelings hospital excitement unhealthy healthy help happy major home care sad challenges parenting newborn baby birth changes life feelings hospital excitement unhealthy healthy help happy major home care sad challenges parenting newborn baby birth changes life feelings hospital excitement unhealthy healthy help happy major home care sad challenges parenting newborn baby birth changes life feelings hospital 1 | Suffolk and North East Essex Integrated Care System Thinking Differently Together - First 1,000 Days Of Life ( We are only just getting started. We want to go further, do more and be better. If you would like to comment, feedback or get involved, please contact us at Suffolk and North East Essex Maternity Services | Lets Talk SNEE 22 | Suffolk and North East Essex Maternity Equity and Equality Narrative