Maternity safety: where does the withdrawal of national service development funding leave us?

National guidance for Integrated Care Boards (ICBs) has recently been changed to remove ringfencing of funding for several national service developments.1 The change is intended to reduce the burden of demands on ICBs from NHS England, enabling ICBs greater freedom to spend their budget according to local priorities.3 The funding for maternity safety initiatives set out in the “Three year delivery plan for maternity and neonatal services” (published by the NHS in March 2023) is included in the change.2 Maternity safety remains a headline focus in the NHS England documentation,3 but the new analysis of the updated guidance has led to concerns being raised by professional and third sector organisations about the potential implications of the removal of ringfenced funding for women and families, including possible exacerbation of inequalities in outcomes.4

In the context of this move away from mandated funding, we should consider whether ICBs are aware of the impact of maternity initiatives so that they can be prioritised in future planning. Developing new services, in response to safety concerns, must be based on evidence. However, the evidence underpinning safety recommendations can be unclear. At the very least, it is essential to embed evaluation of outcomes into service developments—whether funding is ringfenced or not.

Evaluation of the outcomes of the change in services enables local and national policymakers to allocate future funding according to the benefits and cost of different interventions, based on population needs. But it remains uncommon to plan robust evaluations ahead of service developments. Retrospective evaluations might be carried out, but their quality is limited by a lack of routinely available data and/or burdensome manual data collection.5 It is unclear to me why we spend millions of pounds on new service developments without the same evaluative rigour we apply to research innovations.

Robust evaluation of the success of service developments cannot be carried out if new services are only in place short term, or have only been in operation for a brief time. Withdrawal of ringfenced funding could limit our ability to evaluate the true impact of these existing national service developments on maternity safety if ICBs choose to withdraw funding from them.

One of the headline initiatives included in the ringfenced safety funding was the development of Maternity and Neonatal Senior Independent Advocates.2 An evaluation of the 2023-24 pilot programme will be available in June 2025—clearly too late to be used by ICBs for 2025-26 financial year planning.6 When new service developments are launched, the evaluation of their impact must be performed promptly to inform future funding.

Mandated service developments could be implemented very differently around the country, despite a national specification. This makes evaluation even more difficult because the services can vary widely on a local basis. An example of this is the implementation of maternal medicine networks, another initiative no longer supported by national service development funding in the 2025/26 guidance. The network specification includes suggested levels of care for women with different conditions,7 but these can be adapted locally. In practice, the plans for which groups of women are cared for at different levels of the network in each region in England have been modified based on a variety of factors. The postcode lottery of care therefore continued—despite the national funding. The removal of ringfenced funding has the potential to make these variations in care more pronounced. We must acknowledge that differences already exist in the presence of the national service development funding because of these local adaptations.

So, am I concerned about our progress towards improving maternity safety in the light of these changes? I feel it is undoubtedly a risk, but it is too soon to judge. If evaluations of maternity safety initiatives are carried out, and ICBs assess the evidence for what works and equitably prioritise the lives of pregnant women and babies alongside other patient groups, then the answer should be no. However, with 42 ICBs and stretched funding rarely being prioritised for the health of pregnant women and postpartum women, then the answer could be yes. We need to ensure that we have the systems in place to capture, link, analyse, and display electronic data and that staff are trained to respond to safety signals and to identify and act on concerning trends as soon as they occur.8 Evaluation of changes underpinned by robust data are essential to ensure continuing improvements in maternity safety.