The principles of Personalised Care and Support Planning (PCSP) have been embedded in maternity transformation in the NHS. Jennifer Pountain, Community Midwife for Cheadle and Bramhall, Visiting lecturer in Public Health, University of Salford and previous Population Health Fellow NHSE, challenges us to address health literacy as an aspect of public health and PCSP going forward.
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In 2021, NHS England (NHSE) published personalised care and support guidance to assist all Local Maternity and Neonatal Systems (LMNS) to improve the safety of care and choice 1. This followed the NHS Long Term Plan, which recognises informed decision making as the cornerstone to providing personalised and safe care universal to all 2; in essence, creating a more equitable maternity service personalised to individualistic needs.
In the wake of a series devastating reports, including the Ockenden 2022 review of The Shrewsbury and Telford NHS trust, the lack of personalised care and support planning (PCSP) was found to have been a confounding factor in poor maternity care 3.  For example, the review recommended that, to provide safe and individualised care, PCSP must underpin and provide the foundations in a woman’s pregnancy and birth journey 3.  Maternity care is chronically risk adverse, funded through acute secondary settings; despite this the continued failings and poor care outcomes persist. Hence, maternity care must reconfigure. Indeed, Lord Darzi’s recent independent investigation of the NHS in England, discussed the ‘power of prevention’ in improving maternity care, noting maternity services as a key area of concern within the NHS 4.    Therefore, to deliver an equitable, safe maternity service health literacy and empowerment, the foundation of public health, is the future to improving maternal and neonatal outcomes.
What is health literacy?
The World Health Organization (WHO) defines health literacy as the ability to empower individuals to gain access to information and understanding which promotes good health wellbeing 5. Health literacy is more than understanding a health promotion leaflet or making an appointment, health literacy is much more. To be health literate is also a means of driving optimal population, community and family health 5. Mobilising change to tackle the social determinants of health, therefore is a collective act, not just framed as a sole person’s responsibility, but a government and health systems obligation to acknowledge and ensure equitable policy planning and care.
Maternal health literacy
Globally, WHO declare health literacy and health empowerment as the pivotal components of providing maternity care 6. A growing body of evidence definitively highlights a strong correlation between maternal health literacy and positive health outcomes. For example, a qualitative study focusing on maternal higher weight found that health literacy in pregnancy translated into personalised healthy behaviour, also benefiting the most vulnerable women and families 7.  Moreover, maternal health literacy enables the provider to incorporate an understanding of cognitive and social skills to empower women to access, utilise and evaluate guidance that’s personalised; to improve maternal, neonatal and early year’s health 8.
What is Personalised Care and Support Planning?
PCSP in maternity is a holistic assessment of women’s health and wellbeing prerequisites 1. Guided by the principles of health literacy, the woman collaborates with health professionals to produce a care plan stipulating their decisions and care choices. PCSP are in essence the facilitation of informed conversations 1, so to aid the exploration of own health and wellbeing in the protection of safe and equitable care delivery.
There are 5 strategic guiding principles to ensure the success of delivery. These include:
- Women as central to PCSP, including decisions on who is involved in their care.
- Proactive conversations including focus on the wider determinants and care that matters to them.
- A collective agreement of health and wellbeing outcomes.
- All women have a PCSP that is structured and shareable within the service.
- The ability to be able to formally and informally review their PCSP 1.
Moreover, PCSP are to ensure the inclusion of equality and diversity, with a mandate to include ethnicity, age, and social determinants of health, including economic, digital exclusion and literate considerations 1. Additionally, there is recognition of need for staff to receive support and training in cultural competencies and the risks of unconscious bias 1.
How will PCSP increase health literacy and improve care?
PCSP implementation is encouraging and rejuvenating in a system that acknowledges the necessity of personalised care, yet continues to follow extensive un-personalised policy to drive the majority of maternity care.
However, guidance for PCSP was introduced by NHSE in 2021, therefore it is acceptable to expect to see variances in whether PCSP has been implemented effectively, versus the effect on maternal and neonatal outcomes; however this data is sparse. It is also fair to surmise that the depletion of midwifery workforce in an ever-growing complex care system may be proving difficult in implementing and evaluating PCSP model of care. Moreover, CNST policies are forefront of many maternity providers obligations, potentially shadowing PCSP implementation.
The evidence is overwhelmingly clear, health literacy positively affects maternal and neonatal health. As such PCSP has to be the future of the maternity care we provide, as important as other maternity policies; in the pursuance to provide safe and effective care. PCSP however goes a step further, it incorporates public health theory, with a vital emphasis on those wider determinants of health that prove time and again the detrimental and lifelong affects it has on our populations health.
References
- (2021). Personalised care and support planning guidance: Guidance for local maternity systems. In Personalised Care and Support Planning Guidance: Guidance for Local Maternity Systems. https://www.england.nhs.uk/wp-content/uploads/2021/03/B0423-personalised-care-and-support-planning-guidance-for-lms.pdf.
- NHS England. Â NHS Long Term Plan. https://www.england.nhs.uk/long-term-plan/
- Donna Ockenden. (2022). OCKENDEN REPORT – FINAL. In Honourable the House of Commons [Report]. House of Commons. https://www.ockendenmaternityreview.org.uk/wp-content/uploads/2022/03/FINAL_INDEPENDENT_MATERNITY_REVIEW_OF_MATERNITY_SERVICES_REPORT.pdf.
- Darzi, R. Hon. P. T., OM KBE FRS FMedSci HonFREng. (2024). Independent investigation of the National Health Service in England. https://assets.publishing.service.gov.uk/media/66f42ae630536cb92748271f/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England-Updated-25-September.pdf.
- Health literacy. https://www.who.int/teams/health-promotion/enhanced-wellbeing/ninth-global-conference/health-literacy.
- World Health Organization. New insights into quality of care for girls and women facing the complications of unsafe abortion. 2022; Available from: https://www.who.int/news/item/26-01-2022-new-insights-into-quality-of-care-for-girls-and-women-facing-the-complications-of-unsafe-abortion.
- Meldgaard, M., Jensen, A. L., Johansen, A. D., Maimburg, R. D., & Maindal, H. T. (2022). Health literacy and related behaviour among pregnant women with obesity: a qualitative interpretive description study. BMC Pregnancy and Childbirth, 22(1). https://doi.org/10.1186/s12884-022-05023-0.
- Tavananezhad, N., Bolbanabad, A. M., Ghelichkhani, F., Effati-Daryani, F., & Mirghafourvand, M. (2022). The relationship between health literacy and empowerment in pregnant women: a cross-sectional study. BMC Pregnancy and Childbirth, 22(1). https://doi.org/10.1186/s12884-022-04686-z.
Jennifer Pountain
Community Midwife for Cheadle and Bramhall; Visiting lecturer in Public Health, University of Salford;previous Population Health Fellow NHSE
October 2024