Evaluating a new Maternal Mental Health service in BNSSG

The NHS Long Term Plan (2019) committed to providing specialist Maternal Mental Health services for women experiencing moderate to severe or complex mental health difficulties directly arising from, or related to, their maternity experience. This may include those who experience post-traumatic stress disorder following birth trauma, perinatal loss, or severe fear of childbirth (tokophobia).

The service for Bristol, North Somerset and South Gloucestershire (BNSSG) is called the Maternal Loss and Trauma service (MaLT). It is led by the Avon and Wiltshire Mental Health Partnership NHS Trust (AWP), with clinical support from maternity services in University Hospitals Bristol & Weston NHS Foundation Trust (UHBW) and North Bristol NHS Trust (NBT), and a holistic peer support element, also coordinated by AWP.

A national evaluation of Maternal Mental Health services is planned, and in BNSSG it was decided to complement this with a local evaluation to explore specific aspects of the MaLT service; the service structure and staff skill mix.

The Clinical Effectiveness team’s impact

Funding was made available to procure an external evaluation of the MaLT service. The BNSSG Integrated Care Board (ICB) Clinical Effectiveness team supported the procurement process by:

• Scoping the evaluation with the ICB Perinatal Mental Health contract lead
• Defining the evaluation questions, suggesting appropriate outcome measures and drafting an initial evaluation plan
• Revising and finalising the evaluation plan according to ongoing discussions with the project team
• Supporting the procurement of an independent evaluation; sharing costings, reviewing and editing the evaluation tender, drafting and promoting an evaluation brief, working with the project team to appoint an independent evaluator

The Clinical Effectiveness Team worked with the ICB Perinatal Mental Health contract lead to navigate some challenges along the way, including substantial personnel changes within the project team and a reduction in the tender limit which required negotiation with system leaders to secure a waiver in order to continue with the procurement process. But these navigations were successful and in August 2023 an independent evaluator was appointed to deliver an evaluation that will explore the impact of the MaLT Service as it is structured in BNSSG, and contribute to the local and wider evidence base on staff/skill mix in service delivery. This report will be available by April 2025, and the Clinical Effectiveness Team will provide ongoing support to ensure that the report meets the needs of local decision-makers, to inform the future of the MaLT service in BNSSG.