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The Importance of Supportive Commissioning and Leadership Locally
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Recommendation 1 Foster Supportive Leadership at ICB and Trust-level Supportive leadership from both Commissioners and Trust managers is vital to mitigate barriers to setting up and maintaining a consistent service, and to ensure that the necessary resource and capacity is secured. It is important to demonstrate how essential a PPC service is via a strong business case to obtain leadership buy-in. This report aims to provide resource for the business case, and the companion report will be helpful in influencing policy makers Services must be supported through effective commissioning and provider training to ensure all methods, including LARC, are available. 29
“Strong leadership is essential to drive service improvements and advocate for necessary resources. Obstacles include limited budget, staff capacity, and the need for continuous advocacy to maintain support for the service” Public Health Principal, Portsmouth The strong consensus from contributors is that ICB and hospital Trust-level senior leadership is essential when developing and sustaining a PPC service, particularly to mitigate the various barriers involved with setting up and maintaining an offer of PPC consistently to women. The PPC service in South Tees emphasised how strong top-down leadership is vital for culture change to happen: “…we need top-down passion for post-natal contraception, in addition to the few of us that are passionate on the floor”. Consultant Obstetrician, South Tees In Liverpool, PPC was supported by leaders locally through the inclusion of the integration of contraception provision into the maternity pathway as a key action in the Liverpool Sexual & Reproductive Health Strategy (2024-2030) : “The local authority supported and funded the LARC pathway and devices, with the ICB/NHS picking up the cost of routine
The Importance of a Contraceptive Champion
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Contributors spoke about the importance of a Contraception Champion within the service to drive forward progress locally. This is often on a maternity ward, as discovered by research in NHS Lothian, Scotland: “Contraceptive Champions are hospital and community midwives in NHS Lothian trained to advise women on postnatal contraceptive methods.” 30 In Greater Manchester, the Public Health Matron within the midwifery team has played a pivotal role in facilitating the PPC pilot project: “The dedicated time and input from this position [of the Public Health Matron] have been essential to its progress, and the work would have been significantly more challenging without it. And it is recognised, that not all Trusts have access to this role.” Public Health Strategy Manager, Salford City Council In addition to midwifery staff, it is also vital to have other staff championing PPC, as services in South Tees and Bedfordshire outlined: “Clinical leadership and advocacy within midwifery and consultant level is key. We had consultant leads in both of our Trusts championing the pathways and developing the standard operating protocols which helped with leadership within the Trusts.” Commissioner, Bedfordshire, Luton and Milton Keynes ICB Due to their passion to provide PPC, many staff were doing this work in addition to their already demanding workloads. However,
contraception.” Commissioner, Liverpool
Gloucestershire also secured local authority funding for PPC, which proved vital to establishing a sustainable service: “This funding mechanism has ensured sustainability post-pilot and allowed the service to grow in reach and consistency
across Gloucestershire.” Specialist Midwife, Gloucestershire
The importance of supportive leadership ‘from higher up’ was clear from contributions to this report and suggests that Government providing this support nationally could deliver huge transformational change to PPC provision across the country.
29 NHS England. Principles for commissioning abortion services. 30 Gallimore A, Craig A, Cameron S, et al. Developing the role of midwives as ‘contraceptive champions’ to support early access to effective postnatal contraception for women. BMJ Sex Reprod Health 2019; 45:309-312.
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