Paper short abstract:

This paper explores doing healthcare reform in the NHS, through ethnographic research on the implementation of a quality improvement framework in English midwifery care. We look at what is (re)done in the process, as well as what is left undone and consequences of reform procedures.

Paper long abstract:

In recent years, England’s maternity services have been facing a reckoning – high-profile national inquiry reports into failings in care, stark inequalities in outcomes among women and their babies and acute staffing shortages – leading to calls for reform. Improvement now focuses on quality and safety, underpinned by national health policy to facilitate choice and compassionate, respectful care.

Maternity services in the National Health Service (NHS) are primarily provided by midwives, including intrapartum and birth care. Choice in place of birth in England includes settings that are midwifery-led, called ‘midwifery units’ (or ‘birth centres’). Midwifery units confer benefits for women, birthing people and their babies and are associated with improved outcomes. However, they too face questions of safety and viability as a birthplace option and, as part of the wider healthcare service, requirements to reform in line with national improvement initiatives.

We undertook ethnographic research on the regional implementation of a quality improvement framework for midwifery units and, through this lens, explore doing healthcare reform work in the NHS. We look at what is (re)done in the process, as well as what is left undone. Our discussion touches on redefining philosophies of care and midwifery as a profession in more holistic terms but also the “social consequences” of reform and assessment procedures (Strathern, 2000) and entanglements with the ‘heavy’ bureaucracy of the NHS. Finally, we consider how healthcare change in England might be done against the backdrop of ongoing challenges and with shifting notions of safety and wellbeing.