Lethbridge, Jane ORCID: 0000-0002-0094-9967 (2022) What are the barriers to improving public value – the case of maternity services in England? In: European Group for Public Administration Annual Congress 2022, 7-9 September 2022, Lisbon. (Unpublished)

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Abstract

Benington (2009) identified front-line public service organisations, where public professionals interact with service users, citizens and communities, as one of the main places where public value is created. As a way of exploring some of the challenges in trying to improve public value, this paper will use a case study of the crisis in maternity services in England, as seen through the reports of two enquiries (Morecambe Bay NHS Trust and Shrewsbury and Telford NHS Trust) and the responses to these reports by midwives, managers, politicians, women and their families.

There are several reasons why a study of the crisis in maternity services in England is useful for trying to understand some of the barriers for public professionals in delivering public value. In the last 20 years, there has been a move away from medical interventions to a natural birth approach, due to demands made by women’s campaigning groups in the 1980s and 1990s. Health professionals have had to respond to these demands. At the same time, the National Health Service (NHS) adopted public management reforms with the introduction of targets, increased use of evidence-based medicine to determine clinical practice, accompanied by budgetary pressures. These changes have brought politicians, managers and health professionals into uneasy alliances, all working towards slightly different versions of public value. Maternity services are significantly different to other health care services because women are not technically ill, although there are elements of risk involved in giving birth. This generates conflicts about how to deliver the public value of maternity services. The concepts of risk and uncertainty will be used as a theoretical basis for this paper.

Since 2015, there have been two public enquiries into the delivery of maternity services in two NHS hospital Trusts. Further inquiries into two other hospitals are currently underway. The recommendations of the first two enquiries were similar: the importance of safe staffing, training, an organisational culture to reflect on practice, and the importance of listening to women and families. This paper will examine how these recommendations can inform improvements and professionalisation and what political and professional barriers exist.

Benington J. (2009) Creating the Public In Order to Create Public Value International Journal of Public Administration 32:232-249
Benington (2009) identified front-line public service organisations, where public professionals interact with service users, citizens and communities, as one of the main places where public value is created. As a way of exploring some of the challenges in trying to improve public value, this paper will use a case study of the crisis in maternity services in England, as seen through the reports of two enquiries (Morecambe Bay NHS Trust and Shrewsbury and Telford NHS Trust) and the responses to these reports by midwives, managers, politicians, women and their families.

There are several reasons why a study of the crisis in maternity services in England is useful for trying to understand some of the barriers for public professionals in delivering public value. In the last 20 years, there has been a move away from medical interventions to a natural birth approach, due to demands made by women’s campaigning groups in the 1980s and 1990s. Health professionals have had to respond to these demands. At the same time, the National Health Service (NHS) adopted public management reforms with the introduction of targets, increased use of evidence-based medicine to determine clinical practice, accompanied by budgetary pressures. These changes have brought politicians, managers and health professionals into uneasy alliances, all working towards slightly different versions of public value. Maternity services are significantly different to other health care services because women are not technically ill, although there are elements of risk involved in giving birth. This generates conflicts about how to deliver the public value of maternity services. The concepts of risk and uncertainty will be used as a theoretical basis for this paper.

Since 2015, there have been two public enquiries into the delivery of maternity services in two NHS hospital Trusts. Further inquiries into two other hospitals are currently underway. The recommendations of the first two enquiries were similar: the importance of safe staffing, training, an organisational culture to reflect on practice, and the importance of listening to women and families. This paper will examine how these recommendations can inform improvements and professionalisation and what political and professional barriers exist.

Benington J. (2009) Creating the Public In Order to Create Public Value International Journal of Public Administration 32:232-249

Item Type:	Conference or Conference Paper (Paper)
Uncontrolled Keywords:	public values, maternity services, health care policy, professionals
Subjects:	H Social Sciences > H Social Sciences (General)
Faculty / School / Research Centre / Research Group:	Faculty of Business > Centre for Work and Employment Research (CREW) > Public Services International Research Unit (PSIRU) Faculty of Business Faculty of Business > Centre for Work and Employment Research (CREW)
Last Modified:	25 Apr 2023 06:48
URI:	http://gala.gre.ac.uk/id/eprint/41759

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