NHS South West London are developing a Clinically-Led Strategic Plan. The plan will be underpinned by high-quality evidence, analysis and insight, and shaped through insight and engagement with patients, the public and partners across the system. This is an opportunity to design a sustainable, effective health and care system that meets the needs of our communities now and in the future.
This will include looking at:
- understanding and predicting the future health needs of our local population in South West London
- our clinical outcomes in South West London compared to national best practice
- local operational data that shows we are performing for patients
- workforce intelligence to support frontline staff to reshape services and work in new ways
- insights from the experience of patients, local people and communities who want more control to manage their own health.
To help inform clinically-led discussions, the South West London ICB community engagement team provided an overview of insights gathered from people and communities on the following areas:
1. Frailty
2. Maternity and neonatal
3. Mental health
4. Planned specialist care (end-to-end care from outpatients to intervention)
5. Long term conditions
6. End of life care
A series of clinically-led workshops are bringing together partners to discuss each area, between October and early 2026. This insight on what matters most for communities was presented at the beginning of each specialist workshop.
What we did
The South West London community engagement team undertook a desk top literature review of insight for each of the specialist clinical areas each workshop is focusing on, pulling out key themes from multiple insight sources to show ‘what matters most to people and communities’.
We started by mapping sources of local existing insight for each area, drawing on reports from partners locally and relevant regional and national reports. A nominated member of the team was responsible for coding and theming the insight for each topic – pulling out the consistent and frequent themes. All the reports we analysed are included in the reference section of ‘Sources of insight’ for each clinical area.
Insight from people and communities
Themes we have heard about maternity and neonatal care
Information and informed choice
- People reported a lack of clear, accessible information during pregnancy, labour and after birth, leading to confusion and difficulty making informed decisions. For example, not being adequately informed about the possibility of a c-section or the delivery process in advance or having information about staying healthy during pregnancy.
- “Give options about where I will be able to get advice and additional support for the services available to me.”
- “I would have liked to have known about problems with breastfeeding, how the milk comes in and latching. I would have liked awareness that breast feeding doesn’t come easily.”
- Some people reported being told what to do rather than being given the opportunity to discuss choices with clinicians, feeling overlooked and not involved in bedside discussions and decisions.
- People would like to see more choice included throughout the patient journey, not just choice about which hospital to give birth in.
- “Support my choices, whether it’s for a home birth or my choice of pain relief. Respecting my decisions empowers me.“
- “What is key is that choice can be offered at latter stage but may have to be altered due to problems that may occur within childbirth and all mothers, fathers and family members, who are birthing partners, should be made aware of what precautionary measures, may have to be put in place or taken.”
Mental health and emotional support needs
- Emotional wellbeing was sometimes overlooked by staff with a lack of signposting or superficial responses, for example being just given leaflets rather than further discussion or support.
- Some people were unsure how to access support and would have liked more information earlier on in pregnancy.
- There is still stigma around talking about mental health in some communities, health and care professionals having a greater understanding of potential cultural sensitives may mean they can better inform and support patients during and after pregnancy.
- People value peer support groups and for these to be available before and after giving birth.
- “I told my health visitor about feeling detached from my baby but just being given a leaflet. The health visitor promised a return visit and counselling support but never got back in contact.”
- “Educate support staff to handle difficult conversations with emotional intelligence. This includes using the right tone of voice and being transparent in interactions.”
- “I think it would be nice if we could see new mums together, have some sort of coffee mornings together as new mums, just speaking about our different experiences – that makes it feel like you’re not alone.”
Continuity of care
- Continuity of care is highly valued but often lacking with people having different midwives and healthcare professionals involved throughout their pregnancy; causing stress, anxiety, inconsistent advice and missed information. This can create barriers to building trusting relationships with healthcare professionals.
- “It’s nice that you have the same midwife/nurse because it makes a big difference. I was very nervous, lots of people telling me different things but my midwife reassured me and informed me of choices.”
- “I saw a different midwife every time, repeating myself over and over, creating unnecessary anxiety and too much different advice which I found hard to sift through.”
- “I had to keep explaining again and they did not know me and did not see or understand the progress of me and baby.”
Not being listened to or believed
- Many people who took part in engagement, particularly Black and Asian women, describe being dismissed or their voices ignored during pregnancy, labour, or postnatal care. People feel they need to be assertive, to “stand up for themselves” to make sure they were being treated fairly and believed by professionals.
- “It was just a bit frustrating really trying to advocate and say, no, I really am very far along and just not being believed.”
- “Some participants talked about not feeling listened to, having their concerns dismissed or feeling like they were on a “conveyor belt”.”
- “When I mentioned to one midwife at the end of pregnancy that I was struggling she wasn’t really listening and wrote in my notes that I was doing well. I came away feeling like I didn’t matter.”
Experiences of racism, bias and cultural insensitivity
- Black and Asian women in particular highlighted experiences of racial and unconscious bias, stereotyping or neglect, from antenatal appointments, birth and through to postnatal care. They described notes not being read, plans not being followed, and having to push to be believed, especially when in pain or distress. This led to fear and mistrust of services and increasing the need to advocate strongly for themselves to get safe and respectful care.
- Experience of language barriers and the need for healthcare professionals to show sensitivity and patience when supporting a patient for whom English is a second language.
- “Assumptions about my background or medical understanding should not be made. Cultural competency and seeing things from my perspective can greatly enhance my care experience.“
- “I realised the interaction and education they give to the White people was different. They were calm, friendly and helped them laugh, but when they approached me, they were very straightforward. More like in a rush to leave.”
- “The health visitor said in Africa they let their women die, so it was lucky I had the care I did in the UK.”
Postnatal support
- People described postnatal care as rushed or insufficient, with limited follow-up visits and inadequate breastfeeding or mental health support.
- “Afterwards, when you’ve given birth it can feel a little lonely… I was so depressed and I wanted a healthcare worker to speak to. I wanted reassurance, I was ill and tired and low, and having someone to speak to properly would have really helped.”
- “More focus on breastfeeding support for all mothers, both at home and at community hubs, often breastfeeding mothers who are struggling with breastfeeding have other mental health concerns and it can be a struggle to get out of the house, so more home visits from HCPs with lactation support qualifications, get more health visitors qualified in giving breastfeeding support and perinatal mental health”
- The importance of having post natal care delivered by health care professionals who understand cultural sensitivities and lived experiences of new parents.
- Some people described difficult births and problems when returning home with a new baby or the emotional impact of miscarriage. It was felt that early emotional or low-level mental health support could make a positive difference.
- People found they were given less support for second babies on the assumption that parents did not need it which could lead to health issues being overlooked.
Digital care – apps to support pregnancy and postnatal care
- There was interest in apps to provide trusted information, reminders, and community support. Value seen in functions such as reminders for pelvic floor exercises, access to clear trusted health information and patient notes, links to local support groups, and space for peer support.
- Digital platforms and apps that are accessible and personalised to complement existing care, not replace face-to-face support.
- “Having an app would put my notes in one place and accessible to maternity services.”
- “Information should be accessible to everyone. I appreciate an NHS website that includes an accessibility bar for language translation.”
Five x more Black maternity experiences report
An extract from the executive summary of the national report – Five x more Black maternity experiences report: Continuing the conversation on Black maternal care in the UK (2025)
What the evidence tells us?
Despite recent campaigning and rising political attention, the lived reality for Black women accessing maternity care in the UK has not fundamentally changed. Racism, both structural and interpersonal, continues to shape Black women’s maternity experiences. On top of this, poor communication, lack of empathy and unequal power dynamics leave Black women feeling unsupported and unsafe.
What has changed, however, is Black women themselves. More are entering maternity care informed and ready to advocate – though we note that self-advocacy is more often a survival mechanism, not a sign of progress. When women feel they must fight to be heard or believe they need to prepare for biased assumptions before even arriving at hospital, the system is failing them.
Reassuringly, we saw that personalised, compassionate care can make a tangible difference. Black women who received this kind of care remembered it and felt safer because of it, highlighting that high-quality, respectful care is not only possible but is already happening in some places. What is needed now is for this type of care to be the norm, not the exception.
Importantly, this report serves as a clear reminder that privilege does not shield Black women from poor or harmful maternity care. Specifically, our findings challenge the notion that income, education, or language fluency are protective: many of the experiences described in this work are those of highly educated, native-English speaking women in employment. When racial inequity is embedded in the system, social and economic privilege is not enough to ensure safe or respectful care.
Improved care for Black women requires real accountability and investment in the workforce as a core component of safety in maternity care. Until then, Black women will continue to carry the burden of keeping themselves safe in a system that too often overlooks or devalues their needs.
Sources of insight
These are the reports we have used in this summary of insights around maternity and neonatal care. We have used reports from our South West London insight bankdrawn together from engagement work across South West London including from our Healthwatch and voluntary and community sector partners:
- People’s experiences of maternity services in the London Borough of Sutton (2025) Healthwatch Sutton – interviews and conversations with 34 people
- Service user experiences of perinatal mental health services in Croydon (2019) Healthwatch Croydon – experiences of 77 new mothers and their partners’ about maternity, pregnancy care related areas using a survey. Healthcare professionals were also spoken to, to gather their views on perinatal mental health services.
- Epsom & St Helier Whose Shoes? Event report (2024) – 30 participants (not yet published)
- Perinatal mental health experiences of our diverse borough (2023) Healthwatch Wandsworth – experiences of 13 birthing parents, who had given birth since 2020 including population groups from Africa, the Caribbean, Middle East, South Asia and South America
- Experiences of perinatal mental health services (2021) Healthwatch Wandsworth – 64 participants, general experience of mental health during perinatal period.
- Maternity stories: A deep dive into the maternity journeys of 10 women of Black and Asian ethnicities (2022) SWL Maternity Voices Partnership – 10 women (not yet published)
- Five x more Black maternity experiences report: Continuing the conversation on Black maternal care in the UK (2025) – 845 responses from women
- Grants programmes in winter 2023/24, winter 2024/25 and spring 2025 – partnering with VCSE sector to gather insight from communities disproportionately impacted by health inequalities and most likely to experience the worst health outcomes
- Developing an Anti-Racist Health and Care System: Community insight from South West London (October 2025) – Kingston Race Equalities Council report which includes key patient and public experience insights from global majority communities including stereo-typing, discrimination, religious and cultural needs not being respected – 887 people through various engagement activities
- 10 year health plan engagement (January 2025) – around the NHS 10-year plan 3 shifts and key themes from local analysis of engagement reports in 2023/24 – 80 community and voluntary sector leaders
- Insight from local people and communities in South West London updated in 2024 (March 2025) – summarises the insight from people and communities in 2023-24 submitted by Healthwatch organisations, voluntary and community sector organisations, NHS Trusts, local councils, and Place-based public and patient engagement teams – examining 300 reports from various sources
- Our five-year plan for the NHS in South West London. A Joint forward plan 2023-2028 (July 2023) – patient and public insights against the priorities in the plan based on the engagement activities in April to May 2023.
- Joint Forward Plan – Our engagement with people and communities, April to May 2023 (June 2023) – engagement on the first phase of the NHS Joint Forward Plan published in March 2023, focusing on populations and geographies identified through the gap analysis of our insight from people and communities review – 1,446 responses to the survey, 187 people in focus groups and one-to-one interviews