We developed the Health Equity Assessment and Resource Toolkit (HEART) and Health Equity Warning Score (HEWS) to help us recognise and analyse health and social inequalities in our investigations.
Health equity analysis has been part of our investigations since October 2023. These additional resources will help us ensure that we systematically consider health equity factors in every MNSI investigation.
Across the maternity pathway, equality, diversity and health equity data consistently show that women and birthing people from an ethnic minority background, and their babies, have poorer perinatal outcomes than those from White ethnic groups. MNSI wants to build on the intelligence we have already gathered and understand the reasons for these outcomes, while exploring what prevents people’s care from being tailored to meet their individual needs. All new MNSI investigations carried out from 4 December 2024 will incorporate the new toolkit and HEWS score.
Health Equity Warning Score (HEWS)
We developed the Health Equity Warning Score (HEWS) to classify a person’s risk of experiencing barriers to health equity. It considers their protected equality characteristics along with health and social factors, which may have been a barrier to equitable care, and from this provides a ‘HEWS’ score. This helps our investigators to focus on non-clinical factors that could have an impact on a person’s care and its outcome. This score is recorded in our investigation management system and reviewed by our clinical advisory panels to explore how health equity factors can form a key line of enquiry in the investigation. It will produce a score for most people.
Health Equity Assessment and Resource Toolkit (HEART)
The Health Equity Assessment and Resource Toolkit (HEART) is an interactive PDF that highlights key information and resources. It goes beyond HEWS to provide prompts and questions in relation to a person’s protected equality characteristics and health and social determinants. HEART promotes a deeper understanding and greater perspective around the evidence and analysis of factors that affect maternity outcomes, but which have been harder to explore than clinical care.
The toolkit will help MNSI investigators by providing:
- a topic summary
- triggers to recognise health inequalities
- a question bank for family meetings
- a question bank for staff meetings
- a glossary of key terms
- a comprehensive evidence repository
- links to previous MNSI reports and safety recommendations
How we will use HEART and HEWS
These tools will allow our investigators to make safety recommendations and prompts to NHS trusts that focus on health equity to ensure that they consider personalisation in all areas of maternity care.
In the long term, using HEART and HEWS will help us collect detailed data on health and social inequalities, and identify themes to feed back into the wider system. Over time, it will enable us to retrieve meaningful data to analyse trends and identify common health equity challenges. This data is crucial for developing targeted interventions and sharing insights both locally and nationally.
Implementing HEART and HEWS puts health equity at the forefront of our maternity investigations. They will help us improve equitable care for all mothers and birthing people and their babies, while contributing to broader health equity initiatives.