Shared learning database

NHS Plymouth
Published date:
October 2012

The Plymouth volunteer breastfeeding peer support service has grown in size, quality, accessibility and effectiveness since its inception in 2003. The volunteer service has adapted to meet the needs of mothers and families from different socio-economic and cultural backgrounds. Delivered in partnership with midwifery, health visitors, children's centres and volunteers, the peer support service can engage with women during both the antenatal and postnatal period.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of the breastfeeding peer support project is to increase breastfeeding initiation and duration rates amongst all women across the City of Plymouth, with increased activity in targeted areas to address health inequalities. The service will remain flexible to meet the needs of all women and their supporters (partners/grandparents). This is achieved by providing practical support and information on various days and times (inc weekends and evenings), in various locations (children's centres, maternity unit, groups, telephone and shopping areas), in various formats (face to face, telephone, 1:1, literature, facebook, website)by women who are peers within their community.

Reasons for implementing your project

Plymouth breastfeeding rates are below the national average for both initiation and at 6-8 weeks. As a Public health priority, work was undertaken to monitor rates at locality level. This was compared to the National patterns and a robust evidence base which consistantly shows that women from the most deprived areas, with poor educational attainment, under 25yrs, are least likely to breastfeed. Infants born within areas of deprivation are likely to experience more ill health and inequalities than their counterparts in the least deprived areas. Research has provided evidence that an increase in breastfeeding rates, offers huge potential saving to the NHS in reduced treatment costs from childhood illnesses such as gastro-enteritis, otitis media, respiratory infections and necrotising enterocolitis. Many women do not access "formal" services or do not wish to engage with them.

NICE guidance PH11 sited peer support as an effective intervention, which should be offered with 48 hrs of delivery, with ongoing access dependant on a mothers needs. Peer support training began in Plymouth in 2003 with a training programme delivered by local healthcare practitioners. A breastfeeding group was set up in a local supermarket, offering accessibility through free buses,non-stigmatising and within walking distance of the target community. Now, 10 years into this project, there are 14 groups across the City. Peer support training is fully accredited through the Open College Network and there is a substantiated peer support mentor post. The volunteers make contact with women during their pregnancy, following delivery of their baby, on the maternity unit, on the Neonatal unit and in various community settings. Stakeholders are involved in service development through network meetings, online forums, and a multi-agency steering group. Plymouth implemented a breastfeeding strategy in 2007 with partnerships forged across local authority, commerce, businesses, healthcare providers, education and voluntary sector. The strategy and DoH directives have enabled us to implement robust data collection systems, these provide evidence of increased breastfeeding rates. parent surveys and evaluations have provided positive responses, increased knowledge about breastfeeding benefits and improved practical skills to sustain breastfeeding.

How did you implement the project

NHS Plymouth are committed to achieving UNICEF baby friendly initiative (BFI) accreditation in the community and maternity unit by early 2013. PH11 NICE guidance has been integral to this process. Both BFI and PH11 identified peer support (in conjunction with other standards) as an effective intervention to help mothers sustain breastfeeding. Although peer support was already established in Plymouth, it was apparent that quality assurance measures needed to be implemented. The strategic group overseeing this programme identified a number of areas to address based on NICE guidance, which incorporated audit, governance, accreditation and quality assurance. Through the strategic group measures were put in place with a strong emphasis on partnership working and user involvement. Local Children's centres adhered to quality measures required by OFSTED, to enable effective development of their peer support volunteers. This included a robust data base of health and safety checks, as well as opportunities for personal development. Public Health submitted a business case to appoint a peer support mentor, who would be a point of contact for volunteers and maintain communication networks. The spread of groups across the City needed careful monitoring to ensure that standards were maintained and that there was equity of service for all women. The strategic group developed a terms of reference with contribution and ownership from all agencies involved. Focus turned to quality assuring the peer support training programme, which required a revision of the existing training. New resources were developed to reflect learning outcomes and an internal verifier trained. In 2011 NHS Plymouth became an accredited OCN traning centre. An annual programme of audit was implemented to identify skills and knowledge gaps for all staff and volunteers. The training needs and updates are delivered through a series of network events and are tailored to meet any skills or knowledge deficits. The value of providing peer supporters with the opportunity to network brought added value through shared experiences, skills, reflection and opportunities. This has been developed further through a social network site, which attracts regular positive attention and feedback. Implementing peer support has incurred some recrurrent costs for accreditation,the mentor post and training resources. However the strong emphasis on partnership working has allowed some of the expenditure to be shared.

Key findings

By adopting NICE guidance PH11, alongside the structured BFI process, we have seen a growth in breastfeeding support groups across the City of Plymouth. Pregnant women and new mothers have greater access to information and skilled practitioners. The "Latch-on" groups have been intergrated within the Children's centres delivery programmes.The quality of the groups and peer support volunteers is widely acknowledged, which has enhanced their reputation for offering reliable, consistant and friendly support. Healthcare practitioners facilitate and endorse the groups during their "patient" contacts, which gives them additional credibility. The peer support service compliments other targeted interventions and allows for "mother and baby focused" managment of conditions also requiring medical support i.e mastitis, thrush or tongue tie. Early intervention and careful managment by skilled practitioners reduces subsequent visits to the GP. The involvement of peer support during the antenatal education programme, has given women continuity and help to overcome some perceived barriers, and demystify access to groups. The data collection systems have enabled us to monitor attendance, interventions, satisfaction, and breastfeeding outcomes. Our locality data can be mapped against the Children centre's catchment to monitor 6-8 week rates. The 6-8 wk rates for 2010/11 were 34.6%, which is still below the National average. However with increased coordinated activity alongside the BFI work programme, this figure has risen to 36.6% for 2011/12. A similar increase has been observed with the inititiation rates which rose by 1.7% over the same period. As the groups form part of the early years service delivered by children centres, there have also been case studies and qualitative evaluation produced as part of their wider self assessment framework. Our evaluations have provided consistant positive feedback from parents, with phrases such as "empowered", "would not of continued" "supported" "encouraged" "reassured" and "Kept me going" being regularly used. The added value of this project has been to empower peer supporters with increased skills, knowledge and confidence. The recruitment and retention rates are high, with 6 volunteers pursuing a career in midwifery! Many women who have been inspired by attending the groups, subsequently train to become peer supporters themselves

Key learning points

It is important to engage with key stakeholders as early as possible. The vision of a service can be idealistic, so may require compromise to meet the needs of all partners. There needs to be attention to the systems which allow for monitoring and evaluation, such as data collection and audit. If data needs to be shared, consideration needs to be given to policies and agreement processes. Voluntary services need to have attention given to detail, with contingency plans/processes in place for all outcomes. Volunteers are not paid, so don't have unrealistic expectations of them, they need support, personal development and to be valued like all practitioners. Develop a steering group who can monitor and influence service design. Be clear about your reporting mechanisms and lines of accountability for everyone involved in the project delivery. A clear terms of reference enables all stakeholders to specify their level of commitment. Share the successes, partners deserve recognition for their contribution to the project. Share the learning, hindsight is a wonderful thing!

Contact details

Jan Potter
Plymouth breastfeeding coordinator
NHS Plymouth

Is the example industry-sponsored in any way?