In November 2006, NHS hospitals were given the green light to advertise services to the general public, with

the publication of the Department of Health (DH) marketing code. Although controversial, it was one of the first signs that health care may have to compete with the private sector for business. Within maternity services especially, competition is fierce and a marketing strategy must be considered to ensure that not only are the service users provided with information to make informed choices, but also those who influence patient choice. Already successful within maternity at identifying the needs of the consumer through continuous customer and competitor analysis, a marketing strategy will enable the focus to be directed at the different stakeholders and avoid the confusion that Kong (2008) suggests exists in the NHS, as to how marketing fits into its business model and culture. Accompanied by corporate analysis, the best services could be determined in relation to both offering quality and finance. There are benefits of marketing maternity services within the NHS. In relation to trust board stakeholders, vying for obstetric business in both the public and private sector, maternity services would look to effectively use marketing measures to reduce costs and allocate resources where needed, especially with payment by results introduced by the DH (2000) ensuring funds followed the patient. However, stakeholders in the form of consumers, primary care trusts who commission services, GPs who are responsible for referral, employees and the trust board will each have their own itinerary causing a marketing challenge for all maternity care providers. In relation to maternity services as a product, the strategy would be to demonstrate the benefit of providing a wide range of treatments, screening tests and personalised care, allowing targeting of a larger segment of the public. In promotion of the services, personal selling would be most beneficial, acknowledging the strength of word of mouth and repeat use of services when encouraging women to return for subsequent pregnancies. Ensuring all staff are on board with marketing would ensure that the corporate vision is not undermined and to this end, internal marketing is an essential component to reduce conflicting agendas between healthcare professionals and to ensure continued motivation. Successes should be communicated to all stakeholders (Owens and McGill, 1993), as verbal recommendations are important as well as visual advertisement in line with leaflets and newsletters. Representatives of the service must be aware of the image they present both in the visible sense but also in the provision of information a knowledgeable practitioner will exude confidence and appear competent in their role. Easy access to maternity services is essential in successful marketing with the utilisation of buildings already established in the community, such as childrens centres. Budgetary awareness, which includes looking at innovative ways to offer choice and easy access to midwifery care and market segmentation, will ensure that resources are utilised with maximum return. Although, in relation to quality, Kong (2008) advises that the amount of work involved in ascertaining market profiles means that some NHS organisations have a way to go in delivering a personalised service.

The marketing environment also affects maternity services. On a macro level, political changes in government have led to the budgetary restraints felt at present leading to consideration of the use of private facilities for the provision of health care by hospitals, consumers and GP practices. Pressure has also been placed on maternity services with a rise in public expectations in relation to choice, access of services and continuity of care following the publication of DH guidance such as Changing Childbirth (DH, 1993) and Maternity Matters (DH, 2007) and, in a socio-cultural context, demographics no longer play a major part in place of delivery with women choosing to travel further afield for the provision of a service that fully meets their needs. Negatively, the public perception of services can also highlight discrepancies between regions, demonstrating postcode lotteries and unfair discriminations (Chartered Institute of Marketing, 2008). In the micro-environment, the maternity unit must demonstrate to stakeholders that equipment, premises and practitioners provide the service that is required to meet the needs of the large target segment of pregnant women. This is important, as competitors not only consist of local hospitals but also birth centres, independent midwifery and private institutions with substitutes presenting themselves regularly offering a specialised service or personalised care throughout the pregnancy. In midwifery and obstetrics, marketing planning is essential in capturing changes and identifying trends, which may present favourable opportunities and in contrast to previous times, transform the public recipients of health care to become active consumers (DH, 2007). For each stakeholder, marketing will be interpreted in different ways and hold different benefits. A successful marketing strategy will result in the provision of information that is easily accessible and understood. Consumers will have the power to control services by having a say in what is offered, leading to a true patient-led service. With pregnant women involved in decisions regarding their care, should their needs not be met, they may choose to book and deliver elsewhere or be referred to another hospital by their GP, who also has the power to act as an advocate to his patient. GPs will have easier access to services and, with increased transparency, they can refer a patient to a hospital that has the highest standards of care accompanied by the lowest infection rates. Communication has already improved with internet sites providing information about individual hospitals, accompanied by published data on targets such as breastfeeding rates and normal birth, allowing women to shop around. From a staff perspective, successful marketing will demonstrate that they are delivering high-quality care which, in turn, requires self development, motivation and job satisfaction (Proctor, 2008). Maternity services have always provided woman-centred care. What is now required is the commitment to continue monitoring the different perspectives in an ever-changing environment, while ensuring a positive relationship with all of its stakeholders.

So is marketing of maternity services required? Yes, I believe so, and I feel that the development of a successful strategy will help units maintain financial sustainability, hopefully resulting in a reduction in closure and mergers, which realistically faces many institutions in the current economic climate. (http://www.rcm.org.uk/midwives/features/marketing-in-maternity/)