Maternity Matters Choice, Access and Continuity of Care in a Safe Service

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Maternity MattersChoice, Access and Continuity
of Care in a Safe Service

• Caroline Donovan
• Deputy Head of Workforce Development
• West Midlands Workforce Deanery

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Purpose and aims of today

• An opportunity to hear the key workforce
  challenges of Maternity Matters from a range of
  stakeholder perspectives
• Hear about the support, guidance and tools to
  help local workforce planners supporting delivery
  of Maternity MattersHear and share some local
  examples of good practice
• Through locality based discussions identify
  priorities, levers and challenges in
  implementation
• The workshop will support organisations in
  developing the integrated workforce plans that
  will be needed to deliver the new policy.
• Define regionally and locally our next steps

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• Welcome and enjoy the day!

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Issues identified from the NHS WM/ DH/CSIP day
15th May 2007

• Sue Hatton
• Workforce Specialist
• West Midlands Workforce Deanery

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Issues identified from the NHS WM/ DH/CSIP day
15th May 2007

• Wealth of expertise and good practice
• Useful to have an opportunity to air issues in
  safe environment
• To meet colleagues and find Commissioners (!)
• The need for local vision around maternity
  services.
• Areas are at different stages of development for
  implementation there are specific local
  challenges.
• Self assessment benchmarking tool (SAM) useful
• Concerns about how to guarantee choice
• Importance of user involvement, clinical
  leadership and multidisciplinary working.

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Contd

• Development of multi-agency care pathways with
  the right skills and competencies essential
• Maternal Mental Health pathway
• Workforce solutions/skill mix to increase
  workforce capacity e.g. MSW
• Need for more midwives, increase in training
  commissions and further development of the role
  of MSW (around home births)
• Community midwifery caseloads vary in between 90
  to 180 per midwife.
• Return to Midwifery Practice
• How do we prepare clinicians/ have skills to
  offer choice
• Share good practice using CSIP Share Spread
• site

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Useful websites

• www.cypf.org.uk/maternity
• for resources relevant to Maternity Matters and
  sharing promising
• practice.
• www.cypf.org.uk/maternity/tools
• for links to the online maternity matters
  baseline self assessment
• Matrix to benchmark progress and support action
  planning and
• other key tools.
• http//kc.csip.org.uk/groups.php?grp593
• to join the discussion area.

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New Challenges

• Commissioning
• Payment by results (PbR)
• Close (seamless) working with other organisations
  in new locations
• Closer working with women (choice)
• Development of current services within existing
  resources
• Variations across the region in trends in the
  birthrate
• Increasing complexity

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NHS West Midlands Workforce Deanery
Caroline Donovan Deputy Head of Workforce
Development
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NHS West Midlands Workforce Deanery

• The West Midlands region
• One SHA
• (Population 5.6 million)
• One Workforce Deanery
• (Budget c 420million)
• Nine universities
• Three medical Schools
• Birmingham
• Keele
• Warwick

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SHA emerging priorities

• Secondary to Primary shift
• Long term conditions
• 18 weeks and diagnostics
• Women's and Children/young people
• Emergency care
• End of life care
• Mental Health
• Dentistry
• Public Health
• Empowered patients and self care

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Future Workforce Direction

• Workforce which is designed around the needs of
  patients and can rapidly respond to expectations
  of public
• Workforce which matches demand and supply
• Workforce who is fit for purpose
• Flexible workforce who can work across teams and
  organisations
• Opportunities for continual increasing skills and
  career pathways that are flexible and respond to
  the service
• Leadership at all levels
• Widening participation
• A workforce which is representative of the
  community
• Safe and regulated workforce
• MHC careers

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So what is the SHA role?

• Strategic overview of the workforce in line with
  SHA framework
• Commission for supply and quality assure
• provision
• Test and spread new ways of working and
  commission new roles
• Link with DH for Modernising Health Care Careers
• Recruit and train doctors
• Enable and support best HR practice

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So what is the SHA role?

• Maternity Matters workforce elements
• Lead the development of the NHS workforce
  strategy, workforce modernisation and workforce
  planning development
• Ensure that opportunities exist for three year
  and 18 month pre-registration programmes, reduce
  attrition rates
• programmes and flexible return to practice
  midwifery programmes
• Hold PCTs to account for commissioning
  comprehensive maternity services
• Ensure that Local Supervisory Authority standards
  and activities promote safe,high quality care for
  women and their babies and monitor standards of
  midwifery practice
• Ensure that the local community has
  representation on a local MLSC orequivalent and
  other user involvements groups e.g. LINKs

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NHS West Midlands SHA Workforce S/C
NHS Stakeholders
HESP
Workforce Deanery Management Team
Business Management
Innovation new ways of working
Education Workforce Development
Primary Care
Hospital Specialist
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Head of Workforce Development/ Postgraduate
Dean Professor Steve Field
Deputy Head Business Management Alan Hanna
Deputy Head of Workforce Development Caroline
Donovan
Hospital Specialist Jenny Powell
Innovation new ways of working Vacancy
Education, Research Quality Management
Jackie Wallsgrove
Primary Care workforce development Ruth Chambers
Workforce Information
Board of Postgraduate Medicine
------------------- 6 Foundation Schools
11Postgraduate schools of medical dental
specialties
Contracts
Nursing/ AHPs
Surgery / Anaesthesia
Leadership development
Quality Assurance
Commissioning
Access/ Assistant Practitioners
Deanery Action Team- WTD
Medicine
GP
Medical dental training recruitment and
programme management
New ways of working productivity
Education Development research
Pharmacy
Mental Health
Women Children
Public Health
Supporting trainee doctors in difficulty
Advancing Practice
Regional Library Unit
Diagnostic and Scientific
Dental workforce
Modernising Healthcare Careers
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How do we want to work?

• cost effective and efficient.
• demonstrate accountability for Multi Professional
  Education and Training (MPET) levy funds.
• being flexible in responding the workforce issues
  emerging from clinical and service priorities.
• working in partnership with key stakeholders
  egTrusts, FTs, PCTs, LSC, Skills for Health, NHS
  Institute, Social Care, Higher and Further
  Education and Voluntary and Independent Sector.
• demonstrating probity and sound corporate
  governance.
• ensuring that reducing inequalities and
  regenerating local communities is a core
  principle of operation.

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The Career Framework
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Classical organisation profile (band width
indicates no. of jobs)
Level 9
Level 8
Level 7
Level 6
Level 5
Level 4
Level 3
Level 2
Level 1
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Main themes of maternity matters

• Choice of how to access maternity care
• Choice of type of antenatal care
• Choice of place of birth
• Home/Local facility/Hospital
• Choice of place of postnatal care
• Continuity of care

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Where are we starting from?

• Excellent training
• Good reputation
• Lots of enthusiasm
• Wealth of expertise
• West Midlands traditionally have poor home birth
  rates
• High perinatal mortality rates
• Different models of practice around when women
  are booked, community midwifery caseloads etc..

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Birth rate trend in England Wales and the West
Midlands.
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But.

• West Midlands Region has the highest perinatal
  mortality rate in England, and the gap is
  widening 1.0 above the England rate in 1993,
  1.9 above in 2005
• Some areas have very high levels of deprivation

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cont.

• Birth rates are much higher in some areas with
  younger populations 50 of population in HOB is
  of childbearing age compared to 36 in Shropshire
  
• Increase in demand from migration from the
  accession countries to the WM (46,000), about one
  third of which are female and of childbearing
  age. (1.6 of all women 15-44 in WM)
• This has a disproportionate impact in some areas

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Current workforce

• There are 2,092 FTE midwives in the West Midlands
  (2,770 headcount)
• 5 increase in England but no increase in WM
  since 2001 - and 1.5 reduction 2005-2006

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Current workforce

• The non-registered maternity workforce in the WM
  has also changed little since 2001.
• Most midwives (80) work part-time (gt.9 FTE)
• Part time working has risen more in the West
  Midlands than England
• 3 month vacancy rates are low and have fallen
  from 0.9 in 2005 to 0.2 in 2006
• Only 16 new graduates reported not to have found
  jobs in NHS in 2006/07
• 7 redundancies in 2006/07- all voluntary

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Age profile of midwives in the WM

• Significant numbers of midwives are likely to
  retire over next 5 years
• 23 aged over 50, 10 over 55

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Future workforce

• The number of education commissions was increased
  by 10 in 2003/04 and 2004/05 graduating in
  2006 and 2007
• This should lead to a slight overall increase in
  the numbers of midwives over the next 5 years
• There are 148 OG consultants and 323 other
  medical staff.
• There are plans to increase the numbers of
  consultants in the medium term through changes to
  the training grades
• Nationally, there has been a much larger increase
  in the number of OG consultants (40) than in
  midwives (5) since 1997

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Workforce Issues- In Summary

• Organisational culture leadership, flexible and
  multi-professional working
• Overall, skills and knowledge rather than roles
  need to be looked at from an early stage. This
  emphasis may lead to the development of new roles
  and ways of working.
• Education and development
• Return to midwifery practice
• Improving working lives including practice models
  and skills mix

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Summary Next Steps

• Peter Blythin
• Director of Nursing and Workforce Development

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Thoughts from Today

• Lots of enthusiasm.
• Wealth of expertise and examples of good
  practice.
• The need for local vision around maternity
  services.
• Importance of user involvement, clinical
  leadership and multidisciplinary working.
• Areas are at different stages of development for
  implementation there are specific local
  challenges.
• Workforce solutions/skill mix to increase
  workforce capacity.
• Development of multi-agency care pathways.

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Next Steps From Today

• NHS West Midlands is working in partnership with
  CSIP, GOWM and NWP.
• Record discussions and ensure all materials on
  line.
• Local implementation arrangements.

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Next Steps

• NHSWM - Geographical based action learning sets
  around workforce planning.
• CSIP to support implementation of the maternity
  toolkit, the MM Self Assessment Tool and working
  within the patch to decide the best way on how we
  will deliver on this.
• West Midlands Maternity Matters Implementation
  Board.
• Directors of Commissioning meeting.