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

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


1
Maternity MattersChoice, Access and Continuity
of Care in a Safe Service
  • Caroline Donovan
  • Deputy Head of Workforce Development
  • West Midlands Workforce Deanery

2
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

3
  • Welcome and enjoy the day!

4
Issues identified from the NHS WM/ DH/CSIP day
15th May 2007
  • Sue Hatton
  • Workforce Specialist
  • West Midlands Workforce Deanery

5
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.

6
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

7
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8
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.

9
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

10
NHS West Midlands Workforce Deanery
Caroline Donovan Deputy Head of Workforce
Development
11
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

12
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

13
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

14
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

15
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

16
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
17
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
18
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.

19
The Career Framework
20
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21
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
22
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

23
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..

24
Birth rate trend in England Wales and the West
Midlands.
25
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

26
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

27
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

28
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

29
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

30
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

31
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

32
Summary Next Steps
  • Peter Blythin
  • Director of Nursing and Workforce Development

33
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.

34
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.

35
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.
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