Implementation of A-EQUIP Advocating & Educating for QUality ImProvement Joy Kirby - Regional Maternity Lead Katherine Hawes -Deputy Regional Maternity Lead NHSE - Midlands and East July 2017

Background PHSO report into 3 complaints from parents relating to care at Morecambe Bay The NMC commissioned the King’s Fund to undertake an independent review of midwifery regulation The Kings Fund review (January 2015) recommended that the supervision and regulation of midwives should be separated and the NMC as the regulator should be in direct control of all regulatory activity. The governing legislation (the Nursing and Midwifery Order 2001) was subject to a Section 60 order and the function of LSAs and statutory supervision of midwives was removed on the 31st March 2017

England Supervision Taskforce Responsibility of the Chief Nursing Officer to: Convene a task force to develop a new model of supervision Oversee the transition from a statutory model of supervision to an employer led model Taskforce supported by work streams: models, education, commissioning, editorial and HR

Regional re-organisation Recognising the benefits of regional strategic midwifery leadership, the new Regional Midwifery Leads and Deputy Regional Maternity Leads appointed in April 2017. These roles will provide strategic midwifery leadership and professional guidance regionally, and across the health system. The role will include working with a broad range of stakeholders including commissioners ,improving quality of care, acting as an expert reference group for the maternity policy leads at the Department of Health, supporting regional chief nurses on matters relating to maternity providers and the provision of specialist subject knowledge, including undertaking external reviews.

Transformation The new model of midwifery supervision is a fundamentally important part of the wider Maternity Transformation Programme (Better Births 2016) A key part of work stream five – transforming the workforce The new model of supervision will support midwives to provide high quality care, placing women and their families at the centre of care within a community hub and across a Local Maternity System The model supports the choice, education and safety aspects of the vision set out in the National Maternity Review report, Better Births

Levers and incentives The NHS Standard Contract (NHS England 2017/18), is mandated by NHS England for use by commissioners for all contracts for healthcare services other than primary care Clinical Commissioning Group Maternity Specification CQC inspection

The A-EQUIP Model Women and babies Monitoring, Evaluation and quality control (normative) Clinical Supervision (restorative) Personal action for quality improvement Education and Development (formative) The A-EQUIP model is made up of four distinct functions: restorative, normative, personal action for quality improvement and education and development. The model supports a continuous improvement process that builds personal and professional resilience, enhances quality of care and supports preparedness for appraisal and professional revalidation. The ultimate aim of using the A-EQUIP model is that through staff empowerment and development, action to improve quality of care becomes an intrinsic part of everyone’s job, every day in all parts of the system.  The new model of midwifery supervision is a fundamentally important part of the wider Maternity Transformation Programme (Better Births 2016) A key part of workstream five – transforming the workforce The new model of supervision will support midwives to provide high quality care, placing women and their families at the centre of care within a community hub and across a Local Maternity System The model supports the choice, education and safety aspects of the vision set out in the National Maternity Review report, Better Births

The role of the Professional Midwifery Advocate (PMA) ● Deployment of the A-EQUIP model ● Supporting and developing the advocacy role of midwives ● Supporting and guiding midwives through actions that will be of benefit to women and their families ● Providing support and feedback to develop, progress and strengthen the capabilities of the midwifery workforce

The Role of the Professional Midwifery Advocate Selection of PMAs is the responsibility of the Head/Director of midwifery National Job Description – 8a Sessional PMA’s See operational guidance, publication date March 2017

Education of the Professional Midwifery Advocate (PMA) Shortened PMA programme (4 days, may be taught in-house by your HEI) – designed to prepare midwives who were previously SoMs Long PMA programme (still in development ) – designed to prepare midwives who have never completed the PoSoM or associated programme A-EQUIP e learning module – 30 minute module that will compliment and replace aspects of the short and long PMA programme (available now) Until the course is completed cannot be called PMA

Scoping exercise with HoMs During this transitional period what do you have in place to support midwives and women?    Are you intending to use A-Equip Model or your own model? If using your own model please can you outline the principles of your model? When do you intend to implement the new model? How many Professional Midwifery Advocates (PMA) are you intending to have? Are you going to use previous Supervisors of Midwives? If so how many?   How do you intend to recruit new PMA’s? Do you have funding for the new model?

6 Trusts are using Senior Midwives / Management Teams. During this transitional period what do you have in place to support midwives and women?    18 Trusts have continued using the original Supervisors of Midwives (SoM) Team removing the statutory requirement from the role.   6 Trusts are using Senior Midwives / Management Teams.   8 Trusts are using a mixture of previous SoM’s (removing statutory requirement) and Senior Midwives/ Managers.  1 Trust was unclear in their answer

13 Trusts are adopting the A-Equip Model Are you intending to use A-Equip Model or your own model? If using your own model please can you outline the principles of your model? 13 Trusts are adopting the A-Equip Model 14 Trusts are adopting the main principles of the A-Equip Model, but will be adapting to suit the purposes of their own Trust. 4 Trusts using their own model   1 Trust undecided 1 Trust response unclear

Scoping Exercise When do you intend to implement the new model? How many Professional Midwifery Advocates (PMA) are you intending to have? Are you going to use previous Supervisors of Midwives? If so how many?   How do you intend to recruit new PMA’s? Do you have funding for the new model?

Model Examples Coventry , Warwickshire and Nuneaton Kettering Nottingham

Identified Challenges Requires support – maternity providers, commissioners and HEI’s Willingness to participate by previous SoMs Number of SoMs who intend to take up the PMA role Funding for bridging course and full course Informing Midwives Informing, supporting and involving women Transition period – end point

Conclusion Regional Maternity Team continue to support HoMs and DoNs to implement A-EQUIP 2 forum days offered to HoMs, CCG and DCO Maternity Leads with good response Continued sharing of good practice across Midlands and East