The West Midlands LSA ANNUAL REPORT

The West Midlands LSA Team The LSA Team Barbara Kuypers LSAMO Lisa Wilkes P.A. to LSAMO Supported by Link Supervisors Ann Kingscott Toni Martin Carmel McCalmont

Role of the LSA & Midwifery Officer Implementing the legislation from Nursing and Midwifery Order Compliance with the Midwives rules and standards Rules, 8 MW Standards and 38 LSA Standards. Guidance for LSAs around Audit and compliance with standards Receiving the Annuals Reports Recognising excellence and sharing good supervisory practice Assessing risk and providing support and guidance.

West Midlands LSA 15 Acute Trusts providing maternity services 17 Acute Hospital Sites 12 Midwifery Led Units Midwife ITPs 230+Supervisor of Midwives 1/14 LSA SoM to Midwife Ratio

NHS West Midlands Local Area Teams Arden, Hereford and Worcester Worcester & Redditch Hereford Warwick Coventry Nuneaton Shropshire and Staffordshire Shrewsbury Mid Staffordshire North Staffordshire Burton Birmingham & Black Country Heart of England City Birmingham Women’s Dudley Walsall Wolverhampton

THE NHS England 6C’s Campaign

NHS England Mandate for Pregnant Women The NHS will: Offer women the greatest possible choice of providers Ensure every woman has a named midwife who will make sure she has personalised, one to one care throughout pregnancy, childbirth and during the postnatal period, including additional support for those who had maternal health concerns. Reduce the incident of and impact of postnatal depression through earlier diagnosis and better intervention and support. Recommendation of Services via Friends and Family test.

Communications Annually: 4 combined meetings with: Link Supervisors Contacts Lead Midwives for Education Annual meetings with new Supervisors 6 Heads of Midwifery meetings Student POSOMs throughout the programme Adhoc policy review work

LSA Event Calendars Supervision workshops – NMC Standard of Investigation Practice Forum – Case Reviews Maternal Mortality and Morbidity study days Bond Solon Annual Academic Day at University Annual LSA Conference National LSAMO Bi-annual Conference Mediation & reconciliation Attitude & bullying Child Safeguarding Advocacy for Normal Birth The ‘business’ of midwifery Achieving success in Midwifery Led Units Debate – Duty of Care

Preparation of Supervisors of Midwives Programme (POSOM) 32 Places to take up annually at Birmingham Universities Ballot and selection process reviewed Peer & Panel discussions as part of selection LSAMO as part of the curricula & planning Looking to host spring and autumn programmes at Birmingham Degree and Master’s Programmes Support and reflection at 6 months post appointment for new SoMs

For the Trust to consider for the Maternity Pre-ceptorship Packs to integrate pages for supervisory communications or to provide a separate booklet. These can be noted with the LSA Logo for all discussions held between the registrant and their Supervisor of Midwives and also on the pages used for the Reflective Diary. Pre-ceptorship For the Supervisors to provide guidance at Supervisory Annual Reviews with regard to ensuring all midwives understand and take on their full role as teachers of the profession as described in The Code (2008) so that student midwives received excellent clinical support and assessment whilst undertaking their training in the clinical placement.

Audit Themes 2007/8 – Benchmark against 5 LSA Standards 2008/9 – NMC Standards of Investigation & Supervised Practice 2009/10 – Web based questionnaires Electronic collation of activity and trends – Audit of impact of Supervision on: Women’s Choice Student Learning Pre-ceptorship (1 st three years of registration 2011/12 Review of Incident Investigation and Supervisory Practice 2012/13 Supervision contribution to Leadership

Table to demonstrate the ratio of Midwives per Supervisor with each Trust, and the ratio for the whole LSA. In addition provides numbers of midwives with Universities and the West Midlands Perinatal Institute. AREA TEAMSupervisorMidwivesRATIO RATIO Head Count ARDEN, HEREFORD & WORCESTERSHIRE Worcester & Redditch Wye Valley Nuneaton Warwick Coventry SHROPSHIRE & STAFFORDSHIRE Shropshire & Telford North Staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart of England City Birmingham Women’s Dudley Walsall Wolverhampton Total

Table to demonstrates the numbers of midwives working in managerial or specialist roles at Band 7 to 9. AREA TEAMS FUNDED SMP W.T.E. FUNDED 8D W.T.E. FUNDED 8C W.T.E. FUNDED 8B W.T.E. FUNDED 8A W.T.E. FUNDED 7 W.T.E. TOTAL WTE ARDEN, HEREFORD & WORCESTER Worcestershire Acute (inc Redditch) Hereford Nuneaton Warwick Coventry SHROPSHIRE & STAFFORDSHIRE Shrewsbury North staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart Of England Sutton Coldfield W.Birmingham – City Bwh Dudley Walsall Wolverhampton TOTAL

Table to demonstrates the numbers of clinical midwives Bands 5-7 AREA TEAMS CONSULTANT MW BAND 7 MW BAND 6 MW BAND 5 MW TOTAL FUNDED ARDEN, HEREFORD & WORCESTERSHIRE Worcester & Redditch Hereford Nuneaton Warwick Coventry SHROPSHIRE & STAFFORDSHIRE Shropshire North Staffs Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart of England Sutton Coldfield W. Birmingham City BWH Dudley Walsall Wolverhampton TOTAL

Table to demonstrates the total staff of midwives, nurses and non-qualified staff working in maternity services giving direct care to mothers and babies. Non-qualified staff, includes maternity support workers, auxiliary staff and nursery nurses. AREA TEAMS MIDWIVES W.T.E. NURSES W.T.E. HCA/MCA W.T.E. TOTAL W.T.E. ARDEN, HEREFORD & WORCESTER Worcester Hereford Nuneaton Warwick Coventry SHROPSHIRE & STAFFORDSHIRE Shropshire North Staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart of England Sutton Coldfield W.Birmingham - City BWH Dudley Walsall Wolverhampton WEST MIDLANDS TOTAL

Table to demonstrates midwives working in community settings TRUSTS WTE Community % of WTE Establishment WORCESTERSHIRE Worcester & % Redditch HEREFORDSHIRE % SHROPSHIRE % NORTH STAFFSStoke % SOUTH STAFFS Stafford % Burton % WARWICKSHIRE Nuneaton % Warwick % Coventry % HEART OF ENGLAND Heartlands/Sol % Good Hope % BIRMINGHAMCity % BIRMINGHAMWomen’s % DUDLEY % WALSALL % WOLVERHAMPTON % WEST MIDLANDS TOTAL %

Table to demonstrate (Crude) birth to midwife ratio over 3 year trend AREA TEAM ARDEN, HEREFORD & WORCESTERSHIRE Worcester Redditch28.4 Hereford Nuneaton Warwick Coventry SHROPSHIRE & STAFFORDSHIRE Shropshire North Staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart Of England Sutton Coldfield W.Birmingham - City Bwh Dudley Walsall Wolverhampton West Midlands Total

Table to demonstrate Births over a 3 year trend AREA TEAMS ARDEN, HEREFORD & WORCESTER Worcester Redditch Nuneaton Warwick Coventry Hereford SHROPSHIRE & STAFFORDSHIRE Shropshire North Staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart Of England Sutton Coldfield W.Birmingham - City Bwh Dudley Walsall Wolverhampton West Midlands Total

Table to demonstrate the Confinements by place of birth during TRUSTS AND SITES TOTAL HOSPITAL MLU BBAS HOME ARDEN, HEREFORD & WORCESTERSHIRE Worcester Redditch Hereford Nuneaton Warwick Coventry SHROPSHIRE & STAFFORDSHIRE Shropshire North Staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart Of England Sutton Coldfield W.Birmingham - City Bwh Dudley Walsall Wolverhampton WEST MIDLANDS TOTAL

Table to demonstrate Elective and Emergency Caesarean Section Rates AREA TEAMS TOTAL BIRTHS CAESAREAN SECTIONS EmergencyElectiveTotal% of births ARDEN, HEREFORD & WORCESTERSHIRE Worcester Redditch Hereford Nuneaton Warwick Coventry SHROPSHIRE & STAFFORDSHIRE Shropshire North Staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart Of England Sutton Coldfield W.Birmingham - City Bwh Dudley Walsall Wolverhampton WESTMIDLANDS TOTAL

TRUSTS & SITESTotal BirthsTotal C/S% rateEm PrimipEm MultipEl PrimipEl Multip ARDEN, HEREFORD & WORCESTERSHIRE Worcester % Redditch % Hereford % Nuneaton % Warwick % Coventry % SHROPSHIRE & STAFFORDSHIRE Shropshire & Telford % North Staffordshire % Stafford % Burton % BIRMINGHAM & BLACK COUNTRY Heart of England (BHH & Sol) % Heart of England (Good Hope) % W.Birmingham - City % BWH % Dudley % Walsall %0000 Wolverhampton % WEST MIDLANDS TOTAL % Table to demonstrate Primip and Multip Elective and Emergency Caesarean Section Rates

Table to demonstrate rates of Instrumental Delivery Trusts & SitesTotal BirthsForcepsVentouseVg Breech ARDEN, HEREFORD & WORCESTERSHIRE Worcester Redditch Hereford Nuneaton Warwick Coventry SHROPSHIRE & STAFFORDSHIRE Shropshire North Staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart Of England Sutton Coldfield W.Birmingham - City Bwh Dudley Walsall Wolverhampton West Midlands Total

Tables to show 3 Year Clinical Trends Other Modes of DeliveryTotal BirthsForcepsVentouseVg Breech TOTAL TOTAL TOTAL Other Modes of Delivery Total BirthsWater LaboursWater Births VBAC Labours VBAC Births TOTAL TOTAL TOTAL Year Total Hospital MLU BBA Home

Table to demonstrate the outcomes for babies born in West Midlands AREA TEAMS TOTAL BIRTHS (WOMEN DELIVERED) TOTAL BABIES BORN BABIES BORN ALIVE STILL BIRTHS INTRA-PARTRUM STILLBIRTHS (DURING LABOUR) ARDEN, HEREFORD & WORCESTERS Worcester Redditch Nuneaton Warwick Coventry Hereford SHROPSHIRE & STAFFORDSHIRE Shropshire North Staffordshire Stafford Burton BIRMINGHAM & BLACK COUNTRY Heart Of England Sutton Coldfield W.Birmingham - City Birmingham Women’s Dudley Walsall Wolverhampton WEST MIDLANDS TOTAL

Analysis of Supervisory Investigations 73 Supervisory Investigations. 59Local Action 21 Developmental Support 11 Supervised Practice 8 LSA Practice Programmes 4 Referrals to the NMC Issues: Regulation:Failure to comply with PREP requirements Operating and working out side of usual sphere of practice and competency Clinical:Failure to recognise abnormal progression of labour Failure to recognise abnormal CTG or signs of fetal distress Failure to act Failure to refer to appropriate physician Failure to document and record appropriately Failure to administrate correctly and record medicines ColleaguesFailure to provide a safe environment for practice Failure to check equipment required for safe and effective care Failure to support students or newly qualified colleagues