1. The West Midlands LSA ANNUAL REPORT 2012-2013

2. 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

3. Role of the LSA & Midwifery Officer Implementing the legislation from Nursing and Midwifery Order Compliance with the Midwives rules and standards. 2012 15 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.

4. West Midlands LSA 15 Acute Trusts providing maternity services 17 Acute Hospital Sites 12 Midwifery Led Units 3100+ Midwife ITPs 230+Supervisor of Midwives 1/14 LSA SoM to Midwife Ratio

5. 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

6. THE NHS England 6C’s Campaign http://www.england.nhs.uk/nursingvision//

7. 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.

8. 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

9. 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

10. 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

11. 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.

12. 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. 2010-2011 – 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

13. 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 20112012 2013 ARDEN, HEREFORD & WORCESTERSHIRE Worcester & Redditch19299 16.916.716.8 Wye Valley772 13.111.213.7 Nuneaton985 9.78.110.0 Warwick10130 13.313.514.1 Coventry21254 11.212.3 12.8 SHROPSHIRE & STAFFORDSHIRE Shropshire & Telford16289 21.3 16.3 North Staffordshire18265 12.71314.2 Stafford8107 14.213.313.8 Burton11138 1211.912.5 BIRMINGHAM & BLACK COUNTRY Heart of England27472 14.414.017.03 City20258 12.14.214.05 Birmingham Women’s21354 14.12.817.05 Dudley17179 10.210.512.0 Walsall9180 14.214.720.0 Wolverhampton18147 9.47.78.95 Total234338813.213.1 14.4

14. 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)0.00 1.000.005.009.615.60 Hereford0.00 1.000.002.005.638.63 Nuneaton0.00 1.000.004.205.20 Warwick0.00 1.000.002.001.204.20 Coventry0.00 1.000.004.003.207.20 SHROPSHIRE & STAFFORDSHIRE Shrewsbury0.00 1.00 3.5919.7225.31 North staffordshire0.00 1.000.003.002.85.80 Stafford0.00 1.00 7.009.00 Burton0.00 1.000.002.004.407.40 BIRMINGHAM & BLACK COUNTRY Heart Of England0.001.003.002.005.604.2815.88 Sutton Coldfield0.00 3.000.003.00 W.Birmingham – City0.001.000.001.003.008.7513.75 Bwh0.00 3.001.006.8210.82 Dudley1.000.00 1.007.0010.00 Walsall1.000.00 4.000.005.00 Wolverhampton0.00 1.003.007.8011.80 TOTAL2.00 10.00 20.6034.6570.25

15. 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 & Redditch0.0020.32166.280.00203.53 Hereford0.0011.3042.91 6.00 60.21 Nuneaton0.007.50 50.187.45 67.76 Warwick0.0015.09 65.6111.00 86.29 Coventry0.0040.00 110.0030.00 179.50 SHROPSHIRE & STAFFORDSHIRE Shropshire0.0031.57 132.3416.28 179.31 North Staffs0.0022.70 147.3422.20 187.89 Stafford0.0012.52 60.700.41 187.89 Burton0.0014.20 84.4910.47 114.86 BIRMINGHAM & BLACK COUNTRY Heart of England0.0049.11 185.610.00 230.47 Sutton Coldfield0.0026.63 82.592.84 114.06 W. Birmingham City1.0044.54 125.5732.40 214.34 BWH1.0037.49 173.5136.41 235.80 Dudley0.0014.96 95.4015.30 134.21 Walsall0.0013.51 93.688.79 117.29 Wolverhampton0.0011.47 102.111.00 120.52 TOTAL2.00372.911718.32200.552433.93

16. 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 Worcester196.372.0061.28259.65 Hereford69.750.8018.7089.25 Nuneaton73.780.0015.1288.90 Warwick91.700.0023.69115.39 Coventry188.400.0048.60237.00 SHROPSHIRE & STAFFORDSHIRE Shropshire205.500.0063.21268.71 North Staffordshire194.940.8068.38264.12 Stafford73.220.4117.8591.48 Burton119.960.0030.32150.28 BIRMINGHAM & BLACK COUNTRY Heart of England234.720.0075.07309.79 Sutton Coldfield112.060.0034.29156.35 W.Birmingham - City203.510.0042.18245.69 BWH258.680.0064.02 322.70 Dudley129.590.0037.70 167.29 Walsall139.005.0054.00 198.00 Wolverhampton131.820.0041.55 173.37 WEST MIDLANDS TOTAL 2432.64 9.01 299.81 1573.19

17. Table to demonstrates midwives working in community settings TRUSTS WTE Community % of WTE Establishment WORCESTERSHIRE Worcester &54.9326.4% Redditch HEREFORDSHIRE 19.6835.6 % SHROPSHIRE 49.8928.3 % NORTH STAFFSStoke52.5028.0 % SOUTH STAFFS Stafford34.3044.5 % Burton31.8827.8 % WARWICKSHIRE Nuneaton14.8024.3 % Warwick19.0023.7 % Coventry39.0027.1 % HEART OF ENGLAND Heartlands/Sol55.5723.9 % Good Hope24.3720.6 % BIRMINGHAMCity67.3034.4 % BIRMINGHAMWomen’s59.7024.4 % DUDLEY 28.0022.0 % WALSALL 34.7833.0 % WOLVERHAMPTON 28.0024.0 % WEST MIDLANDS TOTAL613.7027%

18. Table to demonstrate (Crude) birth to midwife ratio over 3 year trend AREA TEAM2010-20112011-2012 2012-2013 ARDEN, HEREFORD & WORCESTERSHIRE Worcester27.9 29.89 31.6 Redditch28.4 Hereford37.1 31.30 28.8 Nuneaton35.6 34.94 31.2 Warwick33.7 33.29 31.9 Coventry36.6 34.0 32.1 SHROPSHIRE & STAFFORDSHIRE Shropshire27.1 32.21 28.6 North Staffordshire31.632.2130.8 Stafford24.5 22.80 27.2 Burton32.4 32.34 30.2 BIRMINGHAM & BLACK COUNTRY Heart Of England30.6 30.88 29.7 Sutton Coldfield32.7 31.26 34.1 W.Birmingham - City30.8 28.40 29.6 Bwh29.8 31.24 31.8 Dudley37.5 38.90 36.9 Walsall34.4 32.3 32.7 Wolverhampton33.4 33.83 30.2 West Midlands Total 33.0 31.8 30.7

19. Table to demonstrate Births over a 3 year trend 2008 - 2012 AREA TEAMS2010-20112011-20122012-2013 ARDEN, HEREFORD & WORCESTER Worcester39853969 4114 Redditch20542085 2071 Nuneaton24472368 2361 Warwick28432873 2926 Coventry60066088 6031 Hereford20471888 2007 SHROPSHIRE & STAFFORDSHIRE Shropshire51145241 5154 North Staffordshire58816052 5840 Stafford19981865 1995 Burton38313812 3623 BIRMINGHAM & BLACK COUNTRY Heart Of England70967160 6961 Sutton Coldfield38283681 3824 W.Birmingham - City61485690 6026 Bwh73427449 8218 Dudley48425222 4784 Walsall39954502 4678 Wolverhampton40994112 3967 West Midlands Total 73556 74057 74580

20. Table to demonstrate the Confinements by place of birth during 2010 -2012 TRUSTS AND SITES TOTAL HOSPITAL MLU BBAS HOME ARDEN, HEREFORD & WORCESTERSHIRE Worcester4114402203161 Redditch207120450422 Hereford2007190901754 Nuneaton2361227001621 Warwick2926285902344 Coventry6031581307055 SHROPSHIRE & STAFFORDSHIRE Shropshire5154400910332191 North Staffordshire5840403813425334 Stafford199517581881930 Burton36233261276420 BIRMINGHAM & BLACK COUNTRY Heart Of England696168959134620 Sutton Coldfield382437537452645 W.Birmingham - City60264251163910432 Bwh8218809615813983 Dudley478441286211622 Walsall4678446816712 Wolverhampton396736552514715 WEST MIDLANDS TOTAL74580672308756537651

21. Table to demonstrate Elective and Emergency Caesarean Section Rates AREA TEAMS TOTAL BIRTHS CAESAREAN SECTIONS EmergencyElectiveTotal% of births ARDEN, HEREFORD & WORCESTERSHIRE Worcester 411461935695523.21 Redditch 207131815547322.84 Hereford 200734023157028.40 Nuneaton 236132924557424.30 Warwick 292643335979227.07 Coventry 6031833 166627.62 SHROPSHIRE & STAFFORDSHIRE Shropshire 515440243783916.28 North Staffordshire 5840813640145324.88 Stafford 199525413138519.30 Burton 362359034293225.72 BIRMINGHAM & BLACK COUNTRY Heart Of England 69611028738176625.37 Sutton Coldfield 3824582468105027.46 W.Birmingham - City 6026902419132121.92 Bwh 82181315885220026.77 Dudley 4784706579128526.86 Walsall 4678819570138929.69 Wolverhampton 396759739799425.06 WESTMIDLANDS TOTAL745801088077851864425.02

22. TRUSTS & SITESTotal BirthsTotal C/S% rateEm PrimipEm MultipEl PrimipEl Multip ARDEN, HEREFORD & WORCESTERSHIRE Worcester411495523.2%38523565291 Redditch207147322.8%19412433122 Hereford200756528.2%21112938192 Nuneaton 2361 57424.3%16416537208 Warwick292679227.1%28215174285 Coventry6031166627.6%371462167666 SHROPSHIRE & STAFFORDSHIRE Shropshire & Telford515483916.3%20821286351 North Staffordshire5840141824.3%439348124507 Stafford199538519.3%1501044091 Burton362393225.7%26432646296 BIRMINGHAM & BLACK COUNTRY Heart of England (BHH & Sol)6961176625.4%421606147592 Heart of England (Good Hope)3824105027.5%26831473395 W.Birmingham - City6026137723.0%378437191371 BWH8218220026.8%776358539527 Dudley4784128526.9%456250126453 Walsall4678138929.7%0000 Wolverhampton396799625.1%37122675322 WEST MIDLANDS TOTAL745801866225.0%5338444718615669 Table to demonstrate Primip and Multip Elective and Emergency Caesarean Section Rates

23. Table to demonstrate rates of Instrumental Delivery Trusts & SitesTotal BirthsForcepsVentouseVg Breech ARDEN, HEREFORD & WORCESTERSHIRE Worcester411425821216 Redditch2071112918 Hereford2007931474 Nuneaton 2361 901160 Warwick29261741918 Coventry603145521434 SHROPSHIRE & STAFFORDSHIRE Shropshire515424127141 North Staffordshire584024837036 Stafford199511522914 Burton362313743322 BIRMINGHAM & BLACK COUNTRY Heart Of England696133732940 Sutton Coldfield382424617812 W.Birmingham - City6026516010 Bwh821862565762 Dudley478433214011 Walsall467836716713 Wolverhampton396719021824 West Midlands Total 7458045363963355

24. Tables to show 3 Year Clinical Trends Other Modes of DeliveryTotal BirthsForcepsVentouseVg Breech TOTAL 10-11 73556 3551 3918 425 TOTAL 11-12 7405740514167453 TOTAL 12-13 7458045363963355 Other Modes of Delivery Total BirthsWater LaboursWater Births VBAC Labours VBAC Births TOTAL 10-11 735562453165119041735 TOTAL 11-12 740572523231423572274 TOTAL 12-13 745802523231423802251 Year Total Hospital MLU BBA Home 2010-2011 73556 65084 7110 489 873 2011-2012 74057 65433 7485 589 688 2012-2013 74580672308756537651

25. 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 411442604229150 Redditch 207121362120 6 0 Nuneaton 236123342323110 Warwick 29262954294950 Coventry 593860316005262 Hereford 19802007199891 SHROPSHIRE & STAFFORDSHIRE Shropshire 505851545128272 North Staffordshire 584059005873271 Stafford 19862015200690 Burton 356136233612110 BIRMINGHAM & BLACK COUNTRY Heart Of England 685369616915460 Sutton Coldfield 37653824381680 W.Birmingham - City 578760265969351 Birmingham Women’s 808682188179371 Dudley 478447874760270 Walsall 461946784596230 Wolverhampton 396740334010231 WEST MIDLANDS TOTAL736427494174498345 8

26. 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