Leading change

Midwives and midwifery support workers at Wrightington, Wigan and Leigh NHS Foundation Trust, in collaboration with the Local Authority, led the development and implementation of a new Integrated Health Service team (IHST). The new integrated service team has led to improved outcomes, working with the most vulnerable families locally, by providing support on a 1:1 basis, enabling services to be designed around each family’s specific needs and addressing health inequalities.

Where to look

The midwives and midwifery support workers at Wrightington, Wigan and Leigh NHS Foundation Trust identified unwarranted variation in the engagement and uptake of support for those pregnant mothers who were considered to be vulnerable. Research identifies that intensive input with vulnerable families will improve outcomes for both mother and baby.

The NHS Healthy Child Programme emphasises partnership working, on the premise that the best outcomes for children and families rely on a multi-professional, multi-organisational care and support. No single profession or organisation that can ensure the best outcomes for children and families.

What to change

With support from the local authority the public health midwives and midwifery support workers identified an opportunity to redesign services to provide 1:1 support to families, offering bespoke parenting sessions, meeting the individual needs of the family. Support included, contributing to many aspects of clients’ care, including meetings with social care and providing parenting updates and reports for social care assessments.

The Integrated Health Service team (IHST) was created initially only to receive referrals from midwives. However, due to the expansion of the programme, increased visibility and engagement with multiagency partners the programme now receives referrals from a variety of agencies e.g. social care, health visitors, homeless teams, mental health workers, Start Well Centre workers, probation and stop smoking advisors. The IHST communicates across agencies to support the development of the 1:1 family plans.

The IHST often receives calls from other agencies requesting support and advice regarding a family and the team support and guide agencies and if needed request the family to be referred to the team.

The IHST provides a form of advocacy service, undertakes joint visits supporting and increasing family engagement with a wider range of services and agencies. The staff in the IHST aim to ensure improved outcomes to babies and their families through new ways of working by:

• Making services more accessible to families, within the home or closer to where people live, utilising Start Well centres and community hubs to meet with families and provide support.
• Ensuring that services work together in a more joined up manner, so they can work more effectively together with families in a whole-life approach and removing duplication in practise.
• Connecting families to opportunities in their community.
• Having a different conversation with families, helping to recognise what is important to them. Helping them recognise and develop their own strengths, and the strengths within their community, in order to help them be the best that they can be and build resilience in families and within their community.
• Providing advocacy to support the voice of the family and enabling them to engage with a wider range of services appropriate to their needs.

How to change

The IHST was commissioned to support around 75 families a year locally. As many of the families using the service have learning difficulties or disabilities the team actively promote the use of individualised resources used in a range of ways to assist in understanding relevant information and support available for them.

The midwives and midwifery support workers attend specialist education and training courses, which has helped them develop and implement a comprehensive parenting programme which was rolled out across the service.

The midwifery support worker’s practical parenting sessions include:

• Safe sleep sessions
• Breastfeeding sessions
• Making up of artificial feeds / sterilisation
• Baby bathing
• Bonding and attachment
• alongside offering emotional support, health advice & clinical support.

Each family has a plan of support agreed with them and tailored to meet their individual needs and learning style. This includes supporting and contributing to a variety of aspects of a family’s care, including attending appointments with the family and meetings with social care and other supportive services. As part of this role the midwifery support workers are able to contribute to the social care assessment by providing parenting updates and reports regarding progress and ongoing support needs.

The public health midwives and midwifery support workers promoted the programme initially through midwifery services, supporting families through their early pregnancy. The programme was then communicated with a wider multiagency focus to ensure that the programme was receiving referrals for the vulnerable families who needed the support.

Adding value

Better outcomes – Following the introduction of the service there has been a notable increase in breast feeding rates amongst our families, a reduction in smoking and an increase in smoke free homes. Families have a better knowledge of their needs and skills meaning they make positive choices more frequently. They are also notably more confident in their own ability to parent their baby positively, increased bonding and a better understanding of early communication with their babies. These factors contribute to the baby remaining in a safe home environment with their families with the support of services.

Better experience – The service has been positively received from families as well as professionals working with families. Families report they feel better supported by the service and this in turn has support effective engagement with the IHST. Professionals and staff working with the families have reported the service has improved their understanding of the family’s needs and therefore are positive about being able to care and support the families more effectively.

Better use of resources – The IHST is supported by bi-monthly multidisciplinary allocation / panel meetings which has facilitated timely triage of families into relevant services. Representation on local perinatal mental health task group has also led to involvement in this area of support for families including supporting development and management of a comprehensive mental health care plans to support them during hospital which also supports staff involved with their care. A further strength of the service is the dual role of the MSW’s across the IHST and the maternity ward which has meant consistent care that is wrapped around the family supporting advocacy whilst at home and when admitted to the ward. This integrated working has lowered duplication of services and enables organisations to provide effective, cost effective and timely services.

Challenges and lessons learnt for implementation

It’s important to remain persistent and to listen to the families and have a non-judgmental approach to what is going on in their life.

Ensuring the specialist workers and the partner agencies are effectively trained and possess the key knowledge about the range of support agencies and services available will enhance the delivery of this support programme.

Due to the success of the MSW role this has expanded to include representation on the local Parenting working group, Safe Sleep implementation group and the Breastfeeding baby friendly action group. The Local Authority are working towards a parenting strategy for all staff working with families with children. The midwifery support workers are involved with the multidisciplinary working group looking at creating an online digital platform to signpost all professionals to up to date parenting information.

For more information contact

• Anne Allen (Midwifery Support Worker) anne.allen@wwl.nhs.uk
• Julie Middlehurst (Midwifery Support Worker) Julie.middlehurst@wwl.nhs.uk
• Michelle Hartley (Midwife) michelle.hartley@wwl.nhs.uk