Did you take part in our #A_EQUIP week of action?

Last week we saw blogs from a wide range of individuals and organisations who came together to represent the work that the national local supervisory task force has undertaken to develop a new model of supervision for midwives on behalf of the Local Supervising Authority (LSA) for England.

On behalf of the Chief Nursing Officer for England, Professor Jane Cummings, I have chaired the England LSA taskforce, working with midwives and women across the country to produce a model of clinical supervision for midwives that aims to value, support and develop midwives to provide high quality safe care for women and their families. A-EQUIP has the potential to make a real difference to the outcomes and experiences of women, babies and their families.

I’m delighted and grateful to have seen enormous support from midwives, healthcare leaders, Royal Colleges, Health Education England, NHS Improvement, NHS England, Educationalists and the Nursing and Midwifery Council (NMC). It has also been inspiring to see how the new employer led model of midwifery supervision, A-EQUIP, has caught a wave of enthusiasm right across the country.

It is really important that we continue to improve maternity services and we are proud of our midwives who constantly strive to provide safe, high quality care. It is crucial that we learn from women and their families, especially those who have experienced care that has resulted in poor and sometimes tragic outcomes. The generosity of families combined with their insight and leadership are helping us to transform maternity services across England.

The new model of supervision forms part of a wider transformation programme that will improve safety, quality of care and choice for women who use maternity services. The development of continuity of carer and investment in the workforce through the A-EQUIP model will support the provision of clinical excellence and teamwork that involves women and their families.

The new model of supervision has resulted from some specific lessons learnt from national investigations and reviews. Here is a summary of the background.

As we know, the Parliamentary and Health Service Ombudsman (PHSO) and a Department of Health (DH) investigation led by Dr Bill Kirkup produced reports that were critical of the additional tier of midwifery regulation provided by Statutory Supervision of Midwives. Following this critique the Nursing and Midwifery Council (NMC) commissioned The King’s Fund to undertake an independent review of midwifery regulation.

The findings of The King’s Fund review (January 2015) was broadly aligned with the findings of the PHSO report and, subsequently, the Kirkup Report (March 2015) made the recommendation that the supervision and regulation of midwives should be separated.

It also recommended that the NMC as the regulator should be in direct control of all regulatory activity. The main conclusion of The King’s Fund was that the peer investigation model, a key function of the statutory framework, was not impartial, and led to confusion about processes of clinical governance. The NMC agreed with The King’s Fund recommendation in January 2015 and commenced proceedings to secure legislative change which now will take effect from 31 March 2017.

The new model has been developed in line with the DH requirements outlined in the ‘Proposals’ paper (DH 2016). Alongside this, the national LSA task force agreed that the new model should adopt a set of principles that include consistent standards developed nationally, delivered locally with education and training.

It is also a strategic response that links the requirements of existing national plans and frameworks such as the quality and safety aspects of the Five Year Forward View, the DH mandate from Better Births, the report of the National Maternity Review, NMC revalidation requirements and Leading Change, Adding Value, a framework for nursing, midwifery and care staff with a focus on reducing unwarranted variation. Finally, the model is designed to be and employer led and therefore integrated into local governance arrangements.

The blogs last week narrated a story of how we have reached this point in time and it is important to note that the midwifery profession has worked with others to turn what could have been seen as a crisis with the loss of the statutory framework into a real opportunity to support midwives to be reflective practitioners who routinely build their skills of improvement in order to achieve good outcomes and to build pride in the profession.

The pilot sites have shown that A-EQUIP enables the flexibility required for healthcare organisations to implement this model according to their own workforce requirements. They have also demonstrated how the model can be deployed to other professions. This means that unlike the current statutory model of supervision where every element had to be deployed, the new employer led model means that there is flexibility, depending on each employer and the issues and challenges they face.

Of course it must be remembered that some of the foundations for the A-EQUIP model were already laid by the statutory function of supervision of midwives and I’d like to take this opportunity to thank all our Supervisors of Midwives, LSA support midwives and LSA Midwifery Officers who, along with women and others, contributed significantly to the model whilst also carrying out their statutory functions during this period of significant change.

I thank each and every one of them for creating such a strong platform of support and advocacy that enabled A-EQUIP to be developed.

I look forward to working with you all as we move into the implementation phase of the A-EQUIP model; building on the best of what has gone before and moving forward with the aim to reach the potential that can be achieved to secure England’s place in the provision of fantastic maternity services that are amongst the safest and best in the world.

Hilary Garratt

Hilary Garratt CBE, BSc, MSc, RGN, RHV, PGCE is the Director of Nursing in NHS England and Deputy Chief Nursing Officer for England.

Hilary leads a nursing and midwifery team in NHS England that focuses on a number of national statutory functions and professional development priority areas.

She is a registered Nurse and Health Visitor with over 30 years’ experience of working in the NHS. Hilary has held a number of director posts and a deputy chief executive post in both Commissioning and Provision and has been working at National Director level for the last four years.

From 2013 – 2017 Hilary also volunteered for BBC Children in Need and was a committee member that undertook grant making for the North of England. She is also a trustee of a charity, “Giving to Gambia” and enjoys working in the Gambia for a short time each year as a volunteer to support initiatives that improve health and wellbeing.

Hilary worked in the Calais refugee camp in 2016 and witnessed the reality of individuals, living through unimaginable trauma. She saw children being lured into the hands of criminals for want of a better life and seeing this first hand brought home the sheer importance of the NHS and other organisations across the health and care system working together to protect the most vulnerable people in society.

Hilary received a CBE in the 2017 New Year’s Honours for services to nursing, particularly her work to safeguard some of the most vulnerable people in society

Follow Hilary on Twitter: @HilaryGarratt.

One comment

  1. Beverley A Lawrence Beech says:

    So where do women go now when they want care outside the guidelines and they no longer have a supervisor they can approach?