Supporting midwives to provide high quality care

Just over a year since the launch of the non-statutory model of midwifery supervision, NHS England’s Head of Maternity, Children and Young People shares some key highlights of how the experiences and outcomes for women, their babies and families are changing for the better.

I am delighted to be able to highlight some early outcomes and achievements since moving to a non-statutory model of midwifery supervision in England.

The new model, Advocating for Education and Quality Improvement (A-EQUIP) was developed as a response to the removal of statutory supervision from the Nursing and Midwifery Order 2001 on 31 March 2017.

This meant that midwifery roles and functions associated with Local Supervising Authorities (LSAs), Local Supervising Midwifery Officers (LSAMOs) and Supervisors of Midwives (SoMs) would no longer be a required function.

These changes to the Nursing and Midwifery 2001 order were debated in the House of Commons and House of Lords, which resulted in a call to ensure that some form of midwifery leadership replaced the existing LSA structures. This was supported by the Royal College of Midwives in their letter to the House of Lords Scrutiny Committee.

In response, a multi-stakeholder taskforce oversaw the development of A-EQUIP and the role of the Professional Midwifery Advocate (PMA), which was informed by contributions from over 2,400 people. The PMA role provides midwifery supervision and support through the use of the A-EQUIP model.

A-EQUIP and the PMA role is employer led, and is the responsibility of NHS providers to decide how this role will be implemented in their organisation. This allows maternity providers to be more flexible in applying all or some elements of the model that best supports local needs and priorities. PMAs are qualified midwives that have undertaken further recognised training provided by a Higher Education Institute (HEI). Once selected and trained, PMAs can then undertake a number of duties as part of their substantive midwifery role; this can be in a full-time capacity or on a sessional basis.

Since the launch of A-EQUIP, I am delighted that more than 760 PMAs have been identified by maternity providers across the country and trained to support supervision of midwives. They act as role models, promoting safe and effective evidence based care for women, babies and their families.

This is achieved by supporting midwives to identify how personal actions can improve the quality of care provided to women and families and by using a process known as restorative clinical supervision. This provides midwives with time and a safe space to focus and further develop both professionally and also fulfill career aspirations. This is particularly important if we are to retain our midwifery workforce, supporting them to develop and grow.

Over the last 12 months, two e-learning modules have been developed by NHS England and Health Education England to support implementation. The first module is a pre-requisite to the PMA programme, the second was developed in response to a national survey which sought the views of midwives regarding the role of the PMA and A-EQUIP.

From my recent visits across the country, I have personally seen and heard several excellent examples of how PMA’s are making a difference. One particular example that I would like to share is the approach and focus of how the role of the PMA has been implemented at Poole NHS Foundation Trust. Two PMAs have been appointed, incorporating PMA activities into the Practice Education Midwife role.

This creative approach has been developed in response to local needs and has included, for example; implementation of motivational interviewing training, to further support midwives to lead change in clinical practice. Motivational interviewing recognises that people are intrinsically motivated to improve their health and enables conversations which encourage and support changes in health and lifestyle behaviours.

Over the weeks following the training, colleagues approached the PMA with stories of how motivational interviewing had helped them to better communicate with women and their families, creating a more caring and safer work culture. It is great to see that just a few weeks ago, the PMA leading these and other changes included the development of a Birth Afterthoughts service was awarded a Iolanthe Midwifery Award.

Over the next 12 months, regional maternity teams will continue to support maternity provider plans for PMA provision, ensuring that succession plans are in line with the 2018 NHS Standard Contract. Recommendations from today’s report fall into two categories, with the aim of supporting providers to embed A-EQUIP even further – these are training, monitoring and evaluation.

A national evaluation of the A-EQUIP model and the role of the PMA will be undertaken in 2019, this may include, for example a focus on the wellbeing of staff, supporting staff to feel valued by their employers for investing in their wellbeing and ultimately, improving staff retention.

I am delighted with how midwives across the country have embraced the model and I look forward to hearing further examples of how A-EQUIP is being implemented. I would like to take this opportunity to thank all midwives and support staff for their continued hard work and dedication to improve outcomes and experiences for: women, their babies, families and the work experiences of staff.

Jacqueline Dunkley-Bent

Professor Jacqueline Dunkley-Bent has vast experience in healthcare provision and is the first Chief Midwifery Officer in England.

She has worked as a midwife and a nurse and held senior positions in clinical practice, education, leadership and management including: Director of Midwifery and Nursing positions for Women’s and Children’s services at Imperial College Healthcare Trust & Guy’s & St Thomas’ NHS Foundation Trust.

Academic roles have included: Senior Lecturer, Curriculum Leader, LME and Professor of Midwifery.

Jacqueline was appointed Chief Midwifery Officer in Spring 2019 at NHS England and NHS Improvement and is National Maternity Safety Champion for the Department of Health. She is also visiting Professor of Midwifery at Kings College London and London South Bank University.

Her experience has seen her leading and influencing national maternity standards and guidance. She also influences healthcare, nationally and internationally through research, education and publications and is frequently invited to speak at national and international conferences. She is a member of the British Journal of Midwifery editorial board and until recently was an active member of the Maternity and Newborn Forum at the Royal Society of Medicine.

She has joined the Tommy’s Charity National Advisory Board as Midwifery advisor, and the Women of the Year management committee. Her voluntary work currently includes Midwifery Advisor for the Wellbeing Foundation Africa and until recently a trustee.

In 2014 she received the HSJ, BME Pioneers award and in 2015 she was selected from over 100 nominations for inclusion on Nursing Times’ Leaders 2015 list that celebrates nurses and midwives who are pioneers, entrepreneurs and inspirational role models in their profession.