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A proposed model for the provision of professional
midwifery leadership, support and advocacy in
England
1. Following the publication of the Kings Fund report (Baird et al 2015) and the Report of
the Morecambe Bay Investigation (Kirkup 2015) there has been a need to review the
current system of midwifery regulation across the UK.
2. This paper is submitted by the LSAMO Forum UK and proposes a model for the provision
of professional midwifery leadership, support and advocacy in England which would be
possible to replicate across the UK. The Re-framing midwifery supervision paper
published by the RCM (Gillman 2015) provides the background and context to the current
situation.
3. The Kings Fund, NMC, Kirkup and RCM have all stated the importance of ensuring that
professional midwifery leadership is represented at all levels which this model
acknowledges. The model also provides a means by which a number of recommendations
for NHS England from the Kings Fund and Kirkup’s report are met.
4. The model described in this paper has been generated following discussions with LSA
Midwifery Officers, Supervisors of Midwives, Heads of Midwifery and Educationalists and
provides a vehicle through which the NMCs ‘Moral obligation’1 to ensure there is a
system of support and advocacy for midwives and women is achieved.
A model which is woman focussed
5. The model needs to deliver woman focussed quality care as its main purpose throughout with an
emphasis on improving outcomes for women and their families. This is demonstrated in the
diagram below:
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Stated verbally at Nursing and Midwifery Council meeting during discussion on Kings Fund report 28/01/15
A proposed model for the provision of professional midwifery leadership, support and advocacy/JRead/30/04/15
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A model which provides midwifery leadership at all levels
6. The Kings Fund recommends that consideration is given to filing the gaps in professional
midwifery leadership which would emerge as a result of legislative change to midwifery
regulation.
7. Kirkup recommends that national standards be drawn up setting out the professional duties and
expectations of clinical leads at all levels, including clinical directors, clinical leads, heads of
service, medical directors, nurse directors.
8. Professional midwifery leadership roles should be commensurate with the responsibilities and
level of remuneration of nursing equivalents at each level.
9. It is acknowledged that every midwife on the NMC Register whether working in the NHS or in
the Private Sector or Social Enterprises has a responsibility to engage with and interface with
their statutory and mandatory requirements which are dependent upon:
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Maintaining appropriate Registration with the NMC
To provide evidence for Re-validation requirements
To comply with the NMC Code and the
10. The titles within the model below are to represent each role and can be changed accordingly.
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Outlines of each role
11. National lead for Midwifery (or: Chief Midwife / Director of Midwifery: National)
A role based within the national team, with focus on delivering national objectives and strategy for
maternity whilst liaising with key stakeholders.
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National focus on implementing NHS Mandate for Maternity.
Five year forward view
Incorporate compassion in practice / 6Cs
Advisory / briefing role to DH
Working closely with Obstetric and Children's leads
Contribute to production of Quality National Standards (Investigation, Leadership, complaints)
Participate on review of NHS complaints system
Effective reform of the supervisory system prior to legislative change
Provide a framework for the systematic recording of perinatal and maternal death
Establish NHSE forum for Regional Maternity leads
National NMC link in relation to review of pre-reg standards for Midwifery
Contribute to and implement recommendations from Maternity service review
Interfacing on a national level with governance / quality agenda
12. Regional lead for Midwifery and Quality (or: Director of Midwifery: Regional)
Based within regional team working closely with National lead to deliver objectives and implement
strategy for maternity regionally.
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Focus on improving quality and outcomes in maternity
Implementation of commissioning standards regionally
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Liaising with Commissioners to facilitate woman focussed commissioning
Key role within strategic clinical network for maternity
Regional NMC link in relation to review of pre-reg standards for Midwifery
Overview and assurance of revalidation and ‘The Code’ regionally
Implement and monitor national quality standards
Interfacing on a regional level with governance and quality systems
Manage complaints relevant to midwifery that are submitted to the region
Networking with key stakeholders
Aim for consistency across region
Provide network for Lead midwives
Meet national objectives for maternity services
Support implementation of recommendations from Maternity Service review
Encourage innovation which improves women’s experience
Ensure service users views contribute to improvement of maternity services
Overview of a regional programme for clinical support / supervision2 which could be applied to
the nursing profession
Ensure equity of access to support and advocacy for Agency and Independent Midwives
Overview of a regional programme to provide advocacy for women and midwives
Contribute to the delivery of Patient and Public Voice (PPV)standards
13. Lead Midwife for revalidation and quality
This role would be based within provider organisation; accountable to the organisation for
revalidation and provision of system of support to midwives. (Similar to full time SoM role currently
in Wales and London)
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Oversees revalidation and provides assurance at Trust level
Provides system of support and advocacy for midwives
Oversees clinical support / supervision for midwives
Ensures provision of high quality midwifery care
Provides advocacy for women
Provides assurance of adherence to the Code
Implements recommendations from National reviews (Guernsey)
Implements innovation which improves women's experience
Implement peer review in the Trust investigation process
Support midwives who require remediation
Enhance multidisciplinary team working which improves care to women
Engage with relevant commissioners to ensure women focussed commissioning in line with local
demographics
Provide assurance to the region in relation to meeting National Quality Standards
Liaises with the education team regarding work based learning priorities
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There was an opinion that the term ‘Clinical Supervision’ did not describe the action accurately. Clinical Support was
suggested as an alternative. For the purpose of this paper the phrase Clinical Support / Supervision has been used to
ensure clarity for the reader
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Networks with other lead midwives across region to ensure consistency and share good practice
14. Midwifery Advocate for quality (or: QUEST midwife: quality, understanding, empowerment,
safety and team working)
Based within provider organisations; including employment agencies and Social Enterprises. This
role would be assigned to all Supervisors of Midwives following transition, and the current PoSoM3
course would evolve to provide training for future midwifery advocates. The role would be similar to
undertaking the mentorship course, when midwives fulfil the role within their substantive role.
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Additional role which previous supervisors of midwives will retain
Maintains a caseload of midwives providing support and advocacy
Focusses on high quality midwifery practice
Provides support to students and preceptorship midwives
Facilitates annual clinical support /supervision
Engages in advocacy support for women
Supports midwives in need of local action and development
Supports women through de-brief clinics
Facilitates and implements innovation under steer of Lead Midwife
Provides peer review expertise for governance investigations
Future of the PoSoM course (Preparation of Supervisors of Midwives
course)
15. To prepare midwives to be ‘Midwife Advocates’ The PoSoM course would evolve into a
professional midwifery advocacy and quality course which would prepare midwives for
leadership roles and enable them to advocate for midwives and women.
16. Retaining the requirement of peer nomination to undertake the course would ensure equity of
access to all midwives and fairness in terms of selection.
17. Provider Organisations would support staff to undertake the course in order to facilitate
sufficient clinical supervision and advocacy for all midwives.
Cost Efficiencies
18. For NHSE the cost savings are calculated in terms of employee costs; currently NHSE have 22
employees undertaking the LSA function which includes LSAMOs, LSA support midwives and LSA
administrators. The new model employs 8 staff members including 4 regional leads for maternity
and 4 administrators, taking into consideration that there is already within the structure a
national maternity lead.
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Preparation of Supervisors of Midwives Course
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19. Cost benefit to Trusts is that the role of the Midwife advocate would not be remunerated
(similar to when a midwife undertakes the mentorship course) as it is not a statutory role,
however the supportive and advocacy role which has an impact on the quality of midwifery
practice would continue. Currently the SoM role is remunerated at £500 – £2,000 per annum.
This will incur an immediate cost saving to the Trust which could be utilised to employ the WTE
lead midwife ( see 12 and below)
20. Full time SoM role has been evaluated positively in Wales and London and its role in provision of
high quality midwifery care recognised. The role of the Lead midwife for revalidation and quality
would replace the Full time SoM role therefore no further cost would be incurred in those
organisations that already have a Full time SoM
Strengths to the proposed model
21. Ensures that a clear system of support and advocacy for both midwives and women is
maintained following legislative change
22. Formalises Professional Midwifery Leadership at all levels and facilitates leadership
development for all midwives
23. Facilitates a system of clinical support / supervision for all midwives regardless of employment
status
24. Provides a system of annual review which feeds into triennial revalidation
25. Provides an interface with the NMC proposals for revalidation and will facilitate a system of
annual review and clinical support / supervision which will feed into the triennial revalidation
process
26. Provides for innovation and improvement in quality of maternity services
27. Is a system which would apply to all midwives on the NMC register including self -employed
midwives and agency midwives
28. Applicable to all four Countries within UK and provides for a consistent model across the UK
29. Provides a simple model which is transferrable to Nursing profession
30. Provides a means by which recommendations from Morecombe Bay Investigation Report (Kirkup
2015) and Kings Fund review (2015) are met.
31. Is a cost effective proposal; will incur less on-going cost to NHSE
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Weaknesses of the proposed model
32. The model would be dependent on Mandatory Standards which would need to be written and
disseminated across all Midwives registered with the NMC to incorporate the requirement of an
annual review which would feed into revalidation. The standards should also incorporate the
requirement for clinical support /supervision.
33. Organisations would need to commission places on the ‘Professional Midwifery, advocacy and
quality course’ and set their own standards regarding number of Midwifery Advocates per
organisation.
34. Midwifery Advocates may not want to take on the additional responsibilities with no
remuneration. (Although this has not happened with the Mentorship course and may only apply
to SoMs already in post)
35. Requires support and engagement from Organisations for the model to succeed and be an
equitable option for all midwives.
References
Baird et al (2015) Midwifery regulation in the United Kingdom. The Kings Fund, London
Gillman L, (2015) Re-framing midwifery supervision: a discussion paper.
https://www.rcm.org.uk/news-views-and-analysis/views/first-iteration-of-a-paper-on-supervision
Kirkup B (2015) The report of the Morecambe Bay Investigation. London
https://www.gov.uk/government/publications/morecambe-bay-investigation-report
NMC (2015) The Code www.nmc-uk.org/code
NMC (2012) Nursing and Midwifery Council (Midwives) Rules 2012
A proposed model for the provision of professional midwifery leadership, support and advocacy/JRead/30/04/15