Supervisors of Midwives
Annual Report to South West LSA
2011/12
Standards of Supervision
and
Midwifery Practice at North Bristol NHS Trust
Report compiled by: Stephanie Withers and Nicola Fudge
South West Local Supervising Authority (LSA)
Document purpose
This document has been written for the South West LSA to inform the Annual Report
and to meet the standard set within the Nursing and Midwifery Council Rule 16 of the
Midwives Rules and Standards 2004.
Information contained in this report will be reproduced and will be part of the SHA
Public Board report and this report will also appear on the South West Strategic
Health Authority website).
1
Title
South West LSA
North Bristol NHS Trust
Annual Report 2011/12
Author(s) Stephanie Withers and Nicola Fudge
Publication date May 2012
Circulation list
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South West LSA
Contact Supervisors of Midwives South West
Primary Care Trust Chief Executive
NHS Trusts Chief Executive or Foundation Trust Chief Executive
Director of Nursing
Maternity Commissioning Lead Primary Care Trust
Head of Midwifery
Supervisors of Midwives
Maternity Services Liaison Committee chair
Contact details
Maternity
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB
0117 323 5306
Signatures
Nicola Fudge
Contact Supervisor of Midwives
2
Contents page
Contents page.................................................................................................. 3
Executive summary.......................................................................................... 4
Section 1 - Introduction and publication ........................................................... 5
Section 2 – Supervisor of Midwives appointments, resignations and removals6
Preceptorship for newly appointed Supervisors of Midwives ........................... 9
Continuing professional development for Supervisors of Midwives ................. 9
Protected time monitoring ................................................................................ 9
Section 3 - Details of how midwives are provided with continuous access to a
Supervisor of Midwives .................................................................................. 10
Section 4 - Details of how the practice of midwives is supervised ................. 11
Section 5 - Evidence that Supervisors of Midwives have engaged with service
users .............................................................................................................. 13
Section 6 - Evidence of engagement with higher education institutions in
relation to supervisory input into midwifery education .................................... 14
Section 7- Details of any new policies related to the supervision of midwives15
Section 8- Evidence of developing trends that may impact on the practice of
midwives in the Local Supervising Authority .................................................. 16
Section 9 - Details of the number of complaints regarding the discharge of the
supervisory function ....................................................................................... 27
Section 10 - Supervisory investigations undertaken during the year.............. 28
Recommendations ......................................................................................... 31
Appendices .................................................................................................... 32
3
Executive summary
There are a total number of 20 supervisors’ at NBT of which 16 take part in the oncall of supervisors and receive an annual payment. Two are educationalists, one an
antenatal screening co-ordinator and one works in practice development as part of
her flexible retirement.
Key achievements of the SOM team have been the following:
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To provide a 24 hour on-call system. Even with sickness among the team this
has been achieved for 365 days of the year.
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Supported a senior midwife through her supervised practice programme with
a successful outcome.
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The team of SOM’s have been very active in helping to achieve CNST level 2
and working towards the assessment for level 3 this June.
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The team of SOM’s provide a ‘Birth After thoughts Service’ for debriefing
women.
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Supporting staff involved in serious SI’s including statement writing.
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Supporting midwives with women who make decisions against medical advice
e.g. declining induction, Caesarean Section, unsafe home births.
Challenges have been:
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To maintain the number of SOMS’s within the team as there has been a large
turnover of SOM’s this year. Therefore we are continuing to develop a
strategy for appointing and retaining SOMS.
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Supporting the staff through a very busy year with more complex women and
an increasing birth rate.
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Supporting the staff through an organisational change which has meant some
midwives reapplying for their jobs and being re: banded and new skill mixing
with MCA’s being introduced.
4
Section 1 - Introduction and publication
This report covers the period from April 2011 to March 2012 and focuses on the
supervisory activities, key issues and trends affecting midwifery practice for the
Supervisors of Midwives based at North Bristol NHS Trust. The purpose of this
report is to inform the Local Supervising Authority (LSA) how the supervisors of
midwives met with the standards set within the Nursing and Midwifery Council’s
Midwives Rules and Standards (2004).
NBT do not currently have a website that is available to the public but it is an action
which the supervision team hope to achieve by September 2012.
5
Section 2 – Supervisor of Midwives appointments,
resignations and removals
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Total number of supervisors working in North Bristol NHS Trust: are 16 who
have a full case load and participate in the on-call rota.
Professional development activity includes: attending study days and
conferences, regional and local joint meetings with other Trust’s within the
South West.
Protected time allowed and monitored: On average, Supervisors of Midwives
receive four hours of protected time per month and this is demonstrated on
the off-duty rota.
The Supervisors of Midwives receive £2,000 per annum divided into 12
monthly payments of £166.00. In addition to this, they receive an on-call
payment. Most SOMS do on average 2 on-calls per month.
There are currently no supervisors of midwives on leave of absence.
In total at North Bristol NHS Trust, there are 277 midwives requiring
supervision. 271 are Trust midwives, 6 are non-trust midwives.
There was one new appointment in the year 2011.
There have been a total of 5 resignations in the previous three years (2009,
2010, and 2011). The reasons given were: work load, work/life balance, 1 x
relocation to another Trust, retirement.
There have been no removals at North Bristol NHS Trust.
The ratio of midwives to supervisor of midwives is 1:18.
There is currently 1 midwife on the Preparation of Supervisors of Midwives
programme.
We do an annual review of SoM to midwife caseload and based on this
decide whether we need to recruit more. We have evidence of this in the
minutes of meetings.
At North Bristol NHS Trust, we operate a buddy system for new Supervisors
of Midwives (including on-calls) working closely with another Supervisor until
they feel confident. Usually, we give new Supervisor of Midwifes a reduced
case load of midwives to supervise again until they feel confident.
There are no Supervisor of Midwives suspended from their role at North
Bristol NHS Trust.
There have been no Supervisors of Midwives removed from their role.
6
Current Supervisors of Midwives 31 March 2012
Supervisors of
Midwives name
Substantive post held
Stephanie Withers
Sharon Jordan
Sue Williams
Rachel Fielding
Ann Remmers
CDS Matron
CDS Midwife
CDS Midwife
Deputy Director of Midwifery
Director of Midwifery/Clinical
Director
Community Matron
Community Midwife
CDS Midwife
CDS Midwife
Community Midwife
Community Midwife
CDS Midwife
CDS Midwife
Specialist Midwife
CDS Midwife
Assessment Unit Manager
Screening co-ordinator
Midwifery Lecturer ( still has
1 supervisees but does not
take part in on-call rota)
Flexible retirement – Practice
Development
Midwifery Lecturer( still has 2
supervisees but does not
take part in on-call rota)
Linda Hicken
Rachel Hillan
Heather Wilcox
Maggie Smith
Vanessa Lanham-Cook
Sue Whittles
Beverley Osborne
Louise Pate
Jayne Thomas
Jemima Hillman
Nicola Fudge
Angela Knight
Sheena Payne
Helen Francomb
Marian Bailey
Number of Supervisors of
Midwives
Midwives PREP
supervised 6 hours updating
activity achieved
(Yes / No)
16
Yes
19
Yes
14
Yes
16
Yes
17
Yes
16
17
17
17
16
16
16
18
12
16
20
3
1
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
5
Yes
2
Yes
Supervisors of Midwives appointments
Table - Supervisor of Midwives appointments
Name
Jemima Hillman
Appointment date
July 2011
Supervisors of Midwives resignations
Table - Supervisor of Midwives resignations
Name
Lisa Marshall
Margaret Furner
Helen Francomb
Resignation date
2009
2011
2011
7
Reason
Relocation to another Trust
Work/Life balance
Flexi-Retirement ( still has 5
supervisees but does not take part in
on-call rota)
Name
Karen Fry
Angela Knight
Resignation date
2010
2011
Reason
Work/Life balance
Work Load( still has 3 supervisees
but does not take part in on-call rota)
Supervisors of Midwives removals
Table - Supervisor of Midwives removals
Name
NA
Removal date
NA
Reason
NA
Supervisors of Midwives suspended by the LSA
Table - Supervisor of Midwives suspensions
Name
NA
Suspension date
NA
Reason
NA
Supervisor of Midwives on leave of absence (or long term sick)
Table - Number of Supervisors of Midwives taking leave of absence (LOA)
Name
NA
Date of
absence
NA
Date of
return
NA
Reason
NA
Recruitment strategy for Supervisors of Midwives
The aim of the South West LSA is to have a 1:15 ratio and this will be achieved by
ensuring the successful recruitment of Supervisors of Midwives.
The current ratio at the Trust is 1:18. The total number of midwives on the 2011/12
Preparation of Supervisors of Midwives programme is 1 and therefore the predicted
ratio for September 2012 is 1:18.
The number of midwives required to undertake the programme in 2012/13 is 1. The
selection process is described in the LSAMO national guidance (guideline C
http://www.lsamoforumuk.scot.nhs.uk/).
8
Midwives undertaking Supervisor of Midwives preparation programmes
(starting or completing year 2011/12)
Table - Midwives undertaking Supervisor of Midwives preparation programmes
Name of
Midwife
University Start
date
Completion Academic Date of
Comments
date
level
appointment
as
Supervisor
of Midwives
by LSA
January July 2012
Level 3
September
If
2012
2012
successful
Isabel
UWE
MacPherson
Preceptorship for newly appointed Supervisors of Midwives
Name of
Supervisor of
Midwives
Linda Hicken
Support required
Start date
Completion
date
To be available for support/advice if
required. To be 2nd on-call with Isabel.
September
2012
December
2012
Continuing professional development for Supervisors of Midwives
Each Supervisor of Midwives is required to undertake a minimum of six hours
professionally updating activity annually and this information must be submitted to
the LSA (via the LSA database).
Protected time monitoring
The Trust has given each Supervisor of Midwives 4 hours per month to undertake the
supervision of midwives. It is each Supervisors of Midwives responsibility to ensure
that they are able to take the protected time allocated to them by the Trust.
The Supervisors of Midwives team have usually been able to take their protected
time. The action taken by the Supervisors of Midwives team when they have not
been able to take their time has been to initially discuss this with their manager and
then try and take any time owed in following month.
Statements
Always
Usually
About half the
time (50%)
9
Seldom
Never
Section 3 - Details of how midwives are provided with
continuous access to a Supervisor of Midwives
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Midwives can contact their Supervisor in a number of ways i.e. email,
telephone (both home and mobile numbers are available), or face to face
during a working shift.
Midwives can contact a Supervisor in an emergency by using the 24/7 on-call
rota. The rota is clearly displayed in all areas. Telephone numbers (both
home landline and personal mobile) are also available in all areas.
If in the very rare event the Supervisor on-call is not contactable, midwives
can phone CDS to speak to another supervisor on shift or phone the next
Supervisor on the list.
Two Independent Midwives are supervised by North Bristol NHS Trust
Supervisors.
We are currently in the process of developing a Supervisory website for North
Bristol NHS Trust.
The ‘Support for parents: How supervision and Supervisors of Midwives can
help you’ leaflet is distributed by the Community Midwives to all women at
booking appointments.
We audit annually the supervisory calls received which provides evidence of
how staff and members of the public access a Supervisor of Midwives.
Continuous access to a Supervisor of Midwives is provided by the 24/7 oncall system.
The response times from Supervisors of Midwives to requests for advice from
midwives in challenging situations is usually immediately following being
called through the on-call system. Within the hospital setting, most of the time
there is a SOM working clinically or in a managerial role so access is
immediate.
The response times from Supervisors of Midwives to requests for advice from
women in challenging situations is usually immediately following being called
through the on-call system. Within the hospital setting, most of the time there
is a SOM working clinically or in a managerial role so access is immediate.
For NBT Action plan see Appendix 1.
10
Section 4 - Details of how the practice of midwives is
supervised
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The role of the Contact Supervisor of Midwives is rotated annually along with
the role of Chair therefore the Contact Supervisor of Midwives and the Chair
are therefore helping to develop Supervisors practice.
All communication / information is distributed via Trust email which can be
securely accessed by all midwives at home.
To ensure consistency when carrying out supervisory functions, North Bristol
NHS Trust Supervisors always use NMC rules and the forms and guidance
issued by the LSA.
North Bristol NHS Trust Supervisors are very accessible to women. We are
currently providing a debriefing service following their birth experience.
Supervisors of Midwives are continuously auditing clinical practice as
Supervisors work clinically in all areas. Examples of good practice and
documentation are discussed at each individual annual review.
To be more of an effective team it is acknowledged that the clinical SOMS
need more non-clinical time, especially the contact SOM.
There is a monthly SOM meeting where it is expected that each SOM attends
at least 50% of the meetings.
At the monthly meetings all SOM calls are discussed and actions recorded.
11
Annual reviews up to 31 March 2012 (checked against LSA database)
Table - number of annual reviews achieved by Supervisor of Midwives
Supervisor of
Midwives
SOM / MW
ratio
Stephanie Withers
16
% of annual
reviews
achieved
75%
Sharon Jordan
Sue Williams
Rachel Fielding
Ann Remmers
Linda Hicken
Rachel Hillan
Heather Wilcox
19
14
16
17
16
17
17
100%
100%
100%
100%
100%
100%
99%
Maggie Smith
Vanessa LanhamCook
Sue Whittles
Beverley Osborne
Louise Pate
Jayne Thomas
Jemima Hillman
Nicola Fudge
17
16
100%
94%
16
16
18
12
16
20
100%
100%
100%
100%
100%
75%
Sheena Payne
Helen Francomb
Marion Bailey
Angela Knight
1
5
2
3
100%
100%
100%
100%
Reasons for not achieving
100%
Lack of response by Midwives to
reminders of the need to
undertake supervisory
One midwife…I took her onto my
list last Autumn and have not
been able to make a mutually
convenient appointment as yet
1 midwife currently abroad
Lack of response by Midwives to
reminders of the need to
undertake supervisory
12
Section 5 - Evidence that Supervisors of Midwives have
engaged with service users
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To engage with service users, there is a Supervisor of Midwives who is a
member of the Trust Patient Experience Group. All Supervisors are engaging
with women who request to debrief following their birth experience. As a
group of Supervisors, we act as advocates actively engaging with women in
support of their birth choices.
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To improve service user involvement, community midwives distribute the
NMC leaflet as previously mentioned and how to contact a Supervisor has
been included in the woman’s hand held notes.
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To improve user involvement in the next year, we plan to engage with service
users in recruitment and service development e.g. Cossham Birth Centre.
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There is a Bristol Maternity Services Liaison Committee (MLSC) which is the
voice for local women and men who use maternity and newborn services
before, during and after pregnancy or for anyone who is interested in how
these services are provided. The MSLC is an independent group that is
administratively supported by NHS Bristol. It plays a crucial role in identifying
the needs of local communities and in holding service commissioners and
providers to account to ensure that these needs are met. The group has a lay
chair and membership includes users, SOMS, managers of maternity
services and commissioners.
There is always a good representation of midwives and supervisors on this
committee from NBT as well as midwives from UHBristol who are all
passionate about high quality maternity services. Both NHS Trusts have been
reviewing Maternity and Newborn Services across Bristol, North Somerset
and South Gloucestershire. The findings of this review have been developed
into a set of targets to improve the services currently offered. The MLSC
ensures that the targets are implemented to develop the best maternity and
newborn services that can be offered.
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The SOM’s at NBT provide a Birth After thoughts Service for women who
require debriefing following their birth experience.
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We also support midwives who are caring for women who choose to go
against medical advice and we will also meet with these women.
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Section 6 - Evidence of engagement with higher education
institutions in relation to supervisory input into midwifery
education
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The HEI has an educational supervisor who is part of the supervisory team at
NBT. She is able to feedback on any issues that have been highlighted as
needing addressing and areas of good practice. All students are allocated a
named supervisor of midwives and the name allocated to each has been
disseminated through the HEI. Students are therefore encouraged to discuss
any learning needs or issues they might have with their supervisor.
The LME does not attend meetings. However there is an educational
supervisor at UWE who is attached to NBT. She attends the supervisors
meetings and carries a caseload. There is an educational supervisor’s forum
at UWE which is attended by the LME. Any issues concerning students are
raised in this forum and feedback made to the appropriate trust supervisors.
The NMC quality monitoring was undertaken in 2009 for the Preparation of
Supervisors of Midwives Course. The results in all categories were good with
an outstanding for the admission process. NBT was visited as part of this
audit. The Return to Midwifery Practice programme has not been monitored.
The pre-registration programmes ( 3 year & shortened) were monitored
through the NMC monitoring process in 2011. NBT was audited as part of this
process. Good feedback was received in all categories.
The midwives who undertake Return to Practice programmes who fail to re
qualify are known to the SOM team through the educational supervisor and
practice development midwife, who are part of the team selection for the
returnee. The SHA and LSA officer are informed through the HEI programme
leader that the midwife has been unsuccessful. Midwives on the POSOM
programme who fail to complete will be notified through the programme
leader for the course.
There are 43 student midwives at NBT.
Shortened programme x2
Year 1 = 11
Year 2 = 16
Year 3 = 14
The attrition rate from the pre-registration midwifery programme is
approximately 12%
The number of students commissioned for 2012/2013 is 71
The Return to Midwifery practice programme runs each year. This is done on
an individual basis as there are very few numbers. At present there are no
returnee’s at NBT.
There are no midwives at NBT on an Adaptation programme and this is not
currently provided locally.
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Section 7- Details of any new policies related to the
supervision of midwives
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The SOM’s at NBT are all aware that existing policies relating to the function
of statutory supervision are available on the intranet as they have all been
communicated this at SOM meetings and via e-mail with the below link.
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National guidance http://www.lsamoforumuk.scot.nhs.uk/
South of England LSA guidance
http://www.southwest.nhs.uk/midwifery/midwifery.asp
NMC guidance
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The local Supervisors of Midwives team do not have a web address that the
public can access but it is one of the actions for the SOM team to complete.
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The SOM’s at NBT have developed a new guideline called ‘The Role of the
Supervisor of Midwives on-call in excessive peaks of activity’ to ensure clarity
of the role of the SOM at these times. See appendix 2.
15
Section 8- Evidence of developing trends that may impact on
the practice of midwives in the Local Supervising Authority
Research and Maternity Dashboard at NBT
The regional midwifery research group for the Western Comprehensive Local
Research Network has continued to expand. Led by professor Tim Draycott and
Cathy Winter, they have secured additional funding to expand the group within the
South West region beyond Bristol, Taunton and Cheltenham/Gloucester. Additional
midwives have now been appointed in Bath/Swindon, Poole and soon in Salisbury.
The midwifery research group are helping to support and develop a more regional
research strategy and to encourage recruitment to Portfolio research projects.
One of our current regional research projects, the DASH Study, has been
progressing well and has been awarded a further years funding. Interviews with Risk
management staff and shop floor maternity staff in each of the maternity units in the
South West Strategic Health Authority have been completed and much information
has been gained on our current risk management and outcome monitoring processes
within the region. For the second phase of the project, a computer ‘macro’ has been
installed by the IT departments from each maternity unit to run alongside their own
maternity databases, to produce an automated maternity dashboard of maternal and
neonatal outcomes that all shop floor staff can easily view. The Dashboard provides
a red, amber and green status for 10 key quality indicators for best maternity care,
thus turning the maternity data entered by shop floor staff into information that can
inform maternity care in their own units. The findings of the study will be published
towards the end of 2012.
There have been many other portfolio research projects in which SW units have
participated during 2011/12 including: the Tongue-Tie study, the Diamorphine V
Pethidine study, the follow on study for Birthplace, the BUMPES study, the
PROSPECT study, PROMPT study, and soon to start is the CoCo90’s, the follow-on
study for the Children of the 90’s.
Finally, the Maternity Research Patient panel (Patient panel) continues to collaborate
and help advise our regional research team on any grant applications, study
information leaflets as well as many other aspects of the research process. The
panel members input has been invaluable to the maternity research programme.
The PROMPT Maternity Foundation
Over the past year there have been some very exciting developments for ‘The
PROMPT Maternity Foundation’ (PMF) - Registered Charity No: 1140557.
A team of PMF faculty travelled to Pune in India, in February 2012, to demonstrate
PROMPT training to key leads for maternity care and also Indian Government health
officials. They are very interested in rolling out PROMPT through-out India and PMF
have submitted a research proposal to start the roll-out of training in one Indian
region in 2013.
PMF have also received THET grant funding to introduce PROMPT training in
Zimbabwe, where one in 43 women die as a result of childbirth. The project is well
underway in Mpilo Hospital, Bulawayo, and they have already trained 75% of their
maternity staff. A data collection system has also been set up so that improvements
in outcomes as a result of the training can be monitored.
16
A revised and updated PROMPT 2 ‘Course in a Box’ containing additional modules,
videos and other training materials is being launched in June 2012
(www.promptmaternity.org).
NBT Organisational Change
•
This year maternity have untaken an Organisational change which has
looked at the configuration of our current workforce (registered to
unregistered, deployment of tasks). This has involved band 7 midwives in the
community and on Delivery Suite reapplying for their jobs.
Birth rate
•
Increasing birth rate and complexity of women who access Maternity Services
at NBT
17
Public Health picture
Obesity
The obesity guidelines were amended in January 2012 and were ratified by the
Antenatal Clinical Team in April 2012. What has changed is the management of
classifications. New care pathways have been developed for specific classifications
these are photocopied for individual women and stapled into their notes as a care
plan (a bit like diabetes pathway, twins etc).
Care of women in the community with BMI greater than 30 but less than 40 are still
midwife led care. BMI greater than 40 but less than 50 booking are consultant led
care, with a growth scan at 36/40, mode of delivery discussed, if greater than 220kgs
manual handling assessment needs to be performed and an anaesthetic review. The
usual VTE risks etc will be included for all women. Documenting additional extras
BMI greater than 50 at booking: consultant led in endocrine clinic, ECG 36/40,
consultant at LSCS etc.
We are highlighting the need to have BMI calculated at booking which is being done,
but to raise awareness of need for BMI at 36/40.
Women with gastric bands are referred to endocrine clinic which occurs every
Thursday AM and the band is deflated for pregnancy.
NBT is doing UKOSS surveillance study gathering data nationally to inform us of
management of these women, so far in UK there have been no statistics collected.
With this data we will go on to look at all practice and hopefully to do RCTs to define
best practice.
Also this year we have started obesity sessions as a hot topic for our intrapartum
study days. This will be cascaded as teaching for all midwives in the Trust a
collaborative effort between community and hospital midwives to ensure best care for
this population.
Domestic Abuse
All midwives receive an annual update at the mandatory maternity training and
community midwives participated in follow up study with UWE with regards to how
asking the question and supporting women has now become embedded practice.
This research also asked women survivors their thoughts of being asked about
Domestic Abuse which found that they were grateful the question had been asked
and for signposting- not always necessary at the time but helped for future. Identified
that barriers were the same - partner or significant other (family member) at
appointments, use of interpreter- although this is better with telephone interpreting.
Vulnerable Women – Substance Misuse
Working with women who have complex care and are vulnerable and hard to reach
can be difficult, but by using the NICE guideline Pregnancy and complex social
factors Sept 2010 as a basis for our care is a useful tool. All our care for these
women is tailored to their individual needs, giving women the choice about decisions,
treatment and preferences. Communication is key to linking with the women and
often other ways of communicating need to be utilised, including the use of text
messaging to remind clients re appointments which is what we do at NBT. Often
18
care planning also looks at the most appropriate healthcare setting for the provision
of care by using other members of the multi disciplinary team e.g. GP, practice nurse,
dentist , school nurse etc if engagement with the maternity service is problematic.
Staff attitudes are often addressed and training regarding communication, attitude,
ability to listen and information sharing is provided within the maternity service and
within the trust also and this is included in the NBT maternity study day which is
mandatory for all midwives.. The care is more successful if well co-ordinated and
certainly most women will have one specific named midwife if their particular needs
warrant this i.e. Drugs and Alcohol specialist Midwife or the Teenage Pregnancy
specialist Midwife. The women also have access to a direct work and mobile number,
so that they can get support whenever they require it. Women's care is tracked and
any concerns are documented and discussed with all agencies involved.
Occasionally transport is offered to overcome problems so attendance at
appointments is easier, and timing of appointments can be flexible.
19
Workforce
MIDWIFERY STAFFING ESTABLISHMENT snapshot as of 31/03/12
MIDWIFERY GRADE MIX
In post
WTE
none
1
0
1
6
62.88
116
7.20
194.08
Band 9
Band 8d
Band 8c
Band 8b
Band 8a
Band 7
Band 6
Band 5
Total
Overall ratio of births to midwifery establishment (WTE)
Ratio of births to midwives in post (WTE)
Adjusted ratio of births to midwives excluding maternity leave, longterm sickness, secondments away from unit etc
Total number of midwives employed (head count)
Total number of midwives notifying intention to practise
Vacancies according to funded establishment
Vacancies according to Birthrate Plus
Birthrate Plus undertaken – which year
Birthrate Plus in progress
Birthrate Plus planned – when
Specialist midwifery posts (please specify any not listed)
Consultant midwife
Lecturer practitioner
Practice Development Midwife
Infant Feeding Co-ordinator
Bereavement Midwife
Sure Start Midwife
Midwife Ultrasonographer
Teenage pregnancy midwife
Substance misuse midwife
RGNs employed within maternity setting
Maternity Care Support Workers
Funded
WTE
none
1
0
1
6
62.88
116
7.20
194.08
1:32
1:34
1.36
274
296
none
N/A
2005
No
No
0
0
1
1
0
0
6.6
1
1
2
In post
WTE
None
Funded
WTE
17.24
52.19
17.24
52.19
A4C banding
Band 3
Band 2
20
MIDWIFERY STAFFING ESTABLISHMENT snapshot as of 31/03/12
Nursery nurses
Ward Clerks
Clerical/Admin
Numbers of maternity care support workers/HCAs with NVQs
Level 1
Level 2
Level 3
None, only
employed
by NICU
5.79
6.26
12.96
Midwifery workforce analysis at NBT
Retention Plans We have a low turnover rate of 3% and support requests for employment breaks for
travel/opportunities to work overseas/family reasons, recognising the value of each individual
through securing their employment on their return. Staff are supported with flexible working
patterns and family friendly hours whilst also ensuring the needs of the service are met. All
staff receive a quality appraisal each year and are supported to achieve their personal and
professional development needs. We have a strong culture of staff involvement and
engagement, with every individual having a voice that is listened to, which all supports the
retention of the workforce.
Recruitment Plans
We have a clear and robust process for ongoing recruitment of midwives and MCA's in order
to maintain the safety and quality of our service in line with the funded staffing establishments
in each clinical area and to maintain the Midwife: Birth ratio. Recruitment on a fixed term
basis is also in place to cover maternity leave and long term sick. The Trust also has an
independent bank - NBT eXtra - with midwives recruited either on bank only contracts or in
addition to their substantive post to support the service, usually at short notice. Bank work is
monitored to ensure safe working patterns for staff. We also develop contingency plans when
activity (births) is predicted to peak based on the number of bookings. This includes offering
substantive staff additional hours on a fixed term basis over a specific period of time, or
recruiting additional midwives on a fixed terms basis for the period identified.
Employment of Student Midwives
We have identified a cohort of 5.6 WTE as a minimum to recruit newly qualified midwives
each year for a minimum of one year in support of their Preceptorship Programme. Although
advertised and available to all newly qualified midwives - the stronger candidates are usually
those that have undertaken their placement within Southmead Maternity Services from the
University West of England. We anticipate being able to consider these midwives for Band 6
posts that will be advertised each year in line with the current turnover rate - therefore
releasing the band 5 vacancies for the next cohort of newly qualified midwives
EU Midwives Employment
We have actively supported the recruitment of midwives from the EU, recognising their
value in supporting the diversity of the women of Bristol who access our services.
This has involved partnership working with UWE to ensure they are supported in
fulfilling the requirements for registration with the NMC. For some individuals, this has
meant they have worked as Maternity Care Assistants within our service, gaining
experience of working in the UK whilst gaining the requirements needed to practice in
their registered role as a Midwife.
21
5.79
6.26
Birth trends
Supervisors of Midwives Trust Annual Report
Clinical activity 1st April 2011 - 31st March 2012
1. Total number of women giving birth at this Trust
2. Total number of babies born
Place of birth
Total Consultant unit births
Consultant unit births site 1
Consultant unit births site 2
Total number of births in hospital birth centre
Total number in hospital birth centre transfers
(these are from the co-located birth suite to delivery suite)
Birth centre births (name each centre)
Total number birth centre births
1. Birth centre - NAME and total births
Total number intrapartum transfers
2. Birth centre - NAME and total births
Total number intrapartum transfers
Births at home
Total births in the home
Total of planned home births
Total of unplanned home births (BBA)
Total number of freebirthers
Total number of births delivered by Independent Midwives (if
known)
Bookings
Total number of bookings
Total number of bookings completed by 12 weeks (%)
Antenatal screening tests available to women
Maternal outcomes data
Total number of normal births
Total number of inductions
Total number of accelerated labours
Total number of women having VBAC
Total number of epidurals with vaginal delivery
Total number of women who receive 1:1 midwifery care in
labour
22
2011/12
6305
6427
5358
N/A
697
285
NA
NA
NA
NA
NA
161
209
68
1
0
7267
7,267
3716
1562
2388
109
1092
75% on
average
Total number of caesarean sections
Total number of elective caesarean sections
1738
744
Primip elective caesarean section
Multip elective caesarean section
Total number of emergency caesarean sections
Primip emergency caesarean section
Multip emergency caesarean section
Total number of instrumental deliveries
147
597
994
694
300
839
512
327
0
Total number of forcep deliveries
Total number of ventouse deliveries
Total number of ventouse deliveries by midwives
Total number of Episiotomies
Total vaginal breech births
Total number of maternal deaths
Direct
Indirect
Total number of waterbirths
Postnatal data
604
9
1
206
Total number of women initiating breastfeeding
Total number of women breastfeeding at six weeks
Perinatal outcome data
Total number of babies born
Total number of babies born alive
Total number of stillbirths
Total number of early neonatal deaths
Total number of late neonatal deaths
Total number of intrapartum related deaths
Total number of medical terminations
Additional Unit information
Total number of times unit closed
Total number of times there was a suspension of services
(includes homebirth services)
CNST level attained
Baby Friendly Award or equivalent status
23
5349
Data not
available
6426
6402
24
6
3
3
122
30
0
2
Yes
General information
Yes
Implementation of national recommendations
Do you have the following in place (please tick the
relevant box):
NICE
Guidelines for Antenatal Care
Guidelines for caesarean section
Antenatal and post natal mental health
Guidelines for postnatal care
Guidelines for fetal monitoring
Guidelines for induction of labour
Guidelines for Antenatal Anti-D prophylaxis
Interventional Procedures (NICE)
Technology appraisal e.g. dopplars
Pregnancy – routine anti-D prophylaxis for Rhd- negative
women
Guidance for complex procedures for fetal medicine
CEMACE
Assessing Risk in Antenatal Period
Assessing Risk in Intrapatum Period
Assessing Risk in Post natal Period
Referral by Midwife to Consultant
Referral by Midwife to other Specialists
Evidence of Multidisciplinary Working
Protocol for High Risk pregnancy
Information for parents re choice regarding Postmortems
Bereavement support
Identified Lead for maternal deaths
Identification of disadvantaged groups
Interpreter services 24 hours
Training for staff on recognition of women at risk of
domestic abuse
Ability for midwives to refer directly to community mental
health workers e.g. CPN
Trigger factors for follow up of poor attendees
24
No
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Working
towards
General information
Number of serious untoward incidents reported
Number of times unit closed to admissions
Pathways for care (please list all available)
All available on Trust Intranet – approx. 100
Too many to list.
Professional Education
Please list all mandatory training and updates
including skills and drills provided throughout the
year:













Fire, Health and Safety;
Manual handling;
Maternal resuscitation;
Neonatal resuscitation;
CTG Monitoring Updates;
Obstetric Emergency Training;
Antenatal screening;
Safeguarding children and adults;
Breastfeeding;
Infection Control;
Blood transfusion;
Perineal suturing;
Mentoring students.
25
5
30
Supervisor of Midwives analysis and commentary on Trust statistics (compare
with national data)

Total number of women giving birth
6305
Comments –

Total number of babies born
6427
Comments –

Total number of babies born at home
o
Total no of planned 209 and unplanned
276
68 homebirths
Comments –

Current caesarean section rate
27% 1738
Comments –

Current normal birth rate
61%
Comments –

Percentage of women initiating breastfeeding
5349
Comments –

Number of maternal deaths
0
Comments –

Perinatal mortality figures
12
Comments –

Unit closures and suspension of services
Comments -
26
30
Section 9 - Details of the number of complaints regarding the
discharge of the supervisory function

There have been no complaints received regarding North Bristol NHS Trust
Supervisory team.
27
Section 10 - Supervisory investigations undertaken during the
year

We inform the LSA of serious untoward incidents via the alert system on the
LSA database and e-mail and phone call.

The numbers of investigations undertaken during the year by a SOM are 2.
There were no external SOM or LSAMO investigations commissioned by the
LSA.

There were no Supervisors of Midwives involvements in investigations by the
Healthcare Commission or national equivalent.

We had only one supervised practice programme which involved a midwife
undertaking a role which she was trained to do. No key trend identified as it
was an isolated incident. However, it was identified that the staff involved
were slow to report the incident through the risk management process.

The action taken by the Supervisors of Midwives team to reduce a repeat of
this very isolated and unusual incident was to remind all staff of the
importance of reporting any incident of risk and its process, regardless of the
staff involved or their seniority.

We have had no supervised practice programmes that have not been
implemented due to employer dismissal or refusal by the midwife.

There have been no concerns relating to the competence of newly qualified
midwives, including their original place of training.

The NBT SOM team communicate with the LSA / NMC on any matters of
concern regarding midwifery practice by a direct phone call to the LSAMO
and followed up with an e-mail.

NBT have had no referrals to the NMC during this reporting year.

The SOM’s provide support to all staff involved in SI’s including statement
writing.
28
Supervisory investigations
The Supervisors of Midwives team inform the LSAMO of any investigations by using
the alert system on the LSA database and in addition each Contact Supervisors of
Midwives is informed of all supervisory investigations.
The total number of investigations carried out by the Supervisors of Midwives team
was 2.
The reports made the following recommendation to the LSA:
1. Total number of reports that recommended no further action to the LSA were
none.
2. Total number of reports that recommended a programme of developmental
support was required by the midwife was none.
3. Total number of reports that recommended that the midwife required
supervised practice was one.
4. Types of incidents investigated by a SOM was:
 Supervised practice programme for midwife undertaking a clinical role
which she was not trained to do.
 An SI investigation relating to a prolapsed cord at a home birth which
resulted in a stillbirth
Supported and supervised practice
If anyone (service users, colleagues or managers) has a concern about a midwife’s
ability to practise safely and effectively this must be reported to a Supervisor of
Midwives who will liaise closely with the LSAMO. The Supervisor of Midwives will
investigate the concerns and this will identify those midwives who need additional
support, supervised practice or on the rare occasions, need to be suspended from
practice after investigation by the LSAMO in the interests of their or the public’s
safety.
29
Table - Numbers of midwives on supported development programmes during the year monitored by supervisors of midwives/managers
Midwife
Key failures/omissions identified from investigation
1
2
3
4
None
Total length of
support
programme
Need for
extension
Change from
supported
programme to
supervised
practice (yes/no)
.
Table - Numbers of midwives on supervised practice starting 01/04/11 – 31/03/12
Midwife
Key issues/alleged failures identified from investigation
Total length of
programme
(hours)
Need for
extension
Supervisor of
Midwives
recommendation
to LSA at end of
programme
1
Midwife undertaking a clinical role for which she was not trained to do. Failure of
staff involved to report the incident immediately through the risk management
process.
12 weeks
.No
Midwife to return
to clinical practice
in her normal area
of work.
2
3
4
5
30
Recommendations
This section should include your work plan for the 2012/13 year and should
include the LSA audit recommendations.
The Supervisors of Midwives team at NBT have considered all the information
contained in this report and intend in the 2012/13 year to complete the following
actions.
1. Compile Trust Supervisor of Midwives team website information that is available
to the public.
2. A defined area to be identified for all SOM’s to store supervisory records for 7
years. Minutes of meetings to be stored on a secure drive only.
3. To develop a local strategy by September 2012.
4. To inform all staff at their annual review the process of how new guidelines and
policies are disseminated through practice development (e-mails and newsletter).
5. To continue the development of a recruitment strategy for appointing and retaining
SOMS.
6. Provide supervision of midwifery for Cossham Birth Centre (freestanding) when it
opens in January/ February 2013.
31
NBT Action Plan for LSA Audit 2011
Appendix 1
Criterion Standard
Criterion Met
Action Plan
2.8
Supervisors of Midwives maintain records of Only some are locked. Annual supervisory
supervisory activities that are stored for seven review on LSA database.
years in such a way as to maintain
confidentiality.
A defined lockable area to be identified for all
SOMs to store supervisory records for 7
years. Minutes of meetings are stored on a
secure drive.
5.3
Supervisors of Midwives ensure that midwives
are made aware of new guidelines and policies
and that all midwives have access to
documentation in electronic or hard copy.
To disseminate through supervision all made
aware and have access to electronic and hard
copy. To inform of process of dissemination,
raise at annual review.
All policies and guidelines have a SOM
included in process.
Dissemination of guidelines by practice
development midwives to all midwives via
email and newsletter.
2.11
There is a local strategy for supervision and an
action plan is developed following audit.
Local strategy to be developed by September
2012.
5.5
Supervisors
undertake
audit
of
the Pharmacy undertake audit of control drugs.
administration and destruction of controlled Dispensed and destroyed by pharmacy
drugs.
therefore not applicable.
32
Appendix 2
The Role of the Supervisor of Midwives on-call in excessive peaks of activity
In order to define the role of the Supervisor of Midwives (SOM) on-call it must acknowledged what the role of the SOM is.
The NMC (2004) state that the role of the Supervisor of Midwives is to protect the public by empowering midwives and midwifery students to
practise safely and effectively. Therefore, when midwives are faced with a situation where they feel they need support and advice, the SOM
acts as a resource.
With this in mind, the prime responsibility of the SOM is to ensure the safety of mothers and their babies whilst acting as a resource to both
midwives and mothers.
Criteria of calls – Every midwife has a responsibility to identify, notify and report issues that adversely affect the safety of mother and/or
baby (NMC, 2008)
Community – A midwife who has identified a concern which they feel needs the support/advice of a SOM, will call Delivery Suite (CDS) to
find out who the on-call SOM is and they will then contact that SOM directly themselves.
Hospital –
 In the hospital the midwife who has identified a concern should escalate their concern to the most senior manager/ matron in hours
and the CDS co-ordinator out of hours. This will enable the calls to be triaged and the most senior person on duty will then be the
midwife asking for support / advice, especially if the concern is the safety of the unit due to capacity and staffing.

If the midwife needs to call the SOM for personal reasons then they do not need to go through the above process. However, if they
feel that their concern is not been taken seriously by the senior person triaging the calls to the on-call SOM, and they considered the
safety of a mother or baby is at risk, then they should inform the senior person that their concerns still stand and therefore they will
be contacting the SOM on-call themselves.

If the co-ordinator’s concern is that the unit is unsafe and that she is unable to resolve and needs support, then an SBAR form should
be completed so the SOM on-call will have all the details she needs. This may be due to the staffing, capacity and workload within
the unit at that time.
33

When the SOM is called by the co-ordinator with concerns with the safety of the unit and needs to close the unit, then there must be
a mutual agreement regarding the decision and the SOM should find out the reasons why the co-ordinator feels it is unsafe.

The SOM may not need to come into the unit but the co-ordinator may want the agreement of the SOM with her decision and plan.

If a call is made to the SOM from the co-ordinator to ask her to come in for support, then the co-ordinator needs to explain their
decision, ideally with an SBAR form.

The SOM on-call is not ‘a pair of hands’ but is there to provide support to the co-ordinator. This could be from providing a ‘fresh pair
of eyes’ approach and may need some clinical input BUT this has to be reviewed.

Consideration should be given to Trust management support out of hours and this would be via the CSM (clinical site management
team). They may be able to identify support in theatre, HCA support and cleaning of delivery rooms and theatres. The CSM’s are a
valuable resource as they are aware of what is going on throughout the Trust.

The CSM should only be contacted by the co-ordinator out of hours or managers/matrons in hours.

It may be necessary to escalate concerns out of hours to the Trust Executive on-call person. This person should always be
contacted when the unit is closed.

If the problem is extremely difficult to resolve then the Trust Executive on-call person may need to call a maternity manager.
References.
1. Modern Supervision in Action (2008), a practical guide for midwives, NMC, London
2. Midwives Rules and Standards (2004), NMC, London
34