In this presentation, given at a national conference on February 16, 2017, "Safer Maternity Care: Next Steps Towards the National Maternity Ambition" I cover key issues on achieving the goals of Better Birth and the Maternity Transformation Programme, including HEE's work on ensuring that training supports a culture of continuous learning and improvement in safe services.

1. Health Education England: Transforming the
Workforce funding, education and skills
Professor Lisa Bayliss-Pratt
Director of Nursing & Deputy Director of Education and Quality

2. Personalised maternity care:
Stakeholder event findings
The beginning of HEE's Journey…..

3. • Findings support a system-level shift, from
maternal and newborn care focused on
identification and treatment of pathology,
to a system of skilled care for all, with
multidisciplinary teamwork and integration
across hospital and community settings.
• Midwifery is associated with more efficient
use of resources and improved outcomes
when provided by midwives who are
educated, trained, licensed, and
regulated, and midwives are only effective
when integrated into the health system in
the context of effective teamwork and
referral mechanisms and sufficient
resources.

4. Policy Context
• The evidence shows that the foundations for long-term health and wellbeing
are laid during pregnancy and the early years of life.
• The cross-party 1,001 Critical Days manifesto recognises the human and
economic costs of failing to intervene in this period. Its Building Great Britons
report contains recommendations for local and national government to
implement changes that will improve child outcomes.
• In November 2015, the Secretary of State for Health set out the
Government’s ambition to reduce the number of stillbirths, neonatal
deaths, maternal deaths and brain injuries that occur during or soon
after birth by 20% by 2020 and by 50% by 2030.
• Achieving this ambition requires a co-ordinated response including a strong
prevention focus relating to a range of risk factors pre-conception and in
maternity including smoking, drinking alcohol, healthy weight and mental
health.
• In January 2016, the Five Year Forward View for Maternity, Better Births:
Improving Outcomes of Maternity Services in England was published
including a range of recommendations for all sectors of health and social care
to implement to ensure an improvement in maternity outcomes.

5. National Maternity review ‘Better Births’
The Maternity Review was asked in its terms of reference to:
• Make recommendations on safe and efficient models of maternity services
• Ensure the NHS enables women to make safe and appropriate choices
• Support NHS staff to provide responsive care
• Pay particular attention to more geographically isolated areas.
Better Births sets out a vision for maternity services:
1. Personalised care, centred on the woman, her baby and her family, based around their needs and
their decisions, where they have genuine choice, informed by unbiased information.
2. Continuity of carer, to ensure safe care based on a relationship of mutual trust and respect in line
with the woman’s decisions.
3. Safer care, with professionals working together across boundaries to ensure rapid referral, and
access to the right care in the right place; leadership for a safety culture within and across
organisations; and investigations, honesty and learning when things go wrong.
4. Better postnatal care and perinatal mental health care, to address the historic underfunding and
provision in these two vital areas, which can have a significant impact on the life chances and
wellbeing of the woman, baby and family.
5. Multi-professional working, breaking down barriers between midwives, obstetricians and other
professionals to deliver safe and personalised care for women and their babies.
6. Working across boundaries to provide and commission maternity services to support
personalisation, safety and choice, with access to specialist care whenever needed.
7. A payment system that fairly and adequately compensates providers for delivering high quality
care to women efficiently, while supporting commissioners to commission for personalisation,
safety and choice.

6. We need to embody the values of Better Births:
• Make safety a thread running through everything
• Put women and their families at the center of care
• Seek to give babies the best start in life
• Work on a multi-professional basis and across boundaries
• Value our staff
• Listen and build consensus
• Share best practice
• Learn from what does not work
• Empower and support local change
Values of Better Births

7. Key Themes & Work
Streams
Work stream 5: Transforming
the Workforce led by HEE.
• A cross HEE Maternity Programme
Group has been convened to co-
ordinate the transformation of the
workforce which is key in initiating
the changes required to deliver more
personalised and safer care.
• Chaired by David Farrelly, HEE
Regional Director in Midlands and
East, HEE will be leading,
resourcing and delivering the work
stream on behalf of NHS England,
working closely with key
stakeholders and delivery partners
in other ALBs and the Royal
Colleges.

8. HEE and the Maternity
Transformation Programme
5. Transforming the workforce
Objective(s):
• Transforming the culture of maternity staff to embed multi-professionalism
• Shaping the configuration of staffing to ensure sustainability of care
• Midwifery supervision – develop new system and roll out
No Key Deliverables Milestones
2. Supporting multi-professionalism through review of
education (NMC and RCOG )
• Complete review of education by March 2017 so as to
include changes in curriculum by September 2018
5. Ensure there is an appropriately trained and available
workforce to meet the vision of care outlined in Better
Births, including considering the role which might be played
by maternity support workers. (HEE)
• Analysis by Spring 2017
6. Midwifery supervision – develop new system and roll out
(NHSE)
• Launch April 2017
Lead: David Farrelly (HEE) Working with: RCM, RCOG, RCPCH,
NMC, NHS E, Clinical Networks, NHSI
Governance: Maternity Workforce
Steering Group
• HEE will be leading, resourcing and delivering the work stream on behalf of NHS England, working
closely with key stakeholders and delivery partners in other ALBs and the Royal Colleges.

9. Maternity Safety Training
Fund
HEE and the Maternity Transformation Programme
• Within the 2016/17 HEE mandate, HEE has a commitment to ensure that training supports a
culture of continuous learning and improvement in safe services with a focus on reducing the
rates of stillbirths, neonatal and maternity deaths and other adverse outcomes such as sepsis
and intrapartum brain injuries.
• To meet this aim, HEE are distributing £8m of funding throughout England to fund packages
of multi-disciplinary training, focussing on leadership, multi-professional team working, human
factors training as well as midwifery and obstetric skills e.g. obstetric emergencies.
• Training to commence in 2017. Comprehensive catalogue of ‘approved’ training programmes
suitable for maternity units across England developed to support the Maternity Safety Training
Fund.
• An independent evaluation of the project will be commissioned, to assess the training
programmes and wider impact for patients.
• This project is incorporated into NHS England’s Maternity Transformation Programme, working
with the Department of Health and NHS England.

10. Vision
For all staff to be:
• Supported to deliver care which is woman
centred.
• Working in high performing multi-
disciplinary teams.
• In organisations which are well led.
• Breaking down organisational and
professional boundaries.
• Working together & training together.
• Important to have the right culture which
promotes innovation, continuous learning
and leadership in place.

11. • Formed in January 2016
• Responsible for developing the new
model of midwifery supervision for
England which will be implemented
in Spring 2017.
• The model will be tested in shadow
form from October-Feb 2017 and the
final model will be launched from
April 2017 or when the law is
enacted.
• Further information regarding the
taskforce membership, terms of
reference, programme and
communications plan can be
accessed at the web page
North
1) Airedale NHS Foundation Trust.
2) Calderdale & Huddersfield NHS Foundation Trust.
Midlands and East
3) University Hospital Coventry and Warwickshire,
South Warwickshire Foundation Trust, George
Eliot Hospital Trust & Coventry University.
South
4) Taunton and Somerset NHS Foundation Trust.
London
5) The Whittington Hospital.
6) Barking Havering and Redbridge University
Hospitals NHS Trust.
Towards a New Model of
Supervision:
NHS England Supervision of Midwifery Six pilot sites have been announced
Taskforce

12. Pilot Sites

13. Perinatal Mental Health
i) Maternal and perinatal mortality 2011-2013
Perinatal Mental Health
Between 10% and 20% of
women are affected by
mental health problems at
some point during
pregnancy or the first year
after childbirth.

14. The Perinatal Mental Health
programme has been designed to
help educate and increase awareness
of issues arising from mental
health.
This programme deals with
• Perinatal Mental Health for Health Visitors, &
• Perinatal Mental Health for all professionals.
.
Perinatal Mental Health
ii) Perinatal Mental Health e- learning
http://www.e-lfh.org.uk/programmes/perinatal-mental-health/open-access-health-visitor-sessions/

15. HEE have commission Tavistock and
Portman NHS Foundation Trust to
create a Perinatal Mental Health
competency framework to identify and
address gaps in knowledge, skills &
provision of care across the country.
Pilots in four areas in the UK:
Cumbria, Birmingham, Kent and
Devon.
The future
The competency framework will be
used to assess training needs and
help to develop linked training
programmes so that mental health
care for women during the perinatal
period is standardised and widely
available
9 ‘domains’ of competence agreed
Section 1 Knowledge
Domain 1 - Common emotional and physiological
changes
Domain 2 - Understanding perinatal mental health
conditions
Section 2 Communication
Domain 3 - Having an open conversation about
perinatal mental health
Domain 4 - Understanding the mother’s feelings
about her baby and pregnancy
Domain 5 - Understanding the impact of pregnancy
on others
Domain 6 - Understanding difference, stigma and
barriers to care
Section 3 Delivery
Domain 7 - Understanding risk and protective factors
Domain 8 - Safeguarding vulnerable women and
infants
Domain 9 - Understanding and valuing the
multidisciplinary team and pathway.
Perinatal Mental Health
iii) Perinatal Mental Health Competency
Framework

16. Perinatal Mental Health
iv) Other initiatives planned
• Working with the national Perinatal Mental Health Steering Group established in
2016, PMH clinical networks and local offices, HEE is developing a strategy to
deliver education and evidence based training, to increase access to specialist
perinatal mental health support and improve patient outcomes.
• HEE is working closely with NHSE and the Royal College of Psychiatry to set up
specialist PMH consultant placements and clinical leadership for new areas
under the specialist psychiatry bursary scheme.
• Monitoring current provision and developing training projects with national
partners to increase specialist support, as well as multidisciplinary skills and
awareness, to address regional variation. Supporting local offices developing
regional training proposals.

17. Call the Midwife
Call the Midwife is a BBC
period drama series about a
group of nurse midwives
working in the East End of
London in the late 1950s
and early 1960s.
One Born Every Minute
One born every minute is a first
of its kind in capturing the many
different perspectives within a
room as labour and birth takes
place.
Midwifery in the media
Is it realistic?
Demographic – predominantly female, mature, likely to work part time on qualification.

18. Background and
Challenges
• Time of change and challenge for midwives and midwifery.
• However this can also provide real opportunities for midwives as both leaders
and advocates for women and babies to ensure that their voice is heard.
• Education and lifelong learning must have at its heart, the safety and well being
of women and their babies ensuring they receive the high quality care they
deserve.

19. Workforce
Regulation
• Revalidation
• Supervision
• NMC appoints Professor Mary
Renfrew to lead development of
new midwifery standards
Education
• Capacity and lack of mentors to
support additional numbers of
students in the clinical areas
Numbers & Skill Mix
• Maternity Support Workers
Practice Issues
• Continuity of Carer
• Personalised Care
• Evidence based care
• Facilitating normality
• Public Health/Perinatal Mental
Health
Concerns some of the solutions
looked at within Shape of Caring
Review, may not be appropriate for
addressing issues in midwifery?
Workforce & Practice
Issues

20. Mind the (generational) gap
‘Baby Boomers’ ‘Generation X’ ‘Generation Y’ ‘Generation Z’
1946-1964 1965-1980 1981-1994 1995-2010
Motivated and hard
working; define self-
worth by work and
accomplishments.
Practical self-
starters, but work-
life balance
important.
Ambitious, with high
career expectations;
need mentorship
and reassurance.
Highly innovative,
but will expect to be
informed. Personal
freedom is essential.
25% of the NHS
workforce
40% of the NHS
workforce
35% of the NHS
workforce
<5% of the NHS
workforce
Jones K, Warren A, Davies A. 2015. Mind the Gap: Exploring the needs of early
career nurses and midwives in the workplace. Summary report from

21. Narrowing the Gap:
Gen-gagement
What nurses and midwifes told us…..
• Professional autonomy and meaningful recognition ‘ not just responsibility’ appears
significant to unlock retention challenge.
• Need to match baby boomers and gaps in the system….see as wise owls not
dinosaurs!
• Value, respect and celebrate success.
• We must continue to listen……
www.hee.nhs.uk/wm/narrowingthegap

22. Demonstrating
personal and
professional value
Working to
full potential
Gaining respect
and recognition
Pride
Professional Autonomy
Why is professional autonomy so important?

23. • Systems of governance – 'liberate to lead' ! and 'let nurses nurse'
This links to why Nursing Associate role and new ways of working are so important.
• Shared governance and reducing bureaucratic burden by using evidence based
practice to enable local ownership of care quality outcomes and improvement were
key solutions.
• Growth and advancement – better career development and flexible opportunities,
no matter what your age !!
This links to shape of caring recommendations etc.
The Model for Enhancement

24. High quality clinical learning
environment
3 points for consideration:
1. A high quality clinical learning environment supports the development of a
sustainable workforce, reducing avoidable student attrition and developing
future workforce supply. This is important in view of the cap on agency spend
and on overseas recruitment.
2. A high quality clinical learning environment develops a competent and confident
workforce. Students need the opportunity to deliver hands-on care during their
practice education and models such as the coaching model can supports this.
3. A high quality clinical learning environment supports the retention and upskilling
of the current workforce with preceptorship, new skills and the versatility to
deliver new care models.

25. E-Learning for Health

26. eFM is a comprehensive web based
resource developed by the RCOG &
RCM in partnership with HEE e-LFH.
eFM will teach and assess learners in
all aspects of intrapartum electronic
fetal monitoring and is directed at both
obstetricians and midwives in training
as well as those who have completed
their training.
eFM is split into three sections:
1. A knowledge-based, interactive tutorial
section.
2. An assessment section which formally tests
what knowledge the learner has acquired
from the knowledge-based sessions.
3. A case study section which allows the
learner to practise their skills at
interpretation of an actual fetal heart rate
recording, and the subsequent
management in a virtual labour ward
setting.
Electronic Fetal Monitoring
eFM
http://www.e-lfh.org.uk/programmes/electronic-fetal-monitoring/

27. • Aims to support clinicians in the NHS to gain knowledge and understanding of the
issues around culture and health; and how this might influence health care
outcomes.
• The resource which includes animation, interactive activities and opportunities for
self-reflection and evaluation, covers three modules, the first two for all health
professionals and the third specifically aimed at midwives.
• It was developed through exploratory and development work examining midwives’
knowledge, understanding and experiences of providing culturally sensitive care
as well as the needs of black and minority ethnic service users’ and their
experiences of maternity service provision.
http://www.e-lfh.org.uk/programmes/cultural-competence/
Cultural Competence
New e-learning tool to support health care professionals’
cultural competence

28. Think Sepsis
• “THINK SEPSIS” is a Heath Education England programme aimed at improving the
diagnosis and management of those with sepsis.
• 123,000 cases of sepsis occur in England each year with approximately 37,000
deaths annually: This is more than breast, bowel and prostate cancers combined.
• Prompt recognition of sepsis and rapid intervention will help reduce the number of
deaths occurring annually.
http://www.e-lfh.org.uk/programmes/sepsis/

29. Thank you
W. www.hee.nhs.uk
@hee_lisaBP