South East Region NMC Annual Conference March 2010 Yvonne Bronsky LSAMO South East

1. South East Region NMC Annual Conference March 2010 Yvonne Bronsky LSAMO South East Region

3. The UK Framework

4. LSA - ROLE Publish how it will meet the 54 standards laid down by the Nursing and Midwifery Council Appoints a senior practising midwife as a Local Supervising Authority Officer Authorises the selection, preparation and appointment of Supervisor of Midwives who function within its boundaries

5. LSA Strategy Strategic Goals National Standards & Guidelines Quality Assurance Networks & Relationships Professional Leadership Regulation www.midwife.org.uk Progress Report � May 2009Progress Report � May 2009

6.  Key Priorities for the LSAMO 1. Framework Align the Regional LSA function to ensure the Midwives rules and standards are met 2. National Standards and Guidance Develop new Guidelines Review and update established guidelines 3 Quality Assurance Review mechanisms for auditing statutory supervision of midwives and midwifery practice Maintain consistent LSA standards for statutory supervision of midwives

7. Networks and Relationships Maintain effective relationships with key stakeholders e.g. SGHD, NMC, QIS, NES and Care Commission Encourage public involvement by engagement with service users Professional Leadership Provide professional leadership in response to national policy and emerging local service development Key Priorities for LSAMO

8. NMC framework for Reviewing LSAs On an annual basis the NMC midwifery department will review the LSA profiles to decide which LSAs will be reviewed in the coming year. The decision to review will normally be based on which LSAs may be at highest risk of not meeting the standards and where the greatest risk may be with regards to protecting the public. However, on occasions the midwifery department may select an LSA to be reviewed at random or with a low risk score. This will enable the NMC to audit and test the NMC risk methodology. The decision to review will normally be based on which LSAs may be at highest risk of not meeting the standards and where the greatest risk may be with regards to protecting the public. However, on occasions the midwifery department may select an LSA to be reviewed at random or with a low risk score. This will enable the NMC to audit and test the NMC risk methodology.

9. Statutory Supervision Assists midwives to develop excellent practice Supports good clinical governance mechanisms for services Promotes the sharing of evidence ,knowledge and good practice Identifies poor practice and puts in place programmes of support Reduces the risk to women of poor practice and consequent outcomes Reduces the corporate risk to maternity services.

10. Supervision Assets Legislation & Intention to Practise Named Supervisory support of each individual midwife Annual Review with each midwife as well as other contacts throughout the year Advise and guidance on meeting PREP requirements Support for midwives requiring development

11. Supervision Assets cont Adviser for clinical policy and guidance Can lead in audit and research Investigate and identify poor practice and identify excellence Provide correction of poor practice by mentorship and example Act as a change agent to enhance aspects of practice for a whole service

12. The Process of Great Leadership challenge the process inspire a shared vision enable others to act model the way encourage the heart Adapted from � The Leadership Challenge� Kouzes & Posner 1987

14. Why Change? Historically in Fife, SOMs were managers Not very visible presence Seen sometimes as �policing� Overlap between management and Supervision System not used effectively

15. Why us? Various reasons: Previous experience of Supervision negative Realisation of possibilities of positive Supervision Positive experience � wanted to be part of this system Masters level of study � reflects the standards expected of SOMs

16. Highs Networking Stimulus of learning Looking at the bigger picture Challenge practice Achievement

17. Lows First cohort Volume and level of work Pressures of existing workload Achieving practical component Daunting task - question ability to work effectively as a Supervisor of Midwives

18. Best Practices Encourage sharing of experiences Involvement in groups and committees as SOMs Newsletters and Supervisory Hour - sharing information Involvement of student midwives Protected time Information given to women at booking

19. Our Vision Support from mentors, LSAMO and other SOMs Provision of an approachable, co-operative and proactive Supervisory service accessed by midwives and student midwives Encourage reflection to help identify potential improvements in practice Enable midwives to take change forward � acting as a leader, supporter and facilitator along the way

20. The First Year�. Joined groups / committees as a SoM, raising profile Attended Scottish SoM Conference in Stirling Annual reviews Record keeping audit Most recently, NMC Audit

21. The First Year (not only, but also!)�.. List of supervisees ITPs NMC Student Conference in Edinburgh Supervisory meetings On-call SoM (thankfully, no investigations yet!)

22. Lessons learned Learned that: Effective Supervision is not a passive process - it is a multi-faceted and complex role We must engender trust, motivation and self-awareness in order to fulfil the role laid down by the NMC Just the start of a life-long learning process for us as new SOMs Result in the provision of a high quality, professional service � ensuring the public will be well and truly protected

23. And finally�.. Recognised that changes had to be made Areas of good practice in statutory Supervision which had to be recognised and which could be built on Important not to throw the baby out with the bathwater That really would be a Supervisory issue!

25. Midwifery in the Millenium: the Role of the Advanced Midwifery Practitioner in the promotion of normality. Sue Briggs, Angela Chapman, Michelle Barford On behalf of the team at Diana, Princess of Wales Hospital, Grimsby Northern Lincolnshire and Goole NHS Foundation Trust

26. Advanced Midwifery Practitioner The role was developed in order to continue to provide a comprehensive quality service following : An acute service review and Trust merger Implementation of WTD reducing junior doctors hours Role reconfiguration for junior doctors Plans at that time to relocate maternity services at Grimsby First cohort commenced training in 2001

27. Evolvement of the Role The Political climate continues to influence the scope of midwifery practice and boundaries of care are constantly evolving. The NHS modernisation programme: NHS Plan (DoH, 2000) Making a difference (DoH 1999) Ideology that encourages exploration of new midwifery roles Vision 2000 (RCM 2000) Maternity Matters (DoH 2007) Safe births, everybody�s business (Kings Fund 2007) High quality care for all (Darzi 2008) Standards for maternity care (RCOG 2008)

28. Evolvement of the Role It was envisaged that the Advanced Practitioner would: Build on and enhance the service Develop practice according to service needs Have a dynamic and constantly evolving role Strengthen relationships with medical colleagues by having enhanced clinical, diagnostic and decision making skills Be empowered to increase their knowledge and expertise in managing birth and focusing on �women centred care�

29. Who is the Advanced Midwifery Practitioner (AMP)? The AMP is a midwifery clinician who can advance and develop clinical knowledge and skills to promote excellence in maternity care. She is an experienced Labour Co-ordinator While being trained to an advanced level and able to undertake activities and procedures traditionally practiced by Medical staff the AMP still has a large role to play in the promotion of normality within the maternity services.

30. Training Academic training through local University Initially input into A33 now Autonomous practitioner programme at degree level Clinical training with input from Clinical supervisor � lead Consultant for Labour Competency booklet developed locally Support from rest of senior medical team and AMPs

31. What extra does the role encompass? Input into medical rota 10 sessions/40 hours per week Carry 2nd on call bleep instead of SHO Response to emergencies 1st assistant in theatre Ventouse practitioner Ordering of investigations/initiation of treatment/care planning

32. Role Development The role extended beyond the Labour Ward into antenatal, postnatal and neonatal care e.g. maternal admission and discharge; patients reviews e.g. 1st day following operative/ instrumental delivery, examination of newborn Seamless service, enhanced continuity of care. Guardian of promotion of normality whilst acknowledging and responding appropriately when deviations from normal occur Understanding clinical challenges and supporting all colleagues

34. �Personal Considerations� The Advance Midwife Practitioners Promote a culture of care viewing pregnancy & birth as normal physiological processes. Are �guardians� of normality of childbirth, whilst acknowledging & responding appropriately when deviations from normal occur. Through professional collaboration challenge an overly medical model of care. Remember their �midwifery roots�/ be an advocate for mothers & midwives. Collaborate with Midwives & Medics to develop EB guidelines supporting practice that promotes normality.

35. �Working with mothers� The AMPs support midwives to: Identify low risk women & where appropriate promote home birth & MLC. Help women to view vaginal birth more positively & have confidence in their ability to give birth, breastfeed & be a happy parent. Provide informal Antenatal education that promotes normality & realistic expectations. e.g. VBAC Inform women of alternatives to unnecessary medical interventions / work with them to make evidence based informed decisions about their care.

36. �Creating a conducive Environment�The AMPs:- Promote a relaxed atmosphere conducive to normality. Encourage a �low tech� approach to reinforce concept of minimal intervention. Maintain a �culture of normality� even when intervention is required, e.g. promote skin-skin following uncomplicated ventouse delivery.

37. �Clinical Practice� The AMPs promote normality by: Encouraging & supporting less intervention. Support 1-1 labour care & continuity of care and carer. Encouraging non supine positions in labour & mobilisation. Discouraging inappropriate use of EFM Encouraging & supporting IA via Pinnards / doppler. (NICE, 2001) Encouraging midwives to �get back to basics� by advocating good pressure area, bladder & perineal care.

38. Encouraging & supporting use of non-pharmacological methods of pain relief and coping mechanisms - relaxation, Tens, birthing ball, use of water / birthing pool. Encouraging appropriate hydration / nutrition. Supporting physiological management of 3rd stage of labour for low risk women. Encouraging early skin - skin contact & breastfeeding support Encouraging midwives to get mothers not in established labour / pre- lab ROM home Encourage planned early discharge for low risk mothers (possibly facilitated by AMP/midwife discharge exam of newborn).

39. EducationalistsThe AMPs Utilise opportunities for informal teaching. Are proactive towards multidisciplinary education. Educate staff about the AMP role (not just for the �abnormal�) Promote mothers/ midwives educational resources that focus on normality Facilitate the acquisition of skills/ knowledge in the care of normal low risk mothers. Remind midwives that �1 intervention leads to another!�

40. Educationalists cont The AMPs are actively involved in the in-house training programme which is multidisciplinary CTG Neonatal resus Obstetric emergencies including drills HCA training

41. Staff DevelopmentThe AMPs:- Lead & support the developing role of midwives in line with unit philosophy e.g. LDRP & Midwifery led care. Empower Midwives to have confidence in their ability to manage normal birth using a � low tech� approach. Promote discussion around low intervention for low risk women. Encourage Midwives to think critically & reflect on practice. Support staff to question & change practice.

42. Research and AuditThe AMPs promote normality by:- Keeping up to date with contemporary issues that focus on normality. Critically appraising the evidence base for midwifery knowledge & practice. Considering other National / International perspectives of care / practice. Encouraging research awareness Auditing , reviewing & reflecting on practice.

43. On going Training for AMPs Regular update in ventouse delivery ALSO refresher NLS training Perineal repair training

44. An overview of the AMP role in promoting normality

45. The effects are clear to see Reduced CS rates 17.1% 2009 (16.3% 2008) SVD rate 71.2% 2009 (70% 2008) Birthrate plus in 2009 - 45.9% of all births in the unit within the I and II category which is stated in the report as being �significantly higher than found in many units in England.� Excellent working relationships with senior medical staff . True Team approach

46. The Effects cont Support for junior doctors Seamless approach to doctors rotation Challenge practice e.g. induction of labour Only undertake necessary investigations Keep a record of cases

47. Acknowledgements Special thanks to Sara Butcher for giving us the presentation and allowing us to adapt and add to it The rest of the AMP team at DPOW Sara Butcher, Jeanette Rowe and Brenda Waite The other Co-ordinators Tracy Martin and Carol Horsley The Consultants; Werner Mueller, Ian Stuart, Arabinda Saha, Ibrahim Bolaji, Silas Gimba and Mahadeeva Manohar Staff Grades; Shanka Gangophady and Nasser Mohammed Sheila Youssef Acting HoM, PSM Obs, Gynae & Sexual Health The Midwives at DPOW, NLAG