October 2022

Welcome from Jacqueline Dunkley-Bent, Chief Midwifery Officer for England 

Reflecting back to the Lancet series published in 2014, a series of four papers and five comments, I am reminded of the stark reality that midwifery has a pivotal, yet widely neglected, part to play in accelerating progress to end preventable mortality of women and children worldwide, in England we have made great progress but we have much to do. Without you, without us, we cannot make the changes that are required. What you do ripples through generations, your contribution absolutely matters.

In light of the continued workforce challenges that maternity services are facing, I recently set out essential and immediate changes to the national maternity programme. There will no longer be a target date for services to deliver Midwifery Continuity of Carer (MCoC) and local services will instead be supported to develop local plans that work for them.

At the heart of the MCoC model is the vision that women should have consistent, safe and personalised maternity care, before, during and after the birth. It is a model of care provision that is evidence-based. It can improve the outcomes and experiences for most women and babies, especially women of Black, Asian and mixed ethnicity backgrounds and those living in the most deprived neighbourhoods.

However, over the past two years staff have had to work in ways that they never imagined, in difficult circumstances and we know that maternity services are experiencing stress and strain. This model of care requires appropriate staffing levels to be implemented safely.

We wrote to services on Wednesday 21 September setting  out essential and immediate changes to the national maternity programme in the light of the continued workforce challenges that maternity services face.

There will no longer be a target date for services to deliver Midwifery Continuity of Carer (MCoC) and local services will instead be supported to develop local plans that work for them.

The top priority for maternity and neonatal services must continue to be ensuring that the right workforce is in place to serve women and babies across England.

October marks Black History Month which honours the achievements, culture and history of black people. NHS organisations across the country are celebrating the month with face-to-face and virtual events.  

The theme for the month is ‘Time for change: Action not words'.

Addressing discrimination and disparity is essential, unfortunately, discrimination leads to talent being wasted and poor staff experience leads to poorer outcomes for patients and communities, so it is vital tackling this issue is at the forefront of every NHS organisation.  You can find details of a webinar on this subject in this months edition below.

From the bottom of my heart, thank you to all  #teamCMidO colleagues for all that you do for women and their families and for your continued compassionate leadership in helping to provide the best possible care.

Latest news

Maternity and neonatal services listening sessions

The NHS is working hard to improve maternity and neonatal services and we would like your help to shape how we do it.  Jacqueline Dunkley-Bent, Chief Midwifery Officer, and Dr Matthew Jolly, National Clinical Director for Women’s Health and Maternity, will host a series of sessions for all maternity and neonatal staff in the regions. 

We would like to use this as an opportunity to seek your views which will help to inform a new single delivery plan for maternity and neonatal care. The delivery plan aims to support further improvements to care, and we want to understand how we can best help you to deliver this.  This will be an opportunity to hear from us and for colleagues to share their experiences, concerns and suggestions.

Please click on the below links to register for the sessions:

North East and Yorkshire and North West

• 25 October, 6pm to 7pm
• 18 November, 8.30am to 9.30am

Midlands and East of England

• 27 October, 6pm to 7pm
• 2 December, 8.30am to 9.30am

South East, South West and London

• 28 October 12pm to 1pm
• 30 November, 6pm to 7pm

If you have any questions please email: chiefmidwifery.office@nhs.net

there are separate listening events that are planned for those who use maternity services, including those who seldom have an opportunity to share their views.

Wireless Cardiotocograph (CTG) monitoring

A safety issue has been identified with the use of wireless CTG monitoring. The investigation into the underlying issues is still underway, but it was felt necessary to issue advice in the interim. 

In the identified incident, a CTG machine being used with a wired transducer went into wireless mode unexpectedly, the reason for this is still being investigated with the manufacturer and the MHRA.  When it went into wireless mode, it started to pick up the signal from a transducer in an adjacent room, where CTG monitoring was being undertaken wirelessly, and printed out the fetal monitoring trace from the adjacent room. It was not immediately obvious that the CTG trace was not of the baby being monitored in the room. 

No harm resulted from this specific incident. However if action is not taken and the issue occurs again, there is the potential for an adverse event.

Preliminary investigation findings have identified that the CTG machines, and associated transducers, in the two rooms were set to different channels but had defaulted to the same frequency.  It should be noted that some machines have a range of channels that default to the same frequency.  We are therefore advising that:

• The Head/Director of Midwifery and the Lead Obstetrician should oversee a process to ensure that wireless CTG monitoring is not used until EBME/Clinical Engineering department have checked that the devices have been set up as per manufacturer’s instructions for use, and that no two machines share the same frequency.
• Midwives should be made aware of this issue and should check and document hourly if CTG is recording via wired monitoring or wirelessly, as part of the ‘fresh eyes’ review – this information would be displayed on the screen and/or a symbol may appear on the tracing.

This issue could potentially occur with any wireless CTG device.  Additional information can be obtained from the device manufacturer. 

Vaccination in pregnancy masterclass for health professionals: COVID-19, flu and pertussis

All healthcare professionals have a responsibility to inform and encourage pregnant women to get vaccinated against COVID-19, flu and pertussis.

On 20 October, Professor Jacqueline Dunkley-Bent, Chief Midwife for England, is hosting a masterclass for midwives and fellow NHS professionals, to give objective advice on vaccination, based on the best available evidence. National experts will give talks on the risks of COVID, flu and pertussis around pregnancy; the science behind vaccination; common questions and concerns; and what professionals can do to safeguard women, parents and babies.

The webinar will take place on Thursday 20 October, 9:30am – 10:45am. For further details and to register: Vaccination in pregnancy masterclass for health professionals: COVID-19, flu and pertussis | NHS England Events

Vaccination survey

NHS England is seeking the views of charities, NHS staff and the public on a future NHS vaccination strategy through this online survey – we want a really good response rate so I hope you will share this widely with your networks, for example through newsletters or via social media.

We think it is really important to make sure our vaccination services deliver the right levels of uptake and coverage, improve people’s health and leave no-one behind. Our aim is to support the local teams that plan and deliver vaccinations to build on the success and learning from COVID-19 vaccination, as well as what has worked well for flu and other vaccinations, to provide responsive, accessible, convenient and high quality NHS vaccination services.

New Perinatal Mental Health Resources 

NHS England's Perinatal Mental Health (PMH) Team recently organised a webinar to help systems to work across the PMH pathway, support the delivery of the PMH long-term plan commitments, and better understand the expansion of specialist PMH services and expanded cohorts. The event recording and slides can be accessed on the PMH FutureNHS Collaboration Platform under the LTP commitment section.

The team also recently published implementation guidance to support specialist PMH community teams and maternal mental health services to expand access to evidence-based psychological therapies. This includes individual interventions, as well as, where indicated, parent-infant, couple, and family interventions (including co-parenting interventions). The guidance can accessed on the PMH FutureNHS Collaboration Platform.

Twins Trust webinars

Another series of the Twins Trust's free multiple birth-specific webinars is currently underway. All are hosted by Professor Asma Khalil, Professor of Obstetrics and Maternal Fetal Medicine at St George's University Hospital, covering various topics and case studies.

The next webinar is available to book here and will cover perinatal care of twin pregnancies at the limit of viability. 

Consultation to add folic acid to flour 

Women are advised to take a daily 400-microgram folic acid supplement before conceiving and up to the  twelfth week of pregnancy as it reduces the risk of neural tube defects affected pregnancies. However, as pregnancies may be unplanned or women in the first few weeks of pregnancy may not know they are pregnant, many women may be unaware of this recommendation.

Following a consultation with industry and stakeholders on whether to add folic acid to non-wholemeal flour, the government is consulting on its proposal to add 250 micrograms of folic acid per 100 grams of flour. The consultation closes on 23 November. It is open to everyone.

Adding folic acid will mean foods made with flour, such as bread, will actively help avoid around 200 neural tube defects each year- around 20% of the annual UK total.  

Single Notification Portal - opportunity to get involved 

The Maternity Transformation Programme has been working with the Patient Safety Team to explore ways to efficiently notify national organisations of maternity and neonatal events, such as maternal deaths, through a single notification portal. This work was started a few years ago and we are now in the alpha phase of development, where we are working to understand the current maternity landscape and develop a design for a potential system.

We are hoping to develop a system which will reduce the burden on Trusts by reducing duplicative reporting of the same information to different organisations.

The supplier we are working with, Informed Solutions, is holding some initial user research sessions to inform the direction of the design through better understanding the needs of Trusts and the current processes around recording maternity and neonatal events. Following these initial sessions they will be holding ongoing sessions to ensure the development is aligned with user needs. This is your opportunity to help us to better understand the needs of your organisation and other users, so that we can develop a service which will improve the experience for all who are involved in recording maternity and neonatal events.

We are looking for representation from around 20-25 organisations to be involved in this user research.

We are very conscious of how busy teams are at this time, however if you are interested and have time to be involved or would like to understand more please contact:

hope.bristow@informed.com or michele.dawson@informed.com

Better Births 2022 - 8 November, Leeds

The Better Births conference is an opportunity for staff to come together and explore how maternity care will move forward in the coming years, with the NHS Long Term Plan committed to delivering better, safer, and more personal care for expectant mothers.

There is plenty to discuss, with the final Ockenden report published and the subsequent actions at the heart of planned improvements to NHS maternity care, the NHS is investing a further £127 million to boost the maternity workforce, strengthen leadership, and improve culture. This conference comes at the right time for all of us to reflect on the unique and significant contribution that we make to women, families and babies, but also to consider what we can do individually, and as a team, going forward to ensure safe and personalised care for everyone.

You can find out more and register here.

Black History Month webinar

The Workforce Race Equality Standard (WRES) team at NHS England is pleased to invite you to a Black History Month webinar on Thursday 6 October 12.30 pm – 2.00 pm.

The webinar will focus on the findings of the most recently published WRES data and specific actions we can all take to improve the outcomes and experiences of our staff.

Speakers include Professor Anton Emmanuel, head of WRES, NHS England and Patricia Miller, chief executive, NHS Dorset among others.

The agenda and full list of speakers will be available online shortly. 

If you have any questions, please do get in touch – england.wres@nhs.net

Call out to Midwives and Health Visitors - NHS.UK feedback needed

Our researchers would like to speak to you to improve our NHS website in supporting people during pregnancy and early child development.

One-to-one sessions will be conducted on Microsoft Teams. Each will last up to 60 mins. Sign up with this link if this is something you can help with. Our researchers will get in touch with some more information.

Please share your positive maternity and midwifery stories with us 

We’re always looking out for the positive stories you and your teams have on offer, such as:

• Learning from incidents that has led to sustained improvements in maternity services
• Thank you messages and feedback from service users to your maternity and midwifery teams
• Innovations or new ways of working that have made a difference - tell us what you’ve done and how it has improved care for women, their babies and families, or your working environment
• Inspirational staff, long service awards or interesting career stories
• A story about a student midwife who is making an impact, or a maternity support worker who has gone the extra mile
• A great example of multidisciplinary teamwork between obstetricians and midwives for example, to support patient care.

If you have anything you’d like to tell us about, please email: nursingmidwifery.comms@nhs.net with a few key bullet points/facts about the positive story, the location, and who the key contact is at the trust/region. We can then link in with the relevant colleagues and communications team to explore what’s possible! We look forward to hearing from you.

Culture and Leadership Programme update

We are delighted to introduce our first CMidO Clinical Leadership fellows Sarah Chalhoub and Colleen Wedderburn-Tate; who will be with us until the end of March 2023 and will be focussing on concise areas of work during their time with us.

Sarah is delighted to join the team and to be working on such a fantastic agenda. She is passionate about creating and delivering the best services and care for women and babies but also to support and reignite passion within the midwifery profession. She feels that leadership is a critical part of the wider Maternity Transformation Program, establishing safe and compassionate cultures not only for our patients but for each other.

Having spent 20 years as a clinical nurse and midwife, Sarah feels privileged to have welcomed new life and supported women as they navigate the transition to motherhood, from these experiences, she has learnt so much about humanity. More recently Sarah has undertaken a PhD exploring the role of the midwife and she hopes to use these blended experiences and skill set to support the delivery of the Perinatal Leadership Strategy.

Colleen is currently a Consultant Midwife with University College London Hospital. During her 50  year career in healthcare, Colleen has  held a wide variety of roles including in education, research,  at board level, in the private sector, and has spent several  periods of time attached to international healthcare systems. She has also been fortunate to hold leadership  roles in the voluntary sector and has a particular interest in user-led groups aimed at community development/improvement.

Colleen has held academic positions with The City University, London, and  the Department of Community Medicine, Mount Sinai Hospital School of Medicine, New York City. Her new role as Clinical  Fellow for Leadership provides the opportunity to influence how maternity services are led over the coming  decades so that the safety of our  maternity services are maintained  and improved, for our  staff and the women who use these services.     

Supporting our workforce

Maternity Support Worker awards

At the CNO Summit this month, Dame Ruth May announced the launch of bespoke awards for our maternity support workforce and healthcare support workers. 

Maternity support workers are integral to our workforce and deserve recognition and celebration for all that they do. These Awards will help us all to think more about how we can show our colleagues how much we value the difference they make. 

This extends the existing award schemes in place to recognise midwives, building on the success of these awards to demonstrate the importance of support staff to our wider workforce. 

The awards will also help us all to think more about how we can show our colleagues how much we value the contribution they make, and recognise maternity support workers who consistently demonstrate the NHS values and behaviours that may be needed when they are providing patient care, and inspiration to their colleagues. 

Find out more about the awards and how to nominate here.

Maternity Workforce Programme webinar series: Recognition, Value and Culture

The new webinar series by the Maternity Workforce Programme (MWP), resumes on Thursday 27 recognition, value and culture.

The series continues to explore workforce challenges faced by maternity services across England and shares learning from services that have overcome challenges with practical initiatives.

Please register by 4pm on Wednesday 26 October 2022

Recordings of all the webinars in the series so far are available with supporting resources on the FutureNHS platform.

Maternity Workforce Programme: Supporting the NHS midwifery workforce in England

The Maternity Workforce Programme (MWP) team were delighted to attend this month’s CNO summit and share with delegates more information on the programme.  MWP is an NHS England initiative, focussed on supporting the midwifery workforce.

We are:

1. increasing the NHS midwifery workforce through international recruitment of midwives, dedicated retention resources, and proactively encouraging midwives that recently left the NHS to return
2. maximising clinical time and safer practices through multidisciplinary working, education and training, and additional recruitment and support for support workers in maternity services
3. offering a direct programme of targeted support to address key workforce issues
4. providing national investment, alongside local investment, to support the maternity workforce in line with the Ockenden report’s Immediate and Essential Actions.

In 2021/22 the programme invested £95 million to increase establishment of both midwives and obstetricians

In 2022/23, continued national investment and support is enabling providers to support the maternity workforce by:

• enhancing supernumerary support for midwives through unit-based retention leads
• creating additional obstetric leadership capacity to strengthen collaboration with Directors / Heads of Midwifery
• increasing access to bereavement service training and development
• enhancing the retention and educational development support for maternity services support workers.

Contact the Maternity Workforce Programme team:

Email: england.nursingworkforce@nhs.net

Twitter: @TeamCNO_ #MaternityWorkforce

FutureNHS: Register for updates and best practice case studies on workforce improvements: https://future.nhs.uk/MaternityWorkforceProgramme

Maternity Workforce Programme – Sharing best practice

The Maternity Workforce Programme (MWP) area on the FutureNHS platform shares new best practice case studies covering some of the workforce challenges faced by maternity services across England.

Read about how the Flexible Working Offer at Lewisham and Greenwich NHS Trust is helping to support a better work-life balance.

Cultivating Courage and Compassion for Ourselves and Others

Newly qualified Midwives and Nurses are invited to join a 90-minute webinar exploring the experience and skills of maintaining courage and compassion. The webinar will be delivered by the Florence Nightingale Foundation in partnership with The Bravest Path which helps individuals and organisations develop their authenticity, bravery, and courage.

To register please choose a date and book your place, several sessions are available between October 2022 and February 2023.

New toolkit to support the retention of midwives 

A new toolkit is available to help line managers and employers support and improve the retention of midwives. The toolkit provides additional guidance to help complete the  midwifery retention self-assessment tool, and provides a template retention improvement plan as well as case studies and other supporting resources.

Organisations are encouraged to complete the tool and develop a retention plan to maximise the retention and experience of midwifery staff, as outlined in this letter. For further information, contact the national retention programme: england.lookingafterourpeople@nhs.net

The NHS Pension Scheme for Midwives

We know from focus groups, surveys, and previous pension seminars that staff want to better understand how the Pension Scheme works. For example, what would happen if they moved from full to work part time, the benefits available to them and their loved ones, staying longer and building more pension or returning to work after retirement.

Our pension partners, Isio, will be delivering face to face online pension seminars over the coming months. These seminars are designed to explain the value of the NHS Pension Scheme, at this stage for our midwife colleagues in late career e.g. staff aged 50 or older. 

Isio cannot provide personal financial advice. However, this is your opportunity to ask any questions about the NHS Pension Scheme and have your questions answered on the day. Isio will help clarify any misunderstanding or confusion and most importantly, provide the accurate information so you can make informed decisions about your pension savings.

The seminars will cover:

• An introduction to the NHS Pension Scheme and where to find information on your benefits.
• The impact of flexible working on pension benefits (e.g. part time working, step-down, wind-down, retire/return etc.).
• A brief outline of the McCloud judgment.
• If applicable, how having “Special Class” and “Mental Health Officer” status affects your options.

The seminars are free of charge will last around 1h and 30 minutes, including time for you to ask questions.

To book your place, please use the link provided below.

https://www.isio.com/nhs-nurses-and-midwives/

When you book, you will be invited to answer a few questions and watch a very short video (less than 10 minutes). Our aim is to ensure you attend the seminar which is right for you. .

If you have any questions about the seminars, please contact our mailbox:

england.nhsreward@nhs.net

Free peer to peer support available

The NHS Leadership Academy is partnering with the Florence Nightingale Foundation to offer free peer-to-peer support sessions for midwives at all levels. The sessions will run in October and will provide a confidential space to discuss professional and personal challenges and are facilitated by a trained professional who will create a secure and confidential environment for staff to come together. Find out more and register here.

Supporting staff to help money go further

Across the NHS, employers are actively supporting their staff with information and local offers to help their money go further.  

NHS England’s recognition and reward team have launched a dedicated Future NHS hub which provides employers a space where they can collaborate. It houses information, key links and examples of what is already being done locally as well as a template guide created by NHS England for employers to use when developing a local support offer for staff.  

New information has also been added to the financial wellbeing section on the NHS England website, to help any member of health and care staff make their money go further.  

NHS England will continue talking to relevant suppliers to develop a unique set of benefits for staff that help attract, recruit and retain the health and care workforce.  

If you have any resources or good practice examples to share, please email them to england.nhsreward@nhs.net.

International recruitment update

To date, the Maternity international recruitment (IR) programme has seen a total number of 1221 interviews taking place, with 851 appointments being made and 124 midwives arriving in England (July data) from December 2021, under the original maternity IR Offer 2021/22.

We continue to support maternity IR activities through the following funding offers:

• New to IR Offer
• Go further offer
• Maternity Innovation Fund

We continue to support regions and trusts make progress with their IR ambition via the Universal Support Programme. That is, through:

• Commissioned services: K2MS Perinatal Programme (Clinical adaptation), All4Maternity (CBT, cultural and clinical adaptation), FNF (Cultural adaptation), English language research
• Ongoing support via: FutureNHS Platform, regional assurance meetings, one-to-one meetings, OSCE working group, INMA support.

International midwifery recruitment – case studies

FutureNHS offers several new case study resources detailing how NHS Trusts have worked collaboratively, developed training and induction, and supported their internationally educated midwives.

Learn more on FutureNHS about:

• The role of Professional Midwifery Advocates in supporting Internationally Educated Midwives - by the East of England Regional PMA and Bedfordshire Hospitals NHS Foundation Trust.
• International Midwife Induction Programme – by Frimley Health NHS Foundation Trust.
• Developing a Midwifery OSCE Training Programme – by North Middlesex University Hospital NHS Trust.
• International Midwifery OSCE training programme – by Royal Berkshire NHS Foundation Trust
• International recruitment of midwives – by Royal Berkshire Case Study

North Cumbria Trust recruits first International midwives

Two International midwives have joined NCIC.

Gail Vassallo and Mary Ann Judith Jacob Peara are the latest recruits to join the Trust from overseas.

Gail, 30, has come from Malta and Mary-Ann from Kuwait, although she is originally from Kerala in India.

Gail has moved to Carlisle with her husband and recently started working at the Cumberland Infirmary on the maternity ward.

She said: “I worked as a midwife in Malta for six years. Myself and my husband visited the UK several times and we are big fans of British culture. The UK is similar to Malta. You drive on the same side and English is spoken in Malta so it seemed like a natural choice.

“It was an easy transition to make as I didn’t have to take any language tests.”

Gail carried out her first delivery on the maternity ward last week.

She said: “I delivered a boy. I love being part of the journey and forming a relationship with a couple and being there at a momentous time in their lives. It is very special.”

Gail said she was enjoying exploring the local area and had already been to Windermere. She said: “Every weekend is like a holiday for us at the moment as there are so many places to explore, although it is a little chilly compared to back home!”

Gail says she is looking forward to furthering her career at NCIC.

Mary Ann, 39, has left her family and three children in India while she works at CIC.

She said: “I too wanted to further my career and there are lots of opportunities here. I worked as a midwife in Kuwait for 12 years. This is my first time in the UK and I hope my family will be able to join me soon.”

Both Gail and Mary Ann completed a course in York before starting at NCIC.

Mary Ann said: “I love being a midwife and help bring new life into the world.”

Matron Rachel Fulton said: ““We are very excited to be welcoming the first of our new international midwives to the Trust. The national recruitment challenges within the midwifery profession have meant that we have decided to look further afield and we have been working closely with the international recruitment team over the last few months. Finally, our hard work and investment is coming to fruition and we are able to welcome Gail and Mary Ann into our team. This is an exciting challenge for us all and we look forward to working alongside them in the coming months and years.”

Amanda Kennett, Associate Director of Midwifery and Gynaecology at NCIC, also welcomed Gail and Mary Ann to NCIC. She said: “We are delighted to welcome our first cohort of International midwives to NCIC. They have settled in well and are popular members of the midwifery team. I wish them well in their future careers.”

Special offer for Team CMidO colleagues in the NHS: Get your tickets to see The Nutcracker

The Royal Opera House (ROH) is offering midwives and maternity support workers across the NHS in England the chance to attend a special performance of The Nutcracker in London this December.

The performance, part of this year’s Paul Hamlyn Christmas Treat, is taking place on Saturday 17 December at 1pm and will follow a morning of performances, workshops and crafts from 10am.

If you’d like to attend, register your interest on the ROH website by Sunday 16 October. You’ll be sent an email once tickets go on sale the following week.

Colleagues can book up to four tickets with discounted prices ranging from £5 to £30. Children must be at least five years old to attend. If you have any questions, please contact the ROH at: welcomeperformances@roh.org.uk

Maternity safety and quality improvement

Patient safety incident response framework published

The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety.

Patient safety incidents are unintended or unexpected events (including omissions) in healthcare that could have or did harm one or more people you care for.

You can find out more here.

Chief Midwifery Officer Awards

Our nursing and midwifery awards are for people who have gone above and beyond their duty. The following are those awarded since the last issue of this bulletin:

CMidO Gold

• Kathy Murphy, Director Nursing & Midwifery – Manchester University NHS Foundation Trust. For outstanding leadership, contribution to inclusive increase in student numbers, developing midwifery careers and an inclusive leadership culture and structure, and work with the RCM on freedom to speak up

CMidO Silver

• Clara Haken, Consultant Midwife – Hampshire Hospitals NHS Foundation Trust. For contribution to training and course development and Baby Lifeline’s Community Midwife Bag project
• Michelle Keeler, Fetal Wellbeing Midwife - Medway NHS Foundation Trust. For contribution to training and programme development and Baby Lifeline’s Community Midwife Bag project
• Elizabeth Hick, Delivery Suite Midwife Coordinator – Oxford University Hospitals NHS Foundation Trust. For contribution to quality improvement and support to junior and student midwives

Useful resources

Quick links to resources you might find useful

‘Invisible’ Muslim women’s voices heard in maternity report

Improving equity and equality in maternity and neonatal care

Make every contact count – pregnancy Covid-19 vaccination infographic