1. www.hee.nhs.uk Personalised Maternity Care & Perinatal Services Barbara Kuypers NHS England & Health Education England

2. www.hee.nhs.uk Scope of Project What are our ambitions for Maternity Services for 2022 and what changes to Maternity Provision might we envisage. Which key areas of service provision require development and what implications will this have for training and preparation of the workforce. How will Trusts meet the NHS Mandate for Choice and Personalised Maternity Care and 1-1 care through out. What Models of care might be required. What should commissioners be seeking when negotiating Service Level Agreements and CQUINs

3. www.hee.nhs.uk Background – NHS Mandate 1.Offers women choice of providers. 2.Reduces the incident and impact of post natal depression through earlier diagnosis, and better intervention and support. 3.That every women has a Named Midwife who is responsible for ensuring she has personalised, one to one care through out pregnancy, childbirth and during the postnatal period, including additional support for those who have a maternal health concerns. The Mandate for Maternity supports improvements to the care and experience of women and families during pregnancy and in the early years for their children and asks NHS England to ensure that the NHS:

4. www.hee.nhs.uk HEE Mandate As part of this ambition, HEE should work with the NHS England and others to ensure that sufficient midwife and other maternity staff are trained and available to provide every woman with personalised, one to one care throughout pregnancy, childbirth and during the post natal period. (HEE Mandate 2012-15 (2.3.3.).

5. www.hee.nhs.uk Workforce Requirements Work is already underway with the Centre for Workforce Intelligence looking at the multi-disciplinary workforce requirements for various key pathways of maternity care. The project concentrates on the delivery of a wider workforce able to deliver the care and choices set out within the ambitions of the Mandate by putting in place the necessary actions and levers to ensure that there is an appropriate workforce in place to deliver the capacity and capability required by maternity services in 2022. The project will therefore be included in the Mandate to Health Education England. CfWI just published the Guidelines for Maternity Workforce Planning Pathway Toolkit

6. www.hee.nhs.uk Future Workforce

7. www.hee.nhs.uk WHO MAY BE OUR FUTURE EMPLOYERS?  Acute providers  Integrated Care  Public Health  Private hospitals  Universities  Self-employed  Social Enterprise  Local Authorities  Private Industry and sponsors for future health provision  Non- government organisations  Private, social & charitable enterprise  Schools and Educational departments  Social Services  Prison Services

8. www.hee.nhs.uk 1982-84: Maternity Care in Action Chapters 1, 2 &3 1993: Changing Childbirth Report 2004: National Service Framework for Children Young People and Maternity 2007: Maternity Matters 2014 Ambitions for Personalised Maternity Services towards 2022

9. www.hee.nhs.uk Key Values for Women Choice Continuity Control

10. www.hee.nhs.uk 1990: Acute and Community Services with Home Births. Main Employer NHS 2000: Concept of Choice, Continuity of Care and Named Midwife as philosophy of Maternity Care 2010: Increased number of Alongside and Freestanding Midwifery Led Units 2020: Increased case loading models provided by NHS and Social Enterprise Groups

11. www.hee.nhs.uk Personalised Maternity Care

12. www.hee.nhs.uk Mental Health Support Needs mentalhealthtoday.co.uk

13. www.hee.nhs.uk Midwifery Managed Pathways For every Trust Maternity Unit to have an alongside Midwifery Led Facility that is modern and homely as part of their portfolio of services. For all professionals to understand and apply the findings of relevant research, i.e. the Birth Place Study and positively and actively invite well women to birth in Midwifery Led facilities. For every Trust Maternity Unit to have a total midwifery managed route and pathway from booking to discharge and to include, ultrasound services to neonatal examination and discharge. That the commissioners especially reward or bonus this pathway.

14. www.hee.nhs.uk 1 st Welcome Appointment with Midwife All Investigations and Scans carried out by midwife at local Clinic Health Promotion and A/N Appointments either at home or at local clinic Labour and Birth at Home or Midwifery Unit Neonatal Examination at bedside or at Home Post natal care with infant feeding guidance at home or local clinic Introduction to onward Health Visiting Team and Family Planning Team

15. www.hee.nhs.uk Integrated Pathways of Care To encourage models of care that enable integrated working and reflects a group practice philosophy in which midwives have ‘control’ of their time management. This might reflect an ‘independent’ social enterprise model for particular categories of women such as those that require additional mental health support (Hull) or for those that are reluctant to access traditional maternity routes of care (Sheffield). To target particular groups of women who have social challenges and who require extra support throughout their pregnancy by multi-faceted teams (a little like the sure start model) which may include midwives and HVs (and social workers) working together longer into the PN period.

16. www.hee.nhs.uk Training and enjoying University living for the first time away from home. Preceptorship Year. Also got married. Case-loading Model and working flexibly. Part time working in Acute Services whilst having family. Appointed as Supervisor of Midwives. Working part time in Team Practice for Vulnerable Women. Children now at school. Case-loading with Social Enterprise Model working flexibly on annualised hours contract. Working as Clinical Academic with Trust and University teaching pre and post reg students. Retired with occasional bank hours.

17. www.hee.nhs.uk Acute Obstetric and Midwifery Provision Midwifery Case-loading Teams in partnership with obstetric and physician support. Community Midwifery Provision with Free Standing and Alongside Midwifery Facilities Home Birth Case-loading Team Specialist Partnership with Local Authority for women with Mental Health Support Needs. Specialist Integrated Teams for women with Social Support Needs (Safeguarding) Specialist Integrated Team for women requiring support to access services. New Dimensions Team

18. www.hee.nhs.uk The emotional rollercoaster of pregnancy (from DH Parents' views on the maternity journey and early parenthood, 2011)

19. www.hee.nhs.uk Childbirth & Mental Health Exacerbates pre-existing mental health disorders up to 50% Poorly understood Lack of training Emphasis on ‘wellness’ Screening often ineffective Medication advice poor Stigma, labelling, shame & embarrassment Fear of not being a ‘good enough’ mother Fear from the ‘authorities’ Great deal at stake Midwives often first point of contact

20. www.hee.nhs.uk Obstetrician Physician Anaesthetist Neonatologist and Neonatal Home Support Team Named Midwife General Practitioner and Primary Care Support

21. www.hee.nhs.uk Integrated Multidisciplinary Mental Health Team with access to Mother & Baby Unit Social Services for adult and child Safeguarding Support Local Authority for Housing and DWP Support.

22. www.hee.nhs.uk

27. Health Education England & Thames Valley  Influences the curriculae planning of all under and post graduate education and Perinatal Mental Health (PMH) is included in all Programmes.  Discussing with HEI’s about the need to develop PMH Training for existing workforce.  Supporting a project to develop mindfulness training for midwives and workshops for women.  HETV has supported post doctorate and intern opportunities.  Working to implement the ambitions of Personalised Maternity Care.

28. www.hee.nhs.uk Today and 2022 Students.salford.co.uk Named Midwife Caseloading Models of Care 1-1 Care in Labour Kings Fund Report and dissolution of Supervision of Midwives Future Review of routes for Midwifery Training Kirkup Inquiry and Duty of Candour Workforce Toolkits NHS England Review of Maternity Services

29. www.hee.nhs.uk Total Midwifery Managed Pathways Every Contacts Counts & No decision about me without me

30. www.hee.nhs.uk Thank you