1. Maternity Transformation Programme and the new A-EQUIP supervision model:
Setting the scene
Birte Harlev-Lam
Clinical Director – Maternity and Children
28 July 2017
Title slide with embedded images

2. Maternity Transformation Programme
The Maternity Transformation Programme
seeks to achieve the vision set out in Better Births, the national maternity review which was published in February 2016
the Secretary of State’s ambition to halve the number of stillbirths, neonatal and maternal deaths and brain injuries by 2030

3. Maternity Transformation Programme
Vision
for maternity services across England to become safer, more personalised, kinder, professional and more family friendly, where every woman has access to information to enable her to make decisions about her care and where she and her baby can access support that is centred on their individual needs and circumstances
for all staff to be supported to deliver care which is women centred, working in high performing teams, in organisations which are well led, in cultures which promote innovation, continuous learning, and break down organisational and professional boundaries.
Work streams
bringing together a range of organisations to lead and deliver across 9 work streams, supported by stakeholders that will scrutinise and challenge decisions made by the Board.

4. Maternity Transformation - 9 Work Streams
Local drivers for change
System enablers
Service improvement

5. Work stream 1 Supporting local transformation
Local Drivers for Change
Working in tandem with STP processes, and through NHS Regions and Maternity Clinical Networks, to provide targeted support to Local Maternity Systems. 
Providing Support for 7 early adopters to test the model of care described in BB B
Implementing recommendations from Better Births under 6 headings:
Continuity of carer
Single point of access
EPR
Post natal
Payment methods
Care plan
Aims range from
A single point of access to a full range of wrap around services, including prevention, mental health and well-being support
Small midwifery teams for case loading to promote home births
Co-design, explore and test new local payment methods.
Digital solutions to support personalised care planning
Develop one County specialised “complex care” team to include: Safeguarding, teenage pregnancy, perinatal mental health
Creating a seamless, standardised model of care across the Local Maternity System

6. Work stream 2 Promoting good practice for safer care
Service Improvement
There is much good practice already in the NHS and this work stream aims to ensure widespread dissemination and adoption of best practice, through targeted support to embed a safety, learning and improvement culture throughout NHS maternity services.
Saving lives stillbirth care bundle
Maternity and neonatal safety collaborative
PMR tool
Atain

7. Work stream 3 Increasing Choice and Personalisation
Local Drivers for Change
working with 7 maternity choice and personalisation pioneers to test new approaches to widen and deepen choices available for women.
Objectives
Seven Pioneers, made up of clusters of between 2 and 11 CCGs, are working to achieve three key objectives:
Widening choice across CCG boundaries and deepening choice by providing opportunities for new providers;
Empowering women to take control through Personal Maternity Care Budgets (PMCBs); and
Enabling women to make decisions about the care that they receive.
Sharing of best practice
The success of the Programme will be through the development and testing of products and processes in Pioneer localities
Development of a national dissemination model through:
Regional Chief Nurses, clinical networks, the Regional Maternity Boards and aligned with the Maternity Transformation Plans (MTP)
Evaluation
Current baseline exercise to quantify the existing choices in each Pioneer area
Development of metrics both to evaluate the progress of each Pioneer and of the Programme as a whole, including:
The extent to which the range of choices available to women improves
How many women are offered, and choose to have, a PMCB
The extent to which PMCBs change historic referral patterns
Women’s, and healthcare professionals’, experience of using a PMCB

8. Work stream 4 Improving access to perinatal mental health services
Service Improvement
A joint work stream between the Maternity Transformation Programme and the Mental Health Transformation Board
It aims to improve access for women to high-quality specialist mental health care, closer to home, when they need it during the perinatal period.

9. Work stream 5 Transforming the workforce
System enablers
This work stream aims to ensure that we have the right work force with the right skills to implement the vision set out in Better Births,
That the work force is supported to adopt new models of working, including continuity of carer.

10. Work stream 6 Sharing data and information
System enablers
NHS England is working with its partners to identify a consistent set of indicators, for local use to benchmark quality and drive service improvement.
Identify a data set which can be used in a national dashboard
Consider what data is already being collected to lessen the burden on maternity services

11. Work stream 7 Harnessing digital technology
System enablers
NHS England is working with partner organisations to develop a digital maternity tool and support the roll-out of interoperable digital maternity records.
Development of national maternity pregnancy app

12. Work stream 8 Reforming the payment system
System enablers
NHS England, in partnership with NHS Improvement will review the existing payment system and make recommendations on any reforms necessary to deliver the proposed new models of care in maternity provision.
Any reforms will be subject to consultation and scrutiny before the new funding models are agreed and implemented.

13. Work stream 9 Improving prevention
Service improvement
Public Health England is leading work to prevent poor outcomes through actions to improve women’s health – before, during and after pregnancy to ensure that families get off to the best start possible.
Focusing on public health messages around breast feeding and smoke free pregnancies.

14. For general questions and queries, please contact england
For general questions and queries, please contact

16. An end to Statutory Supervision of Midwives
Prompted by the complaints raised by three families that related to local midwifery supervision and regulation. “In all three cases, the midwifery supervision and regulatory arrangements at the local level failed to identify poor midwifery practice” (PHSO 2013, page 2).
An independent investigation into the management, delivery and outcomes of care provided by the maternity and neonatal services at the UHMB was critical of the additional tier of midwifery regulation provided by Statutory Supervision of Midwives.
The NMC commissioned the King’s Fund to undertake an independent review of midwifery regulation which recommended the removal of statutory supervision and the NMC should be in direct control of all regulatory activity.
The governing legislation (the Nursing and Midwifery Order 2001) has been subject to a Section 60 order and the function of LSAs and statutory supervision of midwifery was removed on the 31st March 2017

17. England Supervision Taskforce
Responsibility of the Chief Nursing Officer to:
Convene a task force to develop a new model of supervision
Oversee the transition from a statutory model of supervision to an employer led model
Taskforce supported by work streams: models, education, commissioning, editorial and HR
Stakeholder engagement:
Listened to staff and women who use maternity services
Informed what the new model of supervision should include
What it should be called
The name of the new supervisor and how they should be prepared for their role

18. The A-EQUIP Model
The A-EQUIP model is made up of four distinct functions:
restorative, normative, personal action for quality improvement and education and development.
The model supports a continuous improvement process that builds:
personal and professional resilience, enhances quality of care and supports preparedness for appraisal and professional revalidation.
The ultimate aim of using the A-EQUIP model is:
that through staff empowerment and development, action to improve quality of care becomes an intrinsic part of everyone’s job, every day in all parts of the system. and how they should be prepared for their role

19. Restorative clinical supervision (RCS) function
Concerned with addressing the emotional needs of staff & supports the development of resilience
It involves the creation of thinking space supporting the practitioner to physically and mentally ‘slow down, through a process of discussion, reflective conversation, supportive challenge and open and honest feed-back.
It restores ‘thinking’ capacity, enabling the professional to ‘understand’ and process thoughts which ‘frees’ them to contemplate different perspectives, and inform their decision making (Pettit & Stephen 2015)

20. Professional action for quality improvement
Requires all professionals to be familiar with and contribute to quality improvement
Aims to ensure that action to improve quality of care becomes an intrinsic part of everyone’s job, every day, in all parts of the system
Aims to equip professionals to be familiar with and contribute to quality improvement that places women and babies at the centre of care. Advocacy and personalisation is central this function
Contributing to systems of quality assurance and quality improvement is a fundamental part of the midwives role

21. A midwife’s personal contribution to quality improvement
This may include the following activities:
Participation in audit
Embedding learning from incidents in practice
Improvements made as a result of user complaints/ staff complaints
Using evidence based guidance to inform practice
Facilitating the implementation of research findings
Any active contribution to a quality improvement activity (this does not need to be in a clinical setting).

22. Education and development
Aims to focus on the development of knowledge and skills through education, to inform appraisal, revalidation and leadership development.
This process can be facilitated by guided reflection (Proctor 1988). Self-leadership can be explored, examining how the midwife interacts with others, influences change and improves care.
The depth and breadth of this function can be influenced by the output of the restorative and quality improvement functions of the A-EQUIP model, whilst assisting the midwife to recognise and build on the links between appraisal and revalidation.

23. The Professional Midwifery Advocate (PMA)
New role that replaces the supervisor of midwives
A midwife must successfully complete a PMA preparation programme provided by the HEI
Shortened PMA programme (no more than 4 days, may be taught in-house by your HEI) – designed to prepare midwives who have completed the PoSoM course to become PMAs
Long PMA programme (length to be confirmed and will be outlined in the operational guidance) – designed to prepare midwives who have never completed the PoSoM or associated programme
A-EQUIP e-learning module, 30 minute module that will compliment and replace aspects of the short and long PMA programme
Selection process and job profile - in operational guidance, published April 2017

24. A-EQUIP pilot sites

25. Thank you for listening
@BirteLam