1. Maternity Strategy Where are we now……and where do we want to get to????

2. Changing face of NI maternity population Older Fatter Greater ethnic diversity More unmarried mothers More long term conditions (e.g. diabetes) More multiple pregnancies

4. Desired Outcomes  Give every baby and family the best start in life  Effective communication and high quality maternity care  Healthier women at the start of pregnancy  Effective, locally accessible, antenatal care and a positive experiences for mothers and babies  Appropriate advice, and support for parents and baby after birth.

5. Give every baby and family the best start in life  A culture of normalisation of pregnancy  Parents should be considered as partners in maternity care and given all relevant information to help make informed choices

6. Now 1 in 60 pregnancies is a twin pregnancy – and one in 30 babies born is a twin!

7. Effective communication and high quality maternity care  Effective clinical leadership and communications pathways  A skilled workforce which understands specific roles and responsibilities  A sustainable configuration of service provision  A focus on improving clinical outcomes  Appropriate ICT support

8. Effective communication and high quality maternity care Maternity services must show good clinical leadership and communication, including in the use of maternity hand held record, Labour ward Forum and other multi disciplinary groups.

9. Inquiry Common Themes Often prompted by public/media concern rather than professional assurance Lack of awareness of level of harm Lack of collective responsibility Lack of sensitivity to day to day operations Lack of learning from errors

10. Healthier women at the start of pregnancy  Emphasis on preconceptual advice and support – Planning for pregnancy  Pathways to support those with long term conditions

11. Obesity in Pregnancy

12. Effective, locally accessible, antenatal care and a positive experiences for mothers and babies Midwife is first contact:  Women to be facilitated to make early contact with a midwife.  For women with straight forward pregnancies antenatal care will be provided primarily by the midwife in the local community

14. Appropriate advice, and support baby after birth. Postnatal care, provided by the maternity team in the community will offer a woman-centred visiting schedule – not less than 10 days

16. Implementing change Assess organisational readiness Create shared purpose Search for unintended consequences Adapt and survive

17. Ingredients Practice Evidence based Care Pathways Consistent processes Education & training People Person Centred Service Safety Forum Support and challenge Education and training

18. What does this mean for midwives? Midwives are expert practitioners in the provision of care to women with straightforward pregnancies.

19. What help do we have??  Maternity Strategy for Northern Ireland  Maternity Quality improvement group-multidisciplinary, regional, evidence based  SAIs: regional learning  EMBRACE: confidential enquiry recommendations; stillbirth reduction  Service: appropriate staffing levels & training, configuration of maternity units  Legal Claims and complaints: potentially a mine of useful information but how to access?  NIMATs  Public involvement - MSLCs and user surveys

20. What help do we have ?  Consultant Midwives  Regional midwives  Practice, education, research, leadership  Commissioning, public health, government  Each other

21. What about the community? Public Health Agency and NIPEC

22. Community maternity care project Objective 10 When a woman becomes pregnant she will be facilitated to make early direct contact with a midwife Objective 12 For women with straightforward pregnancies antenatal care will be provided primarily by the midwife in the local community.

23. Aim Describe and assess, current models of community maternity care with the purpose of proposing a regional model and skills requirement of the workforce.

24. SCOPE OF THE PROJECT Describe and assess the impact of providing more antenatal care in the community taking into consideration workforce/workload and where women choose to give birth in relation to Trust boundaries Undertake a learning needs analysis to assess the current training and skills requirement of lead professionals (community midwives and general practitioners) in providing antenatal and postnatal/ maternity care in the community setting Scope the availability of required resources needed to provide evidence based holistic maternity care (NIMATs and Ultra Sonic Scanners) in the community setting Propose a regional model of maternity care in the community setting

25. Review community midwifery workforce in relation to age profile (rural and urban) in order to facilitate succession planning Examine the impact on community midwifery services of reduced length of stay in hospital for postnatal mothers Describe and assess the effectiveness of the communication interfaces in the community, between midwives, general practice and health visiting SCOPE OF THE PROJECT

26. Conduct a regional review of models of antenatal care currently being provided - by location, frequency and by lead professional to include skill mix - (i.e. maternity support worker) Review community midwifery workforce to include, head count and whole time equivalent per location (rural and urban) Review community midwifery workforce to include, head count per whole time equivalent caseload (rural and urban) SCOPE OF THE PROJECT

27. ALWAYS Ensure that the urgent doesn’t crowd out the important

28. Questions?