LONDON LSA ANNUAL REPORT TO THE NURSING & MIDWIFERY COUNCIL 1 ST APRIL ST MARCH 2012

Transcription

1 LONDON LSA ANNUAL REPORT TO THE NURSING & MIDWIFERY COUNCIL 1 ST APRIL ST MARCH 2012 Jessica Read LSA Midwifery Officer July 2012

2 Contents Page Executive Summary Introduction Demography Publication of the report Numbers of SoM appointments, resignations and removals The Ratio of Supervisors of Midwives to Midwives Trust specific... 7 The Ratio of Supervisors of Midwives to Midwives Trust specific Professional Development of Supervisors of Midwives Details of how midwives are provided with continuous access to a Supervisors of Midwives Details of how the practice of midwives is supervised Rule 3 - Notification of intention to practise Rule 4 - Notifications by LSA Rule 5 - Suspension from practice by a Local Supervising Authority Rule 6 Responsibility and sphere of practice Rule 7 Administration of medicines Rule 8 - Clinical trials Rule 9 Records Rule 10 Inspection of premises and equipment Rule 11 - Eligibility for appointment as a supervisor of midwives Rule 12 - The supervision of midwives Communication National Strategic London Wide Rule 13 The Local Supervising Midwifery Officer Challenges identified by the London SoMs that impede effective supervision Rule 14 Exercise by a LSA of its functions : Evidence that service users have been involved in monitoring supervision of midwives and assisting the local supervising authority midwifery office with the annual audits : Evidence of engagement with higher education institutions (HEIs) in relation to supervisory input into midwifery education Selection days for Potential SoMs SoMs engagement with Higher Education Institutions : Evidence of developing trends that may impact on the practice of midwives in the local supervising authority Birth Rates Clinical Outcomes Home Births Rates Caesarean Section Rates... 26

3 8.2.3 Maternal Death Serious Incidents : Demand Management Suspension of Services Midwifery Workforce Maternity Support Workers Full / part time Midwives in London Age profile of the Midwifery Workforce The London profile of Midwives by practice type : Details of new policies relating to the Supervision of Midwives : Reports on all local Supervising Authority Investigations undertaken during the year Number of Investigations and outcomes Emerging themes Supervised Practice LSA Suspension from Practice : Complaints regarding the discharge of the Supervisory Function : Additional LSA Activities and Achievements Supervisors of Midwives were also involved in the production of a Medicines Management education booklets for midwives, In your Shoes initiatives to gain feedback from service users and the development of midwifery care bundles : Conclusion Acknowledgements Appendix Appendix Appendix Appendix Appendix Appendix Appendix Appendix

4 Executive Summary This report contains details of the Nursing and Midwifery Council s statutory roles, responsibilities and standards relating to Statutory Supervision of Midwives and demonstrates how London LSA is meeting them. The report and appendices include information received from Supervisors of Midwives from all the London Trusts regarding their activity within maternity services. The report format fulfils the Nursing and Midwifery Council (NMC) Guidance related to Rule 16 Annual Report on practice year ending 31 st March 2011/12 and evidences achievement of the 54 standards within the Midwives rules and standards (NMC 2004). Supervisors of Midwives are appointed by the LSA independently of their employers. Trusts have a responsibility to ensure that Supervision of Midwives is supported. Supervision of Midwives is a statutory responsibility and covers all midwives irrespective of employers, therefore midwives practising within NHS London but not employed by the NHS in the Capital, are included. The strategic role of London LSA is to set the direction of the supervision of midwives in line with the NMC s Rules and Standards and LSA guidance. The LSA ensures that there are systems and processes in place to monitor the performance of the supervisors of midwives and midwives within the area. All maternity services in London have been subjected to a formal audit by the LSA, in addition to this; the LSAMO and Assistant LSAMO have met with individual SoMs to verify NMC PREP requirements and individual supervisory activities contributing to all five LSA standards of statutory supervision of midwives. In October 2011 the NMC undertook a full review of the function of London LSA in line the NMCs statutory responsibilities. London LSA was reviewed as part of the NMCs rolling programme across all LSAs in the United Kingdom and followed on from the NMC review undertaken in The review team confirmed that London LSA met 53 out of the 54 NMC Standards and commended London LSA for effectively addressing all the recommendations made in 2009 and recognised the ongoing activities and initiatives which have further strengthened Statutory Supervision of Midwives in London. This report contains a summary of the NMC review and a link to the full report. The LSA and NHS London play a key role in monitoring standards in London s maternity services; working closely with commissioners of services and liaising with the Care Quality Commission (CQC) and NMC. A small number of London s maternity services have been asked to make improvements and the LSA has worked closely with these services to support the development of action plans and further enhancements to the service. There is a robust process for the training and appointment of Supervisors of Midwives. The Standards for the preparation and practice of Supervisors of Midwives (NMC 2006) are used in conjunction with the LSA national guidelines London LSA has access to three programmes within NHS London and one just outside: University of West London, Kings College London, St Georges and Kingston University and Hertfordshire University. The programme is available at degree or masters level and takes approximately one year from nomination to appointment. The number of Supervisors of Midwives has increased to 354 from 345. The NMC require a ratio of 1 supervisor of midwives to 15 midwives, NHS London overall ratio is 1:15.6 which demonstrates an improvement on last years 1:16.1. Investment into maternity services has continued throughout 2011/12, resulting in improvements to staffing, estate and choice for women. There has been a 30% increase in activity through London s maternity services over the last 10 years and this growth continues, although this has been at a slower rate this year of 0.2%. 134,853 women gave birth with 7223 midwives submitting their intention to practice to the London LSA. There was an increase of whole time equivalent 1 Includes temporary (Bank and Agency) workforce used. 1

5 midwives employed in London. There has been a focus on recruitment of midwives across the capital that has resulted in a significant reduction of midwife vacancies; from 12% last year to 9% this year. Some services continue to see a growth in their midwifery workforce numbers whereas others have reduced funded establishment. This report was written in June 2012 and reflects practice during 2011/12. Angela Helleur was in post as the LSA Midwifery Officer for London until November 2011; Jessica Read was seconded to the post of LSA Midwifery Officer for London in November Contact Details of LSA Midwifery Officer and Chief Executive Jessica Read Dame Ruth Carnall DBE LSA Midwifery Officer for London Chief Executive NHS London NHS London Southside Southside 105 Victoria Street 105 Victoria Street London SW1E 6QT London SW1E 6QT Tel: Tel: Jessica.read@london.nhs.uk Ruth.carnall@london.nhs.uk 2

6 1.1 Introduction This report covers the period from 1 st April 2011 to 31 st March 2012 and was produced in order to meet the requirements of Rule 16, The midwives rules and standards (Nursing & Midwifery Council 2004). The appendices in this report contain information related to activity of the London LSA. The purpose of this report is to inform NHS London (NHSL), the Strategic Health Authority, the Nursing & Midwifery Council (NMC) and the public how the Local Supervising Authority (LSA) of NHS London met the standards set within the Midwives Rules and Standards (2004). Within NHS London there are 25 Trusts providing Maternity care on 33 sites. There are two stand alone Birth Centres and 16 co-located Birth Centres in London. The maternity units range in size and number per Trust. The smallest single site maternity service is at Ealing Hospital NHS Trust where in 2011/12 there were 3022 births. South London Healthcare Trust has the largest Maternity service with 9786 births during 2011/12 across two sites. London has one private maternity hospital and provides maternity care to HMP Holloway. London has a number of self employed midwives providing midwifery care outside of the NHS and the highest number of midwives employed by agencies work within London. Analysis from the LSA annual report continued to identify trends in increasing birth rates and increasing complexity of health and social need of the women who use the services. The LSA continues to raise awareness of the effects of the increasing birth rates through its annual report and through individual feedback given to maternity service providers and commissioners. Two of London s maternity services were asked to make improvements by the CQC, Barking, Havering and Redbridge Hospitals University (NHS) Trust and Croydon Healthcare (NHS) Trust. The LSA has worked closely with the management teams and SoMs of both services to ensure that the function of Statutory Supervision meets the NMC standards and to support the development of the action plans whilst assisting with further improvements. London LSA has taken account of the recommendations from the NMC report on London LSA (Nov ) an action plan has been submitted to the NMC and London LSA has been making progress on the recommendations. In July 2010 the Government published the White Paper Equity and Excellence: Liberating the NHS (DH, 2011) 3 setting out plans to restructure the NHS, including the transfer of responsibility for commissioning most services to Clinical Commissioning Groups (CCGs); the establishment of an NHS Commissioning Board for commissioning primary care services and specialist acute services; and the transfer of responsibilities for public health to local authorities and Public Health England. The new Operating Framework recognised that Primary Care Trusts (PCTs) would continue to have a critical role up to April 2013 however; PCTs were not expected to be maintained as fully functional separate organisations up to that time. Instead, SHAs were tasked with managing the consolidation of PCT capacity into transition vehicles. The proposed transition vehicles for London were five clusters; North Central, North West, South West, South East and Outer North East London. In 2011/12 the Clusters have worked on their transition plans and completed monthly dashboards for submission to NHS London to assure their delivery. Maternity Network Boards have been set up with collaborative work being shared across the 5 clusters

7 1.2 Demography NHS London serves a population of 7.75 million representing 12.5 percent of the population of the United Kingdom; the average population density is over 4,900 persons per square kilometre. Half of London s population are aged 34 or under compared to 39 nationally. London s population has grown by 6 percent from 2001; most of this is due to an excess of births over deaths (natural change) rather than migration. The predictions are that the population in London will continue to grow. Between 2011 and 2031 London s population is projected to increase by 13% and reach 8.83 million 4. London is the main centre for international migration to England and is therefore the most ethnically diverse region of England with more than 40% of the population coming from ethnic minority groups. Since 2001 some ethnic groups have grown considerably for example: Chinese population by 38% Other ethnic group by 26% Pakistani and Mixed white & Asian populations by 22% The widening ethnic and multi-cultural society has implications on the fertility rate in the capital. London has a higher birth rate of 69 births per thousand resident women aged than the national rate of 63. The total number of births in London reflects not just the high proportion of 4 Focus on London 2010 GLA Intelligence Unit 4

8 women aged 15-44, but also the distribution of those women in the ages of the highest rates of fertility; late 20s and early 30s. A major contributor to the increased numbers of young women in London is seen to be international migration. Nearly 55 per cent of births in London were to women born outside the UK which has significant implications on London s Maternity Services as these women are reported as having higher levels of risk relating to complications throughout the maternity pathway. Age specific fertility rates show London has higher rates in the 35+ age group than the UK rate. 5 Teenage pregnancies have fallen by 19% over the decade, seen to be as a result of targeted work within inner city Primary Care Trusts and community services. More mothers are likely to initiate breastfeeding in London than anywhere else in England which reflects the good practice of the Capital s diverse communities, for example breast feeding buddies is an initiative in the North East Sector of London, utilising volunteers to support breastfeeding. Over the last decade in London life expectancy has increased by more than two years, with improvements seen in every local authority in the capital at the same time infant mortality has 5 Focus on London 2010 GLA Intelligence Unit 5

9 declined. However child poverty is the same as it was ten years ago with the Capital having the highest proportion of children living in poverty in England 6 NHS London provides strategic leadership for all NHS services in London, including overall responsibility for the performance of 31 Primary Care Trusts (PCTs), 21 acute trusts, three Mental Health Trusts and the London Ambulance Service. NHS London has a role to play in helping trusts achieve foundation status where they can work more autonomously thus ensuring all London s non Foundation Trusts are on target to achieve Foundation Trust status by April Despite the challenges facing Maternity Services in London, progress has been made to match resources to births. London saw a 45% rise in the number of midwives between 2002 and % of Births in England take place in London; despite this the Capital has been responsible for almost half of the net rise in midwife numbers since Most maternity units have reported an improvement in being able to provide one to one care for all women in established labour. Many trusts are facing a retirement bulge with 17% of midwives over the age of 55 years. London s newly qualified midwives are younger than average but many are unable to stay long term in London due to the high cost of housing and living in the capital. Of the 15 LSA s in the UK, London is the smallest by far geographically 1,580 sq km compared to East of England at 19,166 sq km, however London has the largest population of 7.5 million and 134, 000 births per year compared to North West LSA which has the next highest number at 94,000. London LSA also oversees the highest number of midwives and Supervisors of Midwives than any other LSA. (See appendix 1 for LSA profiles) 2. Publication of the report One hundred bound copies of the LSA report are produced. The full report is taken to a Board meeting of NHS London and is signed off by the SHA Chief Executive. It is then sent electronically to the NMC by 21 st September 2012, hard copies are then circulated to the following: Chairs of local MSLC Leads for Midwifery Education at all the Higher Education Institutions Chief Executives of Commissioning Clusters who commission Maternity services in London All current supervisors of midwives accountable to the London LSA Heads of Midwifery Services in London Clinical Directors of Maternity Services in London Directors of Nursing in London Trusts that have Maternity Services Independent Midwives President of RCOG General Secretary of RCM Department of Health Maternity Advisor London Lead for Care Quality Commission NPEU The report is also placed in the public domain via publication on the London LSA website 6 Capital Health Gains London Health Observatory: August State of Maternity Services Report 2011 Royal College of Midwives 6

10 3. Numbers of SoM appointments, resignations and removals Year No. of Midwives SOM Number Appointments Resignations /retired Leave of Absence Removals There have been 37 appointments to the role of Supervisor of Midwives to London LSA in This number includes newly qualified SoMs and Supervisors of Midwives who have moved into London from another LSA. The number of Supervisors retiring remains fairly static since 2006, however the number of SoMs taking a leave of absence from supervision has remained at the same level as last year which is the lowest it has been for 6 years, this may reflect the increased support that is available to SoMs from London LSA. The majority of resignations were due to retirement from employment and a change in personal or family circumstances. Most periods of leave of absence were given for increased demands from substantive roles or maternity leave. 3.1 The Ratio of Supervisors of Midwives to Midwives Trust specific The LSA team and local teams of supervisors of midwives have continued to raise the profile of supervision and there have been a number of innovations by individuals to increase the awareness and understanding of Supervision. In October 2011 the Nursing and Midwifery Council reviewed London LSA against the NMC Standards, 53 out of the 54 standards were met. The standard that was not met relates to the fact that not all Trusts meet the recommended SoM to midwife ratio of 1:15. London LSA has addressed this by a number of initiatives highlighted below: Employment of first full time SoM in the UK: Working with a London Trust who had one of the highest SoM to midwife ratios in London and were under CQC measures, London LSA provided support and advice to the Trust as they appointed the first full time SoM in the UK. Every member of the SoM team were given the opportunity to apply for this post. The SoM meets regularly with the LSAMO and the role will be evaluated after 6 months. SoMs in London are recommended to be allocated 15 hrs per month to fulfil the Supervisory function, by working full time hours of 150 hrs per month the full time SoM equates to 10 extra Supervisors of Midwives which immediately brings the Trust into line with the NMC recommended 1:15 and immediately impacts on the effectiveness of Statutory Supervision within the Trust. 7

11 Extra time for Contact SoMs, 9 out of the 25 Trusts allocate extra time for the Contact SoM role, this varies from 4 hours per week to a full day per week. This is very beneficial to the Trust as it acknowledges the extra time that the Contact SoM requires to fulfill the role effectively and to strengthen communications between the Trust and the LSA. Utilising retired SoMs effectively, a number of Trusts have re-employed retired Supervisors of Midwives on a part time basis, from 2 days per month to 2 days per week, in so doing they are maintaining a high level of experience within the team and enabling these midwives to focus entirely on Supervision. This year the number of supervisors has increased by 2.6 %, which has resulted in an improvement in the overall ratio of SoM to midwife to 1:15.6 (from 1:16.1) however; there has also been an increase in the number of midwives, whose main area of practice is London, all of whom require a Supervisor of Midwives. If the NMC were to consider the number of extra hours now allocated for Supervision of Midwifery across the Capital (as highlighted above) and translated that into SoMs, the London ratio would be 1:15. It is important to identify that London SoMs provide Statutory Supervision for 313 midwives who work outside the London Trusts, this includes: Agency Midwives (121) Midwives working in Higher Education Institutes (93) Independent Midwives (37) Midwives employed by GP practices Health Visitors who are direct entry midwives RCM / NMC/ SHA / PCT employees Neonatal nurses who are also midwives Family Nurse Practitioners who are midwives Practice Nurse who are midwives More Independent midwives and agency midwives submit their intention to practice to London LSA than to any other LSA in the UK. London LSA has a responsibility to ensure that all midwives working within London as their main area of practice have access to a named Supervisor of Midwives. All midwives are given the opportunity to choose a SoM, for those midwives new to London working outside the NHS; the LSA suggests the appropriate SoM team and gives the relevant contact details to the midwife so that she can approach the team directly. 8

12 DoT The Ratio of Supervisors of Midwives to Midwives Trust specific Trust Ratio of Midwives: Supervisors as at 31/03/2010 Ratio of Midwives: Supervisors as at 31/03/2011 Number of Midwives Number of Supervisors * Ratio of Midwives: Supervisors as at 31/03/2012 Royal Free North Middlesex The Royal London Whittington Barnet & Chase Farm Lewisham St. George's King's College North West London Kingston Homerton Imperial College Hillingdon Newham Whipps Cross UCLH Epsom & St Helier Chelsea & Westminster South London The Portland (Private) Ealing Guy's & St. Thomas' Barking, Havering and Redbridge Trust West Middlesex Croydon Health Services Total There is a significant variation in ratios in the different Trusts from 1:8 at best to 1:31 at worst. The role of the LSA support midwife has been invaluable this year in ensuring that there is increased support for SoMs, particularly where there are insufficient numbers. The LSA support midwives have all been able to undertake supervisory investigations, help with annual reviews, attend SoM meetings and provide 1:1 support for SoMs when required. Feed back from SoM teams has been extremely positive about the increase in support. Where the SoM ratios are particularly challenged the LSA has met with the Trust managers to secure additional funding for additional supervisory support to ensure Supervision of Midwifery maintains a high profile within the Trust. This has been the case in the two Trusts where the CQC have requested that improvements be made. The LSAMO has met with the SoMs and Executive teams of these Trusts to ensure that adequate focus, resource and support is given to the statutory supervision of midwives. 3.2 Professional Development of Supervisors of Midwives All SoMs appointed to the London LSA had a meeting with the LSAMO or Assistant LSAMO to discuss their supervision PREP. This provided an opportunity for the LSA to feedback on performance over the last year and for a discussion on specific development needs for the SoMs. Only those SoMs who were on leave of absence were not seen or their PREP not reviewed. A development plan is expected to be formulated by the individual SoM following the meeting and is used to inform the meeting with the LSA in the following year. The LSAMO is able to identify themes for development for the SoMs and is used to inform the LSA local development plan. This 9

13 year the themes from the one to one meetings included: support with time management, skills to promote effective team working and dealing with challenging conduct and behaviour Fitness to Practice Workshops The Fitness to Practice Workshops have continued throughout , the workshops have been delivered to seven local SoM Teams, with % attendance being achieved. The workshops have been highly evaluated and in response to the training, there has been a noticeable improvement in the quality of supervisory investigations from SoMs teams who have attended the workshop SoM team development During annual LSA audits it was identified that some SoM teams were in need of a facilitated team development day, the lack of effective team work was also highlighted in one of the CQC reports on Maternity services. In response the LSA team devised individual team development programmes to address specific team objectives, examples included: uniting and re-energising the SoM team, establishing a clear vision and focus for SoM, agreeing and prioritising supervisory goals and formulating an action plan to achieve them. (Appendix 2 for example of programme) LSA database training The LSA database is used by every Supervisor of Midwives to upload statutory information regarding every midwife they supervise to the NMC. The database has been developed over the last 10 years to provide essential information for Supervisors and London LSA regarding the fitness to practice of every midwife practising in London. During 2011/12 it became apparent that SoMs were not aware of the extent of the LSA database and how they could utilise it fully. In January 2012 London LSA delivered database training to the Contact SoMs with the intention that they cascade the training down to their teams. London LSA produced a database workbook which is available to all SoMs on the London LSA website: Leadership Development The LSA recognises the important contribution of the role of Contact SoM towards the function of the SoM teams and the Contact SoM meetings have increased in number and duration to incorporate training and development to reflect this. In 2011 London LSA was successful in bidding for funding to provide leadership training for Contact Supervisors of Midwives. A procurement process was followed and the bespoke leadership programme: Contact for success will commence in LSA Conferences Two conferences were held in London for the supervisors of midwives in May and December The May conference was titled Compassionate Care and focussed on how to identify and address challenging behaviours and attitudes, presentations were given by NHSL Chief Nurse, the NMC, React Theatre group and local SoM teams. The December conference focussed on Innovation and the Future with presentations from the NMC, and local SoM teams. The evaluation of both conferences was mixed, with targeted comments relating to the venue rather than the content. (Appendix 3 and 4 conference agendas). During 2011 the LSA team attended a number of SoM team development days to present the topics of; supervised practice programmes, dealing with challenging conduct and behaviour, maternal death in London and influencing the quality and safety of maternity services. Other specific training provided by London LSA in included being a witness at an NMC Hearing. The LSAMO, Assistant LSAMO and LSA Midwives spoke at local and National Conferences where SoMs formed part of the audience. 10

14 3.3 Preparation of Supervisors of Midwives Course Within NHS London the Preparation of Supervisors of Midwives course (POSOM) is offered at Kings College University, St Georges and Kingston University and University of West London. The University of Hertfordshire also offers the POSOM course where a small number of students from London choose to apply. St Georges and Kingston University run the only course that commences in April each year, this allows flexibility for SoM teams when they are planning recruitment. The LSA Midwifery Officer is a member of the Course Board of each University and actively contributes to the Course. The Assistant LSAMO and LSA support midwives have also contributed to POSOM courses throughout London. All courses are offered at degree and maters level. Mentors for the Student SoMs are invited to attend with the student early on in the course to ensure they understand the support they are expected to give and the assessment process for the programme. Newly Qualified SoMs continue to be supported by their mentors on appointment with regular meetings involving discussions on clinical cases and by a buddy system for on-calls. Newly qualified SoMs are encouraged to attend the LSA conferences. To secure a place on the course there is a local process involving nomination and selection prior to attendance at an Assessment day which is held at NHS London and hosted by the LSA team in collaboration with the HEI leads for the POSOM courses. London LSA follows guidance laid down in the National Guidelines for Supervisors of Midwives Guideline C. Nomination, Selection and Appointment of Supervisor of Midwives Expressions of interest for SoM preparation courses have increased during with 51 SoM candidates attending the assessment days at NHS London. During midwives successfully completed the POSOM course; a number of the candidates recruited in will not be commencing the course until Work has been ongoing to ensure that midwives are aware of the role of the Supervisor of Midwives, how to apply and how to access support. The Contact SoMs from each team have been pivotal in ensuring that this information is disseminated to local midwives and many SoMs report identifying potential SoMs during the annual review process. Many examples of how SoM teams encourage recruitment of potential SoMs were seen as part of the LSA audit programme. These include SoM walk abouts and open days. SoMs deliver training regarding Supervision of Midwifery on mandatory training days with a specific focus on the role of the SoM. London LSA has published guidance on the London LSA website on the process for selection of SoMs; this was reviewed in March 2012 and the updated version is available on this also includes a template for curriculum vitae to assist potential SoMs with the process. 4. Details of how midwives are provided with continuous access to a Supervisors of Midwives 4.1 Named Supervisor of Midwives All midwives within NHS London LSA have a named Supervisor of Midwives within their main area of practice. Midwives are able to choose their named Supervisor of Midwives. On occasion, they may have to wait for their first choice, if the Supervisor already has a caseload of 15 midwives, in which case their second choice would be offered. It is important that Supervisors of Midwives seek to keep within the 1:15 ratio recommended by the NMC, although this can be difficult when the number of Supervisors of Midwives is low. 11

15 All midwives know how to contact their named SoM for advice and guidance and for planning their annual reviews. More and more use is being made of facilities provided for midwives by the Trusts. In addition midwives may access supervisors of midwives with specialised expertise for specific advice regarding practice situations. Midwives new to organisations are often allocated a Supervisor of Midwives on the first day, as part of their orientation programme. The newly appointed midwives are frequently given welcome introduction letters and advised of the names of all the Supervisors of Midwives within that organisation, informing them that they may wish to change their Supervisor when they have had an opportunity to get to know the individuals. All Trusts are subject to an Annual LSA audit when Midwives are asked: Are you given a choice of who will be your Supervisor? How easy do you feel it would be to change your Supervisor if you wanted to? The majority of responses were that midwives were aware they have a choice and that it would be possible or easy to change if they wanted to. If responses were received that several midwives wanted to change, this would be discussed with the Contact Supervisor who would be asked to write to all midwives giving them an opportunity to change. This did not occur in the reporting year. During London LSA received a number of calls from midwives who wished to work in London as agency midwives and were requesting a named SoM. The LSA reassured the midwives and directed them to the Contact SoM of the Trust that they hoped to work in, advising them to take their ITP in with them when they meet the Contact SoM. Each cohort of student midwives is allocated a named supervisor of midwives who contributes to their professional development and support through group supervision and structured reflection. In the practice areas student midwives have access to all supervisors in the same way as midwives. It is now more common for supervisors to be actively involved in educational matters with the HEI from whence they receive their student midwives. London LSA assisted with the implementation and facilitation of group supervision in six Trusts where the numbers of SoMs were low. This has been well evaluated by the midwives who have requested that it continue despite an increase in SoMs. The Trust SoM teams have taken over the Group Supervision from the London LSA team and have continued with the same model. 4.2 Contacting a Supervisor of Midwives in an emergency Regardless of employment status, all midwives have access to a supervisor of midwives through published 24 hour on-call rosters. Midwives working outside the NHS are able to access this information by telephoning the labour and delivery suites for the name and contact details of the on call supervisor of midwives for that locality. Each individual Supervisor will notify their supervisees of how they can be contacted and how they can contact other Supervisors at any time. The majority of Trusts keep a copy of the Supervisor on-call rota on the labour ward and on the Supervisor of Midwives notice boards. The On Call Supervisor of Midwives is also contactable via the Hospital switchboard. In the unusual event of a midwife not being able to contact a supervisor of midwives, the contact details of the LSAMO, Assistant LSAMO and LSA support Midwives are available on the NMC and LSA websites. In Trusts where there is a significant reduction in the number of supervisors, in order to always cover the 24 hour on-call rota supervision cover from adjacent trusts has been arranged. This has 12

16 not been required during due to Trust mergers where cross-site on call supervision is implemented. On call supervisors reported receiving a number of calls from women and families seeking advice and guidance, especially in Trusts where supervision is widely published and included on their web sites pages. All Trusts are subject to an annual LSA audit and evidence of compliance against the LSA standards for the statutory supervision of midwives (2005). Standard 4.1 states that there is 24 hours access to Supervisors of Midwives for all midwives irrespective of their employment status All Trusts audited by the London LSA, in the period covered by this report, met this standard in full. The evidence submitted often contains supervisors of midwives on- call rotas and call logs of when a supervisor has been contacted. In addition to this the LSA audit team meets with a representative sample of midwives and users and the question of accessibility to a supervisor is asked. No concerns have been raised by Midwives or women in relation to response times from supervisors of midwives. Many examples of when supervisors of midwives were involved in challenging situations were given to the LSA audit team. 5 Details of how the practice of midwives is supervised The Nursing and Midwifery Council (NMC) was established under the Nursing and Midwifery Order 2001, as the body responsible for regulating the practice of those professions. Articles 42 and 43 of the Order make provision for the practice of midwives to be supervised. The purpose of the statutory supervision of midwives is to protect the public and to support and promote good midwifery practice. The local bodies responsible for the discharge of these functions are the Local Supervising Authorities (LSAs). The Strategic Health Authorities are designated the LSAs within England. In NHS London the LSA is the body responsible in statute for the general supervision of midwives practising within its boundaries. NHS London employs an LSA Midwifery Officer to ensure that the LSA function is carried out as required by the NMC. The Order requires the NMC to set rules and standards for midwifery and for LSAs responsible for the function of statutory supervision of midwives. The Midwives rules and standards (NMC 2004) protecting the public through professional standards provide the framework for supervision. This year each SoM team was asked to prepare an Annual Report for the LSA and in addition an individual SoM scorecard has been developed and piloted to monitor supervisory activity. Evaluation of the scorecard demonstrated that further work was required to ensure it accurately captures the supervisory activity of each individual SoM. Work is continuing into 2012 to upload the scorecard (renamed Activity Sheet) onto the LSA database so that each SoM will be able to input their activities electronically on a monthly basis. London LSA will then be able print off reports relating to SoM teams and individual SoM activities within each team. 5.1 Rule 3 - Notification of intention to practise It is a midwife s responsibility to notify his/her intention to practise (ITP) midwifery in the London LSA area when he/she intends to practise midwifery. This notification process is there for public protection as the system enables the LSA to check that the midwife is eligible to practise and so protects the public by ensuring that only eligible midwives practise midwifery. Currently midwives submit their ITP to their named SoM and this information is entered onto the London LSA database. A SoM must only sign the ITP if she can confirm that to the best of her knowledge that the information contained on the form is correct and the midwife has provided the SoM with the evidence that he/she has met the NMC PREP requirements to maintain registration 13

17 as a midwife. PREP is a set of NMC standards and guidance which describes how much clinical and educational activity is required in each registration period. The NMC PREP Handbook was reissued in June 2008 and is available online at: The total number of ITPs successfully uploaded to the NMC during was 7223, the table below demonstrates how this number has fluctuated since Midwives/ITPs in London 2003 to 2012 Year (April- March) Midwives ITPs Rule 4 - Notifications by LSA The LSA publishes the date, the name and the address of the LSAMO to whom the midwife must give notice under rule 3 (1). Each year the LSA Midwifery Officer writes to all Supervisors of Midwives advising them of timings for entering the next year s ITPs onto the LSA database so that, on 1 st April, the NMC website is correct. The LSA database is a web based electronic tool by which the Supervisors of Midwives send the notifications to the LSA. The database enables the Supervisors of Midwives to manage the system and enter data locally and be monitored by the LSA office. There is a daily electronic upload to the Nursing & Midwifery Council (NMC). The NMC electronically advises the LSA that uploads have been successful and identifies where they may not have been. If there are errors, the LSA office informs the Contact Supervisor at the appropriate Trust to have the information corrected. There are very few upload failures (0.001% of all ITPs notified) and the two main reasons for a failure notice was an incorrect date of birth being entered onto the LSA system or the midwife s registration payment had not been processed by the NMC before the ITP was submitted. The LSA requires all Supervisors of Midwives to check the NMC website to ensure all their midwives details are correct and that there is a record of their ITP. The LSA office randomly checks midwives ITP status on the NMC website and takes appropriate action if there are any irregularities. Employers, SoMs and the public may verify a midwife s registration and entitlement to provide midwifery care status on the NMC online register. This verification system supports public protection. This register can be accessed via the NMC s website: 14

18 Only the details of those registrants with effective registration will be displayed. 5.3 Rule 5 - Suspension from practice by a Local Supervising Authority If anyone (service users, colleagues and managers) has concerns about a midwife s ability to practice safely and effectively this must be reported to a supervisor of midwives or directly to the LSAMO. Any concerns raised were investigated and through this process it will identify those midwives who may need additional support, supervised practice or on the rare occasion, need to be suspended from practice by the LSAMO in the interest of their own, or public safety. Section 10 in this report details the investigations, suspension and outcomes carried out in and details how the public were protected. 5.4 Rule 6 Responsibility and sphere of practice Rule 6 describes the sphere of practice and the responsibilities of a midwife, because of this it is the rule most commonly sited as being breached following investigation into a midwife s practice. This rule is particularly relevant when discussing increasing skills such as use of ventouse, examination of the newborn, aromatherapy, acupuncture, reflexology etc. Rule 6 is also discussed when looking at the development of maternity support workers role. This rule also supports women when they are making decisions which do not follow national or local guidance. The midwives must ensure they inform and discuss areas fully with women and respect the woman s right to refuse any advice given to her. If a woman rejects advice then the midwife should seek support and guidance from a Supervisor of Midwives. At the LSA Audit visits several examples are seen where midwives have sought the support and guidance from Supervisors of Midwives. The standards within this rule define what would reasonably be expected from a practising midwife. 5.5 Rule 7 Administration of medicines Supervisors of Midwives regularly undertake audits of records including administration of medicines and controlled drugs. Evidence of these annual audits were reviewed when London LSA visited each Trust and compliance was high. These audits have been taking place for a number of years and the standards and practice have improved as a result. Errors in administration of medicines are small, as can be seen under section 11; of the 5571 midwives practising in London during only 14 medicines errors were investigated by Supervisors of Midwives (0.2%). 5.6 Rule 8 - Clinical trials London LSA are not aware of any clinical trials that conflict with the NMC documents The Code or Midwives rules and standards. There are very few midwifery clinical trials within NHS London those that are in place have been approved through Trust ethics committees. 5.7 Rule 9 Records Supervisors of Midwives audit records on a regular basis. SoMs are encouraged to review midwives records as part of the annual Supervisory review to encourage self audit and reflection. Many Trusts have record keeping and documentation audit as part of their mandatory training programme which all midwives attend. The NMC document; Record Keeping: Guidance for Nurses and Midwives (July 2009) 8 is the standard applied to record keeping and the basis of audit. The Supervisors will also be involved in auditing records for NHS Litigation Authority standards and as part of supervision investigations

19 Supervisors of Midwives follow the national guidance relating to storage of supervisory records; National Guidelines for Supervisors of Midwives B (March 2011). Information Governance including the transfer of confidential information regarding Statutory Supervision available on the National LSAMO Forum UK website Rule 10 Inspection of premises and equipment SoMs must monitor standards and methods of practice and this includes reviewing records, equipment and place of work. Evidence of compliance for this standard was examined as part of the LSA audit. 5.9 Rule 11 - Eligibility for appointment as a supervisor of midwives The London LSA has published information on the appointment of SoMs; this is in line with rule 11 and can be found on the London LSA website at Rule 12 - The supervision of midwives The statutory requirement is that all midwives meet with their named SoM at least once a year for the purpose of statutory supervision. This provides the midwife with an opportunity to discuss their professional development needs. The LSAMO can now monitor the percentage of annual reviews achieved via the LSA database. According to the LSA database 65 per cent of midwives had an annual review with their named SoM during , which is a decrease from The SoMs stated that this was because they had not entered the Annual review on to the LSA database, not because they had not been done. For this reason London LSA has provided database training and a database workbook for London SoMs, with the intention that every SoM will enter the annual review directly on the LSA database whilst it is being undertaken. The most common reason stated for a midwife not having attending for an annual review was clinical demand, long term sickness, taking a career break or being on maternity leave Communication Each SoM has the means to contact the LSA MO ( , mobile phone or direct line). The LSA acts as communication centre receiving and transmitting information from the National LSAMO Forum UK, NMC regulatory body, Department of Health, Royal College of Midwives, locally from the SHA, Trusts, PCTs and from the supervisors. Information flows in both directions allowing the national bodies to be aware of local issues affecting maternity services and ensuring that supervisors of midwives have information distributed directly to them. The following forums facilitate the LSA communication network: National The NMC/ LSA Strategic Reference Group - one of the main functions of this group is to assist in advising the Midwifery Committee on any proposals to make, amend or revoke rules relating to the supervision, practice and education of midwives. There has been significant discussion during on the revision of the Midwives Rules and Standards. The Local Supervising Authority Midwifery Officer Forum UK (LSAMO Forum UK) - the forum meets every 2 months and was established to provide all the LSAMOs with an opportunity to develop their professional leadership role and influence both the quality of midwifery services and the wider NHS agenda. The forum ensures that supervision across the UK is consistent. The LSAMO Forum UK launched a new website and strategy for the

20 next 3 years during the Biannual LSAMO Forum UK Conference in January 2012: RCM / England Heads of Midwifery network Strategic Quality Quarterly Monitoring- Throughout the reporting year London LSA has a quarterly meeting with one of the Midwifery Advisors to the NMC. Prior to this meeting the LSA Midwifery Officer completes a Quality Quarterly Monitoring tool supplied by the NMC with information relating to the Statutory Supervision of Midwives from the previous quarter. The subsequent discussion is centred around particular challenges that are highlighted. The Contact Supervisors of Midwives meeting London LSA facilitates a meeting with the 25 Contact Supervisors of Midwives 6 times a year at NHS London. The Contact Supervisors act as a liaison between the LSA and local Supervisors and are the conduit for passing information on to all Supervisors. It is essential that this communication is two way. The role of Contact Supervisor is rotated between Supervisors of Midwives within organisations, the length of time for this role being determined locally. Agendas are jointly planned and notes of the meetings are circulated to the Contact Supervisors to share with all Supervisors at local meetings. London Heads of Midwifery (HoMs) meeting The LSAMO is a member of the London Heads of Midwifery forum, the HoMs meeting is held 6 times a year and provides an opportunity for networking, sharing of good practice and discussion on topics affecting the whole of London Maternity Clinical Expert Panel: The LSAMO sits on the clinical expert panel for maternity services which has been established by the London Health Programmes Quality and Safety Workstream. The panel has been tasked with providing advice on aspects of the work that relate to the provision of maternity services, as defined by the project scope, the panel report all findings and recommendations to the Clinical Board. The objective of the quality and safety programme is to improve the quality and safety of acute emergency and maternity services across London providers and has been identified as one of the NHS in London s key priorities to deliver by 31 st March Most notably, the programme aims to address the variation that currently exists in service arrangements and patient outcomes between hospitals and within hospitals, between weekdays and weekends. Maternity Provider Network Board meeting: London LSA is represented at this meeting where information is shared and developments discussed relating to the implementation of Maternity Networks throughout London. London Directors of Nursing meeting LSAMO is invited to attend and has presented on one occasion this year. This is a valuable forum in which the LSAMO is able to raise the profile of Supervision of Midwifery amongst the key strategic Nurse leaders in London. London Maternal Death Forum Established in 2011 following the LSA commissioned review of London Maternal Deaths The forum is chaired by the LSAMO and has muliti disciplinary representation. The aim of the forum is to disseminate the findings of the London Maternal Death Review and to facilitate the sharing of good practice through great saves across London London Wide Local Trust Supervisor of Midwives meetings The SoMs in each Trust meet monthly and a member of the LSA team attends on a needs based basis. This is an opportunity for the Contact SoM to cascade information from the LSA to the team and for each team to address local issues and embed the strategy and action plan into practice. Within NHS London there is an expectation that SoMs attend 75% of the local SoM meetings and at least one London LSA meeting / conference a year enabling them to have direct contact with the LSA Midwifery Officer. 17

21 Sector Supervisor of Midwives meetings- The SoMs meet quarterly in the 5 London Sectors, this gives an opportunity to share good practice and discuss developments in neighbouring Trusts. London LSA/ Independent Midwives forum London LSA meets with London Independent Midwives 2-3 times per year. This forum is open to all Independent Midwives practising in London and provides the opportunity for open dialogue and discussion relating to the agenda items. The Maternity Advisor to the DH has been invited to address the forum, as have Midwifery Advisors to the NMC. During the reporting year this forum has drafted a guideline for London SoMs working with Independent Midwives, and London LSA has secured NHS.net addresses for a number of Independent Midwives. London LSA Website- in 2012 a working party was tasked with reviewing the London LSA website, which has resulted in a change of address and reformatting of the home page. This work will continue following transition to the London outpost of the National Commissioning Board. London LSA Newsletter- Early in 2012 the LSA team worked on the first draft of the London LSA newsletter to be distributed in July The newsletter will be sent electronically to all Contact SoMs and uploaded onto the London LSA website. The newsletter will enhance opportunities for the LSA to pass information on to Supervisors, Supervisors will in turn be given the opportunity to submit news items to be incorporated. Meetings with HEI leads for POSOM courses London LSA meets twice a year with the HEI leads for the POSOM courses, this allows for discussion around developments in each site, validation of courses, and issues arising from student recruitment and attendance. London LSA Conferences See Rule 13 The Local Supervising Midwifery Officer In this practice year Angela Helleur was in the role of LSA Midwifery Officer until November 2011 when Jessica Read was seconded into the post. The LSA Midwifery Officer for London is supported by an Assistant LSA Midwifery Officer (Carole Yearley) and 1.2 WTE LSA support Midwives (Manjit Randhawa, Georgina Sims and Clare Capito). The LSA Midwifery Officer is responsible for exercising its functions in relation to supervision of midwives whilst ensuring communication takes place between the LSA and NMC, to enhance protection of the public, especially in relation to the function of Supervision of midwifery and midwifery practice. The LSA Midwifery Officer acts as an essential point of contact for supervisors of midwives to consult for advice on all aspects of supervision, and for advice with especially difficult or challenging situations. During the reporting year the LSA Midwifery has received a number of communications from members of the public who have raised concerns about midwifery practice, these concerns have been addressed accordingly. The LSA has completed 25 annual audit and monitoring visits of the practice and supervision of midwives within the LSA area to ensure the requirements of the NMC are being met. Where NHS Trusts provide maternity services at more than one site, each site was visited. Dates of LSA audit visits can be found in Appendix 5. The LSA Audit visits enable the LSA Midwifery Officer to ensure that the standards set by the NMC are being met in practice. The Midwives rules and standards (NMC 2004) set clear standards which have been developed into an audit tool assessing 54 standards. These standards have been in place now since the publication of the Midwives rules and standards (2004) so the majority of the standards are met by all Trusts. It is envisaged that they will be reviewed when the new Midwives rules are published in Following the LSA audit visit a report is written for each organisation, detailing areas of good practice and making recommendations regarding future developments. An action plan is then developed by the Supervisors of Midwives to enable them to meet the recommendations. The action plan is followed up at the next audit or sooner if serious concerns are identified. 18

22 Challenges identified by the London SoMs that impede effective supervision Each Supervisory team in London reported on the challenges they face that impede the effectiveness of statutory supervision in London, the main themes are identified below: Challenges 2011/ % of SoM teams in London expressed the difficulties they face in accessing dedicated time for supervision. All of the Trusts in London support SoMs to take time from their substantive post to complete supervisory activities, this varies from 7.5 hrs per month to 23 hrs per month, 72% of Trusts allocate 15 hrs for Supervisory duties per SoM per month. Additional time for supervision has been negotiated by the SoMs to undertake investigations if required. In most instances even though dedicated time has been agreed SoMs are overwhelmed by their substantive posts and find the competing demands a challenge. Time management is one of the themes that will be explored during the Contact for Success Leadership programme in % of the SoM teams stated that the low numbers of Supervisors in their teams impeded the effectiveness of Supervision. Despite increasing numbers of SoMs being appointed in London, midwifery establishments are also increasing therefore the ratio of SoMs to Midwives remains a challenge. Teams with high ratios are supported by the London LSA team. 3 16% of SoM teams reported that Trust mergers, restructuring and financial challenges had impacted on the effectiveness of Statutory Supervision during the reporting year. Supervisory teams have been seen to lead on collaborative working following Trust merger, however this takes time as the team find their new identity. London LSA has supported team building events to further enhance team growth. 4 12% of SoM teams reported challenges with completing the annual reviews, issues highlighted included; midwives being allocated protected time to attend their annual reviews, the accessibility of dedicated office space to complete annual reviews, delays in midwives submitting their ITP forms which in turn slows down the annual review process. London LSA is encouraging all SoMs to undertake the annual reviews directly on to the database, which provides the midwife with an electronic copy and the LSA with assurance that the annual review has occurred. During the Annual LSA audit of maternity services the LSA Midwifery Officer makes recommendations that reflect the challenges that have been identified. The Supervisory team then produce an action plan that demonstrates how they will meet those recommendations during the practice year. The LSA Midwifery Officer continues to be available for support and advice for all Supervisors of Midwives. Other challenges across several Trusts include lack of administrative support, lack of time to work clinically with midwives, increasing numbers of junior midwives requiring additional support and having sufficient numbers of SoMs to provide mentorship and preceptorship to newly qualified SoMs. 19

23 5.13 Rule 14 Exercise by a LSA of its functions The NMC has a duty to verify that the standards set for the LSA are being met and has therefore developed a system for reviewing LSAs and this is contained in the document available on the NMC website online: The aim is to ensure that the rules and standards for statutory supervision of midwives and the function of the LSA are being met and to highlight any concerns around protection of the public. The NMC has a process of routinely reviewing LSAs on a two to three year cycle; London LSA was identified for review because it was two years since the last review in The NMC reviewed the function of London LSA from 3 rd 6 th October The NMC review team confirmed that London LSA met 53 out of the 54 NMC Standards and commended London LSA for effectively addressing all the recommendations made in 2009 and recognised the ongoing activities and initiatives which have further strengthened Statutory Supervision of Midwives in London. The Executive Summary is attached as Appendix 6, the full report can be viewed on the NMC website at: Text Version Following receipt of the report London LSA completed an action plan which was presented at the NHS London Quality and Clinical Governance Board before being submitted to the NMC. (Appendix 7) 6: Evidence that service users have been involved in monitoring supervision of midwives and assisting the local supervising authority midwifery office with the annual audits. During 2009, a user strategy was developed which included the proposal for the selection and appointment of London Lay Auditors to support the LSA in the audit of local maternity services. At that time resources were not available to develop this initiative. However, during 2011 funding was secured to implement this project. The lay auditor programme aims to enhance the assessment of Supervision s contribution towards delivering women focused care (Standard 1, LSA 2005), by bringing capacity into the audit team to explore this. The LSA Midwifery Officer sought to recruit ten maternity service users who had used a London maternity service in the past 5 years. London LSA worked in partnership with service users to design and pilot the programme. The LSAMO recruited an experienced MSLC Chair to work alongside her in the programme s development phase. This involved researching the lay auditor role in other regions and interviewing other lay auditors about their work, trialling lay auditor involvement in London LSA audits to explore how best the role could add value, and designing a recruitment, training and induction process that would ensure a range of service users (representative of London s maternity service) would be recruited into the lay auditor role. The LSA received a very strong response to the advertisement of the lay auditor roles with 90 applications received for the ten available lay auditor positions. Care had been taken to publicise the roles through networks of voluntary and community organisations, in particular those working with BME women, as well as through MSLCs via Heads of Midwifery. Effort was also made to ensure that Supervision of Midwives was clearly explained and the terms and conditions of the role explicitly stated. Thirty-three applicants were shortlisted and nineteen interviewed by a panel that comprised London s Assistance LSAMO, the service user recruited to develop the process in partnership with London LSA, and a lay auditor from South Central Coast. Ten lay auditors were 20

24 successfully appointed. The Lay auditors took part in two training days in March 2012 to prepare them for their role (see Lay Auditor Training Programme: appendix 8). The training programme addressed skills development, knowledge building and equality and diversity training. Practical scenarios were presented to allow lay auditors to think through challenging situations they may encounter and participants were introduced to an assessment framework designed to support them in focusing their work on the contribution of Supervision of Midwives towards delivering women focused care. Lay auditors contributed anonymously to an on-line evaluation of the training. The programme will be formally piloted at audits taking place between April and July A toolkit has been developed that provides a detailed guide to preparing for an audit visit, the lay auditors role on the day and the reporting requirements. Ongoing development will be provided for the London lay auditors who will meet at the end of July to assess the pilot period and make changes to the audit process in light of the evaluation. It is expected that a time commitment of between 3-4 days a year will be provided by the lay auditors. Lay auditors have also contributed to the recruitment of potential Supervisors of Midwives, which has been extremely valuable. Lay auditors in training 7: Evidence of engagement with higher education institutions (HEIs) in relation to supervisory input into midwifery education. There are eight HEIs that provide midwifery education in London. They are: London South Bank University West London University St Georges University University of Hertfordshire King s College University Middlesex University 21

25 University of Greenwich City University Three HEIs provide courses for the Preparation for the Supervision of Midwives (POSOM) they are: St Georges / Kingston University University of West London Kings College London One HEI in the East of England is accessed by a small number of SoM students for the POSOM course: University of Hertfordshire The London LSAMO and HEIs work in close collaborative partnerships to ensure that pre and post registration midwifery education programmes are developed, planned and delivered to meet the future midwifery workforce and to ensure that current midwives are prepared for contemporary practice. There are several forums at both strategic and operational levels to ensure this is achieved. These include: The annual NMC/LSA/LME Strategic reference group where all UK LSAMOs meet with the Lead Midwives for Education (LME) for the purpose of debate and discussion at national level. London Higher Education Institution (HEI) Forums. Each university holds regular quarterly midwifery and education strategy group meetings; the London LSAMO is on the membership for each along with the Lead Midwives for Education (LME s), Heads of Midwifery, Lecturer Practitioners and SoMs. These forums provide a valuable opportunity to strategically direct the future education and development pre and post registration midwifery education. Twice yearly meetings between London LSA / HEI leads of POSOM courses. The purpose being to give/receive information from each course leader regarding each of the POSOM courses, to facilitate LSA involvement in planning and management of POSOM courses and to ensure LSA involvement in quality assurance including practice environments and support for development from local and supervisory teams. The POSOM course was validated in 2007 by NMC to ensure that the programme complies with the Standards for the preparation of Supervisors of Midwives (NMC 2006). The programme is due for re-validation in The LSAMO and members of the LSA team attend the Universities regularly to lead specific teaching session on modules which include learning outcomes relating to the statutory functions of supervision and professional issues. LMEs and midwife teachers work collaboratively where programmes of supervised practice have been recommended by the LSAMO, to ensure the academic standard meets those set within the NMC document Standards for the supervised practice of midwives (NMC 2007) 7.1 Selection days for Potential SoMs London LSA work in partnership with the HEI leads with the selection of student SoMs; four selection days are planned throughout the year (two in the spring, and two in the summer) which coincides with the commencement dates of the Preparation of Supervisors of Midwives (POSOM) courses and facilitates improved recruitment to all London POSOM courses. Over the past two years there has been significant development in the structure of the selection days whereby all HEIs offering the POSOM course are involved in the selection process. In addition to this, users of maternity service and SoMs have been involved in selection to ensure that future SoMs have the 22

26 necessary qualities for the role as identified in the Midwives Rules (NMC 2004). The selection process consists of three aspects, a written element assessed by a SoM educationalist, an individual interview assessed by the LSAMO or Assistant LSAMO and group discussion on a given trigger assessed by prepared observers made up of educationalist, Service user and newly qualified midwife or SoM. Each element is assessed and the selection panel meet together at the end of the interviews to share their feedback and assessment sheets. Thus the triangulation of the feedback provides a more comprehensive assessment of the student s potential for the role. Evaluations for student SoM applicants have been positive; they report that the process helps them to be more knowledgeable about the various London POSOM courses and this enables them to make an informed choice of HEI. 7.2 SoMs engagement with Higher Education Institutions The SoMs continue to contribute to the development, teaching and assessment programmes of education leading to registration and the continuous professional development of all midwives. SoM involvement is monitored by the LSA at the annual audit visit. Supervisors of midwives have set up systems of support within the Trusts they work to ensure the continued support of student midwives. In most HEIs, SoMs are involved in the final assessment of student midwives. Most SoM teams assist with interviews for student midwives and contribute to OSCI assessments at the end of the midwifery training. 8: Evidence of developing trends that may impact on the practice of midwives in the local supervising authority The trend analysis in this section is based on data provided directly from individual maternity units, the LSA database and other published information. The workforce and clinical activity data is requested directly by the LSA office from the Heads of Midwifery using a standardised form. This data is submitted on a monthly basis. Information derived from the LSA database has been entered by Supervisors of Midwives. 8.1 Birth Rates Clinical Activity in London Activity Year change (%) NHS 124, , , , , % Non NHS 3,406 3,375 2,612 2,720 2, % TOTAL 128, , , , , % Year on Year change 2.3% 1.9% 0.6% 0.2% London continues to see a rise in the birth rate which is in line with birth projections which estimate the increase to be 2.9% over the next ten years. Clinical activity has increased overall by 0.2% in this year which demonstrates a continual slowing down of growth. The activity profile has changed over the year with some units experiencing an increase in deliveries and others a small decrease. 23

27 The SHA is monitoring the trends in activity and is working closely with commissioners and providers to ensure that the capacity and manpower required to meet the increase in demand is met. Maternity Delivery Trends in London Source: London Series1 Delivery Trends 24

28 8.2 Clinical Outcomes The trends in relation to clinical outcomes are discussed under the following categories: Home Births Rates The home birth rate continues to fall in London year on year. Many services attribute this reduction to increasing accessibility to midwifery led units. Eight of the ten Trusts that have seen a decrease in homebirths have excellent birth centre facilities now on offer to women. Maternity services continue to work closely with commissioners to improve home birth rates and to ensure that all low risk women are made aware of this choice at booking. Trust Maternity Units Home Births 2010 to 2011 Home Birth% Total Women Delivered Home Births Women delivered at home Home Birth % DoT Barking Havering & Redbridge 1.1% 9, % Barnet & Chase Farm 1.2% 6, % North West London 0.6% 5, % Chelsea & Westminster 0.8% 5, % Ealing Hospital 0.8% 3, % Guy's & St Thomas's 2.4% 6, % Hillingdon Hospital 1.1% 4, % Homerton Hospital 2.5% 5, % Kings College Hospital 5.2% 5, % Kingston Hospital 0.8% 5, % Lew isham Healthcare 1.0% 3, % Croydon Health Services 1.8% 4, % New ham Hospital 1.3% 5, % North Middlesex Hospital 0.4% 3, % Royal Free Hospital 9.4% 3, % St Georges Hospital 0.6% 5, % St Helier and Epsom Hospitals 0.3% 5, % South London Healthcare 9, % Imperial 0.4% 9, % The Royal London Hospital 2.6% 4, % University College Hospital 1.4% 5, % West Middlesex Hospital 0.2% 5, % Whipps Cross Hospital 1.2% 5, % Whittington Hospital 2.3% 3, % TOTAL NHS 1.5% 131,824 1, % This table does not include data from private maternity services; The Portland Hospital or the Lindo Wing, neither of which services offer home births. 25

29 8.2.2 Caesarean Section Rates Caesarean Section Rates have decreased in London this year, (the first time since 2006) by 0.2%, taking the rate from 29.1% to 28.9%. The rate varies significantly between NHS Trusts from the lowest rate of 22% at St Georges Hospital to the highest rate of 32% at University College London Hospital. The National average for caesarean sections for was 25%. Maternity Caesarian Section Trends in London % 29.0% 27.0% 25.0% 23.0% 21.0% 19.0% 17.0% 15.0% 28.3% 28.0% 28.4% 28.4% 28.8% 29.1% 28.9% 26.4% 26.0% 24.3% 24.8% All Trusts have adopted a number of initiatives to reduce the rate of unnecessary caesarean sections; this includes multidisciplinary reviews of emergency caesarean sections, VBAC clinics, birth choice clinics, increasing Consultant presence on the labour ward etc. Private providers of maternity care in London continue to see the highest rates of caesarean sections, The Portland Hospital had 2244 births in and 53% were delivered by caesarean section. (See table in Appendix 9) for individual Trust Caesarean Section Rates) Maternal Death Following the London Maternal Death review in 2009/10 London s maternity services have been working hard to instil the recommendations from the review into practice. 2008/9 2009/ / /12 Number of Maternal Deaths A presentation on the findings of the Maternal Death review was given to the London Clinical Senate in June 2011, the London Chief Executives Forum and the London Directors of Nursing. Following the maternal death review the Chief Nurse for London and the Medical Director requested that a maternal death forum be established to ensure the findings of the review were implemented. This multidisciplinary forum is chaired by the LSAMO and first met in the 26

30 2011, a programme of interactive workshops have been formulated and will be taken out to each Trust throughout Twenty three maternal deaths were reported to the LSAMO in 2011/12, eight less than the previous year. Four of the maternal deaths were due to direct causes and nineteen due to indirect causes, of the indirect causes there were two homicides and two suicides Serious Incidents London LSA works closely with the Patient Safety team at NHS London who have agreed a policy for the reporting of serious incidents (SI) which includes a number of circumstances which automatically categorise an incident as an SI. Details of this can be found at The LSA team forms part of the review process for SI reports and any concerns around midwifery practice are escalated to the LSA team. In 2011/2012, there were a total of 4088 serious incidents reported to NHSL on STEIS. Of the 4088 total, maternity Sis equated to 554 (13.5%) a small increase from : 539. The chart below shows the breakdown by percentage of the Maternity serious incidents (SIs) by type. The highest reported type of Maternity serious incident remains unexpected admission to NICU, followed by unplanned maternal admission to ITU /12 Maternity SIs Breakdown 36% 6% 12% 2% 5% 4% Maternity service Maternity Services - Intrapartum death Maternity Services - Intrauterine death Maternity Services - Maternal Death Maternity Services - Maternal unplanned admission to ITU 4% 31% Maternity Services - Suspension of maternity services Maternity Services - Unexpected admission to NICU (neonatal intensive care unit) Maternity Services - Unexpected neonatal death 10 Maternity Serious Incident Themes Report; Patient Safety Action Team NHSL Aug

31 8.3: Demand Management The increasing birth rate has led to increasing demand on London s Maternity services which are evidenced by the number of times a Maternity Service has suspended its services. London has a mobile workforce which adds to the challenge of recruiting appropriate numbers of midwives to meet the rising birth rate Suspension of Services Seventy six suspensions of maternity services were reported via the LSA database during this reporting year this is a substantial increase from last year (31). Since April 2011 London LSA requested that Trusts also report partial suspension of services; this may range from suspension of one site, midwifery led service, homebirth service or postnatal visiting and will account for the increase in numbers. London LSA recognises that suspension of any part of the service can have a detrimental effect on women s experiences and should be monitored in the same way as complete suspensions. London LSA acknowledges that merged organisations (BHRT, Barnet and Chase Farm and South London) manage their activity across sites so that full suspension of services is avoided. The main reason for suspension was insufficient beds followed by insufficient staff; other reasons included issues with the estate (such as fire, flooding etc). Most suspensions lasted for a few hours and all were for no longer than 24 hours. Suspensions of Maternity Services Source: LSA Database This year most suspensions of maternity services took place in NW London, with insufficient capacity being quoted as the main reason. NE London (mainly Whipps Cross) was the next highest reporter. Capacity planning is of particular relevance in these areas. In addition to the successful suspensions there were a number of attempted suspensions of maternity services where suspension was not possible due to the neighbouring units not being able to accept women. 28

32 All suspensions and attempted suspension of services are classified as a serious untoward incident (SI), by the SHA. The full report from the SI is shared with the SHA and with the main commissioner of the service. In partnership with the SHA and the London Ambulance Services, the LSA launched a Pan London Maternity divert policy in October This was developed to support services at times of high activity or when they needed to suspend or divert services. The process appears to be working well; although this is entirely dependant on how fully operationalised the policy is in each Trust Midwifery Workforce This year 5771 whole time equivalent midwives were employed to provide care to women in London, which is an increase of 196 from The London wide ratio of midwives to births is 1:30, this is a slight improvement on last years figure of 1:31. There is a significant range between Trusts from the highest number of midwives to births being 1:22 and the lowest being 1:37. In 2011 London was commended by the Royal College of Midwives for facilitating a 45% rise in midwifery numbers since 2002, equivalent to almost half of the net rise in midwifery numbers 11. Despite the increasing numbers of midwives being employed in the Capital it is a challenge to keep up with the rising birth rate. Deliveries Midwives/Deliveries in London Midwives Deliveries Midwives There has been significant investment in midwifery establishments across London and many Trusts have been successful in recruiting midwives, the vacancy factor has dropped from 12% to 9%. 11 State of Maternity Service Report 2011 RCM 29

33 DoT Table x Midwifery vacancies in London since 2006 London Midwife Vacancies Year London 8% 9% 13% 16% 12% 9% Midwifery vacancies per Trust in London Sector INEL NCL NWL ONEL SEL SWL Maternity Service Vacancy % Vacancy % Homerton Hospital 16% 5% New ham Hospital 8% 9% The Royal London Hospital 6% 6% Barnet & Chase Farm 23% 22% University College Hospital 2% 6% North Middlesex Hospital 5% 3% Portland 10% 7% Royal Free Hospital 16% 3% Whittington Hospital 5% -1% North West London 13% 7% Chelsea & Westminster 18% 8% Ealing Hospital 21% 20% Hillingdon Hospital 12% 14% Imperial 9% 14% West Middlesex Hospital 10% 2% Barking Havering & Redbridge 20% 13% Whipps Cross Hospital 5% 5% Guy's & St Thomas's 15% 9% King's College Hospital 10% -2% Lew isham Healthcare 12% 10% South London Healthcare 11% 9% Kingston Hospital 16% 9% Croydon Health Services 24% 18% St George's Hospital 4% -2% St Helier and Epsom Hospitals 17% 19% Average London 12% 9% At a time where NHS Trusts are under continuing financial scrutiny NHS London has worked closely with providers and commissioners to ensure continual investment in midwifery posts, that adequate numbers of student midwife places are commissioned and Trusts make use of external agencies to ensure that midwifery recruitment is on going. 30

34 8.3.3 Maternity Support Workers The London LSA values the contribution of maternity support workers in supporting midwives in the care of women and their families. Significant work has been done to train maternity support workers in skills which support the role of the midwife and evidence suggests that the use of maternity support workers significantly increases midwifery time. In 2009, NHSL and The London Southbank University collaborated on developing a foundation degree for maternity support workers the first year has been well evaluated and has been welcomed by participants and employers alike Full / part time Midwives in London Full/Part Time Midwives in London 2006 to 2012 Year (April- March) Full- Time Midwives (% of total) Part- Time Midwives (% of total) Total % % % % % % % % % % % % 5771 This year has seen a continuing slight increase in the number of full time midwives compared to the number of part time midwives, which may indicate an increase in the number of midwifery hours Age profile of the Midwifery Workforce Average Age by Full Time / Part Time Year Average Age (Full Time) Average Age (Part Time) 2008/ / / / The average age of the midwifery workforce has remained fairly static with little difference between full time and part time workers. 17% of the midwifery workforce is over the age of 31

35 55 therefore eligible for retirement now whilst 35% of agency midwives working in London are over the age of 60. (Source: LSA database) The London profile of Midwives by practice type Number of Midwives by Practice Type Practice Type Number of practicing midwives NHS (inc Bank) 5348 Private Care 115 Agency 121 Higher Education Institute 93 Self Employed (Independent Midwives) 37 Other 57 Total 5771 London has a higher number of agency midwives and self employed midwives than any other LSA in the UK. 9: Details of new policies relating to the Supervision of Midwives London LSA has published two new documents on the London LSA website during the reporting year: a) Information for Contact SoMs regarding the procedure for selection and appointment of potential SoMs (March 2012) This guidance complements the LSA National Forum Guideline for the nomination, selection and appointment of SoMs, and provides local application for London. b) LSA database workbook: Compiled by J Read and published on the London LSA website in January The workbook was written in response to continuing developments of the LSA database and the need for SoMs to be proficient in its use. c) The LSA National Forum UK guideline J Confirming Midwives eligibility to Practice was reviewed and updated during the practice year. d) The LSA National Forum UK Strategic Direction was launched in January 2012 and sets out an ambitious programme of work to deliver right touch regulation whilst safeguarding the public and supporting midwives in practice : Reports on all local Supervising Authority Investigations undertaken during the year. There are a number of triggers that prompt an investigation into a midwives fitness to practice, SoMs are encouraged to utilise the LSA National Forum UK Guideline L Guideline and process for investigation into a midwife s fitness to practice by a Supervisor of Midwives

36 on behalf on the LSA and guideline La which is a Decision toolkit when there is uncertainty as to whether an investigation is required. On commencement of a Supervisory Investigation the Supervisor informs the LSA Midwifery Officer by placing an alert on the LSA database, which is then ed directly to the LSA Midwifery Officer. Support is available to the London SoMs from the Assistant LSAMO and LSA support midwives who provide guidance and feedback to Supervisors on individual reports. The final report is submitted to the LSA Midwifery Officer for review before the recommendation is made. The SoM is ed by the LSA Midwifery Officer to confirm the outcome and encouraged to feedback to the midwife, complete an outcome summary for the Head of Midwifery and update the LSA database Number of Investigations and outcomes During the number of Supervisory Investigations has increased significantly from 89 ( ) to 154. All supervisors of Midwives have undertaken professional development in relation to undertaking supervisory investigations and their awareness of when a SoM investigation is required has been heightened. Following last years audit of SoM investigations 13 SoM teams were encouraged to review the process of how investigations are triggered, this may also have resulted in an increase in numbers of investigations. The total number equates to 2.6% of midwives practising in London who have had investigations undertaken into their practice. The chart below identifies the outcomes from the investigations. As can be seen; developmental support is the most likely outcome with a very small number being referred to the Nursing and Midwives Council. This is similar to last years findings however; because the numbers of investigations have increased the numbers of midwives on developmental support have also increased. SoM Investigations % 6% 13% 15% Referral to NMC Sup Practice Dev Support Local Action No Further Action 64% 10.2 Emerging themes During an investigation into a midwife s practice areas that require development are identified. This allows London LSA to classify themes that require further training and 13 LSA annual report to the NMC Angela Helleur 33

37 development for midwives in London. Documentation and record keeping was the most commonly identified gap in practice in SoM Investigations Due to the significant increase in the number of supervisory investigations this reporting year, it is difficult to compare to the previous year. However it is interesting to note that the three most common themes are the same in both years. Most Supervisory Investigations will identify more than one theme, an average of 2-3 themes were identified per investigation Supervised Practice Supervised Practice is a formal process with academic and practice learning outcomes that supports and assists a midwife to improve her knowledge and ability so that she can demonstrate that she is competent in practice and fit to stay on the NMC register 14. Four external programmes of Supervised Practice were undertaken due to the midwife not being employed substantively when the Supervised Practice was required. It is becoming more difficult to find supervised practice placements for unemployed midwives as many services do not wish to take the risk of providing an honorary contract for a midwife who has been dismissed elsewhere or is currently unemployed. During the number of midwives requiring Supervised Practice was 22 this is a slight increase from the previous year when 20 programmes were facilitated LSA Suspension from Practice There are a number of occasions which require the LSA Midwifery Officer to suspend a midwife from practice and refer her/him to the Nursing and Midwives Council in line with Rule 5 of the Midwives Rules and Standards. During London LSA suspended eight midwives from practice. London LSA conducted an LSA investigation into each case which was sent to the Nursing and Midwives council along with the referral. The outcomes of those suspensions are detailed in the table overleaf. 14 Standards for the supervised practice of midwives. NMC

38 Profile of Midwife Practice Issues Outcome NHS employed Breach of Rule 6 Breach of Code of Conduct NHS employed Breach of Rule 6 Breach of Code of Conduct Failed extended programme of Supervised Practice Suspended and referred to the NMC Suspension order for 18 months case pending Interim suspension order for 18 months: case pending NHS employed Breach of Rule 6 Interim suspension order for 18 months: case pending NHS employed Breach of Rule 6 Interim suspension order for 18 months: case pending NHS employed Breach of Rule 6 Breach of Code of Conduct Interim suspension order for 18 months: case pending Agency Midwife Breach of Rule 6 Conditions of practice applied: Supervised Practice NHS Midwife Breach of Rule 6 Conditions of practice applied: Supervised Practice NHS Midwife Breach of Rule 6 Failed extended programme of Supervised Practice Interim suspension order for 18 months: case pending 11: Complaints regarding the discharge of the Supervisory Function London LSA received five complaints this year relating to the Statutory function compared to two complaints during the previous reporting year. The contact details for the LSA Midwifery Officer is available on the London LSA website and the LSA National Forum UK. The nature of the complaint and the outcome are outlined in the table below: Complainant Nature of complaint Outcome Independent practice of Midwives Maternity Service User (Father) Concerns relating to content of a Supervisory Investigation Complaint related to Homebirth Service being withdrawn affecting this family. External LSAMO asked to review investigation and address concerns raised. Complaint not upheld Situation addressed and resolved at the local Trust. 35

39 Maternity Service User Maternity Service User Maternity Service User (Father) Complaint relating to the outcome of a SoM Investigation Concerns regarding the outcome of a SoM investigation. Complaint relating to management of a specific case External review undertaken by LSAMO, complaint not upheld, however development for the SoM was recommended. Concerns allayed, no further action required. Concerns being addresses through correct processes locally. 12: Additional LSA Activities and Achievements The NMC review of London LSA in October 2011 demonstrated that despite the challenges facing maternity services in London, a high standard of Supervision of Midwifery is achieved across the capital. A number of specific achievements are acknowledged below: 12.1: Development of the SoM activity sheet London LSA team have continued to work on the development of a SoM activity sheet. This is in response to CQC and NMC concerns regarding equity of activity within SoM teams and the need for consistency throughout London. A small excerpt from the activity sheet can be seen below: An excerpt from the SoM activity sheet Theme Benchmark Answers Goal Red Flag - consider removing Jan Feb Mar Apr 1 Protected Time Linked to LSA Standard 1 Allocated protected time for supervision per month a) Were you allocated time for supervision duties? Supervisors maintain records of their 2 Individual Caseloads supervisory caseload Linked to LSA Standard 2,4 a) Are all your ITP's completed? Free text box with number number of hours 7-15 hours < 7 hours Drop down menu box Yes / No / NA with drop A/l or s/l Yes No b) Are all annual reviews up-to-date? Drop down menu Yes / no 100% 98% c) Annual fees paid? Drop down menu Yes / no 100% 98% Supervisors are accessible to women and midwives Drop down menu Yes / no 100% 98% London LSA has developed the activity sheet so that it will sit within the LSA database and be easily accessible to all Supervisors of Midwives. This will allow the LSA Midwifery Officer to print off reports relating to SoM team activity in each Trust. It will also allow Supervisors of Midwives to collate their activities and identify areas for development. 36

40 12.2: Development of the new LSA Audit tool The annual LSA audit is an opportunity to assess the effectiveness of Statutory Supervision of Midwifery in each Maternity Service in London. The SoM team audit themselves using an LSA audit tool; this involves submitting evidence electronically which demonstrates how the team have met each of the five NMC standards for Statutory Supervision. London LSA have redeveloped the audit tool to bring it in line with NMC good governance principles 15. The tool is divided into four domains: 1) Clinical Governance 2) Statutory Supervision 3) Leadership and teamwork 4) Interface with Service Users Each domain is underpinned by the NMC standards for statutory supervision. The new audit tool will be piloted and evaluated in quarter two of 2012, this will be reported on in next years LSA annual report. 12.3: Recruitment of the first full time SoM in London This achievement has been described under 3.1 in this report, and demonstrates the recognition from Trusts of the importance of supporting the function of Statutory Supervision in line with the QUIPP agenda; the provision of quality, innovation, productivity and prevention. 12.4: LSA Database The LSA database is integral to the function of Statutory Supervision across the UK. The database has grown significantly over the past ten years, starting out as a bespoke database for one team of SoMs in London to store details of midwives practising in the Trust. Within two years the database was being used throughout London, and is owned by London LSA. Since then each of the LSA s in the UK have bought in to the LSA database, which has resulted in the database now being the key portal where every Intention to practise form is uploaded to the NMC. The LSA Midwifery Officer for London chairs the LSA database steering group which meets quarterly. There have been a number of database initiatives developed during 2011/12 including a skills training portal where student SoMs and newly qualified SoMs can learn how to use the database. 12.5: Local achievements See below a number of local achievements by SoM teams that have been presented in the reporting years SoM annual reports: SoM on call undertaking daily rounding, encouraging midwives, addressing issues on the spot, increasing SoM visibility and raising the profile of Supervision to midwives and women. 15 Review of Morecambe Bay NHS Foundation Trust 11/10/11 NMC/CQC 37

41 A number of innovations led by SoMs to increase and promote homebirths: home birth workshops etc SoM Open days facilitated by a number of teams, promoting Supervision of Midwifery to midwives and service users SoM facilitated DVD focussing on communication skills, shown during all mandatory training, using real situations taken from complaints. SoMs implementing a pilot scheme of partners staying overnight in the postnatal ward resulting in higher levels of satisfaction for women and reduction in complaints The development of Maternity notes with SoM involvement to ensure NMC standards for record keeping and documentation are considered Supervisors of Midwives were also involved in the production of a Medicines Management education booklets for midwives, In your Shoes initiatives to gain feedback from service users and the development of midwifery care bundles. 13: Conclusion The birth rate continues to rise in London and although funding for midwives has increased in some areas, this has not been consistent. The number of hours allocated to Supervision of Midwifery in the Capital has increased in some Trusts which compensates for the higher SoM to midwife ratios. Despite the notable challenges faced by SoMs they continue to demonstrate their significant contribution to improving the safety and quality of our maternity services. There is clear evidence that SoMs are applying proactive measures to ensure that concerns about individual practice are supported early on to enable development. The SoMs and midwives are developing and introducing new initiatives to support the public health agenda, more choice and increased access for women to continually improve the care for women within London.. The number of supervisory investigations has increased significantly thus impacting on the workload of the supervisors of midwives. The supervised practice programmes and suspension from practice, although small in number are very time consuming, however, this further supports the protection of mothers and babies from poor practice and reduces the likelihood of referral to the NMC. There is clear commitment from SoMs to support the provision of excellent care for local women and their families evidenced by a number of initiatives such as SoMs involvement in multi lingual parent education and collaborative work with MSLCs in developing a DVD for users of the maternity service. In this time of change and financial uncertainty supervision of midwifery continues to be the foundation of support for women and midwives and must continue to be valued, appreciated and recognised. As stated in the Health Committee Seventh Report: 38

42 The Committee notes that Statutory Supervision of Midwives is a tried and tested means of assuring the quality of midwifery practice. The NMC should consider the costs and benefits of extending the Statutory Supervision Framework as a potential means of delivering an effective revalidation process for all registrants Acknowledgements Compilation of the 2011/12 London LSA Annual Report to the NMC has been undertaken with contribution from the following: The London LSA team covering the reporting year: Angela Helleur, Carole Yearley, Georgina Sims, Manjit Randhawa, Clare Capito and Carol Walsh. Margaret Richardson Maternity Strategic Advisor to NHSL Paul Butler (Information Analyst), Jane Suppiah (LSA Lay Auditor) Sally Luck Patient Safety Action Team NHSL The London Heads of Midwifery who support and promote Statutory Supervision of Midwifery and supply data for the Annual Report. Every Supervisor of Midwives in London who commits time and energy to supporting midwives in practice and safeguarding the public from low standards of Midwifery care. 16 Health Committee seventh Report 19/07/

43 15: Appendices LSA Profiles (Jan 2012) Appendix 1 Area Coverage/pop LSAMO/Support Births (2010/11) Midwives SoMs Ratio North of Scotland South East and West of Scotland North East Yorkshire and the Humber North West Northern Ireland Wales West Midlands East Midlands East of England London South East Coast South Central South West 54,053 sq km 1.3 million pop 23,585 sq km 3.88 million pop 8,573 sq km 2.6 million pop 15,500 sq km 5.12 million pop 14,000 sq km 7 million pop 14,139 sq km 1.74million pop 20,761 sq km 2.97 million pop 12,950 sq km 5.4 million pop 16,640 sq km 4.36 million pop 19,166 sq km 5.6 million pop 1,580 sq km 7.5 million pop 9,324 sq km 4.2 million pop 10,000 sq km 4 million pop 23,829 sq km 5 million pop Mary Vance 14, :12 Yvonne Bronsky 44,575 2, :13 Kath Mannion 31,917 1, :12 Carol Paeglis + LSA Midwife 65,727 2, :14 Lisa Bacon 93, 731 4, :13 + LSA Midwife Verena Wallace 26, :12 Vinnie Ness Julie Richards 36,332 1, :12 Barbara Kuypers , : LSA Midwife Shirley Smith 50, :14 + LSA Midwife Joy Kirby 70,866 3, :15 + LSA Midwife Jessica Read 134, :16 + Asst LSAMO + LSA Midwife Jenny Hughes 53,615 2, :13 Suzie Cro 45, :15 Val Beale 60,500 3, :15 40

44 Appendix 2 SOM Team development Programme NMUT Team Building Day Programme Venue Paediatric Assessment Unit, North Middx University Trust Aims: To unite and re-energise the SoM team To establish a clear vision and focus for SoM Agreed and prioritise supervisory goals and formulate an action plan to achieve them Time Content Facilitators Session 9.15 Introduction and overview of the day Welcome, introduction, overview of the day, agree ground rules Carole Yearley and Clare Capito 9.30 Team experience exercise Carole 9.45 to Getting to re-know each other Activity Coffee 11.00hrs 11.00hrs Team Landscape What does our SoM team look like? A creative session 12.00hrs Moving Forward what is our shared vision Formulating a mission statement Lunch 13.45hrs 13.45hrs Formulating our goals: Our Team Wheel Jess. attending after lunch at 3pm Clare Carole and Clare Carole and Clare Carole 14.45hrs Team Action Planning Clare 15.45hrs Evaluation Close 41

45 Appendix 3 LSA CONFERENCE FOR SUPERVISORS OF MIDWIVES IN LONDON Friday 6 th May 2011 Monckton Theatre, St George s University London, Cramner Terrace, Tooting SW17 Compassionate Care PROGRAMME 08:30 Arrival, Registration & Coffee Morning Session Chair Angela Helleur 09:00 Welcome and Introduction Angela Helleur, LSAMO 09:15 The New Landscape and Challenges for Midwives and Maternity Services in London Prof Trish Morris Thompson Chief Nurse NHSL 10:15 Professional behaviour, Code Michelle Lyne, NMC 11:00 Coffee Attitude You talking to me!! What Attitude!! Royal London SOM Team Alison Herron / Nickey Tomkins Social Networking Implications for Midwives LSA Support Midwives 13:00 Lunch Afternoon Session Chair Jessica Read 14:00 Difficult Conversations React Drama Group 16:.00 Evaluation and Closing Comment Angela Helleur LSAMO 16:15 Close 42

46 Appendix 4 LSA CONFERENCE FOR SUPERVISORS OF MIDWIVES IN LONDON Great Hall, King's College London, 5 Strand Lane, London. WC2R 2NA Innovation and the Future of Statutory Supervision of Midwives P r o g r a m m e Arrival, Registration & Coffee Morning Session Chair Jess Read LSAMO Welcome and Introduction Jess Read LSAMO Future Challenges for Midwives and Women in London Angela Helleur, Deputy Director Medical Directorate, NHS London Update on the midwives rules and standards Colleen Begg, Midwifery Adviser Policy and Standards NMC Coffee Excellence in Supervision: Practice Innovations Social Networking and Professional boundaries Georgina Sims, Clare Capito, Manjit Randhawa, LSA Support Midwives Innovation through a professional development: a programme for the supervisory team at Chelsea and Chelsea and Westminster SoM team Westminster Innovation through evidence: The Birthplace Study: Refocusing our role as supervisors of midwives Plenary session from morning presentations: Questions to the panel Cathy Rogers SoM Barnet and Chase Farm (Cathy will also be Introducing a Midwives Exemption Workbook) Panel Chair, Angela Helleur and speakers Lunch Afternoon Session Chair Carole Yearley Assistant LSAMO Excellence in Supervision: Practice Innovations Growing talent for the future: the London SoM section process from the applicant s perspective Securing the future through supervision: The Merger Journey of Supervisor s of Midwives within SLHT Into the future: the NMC review of the London LSA Plenary session from afternoon presentations: Questions to the panel Lyn Woodward Student SoM (with support from Carole) The SLHT SoM team Carole Yearley Panel Chair, Carole Yearley and speakers Evaluation and Closing Comment 43

47 Appendix 5 LSA Audits Apr 6th Apr 20th Apr 27th May 11th May 25th Jun 1st Jun 8th Jun 22nd Jul 6th Jul 20th Sept 14th Sept 20th Sept 28th Oct 12th Oct 26th Nov 2nd Nov 9th Nov 16th Nov 23rd Chelsea & Westminster Homerton West Middlesex Ealing Croydon Health Services NHS Trust Kings - BHRUT Queens - BHRUT UCLH Lewisham Northwick Park Newham St Helier Epsom North Middlesex Kingston St Mary's (Imperial) QCCH (Imperial) Whittington Guy's & St Thomas' 44

48 Dec 7th Dec 13th Jan 11th Jan 18th Jan 25th Feb 1st Feb 15th Moved to April 27th Feb 22nd Mar 14th Mar 28th Kings College Royal Free Princess Royal Queen Elizabeth Portland St George's The Royal London Whipps Cross Barnet Hillingdon 45

49 Appendix 6 Nursing and Midwifery Council report on the London LSA Date of review: 3-6 October 2011 Date of report: November 2011 Executive summary 46