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ANNUAL REPORT OF THE LOCAL SUPERVISING AUTHORITY MIDWIFERY OFFICER FOR THE NORTH AND EAST YORKSHIRE AND NORTHERN LINCOLNSHIRE LOCAL

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ANNUAL REPORT OF THE LOCAL SUPERVISING AUTHORITY MIDWIFERY OFFICER FOR THE NORTH AND EAST YORKSHIRE AND NORTHERN LINCOLNSHIRE LOCAL SUPERVISING AUTHORITY North & East Yorkshire and Northern Lincolnshire
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ANNUAL REPORT OF THE LOCAL SUPERVISING AUTHORITY MIDWIFERY OFFICER FOR THE NORTH AND EAST YORKSHIRE AND NORTHERN LINCOLNSHIRE LOCAL SUPERVISING AUTHORITY North & East Yorkshire and Northern Lincolnshire Strategic Health Authority Executive Summary This report fulfils the Nursing and Midwifery Circular 15/2006 and is one of two reports produced for the, as was, Yorkshire and Northern Lincolnshire Local Supervising Authorities (LSA) Consortium NMC LSA code 82. Liaison between the LSA Midwifery Officer and the Nursing and Midwifery Council has been at numerous planned events and by direct contact in relation to advice on fitness to practice and regulatory issues. Self assessment of achievement of the 53 supervisory standards within the NMC (2004) Midwives Rules and Standards is provided as an appendix. On 1 st July 2006, the North and East Yorkshire and Northern Lincolnshire, the South Yorkshire and the West Yorkshire Strategic Health Authorities became the Yorkshire and the Humber NHS, that is, one LSA, with two LSA Midwifery Officers (LSAMO) reporting to it. For the next annual reporting period, one LSA report will be produced. The LSA budget has never been overspent and there continue to be no complaints received regarding the discharge of the supervisory function in the LSA. The LSA Portfolio Co-ordinator and the Link supervisors of midwives have provided excellent support to the LSA. Policy formulation has been through well-established working groups. Within this report, a calendar of key LSA events is provided as an Appendix, as are examples of good practice and innovative approaches to the care of women and their families. There were 61 supervisors of midwives in North and East Yorkshire and Northern Lincolnshire at the end of the report year. Four new supervisors of midwives were appointed, seven resigned, there were no removals of supervisors from post, but two requested time out from supervision and stepped-down from supervisory duties. Numbers of supervisors in the LSA increased from markedly at two Trusts, increased at one Trust, decreased slightly at one Trust and decreased markedly at another Trust. All Trusts apart from one fulfilled the NMC recommendation of at least 1:15 supervisor to midwife ratio, but this has since been addressed. However, succession planning for supervisors should continue to be priority in view of the aging profile of supervisors 754 midwives notified their intention to practise in March Trends of numbers of whole time equivalent midwives have decreased from 1999 to 2005 at one Trust, been relatively static at three others and increased at another Trust. All midwives in the LSA have a choice of supervisor. Letters were sent from the LSA to 27 midwives who had not recorded a supervisory review date after December 2004 on their current Intention to practise (ITP) form. There were 32 complaints in relation to midwifery practice across the five Trusts in the report year, with the LSA only being notified of those linked with serious untoward incidents. Six midwifery-related serious untoward incidents 2 were reported to the LSA, two of which related to drug errors. Errors in record keeping were highlighted in many critical incidents. Reporting of SUIs to the LSA vary in numbers across the five Trusts, with one not having any at all in the report year. Eight supervisory investigations were undertaken by supervisors of midwives on behalf of the LSA. One LSA investigation was undertaken in view of the supervisory recommendation to refer a midwife to the NMC. However, the LSA investigation recommended supervised practice and this was successfully completed. One LSA-commissioned external review of the practice of a midwife did not support referral to the NMC, however, the employing Trust referred the midwife directly. No further details can be provided, as it is still being considered by the NMC and so is not yet in the public domain. Six further midwives received supported practice. There were two maternal deaths reported by the same Trust in North and East Yorkshire and Northern Lincolnshire; one due to a drugs overdose and the other a death at home in relation to Diabetes. In line with the national findings of the Healthcare Commission, robust data continues to be a problem. Accuracy and completeness of data is obviously a governance issue, is crucial for planning and evaluating services and based on the experience of collecting the LSA data, will be a challenge for services in relation to Payment by Results, for example. The total numbers of birth over the last 10 years has been fairly static across North and East Yorkshire and Northern Lincolnshire. Midwifery staffing establishments expressed as a midwife to number of births ratio varies across the LSA from 1:27 to 1: Increasing pressures on midwifery staff have been apparent during this difficult financial year and expansions of primary care services including stand-alone birthing units, public health initiatives and home births are being compromised to support acute services. Intrauterine transfers into and out of units continues to cause much additional workload pressure. All Trusts were able to provide data of transfers out and did a combined total of 109, excluding 14 transfers from stand-alone birth units to main units. All but one Trust have had their Neonatal units closed at some point throughout the year and all but one has a guideline in place. These trends are dealt with through the Yorkshire Neonatal Network and the SHA governance route. A self assessment based on the Healthcare Commission s concerns about some failing maternity units was provided to Trusts by the LSA and responses were requested and noted. Meetings were held every quarter by the LSA with supervisors of midwives, with two full day Consortium Supervisors Conferences and two conferences for supervisors of midwives being facilitated. Four meetings for new supervisors of midwives were provided in their first year of appointment. 3 The LSA has been involved in wider SHA/Workforce Development Confederation work including, supporting the implementation of the Children s and Young People s NSF, public health, newly qualified midwives unable to secure midwifery employment and the Chief Nurses meetings Formal audit visits with service user involvement after training, were completed at two Trusts and informal audit visits to the remaining three Trusts. Themes included, a lack of protected time and administrative support for supervisors of midwives, inadequate maternity information systems, low intentional home birth rates, with some suggestions of a rising unintentional, and sometimes unattended home birth rates and a lack of robust preceptorship for newly qualified midwives. Inadequate maternity information systems still make it difficult to evidence progress towards midwife-led care. Additional service user involvement with the LSA has been through the LSAMO attendance at meetings of Eastern Hull Maternity Service Liaison Committee. The LSA has had contact with both universities in the LSA that provide midwifery education and engagement with each of the Lead Midwives for Education (LMEs). There was a further reduction in Return to midwifery practice enquiries across the Consortium during the report year to 24, from 30 last year and 45 the year previously. The LSAMO continues to meet four times a year with all the independent midwives practising within the LSA. Two of these meetings are workshops for independent midwives, their named supervisors of midwives and the liaison supervisors of midwives for independent midwives at each Trust. This liaison continues to provide the benefits to care afforded by enhanced working relationships. The LSAMO role continues to be acknowledged as a clinical leadership role, evidenced by the invitations to present to audiences, locally, nationally and internationally and to write books. A summary of the work done towards and since the transition to one LSA is described, as are the key LSA priorities for the 2006/07 report year. 4 Contents Page No Executive Summary 2-4 Introduction 8 How the LSA report is made available to the public 8 Numbers of supervisor of midwives appointments, resignations 9-11 and removals Details of how midwives are provided with continuous access 11 to a supervisor of midwives Details of how the practice of midwifery is supervised Evidence that service users have been involved in monitoring supervision of midwives and assisting the local supervising authority midwifery officer with the annual audits. Evidence of engagement with higher education institutions in relation to supervisory input into midwifery education Details of any new policies related to the supervision of midwives Evidence of developing trends affecting midwifery practice in the local supervising authority Details of the number of complaints regarding the discharge of the 22 supervisory function Reports on all local supervising authority investigations undertaken during the year Statutory requirement for the LSA to publish Budget 27 LSA Portfolio Co-ordinator 27 Priorities for 2006/07 27 Summary 28 5 Appendices 1. Supervisors of Supervisor/User Auditor Training Workshop Programme 3. Maternal Deaths 4. Midwives Age Profile 5. Statistics for West Yorkshire 6. Statistics from independent midwives 7. Number of women delivered 8. Guidelines for supervisors of midwives reviewed / amended April 05 March Calendar of key LSA events 10. NHS Yorkshire and the Humber Local Supervising Authority Function - Transitional Arrangements 11. Innovative approaches and good practice evidenced as making positive differences to midwives practice and the care of women and their families (annual supervisory reports from each individual Trust for the report year have not been included within this report, but are available on request) 12. Self assessment of achievement of the 53 supervisory standards within the NMC (2004) Midwives rules and standards 6 Annual report of the Local Supervising Authority Midwifery Officer (LSAMO) for Introduction This annual report fulfils the guidance set out in the Nursing and Midwifery Circular 15/2006 dated 12 th June 2006 Guidance for Local Supervising Authority (LSA) Annual Report submission for practice year 1 April st March This is one of two reports produced for the Yorkshire and Northern Lincolnshire LSA Consortium NMC LSA code 82; this one is for the North and East Yorkshire and Northern Lincolnshire LSA, the other report is for the West Yorkshire LSA. The reports have been produced separately to fulfil NMC requirements, however since 1 st July 2006, the Strategic Health Authority (SHA) became NHS Yorkshire and the Humber that is, one LSA, with two LSA Midwifery Officers (LSAMO) reporting to it; for the next annual reporting period, one report will be produced. Examples of good practice and innovative approaches that have been evidenced as making a positive difference to midwives practice and for the care of women and their families are included in the appendices. The Chief Executive Officer (CEO) of the LSA is: Margaret Edwards and the LSAMO for the Yorkshire and Northern Lincolnshire LSA Consortium as was, is Carol Paeglis. Their contact details are: NHS Yorkshire and the Humber, Blenheim House, West One, Duncombe Street, Leeds, West Yorkshire, LS1 4PL. Telephone: , How the LSA report is made available to the public The LSA reports are available in the public domain on the SHA website and are published in hard copy. Copies are distributed to all Heads of Midwifery and Contact supervisors of midwives at each of the Trusts, to the Chief Executive and Director of Nursing of the SHA and to the NMC to be made available to the public. Within the reporting period, it was also presented at the public Board meeting of the North and East Yorkshire and Northern Lincolnshire SHA. No further response was generated from it, although the Healthcare Commission requested a copy of LSA data in preparation for its maternity services work programme. 7 2. Numbers of supervisor of midwives appointments, resignations and removals There were 61 supervisors of midwives in North and East Yorkshire and Northern Lincolnshire at the end of the report year. Four new supervisors of midwives were appointed and seven resigned during the year. There were no removals of supervisors from post, but two requested time out from supervision and were given the opportunity to step down from supervisory duties for either six or twelve months. A list of the supervisors of midwives in the North and East Yorkshire and Northern Lincolnshire appears in Appendix 1. Numbers of whole-time equivalent midwives, of the numbers of supervisors and of the ratio of supervisors to midwives as at 31 st March 1999 to 31 st March 2006 per Trust, are shown in tables 1, 2 and 3. Trends for Trusts are highlighted under each of those tables. Table 1: Number of midwives (WTE) Harrogate Hull & East Yorks Northern Lincolnshire and Goole Scarborough York Trends of numbers of WTE midwives have decreased from 1999 to 2005, decreased significantly in 2002 for Scarborough and North and East Yorkshire Healthcare NHS Trust, been relatively static at Northern Lincolnshire and Goole Hospitals NHS Trust, York Hospitals NHS Trust and Harrogate and District NHS Foundation Trust and increased at Hull and East Yorkshire Hospitals NHS Trust. (Table 1 and last sentence amended on 11 th October 2006 following information received from Hull & East Yorkshire NHS Trust for 2001 figures) 8 Table 2: Number of supervisors of midwives Harrogate Hull & East Yorks Northern Lincolnshire and Goole Scarborough York Table 3: Ratio of supervisors of midwives to midwives 1 supervisor : number of midwives Harrogate Hull & East Yorks Northern Lincolnshire and Goole Scarborough York Data could be compared from 31 st March 2000 to 31 st March 2005 for each of the North and East Yorkshire and Northern Lincolnshire Trusts, although it only provides a snap-shot on those specific dates and can vary throughout the year. Table 2 demonstrates that numbers of supervisors in the LSA increased from markedly for Hull and East Yorkshire Hospitals NHS Trust, York Hospitals NHS Trust, increased for Harrogate and District NHS Foundation Trust, decreased slightly for Northern Lincolnshire and Goole Hospitals NHS 9 Trust and decreased markedly for Scarborough and North and East Yorkshire Healthcare NHS Trust. Table 3 demonstrates that each Trust apart from Scarborough and North and East Yorkshire Healthcare NHS Trust fulfilled the NMC recommendation of at least 1:15 supervisor to midwife ratio. This has since been addressed by new appointees at Scarborough and North and East Yorkshire Healthcare NHS Trust following the supervisory crisis after the resignation of several supervisors who were moving to other employment or retiring. 3. Details of how midwives are provided with continuous access to a supervisor of midwives. As previously stated, Table 3 demonstrates that 9 out of ten Trust fulfilled the NMC recommendation of 1:15 supervisor to midwife ratio. Kirby s 2004 national audit of supervision, demonstrated that this LSA has a higher than national proportion of supervisors of midwives at F and G grade than supervisors of midwives at H and I grades 73%:27% (52.1% : 39.2%) and they are very experienced and on the whole therefore, an aging group, with the average time from midwifery qualification to becoming a supervisor being years in this LSA, with the national average being years. Succession planning for supervisors should continue then, to be priority for Trusts and will be an LSA priority. All midwives are given a choice of supervisor in the LSA. The most common process used is to invite midwives to select approximately three supervisors from the full list of supervisors working in the Trust. This usually guarantees every midwife having a supervisor of her choice and also allows even caseloads for the supervisors. New starters are normally assigned a supervisor initially and then invited to choose a new supervisor or keep the one they were allocated after the six-month orientation period. The supervisors provide their personal contact details for ad hoc contact, as well as arranging a formal meeting every year for the supervisory review. All Trusts in the LSA provide 24-hour on-call cover by supervisors of midwives for contacting a supervisor when the named supervisor is off duty or in the event of an incident or concerns about a practice issue. The on-call rota is kept in a central point and available to all midwives and independent midwives working in the area. A booklet containing the above information about supervision is provided for each midwife on appointment. It is also repeated within the supervisory review documentation. During this report year these systems were audited at the LSA annual audit visits to Trusts, with no issues identified. 10 4. Details of how the practice of midwifery is supervised 4.1 Annual monitoring visits Annual monitoring visits provide the LSAMO with the opportunity to ensure that all midwives have their practice supervised by the supervisors of midwives in their Trust. For all but Scarborough and North and East Yorkshire Healthcare NHS Trust, there was no suggestion that adequate supervision was not being carried out on a daily basis. This was generally done through supervisors of midwives working alongside colleagues in the clinical areas, as well as through the annual supervisory reviews. At the 2004/05 LSA audit visit to Scarborough and North and East Yorkshire Healthcare NHS Trust, the small supervisory team was described as of low morale and enthusiasm, but at this audit visit they were motivated and keen to find their supervisory focus again. This was hopefully achieved at a supervisory time out session that I was pleased to be involved with and in view of their impending increased numbers. A LSA review of midwifery practice Scarborough and North and East Yorkshire Healthcare NHS Trust had been done in 2005, but the authors concerns had been addressed. One major concern that I have is that I could not identify in which forum and by who, outcome statistics and activity are examined and justified or further actions taken to rectify any practice issues that come to light. This is being monitored and I am due to re-visit the Trust again in September. 4.2 Supervisory reviews The new notifications of intention to practise forms (ITPs) continued to focus the minds of the few midwives who had not had a supervisory review in recent times. A recent review is a requirement so that each supervisor of midwives can sign the ITP to say that the midwives on her caseload have achieved PREP requirements. Supervisors are responsible for checking the registration status for midwives on their caseload and the LSA does it on an ad hoc basis. No lapses of registration were notified to the LSA office in this report year. The majority of midwives had received their annual supervisory review during the year, providing them with an opportunity to reflect on practice and to consider goals and objectives for the future. Letters were sent from the LSA to 27 midwives who had not recorded a supervisory review date after December 2004 on their ITP, reminding them of their responsibility to seek one, asking them to contact the LSA if they were experiencing difficulties in arranging a supervisory review and to let the LSA know of any extenuating circumstances. LSA data was returned to Trusts via the Contact Supervisor (see Table 4). 11 Table 4: Analysis of out of date supervisory reviews within West Yorkshire LSA noted on 2006/07 Intention to Practise forms (ITPs) Trust Number of ITPs submitted Number of out of date supervisory reviews % Harrogate Hull & East Yorkshire Northern Lincolnshire and Goole Scarborough and North East Yorkshire York The LSAMO has a small personal caseload of supervisees and annual supervisory reviews were compl
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