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New maternity staffing guidance consultation launched

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NHS trusts must set realistic midwifery staffing levels that take account of holidays, sickness and time needed for training, according to the latest piece of guidance on safe staffing in maternity.

The draft guidance from NHS Improvement also urges providers to ensure flexible working patterns in order to boost retention of experienced midwives and encourages “succession planning” for heads of midwifery and other senior roles.

”The current climate is challenging in many ways. Increasing acuity of births and the lack of availability of maternity staff…are significant issues”

NHS Improvement guidance 

The document, which was developed with input from a range of professionals including midwives, and service users, acknowledges the “many workforce challenges” in maternity settings and states staffing levels “may need to increase” to cope with more complex cases that need specialist input.

“The current climate is challenging in many ways. Increasing acuity of births and the lack of availability of maternity staff reported by the Royal Colleges are significant issues for many units,” states the document.

“Maternity leaders recognise that modernising maternity services will require new ways of working to support midwives and obstetricians, anaesthetists and neonatologists, as well as ensuring that staffing numbers are adequate and appropriate.

“Commissioners, providers and higher education institutions need to work together in designing and redesigning the current and future workforce,” it adds.

When it comes to midwife staffing levels, maternity bosses should follow guidelines drawn up by the National Institute for Health and Care and Excellence (NICE).

”You should follow NICE guideline NG4 (2015) for midwives. This guideline makes recommendations…based on the best available evidence”

NHS Improvement guidance

“You should follow NICE guideline NG4 (2015) for midwives,” the guidance states. “This guideline makes recommendations on safe midwifery staffing requirements for maternity settings, based on the best available evidence.”

It says those responsible and accountable for staffing maternity services “should take NICE’s guidance fully into account”.

“However, it does not override the need for, and importance of, using professional judgement to make decisions appropriate to the circumstances,” adds the NHSI guideline.

The guidance also makes recommendations for other staff groups, including maternity support workers.

While such roles “are integral to the maternity team”, they should not be seen as a substitute for trained midwives, it stresses.

“The key principle in incorporating maternity support workers in the workforce skill mix is to use them to complement rather than substitute for midwives,” it states.

Employers must ensure support workers receive accredited training and that training matches the type of setting where they are working.

“It is important to set a realistic, accurate uplift since an underestimate may not meet day-to-day staffing requirements”

NHS Improvement guidance

“In a ‘high risk’ labour ward, support workers may need further training – for example, for ‘scrub’ roles in obstetric theatre,” says the guidance.

The document reiterates previous advice to trusts that staffing levels should be reviewed at least once every six month using “systematic evidence-based workforce planning tools to assess the total multi-professional staffing requirements (number and skill mix) for their maternity services”.

When it comes to setting maternity establishments it is clear these must include sufficient “uplift” to manage planned and unplanned leave for all staff.

“It is important to set a realistic, accurate uplift since an underestimate may not meet day-to-day staffing requirements,” says the guidance.

“A consequence could be unexpected, unfunded over-reliance on temporary staff,” it adds.

Staffing establishments must also allow for staff to be released to undertake required training and development, the guidance adds.

An appendix to the guide includes a list of key maternity staffing indicators that trusts should use to collect data to inform their staffing reviews and judgements.

“The purpose of this resource is to help providers of NHS-commissioned services, boards and executive directors to support their lead maternity professionals”

NHS Improvement guidance

These include patient experience measures and staff reported data such as missed breaks, overtime working, sickness and staff morale.

The guidance urges NHS organisations to take account of the age profile of their staff and “consider flexible working” and ways to retain staff of retirement age “to ensure valuable skills are not lost early”.

“The purpose of this resource is to help providers of NHS-commissioned services, boards and executive directors to support their lead maternity professionals in implementing safe staffing for maternity settings,” said the regulator.

As well as drawing on the NICE guidance, it builds on other standards and recommendations from the Royal College of Midwives, Royal College of Obstetrics and Gynaecology, Royal College of Anaesthetists and the Care Quality Commission.

When using the resource, midwifery leads should also refer to safe staffing guidance developed by the National Quality Board, said NHS Improvement.

A consultation on the draft document closes on August 11. Midwives and others are being encouraged to complete an online survey.

 

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