The NHS has hit a critical point. Because of inevitable cut-backs on spending, value for money has become a top priority for all trusts. The King’s Fund (2011) recently published a report on the future of leadership and management in the NHS. One of the main findings was that no assessment of the future needs of the NHS has been made, yet the government has imposed a 45% cut in NHS management posts and a 33% cut in administration costs. This will inevitably affect midwifery management.
The report also advises that the biggest weakness in the NHS is the failure to engage clinicians in management and leadership. In an attempt to bridge this gap, the Chelsea and Westminster NHS Foundation Trust has introduced a programme for all senior band 7 midwifery clinicians.
When considering threats to services, band 7 midwives are seen on paper as an expensive option – especially when maternity will need so many. Often there will be a bulk of senior band 7 midwives on a labour ward – ward leads, community leads and specialists – with each hospital deciding which posts they need and how many, within their budget.
The key is value for money and ensuring that band 7 midwives are fulfilling their roles under their job descriptions and/or job plans. Johnson and Dale (2011) believe many midwives in leadership roles feel that they have had little training or support, and that many end up in their leadership role by default.
At the Chelsea and Westminster, it was realised that there was a potential gap in knowledge among the band 7 midwives. With an ultimate reduction in management posts looming, an action plan was put in place to ensure all had adequate training in management and leadership.
A project lead was appointed for three days per week on a six-month fixed-term contract to manage the project. A gap analysis was conducted, training needs were identified and plans put into place for delivering the training to midwives.
All senior midwives were sent a questionnaire asking both clinical and management/leadership questions. The results were very clear – the majority felt confident in their clinical ability, but over 90% of the band 7s did not feel confident or sufficiently trained in the management and leadership aspects of their roles. They highlighted sickness and change management, HR procedures, dealing with complaints and being an effective leader as some of the main areas in which they felt they would like additional training. Many also believed they had not been given sufficient time to be able to fulfil the management aspect of their role.
This is not surprising. Many clinical NHS staff are promoted but frequently no extra training is offered to support the role’s managerial side. What is surprising is that this is overlooked. Band 7s are often the most senior people on duty, resulting in many left in difficult situations, unclear what action they can take.
The results of the questionnaire were compiled in a report and published (Cross, 2010). A knowledge gap in terms of management and leadership was identified and staff recognised this gap too. This was an excellent starting point from which to introduce the additional training; both managers and midwives were in full support.
Delivering the trainingRecruiting external trainers was considered, but within the Chelsea and Westminster, there was a wealth of experience that would cover all areas. All senior staff contacted were happy to provide training.
The head of complaints ran a workshop in which complaints were reviewed and responses written by the midwives. Surprisingly this was the first time that many had seen a complaint, because they were usually dealt with by matrons and administrative managers. The importance of dealing with complaints at the time they are made was highlighted, as well as the role senior midwives can play in reducing them.
The HR department provided training and workshops in sickness and performance management, appraisals and general HR issues.
The lead for risk and governance provided training on risk management. Senior midwives worked through cases using route cause analysis and attended a workshop on investigating completed risk forms, grading and the actions to be taken.
In order to illustrate the gap between senior midwives and senior nurses, the ward sister from the gynaecology department presented her roles and responsibilities – many staff believed she was working at a higher level than the remit of band 7.
The head of midwifery, managers and matrons provided training on such topics as motivating staff, team-working, political agenda, report writing, how services are funded and examples of service changes.
The feedback has been positive and requests for ongoing training have been made. Some staff have viewed the training more positively than others. Surprisingly some staff still believe it is not their role to be a manager and leader. It has been argued that leading a shift on a daily basis fulfils the job role – without doubt, managing a busy unit, labour ward or clinical area is demanding and highly stressful. However, there is a much bigger picture of the NHS that needs to be understood and contributed to, and it is this element that the Chelsea and Westminster committed to develop in staff at this level.
Following the training, with the exception of the specialist midwives, all senior midwives have been allocated management time. To ensure they can fulfil this aspect of their role, they work alongside the matron of their area who provides guidance and support where needed.
Additionally, all midwives have been asked to consider service improvements they can work on either as teams or individually. Currently 15 ideas have been put forward, ranging from development of support workers, setting up an email link for women to have direct access for non-urgent advice, a review of antenatal services to reduce admissions, to setting up a triage/day assessment area in the private maternity wing.
A change in attitude and understanding has clearly been seen. However, giving the staff training does not mean they will use it and some staff have found this aspect of their role more difficult than others.
The overall success cannot be evaluated fully as it will take time for staff to adapt to the change in their roles. However, initial feedback is positive and the training is addressing an area that is clearly lacking across the NHS.
References
Cross C. (2010)
Chelsea and Westminster NHS Foundation Hospital senior (Band 7) training and development for maternity services report. Chelsea and Westminster NHS Foundation Hospital: London.
Johnson G, Dale P. (2011) Leading the way.
Midwives 14(3): 40-1.
The King’s Fund. (2011)
The future of leadership and management in the NHS: no more heroes. The King’s Fund: London. See:
http://www.kingsfund.org.uk/publications/nhs_leadership.html (accessed 14 November 2011).
