One-to-one with Jacqui Williams

By Julie Griffiths on 23 November 2018 Midwives Magazine

Before the NMC undertakes a radical overhaul of education standards, it is carrying out a consultation to help determine which up-to-date knowledge, skills and attributes the midwife of the future will need. Midwives speaks to Jacqui Williams, senior midwifery advisor at the NMC, about why it is vital that midwives’ voices are heard.

Almost a decade on from the publication of its current standards, the NMC, as part of a wider programme of work, is developing new standards of proficiency for the future graduate midwife.

‘We are trying to future-proof, so we are thinking about what the midwife needs by 2030’

The NMC, with internationally respected academic Mary Renfrew appointed to lead the work, is seeking the views of midwives, women and their families, educators, students, advocacy groups and others on what the new standards should include to help midwives provide the best care in a rapidly changing environment.

Time for change

The increased complex needs of women, newborns and families, new government policies, transformation programmes, a developing evidence base, and the shifting needs and expectations of women and families all impact on the role of the midwife, and there is much to take into account.

‘The approved education institutions (AEIs) that provide midwifery programmes have already gone over and above the current standards in terms of their content,’ explains Jacqui, herself a former midwifery lecturer at the University of Nottingham, where she was lead midwife and programme director. ‘We recognise that the current standards are lacking, and the needs of women, babies and families have exceeded the demands of the current standard.’

But the new standards are not just about catching up, she adds: ‘We are not just thinking about what a midwife will need in five years’ time. We are trying to future-proof, so we are thinking about what the midwife needs by 2030.’

Early engagement and research began in August last year, and there has already been extensive consultation work, with workshops held across the four nations, webinar events, and the formation of a diverse virtual thought-leadership group, as well as expert input from the NMC midwifery panel.

‘We’ve spoken to more than 600 people,’ says Jacqui. ‘We’ve talked to midwives of all experience, from newly qualified right through to midwives who are nearing retirement – we are really trying to get their voices heard and learn what they think the future midwife needs at the point of registration.’

All about Jacqui

  • Qualified: Jacqui qualified as a state registered nurse in 1979, and as a midwife two years later.
  • Diverse career: She served as a midwife with the Princess Mary’s Royal Air Force Nursing Service and was a midwife and educator in Saudi Arabia.
  • Educational work: She was senior lecturer at De Montfort University and associate professor at the University of Nottingham, and is an associate lecturer with the Open University.

Emerging themes

‘There are several common themes we are hearing about during our events,’ adds Jacqui. ‘We’ve had conversations about perinatal mental health, about working as part of an interdisciplinary team, about communication, and about continuity of carer.

‘I don’t think the emerging themes have been terribly surprising. As an educator, I think we have recognised the changing landscape of midwifery, which students need to be prepared for, but it’s good to have been validated.’

The increased complex needs of women, newborns and families is another theme raised through the consultation, says Jacqui. ‘But what has come out is that it is not so much about medical conditions, but more around support for women with complex social needs – women living in poverty or facing challenging social situations. Programmes definitely need to strengthen in that area and all our stakeholders are in agreement on that,’ she adds.

And maternity transformation programmes taking place across the nations will also have an inevitable impact on the new standards.

‘We are thinking about the skills midwives will need to work in these new environments, and the new ways of working, which is why continuity of carer is coming through loud and clear,’ says Jacqui. ‘Students need to be prepared in their midwifery undergraduate programmes for working in those sorts of ways, and while case-holding approaches are already included, that might need to be strengthened.’

In particular, as maternity services transition, continuity-of-carer models will need to ‘feature quite strongly’ in undergraduate programmes, says Jacqui, until those new ways of working are embedded in practice.

The NMC is also consulting with a range of other professional groups, and crucially with women and families. One of the areas women focus on is the softer skills, adds Jacqui. ‘They want midwives to be kind, to be honest, and they want to be supported through their experience. Those values and attributes are as important to them as the other skills and knowledge, and they will be in there for certain.’

Midwives of the future will also need to have an understanding of areas such as self-care and leadership, their role as a coordinator of care, advocate for women and families, and communication skills, she adds.

‘There’s a lot of discussion around how much we can expect these students to receive as part of their pre-registration programme. They can’t possibly be the finished article, and there need to be areas of development as they move into different specialist roles, but there is a range of skills they can be introduced to, to build on after they qualify.’

New directions

It is a real opportunity to have a voice on the future of the profession and the standards required for midwives at registration

Jacqui also makes the point that the new standards will be based around the framework for quality maternal and newborn care developed in The Lancet series on midwifery. It recognises that high-quality midwifery care is always needed, even in situations where other forms of care are needed as well.

‘All women fundamentally need midwifery care,’ says Jacqui. ‘While some women will need more care and support from an interprofessional team, midwives will still continue to coordinate that, and none of that midwifery care will be lost for women with more complex needs. That’s exciting, and it really raises the profile of what a midwife is and what they do.’

And, in keeping with Standards framework for nursing and midwifery education and Standards for student supervision and assessment, released in May, the new standards will also reflect the NMC’s underlying shift from a prescriptive, process-based approach to a focus on outcomes.

‘That will give AEIs the opportunity to develop and innovate,' says Jacqui. ‘Programmes could be quite different across the UK, as long as the midwives at the point of registration meet that same outcome. That is a new direction for the NMC, and that can feel scary, but a lot of people are embracing it and excited about the possibilities.’

Midwives’ voices

The next step in the process is to complete the draft standards, followed by a formal consultation in February next year. An external company will be hosting the online consultation and supporting with analysis, but the NMC will be engaging widely and encouraging feedback throughout with workshops, digital engagement and specific work with women, families and the public.

Midwives’ views are being taken very seriously across the organisation, says Jacqui, and she is calling for as many as possible to contribute.

‘This is not just the NMC developing and publishing standards, it is a much wider approach,’ she adds. ‘It is a real opportunity for people, whatever their interest in women and families and maternity services, to have a voice on the future of the profession and the standards required for midwives at the point of registration.

‘It’s a very exciting time to be involved, and the more views we have, the more themes we are beginning to see emerge, which gets us working in the right direction.’ The final standards will be published in 2020.

The engagement project: fast facts

  • Engaged 600+ people
  • Thirteen workshops across the UK – mainly with clinical midwives and midwifery educators – in Manchester, Belfast, London, Cardiff, Antrim, Edinburgh, Glasgow, Swansea and Birmingham
  • Nine small focus groups – two in Cardiff, two in Belfast, one in York, one in Manchester, and three in London
  • A roundtable with multidisciplinary health and social care professionals
  • Conversations with advocacy groups – including Rethink Mental Illness, the NSPCC and Women’s Aid
  • Meetings with professional associations and representative bodies
  • Nine thought-leadership group meetings
  • Five virtual thought-leadership group webinars.