Promoting, Influencing and Supporting on behalf of our members around Continuity of Carer

By Mary Ross-Davie, Dircetor of Scotland and Kate Brintworth, Head of Maternity Transformation on 10 July 2019 Midwifery Continuity of Carer - MCOC Maternity Services RCM i-Learn

This week we have seen the publishing of figures that show that 17.3% of women in England are now being booked onto a care pathway that should ensure they receive continuity of carer throughout pregnancy, whilst giving birth and in the postnatal period. This is a massive change from early 2018 when the figures showed that only 2% of women were receiving this type of care.

Similarly in Scotland, which started on this journey a year later, the five early adopter boards have made huge steps forward with setting up continuity teams. One Health Board is already providing a continuity pathway to the majority of the women in their care from this summer and between 5% and 10% of women in the other early adopter boards are receiving continuity of carer.

It is a tribute to a lot of hard work and dedication by midwives in all roles in maternity services that they have been able to achieve so much. But we know that this is just the start and that both the English and Scottish Governments are expecting these figures to keep growing and growing, causing a lot of midwives to worry about what happens next. So we thought it would be a good moment to update what the RCM is doing on your behalf in relation to the development of Midwifery continuity of carer.

What is RCM's position on continuity of carer?

As a professional organisation we are committed to promoting safe, high quality maternity services based on good evidence. Added to that, as your Trade Union we are committed to ensuring that any policy takes into account the needs and rights of the staff charged with implementing the change and that changes to service are not to your detriment and that your rights are respected.

We are clear, and have been since the publication of Better Births and Best Start, that safe, successful, sustainable implementation of continuity of carer is only possible if midwives are engaged, consulted, supported, prepared and willing to work in this new way.

To support that, all of the RCM team has been consistently making the case for our members at a national and local level at all of the meetings we are involved in. One of the ways we have done this is to make clear the conditions we believe need to be present for successful implementation to occur:

  • Ring fenced investment in implementation of Midwifery Continuity of Carer (MCOC)
  • Safe levels of midwifery and wider maternity team staffing
  • Flexibility and self management for MCOC midwives and teams
  • Respect for employment and working time regulations
  • Enablement and co production
  • Team working and mutual respect
  • Evaluation (RCM Midwifery Continuity of Carer position statement, November 2018)

Our local workplace representatives are able to use these clear conditions as a starting point to identify the level of readiness in a local area and push for these to be met.

What has the RCM done at a national level?

For our members we have developed educational resources including an online interactive workbook, a suite of powerpoint presentations, an i-learn module and the 'Continuity counts' game. We have produced publications for England and Scotland, called the 'Nuts and Bolts' which detail the Employment relation protections and relevant guidelines that are relevant to MCOC implementation.

We have also provided a series of regional workshops across Scotland and Train the trainer sessions in England. During 2019, we are developing a further range of resources on this topic, including a further I-learn module and a series of factsheets on practical issues around MCOC. We have also provided some workshops on continuity of carer in Wales and Northern Ireland, who are at an earlier stage in thinking about continuity. The aim of all of these resources is to ensure that you, our members, whatever your role, have the information you need to make informed decisions.

We are also speaking on your behalf at the national overarching implementation groups for Maternity Transformation and Best Start in England and Scotland respectively. In England, we also sit on the Continuity of Care Expert Reference Group that directs English policy on MCOC and in Scotland we are represented on the Continuity of Carer and Local Delivery sub group of the Best Start implementation board. At these meetings we are able to raise key questions and challenge assumptions from a professional and trade union perspective in order to shape and steer the process underway.

The feedback that you give us is invaluable in doing this and has enabled us to discuss the realities of your working lives in a range of ways from on call patterns, to pay and work life balance to caseload size. This in turn means that we can then work to ensure that aims and timescales are realistic and that staff needs are properly addressed.

In Scotland, we lobbied successfully for ring fenced funding for implementation and have continued to so, gaining a further commitment to future funding at a Scottish parliament debate on midwifery in May. We have also been successful in our lobbying to continue to increase the number of student midwife training places in Scotland and to support students by maintaining and increasing the bursary. In England we have successfully argued for the Government to address the shortage of midwives, with more student places being created this year, as well as arguing for funding for training and implementation. We want to assure you that we have been working hard to positively influence key aspects of the national strategies on implementation for the benefit of our members.

What is the RCM doing locally?

Our network of national and regional officers and workplace representatives are active on a range of regional and local implementation boards and groups, keeping a watchful eye on implementation processes and ensuring that there is an emphasis on encouraging strong consultation, collaboration and co-production of new models of care with the health professionals charged with providing them.

Our workplace reps are also available for all of our members to discuss individual issues and concerns and offer you advice, support and representation as you need. In Scotland, our workplace reps have set up monthly drop in surgeries from the end of May for members to come and talk through concerns or issues. We are looking to test whether this would be a positive step across England as well. We have also supported local branches to hold Continuity of carer information sessions using the Continuity counts game and the Nuts and Bolts publication and presentation.

We have had success in several local areas in highlighting where processes have not been appropriate and working collaboratively to ensure that change is implemented in a way that is safe and sustainable at the right pace for a local workforce.

Finally, we would really like to encourage you to get as much information as you can about the proposed new models through our resources and by attending any local information meetings that you can. Continuity of carer is a big change for everyone that needs to be done well and in such a way that the changes work for all midwives, wherever and however they work. So, keep reading, listening and talking to us to make sure that we will all be shaping policy so that it is good for women and good for midwives.

If you would like to speak to your local RCM workplace representative about MCOC in your area, please call RCM Connect on 0300 303 0444 or go on to our new RCM website, where you will need to re-register and provide us with up to date contact details when you submit a request for contact.