The Big Conversation: Listen and learn

By Juliette Astrup on 07 March 2018 Midwives RCM Midwives Magazine

Juliette Astrup spoke to RCM CEO Gill Walton on why she is throwing open the door to midwives’ ideas on shaping the future of the profession.

Gill Walton, the new RCM chief executive, has launched ‘The Big Conversation’, an engagement exercise with a difference. With a focus on positivity and possibilities, the RCM is reaching out to every member, calling for their input and ideas to steer the course of the organisation and help shape the future of the profession. 

Being the best you can be

How can ‘OUR RCM’ support you to be the best you can be for women and families? This is the question at the heart of The Big Conversation, a new campaign that aims to put members in the driving seat as the future course of the RCM is set.

It is the brainchild of Gill, who devoted her first 100 days in office to ‘listening, engaging and understanding’ – an experience that inspired the new campaign.

‘The most important thing about the RCM is the members,’ she says. ‘I want to create a feeling of “OUR RCM”. That is the members feeling like part of the whole, and engaging in a different way with each other.’

As well as creating a ‘sense of belonging’, she hopes The Big Conversation will generate key ideas about what could be done differently to empower members to support each other, to advocate for women, to influence locally and to share best practice.

She adds: ‘It’s not about what you want the RCM staff to do for you – it’s how the RCM can support you in practice, in education, in research, in all the places midwives and MSWs work. It’s a different approach – really putting members in charge.’

What exactly is The Big Conversation?

Launched on 1 March, The Big Conversation will continue until the end of May, during which time members will be asked to respond to five questions (see below), and encouraged to put forward their own ideas and suggestions as well.

1 If you were CEO, what three things would you focus on and why?

2 How can we help you strengthen your professional networks?

3 How could professional relationships be improved locally?

4 What do you think we could all do together to improve the voice of maternity care?

5 What can our RCM do to keep your passion for maternity services alive? 

Take part in the survey at It is also available on postcards at all RCM visits and events across the four nations, throughout the three-month campaign period.

Expect to hear about The Big Conversation everywhere, from service visits and branch meetings, to training and development days, residential study days, and through student midwives’ forums, student midwifery societies and RCM networks. It will also be discussed at national and regional HoM meetings.

In addition, the RCM’s senior team will be organising specific Big Conversation events, and members will be kept in touch with weekly updates through social media, email and the RCM website.

Why now?

As well as coinciding with the tenure of a new chief executive, a natural period for renewal, The Big Conversation is taking place at a time of intense pressure on maternity services.

While the birth rate in England and Wales, which had been rising steadily for years, has now stabilised, the trend towards older mothers with more complex health conditions has continued (Kelly and Lee, 2017). Scotland’s birth rate is the lowest in the UK (National Records of Scotland, 2016), and around a fifth of children born in Northern Ireland have mothers over 35 (Northern Ireland Statistics and Research Agency, 2017).

Midwives and MSWs are being overstretched in the face of staff shortages and a recruitment and retention crisis: the latest figures show more midwives and nurses are now leaving the profession than joining it, with many citing working conditions as the reason (NMC, 2017).

The RCM’s 2016 Caring for You survey also reflected a troubling picture of the impact these increased demands are having on the health, safety and wellbeing of midwives and MSWs. Members reported feeling stressed, burnt out and unable to give high-quality care to women and their families (RCM, 2016).

In last year’s RCM members’ pay survey, over 60% of respondents said that they were considering leaving the service in the next one to two years (RCM, 2017).

Gill, who launched The Big Conversation with a video message, says: ‘Working in maternity services is rewarding, but it is also very hard work, and working in the NHS at the moment is particularly difficult.

‘We really need a resilient and supportive workforce that keeps on delivering brilliant services for women and families – that’s what’s in our hearts, that’s our passion.

‘The question is how do we support each other so that we don’t want to leave? So that the profession is somewhere we want to stay?

‘The RCM absolutely has a responsibility to influence government policy about pay and about workforce numbers – that is part of our job and we will keep doing that.

‘We also have to support the resilience of the workforce, so that they want to continue in maternity services. We will work together to do that, and offer our support.’

Maternity transformation 

It is also a time of great change, with sustainability and transformation plans redesigning NHS services across England, and new five-year plans – Better births in England and Best start in Scotland – driving through change in maternity services.

‘It’s a good time to think about how we make maternity services safe and improve maternity provision,’ says Gill. ‘And to think about changing the way we work. We can’t do that from the top down – we can only do that with all the members supporting each other locally.’

Gill believes midwives have a key leadership role to play in this transition phase of maternity services across the UK.

‘Nobody else is going to do it – it will be midwives, and it needs to be – they are the advocates for women,’ she says.

‘That’s one of the reasons we are having this conversation now – we want “OUR RCM” to come together, to talk about how we are going to do this. What support and help is needed? How do we share best practice? How do we make it happen in the best way possible?

‘We want ideas about the best ways to help people do that locally.’

Building on history

While The Big Conversation is focused squarely on the future, it doesn’t disregard the RCM’s past, which is highly valued by members.

A survey, commissioned at the end of 2016 to test members’ attitudes to the RCM and its work, showed satisfaction rates had gone up – with the RCM scoring highest in terms of its research, best practice and influencing opinions on childbirth (Skewes, 2017). 

But it was seen as less effective in influencing government and NHS policy, and in national negotiations – something identified as a top priority by 61% of respondents.

‘There are a lot of things we are doing well. We want to build on that,’ says Gill. ‘It’s not about starting again – we are good already – it’s asking how do we become the best we can be? How do we become future-focused?’

She is also keen to build on the success of the Caring for You campaign, which was driven at a local level by RCM health and safety representatives and HoMs working with staff to develop and implement local action plans on health, safety and wellbeing issues (see box, left).

‘What was great about the Caring for You campaign was the engagement – going out into branches and bringing together RCM members with local initiatives to support each other,’ says Gill.

‘It had a health and safety focus, whereas The Big Conversation has a professional focus, but the ethos is the same – how can we help you help yourselves?’

Who should get involved?

In short, everyone, says Gill. ‘This is UK-wide. It is just as important to hear from members in the Outer Hebrides as members in London. It is my ambition to reach every single member – and beyond that, to reach those midwives and MSWs who are considering membership.

‘MSWs are a really important part of the maternity team, and we want to engage with them just as much as with midwives.’

The RCM of the future

So, what might the outcomes be – and what difference could they make?

‘It really is a blank sheet of paper,’ says Gill. ‘We want to listen to what people are saying, with no preconceived ideas at all. You won’t be getting a complicated survey – it’s much freer than that. A survey is all about the past – we’d rather get people to think about the future and what that might look like.’

But, without wishing to pre-empt the direction The Big Conversation might take, Gill hopes it can bring midwives together, and unlock their collective potential.

‘We want to create that sense of cohesion, that sense of belonging, that excitement, passion and resilience,’ she says. ‘We want to demonstrate that the RCM is listening, we are future-focused, it’s an exciting organisation to be part of. That’s what we want people to feel.

‘If every single member feels like they are the RCM, that has so much power,’ she adds. ‘If local support networks develop – maybe across systems, not just local maternity services – sharing good practice, supporting and collaborating, that could be really powerful.’

She adds: ‘We want to know what the key things are that members would like us to influence. And how can we support them to influence locally?

‘Whether you are talking to local chief executives or Jeremy Hunt, if we are all saying the same thing, there is a consistent message.

‘If you have that clarity, you have strength through the whole of the RCM, and therefore through maternity services.’

What happens next?

The outputs from The Big Conversation will underpin the next steps for the RCM.

When it meets in July, the RCM board will consider all the information and feedback from the campaign, using it to create a five-year strategic plan, which it will then monitor and oversee to ensure those ambitions come to fruition.

Julie Richards, chair of the RCM board, says:
‘Members are at the heart of decision-making for the profession and for the organisation. It’s very important that our RCM vision and priorities are informed by hearing from them.

‘Looking forward, I would like each member to know what the strategic vision of “OUR RCM” is, and what progress we are making towards achieving those objectives.

‘Also, from a woman’s point of view, I would like them to be able to see the very clear difference that the strategy is making to the quality of services for them and their families.

‘This is a golden opportunity for members to put forward what they think makes the RCM strong, and what needs to be done to promote, support and inform good-quality maternity services.

‘It’s a real chance for members to be very much part of the RCM – “OUR RCM”.’

How can our RCM support you to be the best you can be for women and families?

17% More than one in six midwives were working at least five hours overtime unpaid every week.

48% Almost half of RCM members said they felt stressed every day or most days. The most common reasons for stress were workload, staff shortages and not enough time to do their job.

62% of RCM members delay using the toilet at work because they don’t have time.

18% of RCM members strongly agree with the statement ‘I often cry at work because of the pressure I am under.’

50% of RCM members strongly agree with the statement ‘I am worried about making a mistake at work because I am exhausted’.

21% of RCM members said they take their entitled breaks most or all of the time.

(RCM, 2016)

Get involved

Who? All 47,000 RCM members

Why? To shape a positive future for the RCM and for yourselves

How? Complete the survey online at, keep in touch across social media and join the conversation at events across the UK

When? The Big Conversation launched on 1 March and will continue until the end of May


Kelly E, Lee T. (2017) Under pressure? NHS maternity services in England. Institute for Fiscal Studies. See: (accessed 5 February 2018).

National Records of Scotland. (2016) Vital events reference tables. Section 3: births. See: 5 February 2018).

Northern Ireland Statistics and Research Agency. (2017) Registrar General Northern Ireland annual report 2016. See: (accessed 5 February 2017).

NMC. (2017) The NMC register. See: (accessed 29 January 2018).

RCM. (2017) Evidence to the NHS Pay Review Body. See: (accessed 29 January 2017).

RCM. (2016a) Caring for You campaign: survey results. See: (accessed 29 January 2018).

Skewes J. (2017) What members want. Midwives Autumn: 49.