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Birthrate Plus

Birthrate Plus. More than just a number. What is it and who can use it?. National tool that for any given maternity service calculates the number of clinically active midwives required to deliver a safe high quality service

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Birthrate Plus

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  1. Birthrate Plus More than just a number

  2. What is it and who can use it? • National tool that for any given maternity service calculates the number of clinically active midwives required to deliver a safe high quality service • Individual trusts use it to determine their own staffing needs (individual ratio) • Regions or areas use it for workforce planning, commissioning student numbers (aggregate ratio) • National orgs (DH, RCM) use it to make broad statements about supply and demand (overall ratio)

  3. So simply? Number of births _______________ Number of midwives

  4. 1.Using BR+ in an individual unit • Quantify all activity – how many births, how much antenatal care/postnatal care, how many home births how much additional work: inductions, women not in established labour • Distinguish work involved – 5 point categorisation from normal/healthy “simple” maternity care to high risk/complex high degree of support and intervention • Collect data over agreed period usually 4/6 months • Data analysis makes allowance for time lost (travel, sickness, leave etc)

  5. Translating labour ward workload into midwifery hours

  6. Example: St Anywhere Trust – 5,200 Women: Labour Ward Workload

  7. Assessing staffing needs in all other aspects of midwifery care • Hospital: antenatal clinics, antenatal admissions, triage, day care postnatal inpatient stays • Community: antenatal care, parentcraft education, postnatal care • Methodology: Expert Group/Professional Judgement

  8. Example: St Anywhere’s community workload for 5200 deliveries

  9. Example: St Anywhere’s additional hospital workload

  10. What’s in & out

  11. Result: An individual ratio • Ratio is expressed as midwife to births • Could be anywhere in the range 1:27 – 1:32 THIS IS ONLY CLINICAL MIDWIVES • Depending on • Split between high/low risk women • Amount of time given to travel and other variables • Cross border activity ie antenatal/ postnatal care to women not counted as births

  12. Local decisions using ratio • How many additional non-clinical midwives (usually between 8-10%) • How many midwives can be replaced by MSWs (usually between 10-15%) • How to deploy midwives – staffing and service models THIS WILL DETERMINE HOW MANY ACTUAL MIDWIVES ARE EMPLOYED

  13. 2. Using BR+ at a regional/planning level – desk top exercise • For hospital activity only • Tertiary services 1:38 • DGH with >50% in cat IV & V 1:42 • DGH with <50% in cat IV & V 1:45 • Homebirths & MLUs 1:35 • For community activity only • Antenatal/postnatal 1:96

  14. Example: Smallcity Trust Wengerville Trust is a medium size obstetric unit with a small free standing midwifery unit. There is a neighbouring Trust nearby and in consequence there is some cross border movement of women

  15. Calculating Staffing Using Differentiated Ratios

  16. How do you express that? • 191.41 wte is a ratio of 1:27.8 across all BIRTHS • In the OU the ratio is 1:28.3 across BIRTHS but 1:28.5 across all activity • In the FMU the ratio is 1:21.5 across BIRTHS but 1:55 across all activity The amount of antenatal/postnatal care is a significant part of the story

  17. Planning midwife numbers • Desk top review easily identifies number of midwives required in each trust • More robust than simply applying 1 national ratio • Local decisions about management time and MSWs • Compare requirements with actual staff in post • Develop plans for moving from here to there • Factor in vacancy rates, retirement predications, local churn • Determine number of student midwife commissions required to move from here to there

  18. Safety when BR+ is not met? • How many women get 1 to 1 care in labour? • What % of women are booked by 10/40? • What degree of continuity do women receive antenatally and postnatally? • Is there a supernumerary ward coordinator on every shift? • What specialist roles are funded? • How many non-clinical midwifery roles are funded? • What are levels of vacancy, turn-over, staff morale and sickness?

  19. 3. Using BR+ at a national level ASSUMPTIONS? • Average ratio around the country 1:29.5 • Birth rate in England around 700,000 • Around 96% births in OU • Around 8% additional non-clinical midwives required • Around 10-15% of clinical midwifery posts can be replaced by MSWs

  20. Translates into ?

  21. Issues going forward • National overall ratio changes over time • Are we going with 1:28, 1;29, 1:29.5? • Professional consensus on time for community activity probably needs review • Professional consensus on MSW time definitely needs review • How do we draw attention to the implications of NOT staffing at BR+ recommended ratio? • As birth rate goes down will need for midwives? • Not if you take into account increasing complexity

  22. Download a copy of the tool http://www.rcm.org.uk/college/policy-practice/joint-statements-and-reports/

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