Shaping the North East and North Cumbria Maternity and Neonatal Services

Final Report from our coproduction event on 10 May 2023 at Durham County Cricket Club, Chester-le-Street, Durham

Download PDF version of THE report

1. In Essence

On 10 May 2023, the Local Maternity and Neonatal System (LMNS) for North East and North Cumbria held a multi-stakeholder, co-production workshop to shape the future of services across our system geography.

The key output is a starting point in developing a shared vision of future services and ways of working together, that are fundamentally better than now, bringing benefit: to our people, women, babies and families; to our current and future staff; and to our organisations and wider system.  We need to continue to develop that shared vision, to reach out across all our communities and stakeholders, and to hear every voice so that everyone can contribute to the better future we all wish to create.

Alongside our emerging shared vision, a further output of the workshop is a set of broadly defined key themes that will see us establish a number of collaborative work programmes across our system. These work programmes will likely span a number of years and continue to shape and flex over time so that they remain meaningful at all levels, from front line staff and users of services to place-based services and our wider system.

Our work here will be core to our immediate response to the Three Year Delivery Plan for Maternity and Neonatal Services and indeed will go beyond it, planting our thinking, leadership, partnership working, effort and decision-making firmly into our long term, sustainable and better future.

What lies ahead is a tremendously exciting challenge for everyone, in every area and community, at every level of our service and every level of our system – at times the journey may prove difficult, at times it may be uncertain but if our workshop on 10 May 2023 demonstrated anything, it is that by working together we are far stronger, far more knowledgeable, far more resourceful and far better positioned to deliver a better future for us all.

2. Our Approach

It is worth highlighting the design of the event itself and the approach taken.  It was important that this reflected our values and the collaborative approach we wished to foster, and it was also important that we followed an evidence-based approach so that we might take one more step toward being the ‘best at getting better’. To that end we did two things: we sourced the help of an expert facilitator team[1] and we established a multi-stakeholder design group that together guided and shaped our overall approach. Our approach sought to:

• Get people working together and break down barriers, real or perceived.
• Establish common purpose and the collective interest of all stakeholders.
• Acknowledge the challenges of today without being hamstrung by them, and more so highlighting the many times we have together overcome challenges in the past.
• Focus on developing a shared vision of a fundamentally better future, one that is compelling and so makes sense both logically and emotionally.
• Identify the common, key themes that ‘come out of the page’ when we talk about our future – and to ensure we broadly specify them so that they become more than soundbites.
• Capture and embed in our shared vision and key themes, the many perspectives we collectively hold, recognising the validity of each and ensuring everyone has their fingerprints on our future.
• Recognise the multiplicity of stakeholders and the need to involve them all if we are to realise our goals of co-production and collaboration, setting the tone for distributing leadership across our system.
• Give us a starting point from which to engage further and build enthusiasm and momentum for the changes ahead.
• Use the opportunity provided by the direction set in NHS England’s Three Year Delivery Plan for Maternity and Neonatal Services guidance, but not be constrained by it, ensuring we seize a future that stretches beyond the 3 years and scope of the NHS England plan.

[1] Ian Railton and Laura Woodward of Verandern ltd work extensively across the NHS in England and specialise in quality improvement and large scale change.  Ian was external faculty to NHS England’s Academy of Large Scale Change and Quality Improvement programmes from 2017-2023.

3. Our People

Over 80 people attended the workshop on 10 May, drawn from all areas of our geography, with the range and representation of people attending made as wide as possible; the event was over-subscribed.

In the North East and North Cumbria there are over 25,000 births per year – that is at least 25,000 babies, mothers and family members with a stake in the future of our services.  There will be another 25,000 next year, and the year after.  At the same time there are thousands of people currently working in our LMNS with hundreds of new people joining each and every year – in only 5 years over 25% of the workforce could be different to today.

The point is this: our workshop is only a starting point, a relatively small ‘coalition of the willing’ drawn together to set out and frame their shared view of a better future. The output of the workshop and the collective leadership of the participants will help drive us forward and help us organise our work, but perhaps the biggest and most important part of that will be to turn the enthusiasm of 80 into the mobilisation of many thousands, each with an important role to play in helping determine and realise our better future by engaging and involving themselves in the changes we all need to make.

Representatives in the workshop on 10 May included:

• Maternity Voice Partnerships and Service User Voice Representatives
• Maternity & Neonatal Clinicians and clinical leads
• Students and newly qualified staff
• Neonatal Care Coordinators
• Specialist role clinicians i.e. Professional Midwifery Advocacy, Public Health, Maternal Mental Health, Digital
• Maternity Support Workers
• Heads of midwifery
• Service managers
• Clinical networks and collaboratives
• Maternity Transformation Programme
• Exec and Non-Exec Directors
• Provider Collaborative
• Specialised commissioning

4. Our Outputs

Shared Vision

We divided our 80+ workshop attendees into smaller, multi-perspective groups of 10. Their task was to imagine and discuss what a fundamentally better future for Maternity and Neonatal service across the North East and North Cumbria would look like and draw it.

We asked people to be brave, bold and imaginative in their thinking but also to remain grounded and recognise the reality of the constraints we are operating in. We asked people to go beyond the structural and also articulate what it would feel like, look like and act like from a range of perspectives.  We asked people to think beyond the here and now and route themselves in what it could be, should be like in 5 years’ time.

 

Each group was armed with a large piece of paper and at least one pen per person – so everyone on the table had the opportunity to input into the future vision. The output was 8 images of what could be.

Key Themes

From our 8 visions of the future, our task was now to understand the common, key themes underpinning them so we could create a collective, shared perspective.

Each table was paired up with another and as one table retold their narrative of their future vision, everyone listening noted down the key words or phrases they were hearing, generating 100s of sticky notes in the process.

Each table themed all the key words/phrases captured for their own vision and put them in priority order.

 

 

The facilitation group took the sets of themes from each table and combined them into a single list of common, key themes.

The common key themes:

• Collaboration
• Communication and Language
• Data and Digital
• Equity, Equality and Access
• Personalised Care
• Prevention
• Safety Culture
• Workforce and Training

The issue of finance was discussed on the majority of tables, but it was collectively agreed that this, in its own right, was not a theme.  Rather it was acknowledged that if our work is to be successful, the initiatives and changes would need to be appropriately resourced.

Theme Specification

The final task for our workshop was to produce an outline specification for each of our key themes.  Workshop participants migrated to the theme they had the most interest and enthusiasm for.  Together, each group completed a proforma that considered pertinent questions to guide thinking around their theme:

• What the theme will achieve, its purpose, ambition and outcomes.
• What change is needed to be successful, including change in system behaviours, processes and roles/structures.
• How changes will be organised, the nature of the change and the likely key components of a plan with key risks.
• What resource is required at what intensity in the context of organisations, people and infrastructure.

Taken together the output is the bones of a whole programme specification aligned to enabling the implementation of our vision for a fundamentally better future.

Following the group discussions, the high-level purpose for each of the key themes is summarised below:

• Collaboration to foster and support collaboration across our system so that together we can turn ideas into action, most effectively use our funds, establish meaningful outcomes across services to help realise our shared vision and goals.
• Communication and Language to create the right culture and language of communication that is open, clear, personalised, compassionate and effective.
• Data and Digital to provide consistent collection of digital information that is accessible to providers and users, and to use data to improve safety and learning.
• Equity, Equality and Access to improve access to services to the right people in the right place at the right time, tailored to their needs.
• Personalised Care to improve the overall experience and choice for women.
• Prevention to provide the systematic use of evidence-led intervention to reduce the prevalence and impact of modifiable factors known to increase risk of adverse outcomes through maternity and neonatal journey.
• Safety Culture to ensure service users feel safe and well cared for, and that staff delivering care feel like they can be honest and escalate concerns without fear or prejudice.
• Workforce and Training to provide safe and sustainable staffing – right people, right place, right skills.
  

  5. Our Next Steps

  The enthusiasm and opportunity generated during the workshop must be harnessed and further galvanised so that we might involve more people, attract more support, unleash more energy and opportunity, and build good momentum to carry us forward.  Our immediate steps must be thoughtful and enacted expeditiously.  For this to happen, we have taken the work undertaken by each of the groups and linked it to both the Three Year Delivery Plan for Maternity and Neonatal Services and the developing governance arrangements for the North East and North Cumbria Maternity & Neonatal Alliance and the Local Maternity and Neonatal System.

  To begin with, we have developed a referencing system for the three year delivery plan guidance which has four themes and twelve objectives. We have given a reference number to each of the deliverables listed under the twelve objectives. We will use this referencing system in all our work sothat we can see a clear golden thread between the guidance and the activity led within individual groups.  A copy of the NENC LMNS 2023/24 Deliverables v.03 (Three Year Plan Guidance, themes, objectives and deliverables) can be found in Appendix 1.

  We have then used the work undertaken by each the groups and produced an outline programme of work for each of the 8 themes. Each outline programme of work includes:

• Theme
• What is the purpose of the theme?
• What does, it look like, when it is delivered?
• What is the outcome?
• What has to change?
• What is your plan (including deliverables that link to the three year delivery plan)?
• What might go wrong with the plan?
• What is the nature of the work?
• Summary
• The group, clinical lead, PMO lead, PPV representative responsible for ensuring this work is woven into future North East and North Cumbria work plans.

The 8 outline programmes of work, which can be found in Appendices 2 – 9 of this report, completely reflect what was discussed by each of the groups and no changes have been made to what was scribed on the day.  We have however, attempted to link what was discussed to the deliverables in the three year delivery plan. You will notice that some of the outline programmes of work will need further work to complete all sections of the template.

We have allocated a ‘home’ for each of the 8 outline programmes of work, so that specific groups will be responsible for driving this work forward.  It is acknowledged, that in some instances, the individual groups will have to work with other groups to complete the deliverables identified in the outline programmes of work.  The Themes have been identified as follows:

 

Theme – Outline Programme of Work	Group Responsible for Ensuring this work is completed
Collaboration	North East and North Cumbria Maternity & Neonatal Alliance Board
Communication & language	North East and North Cumbria Maternity & Neonatal Alliance Operational Group
Data & Digital	Data – LMNS Data Quality Task & Finish Group Digital – LMNS Digital Steering Group
Equity, Equality & Access	LMNS Equity & Equality Steering Group
Personalised Care	To be confirmed (to be discussed at LMNS Board, 19 September 2023)
Prevention	Public Health in Prevention Steering Group
Safety Culture	LMNS Quality & Safety Group
Workforce & Training	LMNS Workforce Multi-Disciplinary Steering Group

Our next steps also include:

• Socialising of the report via the implementation of a post event communication plan which will include:
  • Sharing the final report with a wide range of stakeholders such as event participants, HoMs, Clinical Directors (Maternity & Neonatal), LMNS Board, LMNS Subgroups, Northern Neonatal Network, MVP Lead/CoLeads, Service User Voice Representatives, ICB Directors of Nursing, Directors of Place, Commissioners, Maternity & Perinatal Clinical Network etc.
  • Blog content
  • Web information
  • Social media post and artwork – use of videos and clips from the event
  • Event video
• Supporting wider engagement of stakeholders to gain commitment for our emerging programme and ensuring it develops into meaningful change at all levels of our system.
• Progress will be monitored by the North East and North Cumbria Alliance Board via the Alliance Operational Group.

6. In Conclusion

The work we have done together is a starting point in developing a shared vision of future services and ways of working together, that are fundamentally better than now, bringing benefit: to our people, women, babies and families; to our current and future staff; and to our organisations and wider system.

These work programmes will likely span a number of years and continue to shape and flex over time so that they remain meaningful at all levels, from front line staff and users of services to place-based services and our wider system.

As previously stated, what lies ahead is a tremendously exciting challenge for everyone, in every area and community, at every level of our service and every level of our system – at times the journey may prove difficult, at times it may be uncertain but if our workshop on 10 May 2023 demonstrated anything, it is that by working together we are far stronger, far more knowledgeable, far more resourceful and far better positioned to deliver a better future for us all.

Document reference: 230714 NENC LMNS 3year Plan workshop final report v.01

 

Appendix 1       NENC LMNS 2023/24 Deliverables v.03 (Three Year Plan Guidance, themes, objectives and deliverables)

Appendix 2       Collaboration Outline Programme of Work

Appendix 3       Communication and Language

Appendix 4       Data and Digital Outline Programme of Work

Appendix 5        Equity, Equality & Access

Appendix 6       Personalised Care

Appendix 7       Prevention

Appendix 8       Safety Culture

Appendix 9       Workforce & Training

 

To view the Appendix items and the full report, please click here: Final Report: Shaping the North East and North Cumbria Maternity And Neonatal Services