 And I want to introduce and welcome everybody to this session that's going to be presented by Jillian Adji today. She's joining us from the Royal College of Midwives and her campaign and her research is really interesting, looking at listening really to the voices of midwives. So I'm going to go ahead and hand the presentation over to you, Jillian. We're going to take questions as we go, but we'll answer them at the end. So feel free to type them in. Hello everybody and happy International Day of the Midwives. I'm absolutely delighted to be doing this presentation for everybody. I've worked for the RCM since 2006. I am a midwife. I was a clinical midwife for nearly 25 years in Sheffield. That's where I practice. And I supported midwives when I joined the Royal College of Midwives as a regional officer. And I now manage a team of regional officers across the north of England. I led on this campaign caring for you for the Royal College of Midwives from 2016 to the end of last year. And it was a really important campaign for us. We knew that our members were complaining of feeling stressed in the workplace, not being able to get a break, etc. Or even have a drink while they were at work because of the increasing workload. So we did feel that we needed to raise the importance of the health and well-being of our members. And I suppose it really started to hit home when we were campaigning for better pay in 2014 when midwives were telling us how bad they were feeling. So the campaign caring for you, as it says there, was to improve off the members health safety and well-being at work so that they were able to provide high quality maternity care for the women and their families. And I think we know that supportive and open workplaces benefit both staff and service users. There's lots of research around if you feel happy and motivated, you feel well supported at work, then you perform much better, you're confident, you're in good health and obviously good health, safety and well-being. Underpins all of that. And clearly an investment in staff is an investment in the care for women and families. We know that the NHS budget is primarily spent on staff, so it's really important that staff are well cared for, but it's also very important that those staff are well and are at work because they are a valuable resource. And I think also when we look back at research into health and well-being over the years, Boorman in 2010, I think it was, he started to look at health, safety and well-being of NHS staff. And actually that work hadn't really gone very far. Simon Stevens, the CEO for NHS England in 2016 said that he really wanted to improve staff health, so actually they are in running this campaign. The RCM were actually pushing on a door that was wide open really as far as the NHS was concerned. The campaign was launched in June 2016, but prior to that for the first six months of 2016, the campaign steering group set about planning the campaign, making sure that we had all of our ducts lined up for the campaign launch. The really important part of the campaign was obviously doing a benchmark about how our members were feeling, and we conducted a survey of RCM members in March 2016, and we asked them a number of questions about their health, safety and well-being at work, how they were feeling, stressed, undermining behaviours, whether they had access to occupational health in their own organisations, and whether they were aware of the organisational policies in their organisations that could help support their health, safety and well-being. We had four themes that we wanted to concentrate on for the campaign, and we wanted to make sure that we tried to cover these themes over the course of the 18 months of the campaign. Although the campaign did come to an end in December 2017, we actually have tried to now embed caring for you into everything that we do at the RCM, and hopefully everything that our members and our activists are doing in workplaces across the UK around looking after each other, looking after the colleagues that we work alongside, and clearly making sure that we look after the women that we're caring for. So the themes were around maternity working conditions, because we knew that staffing levels weren't good. Displants, we knew that our members weren't necessarily being offered a variety of shift patterns to work along, and obviously a big thing was around taking breaks. We've known for a number of years that there's an issue with undermining behaviours in the NHS, and certainly maternity services, we've always been unfortunately in maternity services and obstetrics at the top of the list for undermining behaviours in NHS staff surveys. The RCM had previously done and continues to work with the RCOG on undermining behaviours, and we had previously done work and produced a toolkit for undermining behaviours for both obstetricians and midwives to work together to improve the culture in their workplace. We also knew that we were looking at different ways of working for our members and continuity of carer, which is clearly now post-beta birth, is definitely something that organisations are trying to look at models of continuity of carer now, so that we wanted positive working styles to be a win-win scenario so that we could get some flexibility for our members and that actually those positive working relationships would start to underpin everything that we do. We also, because we represent a lot of our members following serious incidents, so we knew that resilience and coping and post-traumatic stress was definitely a problem for some of our members, and we did have a lot of discussions around how we wanted to make our members more resilient, and we didn't want to make them more resilient just so that they could work harder and they could endure more stress, but actually we've got a very stressful job and it's very difficult at times to handle difficult situations, so we do feel that our members need to be supported when they're going through some very difficult times, and that was the resilience that we were looking at, and I'll come on to a little bit more about that later on. As I said, we know that supportive and open workplaces benefit both staff and users and investment in staff is an investment for the women that we care for, so we launched our campaign and we had the survey results ready, that's a document that you can download from the RTM website, and certainly some of the things that I'm talking about this afternoon is in the survey results for you, and there's also a number of quotes from our members from 2016 about how they were feeling at work, which is really interesting to read and really quite sad as well some cases because of how our members were feeling, so we really really wanted to make some inroads in improving how they were feeling over the course of this campaign. So the second publication, which went along with the launch in 2016, was how are we going to do it then, so as part of the plan we needed to think about, we've done this survey, so actually how now are we going to go about supporting our members in the workplace, and the idea was that we want obviously health, safety and wellbeing should be key to everything that we're doing and that clearly our members should all want to be involved in it, so as a trade union as well as a professional organisation, we organise in our workplaces, so we organise to engage with our members to see what they want and see what we can do for them, we organise them so that we can recruit more members and we organise so we can recruit more activists in organisations because the RCM is the strength of its members and that's what's really important, so it's a two-way communication between our members and the RCM, so this publication supported the campaign and how our health and safety reps and our stewards could work with the heads of midwifery in partnership on the charter commitments, so what we were asking organisations to do was to sign up to this campaign charter and we wanted to make the charter as broad as we possibly could, so things were going to be achievable and we asked our stewards and our heads of midwifery, as I said, to work in partnership to sign up to this charter and the first thing that they needed to do was they needed to develop and implement an action plan, so throughout the course of the campaign our reps and our heads of midwifery were sending us their action plans to look at so that they were telling us the sort of things that they were looking at, whether it was something as simple as ensuring that our members got a break, which seemed to be the smallest thing that made a massive difference to our members as I was going around the country during the campaign. We wanted to make sure that midwives and maternity support workers had access to a variety of shift patterns so that they had the ability to work flexibly and we obviously wanted to promote positive working cultures and a working environment and that had included in taking breaks. Just working on what we'd already done with the RCOG, we had a statement of commitment calling for zero tolerance for undermining behaviours so we wanted to make sure that this was part of the campaign charter, so as organisations signed up for caring for you, they were also signing up for the zero tolerance to bullying behaviours and we as I said that many of our members couldn't access occupational health or they weren't aware of organisational policies for their mental health and physical health safety and wellbeing, so as part of the campaign we hoped that action plans would look at how those policies and working with occupational health that members would have greater access to support in the workplace and clearly nurturing a compassionate and supportive workplace that cares for the midwives and MSWs and students and obstetricians and anybody else that's working alongside midwives is really important so that they can obviously best care for the women and families that they are looking after. So this is what our members were telling us, they were tired, they felt unwell, they were dehydrated because they were doing 12-hour shifts and they weren't having a drink, they felt like they wanted to cry because of the pressures of work and some of them were telling us that they didn't even have a chance to go to the toilet. So some of the results and these are just a few of them so if you wanted to look at more results from the survey that is in the publication that is on our website. So 50% of our members were worried about making a mistake at work because they felt so tired and that was clearly really worrying for us and we had some really strong comments from members about how tired they felt and 71% of our members were telling us that they had come to work in the last three months despite feeling not well enough to perform their duties and some of the quotes that we got back from members around this was that clearly they didn't want to let their colleagues down and they didn't want to let the women down that they were caring for but they were also worried about punitive sickness absence policies and they also felt unfortunately for some of their colleagues that they would be criticised for being off work ill and again this just showed us or highlighted that the lack of empathy towards our colleagues that we were working with and I think some of that was just because maternity services were so intense we knew that we were three and a half thousand midwives short just in England alone of midwives to be able to deliver a safe service so actually the pressure that midwives and maternity support workers were under and still are under is absolutely immense and I think members tend to just come to work look after the patients that they need to look after and they tune out to everything else that maybe is going on around them with their colleagues because actually that's the only way that they could cope and get through a shift and when they went home they had caring responsibilities they they just zoned out when they were at work but actually what we did know is that that they weren't doing a bad job so that women still felt that they were being cared for by the midwives it's just all the pressure was being taken by the by the midwives themselves and clearly it says 84 percent of our midwives said that they had an increased workload in the last six months so this is 15 to 16 remember this these survey results are from March 2016 we know as I said there's a shortage of midwives and there still is which is an issue that we are trying to address and 22 percent of our members the only only 22 percent of our members felt that they had time to build a rapport with service users now this obviously is something that's really quite worrying time to do their job trying to build up those relationships with women that is really really important but we also know from women because we've done a previous survey with women around how they felt about the time that they spent with midwives and actually women were telling us that they could sense that midwives were short of time and they could sense that they probably didn't have enough time to discuss all their issues with them so if they were going to an antenatal clinic to see their midwife and they may have had I don't know half a dozen or 10 questions that they wanted to ask them because they knew the midwife was under pressure and they only had a 10 or 15 minute appointment they had to think they told us that they had to think of the top three questions that they really wanted their midwife to ask so obviously our members and women were saying the same thing is that we haven't got enough time to to build up that rapport and actually women were saying we don't feel we're getting enough time with our our midwives either okay so 48 percent of our members were saying that they felt stressed every day at work almost days and the most common reasons for this which I've already talked about was the workload staff shortages and that feeling of not enough time to do their job and then looking at the the dilemma around breaks 62 percent of our members said that they felt dehydrated at work and actually there is evidence now to show that cognitive function actually decreases when we're dehydrated so if you know I know midwives that seem to wear is a badge of honor that I'm doing a 12 hour shift and I've had I've had one drink and as before I've managed a 12 hour shift and not gone to the toilet it was it was a bit like I remember thinking when I was a nurse and working on a care of the elderly wall thinking gosh my back really ached today I'd worked hard when completely that was the wrong thing to be thinking so what our members were telling us out there in the field when we were out and about they weren't getting their breaks they weren't even having a drink actually this survey absolutely told us I suppose what we already knew and it's not I'm sure it's not just in the UK this problem and I can see some questions the tisha is saying that this is a universal problem for us all and yeah you are legally entitled to a break and I think it's about you need to make sure you're getting a break and I think when we when I went around the country and we were talking about breaks and as I said before the smallest thing having a drink has made the biggest impact so actually if this campaign has done anything and it's about asking your colleagues if they have had a break looking out for each other asking your colleagues can I get you a drink can I bring your cup of tea and can I bring your coffee in that's really really important because we need to look after each other as well as managers looking after us we also need to look after each other I think the other thing is that I went to a service in the Midlands a few weeks ago and it was really really funny because they hadn't signed the caring for you charter but they were going to sign it that day and we'd be looking at an action plan and the midwives in the room before the head of midwifery arrived said we can't have a break and we're not allowed to take drinks into the room well the head of midwifery came along and said she'd never said that and that actually we solved the problem of having a drink really really quickly because the head of midwifery in front of lots of midwives says you can have a drink obviously you need to risk assess that if you're taking a hot drink into a room where there might be little children but yeah absolutely you must have a drink so I think it's really important that we look after each other and it's not just the manager's responsibility to do that yes they have got a responsibility to do it but actually we need to be asking for it and saying we need a drink so I suppose if you dehydrated you're also delaying using the toilet and some criticism I had about this statistic was really quite interesting from a head of midwifery who said if they can't if midwives can't get themselves to the toilet how on earth can they advocate for a woman if they can't get themselves to the toilet well actually being a clinical midwife and being a a label coordinator for a number of years you would set off to go to the toilet but you just need to stop and talk to somebody that needed you quite quickly or you'd need to go into a room you know it's sometimes it's easier said than done and I can absolutely see where you delayed going to the loo because work didn't allow it and the other figure on this slide it's around the number of hours that our members would tell us that they worked unpaid in 2014 when we were doing the pay campaign we asked the same question and our members were saying that they worked three hours unpaid so a year and a bit later they were telling us it was five hours unpaid a week so if you add that up that's a lot of time the NHS is getting out of midwives and maternity support workers I think we also believe that this is an underestimated figure of five hours so actually I'm just going to have a look at the next slide and see what we've got or let me just go back a bit so what did we do when we got these survey results is that we launched the campaign we wanted organisations to sign up for caring for you we publicised when those organisations signed up so we used social media we asked people to take photographs of them signing the charter of any events that they did when they when they signed the charter quite a lot of them had tea parties or pampering sessions for their midwives and support workers and students so our success over the over that 18 month of the campaign is that about 134 organisations signed up during that 18 month period and that's out of a total of 164 that was about 81 percent of organisations across the UK four more organisations have signed up since we actually officially closed the campaign but we're still we're still allowing organisations to sign the charter obviously because it's really we know how important it is so health and safety reps have worked in partnership with HOMS to develop action plans and they're working through those action plans as we speak today what I would say is clearly for the organisations that signed the charter first which was central Manchester I think they may be on the next slide central Manchester signed our charter first and this is then our health and safety rest excuse me I'm the head of midwifery on the 6th of June 2017 now central Manchester already we're doing some work around their staff's health safety and well-being so actually they're really they're two years on with their action plans having signed their charter some organisations have only just signed so they're not as far on with their action plans so that I think when we resurveyed our members at the end of last year obviously there was a mixture of responses and some were further on than others and some organisations hadn't actually signed the campaign charter so this is the work that central Manchester were doing and they were they were working not only with midwives but they were also working across gynecology and neonatology as well and actually central Manchester have resurveyed their staff last year and also resurvey and also surveyed the women that our staff are caring for and that actually that survey showed that women felt well cared for that they felt that the atmosphere and the environment that they were being cared for was a happy happy place to come into they felt that it felt like a supported environment the the number of complaints received from women had gone down fitness absence for our members had improved in central Manchester so I think the work that they're doing has absolutely supported our members there and I view central Manchester because they were the first but there are a number of organisations and best practice that we've got in the in the in the RCM where organisations are really working hard to improve staff health safety and well-being this was in Northampton there was a trust in the East Midlands that again they've signed our charter but actually as an organisation they were already committed to health safety and well-being so as I said at the beginning of the presentation we were pushing on the on an open door as far as this campaign was concerned to a to a certain extent because organisations were buying into it really really easily during the campaign we obviously needed to think of things that would keep the momentum going for the for the campaign so to keep the interest up so we thought of a number of initiatives one of them was a predominant predominant per dot can't even say it predominant a challenge which we actually did in April last year which was the fortnight before idm last year so the if the challenge ended just in idm week so when the challenge ended we also encouraged our members at that point to have a celebration for idm so I had a really brilliant idm celebration last year on the back of the activities that we were doing for caring for you and you can see from this slide our members walked ever so many steps and the winning team was from Urdale and they walked nearly 1.5 million steps and I know that talking to the teams that were walking it was absolutely huge the nearly one in the numbers of teams that took part and what they were getting out of it and they were taking their kids for walks afterwards it wasn't just about how many steps we walk at work and would clearly midwives and support workers walk many many steps at work this was about looking after yourself and being well and doing something outside of work yes we were counting the steps while we were at work but it was really important to actually as a team count those steps outside of work and be more active and also the campaign gave the RCM the ability to organize workplaces as I said before we're a professional association and the trade union and trade unions organize their members and that obviously this campaign encouraged workplaces to get organized it encouraged our members to work together it encouraged us to engage with our members and hear what they were saying we could recruit new members and we could recruit new activists we could it helps retain our members because they think that we're doing something positive to support them and clearly health safety and well-being is something that everybody can sign up to because it's very close to our hearts as I said that the the pedometer challenge led very nicely into IDM 2017 and with that came our caring for UT party so we produced caring for you bunting for IDM we encouraged our workplaces to look after each other and have tea parties to celebrate IDM and caring for you we also used IDM last year to encourage some activity in workplaces around IDM but also use that activity as a springboard to sign the caring for you charter so IDM and caring for you last year went very much hand in hand and actually this year over the past two weeks RCM staff have been out and about across the UK celebrating IDM with our members again this year and many of them have continued the same sort of theme around caring for you and looking after each other sitting down having a cup of tea and talking about middle free and middle free issues and International Day of the Midwives so I think it's been a really really positive IDM for us in the UK this year and I know we couldn't cram in all the IDM events we wanted in the last fortnight so I know that we've got some spilling into next week and the week after as well so that's really really great news for IDM so the other thing that we did is that we encouraged organisations to send us their best practice submissions and we had some we didn't have as many as we wanted so some of these things on this screen was some of the things that they did so for example one organisation in the south west of England decided we needed some emergency toiletries for when staff have had a busy shift and they want to freshen up at work we needed some emergency supplies some healthy snacks for our staff if they've not been able to get a break on really busy shifts because I think we can all understand that although yes we should be getting our breaks that sometimes those shifts that are just the shifts that are that maybe nobody will go get a break so actually the RCM branch made sure that there was healthy snacks fruit and drinks for members to have when they couldn't get to the canteen and we also lots of organisations came up with celebrating midwifery and and their colleagues so they would have employer of the month or and that would be for everybody some people had really silly challenges to sort of improve morale the midwife that talks the most that happens to be me today at the moment and just to get people involved and talking and to just got that sense of we're all in it together and we're working together and actually what couple of the best practices I can share with you I think I've got time is Cardiff wanted a some robust really robust methods to engage with staff and to get feedback from their 300 midwives that they've got working in Cardiff so the RCM reps and human resources would do walk around the unit so their forces they were seen working in partnership and that they would be dealing with concerns of the midwives as they were walking around the unit and be able to talk to them together to deal with their concerns and certainly at the same time promoting staff well-being Cardiff found that morale had increased over the course of the campaign and they held days on resilience they held days around they had appreciation boxes so people could put in I suppose it's like a suggestion box idea so that somebody if they appreciated some somebody something somebody did that they could actually put in a little box that they they were thanking that person lots of people had shout-out boards where they could say Geolagi was really fantastic today she really helped me when I was having a difficult time those sort of things so that they could have shout-out for for staff which which was really really very positive and Cardiff started small they had a staff Facebook page and although they thought they were starting quite small they actually 250 people signed up really really quickly they have coffee and cake and catch-up sessions so again working on this theme that midwives have got to have cake which of course we have but actually using those opportunities to chat and discuss their problems and issues and sometimes that wouldn't necessarily just be work issues that would be personal issues because I think I found with 12 hour shifts that actually you come in you do your job you go home you don't actually know what's happening in anybody's lives so really our members really appreciated this they also in Cardiff supported newly qualified midwives and maternity support workers and just recently they've had a 10 week yoga for beginners for all their maternity staff which has been supported by the trust which has really really increased staff morale and there's quite a few examples of best practice where midwives who maybe did hypnotherapy or massage for women were then given time protected time by their heads of midwifery so paid time within their working week to run sessions for their colleagues so that that's proved really really good I think that was Bristol actually that that did that. County Durham and Darlington set off with a running club and they started off doing a 5k challenge and then they thought crikey we can do this and now they're running half marathons but again it's about teamwork and working together and actually doing something that's not work but actually something that you can do as a team together which increases your morale and how you work more positively when you are at work and one of the other examples we had was from let me think George Elliot and they they did have an issue around staff getting their breaks and they also had no access to hot food so they surveyed the members and they they went to senior managers and they made sure that staff were relieved for their breaks and they set up a budding system for breaks they also made sure that the little hospital cast that was there for patients as well but they they they were able to extend that and put in more tables and chairs so staff could also get a break there as well and this hospital as well they had a seating area outside which is a bit of a not a particularly nice garden area but they managed to get some funding to clear the garden put tables and chairs outside so on nice days so I'll keep my fingers crossed today in George Elliot Trust that there are midwives having their break as we speak in the sunshine in the East Midlands. Okay so we also did a little bit of research during the campaign this wasn't a piece of RCM research but it was some research that Louise Silverton from the RCM advised the Poppy Programme and Professor Helen Spidey from Nottingham University and who's a midwife and Professor Pauline Slade who is a psychologist in Liverpool University had been studying post-traumatic stress in midwives for a number of years and they had got with some interventions to support midwives Liverpool Women's Hospital and signed up to working with Helen and Pauline and we're still waiting for Helen Pauline's report to be published actually I've got on here it's the end of 17 but it's not being published yet but what we do know from Liverpool is that what they try to do is they try to look at interventions would support midwives if they were they've gone through a traumatic experience so a poor outcome that they weren't expecting so there were three steps to this one self-help which is just information leaflets peer support system and then psychological intervention if that was necessary the take from midwives at Liverpool was high trauma focused clinical psychology was actually well received but certainly they felt that more work was needed with the peer support to increase the workshop numbers of the midwives that were going through the workshop so that they could act so that and more midwives could access that midwives did report increased job satisfaction during the period and I know from speaking to Helen Spidey that sickness absence rates were reduced and I believe quite significantly and midwives who had previously reported they wanted to leave the profession were there were few by the end of the work that they do in Liverpool there were fewer midwives reporting that they wanted to leave the profession now I know Helen and Pauline really want to look at this in a much wider scale because sort of working with one unit although they've had really good results they would like to work across a a bigger area which would involve a number of maternity services so at the moment I know that they're looking for funding and submitting funding bids for that so I really do hope that they get some funding because I think it's a really interesting piece of research and again the RCM representing members I know of a number of members that we're representing at the moment through internal mechanisms through internal investigations and NMC investigations how traumatic they are for our members so any support that we can give our members to be able to go through these sort of investigations would be really really good and I suppose this really was the bit that sort of linked into the resilience and coping mechanisms part of the scene for the campaign so the other bit of research that we actually commissioned in 2017 was the work and health and emotional well-being of midwives the well-study and this was commissioned by us and I'm sure maybe some of you may be aware of it it's work that's also been undertaken in Australia New Zealand Sweden and Finland I believe it's maybe or has been also undertaken in Canada and there's also proposals for it to be undertaken in Germany and Ireland this obviously allows for international comparisons to be made despite the variations in national health systems and models of midwifery development the study was carried out by Billy Hunter at the University of Cardiff in collaboration with the Griffin University I know that's due for publication anytime soon nearly 2000 of our members responded to the survey in May June last year this was well above population norms and those other well and those other well countries the RCM now needs to discuss how we're going to use the information that this study has given us to improve staffing with a focus on retention I think increasing support for interventions and giving time off to staff time off to attend the support that we can give them I think I might be running out of time okay so very quickly these are the highlights of the campaign I've already talked about the numbers of organizations that signed signed up we also held a number of events during that 18 months and and clearly those numbers were high this sort of links into being an organizing trade union we had hoped that we'd get more health and safety reps but I think with any trade union I think the numbers of representatives whether they're stewards or whether they're health and safety reps there is a certain amount of churn and so unfortunately we only had a net increase of 10 health and safety reps which was disappointing but it's work in progress and obviously we hope that that will improve and so the follow-up survey that we've just published there were some improvements I would say but maybe not as much as we would have liked again think back to what I said earlier around organizations being at different parts of their caring for you journey as far as their action plans are concerned so what obviously we surveyed all members we have to we know we surveyed all members but there were some improvements you've also got to look at it and the backdrop of the NHS as it is at the moment it's not got any better our members still felt underpaid undervalued so morale was still low and clearly we were three and a half midwife sure these are some of the things that our members were telling us so again some good things and some not so good things not massive dramatic changes but I said you need to consider this in the backdrop of what the NHS is like at the moment this is some of the good things around certainly there's some good things here about taking a break but then some not a very positive comment from a midwife in England below but I think what it has done is it does raise awareness about how we look after each other and how we should be should be looking at each other okay so again not so brilliant results around the sickness absence and improvements so still working progress for us there again this is a little bit around what our members told us in November 17 and this is what we're going to be carrying on doing in 2018 so we're still finding up those organizations it can't be the only step you've got to work on your action plan we will continue to showcase good practice and we work with other trade unions and royal colleges because I know there's a lot of trade unions and royal colleges that are absolutely talking about the same things at the moment so again that door is wide open for us to work with so oh might I just skip okay so what we're doing so we've we've clearly the Secretary of State for Health has announced recently that there's going to be 3000 more midwives student midwives coming into training that is not without its challenges clearly for our HEI colleagues capacity in the workplace etc we're looking at how we support our maternity support workers we will continue to raise concerns around health safety and well-being we want to strengthen literary leadership and we will be making announcements at our annual conference in October around what we're going to do about leadership we really want to support multi-professional working we know that people who train together work better together there's better communications and we're definitely promoting safe maternity care for women and babies and I just want to say this is midwives in Liverpool which is my hometown if anybody hadn't clocked the accent that I've got is together we can make a difference but we have got to work together to do that thank you very much I'm not sure whether we've got any time for any questions thank you so much Jill that was a very inspiring presentation it's amazing the work that RCM has done just in the last year and unfortunately we don't have time for questions