The ‘old’ has been a sad and emotionally challenging period for both the families and staff of East Kent, and has included a combination of revelations and investigations. The impact of the sad failings found in these reports on women and families will be lasting. Staff were also impacted by the tragic incidents and some midwives were left feeling ashamed to admit that they worked for the maternity department.
During the COVID-19 pandemic, maternity staff, as with everyone else working in the NHS at this time, were stoic and existed through those difficult months until they finally emerged out the other side. Not long afterwards, Dr Bill Kirkup's (2022) report was published, followed a few months later by a report by the Care Quality Commission (2023) that rated the maternity service as inadequate.
As Covell (2023) pointed out, constant exposure to stress can impact staff morale, leading to burnout, which can subsequently affect patient care. In oral comments to the Health and Social Care Select Committee (2021), Professor Michael West of the King's Fund provided descriptions of burnout that include ‘emotional exhaustion’ and ‘moral distress’, and noted that these can negatively impact a carer's perception of the quality of care they are providing and their ability to make a difference. Combining burnout, and the potential negative consequences it can have on patient care, with a maternity service already beleaguered with tragic results could be considered a perfect storm that could implode, leading to even more devastating outcomes than the trust has already experienced. Therefore, it was imperative to do something that would have a positive impact and begin to turn around maternity services at East Kent.
Changes East Kent Hospitals Trust
The professional midwifery advocates at East Kent hospitals were as disillusioned as their colleagues. The advocate team, consisting of one full-time lead and 17 sessional advocates, were impacted by the same feelings of sadness and stress that their colleagues were. This, coupled with the pressures of day-to-day clinical activity, left them unable to be the effective team that they wanted to be. As a result, some members of the team took up other roles.
In 2023, a new substantive director and deputy director of midwifery came from a high-performing trust (Care Quality Commission, 2018). The new directors gave the professional midwifery advocate team energy and in the spring of 2024, I was seconded into the lead professional midwifery advocate role. Up until then, I had been a sessional professional midwifery advocate and had been informally leading the team following the departure of the previous lead. With the backing of the new directors, both professional midwifery advocates themselves, the team were reinvigorated and started to create the changes we wanted to see.
We began with a bang. While there are still ongoing challenges for the service, there is also a huge amount of good occurring, and we wanted to celebrate this. To coincide with the annual International Day of the Midwife in May 2024, we created the East Kent maternity professional midwifery advocate awards. We voiced this idea to the new directors, who gave us their full support. Unsure at first how the awards would be received by our colleagues when they were announced, we realised we need not have worried; the staff embraced them and the nominations came flooding in. In the week running up to the International Day of the Midwife, every one of the 96 staff nominated received a certificate that acknowledged their nomination and thanked them for their hard work and positive contribution to our service.
We had invited an external select committee that included the director of maternity services in Kent and Medway, a senior regional professional midwifery advocate and our local Maternity and Neonatal Voices Partnership lead to choose the winners of our awards. They commented on the high standard of nominations and between them, chose 11 winners for the 10 categories, as they could not distinguish between the excellence of two staff nominated in the education category.
On the Friday prior to International Day of the Midwife 2024, we held celebratory events at our two main hospital sites. These were attended by our regional lead midwifery and nursing officers, members of the committee who had kindly given up their time to help select the winners and our new maternity directors, CEO, CNMO and other trust executives. The winners of each award category were presented with a glass trophy and certificate during the celebrations by one of the senior leaders present.
As hoped, the awards created energy among our staff as well as the professional midwifery advocate team, inspiring us to continue the good work. We used the awards to embark on a relaunch of the professional midwifery advocate team, to promote the professional midwifery advocate role. Following the awards, a few ex-professional midwifery advocates were inspired to rejoin the team, new staff that were already professional midwifery advocates joined East Kent and four student professional midwifery advocates qualified. Combined, we now have 27 professional midwifery advocates, including me, in the full-time role.
While we are continuing the fun theme with regular trolley dashes and Career Cafés, we are also getting down to the essential work of providing support for staff. We are working hard to improve the provision and engagement of restorative clinical supervision sessions for staff, as promoted by the A-EQUIP model (NHS England, 2017), both one-to-one and in groups, online or face to face. Pettit and Stephen (2015) explained the benefits of clinical supervision, highlighting that it can improve outcomes for patients while increasing job satisfaction for professionals. Therefore, restorative clinical supervision must be a fundamental element of our activity as professional midwifery advocates, so we can appropriately support our staff.
Conclusions
As a maternity team, we have a long way to go on our journey of improvement, but we have also come a long way. We are fortunate that along with our new directors, we are already attracting other new staff who have clinical expertise and influence; their freshness and enthusiasm will help reinvigorate us. Efforts to promote staff support and engagement are multifaceted, with a large proportion coming from the growing dedication of our professional midwifery advocate team providing a sustained programme of restorative clinical supervision and other activities that go towards healing our staff. By caring for our colleagues, we will be indirectly caring for the families we serve too. As a maternity team, we aim to shine bright and be proud to be midwives of East Kent once again.