The Welsh Government established Health Education and Improvement Wales (HEIW, 2023a) on 1 October 2018, with the aim of ensuring that the people and healthcare professionals of Wales benefit from a cohesive, consistent approach to education and training, as well as workforce modernisation and planning.
The annual development of an education and training plan is one of the statutory functions of HEIW (2023b). The plans detail the training and commissioning numbers for education of the health professional workforce in Wales, together with workforce planning information. The education and training they receive is vital to the sustainability of NHS Wales and ensures the capacity and capability to drive high-quality, safe patient-, person- and community-centred care. It is continuosly shaping and developing the healthcare workforce, identified as fundamental to the quality delivery of care and achievement of the Welsh Government’s (2021a) vision for the NHS in Wales.
Informing this development, HEIW considers workforce plans from all NHS Wales health boards and trusts. It also incorporates advice and the views of wider stakeholder groups, such as royal colleges or higher education institutes, to inform HEIW’s (2023c) vision to transform the workforce for a healthier Wales. One
Developing an undergraduate midwifery programme
Bangor University has a longstanding history of working with HEIW in the delivery of its midwifery programme. In 2021, Bangor successfully bid to tender new contracts with HEIW to deliver midwifery for the next 10 years. The new contract specification began as part of an all-Wales strategic review of education (HEIW, 2021).
The commissioning process for midwifery was part of the all-Wales procurement for nursing and healthcare pre-registration education. Following Bangor’s successful bid in 2021, the two organisations worked closely to ensure that the contract requirements were implemented prior to the contract’s commencement in September 2022.
Prior to the commissioning process of the Bangor pre-registration midwifery programme, HEIW (2019; 2020) undertook initial research in partnership with stakeholders, to identify the future ‘picture’ of midwifery training in Wales. The aim was to identify and prioritise educational programme needs required to meet political policy, to ensure that midwifery was a valued lifelong career and to meet the requirements of the populations it serves in all areas of the country.
The data and information produced were scrutinised, analysed and constructed to ensure that the proposed ‘ask’ for pre-registration midwifery education in Wales would be national, strategic, recurrent and impactful. To ensure that HEIW had interpreted the data correctly after developing the initial ask, further stakeholder feedback events were subsequently undertaken. These included engagement with members of midwifery teams and management from health boards and trusts, as well as an open invitation to relevant parties from the Nursing and Midwifery Council (NMC) and professional bodies. HEIW wanted to sense check each ask of the proposed education, to ensure that it was developed to meet service needs.
To ensure governance and quality were assured once the ideal ask for pre-registration midwifery had been established, scrutiny was undertaken by a broad range of groups and organisations. These assurances and approvals were carried out by a project board, the HEIW (2020) executive team, education commissioning quality committee and executive board, NHS Wales Shared Services Partnership and the Welsh government. In order for the ask for the proposed programme to be viable, achievable and deliverable, education providers needed to ensure attainability premarket engagements to meet assurances.
Commissioning
The next stage of the cycle was commissioning the programme. Fundamentally, this was the agreement made between HEIW and Bangor University in relation to the development and delivery of the undergraduate pre-registration midwifery programme.
Interprofessional education
One of the key elements of the new education contract was for Bangor University to embed interprofessional education placement learning in programmes. While interprofessional education was already a key part of programme curricula and placement experience (HEIW, 2022), new contract interprofessional specifications were applied. The new contracts required the programme to include interprofessional education opportunities that constitute a minimum contribution of 20% of overall student learning experience, quantified as the number of academic credits, learning outcomes or learning hours (HEIW, 2022).
Education providers were also required to provide students with the opportunity to work collaboratively with professional groups that they were likely to work with in future. Bangor University and placement providers were required to embed arrangements and enable students to evidence 150 hours of interprofessional placement activity (HEIW, 2022).
Welsh language requirements
Another key element was the requirement that all undergraduates undertake an annual 1-hour module on Welsh language awareness. Every student who wants to study Welsh receives free lessons and education providers assess the demand for Welsh teaching when developing new courses (HEIW, 2019b). This aligns with the Welsh Government’s (2021b) strategic framework to strengthen Welsh language provision in health and social care in Wales.
Its aim is to support Welsh-speakers to receive services in their first language. An independent evaluation demonstrated that for many Welsh-speakers, being able to access services in Welsh made a significant positive difference to their overall experience and, in many cases, their health and wellbeing outcomes.
Performance and quality management
Following commencements of the new midwifery students at Bangor University, HEIW met regularly with education providers to discuss their performance against identified key performance indicators, as part of ongoing contract management. Bangor University also submitted agreed data to summarise key aspects of education delivery.
One important element of quality management was direct feedback from students enrolled on the course. Members of HEIW’s (2020) education, commission and quality team spent time interacting with students to determine their level of satisfaction with all elements of the programme, from academic support provision to the social resources available to enhance the student experience and feeling of community. This provided the opportunity to identify what was working well and any areas where there may be room for improvement. The information gained during these sessions was then anonymised, themed and fed back to Bangor University.
HEIW’s quality monitoring process highlighted that the pre-registration midwifery programme at Bangor University was meeting and exceeding both the stipulations of the contract and the expectations of the students. This provided a valued and impactful educational experience that would equip them for their future careers as midwives.