Maternity Services Template Document for Staffing Levels
NHS Trust
Maternity Services Template Document for Staffing
Levels
Version:
Ratified by:
Date ratified:
Name of originator/author:
Name of responsible committee/individual:
Name of executive lead:
Date issued:
Review date:
Target audience:
V.3
March 2012
Page 1 of 17
Maternity Services Template Document for Staffing Levels
Contents
1
Description of the Maternity Service....................................................................... 4
2
Purpose of the Document........................................................................................ 4
3
Description of the Staff Utilised within the Maternity Service ............................... 4
3.1
3.2
3.3
3.4
4
Midwives, Nurses and Support Staff....................................................................................... 4
Consultant Obstetricians......................................................................................................... 5
Anaesthetists and their Assistants .......................................................................................... 5
Others ..................................................................................................................................... 6
Required Staffing Levels .......................................................................................... 6
4.1
4.2
4.3
4.4
5
Midwives, Nurses and Support Staff ...................................................................................... 6
Consultant Obstetricians......................................................................................................... 7
Anaesthetists and their Assistants .......................................................................................... 7
Others ..................................................................................................................................... 8
Staff Duties ............................................................................................................... 8
5.1
5.2
5.3
Labour Ward Coordinator ....................................................................................................... 8
Consultant Obstetricians......................................................................................................... 8
Consultant Anaesthetists ........................................................................................................ 9
6
Process for the Annual Review of Staffing Levels ................................................... 9
7
Process for the Development of Business Plans ..................................................... 9
8
Process for the Development of Longer Term Contingency Plans ........................ 10
9
Process for the Development of Short Term Contingency Plans .......................... 10
10
10.1
10.2
11
11.1
12
Monitoring Compliance with the Document ..................................................... 10
Process for Monitoring Compliance ..................................................................................... 10
Standards/Key Performance Indicators ................................................................................ 10
References .......................................................................................................... 11
Guidance from Other Organisations ..................................................................................... 11
Associated Documentation ................................................................................ 11
Appendix A – Maternity Services Template Document for Staffing Levels ................. 13
V.3
March 2012
Page 2 of 17
Maternity Services Template Document for Staffing Levels
Review and Amendment Log
Version No
Type of Change
Date
V.2
Annual review
Mar 2011
V.2
Amendment
Mar 2011
Description of change
Addition of amendment log
Addition of examples of associated documents
V.3
Annual review
Mar 2012
V.3
Amendment
Mar 2012
Update to format including automated
contents page
Addition of content for 1.6 ‘Labour Ward
Staffing’
Please Note the Intention of this Document
This document has been developed with the aim of providing a model document template.
However, any documentation subsequently produced must follow its own rules and include details
of all the requirements set out in sections 1-12, where relevant. The maternity service may use this
template and adapt it to reflect procedures within the organisation or alternatively use a document
already in existence. Whichever approach is used the maternity service must ensure it is compliant
with the minimum requirements of the Clinical Negligence Scheme for Trusts (CNST), Maternity
Clinical Risk Management Standards.
a
To assist the maternity service, areas have been identified in the margins where the
section within the template document relates to the minimum requirements for the
criterion in the relevant CNST Maternity Clinical Risk Management Standards.
It is important that the document should follow any pre-existing guidance within the organisation in
relation to style and format of documentation. Please note that a template document entitled An
Organisation-wide Document for the Development and Management of Procedural Documents can
be found on the NHSLA website which may provide the organisation with additional guidance.
V.3
March 2012
Page 3 of 17
Maternity Services Template Document for Staffing Levels
1
Description of the Maternity Service
This section of the strategy should describe the maternity service. The description should
include all care settings within which the maternity service provides care to women and
their babies. A description of the styles of care provided should also be included here and
information of the professional groups for which the maternity service provides training.
2
Purpose of the Document
This section should include an explanation regarding the intent/aim of the document. This
should include the rationale for development of the document and an outline of the
objectives and intended outcomes of the process. This may include a description of:
3

how staff are utilised within the maternity service; and

how the maternity service addresses any staffing issues it may have.
Description of the Staff Utilised within the Maternity Service
This section of the strategy starts to look at the staff utilised within the maternity service.
Ideally the maternity service should have one approved document that covers all groups of
staff; alternatively the maternity service could produce three approved documents covering
each group of staff reviewed as part of the CNST Maternity Standards.
3.1
Midwives, Nurses and Support Staff
1.3a
This section should include a description of all midwives, nurses and support staff
utilised throughout the service. The maternity service should also mention the
professional groups in training for which they provide clinical placements. This
section might benefit from a sub-division for each of the groups above.
For example:
Midwives
It is recognised that, regardless of place of birth, midwives will care for women and
their babies. At Happytown Hospital NHS Trust midwives work throughout all areas
of the maternity service.
Hospital Services
Within the hospital, midwives work on the labour ward and the two postnatal wards
24 hours a day, seven days a week. Midwives work in the day assessment unit, week
days between 08.00 and 20.00 and at weekends from 09.00 to 13.00. During the
working week midwives work in the antenatal clinic between the hours of 08.30 and
17.00.
Community Services
Midwives provide both antenatal and postnatal care within the community setting.
For those women who request a home birth this care is provided by the community
midwives. Midwives work in the community between 08.30 and 17.00; outside of
these hours an on call service is provided.
V.3
March 2012
Page 4 of 17
Maternity Services Template Document for Staffing Levels
Nurses
Nurses support midwives in providing care to women and their babies. Nurses
provide a full recovery service for women who have had operative interventions
either under regional or general anaesthetic. Additionally nurses provide support in
the obstetric theatre. This support is provided 24 hours a day.
Support Staff
The maternity service utilises the invaluable resource of maternity care assistants
within the hospital and within the community. Maternity care assistants are
available 24 hours a day within the hospital and work within the community between
08.30 and 17.00.
The maternity service also offers clinical placements for student midwives and
student nurses.
3.2
1.4a
Consultant Obstetricians
This section should include a description of consultant obstetricians working within
the maternity service. The description could include the total number in post, those
who provide care on the labour ward, and particular specialist interests.
For example:
The role of the consultant obstetrician on the labour ward is to ensure a high
standard of care for women and their babies with complex medical or obstetric
needs, and to be available for the acute, severe and often unpredictable life
threatening emergencies.
At Happytown Hospital NHS Trust consultant obstetricians are present on the labour
ward between 08.30 and 17.00 (without any other clinical commitments). Outside of
these hours a consultant obstetrician is available on an on call basis and can be
present on the labour ward within 30 minutes. The unit has a list of clinical
situations when a consultant will be available to support doctors in training.
1.5a
3.3
Anaesthetists and their Assistants
This section should include a description of the anaesthetists and their assistants
currently used within the maternity service. This section should describe the
availability of anaesthetists throughout 24 hours of the day. Additionally the
maternity service should describe the staff who act as assistants to the
anaesthetists, perhaps using a sub-division for the assistants as under section 3.1
above.
For example:
National reports have emphasised the importance of anaesthetists as an integral
part of the obstetric team and in the management of mothers who become severely
ill. The anaesthetists who work on the labour ward should be supported by
dedicated trained anaesthetic assistance.
At Happytown Hospital NHS Trust consultant anaesthetists are present on the labour
ward for ten programmed sessions per week; additionally there is a duty
anaesthetist available for the maternity service 24 hours per day.
V.3
March 2012
Page 5 of 17
Maternity Services Template Document for Staffing Levels
3.4
Others
This section could include a description of other groups of staff who provide care to
women and their babies.
For example:
The care needs of women whilst pregnant can be diverse and demanding. The
provision of the appropriate care to these women can only be provided when the
staff caring for them have the appropriate skills.
At Happytown Hospital NHS Trust no others groups of staff are employed within the
maternity service. The maternity service however utilises the skills of the appropriate
professionals when necessary or as described within clinical guidelines used within
the service.
4
Required Staffing Levels
The maternity service should outline here the required staffing levels for each of the groups
of staff previously mentioned above. The description should cover all care settings where
the maternity service provides care to women and their babies.
4.1
1.3b
Midwives, Nurses and Support Staff
This section should include the required staffing levels for midwives, nurses and
support staff throughout the maternity service. This should cover all care settings in
which these groups of staff provide care to women and their babies throughout the
24 hour day. These staffing levels should have been calculated using the guidance
included within Safer Childbirth (RCOG 2007).
For example:
Early
Labour Ward
Ward A
DAU 09:00 – 17:00
Integrated
Midwives
Lab Wd Coordinator
x1
Midwife x 2
Midwife x 1
09:00 -17:00 x 5
Maternity care asst x 1
Maternity care asst
x1
Early call x 4
Midwife x 2
Midwife x 1
Late call x 4
Maternity care asst x 1
Maternity care asst
x1
Midwife x 2
Midwife x 1
Maternity care asst x 1
Maternity care asst
x1
Maternity care asst
x1
Late
Lab Wd Coordinator
x1
Maternity care asst
x1
Night
Lab Wd Coordinator
x1
Maternity care asst
x1
V.3
March 2012
Night call x 4
Page 6 of 17
Team
Maternity Services Template Document for Staffing Levels
An experienced midwife labour ward coordinator should be available for each shift
on labour ward.
1.4b
4.2
Consultant Obstetricians
This section should describe the required prospective consultant obstetrician
presence for the labour ward. This should have been calculated using the guidance
included within Safer Childbirth (RCOG 2007). It should describe the availability of a
consultant obstetrician outside of the hours in which there is obstetric presence on
the labour ward.
For example:
At present the labour ward at Happytown Hospital NHS Trust provides 68 hours of
prospective consultant cover on the labour ward in line with the recommendations of
Safer Childbirth (RCOG 2007). The table below describes the arrangements for cover
and consultants are expected to arrange cover should they be on annual or study
leave. In the event of short term sickness the lead consultant will arrange the
appropriate cover.
4.3
1.5b
1.6d
08.00 to 13.00
13.00 to 20.00
Monday
Mr A
Ms B
Tuesday
Ms C
Mr D
Wednesday
Mr A
Mr A
Thursday
Ms C
Ms C
Friday
Ms B
Ms B
Saturday/Sunday
Mr E
Mr E
Anaesthetists and their Assistants
This section should describe the required staffing levels for anaesthetists and their
assistants on the labour ward. This should have been calculated using the guidance
included within Safer Childbirth (RCOG 2007).
This should include the arrangements for ensuring the availability of a duty
anaesthetist on the labour ward 24 hours a day, 7 days a week.
For example:
Consultant anaesthetists are available on the labour ward at Happytown Hospital
NHS Trust for ten sessions during the week (Mon-Fri, 09.00-17.00). At other times a
specialist trainee is available, supported by an on call consultant anaesthetist and a
dedicated assistant
V.3
March 2012
Page 7 of 17
Maternity Services Template Document for Staffing Levels
4.4
Others
Where the maternity service has included other groups of staff within the strategy it
should include here the required staffing levels for these groups. Where available
this should be in line with national guidance i.e. Safer Childbirth (RCOG 2007).
5
Staff Duties
The responsibilities of some groups of staff working on the labour ward are clearly defined
within national guidance. The maternity service should ensure these responsibilities are
described or a cross reference is included to another approved document that includes this
detail.
For example:
1.6c
5.1
Labour Ward Coordinator
There should be an identified midwife coordinator for each shift on the labour ward.
This person should be clearly identified to ensure that all staff are aware of who this
person is. The approved document should include a description of this role.
1.6d
For example:
For each shift on the labour ward at Happytown Hospital NHS Trust there will be a
designated labour ward coordinator. This person’s role includes:
1.6a
5.2

day to day management of the team and provision of leadership, advice,
supervision and coordination of staff within the integrated team;

mentor for junior midwives and others;

supervision of junior midwives and other members of staff; and

provision of specialist advice to midwives and other members of a multidisciplinary team.
Consultant Obstetricians
Whilst maternity services provide a number of hours of prospective consultant
presence on the labour ward in line with the recommendations of Safer Childbirth
(RCOG 2007), it is also expected that there are clinical conditions where the
consultant will attend the labour ward in person if they are not already present. A
description of these occasions should be described here or a cross reference should
be included to another approved document that includes this detail.
For example:
In addition to the required presence of the consultant obstetrician on the labour
ward it is also expected that the consultant is present in person in the following
clinical situations:
V.3

eclampsia;

maternal collapse (such as massive abruption, septic shock);

caesarean section for major placenta praevia;
March 2012
Page 8 of 17
Maternity Services Template Document for Staffing Levels
1.6e
5.3

postpartum haemorrhage of more than 1.5 litres where the haemorrhage is
continuing and a massive obstetric haemorrhage protocol has been
instigated;

return to theatre - laparotomy;

uterine rupture; and

when requested.
Consultant Anaesthetists
Delivery of anaesthesia and analgesia is the mainstay of obstetric anaesthetic
practice but it can only be done safely if the service is coordinated and organised.
This requires a designated lead obstetric anaesthetist who takes responsibility for all
aspects of the clinical service (Safer Childbirth, RCOG 2007). This person should be
clearly identified to ensure that all staff are aware of who this person is. The
approved document should include a description of this role.
For example:
For each shift on the labour ward at Happytown Hospital NHS Trust there will be a
designated lead obstetric anaesthetist. This person’s role includes:
1.3c
6
1.3e

day to day management of the rota for obstetric anaesthetic cover for both
anaesthetist and their assistants;

ensuring that there is a ‘duty anaesthetist’ immediately available for the
obstetric unit 24 hours a day. This anaesthetist will normally have had more
than 1 year of experience in anaesthesia and must have been assessed as
being competent to undertake such duties; and

ensuring that the duty anaesthetist has access to prompt advice and
assistance from a designated consultant anaesthetist whenever required.
Process for the Annual Review of Staffing Levels
The maternity service should describe here the process for the annual review of staffing
levels for each of the groups described above. The review should consider the current
delivery rate and the recommendations of national guidance, i.e. Safer Childbirth (RCOG
2007). The annual review must be of staffing levels over the full 12 month period.
1.4c
1.4e
1.5c
This section should include a description of the process of the review, including how it will
be undertaken, by whom, where the results will be reviewed etc. The results of the review
need to indicate whether or not the maternity service’s staffing levels for a particular group
of staff are in line with national recommendations.
1.5e
1.5f
1.3f
7
1.4f
Process for the Development of Business Plans
Once the maternity service has completed its annual review it will be aware of whether or
not its staffing levels for particular staff groups are in line with national recommendations.
Where there is a deficit the maternity service will need to develop a business plan to acquire
extra staff. The maternity service should describe here the business planning process. It
may be appropriate to link to or cross reference to an organisation-wide document for this
process. The maternity service should also describe how business plans are progressed
1.5g
V.3
March 2012
Page 9 of 17
Maternity Services Template Document for Staffing Levels
through the organisation, including which committees they will be presented at and how the
final approval is granted and recorded.
1.3g
8
If the annual review undertaken by the maternity service indicates a deficit of staff for any of
the groups the maternity service will need to have in place a contingency plan to address
this deficit. This section should document the contingency plan in detail; it might be
appropriate to describe as per the staff groups previously used. Alternatively this document
could contain a link or cross reference to another document which contains the contingency
plan(s). Examples of longer term contingency plans might include:
1.4g
1.5h
1.3h
Process for the Development of Longer Term Contingency Plans
9
1.4h

reorganisation of staff or services; and

use of long term locum staff.
Process for the Development of Short Term Contingency Plans
All maternity services have in place procedures that are brought into action when there is an
increase in activity or a reduction in staff. These plans should be detailed here, again by staff
group. Where the plans are detailed it may be appropriate to link to or cross reference to
another document containing this information.
1.5i
10
Monitoring Compliance with the Document
10.1
1.3d
1.4d
1.5d
1.6f
1.3i
1.4i
1.5j
10.2
V.3
Process for Monitoring Compliance
This section should identify how the maternity service plans to monitor compliance
with the Maternity Services Document for Staffing Levels. This should include any
auditable standards and/or key performance indicators (KPIs) stated within the
document that can be monitored. As a minimum it should include the
review/monitoring of all the minimum requirements within the CNST Maternity
Standards.
This should include criteria 1.3, 1.4 and 1.5 and must describe the process for
monitoring the progression of business plan(s), contingency plan(s), review of the
results, and the process for the subsequent monitoring of any action plans. There
should be an explicit process described as to:

Who will perform the monitoring?

When will the monitoring be performed?

How are you going to monitor?

What will happen if any shortfalls are identified?

Where will the results of the monitoring be reported?

How will the resulting action plan be progressed and monitored?

How will learning take place?
Standards/Key Performance Indicators
March 2012
Page 10 of 17
Maternity Services Template Document for Staffing Levels
This section could contain auditable standards and/or key performance indicators
(KPIs) which may assist the organisation in the process for monitoring compliance.
11
References
This section should contain the details of any reference materials reviewed in the
development of the strategy. For example:
12
11.1
Guidance from Other Organisations

Department of Health (2007) Maternity Matters: Choice, access and continuity of
care in a safe service London: COI

Royal College of Anaesthetists, Royal College of Midwives, Royal College of
Obstetricians and Gynaecologists, Royal College of Paediatrics and Child Health
(2007) Safer Childbirth: Minimum Standards for the Organisation and Delivery of
Care in Labour London: RCOG Press

Royal College of Anaesthetists, The Association of Anaesthetists of Great Britain and
Ireland (2006) Good Practice - A guide for departments of anaesthesia, critical care
and pain management London: RCOG Press

Royal College of Midwives (May 2009) Staffing Standards in Maternity Services
London: RCM Press

Royal College of Obstetricians and Gynaecologists (RCOG) (2010) Labour Ward
Solutions Good Practice No.10 London: RCOG Press

Royal College of Obstetricians and Gynaecologists, Royal College of Anaesthetists,
Royal College of Midwives, Royal College of Paediatrics and Child Health (2008)
Standards for Maternity Care: Report of a Working Party London: RCOG Press

Royal College of Obstetricians and Gynaecologists, Royal College of Paediatrics and
Child Health (2008) Children’s and Maternity Services in 2009: Working Time
Solutions London: RCOG Press

Royal College of Obstetricians and Gynaecologists (2009) Responsibility of
Consultant On-call Good Practice No. 8. London: RCOG Press

Royal College of Obstetricians and Gynaecologists (2009) The Future Workforce in
Obstetrics and Gynaecology London: RCOG Press

Royal College of Obstetricians and Gynaecologists (2010) Labour Ward Solutions.
Good Practice No.10 London: RCOG Press

The Association of Anaesthetists of Great Britain and Ireland, and the Obstetric
Anaesthetists’ Association (2005) OAA/AAGBI Guidelines for Obstetric Anaesthetic
Services (Revised edition) London: AAGBI/OAA
Associated Documentation
This section should provide a cross reference to any other related organisational procedural
document(s).
The following list is a guide only and is not exhaustive:
V.3
March 2012
Page 11 of 17
Maternity Services Template Document for Staffing Levels
V.3

Maternity services risk management strategy

Risk register

Business plan

Contingency/escalation plan
March 2012
Page 12 of 17
Maternity Services Template Document for Staffing Levels
Appendix A – Maternity Services Template Document for Staffing Levels
NHS Trust
Maternity Services Template Document for Staffing
Levels
Version:
Ratified by:
Date ratified:
Name of originator/author:
Name of responsible committee/individual:
Name of executive lead:
Date issued:
Review date:
Target audience:
V.3
March 2012
Page 13 of 17
Maternity Services Template Document for Staffing Levels
Contents
1
Description of the Maternity Service..................................................................... 16
2
Purpose of the Document...................................................................................... 16
3
Description of the Staff Utilised within the Maternity Service ............................. 16
3.1
3.2
3.3
3.4
Midwives, Nurses and Support Staff..................................................................................... 16
Consultant Obstetricians....................................................................................................... 16
Anaesthetists and their Assistants ........................................................................................ 16
Others ................................................................................................................................... 16
Required Staffing Levels ........................................................................................ 16
4
4.1
4.2
4.3
4.4
Midwives, Nurses and Support Staff..................................................................................... 16
Consultant Obstetricians....................................................................................................... 16
Anaesthetists and their assistants ........................................................................................ 16
Others ................................................................................................................................... 16
Staff Duties ............................................................................................................. 16
5
5.1
5.2
5.3
Labour Ward Coordinator ..................................................................................................... 16
Consultant Obstetricians....................................................................................................... 16
Consultant Anaesthetists ...................................................................................................... 17
6
Process for the Annual Review of Staffing Levels ................................................. 17
7
Process for the Development of Business Plans ................................................... 17
8
Process for the Development of Longer Term Contingency Plans ........................ 17
9
Process for the Development of Short Term Contingency Plans .......................... 17
10
10.1
10.2
11
11.1
12
Monitoring Compliance with the Document ..................................................... 17
Process for Monitoring Compliance ..................................................................................... 17
Standards/Key Performance Indicators ................................................................................ 17
References .......................................................................................................... 17
Guidance from Other Organisations ..................................................................................... 17
Associated Documentation ................................................................................ 17
Appendix A
Checklist for the Review and Approval of Procedural Documents ...... 17
Appendix B
Version Control Sheet ........................................................................... 17
Appendix C
Plan for Dissemination .......................................................................... 17
Appendix D
Equality Impact Assessment Tool ......................................................... 17
V.3
March 2012
Page 14 of 17
Maternity Services Template Document for Staffing Levels
Examples of the Checklist for the Review and Approval of Procedural Documents, Version Control
Sheet, Plan for Dissemination and the Equality Impact Assessment can all be found within the
Organisation-wide Document for the Development and Management of Procedural Documents on
the NHSLA website.
Appendix B in the Organisation-wide Document for the Development and Management of Procedural
Documents contains a flowchart to assist with the process for the creation and implementation of
procedural documents.
Review and Amendment Log
Version no.
V.3
Type of change
Date
March 2012
Description of change
Page 15 of 17
Maternity Services Template Document for Staffing Levels
1
Description of the Maternity Service
2
Purpose of the Document
3
Description of the Staff Utilised within the Maternity Service
4
5
V.3
3.1
Midwives, Nurses and Support Staff
3.2
Consultant Obstetricians
3.3
Anaesthetists and their Assistants
3.4
Others
Required Staffing Levels
4.1
Midwives, Nurses and Support Staff
4.2
Consultant Obstetricians
4.3
Anaesthetists and their assistants
4.4
Others
Staff Duties
5.1
Labour Ward Coordinator
5.2
Consultant Obstetricians
March 2012
Page 16 of 17
Maternity Services Template Document for Staffing Levels
5.3
Consultant Anaesthetists
6
Process for the Annual Review of Staffing Levels
7
Process for the Development of Business Plans
8
Process for the Development of Longer Term Contingency Plans
9
Process for the Development of Short Term Contingency Plans
10
Monitoring Compliance with the Document
11
10.1
Process for Monitoring Compliance
10.2
Standards/Key Performance Indicators
References
11.1
12
V.3
Guidance from Other Organisations
Associated Documentation
Appendix A
Checklist for the Review and Approval of Procedural Documents
Appendix B
Version Control Sheet
Appendix C
Plan for Dissemination
Appendix D
Equality Impact Assessment Tool
March 2012
Page 17 of 17