Realising the benefits of workforce redesign in maternity services


06 / 04 / 2011

The organisation

Heart of England NHS Foundation Trust is one of the largest in England. It includes Birmingham Heartlands Hospital, Solihull Hospital, Good Hope Hospital and Birmingham Chest Clinic. The trust is a world leader in tackling MRSA and specialises in treating patients suffering from a wide range of illnesses including heart and kidney disease, cancer, HIV and AIDS as well as respiratory conditions like Cystic Fibrosis. It also has expertise in premature baby care, bone marrow transplants and thoracic surgery.

The trust achieved foundation status in 2005. It employs around 10,000 staff and from April 2011 it will take on services offered by its local primary care trust. The trust’s maternity service is one of the biggest in Europe with three maternity units, dealing with over 11,000 deliveries every year.

What we did and why

During 2010, Heart of England began to experience, along with many other trusts in the country, a problem with recruiting enough qualified midwives to support maternity services in the trust. The trust needed to take action to ensure that maternity capacity could be maintained and the levels of patient care remained high.

Working closely with the head of midwifery at the trust, the Faculty of Education Healthcare Careers Development Unit and the workforce diagnostics and design team undertook a redesign of the maternity workforce, including the introduction of a new career framework for midwifery support workers.

How we did it

The first stage of the project involved a complete review of the workforce within the maternity service. This review involved mapping the current workforce to the services that were required and a key aim of this was to consider what work could be delegated safely and effectively from the qualified midwives to the support workforce. The teams worked closely to agree the competencies and level of skills that would be needed for the support workers to carry out these tasks.  As well as agreeing the competencies required, the team also considered what band would be the most appropriate for the work to be delegated to. At the end of this process, a framework was developed for support worker roles.

This was achieved using a range of diagnostic methodologies including a review of current job roles; focus groups with midwifery staff and dialogue between senior management, staffside and the local practice educator.  Constant communication and the need to be frank and honest was one of the key lessons learnt by the project team. At the end of the process, agreement was reached as to what elements of the work, currently undertaken by midwives but not requiring specialist skills, could be delegated to midwifery support workers.

Once the principle had been agreed, the team then began the campaign to recruit individuals to the new posts. Heart of England’s Faculty of Education were already running a successful healthcare assistant training programme known as ‘Step into Work’ and this methodology was used to recruit to a trainee maternity support worker programme. 

The Step into Work programme places the emphasis on finding people with the right behaviours and attitude for the role rather than simply looking at qualifications and experience. The recruitment process begins with an open day where around 60 of the original 120 applicants are asked to attend. The open day is used to explain the role(s) of a support worker and applicants are continually assessed during the day’s activities.

The open day is followed by three days pre-employment training.  This gives the applicants a real taste of what the job of a support worker involves, as well as an opportunity for line managers to assess the individual’s suitability for the role.  At the end of programme the applicants are then interviewed. The decision to appoint is taken by the team of people involved in the recruitment process so all the applicant’s behaviours and skills can be taken into account. The interview scores only make up a small percentage of the overall rating, with greater emphasis given to the continual assessment process used at the open day and pre-employment training.

For the first six months the trainees receive a bursary whilst they undergo an intensive development programme that provides them with the key skills required for the role during which they commence a level two apprenticeship programme.  At the end of this period, subject to them passing their workplace competencies, they transfer into a substantive Band 2 position.

Results and next steps

As a result of this innovative recruitment process, a number of successes were achieved:

  • A redesign of the workforce within the maternity services unit resulted in enhancing the potential for delegation of non-midwifery tasks to support workers, releasing midwives to focus on their specialist role
  • The effective pre-employment training, induction and apprenticeship programme meant that support workers were more prepared for their role and as a consequence, drop out rates were lower
  • By using this recruitment method, the trust has noticed a marked difference in ensuring that its workforce reflects the community that it serves
  • The satisfaction rating amongst staff recruited using this method remains high, with many making significant life changes as a result
  • Line managers are supportive of the new process as they see the benefits of recruiting staff based on their attitude rather than simply relying on a short interview. They also like the opportunity to ‘try before you buy’ which the pre-employment placement offers
  • Line managers describe the programme as delivering confident and competent practitioners who are following and upholding standards of care.

Tips for other trusts

  • Board, top management and staff side buy-in for the workforce review is essential
  • Close working with the team(s) involved ensures that you can make progress. You need their support to carry any changes forward
  • Constant communication and honest and frank communication is needed throughout the process
  • Expect some resistance to changes. Restructuring services can result in significant cultural change for some.



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