Stepping up to public health.

MIDWIFERY 2020 outlined several key messages around the public health (PH) role of the midwife. Their ‘unique contribution to public health is that they work with women... throughout pregnancy, birth... and into the first weeks of family life’, hence, they have a vital role to play in ‘improving health and social wellbeing for all women’ (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010: 26). In many instances, midwives’ input and involvement in meeting the PH agenda is not acknowledged. Five high-level priorities were outlined by Public Health England (PHE) in 2013, none of which referred to the midwife: ‘Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the troubled families programme’ (PHE, 2013: 3). Midwives are normally the lead professionals at the start of life and thus should be acknowledged as playing a crucial role in ensuring that women and their families benefit from essential PH messages from the outset. However, the document does advocate for the development of a new PH model for midwives. In response and in recognition of Action Area 1 of the NHS England Compassion in practice: implementation plans that advocate developing a new heath role for midwives, the RCM submitted a proposal to the Department of Health (DH) in England to undertake a study exploring midwives’ and MSWs’ knowledge of, and involvement in, the PH agenda. Findings from both studies informed the development of the online audit/questionnaire, which was rolled out to RCM members. Although the focus was on members across England, the views of others, including health visitors, across all four countries were taken into consideration. Overall 2242 responses were received, which yielded a large quantity of additional significant data. Seven themes were generated: ● Time constraints ● Timing – optimum time for delivery of information to women and their families ● Communication – relaying sensitive information and asking difficult questions ● Continuity of carer – ensuring consistent, individualised care ● Education – training needs for midwives, MSWs and students ● Method of conveying information ● Importance of specialist services. Following analysis and theming of the qualitative and quantitative data, a think tank involving key stakeholders was convened to validate the findings. The group considered methods for interpretation and development of a model. Findings from all studies and events were used to create a robust and useable model for maternity services in England, titled ‘Stepping up to public health’. Two models have been generated – one for women and families, and the other for midwives and MSWs. They are closely aligned to demonstrate how practitioners can work together to achieve the recommendations and ensure a seamless journey for women and families. Innovative components of the model include: