birthrate plus
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Birthrate Plus. More than just a number. What is it and who can use it?. National tool that for any given maternity service calculates the number of clinically active midwives required to deliver a safe high quality service - PowerPoint PPT PresentationTRANSCRIPT
Birthrate Plus
More than just a number
What is it and who can use it?• National tool that for any given maternity service
calculates the number of clinically active midwives required to deliver a safe high quality service– Individual trusts use it to determine their own staffing
needs (individual ratio)– Regions or areas use it for workforce planning,
commissioning student numbers (aggregate ratio)– National orgs (DH, RCM) use it to make broad
statements about supply and demand (overall ratio)
So simply?
Number of births_______________
Number of midwives
1.Using BR+ in an individual unit
• Quantify all activity – how many births, how much antenatal care/postnatal care, how many home births how much additional work: inductions, women not in established labour
• Distinguish work involved – 5 point categorisation from normal/healthy “simple” maternity care to high risk/complex high degree of support and intervention
• Collect data over agreed period usually 4/6 months• Data analysis makes allowance for time lost (travel, sickness, leave etc)
Translating labour ward workload into midwifery hours
category % of av casemix
Av hours in delivery
Midwifery input during labour
Total midwifery time required
I 10.9% 6.6 HRS 1 wte mw: 1 woman 6.6hrs
II 22.4% 7.4 HRS 1 wte mw: 1 woman 7.4hrsIII 17.3% 9.4 HRS 1.2 wte mw: 1 woman 11.3hrs
IV 25.9% 10. 7HRS 1.3 wte mws: 1 woman 13.9hrs
V 23.5% 16.4 HRS 1.4 wte mws: 1 woman 22.9hrs
Cat X 122.4% 1 hr. 1 hr.Cat 1A 11% 4 hr. 4 hr.Cat A2 3% 15 hr. 15 hr.Cat R 1.5% 6 hr. 6 hr.Prostin 33% 2.5hr 2.5 hr.Transfers 0.5% 8 hr. 8 hr.
Example: St Anywhere Trust – 5,200 Women: Labour Ward Workloadcategory % of
casemixNumber in case mix
Av hours in delivery
Mw input Mw time required
Total Mw hrs..
I 10.9% 567 6.6 1:1 6.6 3,742
II 22.4% 1165 7.4 1:1 7.4 8,621
III 899 900 9.4 1.2:1 11.3 10,159
IV 25.9% 1347 10.7 1.3:1 13.9 18,723
V 23.5% 1222 16.4 1.4:1 22.9 27,983
Cat X 122.4% 6,344 1 hr. 6,344
Cat A1 11% 572 4 hr. 2,288
Cat A2 3% 156 15 hr. 2,340
Cat R 1.5% 78 6 hr. 468
Prostin 33% 1716 2.5 hr. 4290
Transfer 0.5% 26 8 hr. 208
85,166 hrs..
Assessing staffing needs in all other aspects of midwifery care
• Hospital: antenatal clinics, antenatal admissions, triage, day care postnatal inpatient stays
• Community: antenatal care, parentcraft education, postnatal care
• Methodology: Expert Group/Professional Judgement
Example: St Anywhere’s community workload for 5200 deliveries
Community services
Agreed hrs.. per woman
St Highbury
Booking visit 2 hrs.. 10,400
Antenatal and parentcraft
5.5 hrs.. 28,600
Postnatal care - simple
5 hrs.. (3120) 15,600
Postnatal care complex
8 hrs.. (2080) 16,640
Home births 17 hrs.. (78) 1326
Example: St Anywhere’s additional hospital workload
Community services
Agreed hrs.. per woman
St Highbury
Antenatal clinics Locally determined
Day units Locally determined
Ward admissions 3hrs, 6 hrs. or 15 hrs.
Postnatal wards routine
4hrs or 6 hrs.
Postnatal wards complex
17 hrs. or 24 hrs.
More……..
What’s in & outIn Birthrate+ Calculation Out Birthrate+ Calculation
All wte clinical midwives wherever they work
Non clinical midwifery roles such as managers, clinical governance/risk mws, % of specialist mw or consultant mw time NOT in direct care of women(add 8-10% of midwifery posts)
Clinical midwives admin time – allow 5% MSWs(lose 10-15% of midwifery posts
Clinical midwives travel time – allow 15-20%
Annual Leave, sickness and study leave etc – allow 17.5-25%
Cross border flows, ie women who receive antenatal/postnatal care in 1 trust but deliver in another
Result: An individual ratio• Ratio is expressed as midwife to births• Could be anywhere in the range 1:27 – 1:32
THIS IS ONLY CLINICAL MIDWIVES• Depending on
– Split between high/low risk women– Amount of time given to travel and other
variables– Cross border activity ie antenatal/ postnatal care to women not counted as births
Local decisions using ratio• How many additional non-clinical midwives
(usually between 8-10%)• How many midwives can be replaced by
MSWs (usually between 10-15%)• How to deploy midwives – staffing and
service models
THIS WILL DETERMINE HOW MANY ACTUAL MIDWIVES ARE EMPLOYED
2. Using BR+ at a regional/planning level – desk top exercise
• For hospital activity only– Tertiary services 1:38– DGH with >50% in cat IV & V 1:42– DGH with <50% in cat IV & V 1:45– Homebirths & MLUs 1:35
• For community activity only– Antenatal/postnatal 1:96
Example: Smallcity TrustWengerville Trust is a medium size obstetric unit with a small free standing midwifery unit. There is a neighbouring Trust nearby and in consequence there is some cross border movement of women
OU FMUBirths to local residents 4669 births 274
Home births 179 Number of women booked who deliver elsewhere
420
Number of women booked who deliver elsewhere
435
Number of women from outside the area
394
TOTAL BIRTH ACTIVITY 5060 274
TOTAL COMMUNITY ACTIVITY 5101 694
Calculating Staffing Using Differentiated Ratios
NUMBER OF BIRTHS
RATIO APPLIED WTE STAFFING
Obstetric unit births 5060 1:42 120.47
Obstetric unit home births
179 1:35 5.11
Obstetric unit community cases
5101 1:96 53.13
Sub total 178.71
FMU births 274 1:35 8.33
FMU community 420 1:96 4.37
Sub total 12.7
TOTAL 191.41 wte
How do you express that?
• 191.41 wte is a ratio of 1:27.8 across all BIRTHS
• In the OU the ratio is 1:28.3 across BIRTHS but 1:28.5 across all activity
• In the FMU the ratio is 1:21.5 across BIRTHS but 1:55 across all activity
The amount of antenatal/postnatal care is a significant part of the story
Planning midwife numbers• Desk top review easily identifies number of midwives
required in each trust• More robust than simply applying 1 national ratio• Local decisions about management time and MSWs• Compare requirements with actual staff in post• Develop plans for moving from here to there• Factor in vacancy rates, retirement predications, local
churn• Determine number of student midwife commissions required to move from here to there
Safety when BR+ is not met?• How many women get 1 to 1 care in labour?• What % of women are booked by 10/40?• What degree of continuity do women receive
antenatally and postnatally?• Is there a supernumerary ward coordinator on
every shift?• What specialist roles are funded?• How many non-clinical midwifery roles are
funded?• What are levels of vacancy, turn-over, staff
morale and sickness?
3. Using BR+ at a national level
ASSUMPTIONS?• Average ratio around the country 1:29.5• Birth rate in England around 700,000• Around 96% births in OU• Around 8% additional non-clinical midwives
required• Around 10-15% of clinical midwifery posts can be replaced by MSWs
Translates into ?BR+ 2013 Data Assumptions
672,000 births at 1:29.5 22,780 plus
28,000 at 1:35 800 plus
23,580 clinical midwives required (skill mix of 10% MSWs 2358)
additional 8% non clinical posts 1887
Total midwifery workforce 25,467Midwives in post c21,000Current Shortages 4,300
Issues going forward• National overall ratio changes over time
– Are we going with 1:28, 1;29, 1:29.5?• Professional consensus on time for community
activity probably needs review• Professional consensus on MSW time definitely
needs review• How do we draw attention to the implications of
NOT staffing at BR+ recommended ratio?• As birth rate goes down will need for midwives?
– Not if you take into account increasing complexity
Download a copy of the tool
http://www.rcm.org.uk/college/policy-practice/joint-statements-and-reports/