I felt honoured and inspired when I read Mary Newburn’s article in the March 2017 edition of MIDIRS Women changing maternity services. A look at service user involvement in the UK. It’s a love letter to a movement with a long history, an active present, and an important contribution to make to Better Births implementation.
It is so easy, as we know in the MSLC and now Maternity Voices Partnerships (MVP) movement, for there to be confusion between engagement (focus groups and similar), and real involvement. We experience – or work for! – real and sustainable involvement in multidisciplinary forums. Local partnership groups, in which service users serve in equality with other members. In which recent service users are mentored by their peers to stay and become advocates and leaders.
Our vision of equity of access to involvement, to public service, is built on the vision that is enacted in the continuing practice of ‘walking the patch’ by established MVPs/MSLCs (an activity which we encourage fledgling MVPs/MSLCs to begin as a ‘place to start work’). There is much still to do, of course.
Looking ahead to the eagerly-awaited commissioning guidance from NHS England for Local Maternity Systems on service user involvement, we need:
- clarity in the guidance – our long experience is that commissioners do not act where there is confusion
- a hub and spoke model – local, accessible MVPs sending their chairs to a regional MVP in each STP/LMS area (both local and regional strategic involvement)
- funding – we know from long experience that sustainable involvement needs fair funding
- clarity that a local MVP is not only a local co-design group:
- the service user chair is appointed to a local public service role, with an honorarium, and works to Nolan principles
- equality of service user, healthcare professional, commissioner and other members under the terms of reference
- an expectation that the group not only monitors service user feedback, but conducts outreach and co-design
- an expectation – this is key – that the group has a role in local governance: monitoring anonymised complaints, and also maternity service data. Because this matters of itself – this is involvement (see page 30) – and because it affords to the group real status
And, since I ask for clarity, let’s be clear why: power in maternity is with the labour ward matron, the obstetric lead, the community matron, the labour ward coordinator – and the further that ‘discussion’ about women’s experiences, and good practice, is away from the clinic and birthing room, the more purely aspirational it is.
A national position statement shared with NHS England by National Maternity Voices (see below) in January included these points – the signatories, MSLC chairs and service user reps from around the country.
Changing things depends on local MVP chairs and lead reps with a bit of status, in a public service framework (that frames their behaviour too), building and working local relationships. Among these local leaders in involvement there is experience of offering informal advice locally to senior maternity professionals – obstetricians as well as midwives – as well as commissioners, on the basis of earned respect. Acting as a sounding board at times, or providing contacts, to help with exploring quality improvement ideas, including associated engagement and involvement work.
I came into maternity work as a woman with a baby in her arms. I stayed to become a long -time mslc rep, a maternity advocate who became an antenatal teacher, a NICE lay member, an LSA auditor, an RCOG lay co-assessor, and a NICE Fellow, along the way. It isn’t always fashionable for service users to say so, but in the MVP/MSLC movement we know the territory: the immediate experience last week, and the long view. MSLCs have not always been popular, even when effective, possibly because effective. I see and experience this movement as values-based: woman-centred and family focused. Recognising the human rights issues in birth. Respecting professional expertise. Evidence-based in approach to service design and information-provision. Valuing questions and debate. Women, professionals and commissioners together – it is an idea with such potential.
I think Bill Kirkup and his team recognised the value of this idea when they made recommendation 13 of the Morecambe Bay Report, that the local MSLC should monitor complaints as part of strengthening involvement locally – well-developed MSLCs review complaint numbers and anonymised complaints at their formal meetings.
I think also of recommendation 1.1.17 of NICE CG190. Governance involving women as service users surely is something on which commissioners – whether at STP level or in CCGs – need clear guidance.
1.1.17 Commissioners and providers should ensure that there are multidisciplinary clinical governance structures in place to enable the oversight of all birth settings. These structures should include, as a minimum, midwifery (including a supervisor of midwives), obstetric, anaesthetic and neonatal expertise, and adequately supported user representation. 
When Julia Cumberlege made the call for everyone to ‘Get on with it – don’t wait – go implement’, before Better Births was published, we in the MVP/MSLC movement already were, and we responded with renewed energy and enthusiasm. Building on decades of experience. Adapting. Changing. Willing to be ‘new.’ Anticipating being understood, valued, listened to.
National Maternity Voices (the new name for the ‘England’ group in the well-established forum for MVP/MSLC service user chairs, which provides support and mentoring to MVP/MSLC service user reps too) is about #collaborativeworking – making involvement fun, clearly (quietly but clearly) values-based, sustainable – and truly accessible. I could cite references on the need to broaden involvement, but one would rather be able to continue to focus on just doing it. So, looking forward to clear commissioning guidance that will enable us to do that.
And we have someone doing a bit of work on the NMV website – news of that very soon…