Item 8.1.3 for 6 Apr 10 NHSG Consultant NMAHP Report

NHS GRAMPIAN

NMAHP Consultants Report ~ 2009

Contents Page 1. Introduction 2 2. Background 2 3. Clinical/professional leadership 5 4. Expert Practice 9 5. Service and practice development/research and evaluation 11 6. Education and professional development 13 7. Conclusions and Recommendations 15 8. Appendix: List of funding, publications and presentations 18

Authors: June Brown and Tracy Humphrey

With acknowledgement to NHS Grampian NMAHP Consultant colleagues 1. Introduction

The purpose of this report is to review the role of the Nursing, Midwifery and Allied Health Professional (NMAHP) Consultant roles within NHS Grampian towards enhancing the health and health care experiences of the population of Grampian.

This report describes the key achievements and contribution of the NHS Grampian NMAHP Consultants towards the development, governance and delivery of both local and national health services. It reflects the four key performance themes of these posts which are:

 Clinical/professional leadership  Expert practice  Policy and service development, research and evaluation; and  Education and professional development.

The activities reported for each of these themes are not mutually exclusive to others and there is often overlap.

2. Background

Although the Consultant Nursing and Midwifery posts were introduced in Scotland in 1999, NHS Grampian’s first appointments were not until 2005. Since, then a further three nurses and one midwife have secured positions within NHS Grampian. In 2001, “Caring for Scotland – The Strategy for Nursing and Midwifery”, secured the future development of these posts as an opportunity for experienced nurses and midwives to retain a clinically based role, whilst developing their leadership, service development, education and research functions relevant to their field of practice. Consultant NMAHPs are now widely viewed as essential leaders within NHS Scotland and an integral component of the nursing, midwifery and AHP workforce.

2 Now policies and strategies, such as Better Health, Better Care: Action Plan and Modernising Nursing/Healthcare Careers and Midwifery 20/20 are the key drivers for the continued development of such roles.

During 2009, NHS Grampian had seven Consultant NMAHPs (>100 in NHS Scotland) in post, working across the region in various roles and specialist areas.

Name Title Specialty Region Year appointed Lynn Adams Consultant Nurse Cancer Grampian 2005 June Brown Consultant Nurse Learning Disabilities Grampian 2008 Francis Edwards Consultant Nurse Children and Young Peoples Palliative North of 2008 Care Scotland Dr Tracy Consultant Antenatal, intrapartum and postnatal Grampian 2007 Humphrey Midwife care Therese Consultant AHP Stroke Rehabilitation Grampian 2005 Jackson Linda Oldroyd Consultant Nurse Patient safety and experience Grampian 2008 Phyllis Smart Consultant Nurse Child Protection Grampian 2005

Now that Consultant NMAHP posts are well established within NHS Scotland, the Chief Nursing Officer Directorate, the Scottish Government and professional organisations priorities have focused on supporting the consistency and sustainability of these roles across Scotland. In order to achieve this, NHS Education Scotland (NES) launched an initiative in 2005 aimed at preparing aspiring nurses, midwives and AHPs to become Consultants and the Scottish Government are in the process of finalising guidance documents for NHS Boards with regards to the development, selection and appointment of these positions in light of local service needs.

3 2.1 National and Local Priorities for 2009/10

One of the five key strategic objectives of the Scottish government is to sustain and improve the health of the nation by ensuring better, local and faster access to health care. Better Health, Better Care (2007) is a 10 year mutual action plan towards a healthier Scotland by health improvement, tackling health inequalities and improving the quality of care. These are ambitious goals, so supportive policies and implementation plans such as the Early Years Framework (2008), Equally Well (2008) and the Quality Strategy (2010) have also been launched. All of these objectives and frameworks are reflected locally in NHS Grampian’s healthcare priorities and plans (Health Plan 2009/10).

NHS Boards are expected to develop and sustain Consultant NMAHP posts in these areas of strategic priority, as their clinical/professional leadership and expertise in practice, service, research and education are recognised as being essential if we are to deliver a person-centred, safe and effective service. National support for these roles by the Scottish Government and special boards continues through:  an established Scottish NMAHP Consultants Network  Career Frameworks/Pathways (NES, 2009)  Nursing and Midwifery Workforce Development: Towards 20/20 (NES, 2009)  Guidance for NHS Boards (Scottish Government, 2010)

Local support for these posts also exists within NHS Grampian and this includes:  NHS Grampian Consultant NMAHP Forum (supported by the Nurse Director, The Robert Gordon University and University of Aberdeen)  Induction packages for new appointments  Honorary contracts with Higher Education Institution partners

This support needs to be consistent and developed if Consultant NMAHP’s are to be effective in their role and contribute towards improved outcomes and patient pathways/experiences. NHS Grampian must ensure that they also have appropriate line management, a conducive working environment, adequate clerical and

4 professional support. This report contains a summary of activity, related outcomes and achievements for each of the domains of practice.

3. Clinical/Professional Leadership

Translating policy into improved service delivery

All NHS Grampian NMAHP Consultants are involved with local, regional and national groups, often acting as Chair in order to review, develop and influence policy aimed at improving and developing services. Leadership is demonstrated by membership of key professional organisations, numerous committees, working groups and advisory bodies. All NHS Grampian Consultant NMAHPs are members of the Scottish NMAHP Consultant Network.

Examples from practice –

Consultant Midwife  Member of the Royal College of Midwives Consultant Forum which aims to influence, consult and implement maternity services policy consistently across Scotland.  Deputy member of the Maternity Services Action Group (MSAG) [representing Consultant Midwives Forum] responsible for the development and implementation of NHS Scotland maternity services policy and setting priorities.  NHS Grampian lead for Keeping Childbirth Natural & Dynamic, a Scottish Government initiative aimed at implementing maternity services policy into practice, thereby improving services, evidence-based practice and health outcomes and reducing unnecessary interventions during childbirth (2006-2011).  Chair of the NHS Grampian Statutory Supervisor of Midwives Forum. Consultant Nurse ~ Children & Young  Links to Managed Clinical Network sub-groups with common agendas around People's Palliative Care children’s palliative care. Consultant Nurse ~ Patient Safety and  Share the lead for “Better Together,” Scotland’s national patient experience Experience programme.  Lead for Delivering Dignity and Compassion in Care project.

5 Consultant Occupational Therapist ~  Member of the National Advisory Committee for Stroke (NACS) at the Scottish Managed Stroke Network Government – contribution to the development of the national stroke strategy with lead responsibility for several rehabilitation strands.  Member of the Scottish Stroke Care Audit committee – contributing to guiding audit and evaluation of stroke services across Scotland.  Member of the UK College of Occupational Therapists, Specialist Section in Neurological Practice – Stroke forum, guiding clinical service delivery and standards of practice across the UK. Consultant Nurse ~ Cancer  As the designated Lead Cancer Nurse for NHS Grampian, provides professional advice at strategic local, regional and national planning groups for cancer services.  Key nursing contribution at local and regional cancer managed clinical networks, which address gaps in service provision to improve cancer care and treatment.  Member of the Scottish Cancer Nurse Consultant/Lead Nurse Group, which has established links with the SGHD.  Chair of the Aberdeenshire Community Cancer Clinics Steering Group. Consultant Nurse ~ Learning  Chair Scottish Senior Learning Disability Nurse Group with an aim to influence and Disabilities direct the development of learning disability nursing policy in Scotland.  Member of Scottish Government LD Health Check group – developing a national health check tool.  NHS Grampian lead for Equally Well change fund programme in NHS Grampian, a Scottish Government initiative reduce the health inequalities for people with learning disabilities.  Member of the Scottish Health Working group influencing Scottish Government of health matters pertaining to people with learning disabilities. Consultant Nurse ~ Child Protection  Member of Scottish Child Protection and Vulnerable Children Lead Nurse Group- the group contributes and advises on national policy and practice.  Chair of North East of Scotland Child Protection Committee Significant Case Review Portfolio Group that oversees the implementation of reviews in collaboration with lead agencies.

Working Across Boundaries to Improve Services NMAHP Consultants demonstrate collaborative and interagency working across boundaries to improve services and patient care. These include interfaces with other health boards, local authorities, voluntary and private organisations, Scottish Government departments, Higher Education Institutes and NHS Education for Scotland.

6 Examples from practice -

Consultant Midwife  Lead for ‘Pushed for Time’ a local initiative (using the IHI Continuous Improvement Model) introduced in 2009 to improve spontaneous vaginal birth rates and reduce unnecessary intervention in the second stage of labour. This work has been presented at a local and national level and collaborative work is ongoing to support the introduction of this innovation in other NHS Boards within Scotland.  Chair of the North of Scotland Clinical Midwifery Leads Group which aims to standardise practice and improve services across the NHS region.  Work collaboratively with the charities and public/service user groups in Grampian to ensure that the development of maternity services is informed by the public and service users (e.g. National Childbirth Trust).  Lead for NHS Grampian working jointly with the Supporting Aboyne Maternity Group towards the development of a regional ‘Birth Choices’ leaflet for all women to support informed decision-making about place of birth (community charitable funds).  Member of the North of Scotland Maternity Services Group aimed at ensuring a regional strategic development of midwifery services and practice and shared learning.  Clinical lead for midwifery in NHS Grampian which involves working collaboratively with the multidisciplinary team, social services and agencies to provide effective care for women with complex needs. Consultant Nurse ~ Patient Safety and  Lead for safe, effective and patient-centred quality healthcare education. Experience  Manage and lead the feedback service through a modernisation process which will facilitate improved learning from complaints across NHS Grampian.  Lead role for Back to the Floor and sharing learning and good practice.  Share lead for implementation and monitoring of national guidelines and best practice.  eHealth lead for acute sector. Consultant Occupational Therapist ~ Stroke,  Lead AHP & core team member for the Stroke Managed Clinical Network in Grampian, Managed Stroke Network developing the strategic plan for stroke services in Grampian.  Clinical lead for specialist stroke teams in Grampian. Consultant Nurse ~ Cancer  Provides strategic direction and leadership to nurses involved in cancer care across NHS Grampian, and contribute to the development and improvement of cancer services in Grampian, Orkney and Shetland.  Key contribution at local and regional cancer managed clinical networks, which address gaps in service provision to improve cancer care and treatment.  Key role in facilitating joint collaborative working between key stakeholders in

7 challenging environments.  Member of the North of Scotland Cancer Nursing Group aimed at ensuring a consistent approach to nursing developments. Consultant Nurse ~ Children & Young  Visible leadership for the development of Children’s Palliative Care (CPC) for clinical People's Palliative Care staff and management across the North of Scotland.  Lead for Children’s Palliative Care on Living & Dying Well Health Board focus groups.  National lead on the development of an End of Life Pathway for Children & Young People.  Lead for the development of palliative care pathways between acute and community settings, between high dependency units and wards, across statutory and voluntary services.  Consultancy work with New Zealand & Northern Ireland on the ’Scottish Model’ of Children and Young Peoples Palliative Care. Consultant Nurse ~ Child Protection  Member of the North East of Scotland Child Protection Committee –improving interagency working, practice and outcomes for children.  Established the interagency significant case review process to enable reviews to be conducted in collaboration with police, social work, and the Procurator Fiscal.  Provide leadership, strategic direction across all disciplines working within NHS Grampian who have a responsibility for child protection or work directly with children and their families. Consultant Nurse ~ Learning Disabilities  Provide strategic direction and leadership to learning disability nurses across NHS Grampian, and contribute to the development and improvement of learning disability services in Grampian, Orkney and Shetland.  Lead in implementing the learning disability health inequality agenda in Grampian.  Manage and lead the learning disability advisory service in Aberdeen Royal Infirmary.  Professional lead for all learning disability nurses in NHS Grampian.  Clinical Lead for recent QIS Learning Disabilities standards review.

4. Expert Practice

All Consultant NMAHPs in NHS Grampian are committed to providing regular clinical care and expert advice to clinical colleagues. As autonomous practitioners they are responsible for making high level, complex clinical decisions working within multidisciplinary teams across the organisation. They undertake regular 8 clinical Continuing Professional Development where required to maintain and develop skills within their area of clinical practice. They also provide mentorship, action learning, and clinical supervision and work shadowing within their own and wider teams. All NMAHP consultants act as role models and are an expert resource in their area of practice.

Examples of Expert Practice -

Consultant Midwife  Four sessions per week are spent in clinical practice delivering care to women in families, in both hospital and community settings across Grampian, working closely with colleagues making complex decisions about care based on the best available evidence.  Lead health care professional for a caseload of women with complexities, who have chosen midwifery-led care and minimal intervention during childbirth (referrals from obstetricians, midwives, GPs and women).  Provide clinical and statutory supervision to midwives in clinical practice.  Provide expert advice to midwives and the wider multidisciplinary team on the management of women and families during childbirth to provide women-centred care that is safe and effective.  Support the provision of an on-call service for homebirths.  Supervise midwives during their training to become instrumental birth practitioners. Consultant Nurse ~ Patient  Provide expert advice to nurses, midwives and allied health professionals to enable them to use a Safety and Experience range of different methodologies to collect patient experience information for the purpose of improving patient care and outcomes.  Assist service providers to use patient experience information to shape service improvement plans.  Develop a data base of patient experience projects for NHS Grampian.  Provide expertise in the field of patient safety, assisting service providers to identify and address patient safety issues.  Develop quality frameworks which provide assurance of safe and effective care. Consultant Occupational  Provision of regular consultations with AHPs in stroke services for the assessment and Therapist ~ Stroke, Managed rehabilitation of people with complex disability. Stroke Network  Accredited (2009) SMART assessor – for people in minimally conscious states.  Invited expert reviewer for the Australian Journal of Occupational Therapy  Chapter author for ‘Occupational therapy and Stroke’ - publication due 2010  Section author for ‘Head injury – a multi disciplinary approach’ – published 2009  Lead for module development of ‘STARs’; an on-line learning tool for the national stroke core competencies and advancing competencies.

9 Consultant Nurse ~ Cancer  Leads the cancer and palliative care nurse specialist team, both individually and collectively.

 Further development of specialist cancer services, which aims to ensure that all patients with cancer, irrespective of their diagnosis or where they live, have access, where appropriate to a cancer clinical nurse specialist.  Leads the development of new cancer clinical nurse specialists, in collaboration with colleagues – identifies new posts required, develop job descriptions and profiles.  Advice and supports the development of clinical practices and protocols for nurse led cancer services. Consultant Nurse ~ Children  Provide clinical supervision for staff working directly around children’s palliative care and complex & Young People's Palliative cases. Care  Working in partnership with clinical staff and families, enabling children and families to maintain ongoing links with local practitioners, they know and trust.  Working in partnership with staff and service leaders to establish effective management of complex palliative care cases; offering case reviews as well as debriefing after the death of a child.  Promotion of awareness of the ACT pathway and its use through all presentations, locally, regionally and nationally.  Promotion of awareness and utilisation of GIRFEC framework as a tool to implement multi agency assessment in children with palliative care needs. Consultant Nurse ~ Child  Expert advice is provided to professionals within NHS Grampian area. Referrals from partner Protection agencies and NHS staff are critically analysed, assessed and actions taken are documented and communicated effectively.  Regular practice supervision is provided to professionals with a child protection remit within NHS Grampian and informal supervision is provided to named nurses NHS Shetland and NHS Orkney.  A programme of “back to the floor” events provides opportunity to work alongside professionals working directly with child protection cases and facilitates learning.  Contribute to complex child protection cases through attendance to case conference and strategy meetings and work in partnership with lead professionals. Consultant Nurse ~ Learning  Provide expert advice to all healthcare professionals to enable them to use a range of different Disabilities strategies to improve patient care and outcomes.  Provision of assessment to out of area placed patients.  Involvement in complex clinical cases to ensure accessibility to all healthcare services.  Professional supervision of lead learning disability nurses in NHS Grampian and Orkney.  Acts a strategic link between specialist LD services and generic services to maximise the benefits of collaborative approaches.  Carry out a monthly programme of ‘Back to the Floor’ sessions which includes working in all

10 sectors of NHS Grampian with all healthcare practitioners.  Reviewer for QIS on National Learning Disabilities Standards review. 5. Service and Practice Development/Research and Evaluation

Service and practice development are influenced at many levels. NMAHP Consultants are involved in the development of policy and strategy at local and national levels and they are well placed to bring a service perspective to the planning and review of services. They act as a conduit for information between service managers, professional organisations, Special Health Boards, and Scottish Government. They also help to inform practice and service development in the wider UK by attending network meetings with UK colleagues and presenting at conferences. Within their areas of clinical practice they help develop local services, bringing evidence of the need for role and service development as well as change in clinical practice or improving referral and care pathways.

All NMAHP Consultants hold honorary/associate lecturer posts at the University of Aberdeen and Robert Gordon University. They are responsible for transferring scientific knowledge into practice within their own profession and field of practice, and many are involved in key research projects in collaboration with other organisations and Higher Education Institutions (HEIs).

Examples from practice -

Consultant Midwife  Grant-holder on both internal/externally funded clinically focused research projects.  Provide consultancy and work collaboratively with hospital managers and lead clinicians towards the development of a midwife-led intrapartum service at a hospital in Milan, Italy.  Lead on the development of local evidence-based guidelines/protocols for midwifery-led care in all aspects of care and maternity care settings.  Member of the national multidisciplinary team supported by QIS to develop national pathways for maternity care.  Lead for the implementation of the QIS Maternity Care Pathways in NHS Grampian.  Work collaboratively with the wider maternity care team to develop evidence based guidelines for maternity team care for women with complexities to optimise outcomes and reduce unnecessary interventions.

11  Clinical lead and principle investigator for the ‘Evaluation of Aberdeenshire Birth Units and Community Maternity Unit (Aberdeenshire CHP, 2009)’.  Member of the clinical effectiveness team within Aberdeen Maternity Hospital.  Member of Risk Management Committee, Aberdeen Maternity Hospital,  Supervise midwives and obstetricians to undertake local clinical audits/evaluation of maternity care.  Lead on local policy development towards community based maternity care for women and families (e.g. early transfer of care from hospital to community during the postnatal period, NHSG 2009).  Peer reviewer of papers for publication in scientific journals (e.g. Health Expectations). Consultant Nurse ~ Patient  Use incidents and complaints data to inform audit activity, service improvements and learning and Safety and Experience development needs.  Work with clinical governance staff to ensure quality and safety issues identified through clinical practice are identified and addressed. Consultant Occupational  Review of the patient pathway to identify service gaps and priorities including: Therapist ~ Stroke, Managed o Development of a business plan for new 6 bed stroke rehabilitation unit in North Stroke Network Aberdeenshire – opened Jan 2009 o Lead for the audit of early supported discharge service requirement for stroke services, leading to development of an ESD team in Aberdeen City (Oct 2009). o Lead for Moray sub group of Stroke MCN to develop a sustainable stroke unit at Dr Grays hospital  Initiate and lead the development of tele-rehabilitation in NHS Grampian for ‘remote goal setting’ with Fraserburgh Stroke unit  Facilitation of goal setting systems on the three stroke rehabilitation units in NHS Grampian.  Facilitation of ‘accessible’ service for people with communication problems following stroke e.g. aphasia friendly versions of discharge process and goal setting information. This has lead to an MCN policy to provide all new information in accessible formats  Scientific committee member for the UK stroke forum – the largest multi disciplinary research conference in the UK. Chair and organiser of the rehabilitation training day and chair of parallel session on vision and visual rehabilitation – Dec 2009.  Member of the advisory group for the national stroke research network – Database of Research in Stroke Consultant Nurse ~ Learning  Lead on the review of learning disability nurse management services in Aberdeen City and Disabilities Aberdeenshire.  Lead on the development of learning disability nurse advisor service for Aberdeen Royal Infirmary.  Lead on the audit of acute hospital services in Aberdeen Royal Infirmary to support the

12 development of a Learning Disabilities champion scheme.  Audit of QIS Learning Disabilities Best Practice statement within Primary Care undertaken linking into the development of a Primary care Electronic Toolkit to support the delivery of accessible care. Consultant Nurse ~ Cancer  Leads the development of novel nurse-led cancer clinics in community hospitals, in collaboration with colleagues in the acute sector and Aberdeenshire CHP  Drawing on the document Advanced and Specialist Cancer Nursing Practice, and the Scottish Government Advanced Nursing Practice Toolkit, work is being progressed to ensure a consistent approach to the development of roles. This includes the development of core KSFs and job descriptions, job planning and recording data to assist with succession planning.  Member of reference group for NHS Quality in Scotland Best Practice Statement, the Management of Pain in Patients with Cancer (2009)  Led the first two phases of the evaluation of nurse led clinics in community hospitals in Aberdeenshire  Principal Investigator in NHS Grampian for a national research project investigating patients experiences of living with cancer Consultant Nurse ~ Child  In collaboration with Community hospitals implement an assessment tool for use in Minor Injury Protection Units to identify child care or child protection concerns.  Working with mental health service colleagues to establish a child protection working group to raise awareness and support staff training needs.  Establish an internal NHS Grampian process to enable single agency review of adverse child protection event to facilitate learning and inform practice.

6. Education and Professional Development

As previously stated NMAHP Consultants hold honorary/associate lecturer posts with both University of Aberdeen and Robert Gordon University supporting the delivery of pre and post registration education. Consultant NMAHPs are involved in the development and validation of pre-registration curriculum’s and postgraduate education programmes, ensuring that they are fit for purpose and meet the needs of the profession and service.

13 Examples from practice -

Consultant Midwife  Responsible for working closely with management, professional development and educational colleagues to identify the training needs of midwives in NHS Grampian.  Provide clinical and academic supervision for midwives undertaking post-registration education programmes (MSc).  Scientific advisor for midwives nurses and midwives doctorate students at the University of Aberdeen.  Member of the short life working group at NES responsible for the development of a Clinical Academic Career Pathway and supportive guidance/papers.  Involved in the provision of training for students, midwives and the wider multidisciplinary training within NHS Grampian (e.g. management of second stage of labour, waterbirth etc). Consultant Nurse ~ Patient  Lead the organisation in delivering an education framework which addresses quality and safety Safety and Experience issues including risk, clinical governance, patient safety and clinical effectiveness.  Work with the universities to ensure that patient safety education is embedded in the under- graduate curricula of all pre-registration health professionals.  Provide patient safety education to registered health professionals  Provide patient safety education to university staff. Consultant Occupational  Provide training for post graduate skills based learning courses – neurological rehabilitation across Therapist ~ Stroke, Managed the UK and internationally. Stroke Network  Provision of a ‘Masterclass’ for the College of Occupational Therapists – on ‘Apraxia following Stroke’  Member of the School Review Board for the School of Health Sciences, The Robert Gordon University (including the dept of OT). Consultant Nurse ~ Cancer  Key contributor to university academic programme boards and committees, and NHS Education for Scotland to ensure that degrees, diplomas and short courses, and professional development programmes meet the needs of cancer services.  Implementation of NHS Education for Scotland, Cancer Professional Development Frameworks.  Member of the Editorial Board, European Journal of Cancer Consultant Nurse ~ Children  Promoting an understanding of the issues around children’s palliative care through direct teaching & Young People's Palliative sessions across all professions and services, including meeting and working with the Living & Care Dying Well Care Education champions within the 5 regional health boards. Consultant Nurse ~ Child  Undertaking Clinical Doctorate of Nursing at University of Stirling, research continues to develop Protection understanding a therapeutic commitment theory.  Responsible for ensuring learning disability awareness education in available in NHS Grampian.

14  Professional Advisor at RGU on Learning Disabilities  Audit of acute hospital services completed  Audit of QIS Learning Disabilities Best Practice statement within Primary Care. Consultant Nurse ~ Learning  Undertaking Clinical Doctorate of Nursing at University of Stirling, research continues to develop Disabilities understanding a therapeutic commitment theory.  Responsible for ensuring learning disability awareness education in available in NHS Grampian.  Professional Advisor at RGU on Learning Disabilities  Delivering a programme of education to generic healthcare staff on learning disability issues within all sectors of NHS Grampian.  Clinical coach for Early Clinical Careers fellow.

7. Conclusions and Recommendations

7.1 Clinical/professional leadership Consultant NMAHPs are key contributors to professional committees, working groups and networks at local as well as a national level. Using effective communication and leadership skills, NMAHP Consultants challenge, motivate and inspire colleagues within their professional group or area of expertise, as well as other disciplines and agencies to work collaboratively to provide high quality care that is safe and effective.

With their knowledge and expertise of clinical practice and the effective processing of complex information and evidence, Consultant NMAHPs make informed contributions to the strategic planning of services and change management.

Challenges: 1. Balancing the contribution and commitment made to both local and national groups. 2. Ensuring visibility at both local and national level. 3. Ensuring that group membership is productive and effective. 4. Managing the workload that occurs as being part of action groups.

15 Recommendations: 1. Continuing to work as a Consultant NMAHP group to ensure representation at regional and national forums. 2. Review committee and group membership with line manager and professional lead annually. 3. Consultant NMAHPs should provide mentorship to those newly appointed or aspiring NMAHP Consultants.

7.2 Expert Practice Expert practice is a key element of the Consultant NMAHP role and within NHS Grampian all involved in the provision of clinical care within their field of practice. Their clinical commitment is directly relevant and related to specific areas of practice/service that are being developed.

Challenges: 1. Remaining non-operational and maintaining a strategic and clinical role. 2. When managing a clinical caseload it is difficult to provide suitable cover for Consultant NMAHP at this level of practice. Recommendations: 1. NHS Grampian should have a robust programme of induction for newly appointed Consultant NMAHPs that clearly demonstrates preparation of the organisation for these roles. 2. Realistic work plans should be agreed between Consultant NMAHPs and their line managers and professional lead for existing and new post holders. 3. This aspect of the role needs to be thoughtfully considered when new NMAHP roles emerge through service re-design/development.

7.3 Service and practice development/research and evaluation Consultant NMAHPs not only influence local and national policy at a strategic level, but they also direct practice and service improvement. They should be able to provide evidence about the impact of change or the need for change by leading or contributing to research and evaluation. However, this can often be the most challenging aspect of the role and requires the most support.

16 Regular meetings are being held between these HEIs, clinical managers/leads and strategic leads towards developing research agendas and ensuring that Consultant NMAHPs have access to research/evaluation training and support.

Challenges: 1. Prioritising and accessing research/evaluation opportunities, training and support. Recommendations: 1. Ensure that work plans for Consultant NMAHPs include dedicated time for training and development. 2. Ensure work plans for Consultant NMAHPs include dedicated time for work relating to research/evaluation.

7.4 Education and professional development Within the last year, all Consultant NMAHPs have secured honorary contracts with both the University of Aberdeen and The Robert Gordon University and are contributing to the delivery of pre and post registration education programmes, including the supervision of postgraduate dissertations. They are working closely with these HEIs to ensure that education programmes meet service/training needs, and towards ensuring that education and clinical environments promote positive learning to improve patient care and experiences. Some Consultant NMAHPs are being supported by one of the HEIs towards achieving a formal teaching qualification.

Challenges: 1. Ensuring that the organisations and individuals have realistic expectations about the contributions Consultant NMAHPs can make towards the delivery of HEI education programmes. 2. Ensuring that Consultant NMAHPs contribution towards HEI education programmes is recognised and appropriate. Recommendations: 1. Consultant NMAHP forum should discuss and consider the need for Consultant NMAHPs to have a formal qualification in academic teaching.

17 8. Appendix: List of funding, publications and presentations

Consultant Midwife Funding Tucker, J. Farmer, J. Humphrey, T. Smith, N. Fitzmaurice, A. (Grant-holder) Powell, R. “Psychological wellbeing and social support in hospitalised women in the perinatal period: a prospective urban/rural comparison.” Chief Scientist Office (CSO), Scottish Government Health Department (Sept 2007 – October 2009: £105,319) Entwistle, V. Humphrey, T. Tucker, J. Whitford, H. (Grant-holder) “How is patient-centred care affected by giving women the opportunity to write in hand-held healthcare notes? A qualitative investigation” CSO, Scottish Government Health Department (Sept 2009 – May 2011: £105,319) [University of Aberdeen & Dundee] Tucker, T. Humphrey, T. Crichton, L. Powell, A. (Grant-holder) “Mode of birth after caesarean section: preparatory phase for the implementation of a quality improvement initiative in speciality practice in Scotland (MODEL 1). CSO, Scottish Government Health Department (2009-2010; £92,172) Publications Humphrey, T, Tucker, J.S, Rising Rates of Induction of Labour: Exploring the determinants of induction of labour. Journal of Public Health; 31(1): 88-94 (2009) Humphrey T, De Labrusse C, Tucker J, Women’s contribution to co-constructed hand-held maternity records: Mapping content to theory in patient-centred care. International Forum on Quality and Safety in Health Care (Abstract, International Forum of Quality and Safety of Health Care Conference, 2009). Presentations (Local, National & International) Humphrey, T. “Co-constructed hand-held maternity records: Mapping content to theory in patient-centred care.” British Medical Journal Quality & Safety in Health Care Conference, Berlin; March, 2009 [oral presentation] Humphrey, T. “Midwife-led intrapartum services in Scotland.” Milan; Sept, 2009 [oral presentation]. Humphrey, T. “Women’s contributions to co-constructed hand-held maternity records: Mapping content to theory in patient-centred care.” NHS Grampian R&D Endowment Fund Presentations; Nov 2009 [oral and poster presentation]. Humphrey, T. “Keeping Childbirth Natural and Dynamic: National and Local Perspectives.” Royal College of Midwives, Harriet Watt University, Edinburgh; Nov 2009 [oral presentation]. Humphrey, T “Clinical Academic Careers.” NHS Education Scotland, Crieff Hydro, Crieff; Nov 2009 [oral presentation]

18 Consultant Nurse ~ Patient Key Presentations Safety and Experience Oldroyd, L.“Patient Safety in Scotland" Satakunta University of Applied Sciences,Faculty of Social Services and Health Care, Pori, Finland, Nov 09 [oral presentation] Consultant Occupational Publications Therapist ~ Stroke, Managed  Whitfield et al ‘Head Injury’. Two sections on Occupational Therapy for Brain Injury, and ‘Goal Stroke Network Directed Rehabilitation’ 2009. Key presentations  Leadership of the Profession - College of Occupational Therapists , leadership seminar series, Sept 2009.  Development of the Consultant Occupational Therapist role & key impacts – College of Occupational Therapists, Annual Conference, Brighton, June 2009 Consultant Nurse ~ Cancer Key Presentations  Development of nurse-led, cancer follow-up clinics in community hospitals; European Cancer Conference, Berlin  Better Cancer Care in Scotland, United Kingdom Oncology Nursing Society/British Oncology Pharmacists Association Joint Conference, Brighton. Consultant Nurse ~ Children Key Presentations & Young People's Palliative  Association of Chief Children’s Nurses’ in the UK Care  International World Congress on Children’s Palliative care in Cape Town (2009)  United Nations Panel for ICPCN – Speaking about the Scottish Model & work been done in Scotland in addressing children’s palliative care  CATSCAN Conference – Edinburgh Consultant Nurse ~ Learning Presentations (Local &National) Disabilities Brown, J. “Therapeutic Commitment”, 26th Annual National Network of Learning Disability Nurses Conference, Robinson College, Cambridge University, Cambridge, June 2009 [oral presentation]. Brown, J. “Ensuring inclusion – a joint working approach”, Anticipatory Care – Moving across Scotland Conference, NHS Scotland, Hilton Hotel Glasgow, June 2009 [oral presentation]. Brown, J. “Learning Disability Consultant Nurse Role”, NEATH Network, Atholl Hotel, Aberdeen, November 2009 [oral presentation]. Brown, J. “ Supporting people with learning disabilities in general healthcare services” East of Scotland Learning Disabilities Network, West Park Conference Centre, University of Dundee, November 2009 [oral presentation].