The Early History of Birthrate Plus®
We are often asked about how Birthrate Plus® was originally designed and how it developed. To find out more we interviewed the methodology’s original founder Jean Ball, MSC, RN, RM.
Q: Jean, could you tell us how you originally became interested in NHS workforce planning?
A: My interest in workforce planning began when I was appointed as a Research Nurse to complete and apply what was then the NHS Northern Region’s nursing Workforce Planning Project (WFP). This was in 1983. The work was published the following year. I was then appointed as a Senior Research Nurse at the Lincolnshire North Health Authority to continue to apply the WFP. Whilst our focus remained nursing we began to get more and more requests to apply the methodology elsewhere. In 1988 I was appointed Senior Fellow at the Nuffield Institute for Health Service Studies, based at the University of Leeds. Here I was joined by and worked with Keith Hurst, who provided the basis for what is now the Safer Nursing Care Tool.
Q: When did you start considering safe staffing in maternity services?
A: During my time in Lincoln I met with colleagues from the local Royal College of Midwives. I wanted to assess their opinions on measuring labour ward workforce needs. This project was aided by the Short Report of 1980 which advised that the minimum staffing ratio for labour was that of one-to-one care throughout labour and delivery. I designed an initial methodology which was tested by midwives in Lincoln and a researcher. From there the methodology was applied more extensively across the Trent Region, which is when I first met Marie Washbrook. Marie and I began to work together to help services use the methodology.
From the start we wanted to ensure that the methodology was open to scrutiny and external validation. We did that through presentations at conferences and peer reviewed publications (see further reading below).
Q: How has Birthrate Plus® developed since the early days?
A: The original focus was on intrapartum care but as a result of working with a growing number of services, Marie and I developed a method of assessing hospital workload for antenatal care and postnatal wards, as well as for home births. In the early 1990s we started to use the name “Birthrate Plus®” and in 1996 Marie and I jointly published a book describing our approach (published by Books for Midwives/Elsevier Press).
We also published a number of articles in the British Journal of Midwifery explaining the issues we encountered with services as we deployed Birthrate Plus®. For example, one significant issue was the impact on staffing related to the fact that many a woman may have been booked for care in one health service, but is transferred to another for care, either in the ante-natal period and/ or labour. We developed the methodology to account for this.
A particularly significant development occurred in 2009 when Marie was invited to work with the maternity services of New South Wales, Australia where Birthrate Plus® is now firmly established. We are also used by services in Tasmania. Marie’s work in Australia showed that the methodology could be applied, with amendments, to assist workforce planning outside of the U.K. In 2000 I was contacted by Beijing University as part of a research project they were undertaking looking at staffing levels in maternity services in China, and Marie is currently supporting a senior midwifery researcher in Holland to apply Birthrate Plus® there.
Of course, the most important development was in 2015 when NICE endorsed Birthrate Plus®.
Q: Any final comments?
A: It is fantastic to see how many services now use Birthrate Plus®. It has come such a long way since I started looking at workforce planning in the 1980s. It is incredible to think that all this has been the result of the work of two midwives, supported, of course, by service colleagues and others like the professional bodies.
Below is the list of publications in which Jean and Marie set out the rationale and development of Birthrate Plus®.
Ball J A (1993). Workload measurement in midwifery In: Alexander J, Levy V, Roch S (Eds) MIdwifery Practice; A Research-Based Approach, Basingstoke, Macmillan
Ball J.A. & Washbrook M; (1996). Birthrate Plus; A Framework for Workforce Planning and Decision Making for Midwifery Services. Books for Midwives Press/ Elsevier Press.
Ball J A, Bennett B, Washbrook M, Webster F, (2003). Birthrate Plus Programme: a basis for staffing standards? British Journal of Midwifery: Vol11, no. 5 pp 264-266 May 2003
Ball J A, Bennett B, Washbrook M, Webster F, (2003). Birthrate Plus Programme: Factors affecting staffing ratios British Journal of Midwifery: Vol11, no. 6 pp 357-361 June 2003
Ball J A, Bennett B, Washbrook M, Webster F, (2003). Birthrate Plus Programme: Further issues in deciding staffing needs British Journal of Midwifery: Vol 11, no. 7 pp 416-419 July 2003
Ball J A and Washbrook M, (2010). Workforce Planning in Midwifery: an Overview of Eight Years British Journal of Midwifery: Vol 18 No 8 pp527-532 August 2010
Ball J A and Washbrook M, (2010). Birthrate Plus: Using Ratios for Workforce Planning British Journal of Midwifery: Vol 18 No 11 pp724-730 November 2010
Ball J A and Washbrook M, (2010) Developing a real-time Assessment of Staffing Needs in Delivery suites. British Journal of Midwifery: Vol 18 No 12 pp780-785 December 2010
Ball J A and Washbrook M, (2013). Working with Birthrate Plus® ; Birthrate Plus Consultancy and the RCM 2013