1.  Ipswich and East Suffolk Maternity Voices Partnership (MVP), is an independent[1]multi-disciplinary advisory and action forum with service users at the centre.

 

2. It both uses a formal committee structure, with written agendas and formal minutes of discussions and decisions, and incorporates the principles and practice of participatory co-design and co-production through regular break-out sessions and small group work in order to ensure that the five principles of MVPs are at the core of the commissioning, monitoring and continuous improvement of maternity services.

 

3.  It is maintained by [insert name or names]Clinical Commissioning Group(s).

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[1]See Guidance on maintaining independence at the end of this document.

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Five principles

4.  An MVP creates and maintains a co-production forum for maternity service users, service user advocates, commissioners, service providers and other strategic partners. Members and the collective forum operate on the following founding five principles:

 

• Work creatively, respectfully and collaboratively to co-produce solutions together.

• Enabling people from diverse communities to have a voice. even when that voice is a whisperWork together as equals, promoting and valuing participation.  Listen to, and seek out, the voices of women, families and carers using maternity services,

• Use experience data and insight as evidence. 

• Understand and work with the interdependency that exists between the experience of staff and positive outcomes for women, families and carers.

• Forensic in the pursuit of continuous quality improvement with a particular focus on closing inequality gaps.  

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Aims and objectives

5. The MVP serves the needs of local women and families and the Local Maternity System, including all acute and community services and community hubs. It links with clinical network(s), to contribute towards and follow regional strategic direction, and links with other MVPs within the LMS to share good practice. 

 

6. The MVP advises the CCG(s) commissioning maternity care on all aspects of maternity services, including:

 

• The Sustainability and Transformation Plan for maternity

• Service specifications for maternity service contracts, performance indicators and maternity quality requirements 

• Progress on implementing the national policy and evidence-based standards and recommendations  

• Lessons from investigations and reviews of maternity services by the Care Quality Commission 

• Involvement of women and their families (patient and public involvement) 

• Configuration of services 

• Quality standards for maternity services and ways of monitoring standards 

• Clinical governance, audit and guidelines for clinical care 

• The consistency in the delivery of maternity services and clinical practice across the district, based on reliable research evidence. 

 

7. The MVP will listen to and act upon women, family and carer feedback at all stages of the commissioning cycle – from needs assessment to contract management.  All members are committed to working in partnership and to implementing woman-centred care. Woman-centred care offers women information, choice, and care based on best available evidence, always respecting their choices and human rights. 

 

8. Mirror clauses, acknowledging the role of the MVP are included in the terms of reference of other groups that consult and receive advice from the MVP including the CCG and Trust boards.  

 

Values

9. The MVP is committed to diversity and equal opportunities and upholds women’s human rights in pregnancy and childbirth.

 

10. The MVP is multidisciplinary, so its members will bring with them different beliefs, values and experience. All these perspectives should be valued and respected. Each member should have an equal opportunity to contribute to the MVP discussion and decision-making process. Care will be taken to enable full participation. For example, it is important to check that the terminology MVP members use is understood by all and clarified if necessary.

 

11. Members are acting in a public service capacity and are expected to adhere to the Nolan principles for conduct in public life.[2]

 

Membership

12. Members will normally be appointed for no less than two years and no more than six years consecutively. CCG(s) will ensure that there is a balance of members from professional and user groups. Members may include:

 

Service users - minimum one third of total core membership                            

 

Core Members                                                    

Service users 

Service user representatives (nominated by voluntary maternity organisations and community groups)

Fathers groups 

Family support workers, peer supporters

Local Healthwatch member 

 

Associate / additional members

User or community workers with specific expertise and experience e.g. disability 

 

Clinical commissioning groups 

 

Core members 

Commissioning manager, or other designated lead person, who acts as the link with the Chair and Vice Chair of the MVP 

  

Associate / additional members

GP commissioner 

Clinical governance manager 

Other expertise as needed

 

Local authority 

Core members 

Public health representative 

Health visitor 

 

Associate / additional members

Clinical governance manager 

Health promotion 

LSA midwifery officer 

Other expertise as needed, e.g. School nurse representative

 

Service Provider

Core members 

Head of midwifery 

Consultant midwife

Consultant obstetrician 

Consultant paediatrician / neonatologist 

Midwife in clinical practice (1 or 2 to cover hospital and community experience) 

Bi-lingual link worker or advocate, where employed locally

General practitioner

 

Associate / additional members

Anaesthetics 

Antenatal screening 

Board level maternity champion(s)/ Non-executive director 

Business management 

Chaplaincy or bereavement service 

Health promotion 

Infant nutrition

Medical / midwifery education 

Neonatal nursing 

Obstetric physiotherapy

PND specialist

Psychiatrist 

Parent education

Radiology 

Sure Start / children’s centre coordinator 

Local authority social services

Director of Children’s Services  

Substance misuse lead

 

13. The core membership will vary according to the local situation. It may also be appropriate to nominate associate / additional members, who receive papers and join subcommittees as appropriate, but will only attend meetings where there are issues of special interest to them. If the MVP covers more than one provider unit, each unit should be represented by at least one senior professional. Other professional and staff group representatives may be agreed between the Trust, so that the committee does not become too large.

 

14. Members of the MVP should liaise with the groups or professions that they represent. This will include regular reporting on the activities of the MVP to their group / colleagues and feedback to the MVP. 

 

15. Out-of-pocket expenses will be payable to service user members. 

 

16. The CCG will pay an allowance to [enter details, e.g. the Chair/Vice-chair/all members of the MVP whose attendance is not covered by their employment salary]. (NB Payment is likely to increase the range of local people willing to participate but may affect entitlement to state benefits and is subject to income tax.)  The CCG will ensure that the Chair’s remuneration reflects the skills, experience and significant time required for the role.[3]

 

17. Members shall be given reasonable access to the CCG and provider unit libraries, to the internet and are encouraged to access NICE guidance and the Cochrane Library online. 

 

18. The officer appointed to service the committee will provide information to members of the committee and identify any training needs that members may have. 

 

Chair 

19. The Chair of the committee will be elected by the membership for a fixed term of up to four years. The start and expected finish date shall be minuted. The Chair should be independent of those directly responsible for commissioning or providing services and normally be a user member. If there is no user member willing to take on the role of chair, the commissioning CCG, in consultation with the committee, will consider who would have an informed, user-focused perspective and be able to take on the role. The Chair should not normally be a practising or recently practising member of a profession directly concerned with providing maternity services, or employed by a trust with whom the commissioning CCG has a contract.  

 

20. Where the Chair is not a user member, a user member should be encouraged to take the role of Vice-chair for a fixed term of up to four years. The start and expected finish date shall be minuted. Sharing the chairing role as a job-share or ‘chair team’ is another way to ensure central service user involvement. The Vice-chair provides essential support the committee Chair.

 

21. In the rare absence of both the Chair and Vice-chair, members shall elect one person to take the chair for the duration of the meeting. 

 

Committee proceedings

22. MVP Meetings will be held at least every three months. All core members have voting rights. Associate members do not have voting rights. 

 

23. A quorum shall be one third of the full core MVP membership, including deputies. 

 

24. The Chair may invite individuals on an ad hoc basis to a meeting for particular items on the agenda. 

 

25. The MVP may set up multi-disciplinary sub-groups that include user members to meet in between MVP meetings either on a regular or an ad hoc basis to work on specific topics and report back to the MVP. These sub groups may co-opt members as appropriate. 

 

26. Proposed amendments to the terms of reference shall be circulated to all members in writing at least two weeks before the meeting at which such amendments are to be considered. 

 

27. The CCG commissioning maternity care will appoint an officer to service the committee and ensure that a CCG lead person acts as the link with the Chair/ Vice-chair of the MVP. A current list of named core members, and the person servicing the committee, will be maintained, with changes agreed and minuted.

 

28. Agenda and papers will normally be circulated one week before each meeting. Any members may ask for items to be included on the agenda. 

 

29. The minutes of meetings will be produced, for approval by the Chair prior to circulation, and circulated within three weeks of the meeting to MVP core and associate members, the chief executives of all relevant CCGs and trusts and be made available to others on request.

 

30. Where a member is unable to attend a meeting he/she will inform the committee secretary of this before the meeting and advise whether a designated deputy will be attending the meeting. The deputy will then have full voting rights. 

 

31. Where a member fails to attend three meetings within a one-year period their membership should be reviewed and, if necessary, a replacement sought. 

 

Annual Programme

32. The MVP will be consulted by the CCG commissioning maternity care on:

 

• proposals for developing or changing services, including the Sustainability and Transformation Plan

• service specifications for maternity services, quality standards and performance indicators

• the Joint Strategic Needs Assessment

• implementing standards and targets 

• priorities for clinical audit 

• specific user involvement, personalisation and choice, and women’s experience initiatives relating to the planning and monitoring of maternity services. 

 

33. The MVP will receive reports from, and advise local provider units on:

 

• the development of their business plans relevant to maternity services 

• any proposals for changing or developing service

• clinical governance, including clinical audit 

• work of the labour ward forum where applicable

• the number and nature of maternity services complaints, and actions arising 

• user surveys, complaints and local maternity statistics 

• user involvement in the planning and monitoring of their maternity services. 

 

34. The MVP will review services with information from sources including: 

 

• community groups, consumer research and quality assurance 

• Care Quality Commission findings, statistics and recommendations 

• clinical audit reports from provider units, regular summaries of comments

• subjects/themes of complaints from service users 

• feedback from maternity services user groups. 

 

 

Annual Report

35. The MVP will produce an annual report that includes:

 

• the work of the MVP over the past year 

• progress on local strategies and targets

• work-plan for the coming year 

• links and connections to Community Hubs and community organisations 

• recommendations to maternity care commissioners

 

36.  It may also include a synopsis of local statistics and services and act as an overview prospectus for local unit(s) and services. 

 

37. The annual report will be circulated by the CCG commissioning maternity care to the trust and CCG boards, and other relevant statutory and non-statutory groups with an interest in maternity services. It will be discussed by the Chair and Vice-chair at a meeting with the chief executive or lead director of the CCG, and with the trust chief executive and/or the board level maternity champion, usually with a senior provider manager present.        

 

Date Terms of Reference last reviewed June 2019

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Guidance on maintaining independence

 

The MVP will be independent and accessible to all sections of the community.[4]It must be seen by women and their partners and families as relevant and reflecting the experiences they have when using maternity services and related community support services. To maintain this independence requires the MVP to listen to the voices in their communities carefully and impartially.

 

Independence of purpose, of voice and of action

The MVP must be able to speak up independently, without fear or favour. The chair, other elected officers, and all members of the committee have a responsibility to maintain this independence. Sometimes this may feel difficult. The MVP must work on both popular and minority causes, with mainstream groups and with marginalised and vulnerable groups in order to serve the whole community. Adequate resources must be provided through arrangements with commissioners, service providers, voluntary organisations, Healthwatch, researchers, and/or consultants to make realistic work plans.  

 

To maintain independence, the MVP must make sure that local people and stakeholders on the MVP are clear about the committee’s independent position, which must not be compromised for any reason. Independence can be undermined by external pressures and conflicting expectations, or if the MVP becomes out of touch with the real concerns of local women and families or fails to take account of high quality evidence.  

 

The principle of presenting lived experiences in an evidence based way is vital. If proposals and presentations are not grounded in local service users’ experiences and formal evidence, the MVP will lack credibility. 

 

If the MVP chair, or a subgroup of the MVP, decides to take on extra commissioned work for the CCG/commissioners or Trust(s), additional to the main workplan for the MVP (the usually annual workplan, which all members have agreed by consensus or by voting, under these terms of reference),  it must be clear, within the project plan agreed with the CCG/commissioners or Trust, how the MVP’s independence will be preserved. For example, that the MVP owns the information collected, has the right to publish any information collected and publish a final report in full. It is important to be clear that an MVP is nota body that can enter into legal contracts – it is an NHS working group/partnership with members from relevant stakeholder groups, including NHS Trust staff, service users, NHS CCG/commissioner and others (see Terms of Reference). While an MVP will settle its annual workplan (collectively, at an MVP meeting) following discussion with the CCG and local Trust(s) as organisations (these bodies have members on the MVP who should facilitate these discussions, supporting the MVP chair), this must not compromise the independence of the group and its freedom to work on topics that the MVP has collectively decided are important in the local context.

 

In order to maintain independence and respect, MVPs:

 

• shall work to the highest levels of transparency and accountability in all activities. Good governance is fundamental.

• must declare and manage conflicts of interest – it can be the public’s perception of a conflict that undermines trust and independence. The MVP must be careful about any political affiliations and seek to maintain political impartiality.  

• must be seen as independent and accessible to all, representing all parts of the community. 

• are subject to oversight by clinical commissioning groups and may need to meet requirements in creating and delivering on its workplan in relation to co-design and co-production , however, any control over budget and activities shall not have undue influence on freedom to set priorities.

• in undertaking additional work (such as agreed time-limited projects), may be at risk of commissioners becoming confused about the MVP’s independence. It is important always to make this independence explicit so as to manage expectations. 

• must not compromise their independence through commercial or provider interests. This does not mean avoiding involvement of independent practitioners or NHS providers. Strong and trusted relationships with a range of stakeholders is vital to having local insight and influence. But any conflicts of interests must be stated and managed to maintain the MVP’s independence and credibility.

• must protect the reputation of MVPs and be respectful of local partners and stakeholders, avoiding inappropriate statements, language or associations which cannot be justified or may be damaging. 

• should attempt to resolve any disputes or misunderstandings locally, minuting all formal meetings. They should seek advice from independent trusted sources such as: peers in other MVPs, Healthwatch England, NCT, Royal Colleges, NHS England, Birthrights, known independent service user advocates or lawyers if any tensions or conflicts cannot be resolved locally.

 

 

Managing conflicts of interest

A conflict of interest involves a conflict between a public duty and a private interest, in which the person’s personal interest, e.g. a commercial interest or opportunity for self-promotion, could improperly influence the performance of their public duties and responsibilities. MVPs should manage any conflicts of interest and seek guidance if necessary. Healthwatch England has produced guidance on Conflicts of Interestand there is guidance available for charities.[5]

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1. See Guidance on maintaining independence at the end of this document.

2. Committee on standards in public life. Guidance: The 7 principles of public life. 
   (May 1995) www.gov.uk/government/publications/the-7-principles-of-public-life/the-7-principles-of-public-life--2

3. NHS England, 2015. Working with our Patient and Public Voice Partners Reimbursing out of pocket expenses and involvement payments. Available at: https://www.england.nhs.uk/wp-content/uploads/2015/05/ppv-expenses-involvment-policy.pdf(Accessed 27 April 2016).

4. This has been adapted from Healthwatch England guidance.  

5. www.gov.uk/guidance/manage-a-conflict-of-interest-in-your-charity

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