Today, today has been declared an ‘I have no intention of doing anything that I don’t want to do’ day. Yes, I will be working on 2 databases but that is my choice, sort of, because if I don’t get on with them I will look a right idiot on Monday when I have to present the results of an audit. They are work but there is not enough time to do them during work hours and staying late at work would not help with the production of these beasties because, if you are seen then people feel they have to interupt you, plus it prompts them to dump more c**p at your door. Strange mentality in the NHS, perhaps everywhere, I don’t know. If I noticed someone having to work late, and over their hours, to complete a job then I would acknowledge that they had too much work. I may not be able to substantially reduce it, but I would definitely not go giving them more to do, where I work the opposite appears to be the case.

Work. The cut-backs continue, the unhappiness of the midwives and the women increases. We have just passed through a huge baby influx and it appears we should be back to normal levels until December when there is another little blip. May/June next year are bumper months which was unfortunate as the booking of these women co-incided with the bumper crop of newborns, making a double whammy for community midwives. I’ve had a couple of exciting call-outs requiring me to accompany women on blue-light transfers. In both cases the women were not in danger but the transfers were in the rush hour so 2′s and blues were used to reduce delay. One woman had rocked up at the wrong place in quite advanced labour and had received no antenatal care at all, was newly arrived from an African country and spoke no English. The other had turned up at a clinic, having taken her own discharge from hospital 2 days previously, and her blood pressure was through the roof. With the first lady I saw very little of the journey as halfway to the obstetric unit she started to make the sounds you associate with pushing so I was kneeling on the floor next to her trying to convince her with body language that she should breathe, breathe. I was also sliding up and down the ambulance as it braked for which I bore the bruises for quite some time, but which did make her laugh between contractions. As I was safely strapped in with the second transfer I had a wonderful view of the ‘Moses’ effect i.e two streams of traffic parting to allow the ambulance through. I also witnessed how stupid some drivers are, one even trying to outrun the ambulance, the paramedic told me that is not unusual. Unbelievable!

Work, job number 2. The job is thought provoking and challenging, however my dealings with HR and payroll have been even more thought-proking and challenging. After 3 months of being relaxed about not being paid, no contract etc. I lost my calm, laid back demenour and went for the throat. I have recollections of uttering such blasphemies as ‘grievance’, ‘union’ and then the ultimate ‘I’m stressed’. It does seem to have worked in that I received lots of back pay 2 weeks ago, I eagerly await the 24th of this month. Who is behind this bungle? A totally US manager, even more US than my other manager, in fact so US that my community manager is now beginning to take on the mantle of the most amazing manager, ever.

Home. Well Hubby had to be carried off the golf course after resurrecting his old back problem. He was in agony and was unable to feel anything down one leg, from his buttock to his little toe. G.P? Anti-inflammatories, this was a phone-call trige because there were no appointments and it wasn’t considered urgent. 4 appointments later, when I dutifully waited outside, and 7 weeks later, I marched into the consulting room with my drop-footed, unable to walk properly husband and waited until the G.P had told my husband it ‘would take time’, and ‘at your age’ (58) whilst staring intently at his computer screen, not even shifting his gaze when husband demonstrated the extent of his ‘dead’ leg, then I waded in. ‘What’s the diagnosis then?’ Still not looking away from the screen the doc responded with ‘Well, it’s possibly the same as he had before’. ‘Sure of that are you? Are you not concerned that previously the symptoms were not as severe but that he did require surgery?’ Oh yes, then I had his attention. A withering look was sent in my direction. ’We could try physio, but it would possibly be a waste of time’. ‘It may well be a waste of time but now we are at the point where this is having a detremental effect on our lives. My husband has his own business and is unable to work. He can do nothing, not even pick up his grandchildren. So far you have done nothing, not even attempt a definitive diagnosis. I am thinking MRI to rule out a problem which, rather than resolve, could get worse.’ Over to the G.P, ‘Well the wait for an MRI is about 6 weeks and it may be better by then.’ I am surprised that he didn’t push the emergency button at that point because I erupted. A verbatum transcript is impossible, mainly because anger and indignation took over, but the essence was that if they hadn’t waited so ******long already he would now be having his MRI and physio and we would know what we were dealing with and, just because you are only just out of short trousers, don’t regard anyone who has grey hair as too old to spend money on. Now pension ages have been changed everyone else, except NICE and NHS choices, thinks we have at least 10 years of productivity ahead of us, so don’t dare write my husband off. Hubby now has his physio and MRI appointment.

The grandchildren are all well, and growing but of them are growing quite as quickly as grandchild number 8, who is currently nestled in DIL’s womb and scheduled to appear at the beginning of May. Yes, another one. See below for how the others have grown.

Well. My update is complete. My databases call. Firework night looms and Christmas lurks.

Responsible department: Department of Health

More babies were born in England in 2010 than in any year since 1972, whilst births to women aged 30 or older were at their highest since 1946. The NHS is desperately short of midwives, and the shortage affects every region of England. We need urgent action from the Government, including a target to recruit the equivalent of 5000 more full-time midwives. Care for women but especially babies at the very start of life should be shielded from the cuts.

This is an e petition to H M Government. I would have worded it differently, but there again I am a simple being who would just go to the heart of the problem. The whole world, literally, interprets the current staffing issue within the maternity services as being down to a shortage of  trained midwives but that isn’t the situation, there are plenty of us. The issue is the employment of midwives, and the crux of the matter is funding. The Trusts are having to budget so harshly that coal-face staff numbers are being trimmed to below the quick, and not just midwives, other professionals as well. We do need to recruit more midwives but to do this we need to improve the funding, be shielded from the cuts yes, but also improve the monies available to the maternity services, not for paper-shuffling exercises but to employ more midwives.

Anyway, here’s the link, it can’t do any harm so please sign  the e petition here.

Why am I in such a slough of despondancy? Well, the miasma of NHS bureaucracy has finally overwhelmed me, I am entirely embroiled in the totally mad maze of
management which consticts every aspect of being employed in the health
service, and it is frustrating me beyond belief. I am terrified that I could
well give into panic if I don’t get a grip on all the ends which are snaking
around at will, needing to be organised, needing to all join up. The maze is
constantly causing me to bang up against seemingly inpenetrable, prickly hedges
so I backtrack and try another route, wasting more time and energy, only to
meet another vicissitude.

I don’t want to be a manager in the NHS, I can’t imagine why anyone would want
to, it’s a thankless task. Yes. There are too many managers but it’s all do
with the way the NHS has developed, it strikes me that everything is kneejerk
rather than planned by individuals who understand how the whole organisation
functions. Nothing is radically re-organised, rather, another side-shoot is
grafted on to the already overburdoned branches. The new little side-shoot is
given it’s task and it happily thrives, initially. It receives adequate
nourishment and produces acceptable fruit. After a while the environment
changes, the nourishment is rationed slightly but demand for it’s product
increases. Initially the side-shoot responds by exploiting it’s reserves but
they are limited and soon it displays signs of weakness. What to do? Look for
stronger branches to share the workload, perhaps form a framework, no, just
graft on another shoot to further drain the whole organisation.

Don’t expect any of this to make much any sense, it makes no sense to me so why
should any innocent, who has never really experienced the NHS,
understand this rambling. Many have tales of their encounters with the NHS,
those at the receiving end, patients, or clients as we now have to call them,
let me assure you working for the NHS is no bed of roses either.

Anyway, where was I? I don’t want to be a manager, but I do really, not for ever, or
even a month, just a day would probably allow me time to formulate a structure
which would enable me to work logically and efficiently. Mind you, the Trust
Board would need to be disempowered during my frantic reorganisation, because I
wouldn’t have the time to wait for them to rubber stamp my decisions, and I would
need to be able to command co-operation from other drones but, given those
criteria, I would be flying.

I’m just going around in circles. My new job is an absolute, organisational
nightmare, I keep taking 2 steps forward and one step back. I have 2 different
managers who act as if they function within 2 different organisations, although
we all work within the maternity sector they carry seperate budgets, which they
guard ferociously this impacts adversely due to others not appreciating that I
cannot cross theoretical boundaries. I can’t go into detail so it possibly
sounds as if I’m making a mountain out of a molehill, maybe I am but that molehill is wrong-footing me constantly.

As if the actual working maze is not frustrating enough there is also the minor
fact that 3 weeks after I started my new role, supposedly on a contract, my new
manager confessed to me that she hadn’t gone through the right process so I
have been working on ‘bank’ since I started. I’m just wondering if this is a
double-edged sword as it does mean that I could walk into my new managers
office and tell her to stuff the job. The trouble is that if I can create logical working pathways the role is one that I would love.

 P.S I’m still having real problems posting anything other than the title and category. Wrote this last night but it has taken me hours, literally to post it and it’s still a mess. I give up!

The new job, well I’m still doing my old one as a community midwife but I have now also taken on another role, within the same Trust, midwifery related but not clinical. I know, I’m always wittering on about wanting to retire so what on earth has possessed me? Two things have prompted this, firstly it is a role that has always really interested me, and secondly, due to the bankers and the politicians I am one of the select group of women who find themselves most disadvantaged by the changes to pensions, state and NHS. I was amazed to be selected for the job as on the day of the interview I had some nasty virus which was causing me to appear grey, subdued and huddled and the interview was at the end of a particularly busy working day. I knew one person on the panel but the other 2 were entirely unknown to me so either the other candidates were totally unacceptable drop-outs with no grasp of the language or the one person I knew bribed the other interviewers!

Community is plodding along, this month has on the whole been quieter postnatally but I have managed to squeeze in 2 homebirths and a birth at the midwife-led unit. One of the homebirths set my adrenaline soaring, all my own fault really as I was being too relaxed, so was the woman in labour, and didn’t phone the 2nd midwife in time, in fact I didn’t phone her at all as my hands were full. I had to ask the woman’s husband to phone her and request she come PDQ, unfortunately it wasn’t PDQ enough as baby arrived 15 minutes before the 2nd midwife, luckily all was well though. There was still a slight frisson when I realised that baby was on her way out and I hadn’t got another pair of hands if needed, all the adverse scenarios started racing through my mind, but then I banished them and I concentrated on welcoming baby into the world.

I wrote all of this yesterday but when I ‘published’ it all that appeared was the title, the body of the text had vanished, for good, and this is the second time that has happened, is anyone else experiencing this?

I was at a governance meeting a while back where the topic of community postnatal care came-up, and I was surprised to hear a consultant midwife back the reduction in care whilst supporting her approach by mentioning ‘a study in the Netherlands’ which found no difference in outcomes between those who had care at home after birth and those who didn’t. Well, I think I’ve found the study, Costs and effectiveness of community postnatal support workers, and if this was the study then she was in error using it to support the discussion as the visits by midwives were not changed, more and longer visits were provided by maternity support workers. Well, today I learned that there is to be a study conducted initially in Scotland by Sterling University into postnatal care. Am I hopeful it will be a positive thing? Not really as I’m not entirely sure that it will be woman centred. At the moment all I have to go on is the BBC report,and whilst I love ‘Auntie’ I am aware that reporting on this topic, maternity care, is not always accurate so I’m just going on their take on the information. What concerns me is that NICE have already issued their guidance on Postnatal Care, which Trusts have interpreted to mean that care is taken away from the home and provided at clinics and this study are also going to ’develop a best practice package’… ‘which individual health authorities could then adapt to their needs’, (their needs being to cut costs). I will be interested to read their results but I’m really not going to hold my breath.

My previous musings on this topic include; Letting women and babies down? (2010); The Demise of Community Midwifery – part 2 (2010); What now? (2009); A step backwards (2008); An embarrassment (2007). When reading these offerings prior to linking it was interesting (depressing) to chart the real demise of the postnatal care provision in my area, especially my ‘embarrassment’ at the care I was not providing in 2007 when we were still visiting at home. Now we ‘triage’ on the first day home and basically, if the woman answers all the questions on our pro forma correctly, she won’t get to see a midwife until Day 5, and then the likelihood is that it will be at a clinic, one of which is 12 miles away. I’m not embarrassed now, I’m ashamed.

Jack is now 7 and Amy 6, and both had the same birthday present, a trampoline. I take the blame for this as I acquired one a few months ago and it has been such an amazing hit with all the grandchildren that their parents decided they should have one. I have strict rules in my garden about the trampoline, no bundles, no pushing, no food allowed, there are occasions when Nanny has to turn into a sergeant major but on the whole the children are kept healthily occupied for hours.

From somewhere, and through some movement I have developed ‘tennis elbow’, or lateral epicondylitis. Ouch, ouch, ouch. Nasty condition which catches me out regarding what will elicit an ‘ouch’ and, as a result, what actions I can perform. I can open a car door with no problems but cannot sew. I can get the ironing board out and carry the iron to the board, but I can’t iron (handy that one!). I can chop vegetables but cannot turn the tap on the water butt. On the up-side it is ‘self-limiting’, the down-side is that it can last between 6 months and 2 years. I just hope that time continues to fly.

I was thinking about time today and how we develop our concept of it. I’m not a philosopher, I just heard myself saying ‘You’ve got 10 minutes on the computer Amy’ and so realised that we often give children timings. I will say ‘In a minute’; ‘Give me a couple of minutes’; ‘You’ve got 5 minutes to tidy up’ and other time precise instructions, but they are anything but precise in reality. Do we develop our sense of time from comments like these and, if so, could it account in part for why some people are poor time keepers? Before we learn to tell the time from a clock our concept of time must come from clues given by those who do know about hours and minutes. I had been considering this when daughter came round to collect her off-spring. We sat on the patio having a chat (whilst the children bounced on the trampoline) and after a while she informed them that they had 5 minutes and then they were going home, I waited and timed what would actually happen. In reality it was 20 minutes before they were summoned from their leaping, and then a further 10 minutes before they left to go home. So, having been told that in 5 minutes they would be leaving they really had 6 times that number of minutes, with no correction to the initial instruction. Were they aware that it was more than 5 minutes, or do they now have an erroneous impression of time? Is time a learned concept?

We have also had Jack’s 7th birthday, I can’t believe that he is 7, it only seems like yesterday that my first grandchild was born and now I find myself escorting him and his friends to the O2 dinosaur exhibition, where he proved himself to be as knowledgeable about ‘terrible lizards’ as the guide escorting us. Obviously there was also the family birthday meal and, thanks to the early summer weather, it was a bbq plus an early outing for the paddling pool. One of life’s conundrums – how come that when you pack the pool up for the winter it has no leaks, but when you get it out the following year it has developed one? Grrrr.

Work is another conundrum. Where is it all going? I don’t know, it just seems particularly grim at the moment and I have a premonition that before too long I will find myself reapplying for my job on a lower pay band, not good news leading up to retirement as it would affect my pension. I am having an interesting debate with the people in control of parking. We have to pay, currently £12 per month to park for half an hour a day, at the hospital where we are based. They are now increasing the fee to £20 per month. I have taken issue about this, pointing out that I have no choice about whether I park at the hospital or not and also the fact that the new rules will mean that we have to park a hundred yards from our office where the gas cylinders and on-call equipment are stored. The response I got has inflamed me even more ‘ if you wish to park on the hospital site’. Hang on there you ignorant bureaucrat, I don’t ‘wish’, I HAVE to, it is one of the conditions of my role that I have a car, that I use that car for my job, I cannot do my job without a car. Plus, why should I, as a job-share, pay the same parking fee as a full timer? Any employment experts out there who might like to weigh in on this one?

I know that you, your government, the country need to cut spending. I would know that because my wage packet has already been adversely affected, I accept that and don’t believe that public sector workers should be immune from ‘cuts’. Please note that I have said ‘public sector workers’, not ‘the public sector’.

I can’t comment with any degree of authority on the majority of publicly funded institutions but ask me about the maternity services and I can go on for hours, if not days, perhaps even weeks, you see I’m an NHS midwife, and have been for many years.

At this point I could make lots of self-invented comparisons between the effects of cost-savings within education, policing, parks etc., and the maternity services but they would be trite and not substantiated so, I shall just go straight to the heart of the matter, if you adversely affect the budget to the maternity services it will cost lives. Lives of Mothers and babies.

Please don’t interrupt me at this point and say ‘there will be no cuts in the NHS’ as that is plainly untrue. You seem to believe that is true but let me tell you now, cuts are being made, huge cuts are being made within the maternity services.

Back to my diatribe. The cuts. I work on the community and in an effort to reduce expenditure staffing at the weekend has been reduced by 50%. How has this been effected? Clinics have been set-up at the maternity unit and postnatal women, even those 5 days following a caesarean section, have to come to us. Inconvenient for them, especially if they have other children, and also, due to an appointment system, not practical for giving breastfeeding support. It’s also pared down to the marrow the on-call system, at a time when your government has stated that it supports a woman’s choice for homebirth. 2 midwives on-call on the Friday night who are scheduled to work Saturday and cover the clinic. They get called out all night and so are not working the Saturday, that leaves 2 midwives who are on-call for the Saturday. See where this is going? Yes, they get called mid-morning and wham, bam, no midwives. Homebirths are not the only occurence which can show how stupid, short-sighted and negligent the staffing is at weekends, wish they were but thanks to budgetary constraints community, on-call midwives are also called in to cover the consultant unit and the stand-alone birth unit. Yes, due to the cost-savings ‘bank’ staff are no longer ‘allowed’ to be used to cover absence or staffing shortfalls so on-call midwives are summoned to fill in the gaps. Yes, midwives who have already worked a full day are then called in to work all night. The truly amazing thing is that they have been called out because the hospital midwives can’t cope as it is busy so they are entering a stressful working environment when they are already tired. Do you believe that is safe?

Safety. Let’s consider some recent news items about the maternity services.

April 4th 2011 – In The Independent and also discussed in many other places ’British maternity wards in crisis’ Infant mortality spirals at 14 NHS Trusts.  ‘The safety of maternity care in Britain’s hospitals is under the gravest threat from an over-stretched, under-resourced service which is putting mothers and babies in danger, experts have warned.’

April 4th 2011 – In News West Midlands. ’35 of 45 Infant Deaths Were Avoidable’  The babies’ deaths would have been avoidable if there had been additional staff members and also increased standards of care. The report by the West Midlands Perinatal Institute explained that the maternity service was stretched and short of staff.’

April 1st 2011 – Mail online ‘Midwife shortage is causing Caesareans’  

April 6th 2011 – Access Legal from Shoosmiths  ’Patients and their babies are being put at risk due to midwife shortages’  This article discusses the tragic deaths of Mrs Ali and her baby at  Queen’s Hospital in Romford and includes – ‘similarly catastrophic errors can arise, not because midwives don’t aim to provide their patients with proper care, but because they simply lack the time and resources to be able to do so because services are overstretched and/or because they lack the appropriate training.’

What do you think Mr Cameron, are you happy with the care being provided by the maternity services? Do you really believe that they are not being adversely affected by a funding deficit? How about the rumours of over 200 midwives in Birmingham being forced to reapply for their jobs in an effort to save money by downgrading them. What do you think that will do for for retention?

At this point I will insert a quote from the Royal College of Midwives in an article discussing the perinatal deaths in the West Midlands -

‘The general impression was that the only way this could be explained was that this was an overstretched and understaffed service trying to do the best it can’ and ‘Many midwives are being pushed to reduce the amount of time they spend with women…….If midwives do not have sufficient time to assess and support women things including identification of risk factors can get missed. Women also may feel that they have an issue they want to discuss, but do not want to bother the midwife because they can see how busy they are. This is wrong and potentially disastrous.’

I sympathise with the position the government, and the country, finds themselves in now, I appreciate that savings have to be made. With regard to the maternity services though you have to be honest. Either you stand up and admit to the public that the quality of care is being adversely affected by budgetary constraints or you effectively ring-fence the budget for their maternity services and ensure that those services are not subjected to, what are in reality, ’cuts’.

Yours sincerely

Midwife Muse