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Dear Dave

midwifemuse:

Still current. Perhaps even more pertinent now.

Originally posted on A Midwife's Muse:

Dear Mr Cameron

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…

View original 831 more words

NHS workers went on strike today, and the weather certainly wasn’t helping those on the picket line. This midwife didn’t strike, not because I didn’t agree with the action but solely because I had already, pre-strike call, made an arrangement to meet with a pregnant woman. Midwives were supposed to have badges to wear if they were working but supported the industrial action,unfortunately the RCM ran out almost as soon as they were available, so I just contented myself with telling people I saw that I should have been on strike.

Last night son of my loins phoned me for a chat. During the meandering conversation I mentioned that I should be striking today, however I wasn’t. ‘Good’ was the response from son. What followed was an in depth breakdown of why he felt that NHS employees should count themselves lucky and not expect a pay rise. He works for a company within the private sector where employees, specifically members of his ‘team’, have not received a pay rise in 3 years. He has received a pay rise. I started fairly low key and asked to what professional body his ‘team’ belonged, they don’t. So their annual fees have not increased by over 300% then? Hmmm. How much do you pay to park at work darling son? Well nothing, it’s a company car park. Really love? Well the cost of my parking permit has risen by over 300% in 3 years and is set to rise by another 50% in February. Hey son, when you have to spend the day out of the office who ultimately pays for your food, your sustenance? ‘It’s expenses’ he murmured. He was, by now, remembering that I spend all day, every day out of my ‘office’ and don’t receive any contribution toward food or drink. Hopefully he also recollected that, should I be working in the hospital, I receive no discount on their restaurant food. 3 years ago I did. Incidentally, my daughter, who also works for a private sector company, pays a minimal amount for her meals and if she has to work away from the office receives vouchers for food and drink. ‘You have excellent pensions though’ was the riposte. Well that I’m not totally sure of that, my pot doesn’t seem to me to be that great, but I let him have that point, but not without reminding him that my contributions have increased by over 3% recently. Another deficit in my salary has been the local Trusts decision to abandon the cost of living supplement, that’s over £20 per month. This fact was communicated to son as well. He still didn’t appear to be impressed or feel that I should be protesting about the loss of a recommended 1% pay increase.  Oh well son. Sorry you are comparing to my role to those of your ‘team’. How many lives to they have in their hands. How many times a day do they have to make important, possibly life-saving clinical decisions? How often are they showered in bodily fluids? How often do they work almost around the clock, struggling out of their homes, their beds, to drive to an unfamiliar destination, possibly in adverse weather/road conditions, to be greeted by an emergency situation, totally unsupported? Discussion ended as he remembered the times when ‘Mummy’ would say ‘goodbye’, whilst lugging heavy bags out of the house, just as he was going to bed. Did Mummy receive ‘plumbers rates’ for turning out for hours in the middle of night? No. Mummy received time and a quarter.

Tomorrow, 13th October 2014, is an historic date in the history of midwifery, for tomorrow midwives are striking for the first time since the profession became regulated. Shock horror, women will be left unattended in labour; babies will die, just a couple of scare-mongering comments I have read in response to articles discussing the industrial action. Wrong. Midwives are ‘striking’ from 7am until 11am on Monday. The strike action may affect elective caesarean sections and routine appointments, other services i.e labour wards, birth centres and the on-call provision for homebirths will be unaffected. For the rest of the week midwives will be working to rule, in other words they will take meal breaks and finish work on time.

Well, how much of this will happen? The usual level of staffing for births will happen, as for the rest………it is unlikely that there will be an adherence to the work to rule.

Why are Midwives joining in the action? The pay review body recommended a 1% pay rise, the government decided not to take this advice. At the same time as this has happened the cost to remain registered as a midwife (or nurse) has increased by 31.6%, with a further 20% rise in the pipeline. The pensions contributions have risen from 6.8% to 9.5%. Those are just a couple of the financial reasons but for me, why would I take action*?

I’m sick, tired and fed-up with the way the maternity services rely upon ‘good will’. A joint staff-side survey in 2012 discovered that two-thirds of midwives work more than 2 hours extra each week and, of those responding, only 2.9% have recompense for the overtime. Many Trusts now operate a 12-hour shift system. Staff working these should expect to have a break, in my experience this doesn’t occur, midwives work through, constantly on their feet and making life or death decisions in frequently stressful situations. The community scenario is often equally debilitating. A community midwife can expect to work all day and then, if on call, may find herself continuing to work through to the following morning. This is not necessarily due to a homebirth happening, s/he can be called in to cover a birth unit or the labour ward. A working day approaching 24 hours is not unusual and this is totally due to ‘a lack of NHS funding and a national shortage of 2,300 midwives‘. This is why I support the action. Yes, I would enjoy a pay rise but far more than that I am calling for an increase in staffing levels. I want the maternity services to be safe for women, babies and care providers.

So the report into Mid-Staffordshire NHS Trust is public, and it makes for grim reading for the public and a valediction for many coal-face, NHS workers. For anyone about to become an inpatient it must make them feel extremely nervous. When in hospital you are basically reliant on the care provided for you by the staff, so to read that patient deaths were caused by neglecting the basic standards and that patients were left unfed, unwashed and unmedicated, must be horrifying. At this point is it easy to dump all the blame on those who physically failed to provide care, in this case nurses, but hallelulah, the report then goes on to get to the crux of the matter by finding fault with the Trust Board and the Local Health Authority and then recognising that the Department of Health is ‘remote from the reality of the service at the front line’.
Here is the author of the report speaking at a press conference, he graphically enumerates the failings at Mid-Staffordshire, neglect that makes me shudder, failures in compassion and caring, a culture where patient care was obviously not the top priority. Some of this may well be down to a few front-line workers, to a culture within that institution that has been allowed to continue without investigation, and yes, there should have been investigation, many patients and their relatives had made complaints. Why would this situation been allowed to continue? Lack of leadership, I’m going to qualify that, lack of effective leadership but, being a clinical NHS worker, the words which leap out are ‘Insufficient staff to deliver effective patient care’, ‘a focus on reaching targets, achieving financial balance…. at a cost of delivering acceptable standards of care’.

For years I have been writing about staff shortages and paperwork but in The Safety of Services blog entry I highlighted the government and DoH as being culpable for many failings within the NHS. In fact, reading it now, 5 years after I wrote it as a response to a report from the King’s Fund, I am truly depressed to see how nothing has changed. Substitute NHS for Maternity Services and you have the skeleton of today’s report.

There is a tiny piece of self-satisfaction, knowing that I can sit at home, tapping away in my spare time and come up with an immature version of an official report but there is also huge sadness. It just goes to show that those who are a position to influence and drive positive change in the NHS never listen to front-line workers as what I write thousands voice.

 

 

A cutting comic

One of my favourite comedians is Dara O’Briain. I love his forthright take on issues and his ability to spin off on a fantasy tangent, so imagine my joy when I was watching recently and he began talking about antenatal classes, both NCT and NHS. My ears perked up in rediness for some insightful side-swipes at the presentations he had sat through. It started well, the tone of voice we (some of us) use and the way midwives voice their opinions about doctors being over involved (true). It was during this second observation that my ears pricked up and I started shouting at the TV, something that only usually happens during One Born Every Minute. Mr O’Briain began talking about how the facilitator of the class exhorted the attendees not to let ‘the doctor near them with a knife’, it may have been scissors, or it may have been to cut them, but basically ‘Don’t let a doctor do an episiotomy’. The person went on to say that it was better to tear rather than to be cut, and it was this aspect which Dara went on to disect, using the fact that his wife is a surgeon to support his jocular comments which were ridiculing this attitude.

Tears versus cuts. Research has shown that the use of episiotomy should be restricted, for various reasons, but the one I shall highlight here is healing. As the person presenting Mr and Mrs O’Briain’s classes said, ‘a tear generally heals better than a cut’, this is especially true with muscle. During a caesarean section the surgeons tear the muscle. Why do they perpetrate this violence? If you tear a muscle it generally separates in the direction of the fibres, the fibres can then knit together better following surgery. Move from the abdomen to the perineum and the same logic must apply, with an episiotomy you just cut in a straight line, with a tear it is more likely to follow the fibres, therefore the chances are that it will heal quicker and with less pain. My final thought on this is that an episiotomy ‘may produce a larger wound to heal than would have been produced without intervention‘.

Less pain, better healing and a smaller wound? I know which option I would choose.

Lazyitis

Nearly every night I think ‘I must blog’, and every night I get carried away with something else. Tonight I shall put fingers to keyboard though, after all  I started blogging to maintain an on-line diary, to recount my journey into Grandparenthood. I was amazed when I started receiving comments, I was amazed but I was also gratified. I used to blog freely about my family, but I drew my horns in when a reader took huge issue about a piece I had written and told me that she had discovered who I was and that she was going to notify my employers, and the NMC about my Blog. I was horrified. I was fairly sure that the NMC would not have complaint with me, after all I didn’t break confidentiality or bring the profession into disrepute  however, once my anonymity was compromised then confidentiality issues may have arisen. My employers, they may not have been too happy about my ‘musings’ as they sometimes referred to employment topics and local employment topics at that. I could have been in serious trouble. I closed down my blog for a couple of months, deleted the writing she found offensive and held my breath. Months later, when I had heard nothing, I started writing again. Momentum was suffered though and I had lost the ‘discipline’ of regular blogging. I am going to make a New Years resolution, blog at least once a week.

I’m still a midwife. Recently I received a ‘promotion’, really it is just an official recognition of a role I have been helping with for over a year, but it does give me a new job title. Over the last 18 months I have also assumed two other roles within the maternity services, one clinical and very few hours, the other non-clinical but together they take me up to full-time hours, and more. I am approaching retirement age but, due to my husbands pension having become negligible since G Brown did something, don’t know what but it made Hubby’s pension pot leak a huge amount, and my state pension age running away from me at breakneck speed, I can see that I shall have to put in the elbow grease for a few years yet. Midwives and childbirth have been much in the news over the past few months and, with Will and Kate announcing her pregnancy, I expect procreation will remain in the spotlight.

My family are all well. 16 of us now and all spending Christmas Day together. Hectic week ahead but culminating in a fabulous, chaotic, noisy but joyous celebration and, of course, Ruby’s first Christmas

Ruby Rose

Ruby Rose

Hello!

It’s been a long, long time since I last blogged. Many reasons for this including two new jobs, one new Grand-daughter and work being absolutely manic. The two new jobs are both midwifery related, but non-clinical and I’m still a community midwife, so my hours have now doubled! The latest addition to our family was born in May, quite the most traumatic of all the grand-children’s births, but at least the outcome was a live Mum and baby. Have to look on the positive side. The work that has been manic? Community. There have been more and more changes to how we are able to provide care and the end result has been that 4 midwives, out of a team of 8, have left. 1 handed in her notice one day and went off sick the next, and has stayed off sick for the entire 3 months of her notice period. They are all younger midwives with years left before retirement, 2 have left the profession entirely, unable to face the prospect of continuing and being unable to provide the quality of care they would like to. Drastic action, and really leaving the women and their colleagues in the lurch, but these midwives were not only disillusioned but also incredibly stressed.

The family are all well. The Grandchildren are all growing-up and are all such individuals, even the twins. I still look after the twin boys and their sister after school 2 days a week, but now it’s for only one day a week during the school holidays. Lots of juggling commitments and using annual leave is involved but really worth it to be part of their growing-up.

I’m off now. One more day at work and then 5 days off. I’m so looking forward to it. No getting up at ungodly hours; no dreading the phone ringing in the middle of the night; no piles of paperwork and no realising every morning that there are not enough working hours in a day to complete all the work.

Have you heard of this? Please, please sign it.

Recruit 5000 more NHS Midwives, an e petition to HM Government.

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