Long weekends

Life is full, work, grandchildren and a rapidly growing garden are using up lots of time (and energy). My pond, which I made about 15 years ago, appeared to have sprung a slow leak. Fortuitously a friend had decided to get rid of his huge pond, only a year old and constructed before his son started walking, so had a virtually brand new liner which he gave to me at the end of last year. Re-lining a pond, a much bigger job than I had anticipated. Removing all the edging slabs, catching the 2 remaining goldfish and then emptying the pond, by hand, it took days. My glasses kept falling off and into the mud at the bottom, the frogs kept jumping into the pond and then scrambling to get out, so I’d help them, take them down the garden and then 15 minutes later they would hop past me and launch themselves back into the thick sludge. The sludge, buckets full were deposited around the flower beds, Hubby said that it looked as if a cow with a bowel problem had been let loose in the garden, I’ve been assured that it’s good for the plants though. After days of re-levelling, cementing slabs back, re-filling and re-planting I returned the fish, plus three we had been asked to adopt by son, and then realised that they were too visible to the heron so had to net the pond. It’s been good to have the warm weather but it has created an issue with the pond water, it’s turning green, I suspect because the oxygenating plants are not yet established. Should I invest in an aerator?

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?

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Dear Dave

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 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

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With paperwork

Life as a midwife can be unpredictable but we are always aware on community when it will be busy, just a shame that we can’t be certain which days will be manic and which will just be non-stop. March was a ‘quiet’ month visit wise which was fantastic, we could catch-up with all those add-ons which are mandatory but not time sensitive, however antenatally it was busy. Oodles of pregnant women at the stage of their pregnancy when they start having 2 weekly midwife appointments, if we hadn’t got records showing that a baby boom should be expected in April/May our antenatal clinic’s would alert us to it.

I dread busy clinics, something has to suffer and what I end up minimising is the ‘chat time’. I have to fill in all the paperwork demanded for audit, stats designed by my manager, work timings by the PCT and that’s not even including the woman’s notes and inputting consultation info onto the G.P’s computer. Midwives have been warned that if we fail to submit the bureaucratic paper mountain, ‘stat’, then our pay will be delayed. To me, having the time to sit and talk to my women is often as important as completing their notes, issues we discuss then and any worries they might communicate when they are relaxed can be vital. Having to fill in forms as if they are going out of fashion (wish they would) and hustle women out of the consulting room leaves me feeling as if I am shortchanging the women and not fulfilling my role of being ‘with woman’.

The answer to reducing much of a midwife’s paperwork duplication would be for us to have notebooks or laptops, no, too expensive. Pathetic, shortsighted attitude. All our managers have Blackberry’s, even though they spend the majority of their time in a office, next to a telephone and with their ‘own’ PC in front of them, plus a secretary. Out on community we have 5 chairs in our office, 2 telephones and one PC, most days there are 6 midwives in the office and on some days there also 6 students. Community midwifery has been in existance for 70 years but it operates as if it is a new concept, an add-on which is not considered worth funding, but who does all the initial maternity bookings? Who provides the majority of antenatal and postnatal care? Who is responsible for identifying vulnerable families and liasing with social services and other agencies? Can’t speak for other areas but locally it is the community midwife, the hugely underfunded element of the maternity services where paperwork, even if it has the capability of detracting from patient care is paramount and he area where, when there is a time-saving option which could allow patient care not to be affected, it is dismissed as being too expensive!

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