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’.