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Posts Tagged ‘Maternity matters’

Maternity funding still not being delivered, British midwives claim

Millions of pounds of government funding intended to improve maternity care is still not reaching front line services, midwives say. Despite a rising birthrate, nearly a fifth of the heads of midwifery said that their budget had been cut, and almost a third had been asked to reduce their budgets. Last year the Government promised £330 million of extra funding for maternity services, but this has not been ring-fenced.

The results, from a survey across Britain by the Royal College of Midwives (RCM), come as the Health Secretary is due to speak at the union’s conference in Manchester. Andy Burnham will today announce a new “Start4life” campaign highlighting the importance of breastfeeding and healthy eating from infancy.

The RCM said that 5,000 more midwives were needed to provide safe and quality care to new mothers. Ann Keen, a health minister, said that it was up to NHS trusts how to invest the additional money. “Where funding is not reaching maternity services I call on Heads of Midwifery to challenge their PCTs,” she said. “We recognise there are concerns around staff morale and attrition rates and we are working with the Royal Colleges and the NHS to address these areas”. From Times Online November 27,2009 & Socialized Medicine

When I first worked on the community we all wore a uniform, when we were instructed to be in ‘mufti’ I was uneasy, I liked the fact that that as soon as a door was opened to me I was identifiable as ‘the midwife’. It’s been nigh on 10 years since I donned my uniform, other than odd days when I have been irritated by edits from above advising us to dress like office workers, so I protest by squeezing into my uniform, after all I’m not an office worker, I need to wear outfits which allow me to drive comfortably, plod across muddy fields, crawl around floors and lean over birthing pools. Do I miss my uniform now? No. That’s the thing about change, at first it’s disturbing but eventually it becomes normality.

There, aren’t I the philosopher, quite rational really. Well that stops now, a change is looming which has me seriously concerned, a change which doesn’t just affect how I dress as a midwife but how I deliver care as a midwife. So, what is the association with the quote from ‘The Times’ and my disquiet? My Trust is one of those affected by the PCT with holding government funding intended for maternity services, and what can be done about it? Nothing apparently, and the result, oh the result is fine and dandy, for the PCT, they keep the money but the providers of maternity services, well they have to make cutbacks. Does that suggest that maternity care will be improved?

The cutbacks, or evisceration, are fairly comprehensive. Our antenatal clinics will be moving out of  G.P surgeries and into Children’s Centres. Actually this is a suggestion within ‘Maternity Matters’ , I was going to put a link here, but fittingly the ‘website was unavailable’ since a quick read would reveal quite how loosely the recommendations (promises) are being implemented, the culling continues further though. Women will only receive a home visit from a midwife the day after they return home with their newborn, after that, well its back to the afore mentioned Children’s Centres. Sorry, I fibbed, not all women will have to travel to these centres, those assessed as requiring more ‘assistance’ will have a home visit. Oh, I forgot to say, no visits on a weekend, no clinics either. We won’t be able to do that, well midwives are expensive at a weekend, so it will be a skeleton service, so skeleton that there will have to be 2 midwives ‘on-call’ for the weekend as, if there is a homebirth, there will not be any midwives left. Incredibly cost-effective really as those 2 ‘on-call’ will only be paid £15 each to put their lives on hold for 24 hours, over a weekend, and be at the Trusts beck and call. Real value for money.

Am I blaming the PCT? Yes, but there are also other culprits, they will be in Part 2.

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I received this today from the NCT in response to my communication.

Dear Midwifemuse,

Firstly, I would like to thank you for your e-mail. It’s always really helpful to have feedback in this way.

My name is Jay, and I am the Campaigns Project Officer here at the NCT. As such, it’s very good to be told about the situation for midwives around the country.

We really do acknowledge the work that midwives do – as some of the entries in your blog, and the snapshot you provide show – often under very trying circumstances and without full compliments of staff. The situation you mention, in which two midwives on maternity leave are not being covered, is exactly the sort of situation we are campaigning to prevent. Throughout the country, women are being denied choice of place of birth because of financial constraints on the service. All too often, we are seeing services delivered dependent on budgets, rather than on the needs of women.

 For this reason, we are trying to work with, and put pressure on, the Department of Health and managers throughout the country in order to rectify the disincentives for community midwifery being seen as an option as viable as births in hospitals.

 We hear stories all the time from women who say that they are being actively discouraged from making use of community midwifery, because they can not be guaranteed the service on the day, as a result of staff shortages. Without these choices being realistic and presented to women as such, we will not see the fulfilment of the Government’s choice guarantee.

 We are speaking to the RCM, who are very supportive of this campaign and of the provision of choice. We hope that, by working with them, we will be able to generate a system whereby women have choice and where midwives are not thanklessly working their fingers to the bone. We believe many of the changes necessary for this are related to decision-makers, and should not negatively impact upon midwives themselves.

There are actions that both trusts and midwives can take in order to ensure choice is delivered. Trusts need to make sure that adequate funding and staffing is in place to support midwives in providing choice. Midwives can keep working with women and maternity services to encourage choice and efficient work practices are promoted.

We would also encourage as many people as possible to take action to promote the changes that are needed to bring about choice throughout the UK, not just in England, where the Maternity Matters guarantees apply. The campaign web page – www.nct.org.uk/choice – has information about the campaign, as well as two actions that are quick, easy, and will hopefully be highly effective.

I would also encourage you to join our activist network – NCT Active – as the sorts of views and feedback you have provided are exactly what we like to guide our campaigns and policy.

I apologise for the length of this e-mail, but hope that it explains NCT’s position, and makes clear that we truly have no desire to bring about a situation in which midwives are overworked.

If you have any questions about the campaign, or any wider issues, please do feel free to get in touch with me.

Very best regards,

Jay

I have responded –

Hi Jay,

Thank you for your reply, however the emphasis appears to be on delivering choice in place of birth and the role community midwives play in this. I know that pressure is being put upon government and trusts to improve funding within maternity services to enable the promises made by government to be fulfilled, but trusts are interpreting this as a green light to cease domiciliary visits postnatally and replace them with ‘clinics’. They have been given an open door to introduce this by Maternity Matters – Appendix B; B2

“Reorganisation gives local managers the chance to develop local services that are fit to deliver 21st century care, and in different locations. Antenatal and postnatal care may be provided in community settings such as Sure Start Children’s Centres but care that is more complex may be provided in a hospital within the local network. Reorganisation need not mean closure. It does however offer the option, using the existing infrastructure, to redesign services, which are responsive, flexible and meet the needs of the population, both as a whole and as individuals”

The paragraph which includes ‘to redesign services which are responsive, flexible and meets the needs of the population’ would appear to preclude stopping of postnatal visits but it doesn’t, and it hasn’t. In our area we already operate postnatal clinics at the weekend. How successful are they. Well it depends whether the women you ‘invite’ to attend will co-operate. There are always those who refuse to attend, those who agree but then don’t turn-up and then those who are unable to attend. The result of these non-attendees is that Mondays are now ridiculously busy with community midwives chasing-up, and visiting, those who failed to attend. What will happen when there is no provision for routine postnatal visits? Will the breastfeeding rates fall? Will more babies be re-admitted as ‘failure to thrive’? Will the SID rate rise? Etc.

Childbirth is the head-line catching element of the maternity services but antenatal and postnatal care is just as, if not more important, but we are really in the situation here of throwing the baby out with the bath water.

 Yours truly,

Midwifemuse

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Here we go again, more maternity units scheduled for closure, yet another little side step in the ever more tangled plan that the government has for maternity services. ‘Plan’, did I call it a plan? Sorry, that is misleading, it implies that someone, somewhere has actually thought things through and is now putting forward a researched and structured package and that is something this government has been spectacularly poor in doing. Oh, they are full of ideas and promises, league tables and stars but as regard providing a firm foundation on which to build and maintain these visions they are sadly deficient.

Women and their families are promised 4* facilities, care and abundance of choice. Consultant units, low-risk units, stand alone birth centres and homebirth on demand, whatever the demand the Trusts (aka the staff) will rise to the occasion.  However, now we are hearing that 9 maternity units have already closed, 5 have been downgraded, 15 are threatened with closure and a further 11 are threatened with either closure or downgrading. Why this severe pruning? Well its all down to centralisation and cost-saving. Theoretically these are laudable motives. Centralisation should lead to a consolidation of knowledge, practise and resources, ‘regional super-centres’ , whilst saving money by a reduction in building maintenance and being able to sell off, or convert to other uses, the redundant buildings. Just over a year ago the government published Maternity Matters, a national guarantee, it’s tag line is “choice, access and continuity of care in a safe service”. Well the choice is under the proviso that you are prepared to travel a larger distance; the access will be questionable and the continuity of care will involve a workforce who will, in these times of increased traveling costs, have to travel larger distances to provide the continuity, thus negating a proportion of any cost-saving.

Lo and behold though, there is a plan. Yes, unbeknowns to us mere toilers within the NHS there is a web-site, Healthcareworkforce.nhs.uk, where they have identified the  ‘need for urgent workforce planning principles’ so NWP ( National Workforce Projects) have developed a workforce planning resource pack. Maternity Matters is due to be implemented by 2009, you would imagine that that us ‘on the ground’ would have been briefed in some form concerning the implementation plans/changes, after all they are only 6 months away. However I, and all my colleagues, are strangely ignorant of what our roles will be. I do find this quite concerning as, working within the community, where the government promises provision and continuity of care will be improved I do feel that I should be being prepared for the changes, but I’m not.

As I said, we need good foundations, the staff are the foundations but with lack of consultation, information sharing and cohesion we are weak.

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bed-shortage.jpg

Queuing for a midwife? 

So the maternity services are going to have 1,000 extra midwives over the next year and by 2012 there will be a total of 4,000 more midwives for the hospital and community. Alan Johnson has said ‘midwives’  not maternity care assistants, lets just see if this is what really happens ( cynic, moi ). Good link here for the statement, plus notes to editors, from the Government News Network.

Obvously I’m really happy, ecstatic in fact but…………….Labour has promised that ‘every woman should be supported by the same midwife throughout her pregnancy’ by the end of 2009, how is this supposed to happen when only 25% of the number of midwives required to provide a ‘safe standard’ will have been recruited by then? In ‘Maternity Matters’, the 2007 publication from the DoH, 4 promises are made to women and their families, Choice of how to access maternity care; Choice of type of antenatal care; Choice of place of birth and finally Choice of postnatal care. Hang on there, rewind,  Choice of postnatal care – After going home, women and their partners will have a choice of how and where to access postnatal care. This will be provided either at home or in a community setting, such as a Sure Start Children’s Centre’. Well, well, so Government promised, about a year ago, that by the end of 2009 women (and their partners) can choose to have postnatal care at home. So what is this about polyclinics then and the reconfiguration of primary care where ‘polyclinics will offer access to antenatal and postnatal care’.? Confused? Well I am. Which promises should I believe? Should I, we, believe any promises?

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