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Posts Tagged ‘NCT’

I’m fed-up with constant repetition, my constant repetition. I’ve lost track now of how many times I’ve blogged about the reduction in postnatal care and how potentially damaging that I believe it is – Two minds; Do women have a right to a homebirth? ; The Demise of Community Midwifery  – part 2 and, perhaps the most pertinent and written nearly 3 years ago, ‘An embarrassment’ .

Well, now it’s official and it’s in the news – ‘New Mothers let down by postnatal care’ (BBC). The NCT have completed a survey and have discovered that women feel unsupported following the birth of baby and have summed up the lack of care in one word, ‘shocking’. They go on to say that ‘ Many of these problems the women highlight seem to be due to staff shortages or lack of visits once they have left hospital’. Actually NCT it is not 2 problems but one, the staff shortages cause the lack of postnatal visits. Sorry, repetition as this is one of my familiar themes and, rather than conduct a survey,  all you needed to do was read my blog. I’m just a midwife though, what do I know? But you do know my thoughts as we had a brief email exchange, it was exactly a year ago, I published the mail from the NCT and my response in An email to the NCT and  ‘NCT – A reply’.

I am a Cassandra, ‘ no one would ever believe her predictions’. I’ve got another prediction, it’s going to get worse unless there is a step back and an honest consideration of what is really important in maternity care. Times are hard and the approach should be to consider what part of the maternity services should not be ignored, can we really afford to be touchy, feely? Should monies be spent on staff or surroundings? Homebirths or home visits? If the finances do not routinely allow for both what is important, a live and healthy mother and baby or an empowering experience?  

Other sources which report on the NCT survey – Sky News, Telegraph (the comments are incredible) and the Observer.

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I’m in a sulk. I received an ‘invitation’ to register for a conference today, HSJ Maternity Services Conference 2010 , I clicked on the link and was really interested in the agenda, especially as there was much in there which pertained to community midwifery, both the practice and the funding. I checked the date, yes, I would be fit to attend, Tuesday, not ideal as it’s a clinic day but there is enough time for me to rearrange that clinic, so I clicked on the delegate rates. Now, much as I love conferences and know that I would get a great deal from this one, £399 ( £430 with travel etc) is way out of my price range and, for me, a mega amount of money to spend on a ONE day conference so I shall not be attending and I doubt that any other ‘grass roots’ midwives will either. I would hazard a guess that if I cared to attempt a chat with any midwifery managers that day they would be thin on the ground. They will all be there, in London, chummy, chummy, huddling together and nodding wisely as other managers powerpoint away telling them how to impose more paperwork on clinicians whilst reducing patient contact. Sorry, there is the ‘token’ speaker from a users group, the NCT, she will explain how women are unhappy with the care they receive and what the maternity services need to do to improve the situation. The women are unhappy, well I am as well but it ain’t going to get any better, ever. With reduced budgets, increased workloads and increased paperwork there is no way the service can do anything other than reduce and reduce. If you look at the programme it just about says it all, ‘collecting data; analyzing; compliance monitoring; monitoring improvements; engaging the workforce to gather and report timely information; measuring quality’ of yes, there’s a lot of information gathering going on here and who will do it? The midwives. First though there will have to be lots of nice meetings, brain-stormings and oodles of consultations, I should think a few management companies are rubbing their hands at this point anticipating the studies which will be initiated and the revenue these will generate.

I want to be there, I want to be able to hear rationales, I want to debate and comment on change and, more importantly, is it cost-effective and will it improve outcomes? Personally I’m fed-up with having initiatives  thrust upon us from some faceless echelon which magics up ideas and then expects the workforce to implement, audit and document ad nauseum. In a previous post I recorded a days work and compared the time spent on patient contact with other tasks, and now I find that The Nursing Times has discovered that community midwives spend 40% of their time on paperwork and travelling. and they had to conduct research (wonder how much that cost) to come up with that revelation. Well, now its official will someone please take notice and reduce the repetition and the gathering and recording we have to do. Yes, talk about it at the conference but not as to how midwives can record data but as to how systems can be introduced which will cut down on the repetition and free up midiwives to do the job they were trained for.

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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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I read the NCTS’s research, Location, location, location and felt moved to email them. Here it is, will they reply? Will anyone out there stop the pressure and allow maternity services to make CONSIDERED changes rather than perform ill-judged and poorly planned knee-jerk reactions?

As a community midwife I know that your organisation is represented on local MLSC’s so you must appreciate the constraints which many Trusts are placing on local maternity services. In my area we do offer women ‘real choice’, homebirth, MLU or obstetric unit, but in reality it is the midwives who are allowing these choices to be offered by giving of their own time. Government make promises to the public and allocate monies but then tell trusts that they have to make cuts and, even though the maternity service is within budget, cuts are made within that service.
A snapshot. Locally we are now being told that home visits by midwives following birth will be phased out, with women having to attend drop-in clinics. I think this is a backward step and ultimately will have a more adverse impact than women not having choice in place of birth. The community service is about to lose 2 midwives on maternity leave, we have been told that there will be no cover as the trust cannot afford it. As it is I find myself donating over a day a month to cover my workload, and I am not alone. I can now look forward to more work time being unpaid as the team attempt to pick up 2 WTE’s work over the next year.
I read research like ‘Location, location, location’ and my heart sinks as I know there will be more pressure on midwives. Midwives, not managers, not heads of trusts and not government but midwives, on the coal face attempting to fulfill expectations with no support, just more demands.
You can read more of my thoughts on todays midwifery and the mismanagement of the maternity services on http://www.midwifemuse.wordpress.com

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