Posts Tagged ‘NHS’

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.




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Midwife Muse’s roll call of causative factors so far –

  • PCT’s for with-holding government monies
  • Groups who place the majority of their emphasis on THE BIRTH, and lobby accordingly, putting antenatal and postnatal care on the back burner
  • Trusts for employing too many managers

Fittingly the midwives come last, that’s the usual position we appear to occupy in any planning, so why alter the status quo? Why are we to blame then? Well we will do what we always do when change is foist upon us, we will grumble, get stressed, some of us will even rant, in private but ultimately we will comply. When I used to work in the unit the obstetricians, generally the registrars, would keep coming out with jokes which were always based upon how bolshie midwives are, ‘What’s the difference between a rottweiler and a midwife? A rottweiler eventually lets go.’ That may be true in the one-on-one clinical situation, when we are being an individual woman’s advocate, but as a group, when change is being imposed, our contracts being re-written or some other attack on our ability to provide the care we KNOW that we should provide we capitulate and fail to work together to resist or modify the changes.

My crystal ball is showing me that once again we will moan and have a brief, vaguely supportive interaction with our union, incidentally that won’t get us anywhere (prediction), a couple of us will leave, another couple will retire, half of us will apply for other jobs, perhaps midwifery related but the majority of us will just end up going along with a change we are intensely unhappy with.

Midwives are their own worse enemies. We are already working above our capacities, both within the maternity units and in the community but we don’t ‘work to rule’, we can’t, but we should. The managers are not ignorant of the ridiculous workload and the number of extra, unpaid hours the staff put in, in fact I do believe that the managers join in sometimes, so we are all colluding in the farce which will allow these changes to go through, these changes which will definitely affect the coal-face midwives, the women and babies.

For a profession whose members are portrayed as fierce we are badly misrepresented, we are actually shrinking violets.

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I received an e-mail this week. NMC, RCM, NHS and Alan Johnson, I hope you all feel ashamed of yourselves. 

Hi, I’m really glad I found your blog. I’m a student midwife (ish) I wish
that someone would have told me beforehand that the midwifery you read about
isn’t the reality.
I think you often get glimpses of the midwifery you’d love to practice but
in reality…its paperwork, targets, interventions (did i mention
interventions?) Its like working on massive a conveyer belt in a factory
whilst jumping through hoops. which are on fire!
I’m on a 6 month break from the course after 2 years because I couldn’t cope
with the impossible situation I was put in and the complete lack of support
I am due to go back early next year, unsure whether I should. I dont see
anything changing now or in the future and its such a shame.
I love midwifery in its true form, so maybe if I can hang in there long
enough Ill get to see it one day, in some part of the world?
being a student feels like being a new mum! but really…’no one tells you
its going to be like this’ 🙂

best wishes,

disheartened student!

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So, having been unable to choose and book it all came back to the good old ‘they give you, or not’ , appointments system. That fell apart when they appointment offered, at a weeks notice, was for a Saturday when I was already booked on to an advanced life support study day. That was back at the beginning of September and as I have heard nothing from the London Teaching Hospital I phoned them today. Bearing in mind that the whole process has been going on since the beginning of July I had thought that apologies may be offered, I am such a numbskull and obviously inhabit an entirely different dimension to this sector of the NHS as no regrets were voiced, in fact the appointments clerk I spoke to was quite tetchy with me for presenting them with a problem. Yes, I am a problem since they have, in error, wiped me off their waiting list. The clerk admitted that they had made a mistake and then spoke to her line-manager whilst keeping me on hold for 10 minutes. This numbskull believed that when the clerk came back on the line it would be with the offer of an urgent appointment. I was worrying about if I would be able to make it, supposing that it were for a day when I was working, or I had the boys, or I was doing a school run or, worse of all, if it was during half-term when I’ve got Amy. I need not have troubled myself as I was told that  ‘ My line manager’s gut feeling is that you will have to go back to your G.P and ask for another referral to be done’. AAAAAAAH!!!!! Unfortunately I was less than happy with this solution to their mistake, and the appointments clerk was less than happy with my unhappiness. Her line manager is going to call me back, probably, at some time and tell me if his ‘gut feeling’ was right.

This whole saga has now turned into farce. A letter will be written and an explanation demanded, the system has got to be tightened up or entirely re-thought.

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Microsoft Home Users

I love a bargain, so imagine my joy when I discovered this little gem. Yes, if you’ve clicked the link and read that NHS employees can buy Office 2007 for £8.95, it is true, it is not a scam. Why, why has no one ever told me this before. I couldn’t believe it so I phoned up our computer bods to check with them, well I didn’t check with them, I informed our IT department about it as they were as in the dark as me. Now it is a hassle verifying your NHS email address if you are a busy, community worker but it’s worth it, especially if your home computer has bitten the dust and the new one doesn’t have MS Office pre-loaded. Full of scepticism, after all if this is such a bargain why haven’t my employers informed their employee about this benefit, I opened the email I had forwarded to my home computer from my work one, clicked once, entered my card details, and then downloaded MS Office 2007, it took about 10 minutes in total, and it’s the best bargain I’ve had all year.


If you’re interested, work for the NHS and have an NHS email address then click  HERE  to start buying.

P.S There are also discounts on other Microsoft products.

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“Hi just found your blog on google as I am doing a research project on free birthing and if the NHS should offer help to these people to make it safer, (paedeatric first aid and signs of when its going wrong etc). I was wondering if you knew what the NHS’ stance on this practice is (do they offer any help? etc), as I am finding it dificult to find information on this subject in England, it all seems to be Laura Shanley in America.
I am doing an access course and have aplied to uni’s, so will hopefully start my training as a midwife this sept. yay! Thank you Emily”

I received this e-mail today and I really am not sure of the answer. I have replied to Emily, pointing out that if people wish to be instructed on resuscitation then local Red Cross associations run courses for the public. I notice that Emily has focused on ‘paedeatric‘ [sic] first aid, I should have pointed out that adult first aid should definitely not be ignored (I have assumed that Emily means resuscitation when she says first aid). What I should have said was ‘ Would offering help, in the form of instruction, really make freebirthing/unassisted childbirth safer? I would imagine that any woman seriously considering freebirthing would have read and watched everything possible about labour and birth, what can go wrong, and especially what to do if things do go wrong.’

Emily asks what the NHS’ stance is on unassisted birth? Not too easy to answer that one,  the NMC have issued a guidance for midwives in which we are told we ‘should support the woman and her family’! RCOG are equally non-specific in their 1st statement  saying that they ‘are aware of it………obstetricians and midwives are concerned with the safety of both patients, mother and child…….little research exists regarding its safety and success’ but then are perhaps coming off the fence more in their 2nd statement by saying they ‘are concerned about the practice.’ With regard to the NHS, well neither NHS Choices or Direct give any web space to freebirthing that I could find. Logically though why would the NHS expend any energy on the subject?  Those who wish to freebirth want to avoid any input from those employed by the NHS, so surely they would not desire any ‘medicalised’ input?

I am torn as to whether the NHS should give advice to those intending to freebirth. It would perhaps make people more aware of when, and how to summon help but it may also encourage people to go ahead with it and, if they do go ahead, and something does go wrong, it may be me who has to respond to their summons. So…….no, I don’t think that the NHS should publish a manual. 

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Just when I was contemplating how long it had been without a rant the Telegraph published this article ‘The case for Caesarian Section’. I read the article by Julia Llewellyn Smith with my usual interest as to how someone was about to justify an elective C- section for ‘social’ reasons. Ms Smith starts off by quoting a study by the Birth Trauma Association citing this as showing that fewer women die following an elective (pre-planned) caesarian than during an emergency section or vaginal birth. She helpfully puts a link in, but unfortunately it is to an article, also in the Telegraph, reporting on the study, not giving the details of it’s methods. I can’t comment on the findings, all I will say is that it doesn’t discuss morbidity or the outcomes for the baby.

The authoress then continues with her own experiences, which are bad. Filthy ward, insufficient attention, but then I’m lost as she describes how she wants a section second time around and then continues with problems but I can’t understand whether these are with her second baby or with her first, It isn’t really that important as this just shouldn’t have been her experience but she does say “I wanted my second birth to be conducted by well-rested professionals, to have the energy to defend myself on the ward, to have some control during a process which – thanks to the NHS’s shortcomings – has become the most distressing experience of too many women’s lives”. Did she go privately? Basically it makes no difference within the NHS, whether you have an elective or emergency section, you still end up on the same ward and wherever you have your operation you will still be “dressed in Nora Batty-style surgical stockings, attached to several drips and a catheter, with suppositories administered every few hours for the pain”. I shall dismiss the tale of the friend who laboured on the geriatric ward as elaboration since I regard this as extremely unlikely, not least because that would have entailed a midwife being on the ward with her.

Those are my issues with the article out of the way and, on the whole, I wasn’t too upset by it as it was telling her experience in a maternity service which I will admit is struggling. Then I read the comments and one comment in particular really got me riled. It was from Mark and goes like this:-

“….to have the energy to defend myself on the ward….” says it all about NHS hospitals, staff and processes.

These stories are not unusual. I have heard several similar ones. To go through childbirth in an NHS hospital must be an appalling experience. How anyone can think that this treatment of women is reasonable is completely beyond me. We know it happens, but the NHS staff seem oblivious. No wonder mothers end up with depression and post-traumatic stress.

And it’s not just childbirth where we are let down. The behaviour of some medical staff is unbelievable – rude, arrogant, off-hand. Many do not even seem to know that much about medical matters, and they all seem hidebound by “process” in any case. What’s the point of training to be a doctor if all your actions are pre-determined by “Trust Policy”?

“Overworked” is no excuse – most of the “overwork” adds nothing to patient care, and the staff should have the knowledge and guts to realise this and change the system. Too lily-livered and thinking of their pensions, I guess.

All the NHS cares about is computers, and filling in forms, and administration, so that if someone complains they can produce this worthless twaddle that no-one uses or reads to help the patient. (Although many secondary users have access to it for their “research”, without your knowledge or consent). The intention seems to be that hundreds of thousands of NHS workers can have access to your medical file, so clearly privacy is regarded as not important for the patient either.

But what I find most frightening about the NHS medical system is that no-one is prepared to admit that things could be doen better, or that people make mistakes.

And this whole cra**y, p*ss-poor system costs us a fortune. Also we are not allowed to leave this system, we are issued with an NHS number whether we like it or not, forced to contribute, and then the NHS thinks it owns your body and can do with it what it likes – apparently harvesting your organs without your explicit consent is now considered reasonable.

How can all these highly paid professors of medical ethics that lurk in the teaching hospitals and universities think any of this is even remotely reasonable?

No other 1st world hospitals are like ours, they don’t waste so much time on paperwork, they don’t treat patients so discourteously, doctors expect to doctor, and nurses expect to nurse, i.e. they spend 99% of their time with the patients, not with the computer (aka a fancy filing system).

I want to spend some time with this man. I would like him to spend some time working on the wards etc. and see what the staff are up against. Oblivious are we? We should have the knowledge and guts to change the system. No one is prepared to admit that things could be done better. Does he think that we enjoy all the paperwork, especially when patients, quite rightly, are ringing buzzers, clamouring for discharge papers, and people in strange audit/bed-state/IT offices are phoning demanding numbers of this and that, the woman in bed 3 needs help with breastfeeding and labour ward are doing another caesarian section so they want a midwife there NOW?

That takes me very neatly back to the case for and against caesarian sections from the service providers perspective. How are they positive? Well, as long as nature doesn’t beat the surgeon to it, they are allocated a time slot and adequate and appropriate staff can be arranged.  How about the negative? They are 3 times as expensive as vaginal births. They are staff intensive, normal birth = 2 midwives at any one time, perhaps an anaesthetist (epidural); assisted birth = 1 midwife, 1 obstetrician, 1 paediatrician, probably an anaesthetist; caesarian section = 1 runner, 1 scrub nurse/midwife, 1 midwife, 1 ODA, 1 anaesthetist, 2 surgeons and perhaps a paediatrician. Following the operation the woman requires close observation on a recovery ward and then a high level of nursing care on the postnatal ward. She will be unable to get out of bed for several hours so requires more assistance caring for personal needs and those of the baby and women who have undergone a section often require more help with breastfeeding, mainly positioning the baby. They will stay in hospital longer than a woman who has had a vaginal birth and the baby is at higher risk of requiring treatment for breathing problems. Does that answer the question of why NICE would like to see the section rate go down? Does it also help to explain why the service is struggling to cope?



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