JFHC Blog

...JFHC’s deputy editor Rob Mair highlights the reasons why  

Midwifery is facing more challenges than it has seen in the past 30 years, as it contends with an ageing workforce and ever-tightening budgets. But those two challenges alone don’t account for the state of flux the profession is in.

For many midwives, one of the biggest concerns is the proposed changes to the NHS contained in the Health and Social Care Bill, especially as it comes on top of the £20 billion in efficiency savings the NHS is expected to find in the next four years.

The Royal College of Midwives (RCM) is staunchly defending the profession in the face of the proposed cuts, and has been vocal in its opposition to the Bill.

“The bill is a massively expensive distraction from the challenges that the NHS faces in trying to improve healthcare at a time of severe spending restraint,” said RCM chief executive Cathy Warwick.

“The Royal College of Midwives supports many of the Government’s aspirations for the NHS, such as clinically-led commissioning, greater engagement of service users in their care and more integrated services, but the fact of the matter is that these can all be achieved without the need for this divisive and costly bill.

“Independent analysts have calculated that implementing the provisions in the bill will cost the NHS an extra £2 billion to £3 billion on top of the £20 billion in efficiency savings the NHS has to find in the next four years.”

As well as the cost, the RCM is concerned the bill won’t even achieve its aim of providing sufficient improvement to the NHS:

“The Government has failed to present sufficient evidence that its proposals are necessary,” Cathy said.

“They have failed to present evidence that the upheaval will result in an improvement in services to the people of England. And, they have failed to answer the concerns of the people who fear for the future of the NHS under these plans.

“Breaking up what we have, embracing the private sector, and injecting full-blown competition and market forces is not what the NHS needs or what health professionals and patients want. We join the growing chorus of voices calling for the bill to be withdrawn, and the proposed reforms stopped in their entirety.”

The RCM has also expressed concern over midwife numbers, especially in the context of the Conservative Party’s pre-election pledge to get 3,000 more midwives in post.

Last year, the RCM had to revise its own estimate and called for an extra 4,700 midwives to cope with the rising birth rates and pressure on services from more complex and complicated births.

Cathy explains: “Before the last election David Cameron pledged to recruit an extra 3,000 more midwives in the NHS in England. Once [he] was safely inside Number Ten however the pledge was dropped. The excuse was that the number of births was no longer rising. This is bizarre in the extreme given that in 2010, the latest year for which we have figures, the number of births in England was actually at its highest level for 40 years.”

But there is hope that at least some of the RCM’s concerns will be addressed. The RCM has welcomed proposals put forward recently by the NHS Future Forums, although, of course, these would need to be adopted by the Government if they are to be pushed through.

Jacque Gerrard, England director of the Royal College of Midwives, said: “The upcoming reform of the NHS has generated a number of concerns among midwives about how it will affect the quality of care in maternity services. If accepted by the Government, a number of the Forum’s recommendations will go some way to addressing these concerns.

“In particular the RCM is pleased that the Forum has recommended that health and social care should integrate around the needs of the patient. The suggestion that the NHS should be refocused towards preventing poor health and promoting healthy living, including improving the health of NHS staff is a positive step. Midwives have a vital role to play in promoting and improving public health that is often overlooked.

“There is also no doubt, as the Forum recommends, that workforce planning and education should be responsive to the changing nature of maternity care.

“To ensure the safest services and so that women and their babies receive high-quality care it is crucial that midwives have access to on-going professional development so that their skills are up-to-date. Too often, the pressures of inadequate midwife numbers and the demands on maternity services mean that this does not happen, so the recommendation to support this is very welcome indeed.”

But the pressure of inadequate midwife numbers is being exacerbated by its ageing workforce, and it would appear the issue is not just confined to the delivery rooms. In a survey of midwife lecturers, the RCM discovered more than half were over 50 years of age, and only six per cent were under 40. Combined with increasing class sizes, the RCM expressed concern at the standards of teaching.

Cathy said: “The future of midwifery will be shaped and determined by leadership in education and research today. Knowledge development and dissemination are critical components of any professional organisation, the recruitment and retention of midwifery educators is a growing challenge, especially as we face an ageing midwifery workforce and a rising birth rate, which is already stretching the workforce and impacting morale.”

Elsewhere, ensuring birthing facilities remain available and of a high standard is another key concern – particularly after the RCM expressed its disappointment at the closure of two birthing centres in Derbyshire.

The centres – Darley Dale Birth Centre and its sister site in Buxton – offered an alternative to hospitals for pregnant women with low risk of birthing complications, but had seen a dramatic fall in numbers from around 120 a year to just two at Darley Dale by October 2011. The decision to close the facilities is in direct opposition to the RCM’s principles of offering women the choice to give birth where they want.

Jacque Gerard: “Midwives are devastated at the loss of their local birth centres as women’s choices for childbirth are reduced and they now have to access maternity services in a doctor-led obstetric unit, where medical interventions are more likely, rather than a midwife-led unit.”

With Caesarean rates rising all the time, this is a real concern. Here at Journal of Family Health Care we aim to continue to offer support to our hard-working and overstretched midwives. As a result, we fully support the RCM’s petition urging the Government to fulfil its promise regarding midwife numbers, and would urge all midwives and health professionals to sign it.

The petition can be found at: http://epetitions.direct.gov.uk/petitions/13716.

Last week’s report from the Children’s Society presents findings from their latest survey on children who run away. The survey updates information identified in their previous surveys in 2005 and 1999. This allows for some comparison between the current and previous surveys. However, the new survey also offers additional information on the link between running away and other aspects of children’s lives.

The report is based on a ‘snapshot’ survey with questions focusing on the characteristics of the young people involved, their overall subjective well-being, their feelings about school, their friendships, their home type and family structure, their relationships with family or other carers, and their experiences of running away.

The survey itself was conducted between April and October 2011, in a representative sample of 85 mainstream secondary schools in England. The final sample consisted of 7,349 young people aged 14 to 16.

The report is clear that the nature of the survey places limitations on the general conclusions that can be drawn, particularly about the overall numbers of children who run away, but suggests that best estimates, based on survey findings (6.2% reported having run away overnight) would indicate that over 70,000 young people in the sample age range run away overnight each year in England, and that the figure for all overnight runaways is likely to be higher once younger children are taken into account.

These numbers, however, paint a mixed picture in relation to previous surveys, with some evidence of a lower rate of lifetime running away but no change in the proportion who had run away during the year. They also show similar patterns of variation for different groups with, for example, “higher than average rates of running away amongst disabled young people and young people who have difficulties with learning.”

The survey found similar evidence (to previous reports) of harm suffered, noting that about a quarter of young people had reported harm or risky experiences while away. It suggests that young people who run away will do so on more than one occasion, but most say their absence had not been reported to the police.

Interestingly the survey concludes that although different family structures play a role in running away, their influence may have been over-estimated. Family change, rather than simply structure, emerged as a key factor, with “young people who had experienced a change in relation to which adults they lived with [being] three times as likely as other young people to have run away…”

The report also notes the powerful influence of living in low-warmth or high conflict households with children in either of these situations “being six times more likely to have recently run away…” The effects of these circumstances in combination are seen to be even more telling. And, the report points to the generally poorer quality of life, in terms of friendships, school experience and social isolation experienced by children who had run away.

This blog simply provide a taster of what is a fully argued, but easy to read summary of some of the key facts and figures about, and influences on, children who run away. Well worth a more detailed – and still relatively short read if you have the time…

This blog is taken from CareKnowledge, Pavilion’s update and electronic library system for social care staff. If you’d like more information about the service, click here.

NICE’s soon to be announced recommendation that all women be allowed to have a caesarean birth is surprising given the current economic climate.

However as having a caesarean is medically safer than it used to be a decade or so ago, the argument seems sound for no longer discouraging expectant mothers from opting for one on heightened risk grounds alone.

I also welcome the move on the basis it will ease the very real fears some women have of giving birth naturally. One friend of mine had a horrendous birth experience with her first child and was so scared of a repeat performance that she agonised for months before requesting an elective caesarean for fear she would be maligned, such was the perceived climate at the time. It was only when she broke down in tears that her concerns were taken seriously by her midwife.

Another friend’s wife confessed she has a phobia of getting pregnant because she can’t face the thought of giving birth naturally – this may seem extreme but I have heard anecdotally of other women sharing this same fear. NICE’s move will make requesting elective caesareans for all these women far less stressful.

However, I have concerns about NICE’s decision on other grounds. Requesting a caesarean on purely “cosmetic” grounds has always seemed suspect to me and it is alleged that some celebrities opt for early electives in order to maintain their figures. I believe this is not only morally wrong, but potentially detrimental to the baby’s health.

I also believe that by legitimising a women’s right to choose, we may perversely be in danger of limiting their choice. Women may be lulled into thinking a Caesarean is now a “safe” option when in reality it is still a major operation with serious risks involved. Overstretched midwives with limited resources may no longer have the time to assuage expectant mothers’ fears or explain alternative birth options and methods of pain relief such as hypnobirthing, water births, etc.

I base this argument partly on my own personal experience. Although I am forever grateful that two emergency caesareans at the hands of an expert medical team brought my two daughters safely into the world, it is with the benefit of hindsight that I wish that I myself had been better informed of all the options. Although I attended NCT and pre-birth yoga classes, I felt fairly powerless when faced with the painful reality of childbirth. If I had known about hypnobirthing when I was pregnant, then perhaps I could have learned techniques that would have helped me achieve natural births.

So, my overriding fear is that if women are commonly and increasingly presented with limited choice then they won’t explore all the options. It would also be a real shame if NICE’s ruling pushes the recent call by top doctors for more home births to the sidelines. This would be a retrograde step and we’d be letting future generations of mothers and babies down.

Posted 1415 on November 1st 2011. Comment on this blog by emailing penny.hosie@pavpub.com 

This week, the Department for Education (DfE) published the report Reducing Bullying Amongst the Worst Affected.

Yet its publication is something of a mystery, appearing in the DFE archives rather than as a new publication. Is it just that the report was commissioned by the previous government (although such documents are usually published as “new” and contain the caveat that the "findings do not necessarily reflect current government policy").

Or does it mean the government wishes to distance itself from the findings of the report. Either way, we’ll probably never know.

However, whatever the background to the decision it’s a pity a report like this was buried in the archives. On initial reading I don’t think it’s one that particularly links to previous policy; or makes substantial recommendations for future strategy. It simply seems a reasonable attempt to draw together available research and information sources.

The first thing to note about the content of the report is that, for such a big subject, it really is rather brief (28 pages). It is also, however, clear on its evidence sources and methodology – and generally careful to qualify its conclusions where necessary. It provides a usefully full set of references.

One of the report’s key conclusions, which hasn’t been so much emphasised in other materials on bullying, is the direct influence that perceptions about its frequency and pervasiveness have on bullying behaviour; essentially, the more bullying is seen as the norm in an institution or social setting, the greater will be the tendency for children and young people to bully.

It may seem an obvious finding, but linked to one of the report’s other main points about bullying’s roots in the exercise of social power, it makes a more persuasive argument for the kind of education and information programmes that highlight the actual facts about a relevant group’s (say a school population) behaviour and views on the acceptability of bullying – rather than what may be the commonly held perceptions about its frequency or its acceptance amongst peers.

This is all particularly relevant, because the report points to the school as the “epicentre” for bullying.

On a more detailed note, the report again emphasises the way perceived “difference” contributes to the groups more likely to be bullied – including those with special needs. On this, it’s depressing to learn  the evidence suggests that, whilst other groups of bullied children experience declining levels of bullying as they grow older, this applies much less so, to SEN pupils.

The other depressing finding is how much of bullying is based on “looks”.

Overall, the report provides a useful eight point executive summary; a discussion on the definition of bullying; detail on the characteristics of children affected; an analysis of the impact of bullying; a discussion on its causes; and sections on the role of bystanders, and (with examples) on the importance of communication programmes.

All of this makes the DfE’s decision to “hide” the report all the more puzzling. After all, there’s very little in the report that would provoke such a reaction.

This blog is based on an editorial written for CareKnowledge by its editor, Jim Kennedy. CareKnowledge is a sister web publication of the Journal of Family Health Care.

Last week we ran a story on how a baby’s birth month could affect its future career path. We were delighted with the response and interest the story received (even getting a link from The Huffington Post, a prestigious American website).

For those interested, the original study was carried out by the Office for National Statistics for the Sunday Times, and although the report has not been published we have asked to see the study and will provide more information once we receive it.

It has, however, led to much discussion in the office. Does such a study legitimise astrology and horoscopes (after all, it is based on similar personality traits of people born in the same period of time)? Or is it just coincidence that debt collectors are more commonly born in the dark, grey month of January…

A study earlier in the year, presented at the Cheltenham Science Festival, made the link between health and birth month (which again provoked much discussion) – and shows that exposure to vitamin D in the womb that could influence some life prospects before the baby is even born.

A further study, by Southampton University, made similar findings, this time on the importance of the nine months in the womb and the first two years of life, and the impact of whether the mother smoked, took drugs, drank or was stressed during pregnancy.

It’s clear that the scientific community is taking the notion of early childhood influences seriously, and the above shows that plenty of research has been carried out to find out why those early days, weeks and months are important.

What these reports also show is that for the best chance in life, have a November baby. Two of the last three presidents were born in November and autumn babies live longer (allegedly…).

Can you be too friendly in a work context? Should you be allowed to “friend” or not to “friend”? These were questions raised by the Nursing and Midwifery Council a couple of weeks ago, after they issued new guidance on midwives and nurses using social networking sites and mixing personal and private relationships online.

Staff were also told they should avoid discussing work or colleagues online, else risk being struck off.

But was this a much needed move by the NMC to ensure guidelines are adhered to, or was it, as some critics argue, a case of them meddling a step too far into the private lives of their staff?

It’s a murky area – and perhaps in light of recent cases, in need of clarification.

In the intervening fortnight, we ran a poll on the JFHC website to ascertain feeling about the guidelines. The majority (77 per cent) of nurses and midwives still believed they should be allowed to use social networking sites such as Facebook and Twitter.

While we have no doubt that they should be able to do so, we also concede that by issuing the guidelines, the NMC has reminded staff to be aware of how they conduct themselves online and maintain a high standard of professionalism at all times.

Yet, no matter how well intentioned the NMC’s guidelines were – especially when it comes to protecting their staff – they should also trust colleagues to make the right decisions and know where their professional and personal boundaries lie.

A recent case where a psychiatric nurse in Somerset was struck off for conducting an inappropriate relationship with a former patient started from initial Facebook contact, and highlights how an error of judgement can ruin a career.

Indeed, even a seemingly simple message on a social networking site can be easily misconstrued and makes such errors far easier.

However, with a guesstimated 355,000 nurses and midwives using Facebook, the NMC needs to be realistic and realise that policing the behaviour of staff is far harder than it has ever been before.

Our thinking is that the news of the guidelines perhaps serves as a timely reminder of the delicate balance between professional/personal boundaries and the risks of errors of judgement in crossing them, more than a draconian publication of guidelines.

The irony however, is that those who fall foul of the guidelines and end up in the press will still serve to be much more of a significant warning than both…

Written by Robert Mair on 3.8.11 Comment on this blog by sending it to: penny.hosie@pavpub.com 

For two days, Birmingham’s NEC became a busy medical and social care hub, filled to bursting with people eager to learn the latest thinking on numerous weighty topics.

Of course, with nearly 200 seminars running over the two days there simply wasn’t enough time to go into all of them, and it meant being selective over which to attend – but for the discerning attendee, there was plenty on offer to ensure you made the most of the two days.

I started with Liz Stephens keynote on the future of midwifery, and the notion that midwives are going to have to do more for less. It was an impassioned and considered address which looked at the current challenges the industry faces – but also how they can make a difference as midwives during these difficult times.

A similarly passionate – but altogether different talk was next on the agenda – Deborah Rountree’s look at Managing Children with Challenging and Violent Behaviour – A Family Approach.

This presentation turned the idea of domestic abuse on its head, and looked at how families coped when a child is the perpetrator. The family inclusive approach, going by the case studies presented, seemed to have success, and it was an interesting session on a little-discussed subject.

The afternoon was given over to further sessions in the Child Health Programme which looked at Identifying and Managing OCD in Children, Recognising Children with Special Needs and Developing Effective Behaviour Plans for Children with Autism Spectrum Disorders (ASDs).

While all of the talks were of high quality, the one that caught my attention the most was the one by Professor Ricky Richardson on Recognising Children with Special Needs.

Professor Richardson is the senior consultant paediatrician at Great Ormond Street, and his presentation looked at the thorough diagnostic they’d go through at Great Ormond Street when making a diagnosis if they feel a child has special needs.

But he also looked at the parents’ concerns, and how often they may also be placing unrealistic expectations on their children, especially if they come from high-achieving backgrounds. Invariably, the conclusion of each of the case studies resulted in a review after six or 12 months – but this only served to highlight how difficult it can be to identify the reasons behind a child’s special needs.

As well as the informative talks, there was also an extensive exhibition – and you could easily lose hours wandering from exhibitor to exhibitor.

Of course, not everything was relevant (although that doesn’t stop the browsing) but in terms of covering all of the bases – and this applies to the talks as well – Primary Care 2011 was as exhaustive as you could possibly hope for.

Written by Robert Mair on 27.5.11 Comment on this blog by sending it to: penny.hosie@pavpub.com