We live, as they say, in interesting times. The Government’s concerns about, and intentions for, children’s services are rising in prominence, and moving into a much more directed phase with the confirmation of a Children and Families Bill in the next parliament, and with the publication of the first tranche of adoption scorecards.

Both of these major developments focus, in general, on long term care arrangements for children, and on the need for much greater speed in the care and adoption processes. Neither address directly, the other key question of how our systems for safeguarding and protecting children can be improved – that will depend on other processes. But we note, in passing that Michael Gove, prompted by the events unfolding in Rochdale, is said to have written to the Deputy Children’s Commissioner, to ask her to make early recommendations, in relation to girls, from her wider review of safeguarding in residential care.

In broad terms, the Children and Families Bill is intended to reduce delays in the family justice and adoption systems, by speeding up care proceedings and ensuring that the adoption matching process is not delayed by bureaucratic processes or an inappropriate focus on issues of ethnicity. It is also intended to overhaul the special educational needs (SEN) system, including the introduction of a single, simpler assessment process, backed up by new Education, Health and Care Plans.

Specific proposals for the Bill highlighted by DFE, include:

 - Mechanisms to ensure that LA’s cannot delay adoption matching decisions unnecessarily – with questions of ethnicity to be regarded as a secondary consideration
 - A 6 months’ time limit for the completion of care cases
 - Reductions in the requirements on Family Courts to review interim care and supervision orders
 - The introduction of statutory protections, comparable to those currently associated with a statement of SEN, to people aged up to 25, in further education
 - Requirements on LAs to publish details of the support available to disabled children and young people and those with SEN, and their families
 - The right to a personal budget for their support for parents or young people with Education, Health and Care Plans
 - Mechanisms to ensure that both parents retain relationships with children when families break up
 - Strengthened powers for the Children’s Commissioner, including incorporation of the role of Ofsted’s Children’s Rights Director.

As CareKnowledge readers will know, other aims previously identified by the Government for the adoption system include the creation of a national gateway providing a first point of contact for anyone interested in adoption, and an end to the requirement for adoption panels to confirm that adoption is in a child’s best interests.

The first Adoption Scorecards are based on information gathered between 2009 and 2011. I’ve only had the briefest time to look at them but I have to say that, if part of their purpose is to offer easy access for the public, including adopters, to performance information on their local authorities (a basic requirement, I would have thought, for something called a scorecard), they’ve already failed for me, at least. I find the individual cards difficult to read – and difficult to know what they’re telling me – without careful study – about the local authority concerned. (The cards currently available are for each local authority).

As far as I can see there is as yet no overview report or other detailed material that draws out any comparative lessons learned. (If CareKnowledge readers spot something we’ve missed, please let us know). DFE has, though, provided its own very short synopsis of what the cards show. They say that:

 - Children are waiting an average of 20 months from entering care to moving in with their adoptive parents – which they say is six months slower than the timetable set out in guidance
 - 80 authorities have met both interim thresholds (21 months from entering care to adoption; and the matching of children to families within seven months of a court order being made.

These are to be lowered to 14 months and four months respectively over the next 4 years)
 - But 72 have so far failed to meet one or another of the interim aims
 - There is wide variation across the country – and, in some cases, between neighbouring areas (This point is obviously intended  to scotch any argument that local circumstances dictate performance).

So, the scorecard system has started to roll, and, in one field, at least, we have accelerated away from ideas of a hands-off government letting localities get on with their jobs, free of central government shackles – and into a more familiar micro-managed approach to care services. It will be interesting to see how the practice world responds to these renewed demands for consistency and the achievement of set time targets – and, whether government uses the opportunity of the Bill to tighten things even further…

For more from Jim, exclusively licensed journals and the most up-to-date news on adult and children care services visit www.careknowledge.com

You only have to look at popular internet chat rooms mumsnet or netmums to discover that these figures are arguably downplayed. Becoming a new mother or father, although undoubtedly wonderful, is a life altering experience. Most new mothers experience the early weeks and months in a circular fog of sleeplessness, forgetfulness, and yes - at times – worthlessness. Dads often feel disorientated and "out of synch" too - and just as they're getting used to it they have to return to work. It's hardly surprising to hear that first time mums are especially prone to feelings of anxiety and self doubt... even those lucky enough to get support from partners, friends or relatives. Because everything is “new” and these mums have no experience to compare it to, any “problem” – a cough, a runny nappy, constant crying – is instantly magnified.

Speaking from my own personal experience, even my most seemingly capable NCT friends found motherhood a drain on energy and at times, morale. In fact, in those early post natal meet ups at each other’s houses, we used to joke that our biggest “achievement” was just managing to get there! There was so much to cram in - a seemingly constant changing of nappies, eons of time spent breastfeeding, before gathering and then lugging loads of baby paraphenalia around. As for managing to have a shower before our meet ups – that was a bonus rather than a necessity in those early days ( a quick wash had to suffice!).

Although I was lucky enough to have the help and support of my NCT mums, other mums are not so lucky. Many new mothers live miles away from their own families, and for those single mothers without a supportive partner to reply upon those early days must be challenging to say the least. For all these women, including those with husbands at work who are forced to adopt a "single parenting" style, a health visitor is often the only regular daytime adult company these mothers get. Visiting the baby clinic can seem like an ordeal in itself if you are feeling isolated and low – the baby clinics are often incredibly busy, with an “in and out” system of baby weigh-ins and an emphasis on discussing baby related issues such as feeding, sleeping and development. I remember the stressful experience of having to “queue up” to speak to my undoubtedly overstretched health visitor and I am sure I wasn’t the only mother who felt conscious of not wanting to “impede” too long on her time. It was at times incredibly chaotic and I am sure any mothers wanting to disclose the fact they were feeling down would have been put off by the total lack of privacy. I remember thinking at the time that the mental health assessment offered to new mothers seemed a bit of a joke. Being so busy, the health visitors allowed us to fill in these surveys ourselves so had time to provide the “right” answers – perhaps if the HCP had the time to ask mothers the questions themselves the answers would have been more truthful!

With a husband at work and having only just moved into the area, the mother who killed her 10-week-old son and 14 month old daughter must have been totally overwhelmed by feelings of bleakness and despair.

More money and resources are urgently required to help families of newborns cope with the stresses and strains of family life. Although brilliant charities such as the NCT and Home-Start already exist and offering valuable support to young families not every young mother (or father) knows about, or has access to this support. If more money was given to charities such as these to extend their reach – perhaps offering every mother (and father too, if needed) access to confidential and impartial “buddy” support – then I think this could vastly help to improve the mental health and wellbeing of every new parent.

Helplines:

Homestart’s free information line: 0800 068 63 68 (8am-8pm Monday to Friday and 9am-12pm Saturdays). www.home-start.org.uk 

National Childbirth Trust helpline: 0300 330 0700 www.nct.org.uk/ 

Written by Penny Hosie

While much focus today will quite rightly be centred on the government’s announcement of family friendly policies through its Children and Families bill, I believe there is a fatal omission from this new piece of legislation. 

In their haste to prove to the electorate they are not the "nasty" party, the ConDem coalition has neglected to legislate against the food industry’s insidious marketing moves to foist ever more "enticing" fast foods upon our nation’s palate.

I was personally appalled to read the launch of a new "healthy" fizzy fruit drink. I'd be interested to discover what exactly this global fast food company deems "healthy" about the 12 spoons of sugar this drink is alleged to contain in just one average-sized glass – but let's just say we're not loving it!

One may argue that consumers can vote with their feet – they are not "forced" to buy unhealthy foods and drinks. However, most parents can vouch for the strength of "pester power" and the fact these foods are AVAILABLE in the first place means it is increasingly tricky to ignore them.

For the sake of our children’s long term health this government needs to tackle the food industry head on and get to grips with tighter regulation. The marketing of foods containing high levels of sugar and fat foods is simply not acceptable. I base my argument on rising levels of childhood obesity, with all its related illnesses (a significant rise in childhood diabetes and heart disease being just two). The cost to our nation’s health will be immense if we continue along this all too well trodden path.

If the government can seriously consider placing cigarettes in plain packets to deter children from desiring them, then it can also wake up to the fact that fast foods are a danger to public health, too.

Still not convinced? Here’s a doctors impassioned plea on this same subject, with some startling facts on obesity and the fast food industry: http://bit.ly/zMVLNx 

According to the Children's Society the government's plans for Universal Credit will create "a benefit cliff-edge" meaning that 120,000 families would be worse off if they work longer hours or earn more.

With growing number of teachers already concerned that children are losing concentration not just due to lack of sleep but because of a basic lack of FOOD, then the decision to remove meals is worrying... I would even go so far as to say it’s bonkers!

Why? Well it is a well-known fact that for many poorer children, a meal at school is their only decent hot meal of the day. Remove this and they may effectively be “starved” of the nutrients they need. The parents of these children, already under huge economic pressure, could not then be blamed for resorting to filling their little tummies with cheaper, fast foods. I am not saying that all parents who find themselves in this situation will do so, but “junk” foods are often cheaper and certainly more convenient than healthier options. Of course, these “convenience” foods are often calorie rich and nutrient poor – all key components contributing to Britain’s growing obesity epidemic.

The crisis is serious: government figures published earlier this year revealed that a staggering 25 per cent of children are already overweight or obese when they start school at the age of four.

Southwark Council were so mindful of all of this that last year they made the somewhat controversial decision to pay for ALL children to receive free school meals, thus reducing the stigma. They sensibly argued that not only would all children benefit nutritionally but they would also be better able to concentrate and learn in the classroom. Clever Southwark council!

Of course, long-term strategy would also see the economic fallacy of such a short term goal. Health problems equal more cost to the taxpayer, thus cancelling out any alleged monetary “benefit”.

Ultimately this policy does not work; not morally, not socially, nor economically. Add health implications into the mix and there are so many flaws it’s like making a healthy omelette with no eggs…

The Children’s Society estimate it would cost £500m to extend free school meals to everyone on Universal Credit and have launched an online petition campaigning for FSM for all those living in poverty by October 2012.

If you share our distaste for this unfair and discriminatory policy please show your support for the Children’s Society Free School Meals (FSM) petition by signing here: www.childrenssociety.org.uk/fairandsquare

Written by Penny Hosie Comment on this blog by sending it to: penny.hosie@pavpub.com

In the past week, the issue of depression in new dads has been in the news. While some may have glibly dismissed this as men needing to pull themselves together and get on with it, the condition is something that requires more attention, understanding and treatment.

It all started with a report in the journal Psychological Medicine by researchers at Oxford University, who found that depressed dads are more negative in the way that they talk to their babies. Although the effect of this on the children concerned is not yet known – the researchers called for more research on this question – postnatal depression in mums has been shown to place their children at increased risk of developing emotional and behavioural problems.

The story did not make many headlines in the mainstream media, but was picked up by a couple of national newspaper columnists, who dismissed the issue, saying, in essence, that dads should just "man up" and stop being so self-absorbed.

That may make for a controversial column, but it ignores a potentially serious problem. The Oxford study says that 4-5% of dads are thought to have depression in the post-natal period and while that may be only half the number of mums who have the condition, if accurate, it is still a significant figure, which cannot be ignored.

It is easy to understand why new dads might become depressed. Becoming a father is a stressful – though wonderful – experience. It changes your life entirely, and you are responsible for a person who relies on you completely. Change is hard on the psyche. And, of course, some new fathers may have already been living with depression before their children were born.

So, simply dismissing this issue, out-of-hand, helps no-one – anymore than it does for people suffering from any other form of depression. It just exacerbates the existing stigma around male mental health problems and could discourage men from seeking help, which in turn makes the effects worse and longer-lasting for them – and possibly for their partners and children as well.
 

If a new dad is experiencing depression, then he should be encouraged to seek help and be given the understanding and support he needs. It isn’t about being a ‘cissie’ or ‘weak’; it’s about being human and needing help. Nobody should be condemned for that.

For more from Dan visit http://mentalhealthtoday.co.uk/Blog/blog.aspx 

My colleague Rachel Langdon acted as a wise steer, ensuring all the speakers I’d sourced sent in their biographies and CPD-accredited presentations in time, and keeping calm when things, inevitably, went slightly awry. One speaker had to drop out just a few days in advance and my smugness at finding a worthy replacement was short lived when a stomach bug meant that they, too, had to cancel!

Overall, I think we succeeded in our brief - the final speaker programme was full and diverse with six sessions running across both days and covering a wide range of topics. There was a full programme of school nursing-related talks, alongside a fair few on maternity matters and nursing in the home. Other talks on nutrition ran alongside ones on domestic violence, eating disorders, a disability project, eczema and allergies, teenage pregnancies, constipation and obesity.

The exhibitors seemed delighted with the quality of delegates attending the event, with one kindly taking the time to write a glowing testimonial saying that many had told her that: “the programme was very relevant to everyday practice and of a very high standard”.

So was all the hard prep worth it? I think Rachel and I would both say yes. We enjoyed putting the programme together and one of the undoubted “highlights” was the appreciation shown by many of the speakers who were grateful for being given the platform to present their work and share both ideas and achievements with their peers. This was especially relevant to the Queen’s Nursing contingent, who generally speaking don’t get many public opportunities to shine, being more used to quietly doing their work behind the scenes.

One of them, Janine McKnight, provided a particularly memorable conference moment – she left her baby doll prop to cry outside the seminar room where she was due to give her talk entitled “Stop that shake, babies break”. Janine had primed the room’s technician to shake the doll at a specified moment - and there was a stunned silence in the room as lights on the baby’s head suddenly shone, graphically highlighting damage to the baby’s brain. Janine takes her doll around to many schools in her local area and everyone attending her talk could not fail to be moved by both her passion and determination to prevent further tragic deaths from Shaken Baby Syndrome.

We were also particularly proud of the contributions made by some of our board members. Alison Wall, Barbara Evans, Professor Euan Ross, Barbara Richardson Todd and Dr Paul all offered their support from the off, both with their presentations and willingness to chair talks. Indeed Professor Ross’s name cropped up many times as a conference highlight. Not only was his talk on epilepsy well received, his way of introducing other talks with insightful and delightful anecdotes drawn from a lifetime’s work in paediatrics thoroughly charmed the room (including the room’s efficient technicican!).

Barbara Richardson Todd co-hosted a busy school nurse programme alongside Sharon White – a winning duo whose professionalism and dedication to school nursing is much admired, particularly amongst the younger generation.

Tam Fry was someone we’d never met before, but he proved to be something of a conference “star” not only for his talk on the obesity crisis but for his willingness to step in to chair - and even conduct another talk if we had a speaker drop out at the last minute.

As JFHC’s editor, I was also delighted by the fact the majority of delegates attending seemed to be engaged and happy with the talks. Those who stayed to hear talks on a sunny Friday afternoon were rewarded with brilliant presentations by Dr Alex Richardson on the dangers of sugar and by Dr Gill Harris on fussy eating. I’m also grateful to the organisers and my editorial colleagues who helped by filming, interviewing, blogging, chairing and generally being supportive. You know who you all are.

So, thanks to you all and as for next year, watch this space. JFHC Live may not necessarily be bigger, but your feedback will definitely make it even better.

Written by Penny Hosie on 2.4.12 Please let us know what you thought of JFHC Live by sending your feedback to: penny.hosie@pavpub.com

I glanced at the comments and saw many people were unsympathetic, simply because this family looked well-heeled and middle class. Others were reactionary saying what did they expect , choosing to live in an urban “ghetto”?

Well I live in another London suburb which, although far less salubrious, is still a very green and pleasant area.

Attracting plenty of ordinary and hardworking young families I can regrettably vouch for the fact the violence is happening here, too. A friend of mine was attacked by a small group of youths while walking down the road to pick up her children from school. They whacked her in the face and body, then walked off laughing. Obviously shaken and upset, she put a brave face on this savage and unprovoked attack and viewed it as a one-off. The local police, although sympathetic, didn’t rush out to arrest anyone as my friend wasn’t sure what they looked like (other than the fact they wore hoodies).

However, the following week it became obvious who they were as when leaving a local cafe the same youths spotted her and taunted her from across the street.

This is why I support Charlie Taylor’s recommendation to the government today to encourage early intervention measures from the age of two. Living in a society of fragmented families, it does appear that some children are growing up with no clear idea of what’s right or wrong. Even more worryingly, some children do know what’s wrong, but simply don’t care. I suspect my friend’s attackers fall into the latter category.

This is also why organisations like the charity 4Children deserve our support. Their “Give Me Strength” campaign highlighted the fact that a majority of British families feel stressed and many cope better if offered increased support before problems turn into a full blown crisis. The youths who attacked my friend probably had difficult family backgrounds themselves – a reasonable assumption given that they were hanging out on a street corner when they should have been at school!

I believe that early intervention measures – where families struggling to cope for all sorts of reasons are offered compassionate help and support – are a step in the right direction. If the help is non-judgemental as well as empowering (as it needs to be to reach the “hard to reach”) then all the better. Critics may argue that two is far too early to single out future “problem” children from the typical age-related tantrums two year olds are renowned for!

However, the body of evidence is growing that children do display certain traits and characteristics at this tender early age – and a health professional specialising in this area should be trained to spot these early signs effectively. At worst, it’s worth giving it a go – and hopefully the results should benefit us all.

Written by Penny Hosie   Comment on this blog by sending it to: penny.hosie@pavpub.com 

He interviewed Mary Cronk MBE, a midwife who trained in the 1950s. Mary’s reminiscences were wonderful – just like the TV show she evoked an era where the midwife did indeed attend home deliveries on a bike, dressed smartly in a starched uniform and hat with the obligatory bag of medical equipment precariously strapped to the handlebars. 

I doubt Mary ever fell off her bike like "Chummy" did (brilliantly played by Miranda Hart in the TV series), but nonetheless she captured the essence of midwifery in the 1950s, when one to one home deliveries were commonplace and hospital back up couldn’t be relied upon as it is today. However it can’t have been pleasant attending births where you regularly had to contend with little running water and blocked shared toilets! 

Back then the midwife was revered as an integral part of the community and just like the midwives today, their hard work and dedication meant they would often go the extra mile to support a young woman at the start of her mothering journey.  

That’s not to say that some midwives weren't formidable characters that used to blatantly enjoy being bossy and banning men from attending deliveries. 

The series and this radio show also reminded me of my own dear Grandma who, had she lived, would have turned 90 this week. A kind, practical and no-nonsense Yorkshire woman, she thought nothing of riding a bike to conduct errands right up until the day she gave birth... and once told me of the time she was chastised by her midwife who caught her standing on a ladder to clean around a "dusty" picture rail just a day after giving birth. This was a time when young mothers were commonly ordered to bed rest for a week. 

Mary herself had a long and distinguished career and only retired 3 years ago. At the last community birth she attended with a colleague, they delivered twins and when explaining how the second baby was breech, her words summed up the spirit of midwifery. 

"We just got on with it," she said, "and thanks to the mother’s efforts the baby was delivered beautifully". 

Written by Penny Hosie on 24.2.12 Comment on this blog by emailing penny.hosie@pavpub.com  

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.

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.

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 

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.

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…).

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 

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  

Professor Lord Richard Layard, who’s been dubbed the “happiness expert” visited the RSA this week to promote the new edition of his book on happiness. This tied in nicely with his recent Action for Happiness campaign, launched by Layard and others.

Cynics may say the Prof’s profits from selling 125,000+ copies to date has made him happy, yet the essence of the Happiness campaign is commendable.

Happiness, they say, is achieved partly by advancing the wellbeing of others, or at least removing the reasons they are unhappy. They encourage people to spread a little happiness by performing kind acts, volunteering and showing appreciating to other people (isn’t the latter just basic good manners?).

The Professor’s book is also big on using studies to illustrate the fact that societies with the lowest divide between rich and poor are also the happiest – not just for the poor, but also for the rich. I’ve just written a leader in the latest issue of Journal of Family Health Care (my first!) which cites a study along similar lines.

As we approach Easter, it’s wall to wall sunshine, which always seems to lift our spirits. But when we return to work, dare I suggest the Action for Happiness suggestions may actually work and lift us from our post-Easter blues?

Well, isn’t it at least worth a try? Happy Easter everyone!

Written by Penny Hosie on 21.4.11 Comment on this blog by sending it to: penny.hosie@pavpub.com

But the measured exterior of Anne Morgan, Nurse Consultant for vulnerable children in the London borough of Newham, simply added gravitas to some shocking facts.

Two women a week are murdered in the UK as a direct result of DV abuse by their partners.

Health professionals, she warned, should be especially vigilant when dealing with a client who admits to being a victim of sexual abuse, as a third of these women’s children will be suffering the same abuse. A sexually abused child, she said, can sometimes present as being developmentally delayed.

The signs of serious psychological damage are often starkly clear; with girls especially prone to depression, whereas boys turn to unsocial behaviours and get tagged “young offenders”. Art and drama are often useful ways for children to express what’s happening to them, although unfortunately the resources available are few and far between.

One of the hardest hitting facts for me, though, was the fact that studies have proven that three years after suffering ongoing DV, children displayed stress levels even higher than those of a returning Vietnam War veteran. If you’ve seen Tom Cruise in Oliver Stone’s movie Born on the Fourth of July, you’ll find this detail chilling. In the film, Cruise plays real life Vietnam Vet Ron Kovic, whose troubled and stressful readjustment to civilian life as a paraplegic manifests itself in displays of obvious distress and overwhelmingly violent aggression. He slowly and painfully manages to channel this rage and turn it into a positive; becoming an active peace protester.

What’s especially disturbing, though, when considering that most young victims of DV bottle their emotions up, is the haunting question still remains. Where does all that fear, confusion, anger and upset the children feel go?

NATIONAL 24-HR DOMESTIC VIOLENCE HELPLINE@ 0808 200 0247

Written by Penny Hosie   Comment on this blog by sending it to: penny.hosie@pavpub.com 

There I joined a guesstimated 250-300 health professionals, who had all turned up to network and hear two experts give talks on the night’s hot topic: Domestic Violence (DV).

Tanya Dennis spoke first and you couldn’t fault her knowledge or passion for the subject. Tanya, a Specialist Health Visitor, has worked as a Domestic Violence Lead for Ealing and Harrow Community Services for the last four years, but has an additional decade’s worth of experience in this field. She firmly believes that many mental health conditions in adulthood have their origins in childhood and that early parenting and family support interventions make a significant contribution to the future mental health of the public.

Tanya didn’t shirk from sharing some stark, disturbing facts: DV escalates during pregnancy; and 76% of DV-related murders occur after separation. She also told the delegates that, in the last 20 years, there have been huge increases in cases of sons abusing their mothers (60%).

Most disturbing of all was Tanya’s talk on children, especially when she cited proof that exposure to DV can cause deep neurological changes in a child’s brain. Children, she stressed, rarely lie about DV and can convey the reality of what’s happening at home when they are as young as three or four. Tanya explained that if a child tries to open up and explain what’s going on at home, the adult should open their ears and listen. Failure to do so - or worse, dismissing the information because the child is “too young” to know what they are saying - means the child may not readily open up (if ever) again. As there is often a link between DV and child abuse, it’s vital she asserted, that the warning signs aren’t missed. These can include an unkempt or dirty-looking child, one who regularly appears tired or hungry, or even a child who continually strives to over achieve. Obviously judgement has to be finely atuned in assessing such scenarios, but listening to “instinct” can also play a key role.

Tanya shared an example of how “professionally naive” she was when she first started working with families as a health visitor in 1994. A dad who came along to every baby weigh-in was viewed benignly by her initially. But, far from being the model “good dad”, the truth was rather more sinister. Exceedingly violent towards his partner, his attendance at every single weigh-in and baby clinic was just one example of his highly controlling behaviour.

Tanya also talked about “honour killings”, forced marriages and Female Genital Mutilation (FGM), which typically occur within the Asian and African communities. Rape victims are often subjected to “honour killings”, even though they are unquestionably the victim, as the violent act of rape is deemed to bring “shame” upon the victim’s family. Doubly tragic is the fact teenage brothers of victims are often selected to carry out the honour “execution”. In Tanya’s experience, leaders of faith groups within the communities who carry out these honour killings or condone forced marriages are often shockingly unsympathetic to the female victims’ plight.

Tanya asked every health professional attending to pass the National 24-hour Domestic Violence helpline number onto anyone they suspect may be experiencing DV. The number is 0808 200 0247.

Posted by Penny Hosie on 13.3.11 Comment on this blog by emailing:penny.hosie@pavpub.com;

She brought the NCT (National Childbirth Trust) to task for not offering enough information and advice about Caesareans to pregnant mums - and for making mums who have them feel like utter failures. Kirstie had two Caesareans herself (one emergency, one elective) and as I had two emergencies myself you won’t win any prizes for guessing where I stand. On Kirstie’s side, naturally.

However, what’s great about this whole debacle is that through the power of social networking and the media, Kirstie is highlighting the issues that really matter. Caesareans are on the increase due to a whole host of medical (not just vanity) factors, therefore dismissing every woman who has one as being “too posh to push” is both a fallacy and an insult.

While ranting about the NCT, Kirstie also publically acknowledged her support for the “Save Midwives” campaign. This vital campaign was set up recently, and is just getting into its stride, lobbying support from everyone who see understaffed maternity services as a problem that needs addressing urgently.

It’s never been more topical, either. Last week Radio 4 highlighted a shocking new report*, citing the deaths of 35 babies in the West Midlands as “preventable” and laying the blame for this due to midwife services being “understaffed” and “overstretched”.

The momentum for change seems to be building. At the recent fertility conference I attended (see Conference rookie blog http://www.jfhc.co.uk/Blog/blog.aspx) a midwife there said she had felt forced to leave midwifery when levels of work became far too pressurised. She rejoined in the 1990s, but after a few years realised nothing had changed, so reluctantly took the decision to leave again.

An elderly neighbour of mine, an ex midwife herself, told me that this problem goes back even further. When she first practiced midwifery in the 1950s morale was low for exactly the same reasons. She also loved midwifery, but felt compelled to apply for a general nursing post, as midwifery pay simply wasn’t good enough for the extra hours and stress it all entailed. Many midwives had their own young families to look after, she added, and so the job simply wasn’t compatible.

Midwives fully appreciate the nature of their vocation entails long shifts and hard graft. But the expectation they should work above and beyond their statutory hours to prop up an understaffed and under-resourced service not only abuses their goodwill and sense of professionalism, but it puts everyone in their care at risk.

This can’t go on any further.

So, please do lend your support to the Save Midwifery campaign at http://twitter.com/#!/savemidwifery. The alternative – an irretrievably broken midwifery service, more babies dying unnecessarily, more families grieving as a result - doesn’t bear thinking about. But we can all take inspiration from the Middle East. Therein lies proof that when change is long overdue, ordinary people can make a difference.

Government: take heed. Because for midwives’ sake – and for the long-term health of society generally - you can’t afford not to.

Penny Hosie 22.2.11 Comment on this blog by emailing: penny.hosie@pavpub.com 

*Report by The West Midlands Perinatal Institute. For more background information, click here

On Saturday I attended my first ever health conference as the editor of JFHC. Organised by the RCN, there was a mix of fertility workers, as well as a handful of midwives, who willingly gave up their free time to listen to top experts and advisors speaking at this Midwifery and Fertility Nursing Forum. Rona McCandlish kicked off proceedings with a talk on Midwifery 2020, but there was mixed feedback from the hall. One midwife from Kent said she felt there was plenty to say about how midwives should care for their patients. However the pressures placed on midwives (staff shortages, a lack of resources...) meant there was often  “no care for the midwives”; a view many in the hall appeared sympathetic with.

 Dr Ingrid Granne, a Clinical Research Fellow at Nuffield, followed up with an interesting talk on Pre-eclampsia, a condition which affects 2.5-3% of pregnancies. She said that in Oxford they’re offering pregnant women a selenium supplement, through a trial programme called SPRINT. We will keep our ear to the ground as if this does help reduce the number of women getting this horrible – and sometimes life-threatening – condition, we will let you know.

Changes in the 20-week antenatal screening programme were next on the agenda (see our news story on the home page).

After lunch, Dr Pauline Brimblecombe offered an often amusing take on why it’s vital to offer accurate fertility care information from day one to both partners in a relationship, not just the woman! Men tend to steer clear of the initial appointments, she said, which isn’t always helpful. She also advocated that the message to conceive earlier, rather than leaving it to chance later in life (mid 30s onwards), should filter down to young teens, too. As a GP she sees far too many couples facing the strain and pain of fertility treatment – a huge not just financially, but in terms of emotional and physical health. “Sex is not just for fun, but for looking after yourself for the future,”  is the message she wants to convey.

Next, Professor Henry Leese told the forum that “the issue of nutrition and pregnancy is critical for the health of the mother and child; long and short-term.” He warned that the smaller you are as a baby, the greater your risk of heart disease in later life. He also said there needed to be randomised clinical trials of midwife/nurse-led monitoring of gestational weight gain, which can also have an adverse effect on maternal health.

The conference concluded with talks by specialists on egg and sperm donation and the criteria for eligibility and costs of fertility treatment.

Welcome to our new JFHC website blog. Over the next few months we’re hoping to build a vibrant online community that reflects you – the frontline health professionals who advise, help and support families within your local communities. With government policy in a state of flux there has never been a better time to debate the issues that matter to you. As editor, I’ll be starting the blogs off, but please get in touch if you’d like to blog too. Hold on tight and check back regularly, because it’s about to get interesting...
Bye for now.
Penny
Editor
To blog or respond to any editorial on the JFHC website, please get in touch:
penny.hosie@pavpub.com