Shropshire Birth Centre Closures – Making a Mockery of Consultation

“One of the great strengths of this country is that we have an NHS that – at its best – is of the people, by the people and for the people…we need to engage with communities and citizens in new ways, involving them directly in decisions about the future of health and care services.” (NHS Five Year Forward View) (1)

Shrewsbury and Telford Hospital NHS Trust (SaTH) are repeatedly closing the Ludlow Birth Centre, as well as the Bridgnorth and Oswestry Birth Centres. The closures – for between 12 hours and several weeks – happen without notice, and seem to be stepping stones towards permanent closure. This is a rural area, with long distances to travel from scattered homes to hospital, meaning that the Shropshire MLUs are essential services for the entire maternity journey, providing antenatal, birth and postnatal support to women and their babies without them having to make long, expensive and stressful journeys.

Maternity services are the most commonly used health (as opposed to illness) services provided by the NHS, and they need to be treated like all heavily used services – easy access in the place where people are living. We are not asked to travel to hospital to see the GP or a dentist, and rightly so, as to do so would lead to stress, costs and hospital acquired infections. Yet pregnant women, whose immunity is already lowered by the natural effects of pregnancy, are being asked to travel for miles for regular midwifery appointments and expose themselves and their babies to dangerous bugs. Public transport is very poor, and in some places non-existent. With no local point of contact for midwives, the other option is for midwives to spend hours driving to women to do home visits. New proposals from Shropshire CCG will resolve this issue by simply cancelling postnatal support at home! Meanwhile, SaTH is already reducing access to antenatal and postnatal care during periods of MLU closure.

For some women, the direct effect of this situation is that they are unable to access care, and this disproportionately affects low income women –  a huge irony given that the NHS was created in huge part to ensure that everyone, no matter their financial position, can receive medical attention. “Free at the point of care” is of no use to those who cannot reach the point of care. Some women limit the number of antenatal appointments that they go to, as getting to them is just too hard. Others are unable to travel to hospital during labour, or the midwife is unable to travel to them – so women end up birthing at home without a midwife present. There have been five BBAs in Ludlow alone since May last year. Postnatally, parents who do not have the resources to reach hospital out of hours and who are worried about what may (or may not be) a mild issue with themselves or their baby are waiting until the buses are running again, with the risk that what seems to be minor was actually very serious.

Closing the regional Midwife Led Units means that women and their babies are being put at risk. Women NEED the regional MLUs to be able to access the care that they need. MLUs are safer for women and babies who are at low risk of complications (2) and MLUs are suitable for all women to access routine midwifery care before and after birth.

SaTH claim that they have consulted on some (but not all) of the closures, and claim too that women prefer to birth in hospital, but this is simply untrue. Their strategy has been to regularly close the MLUs, leaving women no choice but to “choose” hospital birth. In fact, engagement carried out by Shropshire CCG found:

“During the engagement work of the CCG, rural women have been adamant that their MLUs are needed and must remain.

Women say they need to reach their intended place of birth quickly and easily. This is to be ended.

Women say they value being cared for by the same midwife, or one of a team of midwives, through antenatal care, birth and postnatal care. This will go, as rural women are to be required to give birth in an unfamiliar setting with staff they do not know.

Women have repeatedly praised the postnatal care available in rural MLUs, and this has been recognised by the CCG as ‘exceptional’. This, too, is to end.” (Shropshire Women Speak Out) (3)

Women and their babies are being put at significant risk of harm, and we call upon the CCG and Trust to implement the directives of Better Births, as well as fulfilling their obligations to providing safe care, by re-opening and supporting the Midwifery Led Units across Shropshire.

 (1) https://www.england.nhs.uk/five-year-forward-view/

(2) https://www.npeu.ox.ac.uk/birthplace

(3) https://shropshiredefendournhs.files.wordpress.com/2018/03/shropshire-women-speak-out.pdf

 

 

 

 

NMC: Not for Midwives, Not for the Public – Not Fit for Purpose!

By Ruth Weston

It is the fifth of May, we are having a protest outside the Nursing and Midwifery Council (NMC) headquarters, and 5 of us get to meet the NMC’s CEO inside (although we did not know until the day that this would happen).

Their response to the outrage pouring out from midwives and mothers regarding the banning of IMUK midwives is revealing, as is their response to the many midwives countrywide upset at the loss of independent supervision, the midwifery code and the attendance of family and friends ban.

The NMC’s clear message was – “We are not here for midwives, it is not about what you want.  Our role is to protect the public.”  And this was the attitude to all of the Midwives’ complaints made during the meeting.

However, when I asked what their public engagement programme was and how people got involved, and how and where the public could hold the NMC account, they were equally clear that they had no programme and no mechanisms for doing so.  They are, they say, just building them now!  So – they ignore Midwives because they say they are not there for midwives’ benefit, but they do not listen to or engage with the public who the NMC say they speak for and protect!

There are two pieces of twisted logic entwined in the NMC’s aims and focus:

On the NMC’s website, under the “about us” section, they say, (link)

“We regulate nurses and midwives in England, Wales, Scotland and Northern Ireland. We exist to protect the public”.  Later in the page, “We are not responsible for representing or campaigning on behalf of nurses and midwives”

The NMC want everyone to know, including midwives, that they do not represent midwives. They are extraordinarily clear about this on their public statements, and they also repeatedly remind midwives of this in communications where midwives are asking for support and guidance.

So here we have what I would term a false dichotomy pitting the safety of the public against the welfare of midwifery as if they are in competition.  Those of us who use the midwifery service (the public which the NMC claim to be protecting) know that our safety and autonomy as women and birthing mothers depends a great deal on the wellbeing and good practice of the midwifery profession and the midwives within it.  They are not competing priorities.  They are the same thing, our interests are entwined: the NMC cannot support safety in maternity without supporting midwives.

But here we have the organisation that midwives are obliged by law to be registered with stating that it ‘is not there for the midwives’.  To make it explicit: the organisation set up to regulate midwifery, set up to ensure good safe midwifery practice, to ensure midwives are good midwives  is clearly  and publically stating that ‘it is not there for midwives’ . How can a profession’s regulatory body NOT be interested in the health and well being of the profession it is regulating and the individuals it regulates?  Surely the point of safety and protection of the public is ensuring that the people you are regulating are fully supported and in the best position to practice in the best interests of the public, the state of midwifery is very much the NMC’s concern because it impacts on their stated public protection obligation.  Only when it comes to the rare conviction of malpractice in midwifery is it a penalising body and by this time harm has possibly already been done to the public. Surely, most of the public protection work is working out what safety means for the public and working with midwives to ensure the profession is in best fit to deliver that safe practice.  It beggars belief that a regulatory body full of highly qualified professionals that are not midwives have not worked this out for themselves – or checked best practice with other regulators.

The second part of their faulty logic and policy is their understanding of what it means to be an organisation that protects the public.  If you make strong statements that you are not there for midwifery, but instead to protect the public, then you would assume that the NMC is an organisation with a strong public engagement ethos or else how can they speak for the public or know what and how the public are protected.  No way!  The NMC is there to protect the public but is only now beginning to set up an engagement programme. At the meeting they admitted to only one consultation meeting with one user organisation – NCT.  No attempt has been made to engage with the wide range of service user organisations in maternity to find out what is important to them in terms of public protection.

To make it explicit, the regulatory organisation which says it is there for the public – does not actually engage with that public, consult and listen to them, nor does it enable us to hold them to account for their decisions.

As one insider said to us of the NMC terms ‘it is dog’s breakfast’.  And this is why the IMUK decision came about as it did and is causing such a problem to the NMC. The NMC did not talk to the women who use the service about what was important to them, they did not listen to the public and consumer organisations, and they did not do an impact assessment on the safety of withdrawing a service at short notice over the Christmas holidays.

And that is why I say #nmcnotfitforpurpose  – because it says it is not there for the midwives but for the public – but it is not even there for the public.  It has set up a false dichotomy between midwives and mothers showing how little it understands the evidence of its own appointee Mary Renfrew in the Lancet Series on Midwifery (link)  Women need a strong, autonomous midwifery profession as this protects women and their babies.  Until the NMC ‘gets’ that it is not fit for purpose as it is, the midwifery profession is not safe. #savethemidwfe

The NMC has its back against the wall –  Now nurses are also angry at the behaviour of NMC – the same grumbles.  And without the support of the public it will have lost all credence.  Time to act! Stay in touch with the campaigns:

  1. Save Independent Midwifery Facebook Group – ask to join – a good place for all kinds of information, and ideas for action and planning to do more
  2. Association of Radical Midwives (ARM) are leading the charge in setting up a new regulator – join this wonderful organisation whether you are a midwife or not and watch out for campaign meetings on this issue
  3. Join AIMS, helping to support their work in ensuring that women have a strong and united voice with the NMC.