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

 

 

 

 

Slings and Arrows

Menstrual cycle hit me like a hurricane and I woke up from it yesterday realised once more there was a world out there!

Last Tuesday (I can’t believe it is so long since I posted!) I went to a training seminar on PCT Practice based third sector commissioning. Amongst the jargon and the unfamiliar acronyms I got flashes of understanding about what was going on. I share some of the most relevant bits for the postcard campaign:

This is a new system and everyone is trying to get a handle on it and alot of the commissioners are newly in post.

There lots of aims to the reforms according to who is speaking but it appears to be a government agenda who’s expressed about money followingthe paitent, more choices and a stronger

We now have a district-wide PCT with over all goalsagreed with central Government. Within the PCT,however, there are ‘divisions’ which ironically in Bradford are along the same lines as the old PCT boudaries. Each division sets its own key priorities according to its population mix. checking through the divisions in Bradford and Airedale PCT, 2 of the divisions have priorities/targets around maternal and child health.

Third sector groups can tender to do work that fulfills these priorites and targets. There is a big recognition of social needs and there was much reference to ‘social’prescribing’ recognising that social situations affect peoples health and health choices (or non choices) and that thrid sector organisations in the community can have a positive effect especiaaly here.

There is a cycle/process to ariving at these priorities and this is a key to us effecting policy and priority decisions. The starting point in the cycle is the ‘needs assessment’ that is assessment of the needs of the population. How is this done? By the old fashioned networking method – commissioners talk to people they know, who are recommended to them, who turn up on their doorstep. they go to community and neighbourhood forums. At Practice level commissioning is also very much about what GPs get coming through their surgery doors. This work is combined with national helath frameworks and priorities coming from central Government. Mixed together, these ingredients are formed into local priorites and targets which form the basis of the commissioning process.

Once the priorities are set the PCT welcomes agencies to approach them and tender to do work to fulfill certain priorites – this can be about medical and social need. The amounts tendered for can be small eg. £5000 or huge, say £145 000. It is a three year cycle to provide stability of care to the patient and funding for the organisation.

The key thing for us is to get in there at the needs assessment stage, getting commissioners to talk to groups of women and understand their experience – I keep banging on about one mother one midwife for instance. This is the key as I understand it, users need to voice their needs loud and clear to the PCT because the Government is telling them that they need to be sensitive to the needs of users. Even if you have appeared to miss the initial needs-priority-commissining faze, we were assured (on questioning) that the needs assessment is ongoing – so get in there girls!!!!

How do we get in there? I think the answer is any which way you can or want. At the event I went up to the Head of Partnership Commissioning (I think that is or includes third sector) and asked him for the names (and spellings) of every commissioner who had responsiblity for maternal and baby welfare, childbirth and breastfeeding. What was clear was that childbirth issues are spread around alot of commissioners – which can be looked on as a problem, a challenge or an asset – because you can work with the ones you can owrk with I suppose. My aim is to write to them all in the next couple of weeks to see if I can kickstart some progress on needs assessment that talks to users.

My question in regard to childbirth issues to everyone I speak to is:What is current user involvement in commissioning services? Where is the needs assessment being done? How can users get involved? Where I am asking the questions – there is some interesting responses – I guess because there is no significant user involvement. I don’t think they know how and where to begin in involving users at this stage – so maybe we need to approach them and start offering them some solutions?

This is a very potted assessment of commissioning based on a seminar in Bradford, however, it comes it simpler terms than what I received it! And I hope it gives women nationally an idea of what may be going on in their area. I would strongly suggest getting in there and asking around and finding out the names and contacts of commissioners responsible for childbirth issues and start approaching them. Users need to say what they want and indpendent midwves need to look at how they can tender for services not being currently rendered. It is a steep learning curve – but in anew system we can start to define and challenge how it works by using it.

As always, it needs to be fun. Getting all those names out of that guy was fun. by the time he had finished he had a twinkle in his eye as I had in mine – he knew what I was up to and he knew I meant business. And it amused both of us. Result! He also told me that a piece of work was being done on needs assessment in childbirth at the present time – finishing in October. A good time to get in there then – and all that came with a twinkle in the eye, a smile and a bit of cheek.

Well it is past the time the children should be getting ready for school so I will scarper!

Ruth