Category Archives: Midwives

A midwife at risk – of burnout and retribution. As are all her colleagues if they speak out..

For those used to watching “call the midwife” where there is time for a life as well as work, reading this book might bring you back to NHSreality. The fear of retribution is real… The author is at risk in our English, Scottish, Welsh or Northern Ireland health services. An honest exit interview would be really helpful, but not done by HR in any trust in the employ of the department of health…

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Julia Llewellin-Smith reports 6th Feb 2020 on: The Secret Midwife interview: ‘It was a traumatic 15 years’ – Philippa George wrote a memoir about her time as a midwife after she was signed off for stress. Things need to change, she tells Julia Llewellyn Smith

Philippa George is recalling some of the weirder — and most heartbreaking — moments in her 15-year career as a midwife. “There was the time a woman in her twenties walked in accompanied by her grandma and dumped a Tesco ‘bag for life’ down on the reception desk,” she recalls. “We were, like, ‘What’s this?’ She said, ‘It’s the baby.’ ”

………Sitting in a café in central London, George, who works in a midwifery unit outside the capital, is exactly the person you would want at your side during labour: smiley, calm and empathetic. She went into midwifery straight from school and is adamant that it’s her vocation.

But her account of how her job has altered in the past few years makes for dispiriting reading. I would be uneasy recommending her book to pregnant friends, but women who have given birth in an NHS hospital may experience grim recognition at her accounts of constant short-staffing, which means that many women don’t receive the attention they need in labour and afterwards.

“I used to be able to give one-on-one care; now that’s a thing of the past…….

Now George’s main concern is that, having blown the whistle, management will uncover her identity. “I just don’t know what they might do if they found out about the book. I just don’t want to lose my job,” she says. “Even after everything that’s happened to me, I still think it’s the best in the world.”
The Secret Midwife is published by John Blake on February 6 at £16.99

The Secret Midwife – Full article can be downloaded here..

Inconvenient truth is NHS needs reforms

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If it applies in England that the “poorest get the worst health care”, it does in all 4 health services.

There are perverse outcomes of the austerity years, but more as a result of the rationing of places in medical school over decades. Add to this the removal of nursing grants and subsidies, and less than ideal recruitment for all the para-medical specialities. The short term horizon of politicians has led to a situation where the miners of Tredegar once again get a worse service than the bankers of London. I wonder if any of our politicians have read it? We have to reconfigure the 4 health services.

Spin doctors? Richard Smith isn’t buying it. “The NHS doesn’t need more money, it needs a radical rethink”. 2020

Aneurin Bevan: In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear 1948

Dennis Campbell in the Guardian 23rd Jan 2020: England’s poorest ” get worse NHS care ” than wealthiest citizens

England’s poorest people get worse NHS care – Nuffield Trust
New QualityWatch analysis shows that people living in the most deprived areas of England experience worse NHS care. Read this scrolling story to find out how inequalities have changed over 10 years, and read this briefing for the low-down behind the numbers. The story was exclusively covered by the Guardian.

 

2016:What am I afraid of? More and more… Bringing back fear..

2017: Bringing back fear, and suffering. A return to 19th century inequalities.. How quickly politicians destroyed what was the best safety net in the world?

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

2018: Bringing back fear – in the media led society. Lets charge for screening tests and spend the money elsewhere.

2016: What is the true story behind NICE stopping “A&E safe staffing guidance” levels? Money and fear of civil unrest…

The thin edge of the wedge. Is private A&E going to thrive and become the shape of the future? Aneurin Bevan, what would you do?

 

 

Maternity care is getting more risky, as mothers get older, and as peripheral units have insufficent staff and experience. Shortage of Midwives, GPs and A&E consultants..

The disasters at several maternity hospitals across the country are evident to all. The situation at East Kent is in the BBC News today 23rd Jan but it is symptomatic of a general decline. There are insufficient O&G consultants, there are insufficient midwives, and there is so much litigation that the future debt burden is becoming greater than a complete year’s budget. Nothing significant has been done to increase the number of full time midwives or GPs or consultant obstetricians in training in the last three governments. Yes, choice is under threat in England, but we in Wales have already lost it. The out of date NICE advice from 2014 needs to be replaced. All pregnancies have to be regarded as risky today, even if a small minority are women under 35 with second pregnancies and no previous complications. The numbers of these are too small. The NHS guide: Your pregnancy and baby guide: where to give birth is also out of date. What they should be saying is “where to avoid”! Doctors are often “out of their depth” and “without proper cover” and no wonder they get stress. The least experienced doctors are at the coal face when this should be a place for the experienced brain to triage and sort appropriately, avoid delays and unnecessary mistakes, and avoid over treatment. Working in A&E needs “tough love”… A&E consultants are a rare breed of dedicated people, but there are not enough of them: just like GPs. The difference is that GPs are not contracted to cover emergencies, and they can down tools. The buck stops at A&E departments, and the closures across the country are as a result of too few staff across the board. The shortage was known 10 years ago, covered in the Guardian 6 years ago, and yet nothing has been done.

GPs used to share the care of pregnant women, leading to long term relationships and trust. The GPs are now working flat out and bureaucratically, for long hours, and often without examining patients.  The Nuffield Trust reports on the falling number of full time equivalent GPs across the UK, but agrees that the number of GPs has stayed the same!

A year ago in the Guardian Dennis Campbell reported: Concerns over birthing options as NHS shuts midwife-led centres – Trusts say midwives needed in hospitals, as critics argue women’s right to choose under threat

in 2014 NICE announced that Midwife-led units (are) safest for straightforward births – More women should be encouraged to give birth at midwife-led units rather than traditional labour wards, says NICE.

The NHS guide: Your pregnancy and baby guide: where to give birth 

Death of at least seven babies in East Kent: the Mail 23rd Jan

BBC M Buchanaon and J Melley cover this 23rd Jan: East Kent hospitals: Baby death parents’ heartbreak over errors

The Press Reader comment son the “extra holidays” being offered as inducements to GPs.

Pulse reported in May 2019: 11 hour days, 41 daily contacts (that’s face to face) and half of GPs working unsafe levels.

July 2013 in the Guardian: A&E crisis: shortage of consultants a ‘considerable concern’ – MPs raise alarm over ‘extraordinary’ lack of top doctors in NHS hospitals

July 2018: 4 UK health services all seeking midwives and nurses. Its getting worse, and it will progress further..

August 2017: Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

2016: The long term results of rationing midwives and doctors in training…

To date many midwives and nurses have not been able to “demonstrate they can communicate effectively”. Communication and cultural barriers in health acknowledged. Litigation results..

Poverty and Wealth, and pregnancy rates. Will the slave society mean that Middlesborough et al supply the future low paid workforce?

The Economist in an article on 20th April reports on the state of childbirth demographics, and the differences between rich and poor areas.  Surprisingly, Wales is improving compared to the North East and even in Breast Feeding, although the length of time this applies to is not recorded in the Guardian figures…. How many of the IVF conceptions (3% of all) are private and how many public? The health divide ….. The Economist says it explains: Why the middle-aged are replacing teenagers in maternity wards – The conception rate is rising for women over 40, even as it crashes among under-18s.

There are many interesting graphics below, and the Teenage Pregnancy Rates in England and Wales) are most interesting. They do not include Scotland and N Ireland. Presumably Scotland similar to Wales, and N Ireland will have many, and fewer terminations because of their archaic laws.

Since most pregnancies are “high risk” in older first timers, will this mean that midwifery led units disappear? They should. (The risks in having babies in rural areas – midwifery-led units questioned by consultant.)

Will the slave society mean that Middlesbrough et al supply the future low paid workforce?

Maybe Later baby – The Economist 20th April

…. The conception rates of the youngest and oldest mothers are now close to converging (see chart). Middle-aged maternity may soon be more common than teenage pregnancy.

Advances in health care help to explain the convergence. Although assisted conception accounts for only a small proportion of pregnancies, it is growing more popular and more successful. Between 1991 and 2016, birth rates from in vitro fertilisation treatment increased by more than 85%. In 2016 more than 20,000 babies were born following IVF (out of a total of 696,000 births that year). About three-fifths of women who use it are 35 or over. Demand is likely to increase as women learn of others whose treatment has been successful. Ms Fenelon was inspired by a magazine article about egg-freezing……
Patrick Butler in the Guardian 2018: New study finds 4.5 million UK children living in poverty

New measure by Social Metrics Commission aims to focus political attention on the issue

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Can the NHS be saved? Only with different local and global thinking, and changing the “rules of the game”.

All of us in the caring professions know the answer to this question, and indeed that there is no “N”HS any longer. The Guardian knows the answer….. Iain Robertson Steel, a retired medical director acknowledges the problem (But suggests no answer/solutions), but on 26th April  in the Western Telegraph I suggested a “fourth option” for people in Pembrokeshire.  This last is only for local needs, and a letter suggesting a global rethinking was in the Western Mail 25th Jan 2018 is at the bottom of this post. What can save the 4 health services is not clever reorganisations, but an honest debate on overt rationing, and making it clear to everyone what is not available free, for them. ( Changing the rules of the game )

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Can the NHS be saved? The Guardian – Dennis Campbell – 

…the Guardian’s health policy editor Denis Campbell spent a day in King’s College hospital in London. He found staff and patients who are devoted to the NHS but who can also clearly see what is needed in order to sustain the service for future generations.

A long-term plan designed to secure the future of NHS England has been delayed once again by Brexit. But as Britain’s health service heads into its annual winter beds crisis, the Guardian’s Denis Campbell visits King’s College hospital in London to find out what staff and patients need for the future – and how much it will cost. 

“The Welsh NHS and social care is a shambles and no longer sustainable or fit for purpose.” Dr Iain Robertson Steel in the Western Telegraph 7th December.

Health service needs to be remodelled Western Mail 25th January 2018

From the perspective of west Wales there is no British health service.

I do not have access or choice to anywhere outside my own rural trust (Hywel Dda) unless the service needed is not available here. Even a second opinion has to be within the same trust.

There are four, and possibly five health services if Manchester is included. The WHO has said it will no longer report on an “NHS”.

The lack of choice, the covert rationing, and the unequal access to tertiary centres, primary care, and palliative care threaten to bring on civil unrest.

A Welsh mutual of three million people cannot offer the same quality of healthcare as one of 60 million. Even if the Welsh Government has tax-raising powers, there are not enough taxable earners to rise above the decline.

We seem to have forgotten the power and improved health outcomes in large mutuals. Since the UK’s health service has to be refashioned, now seems a good time to unify again, and re-establish the same rights across the country.

Increasing taxation to pour more into a holed bucket should not appeal to most taxpayers.

We need a new health insurance system (the original NHS was insurance based) and the caring professions will remain cynical until what replaces “in place of fear”, avoids bringing it back.

Dr Roger Burns

Haverfordwest

Pembrokeshire GP urges a “fourth option”. Western Telegraph 26th April 2018

The finances are in such a mess, that local post code and unexpected rationing is everywhere… The “Rules of the game” need to be changed…..

Changing the rules of the game

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Who is going to be the last nurse standing?

The mental cost of health and social care, especially for the elderly, is getting so heavy that Nurses are leaving. The monetary cost is so great that we may have to find completely novel solutions. Meanwhile, who is going to be the “Last Nurse Standing”?  Don’t worry. patient and nurse will be smiling…

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Nick Triggle for BBC News reports an unfortunate truth 17th Jan 2018: NHS ‘haemorrhaging’ nurses as 33,000 leave each year

he NHS is “haemorrhaging” nurses with one in 10 now leaving the NHS in England each year, figures show.

More than 33,000 walked away last year, piling pressure on understaffed hospitals and community services.

The figures – provided to the BBC by NHS Digital – represent a rise of 20% since 2012-13, and mean there are now more leavers than joiners.

Nurse leaders said it was a “dangerous and downward spiral”, but NHS bosses said the problem was being tackled…..

The Nursing Times 8th March 2017: ‘Critical’ reasons behind nurses leaving profession laid bare | News …

2nd November 2017: Nurses and midwives leaving the NHS at an ‘alarming’ rate – The i …

The Guardian 2nd July 2017: More nurses and midwives leaving UK profession than joining, figures …

The cost of care is so great that we may end up exporting our elderly….

 

Child and Neonatal health, Intrauterine deaths and maternal deaths. How do we compare? Shamed…

Poor results are expressed in increased deaths. The Mail 19th December calls it shaming.

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NHSreality has tried to get an answer from our local Trust on the relative rates of Neonatal, Infant and Maternal Mortality through a FOI (Freedom of Information) request. The result is below, but readers can read that it fails to address my questions. I asked for the relative perinatal, infant and maternal mortality rates for Hywel Dda compared to Wales and UK averages.

FOI 255 17 – Final Response Mortaility rates

The failure to answer the question is justified by small and meaningless numbers, BUT if these are consistent and have not improved since 20 years ago this is significant.

Ben Spencer for the MailonLine reports 19th December 2018: Failure on sepsis sees UK plunge in world rankings for child mortality: Britain is 19th in league of 28 EU nations after falling from ninth in 1990

Stillbith attitudes also have to change:

Stillbirths – Janet Scott

FE News 7th December reports: EAC Chair urges Justine Greening to use UN Sustainable Development Goals in National Curriculum

Sarah Kate Templeton on December 3rd in the Times reports: Father’s agony drives bid to cut stillbirths – Health secretary Jeremy Hunt has revealed how meeting a man who had lost his wife and baby son inspired care reforms

A meeting with a father who lost his wife and newborn baby inspired Jeremy Hunt to tackle Britain’s shamefully high rate of stillborn babies.

The health secretary said he would never forget the encounter with Carl Hendrickson, whose wife, Nittaya, and newborn son, Chester, died in 2008 during the scandal at University Hospitals of Morecambe Bay NHS Foundation Trust.

Hendrickson insisted his surviving son, Conrad, who was 11 at the time, attend the meeting so he would “know for the rest of his life that his dad had done that”, Hunt said.

After this newspaper’s Safer Births campaign, the health secretary, who praised our highlighting of the issue, published plans last week to save more than 4,000 lives by halving rates of stillbirths, neonatal and maternal deaths and brain injuries.

Every day, eight babies are stillborn in England, the highest rate in western Europe……

Sarah Boseley in the Guardian April 4th reports: Stillbirth rate in UK one of Europe’s highest, Lancet finds – Report says many of 4,000 babies stillborn each year could be saved with increase in awareness and research

Around 4,000 babies die unexpectedly in the last months of pregnancy or during labour every year in the UK – one of the highest rates of stillbirth in Europe, according to a major new series of reports by the Lancet……

Stillbirth rates by country:

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Neonatal death by country:

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Infant mortality rates by country:

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and by Region in the England (But not able to compare with Wales, Scotland and N Ireland):

 

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Causes of Infant Mortality in the UK 2014:

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Causes of Maternal Mortality UK:

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The National Centre for Disease control and Prevention 2009 shames the USA: 

Behind International Rankings of Infant Mortality: How the United States Compares with Europe