Category Archives: Midwives

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….

 

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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

 

In Wales they really can waste money: £68m unveiled for health and care hubs

BBC News reports 6th December: £68m unveiled for health and care hubs

The profession will not see this as positive. It marks the beginning of the end for self employed GPS. It is probably a waste of money, and it is part of the direction of travel, where fewer and fewer people have access to the expertise needed when they are ill. Differential diagnosis, risk analysis and safety netting are all part of a Drs training, and in the case of GPs, living with uncertainty so that good gatekeeping ensures minimal waste. These GP “Geese” who laid those golden eggs are not here now….

But it may be attractive to part time GPS with families often married to other doctors.

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ITV News 6th December covers the initial reaction of the profession: Plans for 19 new health and care centres…..

…Dr Charlotte Jones, chair of the BMA’s General Practitioners Committee says she’s concerned about the lack of involvement of local clinicians:

Whilst we welcome improving access to services closer to people’s homes, it’s difficult to assess the impact this will have without knowing the intricacies of how it will work. It’s concerning to us that the initial reaction from LMC members suggests that they haven’t been involved in the design of the scheme.

It’s vital that local clinicians, who understand the needs of the local community, are involved in service design to ensure that patients receive the services they deserve.

As part of the work to improve access to local services, investment is desperately needed to ensure the GP estate is fit for purpose. Robust premises strategies must be developed, with the full involvement of LMCs. – Dr Charlotte Jones, Chair GPC Wales

Dr Ian Lewis reports 26th November in Walesonline another money spend, mostly from charitable fund raising, which will cut out the GP. By deskilling the GP how does society gain? This is the opposite of utilitarianism. (Greatest good for the smallest number) and brings back the suggestion of the Court Report in the 1970s#; A child health centre in West Wales could be created 20 years after it was proposed – The venture has been in the pipeline for almost 20 years and is estimated to be worth £2.5million

Just as there wont be enough Doctors, there won’t be enough care homes. There are many opinions, but NHSreality fears that Wales is pouring money into a number of buckets which have holes in them. There are just not enough trained people: GPs, Nurses, Physiotherapists, Psychologists, OTs, Psychotherapists, Radiologists, Anaesthetists, you name them…

Mark Smith reports in Walesonline 4th December: The Welsh care homes under threat for not meeting standards – Care homes in Wales are under threat of being suspended or de-registered

BBC News 21st September: NHS reform can cut costs, says local council leader

BBC News 4th December: Cash ‘ploughed into NHS’ preventing change, AMs warn

BBC News 5th December: Welsh Government ‘sticking plaster’ on health services

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A stillbirth is not a person: so no coroners inquest. But the rates differ greatly around the country… Lets stop the blame culture winning..

A sad and disturbing case illustrates a greater problem. The rates for Stillbirth in Wates are 20% higher than in England. Has this always been the case? On June 15th this year I wrote to the Chief Medical Officer of Hywel Dda University Trust asking for information on the rates of Maternal Death, Neonatal Mortality and Infant Death for the Trust, compared to the all Wales and to the all UK figures. I received the acknowledgement reply and was informed I would get a proper reply in 7 weeks. It is now some 14 weeks later and I have not had a reply. The case in the news involves intelligent and well informed professionals, who wish to remain part of a team and work  within the health service. They are not trying to “gain”, but wish to change a culture so that learning occurs, and repetitive mistakes do not happen. If we wish to avoid the blame culture we need open and honest debate. No fault compensation would help greatly… Meanwhile I am writing again and including Stillbirths in

Lucy Bannerman reports in the Times 7th October 2017: Parents call for NHS stillbirths to be investigated

Two health professionals whose daughter died during labour after a series of hospital failures have called for coroners to be given power to investigate stillbirths.

Sarah Hawkins and her husband Jack said that it was “absolutely ridiculous” that baby deaths in England and Wales only merited the independent scrutiny of a coroner’s court if the child was alive when born.

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Their daughter, Harriet, died in April last year, at 37 weeks, after errors by Nottingham University Hospitals NHS Trust, including repeatedly denying Mrs Hawkins admission to hospital and failing to declare an obstetric emergency.

Mrs Hawkins was in labour for five days and after being told the baby was dead had to wait nine hours before Harriet was delivered.

Both worked for the trust, she as a senior physiotherapist and he as a consultant, but when they asked for an investigation they said they “were dismissed as mad, grieving parents”.

Mrs Hawkins, 34, said: “It just felt they were saying, ‘This is very sad, these things happen, now go away and grieve’. But we have both worked in the NHS all our careers. We wanted to tell them what they needed to know, to make sure it wouldn’t happen again.”
The couple were told there would be no inquest because the law states that a stillborn child or foetus is not a “deceased person”. “As a mum, to be told that your daughter isn’t defined as a person, because she wasn’t born alive is absolutely ridiculous. She had been kicking around, and had her foot under my ribs for months,” Mrs Hawkins said.
The couple said they were told by the trust that Harriet’s death was caused by an infection. It was only after challenging that and pushing for an external review that the death was “upgraded” to a serious untoward incident (SUI).

“It has been battle after battle after battle,” said Mrs Hawkins. “We don’t want sorrys. We want answers.” Mr Hawkins, 48, said: “I don’t think they really had a clue that the death of a baby in labour was a major incident. Their attitude was very laissez faire.”

Peter Homa, chief executive of the trust, has apologised but denied a cover-up. “I reiterate my condolences to Jack and Sarah and acknowledge the unimaginable distress and sadness caused by Harriet’s death,” he said.

“I apologise unreservedly that their pain has been worsened knowing that, had the shortcomings in care late in Sarah’s pregnancy not been experienced, Harriet might be alive today.”

The couple believe their daughter might have lived had inquests been held into previous stillbirths at the trust. They want the law to be brought in line with Northern Ireland where coroners can investigate stillbirths.

Mrs Hawkins vowed to keep campaigning. “We want to get justice for Harriet but also for all the other parents before us, and after us,” she said.

ITV News 5th October: ‘Now we want justice for our daughter’: Hospital says failings in …

ITV News yesterday: Hospital trust apologises for failings after stillbirth of employees …

Hospital apologises to parents of stillborn baby for ‘unimaginable … Nottingham Post

 

Sands – Stillbirth and neonatal death charity

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

Mothers are having fewer children later. This makes them more high risk, and most sensible ones will have whatever form of delivery gives the best chance of a normal child. 

Born Free. Times leader 12th August 2017: Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

For an event so natural that none of us can avoid it, the business of childbirth has become an unfortunately ideological battleground. Since the 1960s advocates of “natural” birth have been pitted against defenders of medical intervention. The assumption, driven in part by advice from midwives, has been that a natural birth is somehow superior. In an interview with The Times today Cathy Warwick, chief executive of the Royal College of Midwives (RCM), acknowledges that her profession has got the emphasis wrong. There are great benefits to birth without interventions, but they should be pursued in a way that is sensitive to every woman’s situation, not as an article of faith.
For 12 years the RCM, midwives’ professional and representative body, has campaigned, as a matter of policy, for births where the mother enters and completes labour without medical intervention. Avoiding epidurals, forceps, artificially induced labour or a Caesarean section, the RCM argued, was better for mother and child. Yet that orthodoxy has been criticised, on two grounds. First, it can take a psychological toll on mothers. Those who ask for medical intervention because of their own anxieties or past experiences, are often left feeling as if they have failed. The RCM has sensibly decided to scale back the use of value-laden terms such as “normal birth” in favour of more neutral phrases like “physiological birth”.
The second, and more trenchant criticism of old habits is that they risk putting patients in danger. There is some evidence to support this charge. In 2015 an inquiry into a catalogue of unnecessary deaths in a Morecambe Bay hospital found that midwives’ pursuit of normal childbirth “at any cost” was, in part, behind the failures.
James Titcombe, who brought the scandal to national attention after the death of his son, has warned that the pressure for a delivery without medical intervention is rooted not in concern for patient safety, but in ideology. There have been concerns, too, about the role that midwives’ prejudices may have played in a string of deaths at Shrewsbury and Telford Trust.
None of this means that more intervention is always better, or even that it often is. There is value in a physiologically natural birth — the touch of a mother’s skin to her child’s in the moments after delivery helps to build a bond; a profusion of tubes, doctors and medical instruments does not. Caesarean sections come with well established risks. Mothers are vulnerable to the complications of any major surgery, and researchers have found some evidence that babies born this way are more likely to suffer from asthma and obesity in later life.

However, parents are well able to understand these risks and come to a considered view on what is best for them. The dangers are greatest, in any event, when interventions are emergency measures, taken after the failure of a “normal” birth. Better that midwives speak openly and neutrally about the benefits and risks of epidurals, inductions and Caesarean sections, well in advance, to avoid eleventh-hour panics.
Healthcare in Britain mostly compares favourably to that in other countries. Childbirth, however, is the exception. Britain has among the highest infant mortality rates in western Europe. That is all the more reason for midwives to eschew ideology and focus instead on what will work best for mothers and babies.

Mums, you have a 1:200 risk of stillbirth – what can you do about it?

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

Mums, you have a 1:200 risk of stillbirth – what can you do about it?

Sorting out the figures from the office of National Statistics is not easy. Comparisons between the 4 different jurisdictions are not obvious. Different countries produce figures in different years and the speciality is changing rapidly. Concentration of specialist services has been shown to work, provided transport links are good. Even remote areas of Canada and Australia can have good figures given the right infrastructure. The latest (2013) BBC report from Wales indicates there is a lot to be done in our poorest region. (Stillbirth rate ‘unacceptably high’ in Wales say AMs) The rates for the different Welsh regions are summarised and available in real time, and show that Cardiff and Vale trust is worse than Hywel Dda. 15 babies a year die daily (The SANDS charity) in the UK. It is time to address this, and locally led midwifery units at a distance from specialist centres may not help. Deprivation and smoking go together…

So what can you do about it? Mums can stop smoking, stop alcohol, stop drugs, reduce weight if obese, eat a better diet, keep active and fit, go to antenatal classes, and meet other mums for support. Moving to a richer area would not affect an individual’s risk, but if moving meant the specialist services for a high risk pregnancy were closer this might be well worth considering… The governments job is to treat populations and the illiberal success of the anti-smoking lobby is a major gain. Going privately may increase your chances of intervention (perverse incentives) and figures for private outcomes are not available from the UK. Australian results suggest worse outcomes.. Its an option not only to make the baby on holiday, but to have it away from home..

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There is good news in the latest statistics, but the BBC announced yesterday that there was only one country worse in the EU and that was Malta. There is much to be done.. The Times leader on Stillbirths – by Janet Scott of SANDS.

Chris Smyth reports in the Times 21st June 2017: Better care during birth could have prevented hundreds of baby deaths

Three quarters of babies who die or are brain damaged during birth could have been saved with better care, a study has concluded.
Hundreds die each year because mistakes are repeated and hospitals must improve heart-rate monitoring and staff communication, the report by the Royal College of Obstetricians and Gynaecologists said…. almost one in 200 babies is born dead…

and on June 22nd: Stillbirth rates decline for the first time in a decade

Stillbirth rates have started to fall for the first time in a decade, according to figures that underline the importance of pressing hospitals to take action.

In 2015 about 250 babies survived who would have died two years earlier, figures that recorded an 8 per cent drop in stillbirth rates suggest. Experts said that the fall would have to speed up to meet a target to halve stillbirths by 2030.

There are also still big variations, with death rates a third higher in the worst-performing areas than in the best-performing.

The Royal College of Obstetricians and Gynaecologists (RCOG) said yesterday that three quarters of babies who died or were brain damaged at birth could have been saved had they received better care.

It was the latest in a series of reports and safety initiatives underscoring repeated errors in maternity units that have appeared since The Times highlighted complacency in the NHS over stillbirths in 2012. The latest figures suggest that such messages are starting to filter through, with stillbirth rates falling from 4.2 per 1,000 births in 2013 to 3.87 in 2015, according to the most authoritative academic study…

…Overall in the UK the number of stillbirths fell to 3,032 in 2015 from 3,252 the year before, but deaths before and soon after birth still vary around the country, from 5 to 6.5 per 1,000…. Disappointingly, the findings show only a small reduction in neonatal death rates.”

…Deaths within the first week of life were 1.74 per 1,000 in 2015, compared with 1.84 two years before….

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Infant Mortality and Stillbirth in the UK – Parliament UK (2014) .pdf

Infant death rate ‘lowest ever’ recorded – BBC News (best in the affluent areas, and some areas saw worse results).

It does  not help when a charity (Kicks Count) is reported in the South Wales Argus 20th June:  Baby heartbeat detectors should be banned, says pregnancy charity when they really mean for unqualified patients.

In Scotland the Herald on 15th June reported the main reason for improvement: Smoking rate in UK second lowest in Europe after 25 per cent fall …

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

“Reducing the ratio (of maternity staff in Surrey) to balance the books is the worst of all decisions.”

Stillbirths in all different UK systems are still too high

50,000 short – not £millions but staff…. 

and now we need more despite Brexit: (Chris Smyth June 22nd – NHS in talks to recruit Indian nurses to deal with staff crisis).

Michael Safi in the Guardian 2014: Babies born in private hospitals ‘more likely’ to have health problems – The Study, which looked at 700,000 ‘low-risk’ births in NSW, suggests higher rates of medical intervention could be the cause

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The Times leader on Stillbirths – by Janet Scott of SANDS.

 

 

 

“Will all those that are not dying please go home!” Rationing hits the headlines..

Its all going the get worse….“Will all those that are not dying please go home!” Rationing hits the headlines again and again whilst denied by government.. More and more Health Service employees realise the truth and are voting with their feet. Katie Gibbons reported 2nd August – “Exodus of paramedics causes 999 crisis” and nobody cares…The Perverse Incentive to deny is evident in the fact that none of the paramedics or the midwives (see below) will get even get an exit interview, so their masters will not hear the truth.

Rob Merrick reports in the Independent firstly on 18th October: Jeremy Hunt tells NHS Bosses who are “rationing” not to make ‘easy’ choices

The Health Secretary also dropped his claim that the NHS had been given all the money it requested – admitting it was only enough to “get going” on a restructuring plan

19th October 2016: Theresa May fails to rule out possible casualty department closures in hunt for ‘efficiencies’

Challenged by Jeremy Corbyn, the Prime Minister said key decisions must be made ‘at local level’

and the Guernsey Press on the same day reports: Charity calls on Jeremy Hunt over pledge to ‘step in’ where care is rationed

A fertility charity has called on the Health Secretary to take action after he promised to “step in” where care was being rationed.

Laura Donnelly in The Telegraph on 19th October reports: NHS spending will drop per head despite ageing population and growing demand, says chief executive 

…Officials said it is unclear whether a per capita cut to the health budget has ever happened before in the NHS’ entire 68-year history….The NHS last year recorded the biggest deficit in its history, at £2.45bn, and hospitals across the country are drawing up plans to try and make services “sustainable”….

“We are looking after one million more over 75s than were were five years ago and in five years time we will be looking after another million over 75s in England and that produces massive pressure on the NHS front line.

“People working in hospitals have never been busier, people in GP practices and in the social care sector the same.”

The Health Secretary refused to be drawn on recent reports that Theresa May has said the health service will see no increase in funding, or on whether the Autumn statement will see a boost for social care.

Mr Hunt said all areas of the NHS needed to make “painful and difficult efficiency savings”. But he said this should not mean denying patients the care they needed.

“I don’t at all accept that in order to make these efficiency savings we need to reduce the quality of care for patients,” he said….

Mr Hunt pledged to intervene, if the local NHS took decisions to ration care for patients.

“When we do hear of occasions that we think are the wrong choice has been made – where an  efficiency saving has been proposed that we think would impact negatively on care – then we step in,” he said.

He said improvements in safety and quality of care would save the NHS money, in the long run.

“If you get an infection when you are having a hip replaced that will cost theNHS £100,000 to sort out as well as being incredibly painful and horrible and for the patient concerned,” he said.

Improvements in cancer care would save NHS funds, as well as lives, he suggested.  “We know its two to three times cheaper to catch cancer at stage one rather than stage three or four,” he told the select committee.

Guernsey Press: Government to step in if local NHS chiefs make ‘wrong choices’ over care

The Government will step in when it thinks local NHS leaders have made the “wrong choices” about care being rationed in the health service, the Health Secretary has warned.

The Times reports 19th October: Midwives quit over dangerous work conditions and Kate Gibbons reports that “A third of ambulances miss emergency response targets”

Civil Unrest starts in Enfield? This site began life on 15th October 2016: Defend Enfield NHS – Their strap line is “Will all those that are not dying please go home!” 

natural-death