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.
…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
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…
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
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.
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.
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.
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..
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.
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…
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….
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.
…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.
Two items in the news today (Sunday Times – Sarah Kate-Templeton 15th October 2016) reveal the long term results of rationing midwives and doctors in training. When you control the supply side completely, and have many years notice to plan, this is irresponsible government. It represents a collusion of denial. Market forces are giving the government a problem, but they control the market..
NHS hospitals have had to pay up to £155 an hour for doctors despite a cap introduced last year on the amount trusts could spend on agency locums.
One hospital in the north of England paid more than £10,000 a week for three locum agency doctors. Two locum agency doctors between them racked up more than 4,400 hours over a year, which equates to them each working more than eight hours every weekday.
This weekend NHS Improvement, the hospitals regulator, warned that while the government cap had succeeded in reducing the amount the NHS spent on agency nurses, trusts were still overriding the limits, sometimes paying double the permitted agency rates…..
Last year the NHS spent more than £72m on agency, overtime and bank midwives, according to a report by the Royal College of Midwives (RCM). The RCM says that, for the same cost, 3,318 full-time midwives could have been employed.
The report found that, in December 2015, NHS hospitals spent an average of £50.58 an hour on agency midwives….
Hundreds of mothers booked into their local maternity units have had to give birth in towns more than 30 miles away because the hospital closest to them had temporarily closed.
The maternity units were either full or too short-staffed to admit the women. During one closure of maternity units at Cambridge University Hospitals NHS Trust, which lasted for 3½ days, 22 women due to give birth in the city had to have their babies in a range of towns including Norwich, Ipswich, Bedford and Harlow, Essex.
In Chester, women due to give birth had to travel to hospitals up to 32 miles away in north Wales.
The Royal College of Midwives will highlight the problem at its annual conference this week.
Jon Skewes, a director of the royal college, said: “Senior midwives are telling us that they are having to close units because of staffing shortages and the increasing demands on the services that often simply do not have the resource to cope.”….
If Trust Boards and Directors are to be pilloried or dismissed for falling standards, then they have no option other than to close down services. The choice between quality and cost is no longer allowed, (By CQC or patients) so rationing has to increase… So lets make it ethical and explicit. The real risk in continuing denial of the need to ration, is that when it comes, it will be a knee-jerk co-payment system, across an NHS Region, and unfair to the poorest and most diabled.
Several midwife vacancies are to be left unfilled at a major hospital that is trying to save £22m.
The Royal Surrey County hospital in Guildford has warned of “some very difficult decisions and changes to working practice”.
It is cutting its midwife-to-mother ratio but insisted “patient safety, standards and care will not be affected”.
A former NHS trust chairman Roy Lilley said it “was a very bad idea”.
“They are sailing very close to the wind by reducing staffing levels. Unfortunately, finding extra midwives (when you need them) is very difficult, you have to resort to emergency agency arrangements which cost the earth or you simply do not get them.
“Reducing the ratio to balance the books is the worst of all decisions.”
The hospital trust said under the ratio, there would be one midwife per 30 mothers, rather than 29.
Retired NHS midwife Val Clarke, from Epsom, said: “It is very worrying. This can only impact on the mothers. When you are very busy, you are unable to give the level of care to each mother that they should be receiving.”
In a statement, Royal Surrey said: “The safety of our patients is our primary concern and as such we measure our midwife acuity levels on a daily basis.”
The trust said the ratio change was “not driven” by its need to make savings, but came from a “normal monthly process” of reviewing nursing and midwifery numbers.
But it also warned: “This year, the trust needs to save over £22m, which means… making some very difficult decisions and changes to working practice.”
Local hospital campaigner Karin Peluso told BBC Surrey: “If this continues at the Royal Surrey and they start slashing at the frontline services, key personnel like midwives, then the hospital could be on a very slippery slope.”
In April, regulator NHS Improvement began an inquiry after the trust recorded an annual deficit of £11m.
It said the trust has since agreed to develop long and short term plans to improve its finances “without impacting on patient care”.