Thoughts on the 2016 Maternity Review
(March 2016b)
I read the Better Births National Maternity Review (NHS England 2016) with interest and not a little trepidation having spotted a few media headlines before reading the real thing. Many could be forgiven for imagining that the focus of the review would be the personal budget which has receiving so much attention and while I have reservations about this particular aspect, it is short sighted to think this is the beginning and the end of it.
Pic credit (https://www.rcm.org.uk/news-views-and-analysis/news/national-maternity-review-published)
My overall impression of the report was its focus on choice and safety and that the two are not mutually exclusive. My feeling and my experience is that the kind of care the review discusses is largely the kind of care that midwives would like to provide. Certainly it would seem that there are incidents where this has not happened and if we have learnt one thing from Morecambe Bay and Mid Staffs, it is that no one is immune and this is why self awareness and an open and safe working atmosphere is vital for safe and compassionate care.
I believe the barriers to this happening are stress in the workplace caused by insufficient staffing levels and poor morale which cascades from above, resulting in a culture of fear, anxiety and fatigue. This belief is borne out in the results of the NHS staff survey which reports a shocking 46% of midwives have experienced stress in their workplace in the last year (NHS 2015). You only need to look to the news over the last couple of years to realise that midwives feel devalued by the Government in terms of pay and frequently demonised in the press.
I will be very interested to see how the continuity aspect of the report is implemented. I wonder whether this will be the ‘in’ for private midwifery organisations such as ‘One to One Midwives’ to increase their reach within the NHS. From looking at their website and talking to midwives who work for them, I can’t deny that it doesn’t seem like an ideal scenario for women. However the die hard NHS believer in me worries that this is how privatisation will continue in the NHS. That ultimately it will be a postcode lottery as to who gets gold standard caseload care and who doesn’t. Free, high quality care at point of need, it’s a pillar which makes the NHS extraordinary in the world. My preference would be for the NHS to adopt the caseloading model and further develop the homebirth teams already in existence. Perhaps more cross working between community and the obstetric environment would see more women experiencing continuity of carer.
It would be easy, as had already been said, to expect that this review will go the same path as other reports before it, off to sleep in the filing cupboard of good intentions but I am quietly optimistic that this may well be the time for change. That the terrible things which happened did not happen in vain and that we are ready for change. The chatter on Facebook and Twitter, on blogs and at various conferences are of a maternity revolution taking place, midwives shoulder to shoulder with the women and families, working and talking together to make a safer and more open environment where change can really happen.
Reading the report, there are so many opportunities where as a midwife I can step up and be the midwife they are talking about. We can provide excellent personalised care. We can provide informed choice. We can be great team players, collaborating with our various colleagues. We can do our bit to reduce stress in the workplace – be kind to one another, look out for colleagues who are suffering, be aware of the impact of our words and actions and decide to build up rather than break down. Midwifery is a unique profession, often the only ones who really understand are other midwives and this is our responsibility to one another.
References
NHS, 2015. http://www.nhsstaffsurveys.com/Page/1010/Home/NHS-Staff-Survey-2015/
NHS England, 2016 https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf
Pic credit (https://www.rcm.org.uk/news-views-and-analysis/news/national-maternity-review-published)
My overall impression of the report was its focus on choice and safety and that the two are not mutually exclusive. My feeling and my experience is that the kind of care the review discusses is largely the kind of care that midwives would like to provide. Certainly it would seem that there are incidents where this has not happened and if we have learnt one thing from Morecambe Bay and Mid Staffs, it is that no one is immune and this is why self awareness and an open and safe working atmosphere is vital for safe and compassionate care.
I believe the barriers to this happening are stress in the workplace caused by insufficient staffing levels and poor morale which cascades from above, resulting in a culture of fear, anxiety and fatigue. This belief is borne out in the results of the NHS staff survey which reports a shocking 46% of midwives have experienced stress in their workplace in the last year (NHS 2015). You only need to look to the news over the last couple of years to realise that midwives feel devalued by the Government in terms of pay and frequently demonised in the press.
I will be very interested to see how the continuity aspect of the report is implemented. I wonder whether this will be the ‘in’ for private midwifery organisations such as ‘One to One Midwives’ to increase their reach within the NHS. From looking at their website and talking to midwives who work for them, I can’t deny that it doesn’t seem like an ideal scenario for women. However the die hard NHS believer in me worries that this is how privatisation will continue in the NHS. That ultimately it will be a postcode lottery as to who gets gold standard caseload care and who doesn’t. Free, high quality care at point of need, it’s a pillar which makes the NHS extraordinary in the world. My preference would be for the NHS to adopt the caseloading model and further develop the homebirth teams already in existence. Perhaps more cross working between community and the obstetric environment would see more women experiencing continuity of carer.
It would be easy, as had already been said, to expect that this review will go the same path as other reports before it, off to sleep in the filing cupboard of good intentions but I am quietly optimistic that this may well be the time for change. That the terrible things which happened did not happen in vain and that we are ready for change. The chatter on Facebook and Twitter, on blogs and at various conferences are of a maternity revolution taking place, midwives shoulder to shoulder with the women and families, working and talking together to make a safer and more open environment where change can really happen.
Reading the report, there are so many opportunities where as a midwife I can step up and be the midwife they are talking about. We can provide excellent personalised care. We can provide informed choice. We can be great team players, collaborating with our various colleagues. We can do our bit to reduce stress in the workplace – be kind to one another, look out for colleagues who are suffering, be aware of the impact of our words and actions and decide to build up rather than break down. Midwifery is a unique profession, often the only ones who really understand are other midwives and this is our responsibility to one another.
References
NHS, 2015. http://www.nhsstaffsurveys.com/Page/1010/Home/NHS-Staff-Survey-2015/
NHS England, 2016 https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf
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