Confessions of a Campaigner:of Postcards and PCTs

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 run by our local CVS ( Council for Voluntary Services) bless them. 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:

Skip this bit if you have no time to read it all:

This is a new system and everyone is trying to get a handle on it and alot of the commissioners are newly in post.
The stated aim is to deliver world class commissioning ie. health services to citizens.
The framework of health reforms is stated as being about more choice for patients, a stronger voice for users , money following the ‘paitient’, more diverse range of care provision and providers, better patient experience, value for money, quality of care.
There was much talk about the patient pathway becoming a seamless package of social and medical care delivered where and when the patient needs it most. Lord Darzi’s report not then published was alluded to with his recommendation that we should not move the patient closer to care but the care closer to the patient.
The key drivers of this reform were stated as: Local Government and Public Involvement in Health Act 2007, Local Area Agreements, Vital Signs (these are the criteria the Department of Health have for a good PCT), Joint Strategic Needs Assessments (what?), Operating Frameworks, Local Delivery Plans. I know what some of these are – the rest I will ask about as I go along.
They need the third sector: to deliver information for their needs assessment and to deliver care that the nhs cannot provide because a) it is too innovative and b) they cannot get that close to the user to provide appropriate care.

And now for the bit that made real sense in terms of what we need to achieve locally:

We now have a district-wide PCT with overall goals agreed with central Government (35 agreed targets out of a Government menu of 198 to choose from). Within the PCT, however, there are 'divisions' which ironically in Bradford are along the same lines as the old PCT boundaries. 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. It is worth checking what the stated health priorites of your PCT are, and its individual divisions.

Third sector groups can tender to do work that fulfills these priorities 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 third sector organisations in the community can have a positive effect especially here. (YES I know this has been said before but lets take them at their word and demand delivery)

There is a cycle/process to arriving 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 health 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 fulfil certain priorities - 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-commissioning 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. For instance, at the event I went up to the Head of Partnership Commissioning (I think that 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 work with. 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 what the PCT commissioners were saying to us – we need your input, your information to make the process sensitive to people’s needs.

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! Hopefully it gives a flavour of what may be going on in your 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 independent midwives need to look at how they can tender for services not being currently rendered. It is a steep learning curve - but in a new 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 this was achieved with a twinkle in the eye, a smile and a bit of cheek.

Ruth Weston is a mother of five children who runs her own business, building, hiring and selling pools. She is passionate about giving her daughters the opportunity of giving birth at home with a midwife they know, without a fight or a campaign. contact her at ruth@aquabirths.co.uk or sign up to her email newsletter ‘Choices in Childbirth’ at www.AquabirthsATHome.co.uk . for more information on the postcard and other national campaigns see www.saveindependentmidwfery.org

The roller coaster

There I was doing my bit and wondering whether it was going anywhere and then - whoosh!, swept off my feet and carried along by a tide of things. Can't tell you them all because I don't keep a diary and I would need to post every day.

Last Tuesday it was the Choices group - an information and support for parents having babies who are looking for natural options for birth. Midwives come along too and one took away 20 postcards for her surgery - I had already got the GP at her practice to sign a card.

Wednesday I was on Radio Leeds - fluffed promotion of the campign here because was having a hilarious time - and that is the point really of the show and you get to fly your flag in return for making a fool of yourself - which i am pretty good at. But did talk alot about normal birth, being in control, birthstory of no. 5 and placenta curry . . . .does anyone have any recipes? And we got asked back and booked in for September so good work there.

Thursday it was Cash for Trash on TV where I took leave of my senses and de-cluttered my home on camera for charity and a family holiday - and to promote AIMS. Wish the postcard campaign had been going but there again they did not like controversial - we had to clothe it appropriately to make it palatable. Can see it still on BBC website iplayer - well at least until Thursday.
Thursday, wondered whether I had really pushed it too far in my candid reflection on the discusssion of the women who had attended the Choices meeting - to the head of midwifery. But women do need professionals to take account of and actually fully respect our perspectives because after all we live with the consequences of what happens like no one else does. Anyway her reply today showed her to be the big person she is and maybe there is a way to take things forward.
Friday went to the AIMS national committee and handed over most of the Cashfor Trash money and found myslef volunteering to do stuff - ahgg! where is the time? I need a couple of lifetimes to do what I want to do.

I spent the weekend falling asleep all over the place utterly exhausted but managed to drag myslef to a friends welcome to the the world party for babe. it was worth it - she took 50 postcards off me and told me that her hubby had met the PCT commissioner and told her in no uncertain terms why they had opted to pay for midwi
fery care rather than use the local nhs for babe no. 4.

and now the week begins again.

Years ago I remember a colleague telling me that you can only see about 10% of what needs to be done and the possiblities there, and of that you can only humanly manage 2%. As I strain to do yet more for the cause I am so passionate about I have to keep reminding myself of those words and chill a bit. My faith would ask me to call on the communion of saints - we are part of a team - they would say. Hmmm something to reflect on . . .

"No cause was ever won . . ."

This has been a challenging week and I thought I would not achieve anything for the postcard campaign. It was the second week of the children's school holidays with David and I taking shifts to cover a busy office and childcare. That was difficult enough but then suddenly we could download no Aquabirths emails - a bit of downer when it is your business and your main means of communication. And then the 'crowning turd in the waterpipe': David's computer died taking all his emails with it. I looked at the 1950 postcards and was defeated by the enormity of the task in the face of the sludge of life.

When I feel like this I always think of that amazing woman, mother and suffragette. Born into a poor farming community in 1871 and living and working in the northern industrial towns. Despite working long hours, she educated herself and became involved in the suffragette movement and political justice campaigns of the time. Hannah knew what it was like to be a working Mum working for social change. She once said: "No cause was ever won between dinner and tea, and those of us who were married had to fight with one had tied behind our backs . . . ."

And then I know that, it has always been the same. Attending meetings with a child on the hip and another sat on the floor next to you. Fitting your day between school runs, tea time, bedtime. Writing and organising with constant interruption from life and children. I remember realising I could not even have a baby without planning around such things! 4 days overdue with my 5th child I realised this baby could only be born between 9.30am-2.30am and 8.30pm and 6am, because David had to be available to do the school run!

But in the midst of despair the tide turned: I got a phone call from Radio Leeds, would I like to come on an evening chat show and talk about the latest stuff going on in my life - would I! And a local GP signed a card and said he would be happy for me to have them displayed at his surgery - mind you i want more than that - he is an active Lib Dem - and what is the Lib Dem's policy on Maternity Matters implementation? independent midwives? and how do I get the message across to the PCT? And finally next week I am de-cluttering my home on TV to promote AIMS, Thursday, BBC1 11.30am. I wish I had had the postcards when they were filming that - mind you they were jumpy about anything 'controversial' - but it provides another excuse to talk.

Now for rhubarb crumble and tending Stan's 'hurtie foot'! " No cause was ever won . . . .

Hannah Mitchell quote in 'Women and Politics' by Ann Kramer, Wayland 1988 - a book that ever girl should read, or have read to them.

Summoning up the apathy

Is it the time of the month? It could be. But that usual bounce at the end of a holiday with new ideas and new energy for exciting things is not there. I think of that box of 2000 postcards - now less 50 - and groan. What did I say I would do with them all? The thought of accosting 800 people for postcards makes me want to hide under the duvet and sleep for a thousand years.

I know that energy and enthusiasm go in cycles, menstrual cycles as often as not, but it is still depressing when it happens!

Still tomorrow is another day and latest steps forward are:
Visited head of midwifery at local trust, told her about the postcards - she wanted to see some so dropped off 20, this maybe just the start. Told her about the Rikki Lake documentary: the Business of Being Born and wondered if we could have a showing in the Lecture Theatre there. It would be another way of stimulating a discussion about what kind of maternity services we want - 'not a bad idea' was the response. So plans are afoot to bring the film into the heart of West Yorkshire - watch this space. I notice that Denis Walsh is going to the showing in blackburn - so it is a quaestion of what we do for ours?

And that is the best enthsuiasm I can muster - until tomorrw perhaps - but not bad eh?

To learn more about the postcard campaign visit www.saveindependentmidwfery.org or sign up to the monthly Choices in Childbirth e-newsletter on www.aquabirthsathome.co.uk ]
Business of Being Born: for preview and national showings go to saveindependentmidwifery.org