Changing the Way the Wind Blows: Notes and Comments on an official briefing

Notes and comments on Official Briefing of Maternity and Children’s Services on Bradford NHS Trust Corporate Strategy to 2015

See post script to understand the phrase 'the way the wind blows'

I was invited by someone recently appointed to Equality and Diversity work at the BRI to a briefing. I could not find any briefing in the building entitiled Equality and Diversity and came to this one as it was the nearest one that fit the bill! I was the only user present except for a brief entrance of a colleague from a local ethnic minority organisation. I have to say I felt uncomfortable at times – was I really supposed to be there hearing this? Having said that,I stayed in my seat because it was really useful to hear it and as you can imagine I took advantage of the opportunity to ask questions and make comments especially privately. As always these events are as much about making contacts within the organisation as they are about finding out about what is going on from the front, as it were.

I have to say that I was impressed by the briefing. It was upbeat and positive about future developments and improvements. It was positive about achievements but Miles Scott, the speaker and Chief Exec of the Foundation Trust, was also candid about the weaknesses within the organisation and particularly in regard to patient satisfactions surveys. This pleased me no end because it felt like an acknowledgement of my constant complaint over recent years.

These notes do not by any means give you a full picture of what was said. There was no printout of the power point and all I could do was take down rough notes whilst also listening carefully to what was being said. The notes are not comprehensive in terms of the coverage of the briefing either – the notes focus solely on what I thought most relevant, at the time, to maternity services and maternity care. This means that inevitably I will have missed other important points made and for this I apologise to anyone who was there and heard things differently!

The briefing was almost entirely attended by staff and as far as I could tell these staff included midwives ( including senior management), peaditiritions ( community) and nursing staff. I did not see anyone I recognised from obs and gyn - so I doubt that there were any senior doctors there as I recognise most of them now.

NOTES on the Briefing given by Miles Scott:

This briefing was to introduce and explain the new corporate strategy for the Foundation Trust up to 2015.

The strategy takes into account stuff that has happened within the hospital or at PCT/National level eg. developments in community midwifery in 2008/9 [Ruth: they have taken on more midwives to try and alleviate the appaulling lack of continuity of care]

It also takes into account things in the pipeline such as Maternity Matters Implementation

The Strategy begins with a mission statement whose basic points are:

Our mission is
to provide quality healthcare in Bradford and West Yorkshire
teaching and research is central to what we are about
(and whilst recognising that we are a centre for sick people) we want to improve the health of the local population

Aims and Priorities to 2015:

The key priorities of the strategy are patient satisfaction, quality and safety of care

The strategy wants to respond to patient feedback and improve patient satisfaction rates. Indeed the strategy's aim is to be in the top 20% of patient satisfaction rates of hospitals nationally

Miles Scott's comment was that in too many areas of the service the patient experience was poor. When feedback was sought from patients (rather than waiting for them to complain) people were clear about their experience. He pointed out that Bradford (unlike Harrogate!) was not the kind of community that wrote letters of complaint and volunteered comment but he said where views had been sought, people had readily participated and the feedback was not good.

He went on to say that this is not just about people(ie staff) but about processes - we need the right people but also the right processes ( now known as ’the patient pathway’) to make it a satisfying process for the patient. He gave an example of one form of treatment where a ‘process map’ was done: there were 71 steps from visiting the GP to getting the treatment - needless to say there was plenty of scope for things going wrong and the patient experience was poor. Processes need to be simplified.

So another aim of the strategy is to provide the right staff, with the right training at the right time.

Another major priority in the strategy is for patient care to be as close to home as is practical
My comment: this is as close to a charter for homebirth as it is possible to get. If home is convenient for birth then surely there should be provision? And what about community based midwifery care, what about antenatal and postnatal care in the home?

The strategy sees the implementation as requiring:

work with GPs
delivering 50% of out patient care at treatment centres
developing homebased specialist services
teaching cutting edge techniques in Bradford ( I think this refers to medical procedures being in our local hospital instead of going elsewhere)

The strategy also wants to see BRI as being a specialist centre for West Yorkshire. It is already a specialist centre for some things but wants to develop other specialist services where it is appropriate to do so (eg. maternity and children amongst others . . . ), and provide a centre for specialists services that by their nature require greater centralisation across West Yorkshire - as a result of Lord Darzi's 'next steps review' - these might include peadeatrics and neonatal critical care, obstetrics etc (I think this is about the fact that for some critcial neonatal and maternity care women and babies have to be transported distances - sometimes long distances - and maybe we need to prevent this happening by having those specialist services here.

My comment: Wouldn’t it be good if we became a specialist centre for normal birth? A place where more women have normal low tech births than any other large Hospital Trust? How about lowest induction and CS Rates, specialist centre for vaginal breech deliveries and VBACs . Why just be a specialist centre for the high intervention medical end – why not hone the fading skills of enabling normal birth?

The strategy also wants to be a nationally recognised centre of excellence for education and applied health research and it wants to increase research output.

My comment: Midwives doing research projects in Bradford - is this happening - can this happen? Is it happening anywhere else in the UK? A centre for excellence for normal birth techniques and skills????? – could this be Bradford????

Miles Scott said that the way the Government policy and funding is going is towards applied health research - something we ( Bradford) are good at
My comment: something that midwives excel in - so why not do some of it?

Research and Development, the Fieldhouse project - although the big things have been agreed he said there is still alot to play for - so find out what you can and have your say!

My comment: Fieldhouse is the teaching building for the Hospital, a genteel manor of former glory, which will be developed into a 21st century university building for 21st century teaching. Any ideas what I should say here?

The payment on results scheme for hospital trusts is going to be calibrated to patient satisfaction so it is going to be important to find out appropriate ways of getting the feed back from patients and then implementing the learning points.
Comment: this is where we as users come into our own.

Feedback for Birth in Bradford
After the briefing there was a discussion between myself Alex Horsfall and Julie Walker (senior midwifery managers) about the effective ways of women commenting on the care they have received.

Bradford has the back pages of the notes which women can complete. I need to have a copy to comment on it – they are going to forward me a copy.

However, few women complete this page, and when women are being signed off the midwives do not routinely go through this section to ascertain feedback of the service.

My comment. This is particularly important as many women in Bradford would not be comfortable either about writing in English or indeed about writing itself (many white working class communities are mainly oral). I think midwives going through the feedback page as they should with the birth plan is fundamental to making the back page work at any level. I also think that the 10 day discharge is part of the problem - many women are just getting their head around the baby and feeding and recovery from birth etc. Maybe there needs to be a discharge or debrief interview at 4 weeks postpartum this would have benefits for both mother and maternity services.

What to do with the information here and what I am going to do with it:

1. If you are in Bradford then get writing a letter to the Chief Exec, Miles Scott or head of midwifery, copying it to your MP of course. Detail your experience of the service and what improvements and priorities you would like to see. I would love a copy to if you can mange it.

2. I am going to write an email to Miles Scott based on my notes raising the issues above.

3. Find out what consultation is going on in your area and join it! The MSLC has just started up in Bradford and it is an excellent time to join!

4. If you are not in Bradford maybe it is worth finding out what is happening at your local Trust – do they have a corporate strategy and what is it saying about maternity care? How are they implementing Maternity Matters? If it does not say anything write and express your dismay, and state your personal priorities for care particularly those the Trust is not currently meeting. Copy to your MP and a campaign like AIMS or Save Independent Midwifery.org.

5. Use the information here to lever your own Trust. For instance, if they do not have a target to be in the top 20% for patient satisfaction then point to Bradford and say why not? (Of course they may already be in the top 20%!) By networking what is happening in different parts of the country / regions we can play off one Trust against another to raise standards and change policies that are detrimental to normal birth and quality of care. And the networking starts here. So if you have any information about what your Trust intends to do – I would like to know! Especially if it involves continuity of midwifery care, homebirth and postdates inductions

6. I am going to follow up the patient feedback thing because customer feedback is fundamental to improved customer care. And for too long maternity services across the country have not as a routine exercise sought customer/user feedback nor taken it really seriously – and it shows! Users need to be at the centre of care not on the periphery. It sounds awfully thatcherite but I sometimes think this is where the NHS could do with some real market forces – customers/users need to count in the service in a way they currently do not.

(Ruth gets off her soap box and bows)

p.s. why changing the way the wind blows? because Jim Wallis says all politicians are wet fingered - holding up their finger to see which way the political wind is blowing. We do not change things by changing the personnel (although this may need to happen also) but by changing the way the political wind is blowing.

Super Mum: the myth

Once again the devil farts in my general direction! don't you find that when it comes to trying to make the world a better place - or at least birth a better experience for Mums and babies (lets keep things focussed and specific!) - then technology can just let you down, in cahoots with a brain that has far too many things to juggle?



The joys of the summer holidays! I don't mind them really it is just that spending time with the children interferes with the smooth running of campaigns, work and generally getting things done. I juggle childcare, rehearsing with my hubby who is to be where and when until it spins in my head.



And then I do something really brilliant - knowing the pressure I am under - I type up notes from a meeting on my return - before life pulls me off in another direction, email them to myself so I can apply them to the blog when I next have chance. But ahh, I come to said blog 2 weeks later and can I find these emails? Can I heck! - well yes - one of them - the helpful introduction i wrote afterwards in a fit of ultra organisation. The thing is I am at home where all good blogs tend to be written in the wee night hours when the house goes quiet but my mind is still busy, and the computer I tpyed everything up on so labouriously is at the office - and I am not driving there in my dressing gown!



And I just want to rant in sheer frustration because I just can't do anymore in my over crowded life! But of course I demand more of myself because because I want everything to be right. And every campaign to be effective and my personal committments to be reliable.



And so the super mum rises and falls - because as that great author of 'Women who run wild with Wolves', Estes, says - the super mum is simply an archetype and archetypes are not real and the sooner we as women and mothers realise that, the healthier we shall be. Because we set ourselves up to manage everything - partly because we have to to achieve what we want to achieve (I have to look after the kids and change the world!) and partly because we think that is what we should be able to do. But let me tell you girls - it ain't possible! it is a myth! We can do so much more than we think but so much less than we expect of ourselves.



I needed to hear that, again! I shall go to bed and sleep more peacefully and tomorow I will seek out that errant email and write another blog as planned.



God Bless to all you super mums out there - you are not archetypes - just mums like me, doing their best to make their corner of the world a better place. Take comfort and sleep peacefully, too. You are doing OK doing what you can.



Ruth

P.S. As I wrote this blog, the cat came in and was sick next to me. What a wonderful way to end my day!

Writing Letters - tips and ideas

I got this email the other week:

Hi Ruth

I have been reading your blog and loving it, well done, I'm not sure how you have the time to do everything?!

I have a bundle of postcards to go to a couple of Sussex PCTs, I thought that a covering letter would be a good idea to help them 'get it'. Have you done this and if so what do you think are the important points to get across to them?

Many thanks Louise

And I responded with a few ideas which I hope to share with you, plus a letter I sent to my MP a few months ago which may illustrate the technique.

The postcard campaign is a really effective and easy way of making our concerns clear to policymakers in the health service and politics. To learn more go to www.saveindependentmidwifery.org

I can tell you what I would write and in what style but in the end you have to be comfortable with what you are writing.

Say clearly in the first three lines what your letter is about (this particularly important if it is being copied to the media as they will only read the first 3 lines to see if the rest is worth reading)

Using the postcards I think you need to explain/expand on the message of the postcards – that we are ‘only’ asking for them to implement the promises of 'maternity matters' – particularly in regard to continuity of midwfery care and homebirth ( or whatever your pigeon is).

Then what I do is point out the current situation in Bradford in relation to these demands – for instance that that are too many women seeing a different midwfe at each appointment, the Trust admits that a community midwife in Bradford has 170 women per year – an impossible number. Women are regularly having homebirths turned down simply due to staffing issues.

Then you can basically reiterate the point on the postcard which says women having one mother one midwfe care have increased likelihood of a normal birth, higher breastfeeding rates etc etc. And research has shown that women are half as likely to have a CS if the book for a homebirth.

And that is it! Letter should not be more than a page and half, if it squeezes on to one page all the better. Do copy it to your MP or even all the MPs in the PCT district – if you are going to the effort of writing a letter you might as well make the biggest splash you can. I think it might be worth copying to Ann Kean MP. As a midwife you may not be comfortable about copying to the local paper /media – but If you want to go the whole hog then that is the way to go.

It maybe that your letter will open doors - but don’t be disappointed if you are stone-walled or even given a bit of a rough time. Some places are not yet ready to hear and respond to user feedback but just doing it anyway can make an impact even if you are unaware of it. That is why copying it to your MP is good – it provides some kind of protection to you if they are nasty and it gives you another outlet for your concerns and demands – a higher autheority as it were. Even if I have not put letters directly into the press I regularly forward my latest letter to the Chief Exec to journalists and others in key positions just to keep the whole thing rolling.

So good luck with your letter writing and don't forget that if we don't start asking for what we want and complaining if we don't get it, there is no chance we will ahve the maternity care we want.

All the best
Another stroppy woman