It is the eve of Christmas Eve and I am back on form writing after midnight. I have delivered all the cardboard houses (a mad idea which is it's own story!), wrapped nearly all the presents, its just the butcher, the baker, the Asian supermarket and the co-op for David's whisky tomorrow and I am done for Christmas. I have tied up the loose ends I can at work and the rest will just have to wait until after Christmas.
And I finally got our Christmas letter (the special Christmas edition of the Allerton Bugle) ready for publication. And then I sat there and read 3 journals: - one the local 'Streets Ahead' newsletter - which made me feel guilty that I am not more involved in my local community, the second, the Christian Socialist Movement's Christmas edition of Common Purpose - which made me feel guilty about not being more involved in national and party politics to change things! Finally the November edition of the AIMS journal. And there I found my speech at the Sheffield Homebirth Conference in print! I had forgotton about that. Well yes, I am doing something I thought - but of what real worth is that? And I read some of the fantastic articles and stories there of women doing so much where they are - and women who know so much as well. Oh how I wish I had read the NICE guidelines, Maternity Matters, Maternity Doesn't Matter, the local tPCT strategy - I really want to, I really should.
At this point I took a reality check. I have five children between 14 and 4 years, I have no parents or relatives nearby to share regular childcare, just a fantastic hubby. Not do I/we have the luxury of a private income or a hubby who goes out to work leaving me relatively free to pursue my mission - we both work really hard, fulltime, on our small business building it up. I do 40 plus hours on the business and then there are the children.
This is not a get out, this is not an excuse - it is a hard look at the reality - the gifts and limitations of my current position. It is about saying 'I am doing what I can, where I can. I am making a difference and doing it on a limited budget of time and resource. And that is OK.'
And for anyone out there reading this, my litany of limitations and achievement is not a stick to beat yourself up with. It is a reflection on the limitations and gifts we bring. I reckon there are women out there with the time and knowledge to read NICE guidelines etc when I can't and decant them into manageable bite-sized pieces for people like me - if this is your gift please contact me! But maybe speaking at events, asking questions at meetings, running a social enterprise is not. It is about doing what we can, when we can; not doing (or worrying about) what we can't.
And of course the best we bring to this campaign is passion and enthusiasm and the love of life, life in all its fulness. And as mothers we have bags of that - you can see it in our children.
Have a wonderful yuletide if you can - and celebrate the life we have given birth to.
Ruth
p.s. thankyou to those lovely people who have sent comments. Technology is one of my limitations (or rather the time to spend on understanding it, I suppose) and I have not yet worked how to respond to them successfully. But thank you and keep them coming, sisters!
The journal contacts are as follows:
Streets Ahead in Allerton has been read and used for kindling by my hubby, so can give no more info!
www.Thecommongoodmagazine.org.uk
www.aims.org.uk
Tuesday, 23 December 2008
Friday, 21 November 2008
Building Cathedrals - our invisible work
I was forwarded this story and it made me weep - as I too feel that my real work goes unappreciated and I constantly feel guilty for not achieving the heights of super-mum. I share it, hoping that it will encourage and inspire you as it did me. Otherwise find another story that suits you better.
Invisible Mother.....
It all began to make sense, the blank stares, the lack of response, the way one of the kids will walk into the room while I'm on the phone and ask to be taken to the store. Inside I'm thinking, 'Can't you see I'm on the phone?'
Obviously not; no one can see if I'm on the phone, or cooking, or sweeping the floor, or even standing on my head in the corner, because no one can see me at all. I'm invisible. The invisible Mom. Some days I am only a pair of hands, nothing more: Can you fix this? Can you tie this?! ; Can you open this??
Some days I'm not a pair of hands; I'm not even a human being. I'm a clock to ask, 'What time is it?' I'm a satellite guide to answer, 'What number is the Disney Channel?' I'm a car to order, 'Right around 5:30, please.'
I was certain that these were the hands that once held books and the eyes that studied history and the mind that graduated summa cum laude - but now they had disappeared into the peanut butter, never to be seen again. She's going, she's going, she's gone!?
One night, a group of us were having dinner, celebrating the return of a friend from England . Janice had just gotten back from a fabulous trip, and she was going on and on about the hotel she stayed in. I was sitting there, looking around at the others all put together so well.
It wasn't; hard not to compare and feel sorry for myself. I was feeling pretty pathetic, when Janice turned to me with a beautifully wrapped package, and said, 'I brought you this.' It was a book on the great cathedrals of Europe. I wasn't exactly sure why she'd given i t to me until I read her inscription:
'To Charlotte , with admiration for the greatness of what you are building when no one sees.'
In the days ahead I would read - no, devour - the book. And I would discover what would become for me, four life-changing truths, after which I could pattern my work: No one can say who built the great cathedrals - we have no record of their names. These builders gave their whole lives for a work they would never see finished. They made great sacrifices and expected no credit.
The passion of their building was fuelled by their faith that the eyes of God saw everything.
A legendary story in the book told of a rich man who came to visit the cathedral while it was being built, and he saw a workman carving a tiny bird on the inside of a beam . He was puzzled and asked the man, 'Why are you spending so much time carving that bird into a beam that will be covered by the roof, No one will ever see it.. And the workman replied, 'Because God sees.'
I closed the book, feeling the missing piece fall into place. It was almost as if I heard God whispering to me, 'I see you, Charlotte. I see the sacrifices you make every day, even when no one around you does. No act of kindness you've done, no sequin you've sewn on, no cupcake you've baked, is too small for me to notice and smile over. You are building a great cathedral, but you can't see right now what it will become.
At times, my invisibility feels like an affliction. But it is not a disease that is erasing my life. It is the cure for the disease of my own self-centeredness . It is the antidote to my strong, stubborn pride.
I keep the right perspective when I see myself as a great builder. As one of the people who show up at a job that they will never see finished, to work on something that their name will never be on. The writer of the book went so far as to say that no cathedrals could ever be built in our lifetime because there are so few people willing to sacrifice to that degree.
When I really think about it, I don't want my son to tell the friend he's bringing home from college for Thanksgiving, 'My Mom gets up at 4 in the morning and bakes homemade pies, and then she hand bastes a turkey for three hours and presses all the linens for the table.' That would mean I'd built a shrine or a monument to myself. I just want him to want to come home. And then, if there is anything more to say to his friend, to add, 'You're gonna love it there.'
As mothers, we are building great cathedrals. We cannot be seen if we're doing it right. And one day, it is very possible that the world will marvel, not only at what we have built, but at the beauty that has been added to the world by the sacrifices of invisible women.
Invisible Mother.....
It all began to make sense, the blank stares, the lack of response, the way one of the kids will walk into the room while I'm on the phone and ask to be taken to the store. Inside I'm thinking, 'Can't you see I'm on the phone?'
Obviously not; no one can see if I'm on the phone, or cooking, or sweeping the floor, or even standing on my head in the corner, because no one can see me at all. I'm invisible. The invisible Mom. Some days I am only a pair of hands, nothing more: Can you fix this? Can you tie this?! ; Can you open this??
Some days I'm not a pair of hands; I'm not even a human being. I'm a clock to ask, 'What time is it?' I'm a satellite guide to answer, 'What number is the Disney Channel?' I'm a car to order, 'Right around 5:30, please.'
I was certain that these were the hands that once held books and the eyes that studied history and the mind that graduated summa cum laude - but now they had disappeared into the peanut butter, never to be seen again. She's going, she's going, she's gone!?
One night, a group of us were having dinner, celebrating the return of a friend from England . Janice had just gotten back from a fabulous trip, and she was going on and on about the hotel she stayed in. I was sitting there, looking around at the others all put together so well.
It wasn't; hard not to compare and feel sorry for myself. I was feeling pretty pathetic, when Janice turned to me with a beautifully wrapped package, and said, 'I brought you this.' It was a book on the great cathedrals of Europe. I wasn't exactly sure why she'd given i t to me until I read her inscription:
'To Charlotte , with admiration for the greatness of what you are building when no one sees.'
In the days ahead I would read - no, devour - the book. And I would discover what would become for me, four life-changing truths, after which I could pattern my work: No one can say who built the great cathedrals - we have no record of their names. These builders gave their whole lives for a work they would never see finished. They made great sacrifices and expected no credit.
The passion of their building was fuelled by their faith that the eyes of God saw everything.
A legendary story in the book told of a rich man who came to visit the cathedral while it was being built, and he saw a workman carving a tiny bird on the inside of a beam . He was puzzled and asked the man, 'Why are you spending so much time carving that bird into a beam that will be covered by the roof, No one will ever see it.. And the workman replied, 'Because God sees.'
I closed the book, feeling the missing piece fall into place. It was almost as if I heard God whispering to me, 'I see you, Charlotte. I see the sacrifices you make every day, even when no one around you does. No act of kindness you've done, no sequin you've sewn on, no cupcake you've baked, is too small for me to notice and smile over. You are building a great cathedral, but you can't see right now what it will become.
At times, my invisibility feels like an affliction. But it is not a disease that is erasing my life. It is the cure for the disease of my own self-centeredness . It is the antidote to my strong, stubborn pride.
I keep the right perspective when I see myself as a great builder. As one of the people who show up at a job that they will never see finished, to work on something that their name will never be on. The writer of the book went so far as to say that no cathedrals could ever be built in our lifetime because there are so few people willing to sacrifice to that degree.
When I really think about it, I don't want my son to tell the friend he's bringing home from college for Thanksgiving, 'My Mom gets up at 4 in the morning and bakes homemade pies, and then she hand bastes a turkey for three hours and presses all the linens for the table.' That would mean I'd built a shrine or a monument to myself. I just want him to want to come home. And then, if there is anything more to say to his friend, to add, 'You're gonna love it there.'
As mothers, we are building great cathedrals. We cannot be seen if we're doing it right. And one day, it is very possible that the world will marvel, not only at what we have built, but at the beauty that has been added to the world by the sacrifices of invisible women.
Tuesday, 11 November 2008
The Acorn has sprouted
Well my charismatic customers would have described this evening as 'awesome'. I am not sure if I can say why - too close to the evening to have integrated all that was said.
Tonight was Choices night. Let me introduce Choices. Six years ago as NCT Homebirth co-ordinator I set up a homebirth group and after some scouting around found not an NHS midwife to facilitate the meeting - but a breed of midwfe I had never met before - the 'independent midwife'. It was not long before people not wanting a homebirth asked if they could come along, and anyway, we did not just talk about place of birth but birth support, the third stage of labour, Vitamin K, to suture or not to suture and much more. And so we decided to call our group something else - a Choices in Childbirth Group' - or Choices as it is known.
And so for six years month by month we have been meeting - sometimes there is one woman, or one couple, sometimes there are 15 of us - and in a simple informal way we talk around the issues that concern those present.
And tonight was such a night. There was a single Mum, who brought along her young partner, slightly embarrassed, but good for him he was there. Last month she told us that she had been told that she could not have a homebirth. She had been surprised to find someone else there who had been given a similar statement for similar reasons but had decided to have a homebirth as it was the place she would feel most safe and relaxed and therefore most likely to be safe and without complications. This month she told us she had negotiated a homebirth with her midwives. But she now had lots of other questions about pregnancy and birth she needed answering.
Another second time Mum needed to talk about her previous birth and the care which she had received which to say the least had not been always good. These things need to be said and acknowledged. Looking forward to this new baby, she wanted things to be different.
Another woman was moving on from a difficult early pregnancy and looking at possibilities, and looking for better care than she had received in those first 4 months.
And we had the Head of Midwifery at our group. And she was so good, she listened, and it must have been hard to listen and not butt in, but she listened and said some things. And I wanted her to tell the group about the changes planned and the things they wanted to do to improve things. But the people here tonight needed and wanted to talk and every attempt I made was quoshed as they continued to discuss the things that mattered to them. And the Head of Midwifery demonstrated her midwfery skills of reassuring presence, so women talked and were reassured by her presence.
I am on the learner slopes when it comes to these things so I sat with my crochet and watched and listened with awe to the discussions around me, interjecting sometimes with a question or comment or occasionally my passion got the better of me and I said more!
And afterwards I was stunned by the hugs and the thanks. What had I done? I had made this happen, set up the group, publicised, kept battering at the gates of the NHS Trust until they openned a little and then jammed my foot in the gap to make sure it did not shut again! Oh! I had not realised i had done that - I was too busy to notice, and too exhausted to be really honest.
And of course I could not do it without the people who had said thanks - Catriona who had hosted it and invited her firends, her house mate who made the tea and openned the door for everyone, for Kajsa who supports the La Leche League in Bradford and breastfeeding stuff now I do so little of that, and so many others passing on the messages of empowerment and hope to other women. And of course IM Michelle Whittle faithfully turning up to share in 2 hours her knowledge and passion for good birthing month after month, year after year. And tonight, to Julie Walker for coming to our group and respecting us and listening to us, and not trying to defend the service but accepting the criticism and seeking ways to take things forward.
From such little acorns do mighty oaks grow. Maybe this little group is yeast in the dough helping to transform dough to bread. Maybe it is not. But tonight, some of us caught the amazing potential of our births to change not just our own lives but those of our community and city. I hope so.
Choices matter because, to make a choice people need to know they have one in the first place, and they need the resource to access that choice. As far as we are able we try to do that by providing information and offering support. And then using these women's stories to ask/demand better maternity services.
Already we have grown - from 1 group to three or four, with an emailing list of 250. Yes Choices is now an online monthly newsletter as well. So you can sign up and get information on events, latest research, websites, petitions and campaigns, and anything else that maybe relevant. You can sign up at http://www.aquabirthsathome.co.uk/ . We also have links with groups in Manchester, Sheffield, York and Liverpool.
Tonight was awesome not because it was an earth shattering event - but because tonight I could look back and see how far we had come from where we were six years ago - and be reminded by women there of the importance of this groups in their journey to birth. That was awesome. The acorn has sprouted.
Tonight was Choices night. Let me introduce Choices. Six years ago as NCT Homebirth co-ordinator I set up a homebirth group and after some scouting around found not an NHS midwife to facilitate the meeting - but a breed of midwfe I had never met before - the 'independent midwife'. It was not long before people not wanting a homebirth asked if they could come along, and anyway, we did not just talk about place of birth but birth support, the third stage of labour, Vitamin K, to suture or not to suture and much more. And so we decided to call our group something else - a Choices in Childbirth Group' - or Choices as it is known.
And so for six years month by month we have been meeting - sometimes there is one woman, or one couple, sometimes there are 15 of us - and in a simple informal way we talk around the issues that concern those present.
And tonight was such a night. There was a single Mum, who brought along her young partner, slightly embarrassed, but good for him he was there. Last month she told us that she had been told that she could not have a homebirth. She had been surprised to find someone else there who had been given a similar statement for similar reasons but had decided to have a homebirth as it was the place she would feel most safe and relaxed and therefore most likely to be safe and without complications. This month she told us she had negotiated a homebirth with her midwives. But she now had lots of other questions about pregnancy and birth she needed answering.
Another second time Mum needed to talk about her previous birth and the care which she had received which to say the least had not been always good. These things need to be said and acknowledged. Looking forward to this new baby, she wanted things to be different.
Another woman was moving on from a difficult early pregnancy and looking at possibilities, and looking for better care than she had received in those first 4 months.
And we had the Head of Midwifery at our group. And she was so good, she listened, and it must have been hard to listen and not butt in, but she listened and said some things. And I wanted her to tell the group about the changes planned and the things they wanted to do to improve things. But the people here tonight needed and wanted to talk and every attempt I made was quoshed as they continued to discuss the things that mattered to them. And the Head of Midwifery demonstrated her midwfery skills of reassuring presence, so women talked and were reassured by her presence.
I am on the learner slopes when it comes to these things so I sat with my crochet and watched and listened with awe to the discussions around me, interjecting sometimes with a question or comment or occasionally my passion got the better of me and I said more!
And afterwards I was stunned by the hugs and the thanks. What had I done? I had made this happen, set up the group, publicised, kept battering at the gates of the NHS Trust until they openned a little and then jammed my foot in the gap to make sure it did not shut again! Oh! I had not realised i had done that - I was too busy to notice, and too exhausted to be really honest.
And of course I could not do it without the people who had said thanks - Catriona who had hosted it and invited her firends, her house mate who made the tea and openned the door for everyone, for Kajsa who supports the La Leche League in Bradford and breastfeeding stuff now I do so little of that, and so many others passing on the messages of empowerment and hope to other women. And of course IM Michelle Whittle faithfully turning up to share in 2 hours her knowledge and passion for good birthing month after month, year after year. And tonight, to Julie Walker for coming to our group and respecting us and listening to us, and not trying to defend the service but accepting the criticism and seeking ways to take things forward.
From such little acorns do mighty oaks grow. Maybe this little group is yeast in the dough helping to transform dough to bread. Maybe it is not. But tonight, some of us caught the amazing potential of our births to change not just our own lives but those of our community and city. I hope so.
Choices matter because, to make a choice people need to know they have one in the first place, and they need the resource to access that choice. As far as we are able we try to do that by providing information and offering support. And then using these women's stories to ask/demand better maternity services.
Already we have grown - from 1 group to three or four, with an emailing list of 250. Yes Choices is now an online monthly newsletter as well. So you can sign up and get information on events, latest research, websites, petitions and campaigns, and anything else that maybe relevant. You can sign up at http://www.aquabirthsathome.co.uk/ . We also have links with groups in Manchester, Sheffield, York and Liverpool.
Tonight was awesome not because it was an earth shattering event - but because tonight I could look back and see how far we had come from where we were six years ago - and be reminded by women there of the importance of this groups in their journey to birth. That was awesome. The acorn has sprouted.
Tuesday, 21 October 2008
Selling innovation to the NHS - and how!
Sorry it has been so long folks. With my nose to the grindstone I had not realised where the time had gone. But enough! Let me quickly run through some interesting information gained from a short speech at the White Rose Partnership's Health Innovations day.
This was a winding up, showcase of achievements conference for a project to bring Universities, NHS Trusts and commercial companies together to work in partnership to take forward innovations for the health sector. It was a long day with many talks - some of them more intersting and understandable than others, and I do not have time to outline all I learnt. However there is one talk well worth blogging to the stroppy women out there because this is useful information for those of us looking to change the way the NHS works.
The talk was by a charming and articulate man called Dr Chris Herbert, from a Government agency aiming to get innovations into the NHS. You can find his talk on the website linked to below.
Chris re-iterated the oft quoted observation that the NHS is a slow adopter of medical technology. Too right! but then he began to unravel the NHS system and you can see why - and of course by seeing what is making the NHS tick we can on the one hand challenge the system to change but on the other, have strategies to effect change whilst the systems are still in place as they are.
Chris's talk in a nutshell:
There are three levels of procurement in the NHS:
The Hospital level is where it is at and here there is also complexity and further levels to penetrate.
The Hospital procurement process runs along the following lines: a need is identified, a solution is sought and suppliers identified, then a long procurement process ensues (he did not go into detail here!) which can last around 18 months to 2 years. The key decision maker in the process is the Directorate Manager and his/her only criteria for decision making is COST.
Directorate mangers have only an annual budget which they must spend or lose on the one hand but not overspend on the other. This is a very territorial system therefore with your fiefdom defined by the size of your budget. A purchase which has cost savings but outside of their own budget is of no interest to the directorate manager.
The key drivers to the 'not best but cheapest' criteria for decison makers are the Government tools of Commissioning and Payment by Results.
Commissioning has been dealt with in a previous blog around PCT commissioning. Basically the needs of a population are identified and priorities set from these and then health services are bought in to supply these health needs and priorities.
Payment by Results is a mechanism for calculating what is paid to hospitals for the work they do. In maternity services, say in the delivery suite, there is a fee paid for a normal birth, a fee paid for forceps and a fee paid for ceasareans. The fee set is said to be the average cost for these procedures. This is a strong force in driving down costs because you won't want your costs per procedure to be higher than the fee you receive! In fact you will aim for the reverse!
This has implications for those of us wanting to promote normal birth and choice and innovation in maternity care. Trusts get more money for doing lots of Ceasereans than they do for normal births, water births etc. This has been an issue in our local PCT area as it is a driver for the medicalised high tech birth. This payment by results also discourages innovation and innovative practices because if you are on a set fee you will want to do what is easiest and fastest - there is far more risk costwise for innovation.
So in sum, the key levels of procurement are national level, regional level and hospital level. At hospital level the key decision making is at directorate level and their over riding criteria is cost (against a one year budget allocation!). And the drivers in this system are the systems of thecommissioning process and Payment by Results.
So how do you introduce innovation and innovative practice into this scenario - not without difficulty it is clear, however Dr Herbert had a few pointers:
Directorate managers say they are in favour of innovation - but as you see the drivers mean that their practice penalises it, so
It makes me wonder why I do it! But do not be de-moralised - we can change things because the other great driver in current Government policy is patient satisfaction and patient choice. So it really is time to get stroppy because policy is on our side.
Good luck to you all!
Ruth
For all the conference papers for the day (20th October in Harrogate) and slides go to the White Rose Health Innovation Partnership website: www.wrhip.org
This was a winding up, showcase of achievements conference for a project to bring Universities, NHS Trusts and commercial companies together to work in partnership to take forward innovations for the health sector. It was a long day with many talks - some of them more intersting and understandable than others, and I do not have time to outline all I learnt. However there is one talk well worth blogging to the stroppy women out there because this is useful information for those of us looking to change the way the NHS works.
The talk was by a charming and articulate man called Dr Chris Herbert, from a Government agency aiming to get innovations into the NHS. You can find his talk on the website linked to below.
Chris re-iterated the oft quoted observation that the NHS is a slow adopter of medical technology. Too right! but then he began to unravel the NHS system and you can see why - and of course by seeing what is making the NHS tick we can on the one hand challenge the system to change but on the other, have strategies to effect change whilst the systems are still in place as they are.
Chris's talk in a nutshell:
There are three levels of procurement in the NHS:
- the national level ( now a private company called DHL)
- regional level (Regional Collaborative Network. the Regional level do no not buy anything they just set up framework contracts for hospital trusts to buy into)
- and local or Hospital Trust level
The Hospital level is where it is at and here there is also complexity and further levels to penetrate.
The Hospital procurement process runs along the following lines: a need is identified, a solution is sought and suppliers identified, then a long procurement process ensues (he did not go into detail here!) which can last around 18 months to 2 years. The key decision maker in the process is the Directorate Manager and his/her only criteria for decision making is COST.
Directorate mangers have only an annual budget which they must spend or lose on the one hand but not overspend on the other. This is a very territorial system therefore with your fiefdom defined by the size of your budget. A purchase which has cost savings but outside of their own budget is of no interest to the directorate manager.
The key drivers to the 'not best but cheapest' criteria for decison makers are the Government tools of Commissioning and Payment by Results.
Commissioning has been dealt with in a previous blog around PCT commissioning. Basically the needs of a population are identified and priorities set from these and then health services are bought in to supply these health needs and priorities.
Payment by Results is a mechanism for calculating what is paid to hospitals for the work they do. In maternity services, say in the delivery suite, there is a fee paid for a normal birth, a fee paid for forceps and a fee paid for ceasareans. The fee set is said to be the average cost for these procedures. This is a strong force in driving down costs because you won't want your costs per procedure to be higher than the fee you receive! In fact you will aim for the reverse!
This has implications for those of us wanting to promote normal birth and choice and innovation in maternity care. Trusts get more money for doing lots of Ceasereans than they do for normal births, water births etc. This has been an issue in our local PCT area as it is a driver for the medicalised high tech birth. This payment by results also discourages innovation and innovative practices because if you are on a set fee you will want to do what is easiest and fastest - there is far more risk costwise for innovation.
So in sum, the key levels of procurement are national level, regional level and hospital level. At hospital level the key decision making is at directorate level and their over riding criteria is cost (against a one year budget allocation!). And the drivers in this system are the systems of thecommissioning process and Payment by Results.
So how do you introduce innovation and innovative practice into this scenario - not without difficulty it is clear, however Dr Herbert had a few pointers:
Directorate managers say they are in favour of innovation - but as you see the drivers mean that their practice penalises it, so
- Plan strategically
- Look at how to maximise chances of take-up over a wide area
- Intervene early in the process of procurement to enable things to move forward
When looking at an innovation or new practice ask yourself the following:
- Will it solve a problem the Trust has?
- Will it fit the current practice (if it does not then it won't be adopted because changing current practice cost s time and effort that cannot be afforded)
- What is the tariff (in the Payment by Results) for the procedure or service you want to innovate? (You need to show cost benefits or at least neutrality for your innovative practice)
- Identify data and evidence to support you innovation.
Also:
- The key to procurement is hospital uptake so start with them - get to the clinicians and end users.
- Do a trial help set up a tiral - even if there have been research trials done globally they will want to do a trail in their hosital
- Help staff write their business plan to get the money/go-ahead from the management (directorate and remember cost)
- Remember it is not all over until the fat lady sings - until there is a contract signed then nothing has changed
- Once you have got a hopsital or two under your belt then you can start to tackle the strategic health authority. Look for tender calenders on their websites and start negotiating - remembering that price is the big issue - not quality.
It makes me wonder why I do it! But do not be de-moralised - we can change things because the other great driver in current Government policy is patient satisfaction and patient choice. So it really is time to get stroppy because policy is on our side.
Good luck to you all!
Ruth
For all the conference papers for the day (20th October in Harrogate) and slides go to the White Rose Health Innovation Partnership website: www.wrhip.org
Wednesday, 27 August 2008
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
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.
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.
Wednesday, 20 August 2008
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!
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!
Saturday, 2 August 2008
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
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
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