Report published on women’s satisfaction levels with maternity care in Wales

Most women are satisfied with maternity care in Wales with services generally meeting an appropriate standard, says a report published this week by the Auditor General. But the report also highlights some specific problems including the way that labour is managed in some trusts and dissatisfaction with support for infant feeding.

The report includes a survey of new mothers and although many women questioned were satisfied with their experience, a significant minority felt they were not always treated with dignity and respect or kindness and understanding.

Antenatal care generally meets good practice guidelines, but some women do not receive enough check-ups and there is generally low attendance at antenatal classes. The report also shows that women in some trusts tend to receive too many scans whilst trusts are not yet offering the most up-to-date screening for Down’s syndrome.

The way labour is managed in some NHS trusts gives rise to concern. A significant minority of women felt they were left alone and worried during or shortly after labour and some trusts could do more to prevent unnecessary Caesarean sections. Women were least satisfied with the postnatal phase of care, with over a third of women being unhappy with the quality of support they received for infant feeding.

The report calls for the Assembly Government to develop an overall strategy for maternity services in Wales. This would help the planning of maternity services which is currently being undermined by the lack of a clear vision and poor information about the cost and quality of care.

The strategy would also provide a comprehensive source of guidance aimed at removing some of the specific problems with maternity services, such as the failure to meet recommended staffing levels in some trusts and the low level of staff training in many trusts.

The report called Maternity Services makes a number of recommendations for improvement, by calling on:

• the Assembly Government to develop a comprehensive strategy for maternity services, highlighting good practice and offering guidance on local service planning
• new local health boards to assess staffing requirements for delivering safe and high quality services
• local health boards to make sure that all maternity staff receive the necessary clinical training
• local health boards to review their training programmes to ensure that there is sufficient focus on the principles of respect, well being, choice and dignity
• the Assembly Government, in partnership with the NHS in Wales and other key stakeholders, to agree a standard set of data that is routinely collected, monitored and used to support service improvement.

RCOG reports on older mothers

In response to growing concern over the rising incidence of later maternal age in the UK, the RCOG convened a Study Group to meet to discuss the issues. Research shows there is a growing trend in the UK for childbearing to occur at a later time in women’s lives and the RCOG says there is an urgent need for better public information on the issues surrounding later maternity.  The RCOG report that whilst women should be supported, rather than constrained, in their life choices, both women and society need to be aware of the possible problems that older mothers may encounter.
 
RCOG reports that later maternal age is an emerging public health issue and organisations such as themselves, NICE and the Centre for Maternal and Child Enquiries (CMACE) must work together with the Department of Health to tackle these new challenges. 

Research into impact of independent midwifery care published

The British Medical Journal this week published research comparing care provided by independent midwives with maternity care within the NHS. The research compared a wide range of ‘outcomes’ including whether mothers started labour spontaneously, whether their birth was spontaneous, without forceps, ventouse or caesarean section,  where drugs were used for pain relief, and breastfeeding rates. It found that women who used an independent midwife (i.e. a midwife registered with the Independent Midwives Association) were more likely to start labour spontaneously, have an unassisted vaginal birth, use fewer pain relieving drugs and were much more likely to establish breastfeeding.
 
For women with a straightforward pregnancy the stillbirth and neonatal death rate was similar to that for women having their baby with NHS care. There appeared to be more baby deaths among women who had a more complex pregnancy with an independent midwife. Unfortunately the methodology used was unable to compare accurately the women having care with an independent midwife with those using NHS services. Although the sample was matched in terms of age, previous children, year of birth and socioeconomic status there are likely to be many other ways in which the two groups differ, including different beliefs and preferences, making it difficult to make meaningful comparisons.

Government commitment on child poverty to be enshrined in law

The Government has published a landmark child poverty bill that enshrines in law a duty to eradicate child poverty by 2020 – so that all children have the best start in life and have the opportunities to flourish. The cross departmental bill requires Government to reduce poverty so families on low income do not get left behind. It puts duties on local authorities, and partner organisations like the NHS and Police to work together at local level to lift children out of poverty. It also requires Government to report to Parliament each year on progress and creates a new expert Child Poverty Commission to publish advice and encourage progress.

500,000 children have been lifted out of poverty already and measures currently in train are expected to lift around a further half a million children out of poverty. The target for relative poverty requires the UK to go further than the best currently being achieved in Denmark, Finland and other European countries.

In summary the UK-wide Bill will:

• Establish four income targets to be met by 2020, which will define the eradication of child poverty; Relative poverty: Less than 10 per cent of children living in relative low income poverty by 2020 (i.e. in households with less that 60 per cent of the median income); Material Deprivation: Less than 5 per cent of children living in combined material deprivation and low income (i.e. in households with less than 70 per cent of median income); Persistent Poverty: percentage of children living in relative poverty for three out of four years (target level to be set by the end of 2014 as data are currently unavailable); Absolute low income: less that 5 percent of children living in families with an income below an absolute threshold.

• Require the Government to publish a UK child poverty strategy, which must be revised every three years. The strategy will set out the policies that will put in place to meet the targets.  There will also be a requirement for Scottish ministers and Northern Irish ministers to publish child poverty strategies and the establishment of a child poverty Commission to provide advice on the development of the child poverty strategies.

• Require the Government to publish annual progress reports. Place duties on local authorities and other local delivery partners to work together to tackle child poverty, conduct a local needs assessment, produce a child poverty strategy and take child poverty into account in the production and revision of their Sustainable Communities Strategies.

The Government is also announcing the pilot areas that were selected for an innovative scheme which gives local authorities the opportunity to draw up individual plans to tackle local child poverty issues and the areas to benefit from targeted accommodation support for teenage parents.

‘Take Up the Challenge’, the report from the Take Up Taskforce outlines how local services can help poor families to take up their financial entitlements, illustrated by examples of local approaches that are having a real impact. Increasing the take up of benefits and tax credits is an important part of the Government’s strategy, and is particularly important to help vulnerable families through a time of economic uncertainty. This report will help local authorities and partners meet the requirements of the Bill.

Details on the Child Poverty Bill and the Take Up Taskforce’s report can be found at http://www.dcsf.gov.uk/ecm/childpoverty

There are currently 42 Local Authorities running pilots.

HMRC Outreach Pilot: The HRMC Outreach pilot tests whether providing tax credit advice in Children’s Centres will assist in the take up and best use of tax credits for families, ensuring that families in poverty are claiming all that they are entitled to claim to better support them. The HMRC-led and funded pilot began in five Children’s Centres in Preston and Newham in May 2008 has been extended, from April 2009, to 100 Children’s Centres in the West Midlands, NW Lancashire and London areas.

Work Focused Services Pilot: This pilot, led by DWP and DCSF is testing whether placing JobCentrePlus (JCP) advisors in Children’s Centres, along with additional support aimed at getting more people into employment .It was launched in 10 Local Authorities and 30 Children Centres in January 2009 and early anecdotal evidence is showing that parents are making good use of the service and support provided in their Sure Start Children’s Centre.

Family Intervention Pilot: The DCSF has been running the successful Family Intervention Project (FIP) programme since July 2008 and in October of the same year, funding was made available for 10 local authorities to run a FIP programme specifically aimed at supporting families who experience poverty, inter-generational worklessness and other complex needs. Once fully launched, it will be operating in 32 areas with each area working with 40-60 families. It was launched in October 2008 in 10 areas which each area working with 15-20 families. 2 more projects are scheduled to be operational by September 2009.
Child Development Grant Pilots: The Child Development Grant Pilots provides incentive based programmes, aimed at encouraging hard to reach parents to engage in a number of positive activities to help lift them and their families out of poverty. The pilot will run for two years in ten Local Authorities.

Local Area Innovation pilots: In ten LAs, the Local Area Innovation Pilots give local authorities and their partners the chance to draw up new and innovative programmes to help tackle local child poverty issues. The pilots will seek to encourage movement into employment, increase the take-up of benefits and help to raise incomes through measures tailored to support the local authority.

Supported accommodation for teenage parents: In May and June 2009, seven local authorities will test how providing enhanced support for teenage parents’ housing needs can help improve outcomes for teenage parents and their children. The pilots will help to define the best ways of offering enhanced support.

Debate regarding family benefits and absent teenage fathers

Graham Allen MP this week introduced a debate on family benefits and absent teenage fathers.  He used the opportunity to highlight the fact that there is often an assumption that girls should take responsibility for avoiding unwanted pregnancy, and caring for the baby if they fail and that Nottingham has created a teenage pregnancy taskforce to address the issue.

He expressed his concern that most teenage mothers in Nottingham were raising their child on their own, and that relationships between teenage parents were generally unstable. He argued that teenage fathers are themselves children. “That is the central dilemma for social policy generally and the benefits system in particular,” he said. Allen urged the government to encourage teen fathers to do the best they can for their children, emotionally and financially. The new Child Maintenance and Enforcement Commission has the opportunity to make this agenda its own, he said.

Many young fathers feel that the benefits system is complicated and financially burdensome, he said. And, the system does not provide the social and emotional basis for fathers who have no chance of making payments, to make informed decisions. A “one-stop office” for young fathers could offer advice and support and a medium through which to make maintenance payments, he suggested.

Tackling teenage pregnancies and absentee fathers also requires supporting young people before pregnancy occurs. “If young people have the ability to interact, to learn and to resolve arguments without violence…it is virtually impossible to fail in terms of educational attainment, aspiration to work and raising a decent family,” he said.  And, more must be done to encourage teenage boys to delay sexual activity, Allen argued.

In response Kitty Usher, Parliamentary Under Secretary of State at the Department of Work and Pensions (DWP), acknowledged that the benefits system does remain complex.  She said that the system must be simpler, well targeted and empowering but that the government recognises that families are more diverse than ever – Public services and the workplace must reflect those changes across society, Ussher said.

She noted that local services should take a “much more proactive approach to identifying young fathers” through the common assessment framework and targeted youth support arrangements and that the Welfare Reform Bill contains significant change on joint birth registration – an unmarried father’s name cannot appear on the birth certificate without his knowledge. “One aim of the joint birth registration provision is that an unmarried father who registers his child’s birth will acquire parental responsibility,” she said.  She also stressed that the Child Support Agency’s (CSA) role is to alleviate child poverty by ensuring that money flows to children.

Changes to Government Ministers and Departments

Last week saw some big changes to Government including a Cabinet reshuffle and the development of a new department.  The reshuffle saw the replacement of Health Secretary, Alan Johnson who becomes Home Secretary, with Andy Burnham. Other key changes include Yvette Cooper replacing James Purnell as Work and Pensions secretary and Ben Bradshaw becoming culture, media and sport secretary in place of Andy Burnham. Dawn Primarolo, previously Minister of State for Health, is now the Minister for Children replacing Beverley Hughes who has resigned from Cabinet. Ms Primarolo’s replacement has yet to be announced.

The Government has also created a new Department for Business, Innovation and Skills whose key role will be to build Britain’s capabilities to compete in the global economy. The Department will be created by merging Business, Enterprise and Regulatory Reform (BERR) and Department for Innovation, Universities and Skills (DIUS) into a single department committed to building Britain’s future economic strengths. To compete in a global economy and create the jobs of the future Britain requires a regulatory environment that encourages enterprise, skilled people, innovation, and world-class science and research.

The merger of BERR and DIUS brings together the parts of the government with key expertise in these areas. It combines BERR’s strengths in shaping the enterprise environment, analysing the strengths and needs of the various parts of British industry, building strategies for industrial strength and expertise in better regulation with DIUS’s expertise in maintaining world class universities, expanding access to higher education, investing in the UK’s science base and shaping skills policy and innovation through bodies such as the Technology Strategy Board. It also puts the UK’s Further Education system and universities closer to the heart of government thinking about building now for the upturn.

The new department will:

• Advocate the needs of business across government, especially of UK small businesses;
• Promote an enterprise environment that is good for business and good for consumers;
• Design tailored policies for sectors of the UK economy that represent key future strengths and where government policy can add to the dynamics of the market;
• Assess the changing skills needs of the UK economy, especially the intermediate and high skills vital in a global economy and design policies to meets them through public and privately funded life long training;
• Invest in the development of a higher education system committed to widening participation, equipping people with the skills and knowledge to compete in a global economy and securing and enhancing Britain’s existing world class research base;
• Continue to invest in the UK’s world class science base and develop strategies for commercialising more of that science;
• Continue to invest in skills through the Further Education system to help people through the downturn and to prepare Britain for the future;
• Deliver on the government’s ambitious objectives to expand the number of apprenticeships;
• Encourage innovation in the UK;
• Defend a sound regulatory environment that encourages enterprise and skills;
• Collaborate with the RDAs in building economic growth in the English regions;
• Work with the EU in shaping European regulation and European policies that affect the openness of the single market and the competitiveness of European and British companies
• Continue to work to expand UK exports and encourage inward investment to the UK.

NMC to develop practical guidelines for professionals on whistle-blowing

The Nursing and Midwifery Council (NMC) has started work to improve its advice and information on whistle-blowing for nurses and midwives. Representatives from the Royal College of Nursing (RCN), the Royal College of Midwives (RCM), UNISON, Unite/CPHVA and Public Concern at Work, met with the NMC last week to discuss how anxieties about future career prospects, upsetting workmates and management and breaching their Code of professional conduct, can sometimes discourage nurses and midwives from reporting concerns.

Clearer signposts to existing advice and information on whistle-blowing were strongly recommended along with the need to raise awareness amongst nurses, midwives and their employers about existing safeguards for whistleblowers and the responsibilities of employers contained within the Public Interest Disclosure Act 1998.

Commenting on the meeting, Christina McKenzie, NMC Head of Midwifery, said “We are grateful to our colleagues for this first opportunity to exchange information experience and expertise on this topic. As a result of this meeting, we will develop information for nurses and midwives setting out the options for escalating concerns appropriately, in a way that is safe for patients and the public, and in a way that will not bring them into conflict with their Code.”

There was also consensus about the need to involve other stakeholders including patient’s groups and employers of nurses and midwives across the NHS, independent and voluntary sectors. Christina added “We are addressing the matter with urgency but we are mindful of the need for proper, considered engagement with key stakeholders. Regulatory activity in this area will require responsible action by all the partners and this will need to be explored in depth in order to achieve all our goals.”

NHS reflects on delivery of key priorities

NHS Chief Executive David Nicholson thanked NHS staff for their hard work improving care for patients this year, including reducing healthcare associated infections and waiting times, and extending GP opening hours. Launching his third annual report at the annual NHS Chief Executive’s Conference, Mr Nicholson said that while the NHS had delivered what it said it would over the year, it had to go further and faster to improve the quality of services for patients. 

The report states that whilst the NHS has 11 per cent growth in funding over the next two years, which will be locked in on recurring basis, it would need to prepare for leaner times after that. This meant the NHS would need to deliver efficiency savings in the order of £15 billion over the three years after 2011, to address pressures in the system, and this can only be achieved through the improvements in quality and advances in innovation envisaged in the Next Stage Review.

Mr Nicholson said the leadership of the NHS had delivered on what they had promised for patients in 2008/09 and he was confident that they would continue to deliver improvements in the future.
In 2008/09, the NHS:

• met the commitment to treat all patients within 18 weeks from referral to hospital treatment five months early
• reduced MRSA infections by 62% below the 2003/04 baseline – exceeding the target of 50%
• provided extended opening hours at 71.% of GP practices – exceeding the target set by the Prime Minister of 50%
• employing an additional 1,195 midwives by the end of 2009 against a target of adding 1,000 to the 2006 baseline
• exceeding the Gershon efficiency savings target of £6.47 billion, with the NHS delivering £7.88 billion of savings

Public confidence in the NHS rose to the highest levels on record during the year and staff morale also remained at record highs.

The effectiveness of relaxation classes for childbirth questioned

New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology reports that specialist pre-pregnancy preparation for women and their partners, emphasising practical training in breathing, relaxation and massage techniques, and aimed at promoting ‘natural’ childbirth, produced no measureable outcome benefits over the standard classes offered at antenatal clinics in Sweden.

 

1, 087 first-time mothers and 1, 064 of their partners took part in the study by the Department for Woman and Child Health at the Karolinska Institute in Sweden between January 2006 and May 2007.  They were recruited from across Sweden and randomised into two groups to attend specifically-tailored antenatal classes.

 

The ‘natural’ group focused on teaching the women and their partners psychoprophylaxis (relaxation, breathing and psychological coping techniques).  The standard care group were provided with information about childbirth and parenting, modelled on the standard Swedish antenatal education programme.

 

Researchers hypothesised that participants in the ‘natural’ group would have lower rates of epidural analgesia, a more positive overall experience of childbirth, but higher levels of parental stress, as the classes did not prepare them for parenthood.  The main outcome measures were therefore the use of epidurals during labour, and the recorded experience of childbirth and parental stress.       

     

Researchers found that the experiences of childbirth and stress were similar in the two groups.  The epidural rate was 52% and the spontaneous vaginal birth rate 66% in both groups.  The caesarean section rate was 20% in the ‘natural’ group and 21.5% in the standard group.  The instrumental delivery rate was 14% in the ‘natural’ group and 12% in the standard group.  There were also no statistically significant differences between the groups in the satisfaction of the childbirth experience or postnatal parental stress (measured at three months). 

New Social Security Regulations aimed at lone parents announced in Northern Ireland

The Minister for Social Development, Margaret Ritchie, this week introduced new regulations for approval which would provide opportunities for paid work to more lone parents and intends to support them in creating a better standard of living for themselves and their families.

 

 

The purpose of the regulations, which were approved following a short debate, is to implement new arrangements for lone parents with older children who claim income support solely on the grounds of being a lone parent. Instead of continuing to receive income support until their youngest child turns 16, parents who are able to undertake paid work may claim jobseeker’s allowance when their youngest child reaches 12; by 2010, they will be able to do so when their youngest child reaches the age of seven. With support and assistance, those parents will be required to look for paid work that is appropriate to their individual situation.

To ensure a smooth transition, the changes are being phased in, starting with lone parents of children who are over the age of 12. Lone parents who have a disability or health-related condition that limits their capability to work may be able to claim employment and support allowance. The regulations do not apply to lone parents who are entitled to income support on other grounds, such as those who are in receipt of carers allowance or those who foster. Lone parents who have a child for whom the middle or highest rate care component or disability living allowance is payable will remain eligible for income support.

To ensure further that the change does not compromise children’s welfare, the regulations designate lone parents as a vulnerable group so that the jobseeker’s allowance hardship regime may apply in certain circumstances.

The regulations also include transitional protection for lone parents who receive income support and are full-time students; lone parents who are undertaking a work-related qualification; lone parents who are undertaking work placements in the Department for Employment and Learning’s Steps to Work programme; and lone parents who are on an approved New Deal for lone parents scheme.

Lone parents in those categories will remain entitled to income support until their youngest child reaches the age that is in force at the time at which they commence their studies.

To provide opportunities to prepare and support lone parents for the change, the regulations include the introduction of mandatory, quarterly work-focused interviews in the last year in which they are eligible for income support. The changes that are set out in the regulations form part of a package of ongoing welfare reform and are intended to contribute to the strategy to eradicate child poverty.