Last week the quick independent review of the NHS in England carried out for the new labour government was released. Dr Jenny Hall, Editor, Maternity and Midwifery forum, reflects on the maternity services content.
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Last week the quick independent review of the NHS in England carried out for the new labour government was released (not, therefore, reflecting the situation in the other UK countries). Carried out by Lord Darzi, it had been commissioned in July with the aims to assess:
- patient access to healthcare
- the quality of healthcare being provided
- the overall performance of the health system
The picture painted overall in statements and the media afterwards is somewhat gloomy; of an NHS that is ‘broken’. The reasons for decline appear to have been fuelled by a policy of austerity from subsequent leaders since 2012 and of not planning ahead. This is a political problem of managing crisis rather than planning for the future.
There are things to consider in the whole document around aspects that are impacting on women and families and the midwives role, particularly in the public health arena. Social need across large areas of the population has increased, for example in housing. Though smoking in general has fallen, vaping, particularly among girls has increased, deaths from alcohol consumption has increased and women are overall more physically inactive with higher rates of being over recommended weights. This goes alongside local authority spending that that fallen; the highest decreases are to children’s services from 0-5, sexual health services and substance misuse, all with a midwife’s remit. The only funding to increase has been to public mental health. But this is struggling to keep up with increasing mental health needs across the whole population, particularly among young people, who will become clients of the maternity services soon.
The particular focus on maternity services is in the section on quality care of care in the NHS: p38 onwards and is worth reading as a reminder of what we are up against. The facts of increased mortality in relation to race and inequality, more complexity in women’s needs, increasing induction and caesareans alongside an increase in staffing is not new. As part of the contributions to the review Dr Bill Kirkup provided a submission pointing out current issues (p40):
“a. Pressure and stress are at high levels which contributes to poor morale. This leads to burnout, absenteeism, high turnover, and the loss of trained staff. This dynamic impairs patient safety.
- Training in silos impairs teamwork which compromises patient safety. This is partly a result of divergent curricula for different staff groups that damage attitudes and a lack of focus on learning the skills for teamwork.
- Unstable working patterns and the lack of rest space impair teamworking and morale. Having dedicated space and refreshments benefits staff and improves patient safety.
- Leadership is crucial particularly Clinical Directors, but the Clinical Director role is poorly developed, supported and managed.
- Capacity for compassion is variable, sensitive to environment and pressure, but can be systematically improved.
- Transgressive behaviour is more common than admitted, which is very difficult to deal with, and damaging to morale and patient safety.
- Response to safety incidents is dominated by personal reactions; fear of blame by colleagues and others is a significant disincentive to investigation and learning; a culture of openness is essential to patient safety, but often lacking.”
It uncomfortable reading. The reality is current stresses are not going to go away with the public health needs of the population. We need to look carefully at this and start to make positive steps to improve. We must not ignore the facts. Another section of the document pointed to ‘disengaged staff’ particularly following the effects of the Covid pandemic. It is hard to become ‘engaged’ when things do seem so gloomy! Caring for ourselves and each other is a priority in order to effectively move forward.
The three things the Health secretary, Wes Streeting, has pointed to for change are to:
- increase community based care
- Move to better digital systems
- Shift from a sickness focus to prevention.
All of these are in the remit of midwives and provides us with a big opportunity to make the changes we want to see. If we give the optimum care for women and babies right from the start of pregnancy and across the whole continuum then this sets up their health and wellbeing for life. Will you take on the challenge?
Dr Jenny Hall
September 2024