Sunday, 15 April 2018

Midwives, still delivering the next generation of #DifferenceMakers


Last week I chaired the Wrightington, Wigan and Leigh (WWL) NHS Trust Quality and Safety Committee. It is a Wednesday that each month, I look forward to. At the meeting we seek assurance from all those across the entire Trust, engaged in both in clinical and non-clinical activities. We also look at quality improvement initiatives and address emerging risks. Most meetings have a very full agenda, which is manageable because the reports and presentations are of a very high quality. The meeting also provides an opportunity to review and discuss external assessments on our services. Last week there was a CQC Picker report of their survey of our maternity services. 

The Picker Institute has a global reach and since 2002, they have been the partner of choice for over 60% of NHS Acute Hospitals in England. They help each Trust to create, implement and sustain patient experience programmes that can drive real quality improvement in health care. Their approach to gathering and analysing data has been proven to be first rate, and their reports are authentic and reliable. So it was great pleasure that I was able to read that the WWL maternity services were identified as performing significantly better overall compared to the 67 other Trusts surveyed. It was a great report and recognition of the hard work our midwives had put in over the past couple of years in realising their commitment to improve the experience of mothers and their families. 

Midwives are a powerful group of health care professionals, and rightly so. All but one of my children and all grandchildren (now edging toward 11 grandchildren) have been delivered by midwives. Without exception they have provided high quality woman-centred care. They can, at times, also be slightly elitist, as many nurses have found to their peril. I can remember when the midwives joined the University School of which I was Dean. They didn’t come willingly into what at the time was a School of Nursing. They called a meeting and demanded I attend to answer their questions. It was something I was pleased to do and the meeting allayed many of their anxieties over losing their identity, being second in terms of priorities behind the nurses and so on. 

They joined the School in 2010 and proved to be great contributors to the School’s development over the years. However 2010 was also the year that I became embroiled in a fight over the closure of the local maternity services in a planned centralisation of services across Greater Manchester. I was in Chennai, India at the time. My mobile rang and over a very scratchy line came the voice of my Vice-Chancellor. He was in South Africa at the time and was beside himself with rage. One of our midwives was leading the campaign against the closure of the maternity services and had written an armour-piercing and evidence-based account as to why the decision was the wrong one. She had done so as Senior Lecturer at the University.  

My VC ordered me to stop the midwife from opposing the planned closure and to tell her to stop publishing such accounts. If she didn’t like it, I was to discipline her. Now if you have been to any of India’s cities you will know that the noise, bustle and sheer number of people make having a telephone conversations on the street an almost impossibility. I did remind the VC that we were a University and that as such we encouraged independent and free speech. I also said that I wouldn’t discipline someone for exercising that right. His anger notched up a couple of points on the angry VC scale, at which point I lost the connection. For the rest of my trip I kept my phone switched off.

On my return I met with the midwife, and donning my ‘corporate self’ hat I explained that we were in a relationship with the NHS Trust in particular and the wider health economy in general and that her public stance didn’t help further that relationship. Taking of my ‘corporate self’ hat I said I wasn’t going to take any action, but perhaps she needed to think about whether it was helpful to gain a voice that was affiliated to the University. That seemed to be the end to it. The VC never mentioned the telephone call or asked about the midwife. The CEO of the Trust, who I know reasonably well never mentioned it, and the midwife concerned continued to deliver [sic] a fabulous contribution to the School. The maternity service was eventually closed.

So it was wonderful to see last week that women who want to give birth in their locality can now do so. Last week a new birthing centre was opened. For the first time in a long time, babies, other than those delivered at home, can be born in the city once again. Set in a transformed Victorian mansion, the new birthing centre, the first of its kind in Greater Manchester, offer ‘low risk’ mothers-to-be the choice of giving birth in a ‘home from home’. The service is run by midwives and as well as helping to deliver babies will also offer antenatal and postnatal clinics and classes, sessions on hypnobirthing, infant feeding support and a range of complementary therapies. All of which, strangely, gave me a warm feeling of pride.  

Not only do midwives most definitely continue to have a voice, like the Senior Lecturer who so concerned my VC, they continue to offer an ever expanding range and flexibility of choice to expectant mothers. As Kathryn Gutteridge, President of the Royal College of Midwives said at a recent student-led Conference at the University – all midwives are unique and have the potential to be transformational for each baby they help deliver. Truly difference-makers indeed.