25th February 2016

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Prof Sir Mike (Deep-Diver) Richards - CQC
In conversation with Roy Lilley - King's Fund March 1st, 5.30pm
Sold Out  HERE

Cherished memory
News and Comment from Roy Lilley
If I was going to have a baby I would want the head honcho of the Royal College of Delivering Babies standing by.  The boss midwife of the Bosses of Midwives International next to the bed and every bit of kit, caboodle and machines that go beep, lined-up, warmed-up, plugged in and on standby.
The thought of having a baby at home horrifies me; between the wardrobe and the shoe rack doesn't do it for me.  But, what do I know.... I'm an old geezer.
What women want is much more important and what women want is at the heart of Julia Cumberledge's report about the future of midwifery; having babies and bringing them safely into the world.
If Waitrose wrote reports they would probably be like this; it is an elegant production, beautifully reasoned, full of supporting facts and an easy read.
It is gimmick free but does have one novelty.  The foreword is couched as a letter to women and their families.  This tells me the report is a serious attempt to look at life and new life, through the prism of the mum and her nearest.

What this report is not, is a rerun of investigations into failings elsewhere, although there are strong overtones of Morecambe Bay with 13 references.
Cumberledge and her team have given their rail cards a bashing, undertaking a huge number of visits. They have gone out of their way to gather evidence and be very well informed.
They have met everyone you can think of and more.  From travelers to think-tanks.   Bristol to Barrow.  And, Sweden and Denmark which are, apparently, the safest places to give birth.
The press decided the headline grabber was the voucher scheme for women to 'spend' on the type of maternity care they want, in line with NICE guidelines.  The idea is deliberately undercooked to give CCGs room to shape how they might do it, locally, starting 2017.

Critics suspect the managerial allure of home births is that they are cheaper than hospitals and women will be pushed into them.  The report says (P31f):

 "...Women need clear unbiased information to help them make decisions about where to give birth, including: the chances of receiving interventions; availability of pain management; on site availability of obstetric and neonatal services; and the frequency and likely duration of transfer. Such information needs to be personalised according to their individual circumstances..."

It's not just about choice, it's about safe choice.
It's a shame no one bigged-up the recommendation that women should have access to a free App to help and inform Mums with some of the basics.
I have seen the Pocket Midwife version.  Developed at Nottingham FT it is a great idea with implications well beyond midwifery.  Yup, these days mums have smart phones and use them.  They're no stranger to social media.  
There are solid ideas about team training.  Professional culture matters, knowing individual limits and freedom to speak-up still over shadow not just the maternity setting.

Nottingham have posted their 'Shared Governance' approach on the Academy of Fabulous NHS Stuff here... and if babies could talk...

A fresh approach to data-sets that mean as much to the scrutineers as to the front-line who have the burden of collecting it.  Finding out what works and what doesn't.
The background to this report is founded in some unvarnished facts and criticism.  Variation in standards, poor data, mums' mental health, the cost of failure and deaths.  There is a lot to shake-up.

Shifting the model of care, choice, continuity.  Surprisingly, no demand for a huge increase in midwives.  Look out for maternity hubs a-la Barkantine Birth Centre London, (P57).
The report makes sensible recommendations.  Plenty of them.  The annex (Page 101) has them laid out, indexed and time-framed.  Ambitious, but if you are going to ask the likes of Julia Cumberledge and Cyril Chantler to join forces with Kathy Warwick (boss of the RCM), you can expect focussed, thorough, detailed and comprehensive.
Midwifery and obstetrics seem to have a lot of unfinished business. The air is full of angst and recrimination.  The professions must learn and move on.  We can't stay where we are.
This is a must read report. If maternity is not your thing, read it anyway to see how to write a report.  If it is your thing; don't make do with someone else's slide-deck. Read it for yourself.   It is important. You will be rewarded.
Having a baby is a life changer.  It is the most wonderful thing and the hardest thing.  All the clichés about motherhood and babies are right, including the fact that for the next 4 years of your life you'll never sleep and never have any money!
But, it is beautiful.  When tiny pink hands grip your finger your heartstrings will never be the same.
Some of you will have the privilege of being part of that intimacy; the least we can do is make it safe, special and a cherished memory.
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