Delivering a patient centred approach

Putting patients at the centre of the NHS is a challenge facing every single commissioner and provider for our National Health Service. A big part of that is designing services around patients, and the key for that process to even begin is listening to those patients.

Maternity Policy is a good place to start, in so far that unlike other kinds of health care, it has various established longitudinal surveys of women’s experiences. It should be easier to put women at the heart of maternity services, because thousands of women tell the NHS how it was for them every day. Having said this, the research we published last year found that too often, women’s experiences were not being taken into account. How can we ensure the NHS uses the data it has to improve care?

One thing that might help is that just like any other area of policy, in the NHS, money matters. With the UK facing a deficit (and the Nicholson Challenge in relation to the NHS in particular), spending is under greater scrutiny than ever before. It’s up to the Commons’ Public Accounts Committee to hold the government to account for its spending. The Committee builds on the work of the government’s auditor, the National Audit Office. In November this year, the NAO turned its attention to maternity services, which cost the NHS around £2.6 billion in 2012-13.

We published our report Support Overdue on the experiences of women using maternity services a few months before the NAO published theirs. Despite the different approaches of both studies, both accounts of women’s experiences and their hard financial performance data tell a very similar story; there is room for improvement, and this improvement will improve both the quality, consistency and cost effectiveness of services. Alongside the data it has about patient experience, the NHS can learn financial lessons from the NAO’s work, and that is a real opportunity to raise standards of care in a responsible way.

After the NAO’s report, the Public Accounts Committee took evidence from clinicians and NHS leaders in November. They used our report to highlight the inequalities in care, and the gap between the Department of Health’s aspirations and the reality of women’s experiences. The NFWI was heartened to see women’s experiences held up beside financial information to present a fuller picture of what was going on in maternity. MPs on the committee took direct quotes from women published in our report and put them to Department of Health Permanent Secretary, Una O’Brien, and Sir David Nicholson, NHS Chief Executive. Now that’s putting patients at the heart of the NHS!

The Public Accounts Committee has now published its own report into maternity services. Using the NAO’s analysis, the evidence MPs took from clinicians and NHS leaders and the NFWI’s Support Overdue, they found:

- There is confusion around the Department’s policy for maternity services, what it wants to achieve, and who is accountable for delivery.

- The Department has not demonstrated whether its policy objectives for maternity services are affordable.

- The Department lacks the data needed to oversee and inform policy decisions on maternity services.

MPs highlighted the paucity of research into women’s choices around birth. Surprisingly, considering choice has been a cornerstone of maternity policy for seven years, there is little understanding about why women choose particular locations or clinicians for birth. This has a massive impact on the financial viability of new or refurbished maternity units or the provision of home birth. Our study showed that women’s ‘ideal’ birth location was heavily influenced by what her reality was: it was much less likely to even occur to a woman that a freestanding midwifery unit or a home birth was a hypothetical ‘choice’ when it wasn’t actually a real one. The Committee has echoed our findings and recommended that “NHS England should build on recent research to investigate the factors that affect women’s choice of place of birth, including closures of maternity units, and what inhibits women from exercising choice in practice.”

Why does choice matter? Different birth locations provide different types of care for different women, and they allow flexibility and individuality. For the NAO and the Public Accounts Committee especially, they allow the NHS to provide lower-cost options (with no reduction in clinical outcomes, and sometimes, even better outcomes for some women in particular). Choices also have repercussions for the midwifery workforce.

When we made recommendations at the end of our report, we encountered a problem: who should we make them to? Reorganisation of the NHS, in England in particular, has fragmented decision-making. The Public Accounts Committee has encountered the same problem and has chastised the government for making it very unclear who, in fact, is responsible for maternity care, even its very basic requirement like having enough midwives.

We know England in particular is short of thousands of midwives, and we know the ones we have are overworked and many want to leave. We hope the Department of Health and the NHS work constructively with CCGs and Welsh Health Boards to get clear lines of accountability for hiring enough staff and making sure women get the quality care they need. The voices of women are loud, and now the money is talking too.

All photos in this post feature WI members campaigning for More Midwives.

Still fighting to protect libraries

Tomorrow (February 8) is National Libraries Day. The day provides an opportunity to celebrate all of our libraries, from mobile libraries, to university libraries, local libraries, and national institutions such as the British Library. The WI has been campaigning in support of public libraries since 2011, but our relationship with libraries is much more intimate than that. In the 1920s, many WIs were actively involved in campaigning for their establishment, at a time when local government remained unconvinced about their value. Almost 100 years on, local libraries are once again under threat and are closing at an unprecedented rate. A recent government report on the state of public libraries – that quoted a closure rate of 90 static libraries since 2010 – was lambasted by library campaigners as massively underplaying the rate of closures nationally. Official figures published in the Chartered Institute of Public Finance and Accountancy’s UK Annual Libraries Survey show the figures to be closer to 272. Despite the dispute over the numbers, what is clear is that libraries are closing, and that their closures leave many communities without a precious and valued community resource.

This is not just a trend confined to libraries – it’s being replicated in community facilities across the country including village shops, pubs, and post offices. In response to the erosion of important neighbourhood hubs, many communities have decided to take on the running of community facilities themselves, with organisations such as the Plunkett Foundation and Locality providing dedicated resource and guidance for these groups. According to the Plunkett Foundation, there has been a huge growth in community take-overs – in 2013 there were 300 community shops in the UK, compared to 23 in 1993. The government’s localism agenda is promoting these sorts of initiatives and making it easier for communities to take on these facilities when they are facing closure through policies such as the community right to bid. But whilst in some situations this might be a good alternative to the closure of private enterprise such as pubs and shops, is this the best focus for publicly owned facilities?

Towards the end of last year, Lord Stevenson of Balmacara sponsored a parliamentary debate on community managed libraries. The debate touched on the findings of On Permanent Loan?, the NFWI’s research into community managed libraries, and raised some important questions about the degree to which volunteers could – and should – be expected to get involved in running a library service. Of course, the WI is built on the work of volunteers, and as such, we’re an organisation that has a degree of expertise in this area. But as our research showed, asking volunteers to take on the running of a public library, lock, stock and barrel – a role usually reserved for professionals backed up by a wealth of support from local authority experts – is no easy task.

We spoke to the volunteers behind the reins of community libraries up and down the country and learned that volunteers were having to contend with a number of complex issues, from navigating health and safety obligations, to ensuring that they were discharging their legal obligations satisfactorily. All of this was on top of the day to day running the library; making sure there were adequate numbers of volunteers, funds and books. It’s unsurprising that these responsibilities led some volunteers to speak of sleepless nights. This system of library provision has grown organically, and a very likely long-term consequence of this is the development of a postcode lottery of library services, with varying levels of services, book-stock and expertise as local communities grapple to ensure that their library service continues in one form or another. Of course, those communities without the requisite capacity or skills are unlikely to be able to take on the running of their library service if it’s faced with closure.

The advent of community managed libraries comes in the wake of huge cuts in library services. To date, Wales has not suffered from the same significant cuts that have been evident in England, but in light of the recent local government settlement, it is now clear that library closures will become much more commonplace there too. In England, the Libraries Minister Ed Vaizey MP, has recently produced an annual report on public library activity for the year 2012/13. Whilst the report provides an interesting overview of developments in the library sector, it does little to assess the “cumulative effect on library services of the cuts in local authority provision” that was originally committed to at the Culture Media and Sports Select Committee Inquiry into Library Closures almost two years ago. On Permanent Loan? provides a troubling insight into what the future of the library service holds, and unfortunately, present government policies are failing to scratch the surface of a whole range of complex issues that will ultimately impact the long term sustainability of these services.

The fear of many library champions, the WI included, is that plugging the gaps with increasing numbers of community managed libraries will not and cannot present a solution to library closures in the long term.

On the road to the centenary

The Federation Centenary Link project was officially launched in December with the NFWI Trustees and some staff travelling to Anglesey to pass over the baton to the first federation to start the centenary celebrations. Anglesey Federation Trustees and members hosted a fantastic evening of food and music, and after being passed around the room, the baton patiently waited until 1 January 2014 before starting its epic journey through Wales, England and the Islands to visit each and every Federation – all 69 of them! – before finishing its trip with a journey to the Royal Albert Hall for the NFWI Annual Meeting in June 2015 to celebrate 100 years of WI membership. Spending a week in each area, the baton’s arrival is being celebrated in a huge range of different ways – each federation is planning its own event so they are as varied as our members – and we have already learned of some great plans to truly celebrate everything that the WI has offered to all women for almost 100 years.

Having been on the road for a month now, we have already had a great range of photos sent over for the dedicated archive project associated with the baton; each federation is uploading twelve photographs onto a specially designed memory stick, stored inside the baton itself, that represent their local area and their members. These photos are also being shared through dedicated social media platforms to capture the national journey of the baton, and through the NFWI website, to share the photos as widely as possible, and to get as many members involved in the celebration leading up to 2015 as possible. Having travelled through North Wales so far, the baton is heading to its first stop in England today, and then on to the Isle of Man before heading on to the North of England. Full details with dates for each federation can be found online.

Whilst we are receiving the twelve photos each week and happily sharing as widely as possible, we do still need members’ help; what is your federation planning to do to celebrate the baton coming to your local area? What events do you have planned? Please let us know so that we can share details and photos of the celebratory events along with the twelve photos to be saved as part of the project. We want to inspire as many people to get involved with the celebrations when the baton travels to their own area, and to encourage women who haven’t previously thought that the WI was for them to go along to an event to see the huge range of opportunities on offer through the WI.

So far, we’ve seen great baton handovers with events planned to let everyone know what was going on, special banners flown, and special guests invited to get involved and really honour 100 years of WI membership. But we want to know what you’re planning for your future events so we can share as many details as possible and get everyone involved in the biggest WI party to date – if we all work together we can make this the best celebration so far, and really make a mark as we head towards 2015 when a whole host of other activities will be taking place!

So what’s the best way of letting us know your plans? Please follow the dedicated social media platforms on Twitter and Facebook and just send us a message to let us know what will be going on. Many members are already keeping us up-to-date, which is great, but we know that much more is being planned and we’d love to find out what’s in the pipeline. You can also email us to give us an update – we’re always happy to receive members’ news. We’re looking forward to hearing from you!

Will you be a role model?

This is a guest post from Miriam Gonzalez Durantez, originally featured in the February edition of WI Life.

I am asking you for one hour of your time. Not for me (much as I am sure we would enjoy chatting)but for girls. One hour to go back to school —any state school —and share your experiences, at work and in life, whatever they are, whatever you do, wherever you live. Those of you who are teachers, mothers, grandmothers or aunts of girls may not be surprised by the findings of a recent Girlguiding survey that almost nine in 10 girls aged 11 to 21 think that women are judged more on their appearance than their ability.

Worse, one in three aged 7 to 21 feel they have been patronised or `made to feel stupid' because of their gender. I have no daughters, so I was shocked by these figures when I heard them. Every time I go to a school and speak to girls I come back thinking that `our future is going to be OK'. They are curious, they are resilient; they are ambitious, but in a realistic way. So we must be doing something seriously wrong if, with all that potential, those girls are already feeling so constrained at such a young age.

Most girls, when asked, tell us that part of the problem is that, simply, there aren't enough female role models. I hope you agree with me that this is absurd because there are not a few, not many, but legions of female role models out there... in the streets, at school, at home. You are one of them. So are your friends. And most definitely so are your mother and mother-in-law, too.

But I am sure you could name many others: women who are courageous, determined, generous, who have achieved extraordinary accomplishments in their daily lives, women who we would like to be like. They may not be in magazines or on TV but they are the real role models of our time. I could name hundreds of them and I am sure you could too.

Women – all women - should be rushing back to schools to tell girls, if you are looking for role models they are right here. You might be thinking that you are not really sure you have anything to say. But believe me, you do — as soon as they start asking you questions you will realise that the choices you have made in life can be helpful to them. We are not trying to tell girls what to do. We are simply saying that they should feel free to choose whatever they want to do in life —and that includes feeling free and proud to aim high in their careers and in their lives. That is the main purpose of the campaign I'm backing: going to schools, talking to our girls and listening to them. All women, from all walks of life, in or outside paid work, are welcome in this new adventure led by Inspiring the Future, a charity that puts together volunteer speakers and children in state schools.

Our aim is to get 15,000 women talking to 250,000 girls across the country by August 2014. So far, we have received an overwhelming response from volunteers and schools alike. And many companies —big and small —are offering their support, too. So it is totally do-able. I very much hope we can encourage you, our WI friends, to join this campaign. Registering only takes a few minutes. And all you have to do is to give one hour a year to visit a school near your home or work to make a difference.

I know helping other women is what the WI is about. Your help in this campaign would make such a huge difference — please do join us!

The `Inspiring Women' campaign is not directly associated with the WI, but the NFWI supports its aims. Sign up to the campaign at www.inspiringwomencampaign.org or call 0203 206 0510