Episode 65 Wildcard

The HSJ published a list of 20 people the the new NHS CEO should speak to when appointed and my great friend Gill Phillips was amongst them. True to form Gill immediately set me the challenge : what would i want the NHS CEO to know about maternity?

Challenge accepted - Wildcard is my response!

https://www.hsj.co.uk/the-20-wildcards-the-nhss-new-bosses-should-listen-to/7030341.article

 https://www.rcog.org.uk/en/careers-training/workplace-workforce-issues/roles-responsibilities-consultant-report/

https://publications.parliament.uk/pa/cm5802/cmselect/cmhealth/19/1902.htm

You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
 
  My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

Thank you all for listening,  My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running  without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to  support theobspod please head over to my buy me a coffee page  https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes, I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Instagram @TheObsPod and email me on TheObsPod@gmail.com Please also check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.
My bea...

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Florence 0:00

Hello, my name's Florence. Welcome to the Obspod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife, maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case, and for that matter anyone else that's interested, the Obspod is for you. Strange title, you probably think. This is an episode that is literally a wild card. It's one that I haven't been thinking about for a long time. It's one I haven't written with the precision that I normally plan an episode. It's something more spontaneous, impromptu. And it was prompted by the fact that the HSJ recently produced a list, wildcards, twenty top people that the new NHS chief executive, when appointed, should talk to. Not the usual suspects, not the people in power, not the great and the good, but a wide-ranging, innovative, interesting selection. I was completely thrilled when the list came out to find on it my good friend Jill Phillips. She was listed as a campaigner, but she's far more than that. Through her work on whose shoes, she challenges the status quo and dares people to think differently. And through amazing lived experience work brings those thoughts and feelings into someone else's mind, literally walking in someone else's shoes. Hence the name of her work and board game, Whose Shoes. So I was delighted. Jill's fantastic, she's courageous, she speaks truth to power. I couldn't think of a better person for the new NHS chief exec when appointed to sit down and have an honest conversation with. So it always seemed to me very strange that healthcare in our country predominantly picks people up at the end when they have an illness or disease, or a complication or problem with their health, rather than starting at the beginning and being much more preventative. We're starting to think about it a little more now with things like smoking and obesity. But think how much we could shape the health of our nation if we really focused deeply on maternity services and women in pregnancy. Part of the reason we don't is we're short-term thinkers. NHS plans tend to be five or ten years, and what we're talking about is maybe fifty or sixty years in the making. So it's hard as an NHS chief executive whose tenure might be short, to be bold and think about something so long term, but I would urge you to do so. If we're going to be radical and start thinking about maternity and pregnancy care, then we need to start at the beginning. I don't think it's actually any good doing what we're currently doing. We're trying within a system that isn't working in many ways to add more and more to it. We're wrestling with something that probably in a lot of ways is historically generated and not really fit for purpose. Our schedule of antenatal care hasn't changed much in donkey's years. I remember years ago listening to Kipros Nicolides at King's speak about why isn't there a routine early pregnancy scan? The woman's had a positive pregnancy test, she wants to know everything's okay, and there's a heartbeat. Why wouldn't you offer that as a routine test? Why do we make the woman wait until 12 weeks, for example? That may seem radical, but actually there's more and more we can do now in very early pregnancy to predict the outcomes in later pregnancy. So rather than having escalating and increasing appointments towards the end of pregnancy, which is what antenatal care currently does, maybe we need to move the whole thing forward. And come to think of that, what about preconception care, which I covered in a previous episode? It actually starts there. So I think we need to throw out our antenatal care model and we need to think about the latest science and apply it. So if there are things we can do to prevent miscarriage, we should be doing them. If there are things we can do to prevent preterm birth, we're now starting to do those. If there are things that we know in scans or blood tests can predict outcomes from early on in pregnancy, we need to shape our care around that rather than the one size fits all, or using quite blunt risk measures or chance measures, such as a woman's age, which really isn't very scientific. It means we increase intervention, which let's face it is also quite blunt. Usually in med in maternity it's something around timing of delivery, and target things much more to women as individuals. If we're going to rip up maternity services and start again, then one of the key things that I think is lacking is education. And education not just antenatal education during pregnancy, but actually education in schools. How much education do children get about pregnancy? Healthy pregnancy? We're so busy focusing on contraception and sexually transmitted diseases that we barely register pregnancy. What one might do to plan a pregnancy, be healthy through pregnancy, and think about parenthood. So in the words of the government, education, education, education, education in schools so that we know much more about things as we move into our adult life, then proper antenatal education, not as an add-on class that we opt into if we can afford it, but something that is for everybody, that is expected part of your care, integrated. And then postnatally, postnatal classes. Why is it we think that we can just abandon new families a couple of weeks or maybe a month after they've had a new baby? Why don't we have regular postnatal classes too? The other thing we would need to do to create this is staffing, proper staffing, not staffing on a shoestring. And that means training and support, more training of more support workers, nurses, midwives, junior doctors, so that we can run the models that we know make sense, like continuity of care, but in the way that the research was actually done. We're implementing continuity of care, and it's fantastic, but the way we're implementing it isn't actually the model that the research that has so many proven benefits was developed. We're doing it on a budget. Only one of the continuity of care teams in my trust is actually on that model, and we don't have the other teams working on that model because it's too expensive and we can't afford it. And once you've trained these staff and invested in them and they have this wealth of experience and knowledge, then you need to support the workforce and actually look after them and make sure they don't burn out and they don't have time off sick because they're well looked after and there's enough headspace within their jobs and enough balance within their lives to be able to sustain themselves and work for many many years. To achieve that, we'd have to have a genuinely no-blame culture. And although we say we have, I feel it's lip service. There are so many times that I see risk reviews, both internal and external, that do essentially blame people. And much as the Each Baby Counts project is extremely laudable, the work on escalation and communication and using shared language is again blaming the workforce. You didn't use the right language, you didn't escalate, rather than asking the question of why did you need to escalate? Why wasn't there a culture where actually everyone was looking after everybody else? When I look at the tools that are being brought out about escalation, I struggle to understand because I work in a unit where we have a very flat hierarchy. Everyone is educated and everyone discusses fetal heart monitoring, and we come to a team conclusion. And when you're asked the question who can escalate, the answer is everybody. It doesn't actually make sense asking the question about escalation when you've got everybody on the same page at the same time working in the same way and having the same level of knowledge. It isn't like we teach our doctors one thing and we teach our midwives another thing. We all train together and it doesn't matter who's taking the decision, it's common knowledge, it's a common decision, it's a common understanding. And again, with the no blame comes something about regulation. We're having more and more reports about what we should and shouldn't do. It feels like more and more layers of regulation, layer upon layer of bureaucracy. We have to do gap analyses. Have we met this, that and the other process? Or SOP standard operating procedure? We're feeding the beast, we're moving paper around, we're having more and more meetings and having to submit more and more evidence. But that's taking the workforce, the experience, the knowledge away from the caring for women. So we need to get back to a bit more balance. Yes, it's fantastic to have HSIB, the Ochenden Report, the CQC, Each Baby Counts, Embrace, Matneo QI. There are so many initiatives. Yet, how are we as maternity workers supposed to reconcile all these different things and additionally care for the women that we're seeing face to face? There's a new workforce report just published from the RCOG that acknowledges this extremely complex role that consultant in obstetrics and gynecology now plays. And the fact that our jobs need to acknowledge that. Our jobs need to give some allowance for the fact that not only might you have a case which is stressful and upsetting, but then you need to have a debrief, you need to write a statement, you need to participate in a risk review, you then might have an HSIB external interview, you'll then receive a report, you then might have a coroner's inquest, and all these things are very laudable, and it's very important to have transparency and honesty and accountability and answers for the parents, but the increasing demand that that puts on that consultant or that junior doctor or that midwife on top of the clinical job they are already doing is it cannot be underestimated. I think another key aspect is to celebrate the rebels, the courageous. I know many people in maternity services who have stuck their necks above the parapet, as it were. They've suggested new things, they're innovative, they're often enthusiastic at the beginning of their careers, and many of us have the experience of being knocked back, knocked down, that person's got a bit too big for their boots. Our organization might be a little bit sheepish, a bit embarrassed. We're doing something out of the ordinary, we're breaking the rules, we're not conforming. And I would count myself in this camp. It's been difficult. I started a podcast, and many other people have contacted me and been thrilled, and many people I work with equally so. But I'm always waiting for that tap on that shoulder, a ticking off, someone saying I've overstepped the mark, and I'm careful not to talk too much about the place I work in too much detail for this reason. If you really want to change things, you've got to celebrate the people that stand up for what they believe in. Let them flourish, give them a bit of license, give them a little bit of time. It's amazing what they'll achieve. And likewise, if you really want to know what's going on in maternity services as well as talking to those staff, you've got to talk to women. Often I talk to my husband and I get frustrated about what is or isn't being done in maternity services, and are people listening to the maternity voice partnerships and to women's voices? And my husband says, Why? Why would they want to open that can of worms? That's just going to be difficult and uncomfortable for them. It's not what they want to achieve. So my message would be open that can of worms, take a proper look, and then do something with it. Maybe part of that opening the can of worms would be to make chief execs of every trust and chief operating officers of every trust and directors of Midworth Free for every trust go back to the floor. Back to the floor in maternity to live and breathe it, not just to shift, but maybe for a week, how we work, the intensity, the responsibility to really understand. There was an initiative to do that in the Department of Health under Jeremy Hunt, and we had a number of people come from the Department of Health and work with us day to day. I know they found it eye-opening. They found it unbelievable the way we worked, the way we snatched a drink, the incessant bleeps, the constant demands. So that's my wild card. That's what I would want the NHS chief exec to know about maternity. And along with that, I'd want to say, understand that every single person working in maternity is doing their best. We're human, we're imperfect. We have achieved amazing things when we're allowed to. Give us some freedom. And I always end with a zesty bit. So my zesty bit is if you're working in maternity, we've just received the Safety in Maternity Services Parliamentary report. Maybe this is our moment. Maybe we can use this opportunity within our trusts to highlight the issues. Maybe as maternity workers, we can encourage the rest of our trust or our senior leadership to come back to visit us, to talk to us, to run sessions, listening to us. And maybe as a population, we need to use this to influence change. The more we shout about maternity services, the more we ask, the more we demand, perhaps the more we're likely to get. If you're someone who's used maternity services, then identify what are the things that worked well for you, but what were the gaps? What were the things you would like to see what would have been useful? And don't see that as blaming those of us that are working in the service or a criticism. Just see it as an opportunity for development, an opportunity for something better. If we don't ask, we will never get it. I do hope you've enjoyed listening to this episode of The Obspod. Feel free to contact me on Twitter at FW Maternity or at the Obspod to ask me questions, give me topics for future episodes, or let me know what you think. Absolutely fantastic when you get in touch. I really enjoy reading your comments. Usual I've tried to include in the programme notes some extra reading about this particular topic, both for professionals working in maternity care and for pregnant women using services. I'd like to reassure you that although I'm talking about my experiences working in maternity care, I take confidentiality very seriously and do not give any personal information about any of my patients. If you've enjoyed listening, I'd love you to recommend the Obspod to friends or colleagues, and please do leave me a review on whichever podcast directory you find my episodes. Many thanks for listening.