Change for change sake?

Just for the hell of it tonight, I decided to look at the key governement department for children’s services; The Department for Children Schools and Families. The following notice has been put up:

A new UK Government took office on 11 May. As a result the content on this site may not reflect current Government policy.
All statutory guidance and legislation published on this site continues to reflect the current legal position unless indicated otherwise. To view the new Department for Education website, please go tohttp://www.education.gov.uk

A re-branding has begun and I wonder what this will mean. The undoing of 13 years of policy, I expect. A change back to an idea that a child attending school is there to be educated, no more, no less. I wonder what money will be spent to toughen up the look of the department? What work done will be unpicked?

I am due to attend a Children’s Trust local meeting on Monday; is there any point? Will it all be unpicked in a matter of days?  What can be wrong with the logo as shown above?

I have an increasingly sinking feeling about this new government……

If you were going to name a new form of flu what would you call it?

I am pretty sure that if I entered a competition, to name a new form of pandemic flu, first prize a trip to Mexico my answer wouldn’t be ‘Swine’. But I guess that I  might not have forseen the involvement of the pig, so what do I know? The media here are loving this. Yes they would deny it, but if you can put on your front page that 750,000 people are likely to die, why be realistic? I travelled today on a train to London, no one wore facemasks, but then no one sneezed. I spent several minutes myself (currently suffering from hay fever) wanting to sneeze, but fearing panic dared not. Even if I had a tissue handy I had no where to wash my hands or dispose of my tissue and what is for sure I don’ t want to be thrown off a speeding train.

I am not trying to make light of this whole thing, since people have died and it is pretty worrying to those directly involved. However, I think the hysteria misleads and detracts from the seriousness of the situation. Plus please don’t let my reintroduction to clinical nursing be at the sharp end of a surgical mask dishing out antivirals!!!

The picure above particularly fits as my day in london was about a commissioning strategy for breastfeeding. Did you know that breast fed babies are more likely to be healthy and less likely to be obese? No? Well thats cos it is less interesting than a flu from Mexico caused by pigs and called Swine!!

Locking the stable door after the horse has bolted?

I expect I will need to read the entire report that the media have taken small elements from today. That abortion clinics will be allowed to advertise on TV and that Adverts for condoms can be shown more widely and earlier than they can now. Our young people are really not all that well educated about sex and while generally most of them don’t have sex before they are 16, a fair number do and when they do it is often fueled by alcohol. Education in school seems to be no better than I received 30 years ago. It is generally about the biological act of sex rather than being about relationships, about love and about how to have those relationships without sex.

Girls and boys need to be able to form relationships of all types with each other and with their families and teachers. They need to know how to trust, and to understand the issues of real life in the 21st century. They need to know that they can get the best possible education, they need to be able to aspire for the best possible exam results, job and life in general. They need to know that we adults will do the best for them, and that we won’t cause them harm.

Teenage pregnancy and the kind of sexual behaviour associated with it is often concentrated in particular town and parts there of. It is associated with poverty, with poor attainment and attendance at school. These are the same children who are hanging around the streets, maybe getting drunk, they may have families who are complex and who themselves are not in work. Teenagers who become pregnant are often the product of a parent who became pregnant themselves before the age of 20.

By all means advertise condoms and where to go if you become pregnant. But lets actually do more to educate our young people, to love and to nurture them, to care for them and to teach them about relationships not just about sex.

Eight babies – why?

Having treatment to produce a much wanted child when you are unable to conceive naturally is something we have grown used to. At one time, when medicine was still learning about assisted conception there were a many multiple births. But time has moved on and now more embryos that are implanted during procedures like IVF survive, it is no longer necessary to implant quite so many. Plus it is entirely possible to remove some in order to promote the viability of those surviving. Even in this country, where we have a national health service such treatment is not without financial cost. Many people have been denied NHS fertility treatment, though that position has improved recently. But it is not just the assisted conception that you need to consider if you are planning to have a number of embryos emplanted in your uterus. To most people the idea of giving birth to 8 babies is nothing short of abhorrent, but apparently not to a woman in California who delivered that number this week.

On hearing the news this week I was amazed that this event had happened and perhaps a little fearful about what might happen to the woman and her babies. What kind of problems might they encounter, supposing all of the babies continued to be healthy. How on earth would you cope with such a large family? That amazement for me is quickly turning to disgust. This apparently is a woman who had already had 6 children. This is a woman who lives with her parents and is not part of a stable relationship. This is a woman who doctors allowed to undertake this treatment, who had a large number of embryos inplanted and who was allowed to continue with the pregnancy in tact. I do not know how much the hospital bill for the lady is, I do not know if she is paying this herself, but the drain on resources is not purely financial. A neonatal unit that is provided for an area will be seriously stretched if one woman fills it with 8 babies at once. Doctors, midwives and nurses devoting hours of time to one woman and 8 babies cannot be with other women in labour on the same day. The whole thing is almost beyond belief.

When I wonder did it become our right to conceive a child (or many children), to decide that we could put our own life at risk and put each and every one of those babies lives at risk by carrying them all until labour. When was it ok to have a ready made family of 14 without the kind of support systems that every child needs? I hope this lady can give her family the level of care that they will need and that they deserve. Personally I cannot imagine how this can be possible.

How can we better protect our children?

Yet again the TV and written media are full of the suffering of a young child at the hands of his parents. Yet again a catalogue of abuse of a baby despite numerous visits by social and healthcare workers and despite a number of attendances at hospitals. The Times online describes what happened as follows:

When the infant known in court only as Baby P was brought home from hospital days after his birth in March 2006, it was as a bubbly, blue-eyed boy with the first signs of curly blond hair. He was, according to those who came into contact with him, a lively child with a ready smile.

After 17 months enduring abuse of an almost unimaginable cruelty, the boy had been reduced to a nervous wreck, his hair shaved to the scalp and his body covered in bruises and scabs. Physical injuries included eight broken ribs, a broken back and the missing top of a finger, while the emotional damage was almost incalculable. Despite it all, Baby P was said to have still attempted a smile.

Baby P’s life in a council flat in Haringey, North London, began with gradual and growing neglect at the hands of his mother, who would leave him unattended for hours in his cot. The overweight woman, who had never had a full-time job and spent hours trawling the internet for pornography, split from the boy’s natural father when he was 3 months old after affairs with two men.

The authorities had first voiced concerns about possible abuse by October 2006, when a GP noticed marks on the boy. But his mother, in the first of many episodes of deception and false reassurances, insisted she had found that his skin “bruised easily”.

Two months later the GP sent the pair to the Whittington Hospital, North London, after inspecting a head injury. Insisting that her child was “a head-banger” fond of “rough and tumble play”, the mother claimed that fingermarks were merely the result of when he was caught after being lovingly held and thrown into the air.

Social services were informed and visited the flat, which was found to be dirty, untidy and smelling of urine. They learnt that it was shared with the boy’s grandmother and three dogs, including a rottweiler, but remained unaware that it also harboured a violent boyfriend. They decided to let the child stay with a family friend while police inquiries continued.

A month later, in January 2007, with no decision made on any charge against either woman, the boy was allowed back home. As he grew too old for milk and jars of baby food, Baby P scavenged bits of broken biscuits from older children and was even seen eating dirt in the garden. Detectives found that after the boyfriend moved in there was not one piece of the boy’s clothing that was not spattered with blood.

Maria Ward, the case worker, said that she visited the house four days before Baby P’s death for a prearranged meeting. She found the boy in his pushchair, his bruises covered up with chocolate. “He had eaten a chocolate biscuit and there was chocolate over his face,” she told the court. “He had chocolate on his hands and face.” She said that she asked the mother to wipe his face before they went out and the mother started cleaning him. Miss Ward noted that the boy had an infected scalp, which was covered in white cream, and an ear infection.

But she added: “He appeared well. He smiled when I spoke to him.” The case worker said that she had been content to leave the boy with his mother because she appeared to be co-operative and properly supported.

Days later — and 48 hours before his death — Baby P was taken to St Ann’s Hospital amid further concerns for his wellbeing. During an examination by Dr Sabah Al-Zayyat, a paediatrician, his mother and her friend supported the child. Despite Baby P’s repeated cries of pain, the consultant missed both his broken back and ribs.

The next day his mother was called to the social services office. She was told by police that she would not be prosecuted after consideration by the Crown Prosecution Service.

On the very same evening, back at the family home, Baby P received a fatal blow to his mouth, knocking a tooth out. After 17 months of agony, the tiny child finally succumbed. The next day he was found dead in his cot.

8 Years ago the death of Victoria Climbie led to wholesale changes in the way in which different agencies who are involved in the care and welfare of children are expected to conduct themselves. Agencies must work together more effectively, share information, and act always in the best interests of the child. In our area thousands of staff who work with children are currently being trained in ‘integrated practice‘. The is to be common assessment, there are clearer guidelines about the sharing of information and soon there will be a national database containing the details of all children in the country.

But baby P was already known to services, his case was already discussed at safeguarding meetings, the police had already been involved and he had attended the GP and seen a paediatrician. Integrated practice and the introduction of contact point will not help baby P and would never have done so. It is easy to be critical of others but from where I sit those involved in this case needed to focus more on the child than on the parents, they needed to use their eyes, follow their instincts and to ask questions. Surely it is better to remove a child from this kind of situation while an investigation is carried out than to suffer the guilt associated with not having done enough. It must be awful to have your child taken into care and to be wrongly accused of neglect than for a child to die?

Infant mental health

I have been puzzled by this one for weeks (well either side of my holiday since I never gave it a thought while out of the country), how on earth can people talk about the mental health of an infant? Surely a baby in the first days and weeks of life cannot be affected by its relationship with its parents so long as someone gives it food, keeps it warm, and lets it sleep and cry. Of course as often occurs these days since I do a job working in areas where I am no expert, it turns out I am wrong. I am about to embark on a bit of a project around maternal mental health. There are NICE guidelines and locally we just don’t meet them. A piece of work then to bring together all interested parties (midwives, mental health workers, people from primary care etc), map services, plan the pathway, look for gaps, find money and all will be well. Hmm well of course I never thought it would be that easy, and today a conference on Infant mental health told me that the maternal side of things, the antenatal and postnatal period is just part of the issue.

The way in which parents interact with their children affects their emotional health and well being from the beginning. There is evidence that the brains of children isolated in orphanages in Romania were damaged by their experience of isolation. Some of the behaviour we complain about in young children directly relates to the way in which they have interacted with their parents from birth. The way in which we attached to our parents affects the way in which we parent our children. The children of mothers who have experienced post natal depression continue to have attachment problems throughout life! Sometimes in our working lives we have lightbulb moments. Today a whole Christmas tree of lights came on for me! This is a major piece of work because although some good things are going on out there they aren’t joined up, there is no equality of service and what is more the services that exist are underfunded and probably not really commissioned as such.

Thank goodness I have the weekend to reflect on all of this stuff because I tell you I need it!

Catch up part two

A long absence from the blog is always going to require more than one shortish post to catch up, so in the absence of a great title, this is part two. My other interesting encounter of the week was a day spent at an event to do with teenage pregnancy and the government target to halve teenage pregnancy by 2010. This is a complex area of work for those who have been part of this whole thing for the last 7 or 8 years. Many areas seem to have had good success, but others are struggling. We are living in a culture where sex for young people seems pretty much the norm and where despite the publicity and availability of various forms of contraception plenty of girls still don’t use them. This means not only pregnancy but also sexually transmitted diseases like chlamydia.

Interesting as the actual conference was (and as I am only just getting involved in this area of work so it was very informative) that is not really what I want to talk about here. Instead my focus is about the extent to which some people lack insight into the way in which they behave and are prepared to allow people to see their behaviours towards others, and the long running arguments they are involved in where ‘partnership’ is meant to be happening. We were sitting on tables together with people from our own geographical area, alongside others from neighbouring areas. As the new person, I was keen to find out as much as possible, but what I found out was fascinating. Two particular colleagues spent much of the time engaged in what appeared to be a long running dispute about the sharing of information, the lack of engagement of one party, the unwillingness to work together and the feeling that they should tell and dictate rather than share and collaborate. Sadly the main aggressor (and I choose that word with care) was from my own organisation, and sadly also other people sitting nearby were party to what i can only describe as the washing of dirty laundry in public. Sadly also this is going to have to result in me getting involved in areas I would rather not do when I get back to work. My take on such disagreements is this, say what you like to each other so long as the doors are closed and people from outside don’t know how much you despise each other. But please don’t act in a way that demonstrates that you are in turn aggressive and then defensive and which appears do demonstrate something quite unpleasant about the way in which you work in your organisation.

I am sorry to see this morning, that Mousie has taken down her blog. in the context of that, I have thought long and hard about the above post, and have been as vague as I can without it not making sense (I hope). It seems our colleagues in the NHS are waking up to the presence of blogs, which is great, but also makes being open and honest difficult. For now though I continue.

Rounding up the week

I prefer to be the kind of blogger who writes about a specific topic most days of the week, but just recently it has felt that life (at work mainly) has been so busy that my thoughts about potential topics are not clear, and that the work I have been doing has been so specific to my job and geography that it has been difficult to sit down and produce anything worthy of posting to the world wide web. Hence a round up of the week according to Julie.

It is interesting that when I started my job, and for much of last year that job seemed to kind of jog along at an easy pace, while I learned new things and got on with doing what was expected of me. Of course for half of last year I was also studying and writing my masters dissertation which made life in general pretty hectic, but the actual paid work element seemed pretty reasonable. All of a sudden (the kind of sudden that builds up over a few months) I seem to spend my days rushing from one place to another (either actually rushing within a building or driving from one part of the county to another) and getting little time to sit at my desk and start and finish things. I also seem to get more than my share of emails which I can now see on my blackberry as they come in, and phone calls which tend to accumulate on the newly installed telephone system’s voice mail.

So what happened during this busy week that culminated in me missing part of yesterday evening by falling asleep for 2 hours from 9.30pm? Monday was a pretty nice day since I attended the PCT vision and values day. When you have been in the doldrums and no one seems to think much of you what better way to try to make your staff feel better valued than to invite them along to tell them stuff and invite them to feed back their thoughts and ideas. Nice conference centre, ok lunch, whole executive team presence and about 100 staff. I would like to offer up some cynical wisecracks about the whole thing, but actually I thought it was pretty well put together, and if every one of the 3500 members of staff we have attend this thing over the next year as they say will then maybe there is a chance that morale can be lifted and we can make people feel it is worth working hard for this organisation. We shall see! The after lunch energizer was from drumcafe.co.uk, the best thing I’ve done following lunch on any day recently!

Tuesday and I was providing the requisite PCT support to our maternity services liaison committee. No matter how often I attend these meetings, and no matter how efficient I am at sending out the papers in time, no matter how nice the lunch I provide, I am never going to feel like some of those people place any value in me. Sadly the lay members of the group, people who believe in natural child birth and who seem to think all of the NHS is the devil incarnate have not been to the vision and values day, they have not experienced drum  cafe since they are not employees. I shouldn’t come away feeling the way I do from each meeting, but I always feel like I have failed them in some way and usually they appear to think I have.

Wednesday was important because I knocked off early to prepare for the champions league final, shopping, cleaning the house etc ready for a gathering of family in support of hubby who is a chelsea fan. Good news was the 3lb lost for the weigh in at slimming world, also had a good chat with my sister in law. Bad news was the penalty shoot out and hubby’s subsequent unhappiness.

Thursday, and an afternoon contributing to the emotional health and well being strategy. At last a move away from what we do to help mange mental health problems in children and young people towards how attend to the emotional well being of the wider group of children and young people. Great idea, but lots of work there for colleagues working in that area.

So to Friday and the conclusion of the maternity review that started last week. A long day, doctors, midwives and people who think that local health services have been stolen from them to listen to. For the second time in a week I encountered members of the public who spoke to me as if I was some kind of dirt on their shoe. Just because I work for the PCT, just because I am part of the NHS does not make me any less of a person than anyone else. What is more, it would do those people well to realise that those of us who work in healthcare also use it, and being a manager does not make you some kind of a monster. At least my manager appreciates me, she bought me flowers before shooting off home early and leaving me to my late finish. You can’t have it all after all!

It depends on your point of view

As to whether you think it is a good or bad thing that people get moved from hospital to hospital for their treatment. Of course if those people are either pregnant women or new born babies. Maternity services are currently being reviewed. People are pretty confused, because before Lord Darzi stepped up they were proclaiming the merger of smaller units and the formation of larger ones and now Lord Darzi is also talking of smaller, particularly low risk, midwife led units. Meanwhile everything is pretty much in a state of flux, I know this because the commissioning of maternity services falls in my remit.

The recent press stories about lack of beds / staff to safely care for mums and babies could be thought of a really bad, since it shows that units are up to capacity and not able to cope. It shows that perhaps there are insufficient midwives, obstetricians and neonatal nurses and doctors. Well yes it is true that units find it difficult to attract well qualified staff and even harder to retain them. After all while the actual work is fulfilling I’d imagine, there are plenty of reasons why people might not want to continue working in such high stress environments. There are simple things like the politics with a capital P of policy and the politics with a small p of what goes on internally, there are also the stresses of the litigious environment, the apparently thankless task of trying to care for women and babies against the backdrop of increasing expectation. In other words you are often onto a no win. Perhaps the fact that a woman who pitches up to have her baby induced and is sent to the hospital 20 miles away is a really bad thing. Perhaps the fact that 32 week triplets cannot be cared for in the same unit is a bad thing (well certainly for the parents that is not good at all).

On the other hand you could  look at it like this. The units are recognising their limitations. They are recognising when they are full and when they have insufficient staff to do more. While the mother might be annoyed that she couldn’t have the midwife she thought she would get to deliver her baby, actually she has been kept safe and what is more her baby has been kept safe. Also if one triplet has been moved it is because it was safest to move that baby rather than a singleton baby who is more ill. These decisions, while not right in the widest context, are actually made on the basis of clinical safety for those mothers and babies as well as all of the mothers and babies in that unit today. For that we should be grateful.

Family life in the UK

My grandparents on both sides were pretty working class by any estimation. My maternal grandparents, particularly were no strangers to poverty having both come from North East England mining families. Indeed my grandmother was part of a single family as her father died in a mining accident when she was just 5 years old. It is interesting to me that I now find myself feeling quite so middle classed. Ok so I was brought up in a stable family environment, and have been married to the same man for almost 24 years. I am also a professional person (well in my eyes), since I am a nurse and have 2 degrees. The lives of others sometimes show how different things could have been.

More than 3 weeks ago a 9 year old girl, Shannon Matthews, disappeared on her way from school following a swimming lesson. She was from an estate in an area that is perhaps more deprived than average and she came from a large extended family. It is not for me to judge the morals of a woman with 7 children by 6 partners, it is not relevant that her current partner is only 22 while she is 32. However it does mean that pretty much everyone in the area appears to be in some way connected with the family. There were rumblings this week that the case was not being given the same attention as that of Madeleine McCann who disappeared last year in Portugal. The insinuation being that Shannon is not from an articulate, middle classed, professional family, which is true, though at the same time Madeleine was also only 3 and you would imagine not used to wandering the streets at home let alone Portugal alone.  Both mothers though have also in some way been blamed for their daughters disappearance, Madeleine’s after all has been accused in some quarters of actually murdering her daughter.

Thankfully Shannon has now been found. However her discovery is pretty much as strange as her disappearance. She was found in the drawer of a divan bed in the flat of her mother’s current partner’s relative. He is a man who has had more than one name and I guess must have been known to Shannon. During her disappearance there were reports that Shannon was unhappy at home, and that she had told friends she did not want to go home. There are obviously wider issues here. But what is certain is that someone somewhere needs to make a better job of safeguarding this young girl than has happened to date.

Keeping the status quo?

It is a year, pretty much to the day since I started my current job and to be honest I have found it a challenge to learn a whole new area of knowledge, get to know new people and to earn myself some credibility in the field of women and children. Many times I have wondered what I am doing spending my time learning about how maternity and children’s services should be commissioned. I have questioned the need for me to act as some kind of administrative support to the local maternity services liaison committees, or as the target of the wrath of paediatricians or GPs who want to apparently blame me for the perceived ills of the PCT. I have wondered why it is that our maternity services couldn’t have been held up as some kind of perfection by the healthcare commission rather than ‘most weak’, and why everyone can’t just get on nicely with each other rather than trying to score points off of each other.A few weeks ago what I have always considered pretty much my dream job was advertised, one which would allow me to return to the arena of the district nurse, my first love and one that would get me back into managing people, something I also enjoy. So when the postman brought me news of an interview at the weekend why wasn’t I jumping for joy. Why instead was I filled with foreboding at the idea of actually performing well at the interview and being offered the job. I can’t quite put my finger on it, but something just feels wrong. I have spent much of the last 4 days considering things and I have realised that I have unfinished business here. I still have lots to learn, I still have work to do with the two new heads of midwifery locally, and with our other providers. I still have work to do in learning how to be a commissioner, in performance managing the services, in getting paediatricians to work together, in getting GPs to recognise the importance of our local maternity and children’s services.

Tomorrow I am going to tell HR that I am withdrawing my application. I hope I have made the right decision, and that the very fact that I have spent 4 days thinking like this means that I have. Only time will tell.

The picture above is the real Status Quo, i.e. Rick Parfitt and Francis Rossi, kings of 2 chords or whatever it is. I have seen them live when they were on with Queen in 1984 at Knebworth. So there you have it!

How much do we care?

The world of commissioning takes you to a variety of places, and gets to speaking to a host of people about things you would never imagine. That is certainly my thought for the day. Today has been one of those days where I have travelled about a bit and done a variety of things and today is one of those days when I can definitely say I liked being at work and things were good. I started by facilitating a team to look at the way in which people interact with each other, and got them to look at their rights and their responsibilities. Their rights to be treated well, to be respected and to be well managed all came up. However these rights don’t come without responsibilities to patients, to carers and of course to each other. Hopefully I left them with something to reflect on. Then it was back to the office to pick up on some work; emails, phone calls and the like. Then off again to facilitate an action learning group; getting a group of leaders of others to examine issues about their work. Finally I went off for a meeting at a mother and baby mental health unit.

When I had my son I took the whole thing in my stride emotionally. I had been unwell before the birth with pre-eclampsia and it was something of a relief to have actually had the baby and be free to get out and about and do what I wanted. That is not to say every day was a joy, because life with a young baby is tiring, stressful and at times frustrating. However I have thankfully never  known what it is like to suffer from a post natal (or any other) mental illness. But I do know a couple of people who have become seriously unwell following the birth of their babies and know that identifying the illness, treating it and being able to provide care and support to the whole family are vital. We are lucky enough to have a mother and baby unit not so far from here and through a chance encounter we have probably opened a can of worms.

I can’t go into detail about what led me there, but by the time I left I was convinced that we need to do more overall to ensure diagnosis and treatment of post natal mental illness. The links between our maternity units and the mental health team are not what they should be (the healthcare commission identified that too), and with only 100 mother and baby beds in the whole country we do not have sufficient facilities to manage this problem. Apparently 1 in 500 births results in a significant episode of puerperal mental illness, with 1 in 10 suffering what will feel significant enough but which be considered less serious. Our health visitors and midwives are skilled in identifying problems, but without the infrastructure of services, with many women having to be separated from their children and being admitted to ordinary wards and some children even ending up in foster care because families cannot cope then more needs to be done.

As managers in the health service we often get labelled as not caring, not being able to identify the needs of the people out there. I am a novice here, I am just learning about this issue but I am pretty sure that there is some work to be done here to make this situation in our area better. But only if I can find enough people who also care enough.

Do no harm

As nurses and as midwives our main purpose is to provide the best most effective care we can, to promote health and well being, to help our patients to recover from their illnesses and if necessary to enable the best possible death to occur. What we should also do it to do no harm.  Working as a nurse or midwife in the world of hospitals and all things health care today in 2008 is tough. There are challenges we never even thought of 20 or 30 years ago; there are lower staffing levels, there are higher expectations by patients, there is more to do that was formally done by doctors, there is greater risk and knowledge of those risks. One thing has not changed. If we make a mistake we are meant to admit and acknowledge the concequences.

In 2004 Mayra Cabrera, a nurse herself went to hospital and gave birth to a healthy baby. However what should have been a joyful experience for her and her husband turned to tragedy just an hour later when she was given a drug by mistake. A midwife stands accused of administering an epidural drug peripherally instead of saline or some other fluid replacement. She denies that she was responsible. Her manager says she was always a competent midwife and had never made a mistake before.

I do not know if the midwife wrongly gave that drug, but on that day in 2004 a woman died unnecessarily and much as she was a nurse she did not administer it to herself.  I fail to understand how no one appears to know nor accept who actually carried out the task since all drugs should be signed for on the medication chart. I accept that there was a system failure, that procedures must have been at fault and that perhaps it was an accident waiting to happen. However one of those midwives did harm to that woman and as such someone should at least acknowledge that they carried out the mistake.

None of us are perfect. Most of us as nurses have made mistakes, given the wrong drug, at the wrong time perhaps to the wrong person. Generally those mistakes are not serious, not life threatening. In such cases at times people have been treated extremely harshly, punished for what might have been a failure of the system. Maybe that is why no one accepted responsibility and why Mayra’s husband still feels that justice has not been done. Somewhere out there a child of 4 has no mother, and never knew that mother and somewhere out there a midwife knows what happened.

Rights and responsibilities

A story in the news today has troubled me greatly. This was about an 18 year old girl, obviously troubled apparently having had a difficult childhood and having taken drugs and run away from home in the past (so we are told) who has in the last couple of days given birth to a baby. Decisions were taken (without the girl’s knowledge) to remove the baby from her care at birth, but without any kind of court order within hours of the baby’s birth. Once this had happened, the family consulted lawyers and a high court ordered the baby returned to her mother. Sadly this may prove temporary as social services are applying to remove the child once more.I take issues of child protection extremely seriously. I know that social services and us as health professionals have to tread a fine line between supporting a family and protecting the child. There have been more than enough high profile mistakes. However (and of course we don’t know the full details) this strikes me as wrong. What kind of world do we live in where a young woman can give birth and not be allowed to spend even one night (even supervised) with her baby. What kind of world do we live in where a young mother cannot be supported to attempt to bond with her baby and turn her life around? What kind of world do we live in where we want to continue the cycle of difficult childhoods by separating mothers and babies without any effort, without consultation and in our ivory towers.

Maybe there is more to this, maybe I don’t know the facts. But the thought of losing my baby before I had spent even a few hours with him is beyond my comprehension.

Do you really need a specialist nurse?

To listen to our local paediatricians you might think that money needs to be found for about 5 different types of specialist nurse just so that they can make sure children get a service even worthy of mention. In days gone by, when these decisions were based on what was wanted rather than what was actually needed then about £200k might have been found by the NHS trust on the promise that money would have been saved by better use of resources and throughput. Experience has taught me and those of us working in the side of the NHS that coughs up the money that such savings aren’t always going to happen. The other problem is that what I might call specialist and what they call specialist are two different things. They want a nurse who can be at their beck and call. Who can perform the tasks that they think should be performed and at the same time pacify patients and their families into thinking that what they are getting is something special. They don’t want someone who can think independently, who will challenge practice and who might want that practice changed and improved. What they want is a paediatric nurse with a special interest in say allergy, autism, ADHD, someone they can have control of.

My idea of a specialist nurse is someone who works at the forefront of their speciality, who advocates best practice and most of all works in partnership with the medical consultant. They consultant diagnoses the illness, but the specialist nurse takes part in the process of that diagnosis. He or she also offers the patient and their family the opportunity for a quality of care that they couldn’t otherwise have. This is no cheap option and rather than save money this kind of service might actually cost  more. Quality costs after all.

Our doctors need nurses who have an understanding of the patients under their care, they need to know how to work under supervision and to help free up the doctor to spend time doing things that require a specialist knowledge and skill. What they need are regular paediatric nurses who have been skilled up, who have addditional knowledge and who work at a level above the norm. In my book they are not specialist nurses, unless of course you consider a paediatric nurse a specialist in their field anyway.