Wednesday, December 16, 2009

Midwives in meltdown: A former NHS worker reveals how understaffed maternity wards are sinking into chaos

What the British midwife reports below is dreadful but there is often great neglect in Australian public hospitals too. For that reason, when my stepdaughter was going to have her first baby recently, I sent her to a large private maternity hospital nearby, where she got excellent attention and resort-style accommodation. She was admitted on Friday, had the baby on Saturday and kept in until Wednesday morning to make sure that there were no problems: Nearly it used to be and most unlike the public hospital rush these days. I was there a few hours after the birth and found not a distressed mother but a "happy little Vegemite", as we say in Australia. A picture of the happy mother and day-old baby here. Contrast that with the story below. Government medical care is a disaster -- JR

Clutching her husband's hand and with agony and exhaustion etched on her face, a young woman struggled into a room in the maternity unit where I worked. She was in the early stages of labour with her first baby, she was terrified, in excruciating pain and desperate for any crumb of support. Helpless beside her, her overnight bag in his hand, her poor husband looked equally traumatised.

My heart went out to them. But I knew there was little I could do. With five other pregnant women to care for at the same time, all with hugely different and complex problems, I was rushed off my feet and didn't have the time to look after her properly, to allay her fears or to hear about how she wanted the birth to unfold.

I longed to sit with this poor young woman, calm her and remind her gently to breathe deeply through each contraction. Just half an hour of my time could have made all the difference. Instead, I put on my cheeriest smile and followed hospital procedure. 'Would you like a painkiller?' I asked. Ten hours later, after she had been drugged to the eyeballs to dull the pain, I heard she'd given birth. Her baby was healthy, but I knew I'd let her down.

As I watched her being wheeled into the ward, I felt eaten up with guilt. She'd effectively been ignored from the moment she turned up until the moment she gave birth. Plonked on an antenatal ward until her time came, with no one to reassure her during what was most likely the most terrifying moment of her life. No woman should have to give birth in these conditions - let alone in a modern hospital with professional staff at hand.

Welcome to the modern NHS maternity ward. A world of shoddy practice, poor hygiene standards and a shocking disregard for patients' individual needs.

When I read about newly qualified midwife Theresa Naish, who hanged herself in January after a premature baby died on her shift, I couldn't help wondering if she, too, was a victim of the over-worked and under-resourced labour wards I have experienced. Her father Thomas told the inquest into her death: 'Like all NHS staff, she was over-worked, doing too many hours in a department that was understaffed.' Although the child had little chance of survival, poor Theresa spent weeks torturing herself that she was to blame, before killing herself.

I don't want to alarm people for, of course, the vast majority of babies are born healthy and safe, but I think it's time we admit what is happening in our hospitals. Driven by targets and mired in red tape, our NHS maternity wards are becoming baby-producing factories where mothers' needs come very low on the agenda. The quicker midwives turn out babies, the more successful everyone tells us that we are. We might as well be producing sausages. It's utter madness.

I started working as a midwife in Basildon in 1995. I left to work as an independent midwife in January last year because I simply could not bear to let any more women down.

During a typical 12-hour shift, I could be the sole midwife in charge of six women in the antenatal ward - some in early labour - or one of two qualified midwives running a postnatal ward with up to 32 women. If I was in the delivery unit, I would assist in the births of up to three babies a shift.

Obviously, if there was a crisis during a woman's labour - such as a sudden need for an emergency Caesarean - there was always a surgical team on call, and there would be an anaesthetist available to administer epidurals and so on. But in terms of the normal care through labour, that was all down to the midwives. Although we were under huge stress even back in 1995, current cutbacks mean fewer and fewer midwives are caring for more and more women. No wonder new mothers are encouraged to leave hospital just hours after giving birth.

When I started in the mid-Nineties, there were 35,000 midwives working in Britain. A year or two ago, that number had fallen to 25,000, more than half of whom were part-time.

So, how bad did it get? Take one typical day I remember a few years ago. I found myself with up to six patients to look after at once and no back-up. From the moment I stepped into the admissions ward, the area was crammed with women clamouring for attention. Two women were in early labour. I longed to reassure them. But my stress levels rocketed when I saw the dramas that lay ahead.

One young woman, expecting her second baby in three months, had arrived in an ambulance with high blood pressure. She had been sent by her GP, who feared that her life and her baby's were in danger. High blood pressure is often a symptom of pre-eclampsia - one of the most serious risks facing a pregnant woman and one of the most difficult to detect. Terrified she was going to lose her baby, or die, or both, she was frightened. I tried to reassure her.

All the while, half my brain was on the screams of the two women in early labour a few doors away. Did they need more pain relief? When would they need to go into the delivery suite? I had to check my new patient's blood pressure every 15 minutes as well as taking blood samples to be sent for analysis to see exactly what the problem was. It was a race against time because if her blood pressure carried on rising I'd have to ensure she was whisked off for emergency surgery.

As I ran between her bed and the two women in early labour, I barely had time to greet another patient. She was in floods of tears. Her baby was due in a month. He had stopped moving and she was convinced he was dead. Strapping her up to a monitor to check the baby's heartbeat, I tried to calm her. But I didn't even have time to offer her a cup of tea before rushing to another new arrival.

She'd arrived in an ambulance after her waters broke while she was out shopping. The baby wasn't due for another week. Again, her unborn baby had to be urgently monitored.

I was frantically checking my watch to ensure I remembered my patient with high blood pressure when a young woman, hair matted with sweat and eyes wild with fear, staggered towards me. 'I can't take any more,' she said, gripping my hand. 'You've got to help me.' She'd been in labour for five hours and the pain was excruciating. I knew she'd be happier in a delivery room - which is more comfortable and has better specialist equipment - rather than a bed on the ward, but my heart sank. There was no room. I felt sick with guilt as I led her back to her bed. She was in agony, but she'd have to wait.

It was an hour before she was wheeled into the labour room. And in between nursing, I had to write up notes on each patient. There were days when I barely had time to go to the toilet.

In the 13 years since I joined the NHS, conditions have deteriorated. Starting from the moment they arrive through the hospital doors, birth plans tucked neatly in their overnight bags, women are being betrayed. There is reams of evidence to prove that a woman's labour is likely to be shorter and she runs less chance of needing medical intervention if she feels calm and relaxed in the early stages. It's not rocket science. Yet because midwives don't have time to sit with women in early labour for more than a few minutes at most, we are encouraged to do the next best thing. We offer them strong painkilling drugs such as pethidine or diamorphine - which is a form of heroin. Drugs keep the mother nice and quiet which, of course, suits staff. But they also likely to make her and her unborn baby terribly sleepy.

Although these drugs can sometimes increase contractions, they all too often slow them down. The end result at the woman will need more drugs, not fewer, and labour will take longer. But, of course, we don't explain of that as we dole out our pain killers. Besides, on a busy ward, what's the alternative?

Once a woman is in full labour, you'd thought we'd put her needs first. But I'm embarrassed to admit that, all too often, we were not allowed to. Most hospitals rigidly enforce the rule that, once in labour, a woman's canal must dilate at the rate of 1cm an hour. If that isn't happening, midwives are encouraged to tell the her that her baby may be getting in distress - even if that isn't the case. Terrified and exhausted by a haze of drugs, the woman agrees to anything which is offered. In practice, this means we give her extra drugs to intensify the contractions and so speed the arrival of the child.

Her pain levels increase and she'll need an epidural injection in her spine to numb the pain around her groin. It's a vicious circle. I felt terribly mean persuading women to go along with it. I knew I wasn't always acting in their best interests. But what could I do?

It's a joke to say women have choices over how they give birth. The truth is - thanks to the drive to cut costs and improve efficiency - births are turning into conveyer-belt productions. Women dream of having a natural birth and there is often no medical reason why they can't. Instead, they leave the delivery room with a healthy baby, but feeling like a failure because they have used drugs. Some are on such heavy drugs they don't remember giving birth at all. It's heartbreaking.

I also get very angry when I hear NHS authorities extolling the virtues of breastfeeding. According to the NHS website, it's the 'best start in life'. I couldn't agree more. But the truth is that breastfeeding rates are plummeting in the hospitals I've worked in. The reason is simple. Midwives don't have the time to spend helping mothers to feed properly. And without that vital support in the early days, women give up. With three women arriving on a ward at any one time, and three ready to leave, how could I possibly sit for an hour and help a new mother? It's physically impossible, particularly as we are encouraged to rush women home as soon as they are on their feet.

It's to save money, but it does at least reduce the risk of the new mums and their babies picking up an infection. It's no news that hospitals are often dirty. By the time I left, I was almost inured to the filth around me. With so many women and too little time, it was impossible to keep the wards spotless. I regularly found myself wiping off blood which had been missed by the cleaners in their rush.

It's a huge relief to have left the NHS. As an independent midwife in Northwich, Cheshire, I am finally able to help women the way they deserve. Calm, supported and not rushed, my mothers give birth in six to seven hours. In the units where I worked, the average labour was ten to 14 hours.

I feel guilty about the women I let down as an NHS midwife. Weak and in pain, they don't have the knowledge or strength to stand up for themselves. Instead, they end up being patronised by doctors and bullied by midwives into taking drugs they don't want.

But what makes me most sad and angry is that those hospital staff - everyone from managers down - are taking advantage of women when they are at their most vulnerable.


Girl, two, died 24 hours after NHS hospital doctors said she 'had no illness'

Lazy government doctors again. Diagnostic tests? Who's heard of them?

A girl of two died of suspected swine flu the day after hospital doctors allegedly told her parents she had no illness and sent her home. Michelle Fernando, two, began showing symptoms a week after her mother was diagnosed with the virus in November. Her worried father took her to hospital but said medics sent them home, telling him to give the little girl Calpol and water.

The next day Michelle stopped breathing and died. In a tragic twist of fate, it was the day ministers announced that under-fives would be vaccinated against swine flu.

Her mother Uthpala, 27, who lives with husband Rashid and their son Marlon, four, in Bristol, said Michelle would still be alive if she had not been sent home. 'We trusted the doctors but we don't any more,' she said yesterday. 'When Rashid took her to hospital, the doctors told him she had no illness. 'Even when my husband explained I had swine flu, they didn't take it seriously.'

Michelle was taken to Bristol Children's Hospital after she stopped eating and was very weak. Her parents claim doctors did not carry out a blood test or X-ray before sending her home, where her condition worsened.

Her parents were due to receive a report today, which will reveal if swine flu killed her. They have made an official complaint. Health chiefs in Bristol said an inquiry has started.


British doctors often bungle prescriptions

Doctors are to be formally tested on their knowledge of medicines before they graduate amid concerns about poor prescribing practises.

The British Pharmacological Society (BPS) is developing a national prescribing assessment alongside a website where students can practise their skills, including “dragging and dropping” the right drug doses on to virtual patients.

The BPS believes that current training in prescribing is “piecemeal” and more needs to be done to ensure standards are high. In some cases doctors had filled out a hospital prescription care just a handful of times during their entire medical degree — before taking on roles that could require them to write 50 prescriptions a day.

It comes after a study commissioned by the General Medical Council (GMC), published earlier this month, found doctors rely heavily on pharmacists and nurses to correct their mistakes with medicines. More experienced staff act as a “safety net” to help catch errors before they reach patients, it revealed.

The report said a lack of “safety culture” within the NHS is causing some errors, which occur in around one in 10 hospital prescription orders.

But the study found no evidence that junior doctors made more mistakes than doctors who had been in their jobs far longer.

The BPS welcomed that report but said there needed to be far more focus on ensuring medical students are properly educated.

Professor Simon Maxwell, chairman of the BPS prescribing committee, said prescribing was the “core business of the NHS” and the evidence of a problem with its quality was “now overwhelming”. He said about half of all spending outside of staff costs went on medicines and mistakes were a major reason behind why patients sought compensation from the NHS.

“We recognise that the majority of prescriptions are appropriate, safe and effective [but] the evidence is now unequivocal that there are problems,” he said.

“One of the concerns the BPS has is that there is somewhat of a culture of acceptance that medication errors happen but they are stopped by the good actions of nurses and pharmacists.”

He said the NHS could do a lot better and that such an error rate would not be acceptable in industries such as aviation.

There was a lack of skills training for students despite the fact education was “critical” to driving down the error rate, he said. After “years of indifference and even denial”, the corner may now be turned, he said. “I think everybody accepts that standards of prescribing in the NHS should and can be improved.”

Dr Jeffrey Aronson, president of the BPS, said doctors were dealing with more and more complex drugs and more complicated treatments. As people age, they tend to suffer a range of problems and more medications are prescribed, increasing the potential for negative interactions between drugs, he added.


Australia: Loads of money for hospital computers but nothing more for patients?

This is obscene for two reasons: 1). The huge waiting lists for treatment in most hospitals. The money should be spent on more doctors and nurses; 2). The British experience suggests that the money will be completely wasted anyway. The Brits have just given up on their computter system after spending 12 BILLION pounds on it

A BROAD coalition of health professionals believes it made progress in its quest for $6.3 billion in federal funding at the government's massive broadband conference in Sydney last week. The Coalition for e-Health's hopes have been buoyed by strong indications it has support from Kevin Rudd, Health and Ageing Minister Nicola Roxon and Communications Minister Stephen Conroy.

Michael Legg, president of the Health Informatics Society, which convenes the CeH, said the group had been asked to hang tight. Professor Legg said the group had been strongly encouraged by comments made by Department of Health and Ageing deputy secretary Jane Halton at the conference that indicated the department was behind the group. "That's the first time that I've really heard anybody at that level in the department declaring their position with respect to it, which means, I think, that that they do have strong political support," Professor Legg said.

The group has been in limbo since June, when the federal government accepted a report issued by the National Health and Hospitals Reform Commission that found e-health was critical to improving Australian healthcare. The report convinced the government to recognise e-health as a critical component of its health reform policy.

The Business Council of Australia issued a strategy paper last month that suggested Australia could cut $27.8bn from its national medical bill over eight years if $6.3bn were invested in e-health systems over five years. [What utter bull!]

The Prime Minister was expected to provide feedback on the strategy after last week's meeting of the Council Of Australian Governments. CeH wrote to Mr Rudd urging him to move swiftly to accept the findings of the strategy paper. It said in the letter the government had not made its position clear on e-health and asked Mr Rudd to take a stronger leadership position to ensure stronger cohesion between state and federal health jurisdictions. "We ask you as Prime Minister to lead the way," the group wrote.

"This is a nation-building exercise that requires clear vision and strong leadership. To date, your government, while supportive, has not articulated a clear position and commitment. Without this, all jurisdictions will struggle to move ahead . . . We also believe this is a great opportunity to chart a new course; to give the broader health community something to aspire to and work toward, and that this is an essential step towards providing a health system fit for the 21st century." But Professor Legg said Mr Rudd had declined to provide the feedback on the basis the issue was too complex.

The government has isolated health as one of the five key policy areas to be entwined with its $4bn plan to build a super-fast national broadband network. Delivering his opening address to the Realising our Broadband Future conference on Thursday, Mr Rudd said the NBN went beyond communications policy. "In other words, our national broadband policy is not about communications policy," Mr Rudd said. "It is about health policy, education policy, transport policy and the whole way that governments meet the needs of our people."

Labor has given e-health a prominent place in its health reform strategy, but the Prime Minister's positive mood did not carry over to discussion sessions on e-health later in the day. There, frustration was strong over an apparent lack of political leadership backing the vision. In one session Ms Halton faced strongly worded commentary from health professionals on a range of issues. Some bemoaned regulations that prevented them charging for health services supplied electronically. Others were concerned that the e-health agenda was too closely tied to the NBN and urged the government to take "the low-hanging fruit" by supporting health services that were possible with existing broadband connections.

Privately, others expressed concerns that ongoing political conflict over medicine services between the federal government and states and territories was holding back e-health.

However, Professor Legg took up one of the main barriers to e-health services -- the lack of unique healthcare identifiers linking individuals to healthcare records. As discussions were taking place at the conference on Thursday, the federal government released draft legislation to assign such identifiers to providers and patients. [A national ID card by the back door?] That was expected to overcome security and accuracy problems with medical records.

Some questioned the timing of the legislation but Professor Legg said it was a logical progression from the Council of Australian Governments meeting. "The government was moving as fast as governments do," he said.


Senate health bill goes into sudden-death overtime

On Thursday, it will have been 132 days since Congress broke President Obama's August deadline for a final version of his health care plan. That will be exactly twice as long as the time the president gave lawmakers to get the job done when he set the deadline back on June 2. Old political hands knew better than to take Obama seriously when he called for his national health plan to be completed before Congress left for its August recess on Aug. 7. But as he said, it's setting deadlines that's important, not meeting them.

Deadlines, Obama explained, help end the "hand-wringing" that dominated Washington before his arrival. Even if the clock ran out on his plan this summer, he had created some much-needed pressure. "Now, if there are no deadlines, nothing gets done in this town. If somebody comes to me and says, it's basically done; it's going to spill over by a few days or a week -- you know, that's different," was how Obama put it to Jim Lehrer in mid-July.

It's actually been 18 weeks and three days since the Senate left for its August break, and Majority Leader Harry Reid's caucus is in a state of greater disunity now than when Obama was shrugging off missing a deadline because the agreement was imminent. Except for a few bubbles of optimism when Democrats quit talking about the details of health care and focused on how sweet it would be to score such a big win over Republicans, we've seen the Super Bowl of hand-wringing in Washington.

There has not been meaningful debate or useful discussion, but rather the same baloney being sliced in different ways. There is still no consensus on how to expand coverage or how to pay for it, which are the same problems that existed when Obama first called for action in his Feb. 23 address to a joint session of Congress -- 294 days ago.

A plan so sweeping, so expensive and so unpopular has simply proved more than the Senate can handle, especially when Obama has steadfastly refused to be as specific about what he wants in the bill as when he wants it passed.

The House blithely approved a whopper of a health plan. But as Democrats in swing districts announce their retirements and the party keeps slipping in the polls, Nancy Pelosi seems caught in a political kamikaze mission.

After the August deadline was broken in the Senate, Reid and the White House whipped through a series of new deadlines, including Columbus Day and Thanksgiving. Each one was said to be valuable in terms of focusing debate, but all ultimately proved useless. The White House has lately taken to saying that the real deadline was the end of the year all along. This would allow Obama to herald the plan in his State of the Union speech next month, at which time we're told that he intends to cast himself as a budget hawk.

But to strike that unlikely pose, Obama needs the Senate to finish with health care before Christmas. But the yuletide deadline is now slipping as lawmakers await a cost estimate on a new version of the bill.

If Majority Leader Harry Reid had the 60 votes needed to break a filibuster, he could start the process on a final vote today and be headed back to Las Vegas on Dec. 21 as a big winner. But the votes aren't there, and starting the process now would result in a stinging defeat.

Reid was jazzed last week when 10 senators he selected to negotiate a new plan agreed that the thing to do was ditch the idea of a government-run insurance program -- the heart of the Obama plan -- and just expand Medicare. That would be as if the contractor struggling with the roof on your new house suggested that he tear down what he'd already built and just set up a trailer for you.

And Medicare wouldn't even be a double-wide model. It is tens of trillions of dollars in the red, and doctors and hospitals are already fleeing its measly payments and bureaucratic snarls.

It seemed inevitable that the Democratic supermajority would eventually get something passed on health care, if only through an utter indifference to quality. But this process has been grinding on so long to so little effect that if the CBO pans the idea of expanding Medicare, Obama may find that time is really up for his plan.


Anonymous Senate Aide X: Obamacare Going To January. Less Than 50% Chance Of Passage

By John Hawkins

Despite the Democratic attempts to paint the health care bill as an inevitability, the signs of life for the bill are looking ever more faint.

The bill is extremely unpopular and the poll numbers seem to be getting worse for it by the week. Moreover, Harry Reid is having an extremely difficult time getting to 60 votes and his attempt to replace the public option by expanding Medicare seemed like a desperation move. Yet and still, Lieberman and Nelson shot the idea down almost as soon as it was proposed, leaving Reid with no easy option to get a bill passed and a Christmas break coming up where Democratic senators are sure to get an earful from angry constituents who oppose the bill.

So with that in mind, I decided to turn to some of my sources in the Senate to see what they had to say. What follows is an edited transcript of a conversation I had with Senate Aide X, one of my most trusted sources. What you're about to read is probably representative of the behind-the-scenes thinking of Republicans in the Senate and of course, this is being posted with that person's permission:
John: Hey, if this latest Medicare/healthcare bill goes down in flames, will Reid go for reconciliation? Also, I assume if this fails, we're into January, right?

Senate Aide X: Yes, January and I doubt if they'll go for reconciliation.

John: Why do you doubt reconciliation? I ask because I am thinking it won't get 60.

Senate Aide X: I just haven't heard any talk of it.

John: Do you think it will get 60? I am thinking, no.

Senate Aide X: I don't doubt the Dems may do anything to pass it, so I'm not ready to declare it dead.

John: But still, it's looking grim right?

Senate Aide X: They are in much worse shape now than a week ago. If the bill dies this week, it will be because Dems just let it crumble through infighting and the Tea Party/American people standing up in August and demanding through weeks of recent phone calls and protests that it be stopped.

John: If it were to pass somehow, do you think it could die going through ping pong, back and forth between the House?

Senate Aide X: No! Pelosi will rubber stamp whatever the Senate passes.

John: So, you think all these demands from the Left about the public option and the Blue Dogs saying they have to have the Stupak Amendment in there are all for show?

Senate Aide X: No, the left-roots passion is real, but if you are Obama, Reid, and Pelosi, you know this is a one shot deal. This moment won't happen again soon and it's better to cut any deal you can to socialize health care as much as you can now. Take the win, go for more later.

John: One last thing: Chances of passing a health care bill? Give me a percentage.

Senate Aide X: Less than 50% now

John: Thanks for your time. Have a good night.

Long story short, folks, the fight isn't over by a longshot. Reid is still working to get something passed that Pelosi can slam through the House. Moreover, if that doesn't work, Reid may still try reconciliation. But, the odds are slowly but surely turning in our favor. Keep up the good work and we may be able to stop the Democrats from slashing Medicare, raising premiums, raising taxes, funding abortion with our tax dollars, rationing care, and ruining the quality of our health care system.


1 comment:

cold said...

Sounds ridiculous to me...times re very bad and no more goodness around I say.