MNHQ here: after your thoughts on a possible campaign on postnatal care

[RowanMumsnet]

Hello all

As lots of you will hopefully know, we at MNHQ run campaigns every now and then on issues that really matter to MNers. Ongoing campaigns include better miscarriage care (keep an eye out for developments on that in the next month or so), support for families caring for children with disabilities and additional needs (MNHQ has signed up to a new campaigning alliance on that and we'll fill you in on what's happening soon), and rape myths.

We've been thinking for a while, though, that many of the most urgent and upsetting things our users talk about fall under the heading of - frankly - inadequate postnatal care.

MNHQ was involved in the National Maternity Review recently, and even among the senior NHS professionals there it was evident that there's a consensus that postnatal is the 'Cinderalla' of maternity services: underfunded, poorly resourced and rarely thought about - except when it goes horribly wrong.

Obviously this is a huge area and a very complex issue to address - so we'd like to hear from you:

• is this something you'd like to see MNHQ get into?
  
• which aspects of postnatal care need to be improved? We're already thinking about things like: breastfeeding support; perinatal mental health; staffing and conditions on postnatal wards; partners on postnatal wards (we know most of you aren't in favour ); care in the community from health visitors and community midwives; injury care for women post-birth, and longer-term care for pelvic floors; the six-week check and whether it really works for women and babies... but we're sure there are more.
  
• what solutions would you like to see? What's needed (up to and including money) to improve postnatal services for women and their families?
  
  The aim of this thread is to find out whether you think this is a good idea overall, and to get a sense of which issues and which problems you think need attention - so please fire away and let us know your thoughts. When we've got something to work with we'll put together a survey for all our users so that we can get a bit of data to help us make some decisions.
  
  Thanks
  MNHQ

[JedRambosteen]

RedToothbrush your last post was a tour de force. I hope your employer appreciates what you bring to the party, as I think your recent analyses have been really insightful in flagging up areas for action. I hope MNHQ are taking notes.

[annandale]

RedTooth all I can say is that you are amazing.

I agree that Ben Gummer sounds like a potentially good contact. Webchat request? Actually, better than that, webchat debate between RedTooth and Ben Gummer? (RedTooth, are you ready to become a national voice on maternity care??)

[RedToothBrush]

Wow thank you both. I am not currently in work (SAHM) though in part this is down to my last job not ending well (too much pressure and workload piled on me). It means a lot.

A lot of this is supported in the National Maternity Review but its from different sources, and didn't seem to be critical of the CQC in any way which is a bit of a problem given the fact that it relies on the CQC for its implementation in large amounts. I just think it needs to be looked at from this angle to add weight and accountability to the system.

A bit more info. Sorry if this is boring.

Out of my list of 166 hospitals (which is most of, but not all maternity units in England), 6 units had an overall rating of Inadequate.
What I found fascinating is that out of these 6, two had a rating of outstanding for the caring element of the assessment – a rating that only 10 hospitals achieved.

What got me about that, is it raises a question here: were midwives in providing what seems to be a more caring environment than elsewhere doing so at the expensive or to compensate for other areas not being up to standard?

It is contrary to what I expected to see to be honest. Certainly one of these two had excellent friends and family scores and neither were on my list of hospitals to look at a bit more closely.

Also I mentioned that I had difficulty looking at the midwife ratios, but did manage to at least get some idea of what was going on even if some of these figures were questionable. You would expect that the hospitals with the lowest ratios to be the best rated as a rule. They aren’t.

To me that looks like there are some midwives who are doing great in difficult circumstances. (Yay superhero midwives you seem to show up in the data!)

Overall there also does not generally seem to be a strong correlation between ‘worse’ hospitals from the friends and family scores and their CQC rating. The fact there isn’t a stronger link and there are hospitals with poorer than average friends and family scores and good ratings overall is curious (and perhaps a bit worrying).

And finally, this is included in the national maternity review (as well as some of the other stuff I’ve said, but in a different format and from a different source but I think is well worth repeating or point out from a different perspective).

almost half of CQC inspections of maternity services result in safety assessments that are either ‘inadequate’ (7%) or ‘requires improvement’ (41%), 18 Although maternity and gynaecology services perform second best in these respects of all eight service areas in the CQC’s acute hospital inspections.

This is actually alarming. A lot of these do come down to staffing levels being poor (which is more than a basic ratio, and includes a lack of senior level and specialist midwives as well as sheer numbers) but this is not the only reason given.

On my list of 166, 47 rated Good for safety. 10 inadequate. 67 for Requires improvement. (the difference in percentage between my figures and the national maternity review is probably explained because I removed the ones without much data about friends and family from my list – these tended to be smaller units which seem to score better. I appreciate my data is a little off, and not entirely accurate, but I do think it is showing up patterns enough to merit mentioning and further proper exploration).

23 of those which were rated Good overall, scored requires improvement for safety but got good in every other category. Four of these are high on my ‘Shit List’ and I seriously question whether they are really worthy of Good overall rating due to the caring element being suspect. There are others I think what would fall foul of this but perhaps aren't obvious. And I suspect there are others still who are not getting the credit the midwives there rightly deserve.

[RedToothBrush]

As for being a national voice. I'm not sure I'm up to that. I would struggle with the weight of that. I'm flattered, but I think I'm better as someone doing donkey work and research in the background than taking the lead too much. I simply don't have the confidence to do it. I've doubted myself enough on this thread as it is. Part of me honestly wishes I did. I am cowardly when it comes to the final push I guess.

[pitterpatterrain]

RedToothBrush Really interesting research particularly on the variability in the way CQC seems to report and the disconnect between experiences and their ratings - thank you