Examination of Witnesses (Questions 87-99)
Tuesday 20 May 2003
MS LESLEY
SPIRES, MS
MAGGIE ELLIOT,
MS DIANE
JONES AND
MS MY
DIEP
Q87 Julia Drown: Can I welcome you
to this second and last part of our Inquiry into Inequalities
in Access to Maternity Services. I apologise that we are starting
a bit late. Thank you to all of our witnesses for coming. We have
a change on one of the witnesses which is, rather than having
Laky Begum, we have got My Diep who has joined us. You are also
a Community Health Worker, are you, from Women's Health and Family
Services?
Ms Diep: Yes.
Q88 Julia Drown: We are going to
be trying to cover quite a lot of ground today in terms of inequalities
overall and then looking at specific groups: homeless people,
disadvantaged people, people with disabilities and so on. Please
feel free to chip in and answer and give us as much information
as you can. Can I start by just asking you to quickly introduce
yourselves and your background.
Ms Diep: My name is My Diep. I
work with the Chinese and Vietnamese communities in the Women's
Health and Family Services in Tower Hamlets.
Ms Roth: I am Carolyn Roth. I
am a midwife lecturer but I am here in my capacity as Management
Committee Member of Women's Health and Family Services.
Mrs Elliott: I am Maggie Elliott
I am Director of Midwifery for Queen Charlotte's Hospital.
Ms Spires: I am Lesley Spires,
I manage the community midwifery services and am also the One
to One/Community/Birth Centre Manager.
Ms Jones: My name is Diane Jones,
I am consultant midwife at Newham General Hospital.
Julia Drown: Thank you. We are going
to start, as I say, on the wider issues of inequality.
Q89 Dr Naysmith: Good afternoon.
There is a thing called the inverse care law which is not a law,
it is a principle in sociology, and in the provision of public
services in general. It suggests that those who need services
most are the ones who are least likely to get them. Probably you
could expand that a bit, that those who need the best services
actually get the worst services in many instances. I wonder does
that apply in the provision of maternity services? I wonder whether
maybe somebody from Queens Charlottes and Chelsea could start
off by saying what you think happens in your area. Do you think
that is true?
Ms Spires: I think that it is
harder for that group of women to access maternity services. I
think the key is to go out to them, to reach those women, and
not expect them to be able to access the traditional services.
I would agree with that.
Q90 Julia Drown: Sorry, could you
speak up a bit. The acoustics are not that good in this room.
Ms Spires: I think that is true.
It is certainly harder for that group of women to access the traditional
maternity services. We have to go out to reach those women because
they are not going to be able to reach us through the normal channels.
Q91 Dr Naysmith: Do you think that
is something that the service is conscious of?
Ms Spires: Very much so.
Q92 Dr Naysmith: And it really is
trying to address that?
Mrs Elliott: Yes. We are looking
at re-profiling at the moment our One to One midwifery service
so that we actually provide a specialised service for disadvantaged
groups as opposed to the one of the more advantaged groups that
we have in our local area. It is about how we need to actually
re-profile, which is what we are doing.
Q93 Dr Naysmith: How about in Newham?
Ms Jones: Certainly I would say
that disadvantaged women are not aware of what facilities are
available. There is a lot of outreach work that needs to be done
within communities so that they are more aware of services that
they can access for their benefit. Women that are more aware of
it and are more assertive and know how to access health care are
able to do so far better than others.
Q94 Dr Naysmith: Do you think that
this inequality in provision of services that clearly is part
of our current provision that we are all trying to do something
about has any long-term consequences for women and babies?
Mrs Elliott: The national reports
that come out absolutely reflect that. There is a long-term effect
if those women do not receive appropriate care, particularly on
things like domestic violence and all those things, which is why
we provide the service that we do in order to try and prevent
those things from happening.
Ms Spires: It is reaching women
in their homes. You find out much more about those particular
groups, particularly in terms of domestic violence and child protection
issues, if you know women from the beginning of the pregnancy.
That is what we are trying to do, and I am sure that many other
units are as well. If women in those groups do have a named midwife
they can identify with there is going to be a more trusting relationship
between them and more disclosure in these kinds of situations
and also better co-ordination of what other services they require.
It is one thing to provide the service but it is another thing
for that woman to know that the service is there, you actually
have to go and say "This is what we have got for you and
this is how you can reach it".
Q95 Dr Naysmith: Do you think that
works? I have a particular thing about named midwives and named
nurses because I spent some time in hospital a couple of years
back and I had a named nurse given to me on my first day and I
saw her, I think, twice in about three weeks.
Ms Spires: I think that is about
primary nursing where there is somebody who co-ordinates the care
rather than delivers it. Certainly in the One to One caseload
scheme the midwife works all the way through with the woman. We
already have a teenage pregnancy group and have also started caseloading
travelling communities and it has worked well because it is a
particular group of women who traditionally do not attend for
antenatal care and they book late. These are women who have been
identified in the Confidential Enquiry into Maternal Deaths as
having a much higher rate of maternal death than any other group
because they do not access services. It has made a huge difference.
It is also that barrier where women feel that they cannot trust
the professionals. If they get to know individual professionals
then they are more likely to trust the service that they are getting
and to access it and to believe in the people who are giving it.
Q96 Dr Naysmith: I wonder if Carolyn
and My have anything to add?
Ms Roth: I was just going to comment
on that last point. In quite a different capacity I was involved
in a small survey precisely trying to count the numbers of women
who do arrive in labour without having prior antenatal care. We
have very bad figures about that. Very few maternity units can
actually produce the figures that can count that. It is a theme
that runs through a lot of the issues regarding access to services
which is what is not counted does not count. In other words, if
you cannot actually enumerate what the dimensions of the problem
are it is actually very difficult to identify shortcomings in
the service. That is something that runs through both issues around
language and issues around access generally, that it is poorly
documented and poorly monitored.
Q97 Dr Naysmith: How does your organisation
help women, disadvantaged women particularly, access maternity
services?
Ms Diep: We recently changed the
name of the Women's Health and Family Services, before we were
called the Maternity Services Liaison Scheme. That works with
ethnic minorities and most people come from different countries.
For example, I work with the Chinese and Vietnamese and our organisation
has Bangladeshi women and Somali women who have little knowledge
of the health services in this country and they do not know how
to access the services available in this country. We set up this
project to help the people with a language barrier and very poor
access to health services. When we set up in 1981 it was very,
very hard for us to help them because we had to go door-to-door
to tell them about the services available for them and how to
use those services. When we set up it was very, very hard and
it is going on at the moment.
Q98 Dr Naysmith: Do you think the
authorities do enough? Obviously not otherwise you would not be
providing your service. What can the authorities do better to
help you in what is obviously very valuable work?
Ms Roth: I think, as My was saying,
there have been very well developed services in Tower Hamlets
which started with the project that we represent. As a spin-off
from that, the Royal London established an in-house language service
for women having maternity care. The majority of women who deliver
in Tower Hamlets are actually Bangladeshi women, so there is a
big single language group. The services are well provided but
what is also the case is that not all women who would value and
be able to make use of the service get it because in all of the
research that has been done about the actual receiving of those
services there are still shortcomings. There was a survey done
in East London a year and a half ago which showed that 60 per
cent of women still were not getting the service. It is partly
because of the challenge of actually getting the service to the
women when they need it. There are still shortcomings but it is
not because nothing is being done, it is because somehow what
is being done is not working perfectly, certainly in Tower Hamlets.
For example, there have been calls for years and years for a 24
hour service because obviously women in labour need language services.
There is not yet a 24 hour on-call service, or anything like that.
There are certainly huge gaps but even antenatally not all the
women who should have language support get it.
Q99 Dr Naysmith: These couple of
questions are scene setting and most of the things we have touched
on will be picked up later on, but I cannot resist asking a question
of Queen Charlottes. A lot of women who use your hospital are
relatively wealthy and there is quite a lot of private obstetrician
work that goes on. I just wonder does that in any way distort
the service?
Mrs Elliott: There is not as much
private work as you would think really.
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