Examination of Witnesses (Questions 100-119)
Tuesday 20 May 2003
MS LESLEY
SPIRES, MS
MAGGIE ELLIOT,
MS DIANE
JONES AND
MS MY
DIEP
Q100 Dr Naysmith: I do not mean necessarily
in your hospital but the people involved, the obstetricians involved,
do perhaps work elsewhere?
Mrs Elliott: We have a very interesting
mix because we amalgamated the Hammersmith Hospital with Queen
Charlottes in Goldhawk Road two and a half years ago and that
meant there were the wealthy women and then the disadvantaged
women all within the same hospital, so we had to look at how we
could target the disadvantaged groups in some respects as opposed
to the women who were not disadvantaged. I would say it is probably
a 50/50 split roughly. It can be quite difficult sometimes to
provide specialised services for women who cannot speak up because
the women who can speak up demand them. It is sometimes going
against the political climate that is going on at the time.
Q101 Dr Naysmith: How does it interact
with the midwifery services particularly?
Mrs Elliott: With the One to One
midwifery service we are looking at giving caseloading to disadvantaged
groups, which is a huge shift for us. The named midwife is not
like in a hospital, it is a community service, so each woman has
one midwife from the time that they book to the time that they
are discharged in the community when the baby is ten days old,
28 days old, or whatever. It is one midwife providing total care.
It is not just a concept, it is a reality. It does change outcomes
hugely for whichever group they look after.
Q102 John Austin: To what extent
do you think health inequalities might be reinforced by the maternity
services, by cultural or other assumptions made, restriction of
information or availability of services because of assumptions
about particular groups?
Ms Spires: I think it is important
to understand the groups that we are providing the service for.
That is about networking with organisations that serve those groups,
so if people have a particularly high Somali group of women in
the area, the same as the Bengali group in Tower Hamlets, you
need to network with the leaders of that particular society so
that you understand their needs and you are not making assumptions
about what you think that they need, because that can be hugely
different from what we presume. Each group has different priorities
and different needs. If you have got a very diverse population
then that needs a lot of development, particularly with the smaller
ethnic minority groups. If you have got a large group you know
what you can aim at and how you can network for that group. When
you have got perhaps a fairly small Polish community that is something
you have to consider, those small groups, because they are the
ones who are going to slip through the net. A lot of it is about
language barriers and translation services. I would just like
to say that I cannot believe how expensive community translation
services are. Just to cite an example: in-house services can be
provided and they can be relatively cheap but I needed to provide
a translator for a woman in the community who needed to understand
the blood test that was being done for her baby and she was there
for half an hour and it cost £80. If those are the costs
of services in order to provide what we need for women then it
is just impossible.
Q103 Julia Drown: You were saying
you provide in-house translation reasonably. How do you provide
this in-house?
Ms Spires: We have got translators
within the hospital that we can call on.
Q104 Julia Drown: Are they other
members of staff working elsewhere?
Ms Spires: There are members of
staff.
Q105 Julia Drown: So they are not
trained translators?
Ms Spires: No.
Q106 Julia Drown: We have had concerns
raised with us that if they are not a trained translator it can
be inappropriate.
Ms Spires: We can access trained
translators as well. It is the cost of going out into the community
that seems to be so high. It does not seem to be quite so costly
coming into the hospital.
Ms Roth: I am anxious to clarify
some of the word terminology.
Ms Spires: Interpreters then.
Ms Roth: In a sense there is a
continuum of interpreting, translating, whatever, and I think
it is important when we are thinking about trying to address women's
needs that we are not just talking about making medical procedures
understandable to women, and that is where the advocacy service
is actually different from that because it really has to do with
establishing a forum or a vehicle for women to express their own
needs. It is really important not to think that we can serve women's
needs merely by providing them with an interpreter.
Q107 John Austin: That would apply
not just to the language but to social class and other issues?
Ms Roth: Absolutely.
Q108 John Austin: Rather than interpreters,
is there an opportunity there for a growth industry, certainly
in deprived areas, of recruiting people from ethnic communities
or sections of society, not as interpreters but as ancillary workers
who work alongside midwifery services or other services with women
using those services?
Ms Roth: I would say that is definitely
the model that has grown up in East London. What My said before
is really important, that Women's Health and Family Services is
now 22 years old and it was started by women in the community
and it was staffed by women from the community which it was serving.
A similar project began in Hackney at around the same time and
that is quite a different model. It is not a translation model.
It is really about making services accessible by making them responsive
rather than just giving women information in one way. I do think
it is potentially something that would apply not just around language
but a group of workers who are actually focused on women's needs.
I am not suggesting that midwives are not focused but we know
there are problems with the interface between women particularly
who are facing disadvantage and professionals who have sometimes
a lot of pressures to accomplish other things and there may be
a way of developing services that mediate between the two.
Q109 John Austin: And at the same
time providing employment opportunities in deprived communities.
Ms Roth: Yes. The whole issue
of partnership and so on is about finding ways for the community
to have a role to play within the health service.
Q110 Julia Drown: I know we were
going to deal language later but I want to pick up on a couple
of issues that you were saying, Lesley. Is it clear to you within
the hospital when you need to bring in a trained interpreter and
when it is okay to bring in somebody from the hospital who is
not a trained interpreter but can speak another language?
Ms Spires: No, I think a trained
interpreter is always accepted as being the most appropriate person
to come in because it is somebody outside who is being objective
about how they are translating.
Q111 Julia Drown: But that is not
what you do in practice.
Ms Spires: Certainly if we are
out in the community it tends to be more family members. It is
also about picking up the relationship between the family members
and the dynamics within the family which you cannot do when you
just meet somebody for the first time, but certainly through caseloading
midwives do work with and understand the family dynamics. There
is also that element of having a relationship with somebody that
does overcome some of the language barriers. We do use traditional
interpreter services in certain circumstances, particularly in
the hospital, but out in the community it is the midwife communicating
with the woman or relying on a family member.
Q112 Julia Drown: What do you say
to those people who say that it is dangerous ever to rely on family
members?
Ms Spires: I think we do not have
the resources.
Q113 Julia Drown: So you would always
prefer to use others?
Ms Spires: Yes.
Ms Jones: Can I say that within
East London the priority is that we have absolute cover for all
areas and certainly with maternity it is so unpredictable as to
when you are actually going to need it, especially when a woman
is in labour. As my colleague here was saying, one of the things
we have got to look at is a risk assessment of is it better to
have somebody who can speak a common language with this woman
or proceed with care for her that she is not going to understand
and that will have an impact on the care that she is going to
receive. In all cases our policy would be to use a health advocate.
We try and cover the range of languages we have within Newham,
which is about 60 core languages, but at times it is very difficult
to find a health advocate to cover that language and, therefore,
we are looking at an employee who speaks that same language. One
of the initiatives we have is health care assistants from the
community who also are bilingual and can speak other languages
and we offer them training so that they can offer advocacy support
as well.
Q114 John Austin: Talking about addressing
disadvantage issues generally, whether it is through local or
strategic partnerships, neighbourhood renewal or whatever the
programmes are, do you think that maternity services and midwifery
services engage in that process of local anti-poverty strategies
or whatever?
Mrs Elliott: Absolutely. We are
very closely involved with the Sure Start programme and we have
got five going at the moment. Lesley is involved in organising
and supporting that. The interesting thing is that the caseload
midwifery does take care of one of those areas totally which works
very well.
Q115 John Austin: Is that other people's
experience?
Ms Jones: In the area that I work
in we have eight Sure Start programmes and we liaise very, very
closely. Part of our strategy comes through from working with
the community groups, bringing them together on what the priorities
are for the community rather than health care professionals deciding
what is necessary for the community. We do a round of brainstorming
and prioritising the needs for community areas.
Q116 John Austin: Do you generally
feel that there is sufficient recognition in maternity units of
inequalities, whether they are based on class or race or ethnicity?
Ms Spires: Since the Vision
2000 document from the Royal College of Midwives there has
been a real drive towards that.
Mrs Elliott: There certainly should
be, that is the guidance that has come out from the Government
and the Royal College of Midwives. It is certainly what maternity
units should be doing.
Q117 John Austin: What you are saying
is that Vision 2000 is actively engaged with in most maternity
units?
Mrs Elliott: It was three years
ago now when it was saying that we should be looking at providing
specialist services for these groups. It is up to the maternity
unit, is it not, always, whether they take on board those recommendations
or not?
Q118 John Austin: Where does the
initiative come from?
Mrs Elliott: The Royal College
of Midwives.
Q119 John Austin: I know that but
I mean for implementing it, where does the initiative come from
locally?
Mrs Elliott: It gets sent out
to maternity units as guidance. It is not in any way statutory
or anything. It is taken from recommendations from Government.
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