Wednesday, 24 November 2010

Don't get sick in Haringey...

Today I attended the NHS Haringey executive board meeting, and presented a deputation on behalf of the Haringey Breastfeeding Campaign. Before the meeting, we unfurled our spectacular banner on an unsuspecting public - see above photo! Marvellous, isn't it?!

Here's what I said to the board (the most senior three members of which were men in suits, who I am sure are passionate about breastfeeding)...ahem...

"We welcome the review into breastfeeding support in the borough. We have read the report and last week had a meeting with Sheena Carr and Claire Wright to discuss our concerns and our recommended changes to the review.

We welcome the recommendation that NHS Haringey and the North Middlesex Hospital begin the process which will see them accredited as ‘Baby Friendly’, according to the UNICEF model. We would assume that beginning the process would result in actually achieving baby friendly as soon as is feasibly possible. We further welcome the recommendation of training for health professionals which is focussed on high quality outcomes not just attendance of training.

We are however surprised at the report's conclusion that ‘where there are specialists there is a tendency for people to over refer to the specialist service’, and that this leads to ‘staff in universal services’ becoming ‘deskilled’. Having read the draft review we have repeatedly asked for a reference to be included in the review on which evidence this assumption is based. As you will see from your copy of the review there is still no reference to any evidence. We would ask you to disregard this recommendation until sound evidence has been provided to back up this conclusion.

The review further highlights the absence of breastfeeding support skills of universal health professionals. Although 11 out of 15 staff who responded to the survey had received training within the last 5 years, and 8 out of 15 felt they were ‘very’ confident about giving advice, 9 of the 15 scored poorly on basic breastfeeding support questions.

We believe that the post of the specialist midwife needs to be re-instated until universal health professionals have been trained to a satisfactorily level and there is sound evidence available to prove that.

We also believe that you need to allocate a separate budget for breastfeeding support until breastfeeding rates in the east of the borough have improved significantly. The inequalities in health in the borough, which the review highlights begin at birth (with, for example, 64.3% of babies in Highgate ward being wholly breastfed at 6-8 weeks, compared to 26.7% in St Ann’s ward).

By not investing in specialist breastfeeding support now you are failing women and babies in the east of the borough.

By not investing in specialist breastfeeding support now the national health service will have to pay more money in future.

As the review points out a recent study in the United States found that if 90% of mothers followed the recommendation to exclusively breastfeed for 6 months then the country would save more than 13 billion dollars per year and prevent more than 900 deaths.

If one were to extrapolate the findings of the US study to the population of Haringey, then it would amount to a saving of more than 9.5 million dollars per year (6 million pounds). For each 1% increase in mothers breastfeeding exclusively for the first 6 months – which amounts to 42 women, seeing as there were just under 4,200 births in 2009 - the borough would save an incredible £78, 500 per year.

The study looked at only 10 childhood diseases so in fact the savings and deaths prevented would actually be higher. It did not include deaths prevented from breast cancer, for example. If women in the UK breastfed for an extra 6 months on average then 1000 cases of breast cancer, and hundreds of deaths, could be prevented each year.

In the light of all this we are asking you

• to set a separate for specialist breastfeeding support
• to budget enough money to pay for the entire process of achieving UNICEF baby friendly accreditation
• and to re-instate the post of breastfeeding specialist midwife until the borough is accredited with UNICEF ‘baby friendly’ status."


I stayed for the next three hours of the meeting, and here are my observations:

-The PCT will not exist after April. I was concerned in the meeting that there's a real feel of 'we don't know what will happen, and we don't know if we will have jobs, either', so it was as though they weren't sure what they could plan for.

-The breastfeeding campaign presented the case for investing in the borough, as above, explaining how, by investing in breastfeeding support, the borough could save £6m a year. The board didn't respond to this element of the deputation, despite the fact that the focus of almost the entire meeting was on how to save money!

- There was a new 'Interim Chief Exec' at the wheel, one Ian Wilson. He wasn't up to speed on a lot of what's going on (I know he's only been in the job for 5 weeks, so it's not surprising really). At one point, board chair Richard Sumray asked him to comment on something, and Wilson was stumped. Sumray commented "You ARE the executive lead on this..." and Wilson blushed a deep purple. I wonder if he is taking home the same salary as his predecessor Tracey Baldwin (who earned £190,000 pa!) and whether he thinks it is time to accept a pay cut? In the words of David Cameron, we are all in this together...(I am laughing hollowly as I type, dear reader).

- I was shocked to hear that Clinicenta, the medical arm of a construction company, who last year had their north London contracts suspended due to two 'unexplained deaths', are again active in Haringey. They talked about trying to get out of the contract early, but this was for budgetry reasons, not clinical standards reasons.

- The acute sector is where the overspend is, but Haringey, not having any actual hospitals (lest St Ann's, which is of course mostly mental health), has no control over this. I wonder whether there will ever be a day where our borough once again has a general hospital with an A&E. (There used to be 7 hospitals in the borough. Some of these are now luxury housing...).

- There were some concerns expressed about mental health services within the borough, particularly around the treatment of those with psychosis. I wonder what is being done to address this, particularly because the current financial climate means more and more people will be feeling the pinch, experiencing stress, unemployment, homelessness - all which lead to a decline in mental health.

- I sensed that the board were VERY removed from the health services 'on the ground'. For example, at one point, they mused amongst themselves about what it is that school nurses in the borough actually DO. None of the 18 board members knew. I wondered whether, post-April. the set-up we will have will see the people in charge being more in touch with the service they are running (here's hoping!), or yet more divorced from it?

- There was no sense of planning ahead for the long-term health of residents (as evidenced by the breastfeeding issue). It seemed more that they were in a crisis (financial) and were looking at the least painful ways to cut. Simple as that.

My recommendation, then, is clear: if you live in Haringey, don't get sick.

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