Ann Porter

Left Out: How 21st Century Ideologies Have Failed Mothers
Action not Ideology
#binTheTheories #ListentoMothers

[Ann Porter @PorterRend69501]

No, not confined to maternity. This all stems from a partial understanding and poor implementation of the Toyota Production System. I worked in the NHS in London about 25 years ago and remember when this became fashionable. Deputations of NHS managers went to Japan to learn from Toyota. Didn’t work out too well.

[Ann Porter @PorterRend69501]

Today’s Ockenden report starkly describes what went wrong at NUH but offers no analysis of the why. Until we understand why maternity care in the UK is deteriorating steadily, we will never be able to fix it. The four root causes of failure are:
-the dilution of midwifery training, regulation, and statutory supervision over the last 30 years which means a new generation of midwives is not at the right level of competence to take on the lead role in maternity care.
-the wholesale adoption of industrial business models (lean management) as a cost saving measure where pregnant women are treated as widgets on a factory production line.
-the adoption of natural childbirth ideology as a cost saving measure which denies the fact that childbearing is inherently dangerous.
- the unaccountable power of midwife regulatory bodies and unions.
This is why we need a judge-led statutory public inquiry to expose what is really going wrong.

[Ann Porter @PorterRend69501]

@DrJPGannon @Anisocyte Yes, good point. Postmodern theories have no place for the category of women known as mother who share universal experiences.

[Ann Porter @PorterRend69501]

Given the scale of the maternity scandal, I can’t understand why there isn’t public outrage. The magnitude of suffering does not seem to drive political interest. My grandmother, daughter and I all had to undergo emergency, unplanned Caesarian sections because of false ideas about natural childbirth ideology. My grandmother did not survive. This was in 1930, the very year Dick Grantly-Read published his treatise on natural childbirth.

[Ann Porter @PorterRend69501]

Thanks. I will watch this. The mid staffs scandal is similar to the maternity scandal in that any reasonable person would assume the scale of human suffering would surely prompt urgent, immediate action. This did not happen then and it’s not happening now. The mid staffs scandal did eventually gain traction with the public, media, and politicians but this has yet to happen with failing maternity care in the UK. You may be interested to know that safety techniques from the aviation industry were successfully introduced into the NHS around the time Cure the NHS was active- use of checklists in particular.

[Ann Porter @PorterRend69501]

@999Daedalus007 I do see but if people with power in the maternity care system knew how to implement change, they would have done it by now. We need to find new approaches. A statutory PI is just one tactic.

[Ann Porter @PorterRend69501]

Maternity care in the UK is deteriorating steadily despite 60 official inquiries over the last 10 years. To prevent further harm to mothers and babies, we now need a national statutory public inquiry where witnesses will be compelled to tell the truth. The argument against this is that we need to get on with implementing the 750 recommendations that have come out of a decade’s worth of inquiries. This is a delusion. If implementation hasn’t happened so far, it’s not going to. In the business of change management, it is well known that the architects of a system are never the people to change it. If they could have, they would already have done it. We desperately need a radically different approach.

[Ann Porter @PorterRend69501]

@999Daedalus007 Maybe but one thing is for sure. More of the same is going to produce more of the same.

[Ann Porter @PorterRend69501]

Yes, I think a big part of the problem is that investigations have been limited to local hospitals. This however is a nationwide whole maternity system problem. While a statutory PI will not in itself solve the problem, it will raise the stakes and is a clear ask in any campaigning.

[Ann Porter @PorterRend69501]

@999Daedalus007 Because we have had 60 official investigations over 10 years that have produced over 750 recommendations for change. All the while, maternity care in the UK continues to deteriorate year on year. A statutory, judge led enquiry will compel change on pain of penalties.

[Ann Porter @PorterRend69501]

@KenZeroHarm @DadOfAubrey I don’t see any other way to get the system to change. Also, there are other actions to take alongside a PI that will create new pressure for change.

[Ann Porter @PorterRend69501]

Official would be faster but statutory would have legal clout. I think part of the problem is the protection of powerful vested interest groups such as midwife representative bodies and unions. Change hasn’t happened because the problem has not been diagnosed correctly in the first place. The same myths are repeated time and time again. It is much more likely that the problem is not understaffing but midwives no longer being at a level of competence and qualification to take on the lead role in maternity care. But I get your point. A statutory inquiry could take many, many years.

[Ann Porter @PorterRend69501]

I wonder if the scale of the scandal makes it easier for politicians to avoid accountability. So far investigations have all been at a local level and victims are widely dispersed with no collective power. Unlike the post office scandal, for example, it’s hard to get hold of this scandal. You would think the magnitude of the suffering would drive a political response but it’s not happening.

[Ann Porter @PorterRend69501]

The five reasons are:
1. The dilution of midwifery training over the last thirty years with the result that a new generation of midwives is not at the right level of competence to take a lead role in maternity care.
2. The shift away from the external, independent statutory supervision of midwives to an internal concern for their wellbeing, provided by colleagues.
3. The growing power without accountability of midwife representative bodies and unions and the protection of vested interests.
4. The unthinking adoption of natural childbirth ideology as a cost saving measure.
5. The poorly understood adoption of lean management practices as a cost saving measure where pregnant women are treated like widgets on a production line. Mechanical theories are useless in the face of the unpredictability of childbearing. The introduction of physician assistants comes from the same place.

[Ann Porter @PorterRend69501]

Until the RCM drops the myth that the cause of failing maternity care in the UK is under-staffing, there can never be any progress. More probable causes are the dilution of midwifery training over the last 30 years; the adoption of industrial business models (lean management); changes to statutory supervision where the focus is on the well being of midwives rather than external scrutiny and sanction; the wholesale adoption of natural childbirth ideology as a cost saving measure; and the growing power without accountability of midwife regulatory bodies and unions. There have been over 60 official inquiries into failing maternity care over the last decade which have failed to achieve improvements. The opposite in fact. Maternity care continues to deteriorate steadily. I urge the RCM to stop repeating the same tired received wisdoms and to find a fundamentally different approach to fixing the problem, hard though it may be.

[Ann Porter @PorterRend69501]

In her leadership role, we can be certain that Sturgeon was responsible for creating the conditions that gave Murrell the opportunity to steal. My guess is that any interrogation of the SNP’s finances was shut down over years because ring fenced funds were being redirected to general campaigning. Key players on the NEC must now be very worried because the SNP is an unincorporated association. This means if it can be proved that members of the national executive committee were negligent in their responsibilities, it is possible that individuals can be held personally responsible for paying back any financial losses. My second guess is that this is why Swinney is so desperate to portray the SNP as the victim of crime-just like everyone else. He cannot admit the NEC is in any way liable because the financial penalties for individuals could run into the thousands.

[Ann Porter @PorterRend69501]

Yes, I think the corruption goes deep. The problem is that key players in a corrupt system do not have insight into what is happening. It is just the way things are done. My observation is that increasingly people who work in the public sector have little or no understanding of their legal and regulatory responsibilities. They can’t see in their mind’s eye what is going to come back and bite them one day. While there are questions about Sturgeon’s conduct, the most effective point of intervention is going to be (in my opinion) the NEC. Bureaucratic rules may seem boring but this is where wrongdoing can be proved in a rational way.

[Ann Porter @PorterRend69501]

My guess is that prominent NEC members thought they were covering up the misdirection of ring fenced funds and probably were shocked that they were actually covering up large scale embezzlement. Still, if proper financial stewardship arrangements had been in place then Murrell might have been caught earlier.

[Ann Porter @PorterRend69501]

@hedgenettle @_normina_ @staylorish Because there are so many victims of Murrell’s crimes, the starting point should be an independent inquiry into the SNP’s governance arrangements over the last 12 years. It is not fair to place the burden on members/former members/tax payers.