The rise in emergency admissions…

This week, the Health Foundation and the Nuffield Trust released a new QualityWatch report on ‘Emergency hospital care for children and young people’, which shows concerning rises in emergency admissions of infants under 1 years of age over the last 10 years.

The research used routinely collected Hospital Episode Statistics from 2006/07 to 2015/16. Data was analysed for children and young people aged 0 to 24 years, including the under 1 year (infant) age bracket.

Emergency admissions of infants rose more than any other age group over the decadeThe absolute number of emergency admissions for infants increased by 30% (from c170,000 to c220,000 admissions per year). This compares to the total number of emergency admissions across the population increasing by 20% across the same period, and the number of emergency admissions for all children and young people (0-24 years) increasing by 14%.

After taking population changes since 2006/07 into account, the emergency admission rates for infants showed the largest increase of any age bracket at 23% – from 27,415 emergency admissions per 100,000 population in 2006/07 to 33,684 per 100,000 population in 2015/16. Relative to their population size, infants also had the highest number of A&E attendances at 74,522 per 100,000.

The rate and number of particular conditions are behind the increase in admissions of children and young people, including concerning rises in emergency admissions of infants for jaundice, feeding and respiratory problems.

Emergency admissions of infants for jaundice more than doubled, from 8,186 to 16,491. Emergency admissions for conditions categorised as ‘other perinatal conditions’, including digestive system disorders and feeding problems, increased by 74% – from 14,293 to 24,848.

The authors state that ‘The rise in emergency admissions among infants raises some questions about maternity and community care’. They raise concern about the lack of available support outside the hospital emergency care setting. The report refers to Better Births (the NHS England National Maternity Review) as highlighting the need for improved breastfeeding and follow-up support for new mothers in the community.

The authors note that there are various supply and demand factors that can influence emergency attendance and admissions. These include: demographic changes (births, deaths, migration); people’s behaviour (when and how they seek help); the public health system (rise and fall of different types of prevention work); and the availability, accessibility and quality of care in and outside the hospital. Plus there are broader environmental and socioeconomic factors (e.g. financial difficulties and poverty).

They refer to specific policy changes that may have impacted on emergency attendance and admission data. For example, the introduction of 4-hour A&E waiting times may have influenced decisions to admit individuals to hospital. And the Health and Social Care Act 2012 shift in public health function to local authorities was followed by significant cuts to their budgets.

These findings are of significant relevance to those supporting new parents and their babies in both maternity and community settings. They add to concerns regarding the quality of postnatal care and the cuts to public health services, including health visiting and infant feeding. And most importantly, the findings reflect what we hear from women about not being able to access the support they need, when they need it.

Support postnatally and during early parenthood really matters. The health and wellbeing of babies and parents bears the brunt of poor access to community-based support. But the public purse also feels the pressure. When the consequences are such that the cost of emergency admissions and unnecessary hospital care steals from the budget available for preventative and community services. 

I’d love to hear of examples of community or hospital services which have been shown to reduce admissions for infant feeding and related issues. I was impressed to hear about this Rapid Access Clinic at Sheffield Teaching Hospitals service at the UNICEF Baby Friendly conference in 2014. You can see the slides here. Please do share your examples!

Read coverage in the Guardian here.

Breastfeeding support – feedback matters

We have to admit to being a bit nerdy in the NCT Knowledge team. We love working with other teams to develop new surveys. And we love it even more when we have survey data to play with. Quibbling over how questions are worded, watching the response rate climbing upwards, crunching numbers, working through comment boxes to identify themes…. and turning it all into something meaningful and actionable for the volunteers, practitioners and teams we’re working with. It’s what we do.

For me, this is such satisfying work because it’s about making sure expectant and new parents are at the very heart of our charity’s activities. Understanding hopes and expectations, listening to experiences, and exploring the difference we make. It’s only by listening and learning that we can ever hope to support more and more parents to have positive experiences of pregnancy, birth and parenthood.

There is another reason that feedback is so very important though. And that is for us to be able to recognise and value the incredible support being provided by our volunteers and practitioners.

We’ve recently been working up a new survey to gather feedback on women’s experiences of the voluntary postnatal support provided by NCT’s breastfeeding counsellors. There are over 300 breastfeeding counsellors working across the UK, supporting women postnatally at what is often a very challenging time. Research evidence tells us just how many women stop breastfeeding before they want to, and we know from women what a truly miserable experience this can be.

Not being supported to breastfeed or making the decision not to continue, is often combined with not feeling supported to introduce formula milk either – leaving women stuck between a rock and hard place. And it’s a pretty horrible place to be, at a time when women are often also utterly exhausted and feeling the weight of expectation that seems to come with new motherhood.

When support IS available, it can make all the difference. And I mean quality support… responsive, person-centred, non-judgemental, specialist support. Someone to spend time alongside you, to listen and observe, to provide practical and emotional support. To help you feed your baby the way you want to, and make the decisions that feel right for you and your family. And this includes decisions to introduce formula, if and when the time feels right. Not because you’ve failed or not been able to get the help you need – but because you’re supported through your experiences and to make decisions that are right for you.

NCT breastfeeding counsellors put in an enormous number of volunteer hours providing this kind of support for new mums. They know from their day-to-day contacts what a difference it can make, but have been understandably keen to have this core part of their role captured more routinely. So we are introducing a new survey for women to give feedback on their experiences – to let us know how and when they accessed support, their reasons for needing to do so, and what difference it made to their feeding journey. We are also asking them whether they feel there is anything that could be done to improve infant feeding support.

It’s a bit of a challenge to collect routine data from services like this. Breastfeeding counsellorss provide support in a variety of ways (NCT helpline, community drop-ins, home visits, by phone etc) and sometimes it is a one-off contact. So we’re keeping it simple. A survey link which can be shared with women accessing support, which asks straightforward questions about their experiences.

We’re trialling the approach with a group of 10 breastfeeding counsellors at first, to see how well the survey works and what kind of response we get. And then we’re aiming to roll this out nationally. Huge thanks to the breastfeeding counsellors who have been involved in shaping the survey and testing it. Back in office, we’re keenly watching the responses come in and looking forward to sharing a summary of the feedback later this year.

 NCT has lots of information for expectant and new parents in the baby feeding section of our website. 

Breastfeeding counsellors can be contacted via the NCT helpline on 0300 330 0700. Or check out our branch pages or the Baby Cafe webpage to find out what support is available locally. 

If you are an NCT breastfeeding counsellor keen to get involved, then please contact your specialism coordinator (Carolyn Neal) or get in touch with us via research@nct.org.uk.

 

 

Come rain or shine… #myNCTstory

Thanks to NCT’s Nottingham branch for sharing #myNCTstory in their newsletter this month. It has felt good to write, so I am sharing here too!


My NCT story starts similarly to many, walking anxiously into a room of strangers for our NCT antenatal course. After several years of the highs and lows of fertility treatment, it felt wonderful to be doing something so normal, to be finally believing that we were going to be parents at last, and to be surrounded by others at the same stage as us.

Expecting twins did make us feel a bit different – I knew I’d be having a caesarean section due to placenta previa and that my babies would be coming a little early. And I imagined that caring for two babies and getting out the house would be pretty overwhelming. But our antenatal teacher was very reassuring, and did all she could to help us feel included and part of the group.

But after a fab first antenatal class in January 2010, my NCT story was cut short. I was hospitalised due to a heavy bleed before the second class, and spent the rest of pregnancy getting to know Nottingham QMC’s ward B26 and ‘enjoying’ every meal on the hospital menu several times over. When I emerged from hospital 5 weeks later gratefully clutching two tiny babies, the blossom was out, the daffodils were up, and my world was changed forever.

I was lucky enough to be able to make the most of maternity leave. I felt well in myself, have a true partner-in-parenting in my husband, and have parents who are willing to do just about anything (actually anything!) for their grandchildren. But I didn’t get out the house much during the early months, and found it hard to meet other mums or to join in with the usual activities that bring people together.

My local baby group was a lifeline though. I dragged myself round the corner in a dishevelled state once a week for the pure relief of being provided with tea, cake and a chat, whilst two lovely volunteers bounced my babies round the room. I also connected with three other twin mums who were at a similar stage and who provided invaluable friendship and support – and still do.

The first 6 months were a blur of feeding and sleep deprivation, desperate attempts to get both babies to sleep at the same time (so that I could too), and miles upon miles of pushing the buggy round the park come rain or shine. The second 6 months was simply a different kind of blur – still sleep deprived, but now with food spread across every surface of the kitchen and babies crawling enthusiastically in opposite directions.

It was a challenging, sometimes stressful, but wonderful year, which feels like a bit of a dream now. And I do feel a little bit cheated that I only got one. Twin mums should get a second leave entitlement at some point, right? Still waiting for that one….

So how did I get a second chance at my NCT story? Fast-forward to 2013 and I had been back at work for two years, but was restless for change. I felt stressed and frustrated at work, unable to balance competing priorities or feel satisfied with very much at all. Sound familiar? I held a permanent academic post, and my research and teaching had always focused on health during pregnancy and early life. I loved my work – but wanted to do more with it. I wanted to feel like I was using my knowledge, skills and passion to really make a difference for parents and their babies.

So when I saw an advert for a job in the research team at NCT, I jumped at the opportunity to join an organisation directly supporting thousands of new parents every year. At the same time, I felt very daunted. With two year-old twins at home, it didn’t feel like the best time to be changing career direction. And I also wasn’t sure what I’d find on the inside at NCT…

But what I found was pretty amazing, and I haven’t looked back since starting my new job in 2014. I now head up the Knowledge Team, and feel so lucky to be part of an organisation that has such a bright future ahead and that I have come to care so passionately about.

My team gathers feedback on NCT courses – so if you’ve ever received an email with a survey link, then it was probably from us! We collect over 20,000 pieces of feedback every year, and listen carefully to your views to help make sure we support expectant and new parents as best we can. We also evaluate lots of different NCT services, such as Baby Cafés, local support for refugee and asylum seekers, perinatal mental health peer support or volunteer peer support programmes in disadvantaged areas – to measure the impact of our work as a charity.

My team has recently taken on responsibility for NCT’s information for parents on our website and for NCT Matters, the national digital magazine for our members. Led by our brilliant parent content manager, we’re currently planning lots of work to review and update all of this content. One of the things I feel most passionately about is that parents should be able to access trustworthy and evidence-based information, to help you make decisions which are right for you and your families, and to find the confidence and reassurance you need.

We are also involved in lots of research projects aiming to improve services during pregnancy, birth and early parenthood. This includes working with research and clinical teams across the UK. And we support NCT’s campaigns team, such as our recent work to highlight gaps in perinatal mental health services and to raise awareness of mental health issues amongst new parents.

Most excitingly, it is fantastic to be at NCT at a time of such a positive change and renewal – with a new strategy in place to strengthen and modernise what we do, and increase the reach of our support to more and more parents in the future. It’s not going to be easy and it will take time, but together we can make it happen. This is a charity that I am proud to work for, come rain or shine.

 

Girls 2

‘Just About Managing’ is Just About Everywhere

Funny how a new phrase can seem to come from nowhere but end up everywhere. ‘Just About Managing’ (JAM) is one of those phrases, moving from policy report to political narrative at speed. And now infiltrating the funding and service development context too. But who is the phrase being used to describe?

The original Policy Exchange report published in June 2016 used JAM to describe individuals very generally as within the C1 and C2 social grades (representing 48% of the population in 2015)  – ‘people who just manage to get by each month but whose resilience to economic shocks is not high’. The report positioned these groups as overlooked within recent policy development in contrast to the needs of businesses and of families who depend on welfare, who represent the top and bottom ends of the social grades.

Then Theresa May happened. And in her first statement as Prime Minster she set out her focus on families who are ‘just managing’.

“You have a job but you don’t always have job security. You have your own home, but you worry about paying a mortgage. You can just about manage but you worry about the cost of living and getting your kids into a good school.

If you’re one of those families, if you’re just managing, I want to address you directly.”


The Resolution Foundation then characterised the JAMs as – ‘despite being in work and largely outside the system of means-tested benefits, they live on the edge, vulnerable to even modest changes in circumstances’. Their report maps this across to the low to middle income (LMI) bracket; families who have a net equivilised household income of between £12,000 to £34,000. This is defined as those in the bottom half of the income distribution, but above the bottom 10% and receiving less than one-fifth of their income from means- tested benefits (not including tax credit income). Note that ‘net equivilised’ takes into account income tax, national insurance and household size – so LMIs can be earning up to £50,000.

YouGov asked the public what they thought and showed, perhaps unsurprisingly, that a greater proportion feel that they are just about managing – including 1 in 5 people earning over £70k. There is some interesting segmentation in their blog.

So that’s where I have got to – the phrase is starting to take shape, but remains blurred in how it is defined. But one thing is for sure – ‘just about managing’ speaks to a large percentage of our population.

Do you have any thoughts or good sources of insight on this? Guy Standings’ ‘The Precariat’ has been recommended. But I’m ‘Just About Managing’ to read Harry Potter to the kids at the moment, so might not manage this bedtime reading….

The night that Speaking Out stole the show

Monday night saw Mind’s Media Awards take to the stage for a night that turned out to be a real emotional rollercoaster.

I don’t know about other attendees, but I am still going over the incredible stories and speeches in my mind. I really was moved, again and again, and truly inspired – by the very personal stories which lie at the heart of the featured work. And by the difference that we can achieve together if we continue this drip, drip, drip (with the occasional almighty splash) of awareness-raising media coverage for perinatal mental health.

Freddie Flintoff proved the perfect host – sharing his own experiences of depression and stigma with a blend of raw honesty, sensitivity and humour that is so hard to achieve when talking about such a personal and challenging topic.

“When you play sport, you’re not meant to give anything away. You’re meant to be invincible”.

I reflected on the synergies with new parenthood – when you have a baby, you’re not supposed to be sad or anxious or fearful. You’re meant to be over the moon, the perfect parent.

It was no surprise to me that perinatal mental health featured highly on the night. 2016 has been an incredible year for coverage, and postpartum psychosis was the most highly covered condition across the awards – attributed to the Eastenders storyline early this year.

I found myself feeling anxious as the awards began – due to an unashamedly desperate wish for Rosey Adams of PNDandme to win best ‘Blogger‘. How delighted I was when she did! As Rosey said, PNDandme is “so much more than a blog”. The supportive community brought together through #PNDhour is incredible. The power of peer support is evident, as is how much we can all gain from the bringing together of so many different perspectives. I have learnt an enormous amount from the #PNDfamily, and am so pleased that Rosey’s work has been recognised.

It was also fantastic to see ITV Central News accept the ‘News and Current Affairs’ Award for Men under Pressure. NCT worked with the team on content and case studies for the episode on dads’ mental health, and I was glad to be interviewed as part of this. I was especially pleased that Matt Padley’s contribution was recognised, who shared his experiences of male postnatal depression.

One of the most moving parts of the night was the award of ‘Best Documentary‘ to BBC One’s ‘My baby, psychosis, and me‘, which follows two women’s experiences of postpartum psychosis and Winchester’s Mother and Baby Unit. The challenges of both filming and being filmed during this time can not be underestimated, nor can the role of Consultant Perinatal Psychiatrist Alain Gregoire in facilitating this. Alain’s care for Hannah and Jenny was incredible to watch. I remember wishing that we could clone him to enable universal access to this level of skill and empathy. It was wonderful to see Hannah and Jenny take to the stage too – their willingness to share their very difficult stories opened the eyes of viewers to the reality of mental health crisis.

When it came to ‘Soaps and Continuing Series‘, I have to admit to feeling a sense of disappointment that Eastenders didn’t win. It took me a while to compute exactly why I felt this way. It wasn’t any judgement on the winner, BBC Scotland’s River City, whose coverage of self harm clearly had great impact. And it wasn’t disappointment for Eastender’s Lacey Turner and Jimmy Bye, despite them sustaining such a moving and accurate portrayal of the impact of postpartum psychosis during the complex storyline.

My disappointment was for the women and partners who were represented, and whose terrifying experiences were so publicly acknowledged. Who were then given a platform to share their stories and push the coverage out across every inch of print, digital, radio and television journalism. Who took to social media, #realstaceys confirming that Eastenders hadn’t over-dramatised – as Kathryn Grant said, “you can’t overplay psychosis”.

But my disappointment was short-lived….. The final award made up for it a hundred times over. Lacey Turner and Jimmy Bye stepped onto stage to present a special ‘Speaking Out’ award to Eve Canavan and Kathryn Grant, who have both experienced postpartum psychosis and worked with the Eastenders team.

We heard how tirelessly they contributed as experts by experience – to the nature of Stacey’s behaviours and delusions, to the way she protectively held her baby, to the depth of fear and confusion for Stacey and Martin, to the reactions amongst the community, and the impact on wider family. Lacey and Jimmy’s translation of this onto screen was also recognised: “just think how many lives have been changed by their portrayal of postpartum psychosis”. Lacey was genuine when she said “we couldn’t have done this without you”, and explained how Eve and Kat had “fearlessly told their story again and again” in the subsequent media coverage.

Eve then did something extraordinary. She accepted the award and did one of the best speeches I have possibly ever heard! I can’t hope to capture the magic here, but her courage, passion and advocacy are a force to be reckoned with. Kathryn unfortunately couldn’t attend, but the applause for Eve and Kat was such that she may have felt the tremors from afar!

Thank you to Mind for such fantastic recognition of the positive contribution that media can make to raising awareness and challenging the stigma around mental health. But importantly, also recognising that coverage wouldn’t be possible without the women and men who speak out. Who share their stories so powerfully, and advocate for the many more who don’t have their voices heard.

Real people and real experiences quite rightly stole the show.

Eve Canavan, Rosey Adams and Jessica Warne – three of many women who build on their experiences to advocate and provide support for others. NCT is grateful for input of many experts by experience to our work around perinatal mental health, and to have Jessica on the Parents In Mind advisory group.

eve-rosey-and-jessica

Pregnancy through the celebrity lens…

Becoming a mum at an older age was in the news again today. I guess I’m tuned into noticing pregnancy and parenthood stories in the news  – a combination of living and breathing these issues in both my home and work life (and also working with a very efficient press team at NCT!). But it does seem like these stories are prime fodder for press activity – single research studies draw significant coverage, even when they don’t add any where near sufficient evidence to change policy or practice. Add a celebrity, and we have big news….

More than 2,000 babies were born  to mums over the age of 45 in England and Wales in 2015, and I’m sure everyone of those mums are relieved to have not had the press attention that Janet Jackson received this week. Was it fertility treatment? Is it safe? How will she cope with teenagers in her 60s? If she isn’t thinking all of these things over, then the celebrity following is doing so for her.

There are many complex social, professional and financial reasons why a woman might choose to have a baby later in life. And for many women this doesn’t feel like a real choice – they have only just settled with a partner who they feel ready to start a family with. Or have experienced fertility issues for many years, before what feels like a miracle happens. Or perhaps have experienced previous loss or abuse or mental illness or economic or housing uncertainty which meant that pregnancy was just unthinkable at an earlier time. It is not for us to judge. But it is the reality for many.

Research tells us that there are increased risks associated with older age at pregnancy. Data from the UK Obstetric Surveillance System (UKOSS) compared outcomes in women aged between 48 and 61 of age to a comparison group of women aged 16 to 46. All women gave birth in UK obstetrician-led maternity units between July 2013 and June 2014. Older women were more likely to have complications of pregnancy such as gestational diabetes or high blood pressure, and a preterm birth. They were also more likely to experience placental complications or heavy bleeding after birth, to need a caesarean section, and to be admitted to intensive care.

Women of older age were also more likely to have conceived following fertility treatment, to be overweight or obese, to have pre-existing medical conditions and to be carrying a  multiple pregnancy. These factors explain the increased risk of many of the complications observed.

Whilst women should be free to choose when to start a family based on their personal circumstances, there is little that can currently be done to reverse the underlying biological factors that lead to reproductive ageing. Of the 48 to 61 year old age group in the UKOSS study, 78% were conceived by in vitro-fertilisation, compared to 4% in the group aged 16 to 46.

The Birthplace in England study showed greater risk of intervention and adverse outcomes with increasing age in women who didn’t have any known medical or obstetric risk factors prior to the onset of labour, and there was no age at which there was a step-change in risk.

But it’s not just about age – we know there are increasing numbers of women giving birth who have health problems or complicated pregnancies for a whole range of reasons. Whatever your age, whatever your circumstances – pregnancy and early parenthood can be a time of great challenge.

What matters is that every woman is able to access safe, high quality maternity services which recognise and adapt to her individual needs. That she is able to prepare and be informed and be supported in the many decisions that are needed along this most personal of journeys. That she is not isolated or fearful or judged. That she has a support network around her, and an advocate by her side.

And, if she’s Janet Jackson, that she can continue her journey to parenthood without the additional complications of the celebrity lens.

 

 

Me discussing this story with Helen Blaby on BBC Radio Northampton (23:50 in)

http://www.bbc.co.uk/programmes/p048d5yk

The buzz of opportunity…

For many years, I taught undergraduate students at the University of Nottingham and I LOVED Fresher’s Week. Of course there was always the element of nostalgia for my own student days at Leeds, a wonderful nostalgia that never seems to fade! Best stop there. But my re-discovered love of Freshers Week (or should I say ‘induction’) as a lecturer was about much more than nostalgia. There was just always such a buzz – of opportunity! – for friendships, for learning, for new ventures, and for a bright future.

I thought I had left the buzz of Freshers Week behind when I left the academic world for the third sector, joining NCT’s research team in 2014. But no! At the University of Worcester this week, we were joined by 140 new students embarking on their journey towards a Birth and Beyond Foundation Degree, leading to qualification as an antenatal teacher, breastfeeding counsellor or postnatal leader. And what a buzz it was!

Students travelled from all over the UK, from Aberdeen to the Isle of Wight to Wales. Some had trained with NCT previously, others had volunteered with NCT branches, and many more were completely new to NCT. A fantastic mix of personal, volunteering and professional backgrounds, bringing a rich mix of knowledge and experiences to the room. Tutor groups connected quickly and, within 24 hours, it felt more like a reunion than a first get together.

Chatting over coffee and lunch, it was inspiring to hear the stories that had brought these women to be here registering for a University education, and that had motivated them to work towards a role directly supporting new parents. Their enthusiasm and ambition was infectious and wonderfully uplifting.

I was lucky enough to have a spot on the packed induction timetable to talk about ‘NCT as an evidence-based organisation – what does this mean for you’. I talked very generally about how NCT uses evidence and why this is important. We discussed the plethora of conflicting and often unreliable sources of information which new parents are faced with. And we talked about evidence in its broadest sense – not only thinking about communicating risks and benefits of various decisions and options, but how these fit within ‘real life’. How personal, social and cultural circumstances influence our behaviours and decisions, and the importance of a person-centred and non-judgemental approach.

I also talked about the review, improvement and development of NCT’s services for parents. The importance of building on insight, listening and responding to feedback, being open to change, and understanding the outcomes and impact of what we do.

Just a flavour of why evidence (and context) matters. With ‘a little bit of knowledge, and a lot of social network’ just think what we can achieve.

‘Good luck and enjoy!’ to all of NCT’s new students – we are so pleased to have you as part of #ourNCTstory!