I first met Annie Francis many years ago....and realised almost immediately that she was a woman of incredible substance: a wonderful midwife who was passionate about her work, about childbearing women having the best care possible, and who was willing to stand up for what she believed in. Since then, Annie and I have shared the same spaces, striving to maximise opportunities for all women to have a positive birth experience. Recently Annie invited me to become part of her exciting new venture, and of course I accepted. What an honour. I asked Annie if she would write a guest post for my blog, explaining more about this exciting news, and to tell us a little more about and her plans for the future.
Hi Annie! Thank you so much for agreeing to write this post, when I know how incredibly busy you are. Can you tell me a little bit more about Neighbourhood Midwives (NM), and about the new Mother's Fund?
'Hi Sheena....I'll try! I've never done this before, so here goes....
Here at NM we have a simple organisational purpose:….to become an exemplar of a way of delivering midwifery care.
For every decision we make and every action we undertake we ask the question… does this serve our purpose? It is an incredibly powerful way of ensuring that we remain focused on our goal, but also helps when discussing difficult issues - it’s easier to have honest and open conversations when you can keep the shared vision in mind. This week has seen the four of us - all midwives ourselves - who set up Neighbourhood Midwives make a real and significant shift in our understanding of the practical ‘how’ we try and make our purpose and our vision a lived reality.
It has come about through our reading of a book – ‘Reinventing Organisations’ by Frederic Laloux and the case study of Buurtzorg, (which means neighbourhood care), a self managing, Dutch nursing organisation based in the community. Everything we have read about Buurtzorg has chimed with what we are trying to achieve with NM and so, as advocates of active learning, we wasted no time in getting in touch with Jos de Blok the founder, to see if we could go over to meet him and the result is a ferry booked and a trip planned for mid April…'
This sounds really interesting! I am in Holland at the moment, and will make some enquiries. Annie, what would you say to those who suggest that NM is another example of the privatisation of the NHS?
'Firstly, it is important to remember that the NHS has always used private contractors. GPs, dentists, pharmacists and opticians are almost all privately owned. There have always been private providers of various services in mental health. The private sector is involved throughout the NHS providing IT systems, drugs, buildings etc. Most Foundation Trusts use the income from private services to subsidise their NHS work so it is a much more complex picture than is often portrayed.
One anxiety often expressed is about private profit going to the shareholders but as an employee owned, social enterprise, any surplus made within Neighbourhood Midwives will not be siphoned off as dividends for external shareholders, but reinvested into the organisation to improve our service and the welfare of our employees. Our constitution has been written to reflect this position and, should we ever be faced with a hostile takeover, we also have it written into our Articles that any profit from that forced sale would go to a suitable women's charity, not to any individual.
As independent businesses, GPs have a contract with the NHS to supply their services - we would be no different and would be paid the current tarrif for maternity care, no more and no less - just as any other provider giving care under the NHS banner.
The third sector - social enterprises, co-operatives and charities have always had an important role in providing services to the NHS and there are some important benefits attached - smaller, lean and flexible they can more easily target 'hard to reach' groups and can in fact often provide care much more effectively and efficiently than a large and unwieldy bureaucratised system. They have an important role in increasing choice for women/ patients and breaking up the monopoly which can lead to lack of innovation and complacency on the part of the sole provider.
With the correct safeguards in place, my belief is that increased third sector involvement from small, community based providers such as NM can only be a good thing and, with the emphasis on improving outcomes as well as needing to save money, it is time to give us the opportunity to demonstrate what we can do'.
Thanks for clarifying. Would you like to tell us a little about your new initiative?
'Yes! Last week we had the first meeting of the fabulous trustees of our new charity – the Neighbourhood Midwives’ Mothers Fund. The reason we have taken the decision to start a charity is simple, it helps us meet our purpose. Having successfully launched our private service in July 2013 we have been busy building our track record as the first step towards being ultimately commissioned by the NHS. We know that isn’t going to happen overnight though and, through the Maternal Health Alliance’ campaign, Everyones’ Business, we are increasingly aware of the critical lack of perinatal mental health provision in the UK.
Even where this service is provided, the reality is that most areas are unable to offer it through a caseloading and continuity of midwife model. As a social enterprise, always looking to fulfil our social aims and knowing that there is considerable evidence that this type of care can make the difference for women struggling with such issues, we have come up with an additional step along the road to our first NHS contract – to register as a charity, called the Neighbourhood Midwives’ Mothers Fund.
We envisage that it will work in a similar way to the Macmillan & Marie Curie model but with a dedicated midwife providing individualised, holistic midwifery care for each woman referred, who can also act as her advocate and co-ordinate her care with the appropriate NHS/multi-disciplinary teams according to individual need… We are really excited by the possibilities and now we get to have lots of fun doing the fundraising!
So far we have three Trustees, selected for their expertise and dedication to to the cause. These are Cathy Stoddart, Emma Mortoo, and you Sheena!'
Thank you again Annie, what a privilege this is for me. I'm excited to get going now, and to help you to support families most in need. For me, I think this could be a blueprint for other areas, and a catalyst for change for the whole country and beyond.
Lastly Annie, I believe you have been selected to be part of the national maternity review team, brought together by NHS England!
'Yes, I was delighted and honoured to received an invitation to be on the panel. We were already aware that the Five Year Forward View has some very helpful comments about future models of care in maternity:
'To ensure maternity services develop in a safe, responsive and efficient manner, in addition to other actions underway – including increasing midwife numbers - we will:
· Commission a review of future models for maternity units, to report by next summer, which will make recommendations on how best to sustain and develop maternity units across the NHS.
· Ensure that tariff-based NHS funding supports the choices women make, rather than constraining them.
· As a result, make it easier for groups of midwives to set up their own NHS-funded midwifery service.
And so, with the indefatigible Baroness Cumberlege at the helm, I’m really looking forward to contributing my thoughts, knowledge and experience to help make this review a genuine opportunity to explore some new options and different ways of working… the evidence is out there, we just need to be prepared to think outside of the box and, in the words of Goethe:
I am delighted that you are part of the panel Annie, and I know my friends and colleagues are too. We want this review to be the lever for change to enable improvements in the way we deliver maternity services in England, and beyond. Please let us know how we can help you!
There are several ways to connect with Annie, and Neighbourhood Midwives: