Friday, January 11, 2013

Women's Views on News

Women's Views on News

New mothers to rate maternity care

Posted: 10 Jan 2013 09:55 AM PST

The idea is that hospitals really listen to what women say.

The government wants feedback on the services new mothers receive throughout their pregnancy and after giving birth in order to flag up failing areas and to highlight satisfaction so that women can make more informed choices.

It is estimated that 700,000 women give birth in England each year.

The survey is intended to be a more detailed version of the ‘friends and family test‘ which is being introduced into A&E departments in April this year.

Health minister Dr Daniel Poulter, who still works part time as a consultant obstetrician, told The Observer: "The idea is that hospitals really listen to what women say.

“If the feedback says that local women wouldn’t recommend it as a place to give birth and that there are concerns about that unit, then that’s a very strong lever to encourage or force improvements in care.”

The Royal College of Midwives (RCM) is helping to devise the questions with the Department of Health and the new NHS Commissioning Board, which will run the health service from April.

Louise Silverton, RCM director for midwifery, welcomed the tests, saying: "It will lead to women choosing maternity units where they believe they will get high-quality maternity care or go for a home birth or to a midwife-led unit, if these are rated positively by other women.

“Peer-led information is just as important and significant as evidence-based research."

The friends and family test has been based on Net Promoter Score (NPS) which some of the most successful companies, such as Apple, have used in recent years to test customer satisfaction.

It asks how likely a customer is to recommend their service to family and friends.

However the Royal College of Nursing, representing the nursing profession, is critical of the NPS test in general.

In a factsheet it says: "The validity of both the process and the actual questions are both contested, even in retailing.

“In relation to healthcare it is difficult to assign any single motive or rationale to an individual’s choice, and so beyond the simplistic interpretation of an individual being satisfied with their care, it is hard to give any further meaning about how their response is associated with anything related to the actual provision of safe, high-quality healthcare."

Academics from the Kings Fund also ask if this type of survey will result in hospitals raising their game.

They said: "In health care the NPS is controversial. Some people say that it will not work because most patients do not actually choose where they are treated.

“Others say that it will not work because support for the NHS is generally so high that it will not have the sensitivity it has in commerce.

“Some clinicians have expressed concern about what a patient might say after undergoing a necessary procedure or treatment that is distressing or uncomfortable."

Cosmetic surgery industry under review

Posted: 10 Jan 2013 04:00 AM PST

Everyone who decides to have cosmetic surgery should have time to think about the risks.

A government review has called for tighter regulations for the cosmetic surgery industry.

Commissioned by then-Health Secretary Andrew Lansley in August 2012, it is thought that a stricter control of surgical procedures and a ban on cheap sales and marketing techniques will be made into law.

A request for the report was made following the PIP scandal last year when it was found that around 47,000 women had unknowingly received faulty breast implants.

The review was headed by the NHS’s medical director, Sir Bruce Keogh.

He found that very few control barriers currently existed to prevent cosmetic surgery companies from exploiting and pressuring potential customers into ‘limited-time only’ sales deals.

“It’s not always acknowledged that people undergoing cosmetic interventions are not only consumers but also patients,” Keogh said.

Such patients had a tendency to be lured in by offers, resulting in them making hasty and unconsidered decisions to go ahead with high-risk surgical procedures.

“They are taking decisions about medical procedures that can have a profound impact on their health.

“The supply and demand for procedures has outgrown the existing legislation,” he said.

Vivienne Parry, committee member of the review added, “Aggressive marketing techniques are often used to maximise profit.

“This may be the right approach for selling double glazing but not for people having or considering whether to have surgery.”

“Everyone who decides to have cosmetic surgery should have time to think about the risks. Time limited deals and offers on voucher websites pressure people to make snap decisions.”

Rajiv Grover, president of the British Association of Aesthetic Plastic Surgeons (BAAPS), welcomed the results of Keogh’s review.

“We have made the comparison between cosmetic surgery being sold as a commodity, much as a washing machine or off-the-shelf beauty products, many times before,” he said.

“Medical procedures simply cannot continue to be promoted in this manner and although it is tragic that it has taken a crisis of the magnitude of PIP to make the world sit up and take notice, it seems we’re finally making headway towards a safer environment for patients.”

“It’s time to scrub up and take action to restore confidence in our sector,” he added.

Current Health Minister, Lord Howe also commented on the report findings, saying, “It has been a worrying year for women affected by the PiP scare.”

"It has been our number one priority since this issue came to light 12 months ago to make sure women have been kept well informed and received the appropriate clinical advice and care.”

It is thought that bans on manipulative sales techniques from nurses and surgeons, voucher offers and free consultations are just some of the mechanisms needed to prevent instances such as PIP from reoccurring.

"We can't stop someone in another country committing a crime – as happened in this [PIP] case,” Lord Howe added, “but we can make sure that people are properly supported and that they get all the information they need before deciding to have cosmetic surgery."

Sarah Ditum, writing in the Guardian, added that Keogh’s review brought to light how much the cosmetic surgery industry needed to reassess its motives in order to regain a sense of respectability and trust from the public.

“The cosmetic surgery industry is based on telling women (and increasingly men, though they’re still in the minority of patients) that they could have better, happier lives if only they’d make themselves look a bit more perfect,” she said.

“As an individual decision, everyone has the right to do as they wish with their own body within reasonable protections; as the basis for an industry, with advertising designed to show up your flaws and credit agreements to help you pay for their remedy, it’s repugnant.”

The final report and Keogh’s recommendations are expected in March 2013.

Call for equal access to contraception

Posted: 10 Jan 2013 02:31 AM PST

Greater provision of contraceptive services needed for women over 25.

An inquiry established to investigate how best to tackle the UK’s high level of unplanned pregnancy has recommended that  the government should overhaul existing contraceptive services, especially for the over 25s, and implement compulsory sex and relationship education from primary school on.

Labour’s National Teenage Pregnancy Strategy reduced the teenage pregnancy rate by 20 per cent from 1999-2010.

Nonetheless, the UK still has the highest rate of unplanned pregnancy in Western Europe.

The abortion rate in the UK has remained relatively static, although there has been a 10 per cent increase in 30-34 year-olds seeking abortions over the last ten years, and over the same time period the rate of repeat abortions has also risen from 31 per cent to 36 per cent.

And when a woman’s fundamental right to comprehensive information on the contraceptive choices available to her is either compromised or inadequate, then abortion does become a necessary last resort.

A key finding of the report is that nearly a third of women of reproductive age are without this fundamental right.

Long-acting reversible contraception (LARC), such as intra-uterine devices (IUDs), subdermal implants and injectables, offer diverse benefits. One major one is that they do not have to be taken daily like the pill.

They are, however, largely neglected as forms of contraception because women have concerns about efficacy and remain unaware of the benefits.

Such concerns, the report points out, should be being addressed by health professionals, so that women can retain bodily autonomy and assess the risks and benefits for themselves.

‘Full contraceptive advice,’ it says, ‘needs to ensure that the greatest number of women continue using contraception that they feel is best suited to them and that they have had the freedom to be able to make a well informed choice from a variety of contraceptive methods available to them.’

It continues, ‘the notion that there is an objective “perfect” contraceptive does not make sense; a contraceptive may only be perfect from the subjective point of view of the individual women concerned.’

Incredibly, there is no national register of healthcare professionals trained to fit each LARC, and commissioners are unable to assess whether local needs are being met.

Indeed, an investigation by the Advisory Group on Contraception found that two-thirds of Primary Care Trusts could not provide information about the number of trained practitioners able to fit IUDs or subdermal implants they employed.

If this is indicative of the healthcare resources, or lack thereof, available, is it any wonder that women are not using LARCs?

For this reason, a key recommendation by the inquiry is that new national guidelines must be issued to ensure that the provision of contraceptive services around the country is equally accessible and equally comprehensive.

While the MPs concluded that existing contraceptive services need improvement, the report also highlights that access to these meagre services is currently problematic for women over 25.

A key component of the National Teenage Pregnancy Strategy was for local areas to provide ‘a well-publicised contraceptive and sexual health advice service which is centred on young people.’

A consequence, however, of sexual health services targeted on under 25s, is that those in the older age bracket have found themselves excluded from locally operated services.

Indeed, for many women aged over 25, the only way to obtain contraception is to make an appointment with their GP, yet work commitments and childcare issues can often make it difficult to attend in regular surgery hours.

For this reason, the report calls for wider provision of contraceptive services, including making them available in the workplace.

It is also important not to forget that unplanned pregnancies are often interrelated with other issues, such mental health, addiction, and sexual violence.

A ‘combined approach’ is needed, the report suggests, bringing sexual health services together with facilities that come into contact with women experiencing these kinds of difficulties.

And an aspect that is often forgotten in inquiries of this nature, however, is the role that men have to play in unplanned pregnancy.

Perhaps because this cross-party inquiry was led by three female MPs, Amber Rudd, Sandra Osborne, and Lorely Burt, the report challenges the laissez faire attitude of some men and encourages the government to make them more ‘responsible actors’.

This particular recommendation may be easier said than done.

You can read the full report ‘The Morning After: A Cross Party Inquiry into Unplanned Pregnancy’ here.