Over the next few months, the dedicated Pregnancy Outreach Workers Service (POWS) will be closing. POWS is to be consumed into Birmingham’s new Early Years Health and Wellbeing service, which is a partnership led by Birmingham Community Healthcare NHS Foundation Trust (BCHC), so our POWs will be transferring to new roles with BCHC’s partners Barnardo’s, Spurgeons Children’s Charity, St Paul’s Community Development Trust and Springfield Project.
But what about the gaps?
We’re pleased our POWs will be able to continue to make use of their extensive knowledge and specialist skills, and that Public Health has recognised that this group of vulnerable women exist and need support. But POWS will no longer be an identifiable service, and I’m worried this will leave gaps.
As yet, there is little information about how exactly mums and mums-to-be who are at risk will be looked after under the broader Early Years service.
Details of the new model of service often refer to “children and families,” but not to pregnant women specifically. Will pregnant women still receive dedicated support from an early stage of pregnancy? And when a child is taken into care, will the mother continue to receive direct, one-to-one support?
We have asked for reassurance, and have received some further comments from Commissioners, but the information is still sparse. In my opinion there is a potential for gaps here which could, over time, become problematic.
At the moment, POWS offers intervention from as soon as a woman knows she’s pregnant. Often, a POW will get involved at 14 or 16 weeks – sometimes as early as ten – and the earlier we get there, the more we can do. Once the POW receives the woman’s contact details, she’ll be in touch within 48 hours.
These early weeks, while the baby is in the initial stages of development, are always vital, but even more so when a woman has complex needs. Amongst many other things, POWs can help women stop drug use or smoking, ensure she’s eating (and eating the right things), identify suitable accommodation, and make sure she is engaging with midwifery services and attending appointments.
Commissioners have told us: “The health visitors within the new service will receive referrals from midwifery in line with need. Where the woman is vulnerable or has additional needs this will be before 26 weeks.”
The earliest time mentioned in the documentation we have seen is 20 weeks, more than halfway through pregnancy.
Dedicated time, responsiveness and intensity of support
The information we have about the new model talks about an initial visit, and then a second visit. We know this isn’t enough for women with complex needs. Much of a POWs’ work is unpredictable and can include a lot of one-to-one crisis management. For example: taking women to appointments, providing phone and text message support at any time, supporting homeless women to ring round the Housing department and hostels, helping women to remove themselves from domestic abuse and taking them to a safe place, and providing support during mental health crises, including out-of-hours chats and accompanying women to get support from the Community Psychiatric team.
When we raised this with Commissioners, we were told: “The new integrated service will be able to meet needs of the type you set out. There will be the integration with other services across the city ensuring that the service responds at the right time and in the right way, especially as you say in situations of homelessness and DV. The single cross service record will provide assurance on the services and level of engagement of an individual which will also assist the service in supporting women through their pregnancies.”
What we’re not clear about is who will be providing this support. We’re not clear if women will have the chance to build a one-to-one relationship with a support worker who can help her to navigate through services, provide a single point of contact with regular phonecalls/texts and visits, and provide moral support.
Child Protection Plans
The potential gap that troubles us the most is safeguarding. When a child is taken into care, who is there for mum?
Women with a safeguarding need make up about 20% (80-90) of the women POWS support annually, with about 50 of these needing intensive support – between half a day and a day a week. Where a woman is facing the removal of her baby, the POW is often pivotal: ensuring mum understands what is being said, and being on hand to make sure she takes the necessary action in relation to the Child Protection Plan.
But, again, we’re not sure who will provide this support in the new model.
Commissioners told us: “The provision of support to enable parents to develop the skills they need to parent well and the provision of step down services for those who are in the social care system are important elements of the new model.
“Within the new model no specific timeframes have been set for support to this group, it is our expectation that support is provided in line with need. This flexibility will help to build upon the approach currently operated within the POWS service.
“The new model is health visitor led with the health visitors identifying and brokering support for children and families in line with need.”
But will it provide intensive support for mum? I would really like to be reassured that women will get the continuity, trust and flexibility that they need in these circumstances.
I feel like Commissioners have given us the opportunity to have our say. I’ve filled in impact assessment forms with input from the POWs, and when I’ve raised my concerns I’ve been invited to say where the gaps are.
But I’m just not convinced we’re being listened to or understood. Although I’ve received responses, they feel flimsy. I don’t feel they’ve been detailed enough to provide me with reassurance, and this leaves me worried.
I really hope the new service will prove me wrong.