We know two things that are proven ingredients to a healthy pregnancy are early booking and continuity of care (that’s regularly seeing a midwife – and ideally the same midwife). The absence of either of these things is seen as a risk.
Women who have recently arrived in Birmingham, such as those seeking asylum, are far less likely to be able to book quickly, due to them not being able to navigate the system in a new country – so being a late booker makes continuity of care even more important.
But continuity of care during pregnancy is difficult when asylum seekers are moved around so often.
The UK Border Agency’s policy of “dispersal” spreads asylum seekers around the country on a “no choice” basis, often moving people many times.
As well as the medical risks for pregnant women, there are the social risks of being moved away from their support networks. This can be socially isolating, but can also have an impact on their ability to get to appointments and understand what they’re being told.
Winta – a refugee from Eritrea – had only been in Birmingham for six months, but this was long enough for her to have formed relationships and make friends. She had joined a local church and her 11-month-old daughter attended a nursery. Winta had a regular midwife and had been going to antenatal classes, where she’d met other mums-to-be.
She shared a house just north of the city centre with another woman, also an asylum seeker. However, just three weeks before Winta was due to give birth, her housing provider decided to shut the accommodation down and move the two women elsewhere.
Under the policy of dispersal, asylum seekers are accommodated wherever there is “a ready supply of housing”. In Winta’s case, she was told that she’d be moving to Wolverhampton – a place she didn’t know at all.
She would have to leave all the support networks she’d formed – and instead start from scratch, finding a new GP, new midwife, new antenatal clinic and new nursery for her 11-month-old, in a city where she knew no-one and struggled with the language, when the baby could come at any time.
“She was due to move on the Monday, but I only found out on the Friday,” says Winta’s Pregnancy Outreach Worker, Jacqui. “So I had to move fast. I phoned the Refugee Council and explained the situation: she was three weeks from her due date – could they help me to find a way for Winta to stay, at least until the baby was born? They said they would do what they could.
“I explained to the housing provider that we were appealing the decision but, initially, they insisted that the move would still go ahead. It was quite a battle to get them to wait for the process to complete. Meanwhile, the Refugee Council had phoned the UK Border Agency, to be told we’d have to appeal in writing. So the Refugee Council had to write a letter and fax it over to them. Once that was done, we just had to hope the UKBA would take it from there. It was a stressful weekend.”
Why did this happen?
A recent report from the Refugee Council concluded that “
the UK Border Agency’s dispersal policies are putting the health of pregnant women and their babies at risk. By moving them to accommodation around the county, women are uprooted from essential healthcare and their support networks, leaving them isolated and vulnerable.”
Guidelines introduced by the UKBA last year already stipulate that
pregnant women should not be dispersed within a protected period; normally from four weeks before the estimated date of delivery until four weeks after the birth. However, it doesn’t look like this is communicated in all circumstances.
Luckily for Winta, Jacqui’s intervention meant that the UKBA were able to act quickly enough to save her from a stressful move. The housing provider told her she could stay in the house until the baby arrived.
A few days after the baby was born, the housing provider told Winta that they still wanted to refurbish the house. But instead of moving her to Wolverhampton, they found her another shared house, just a couple of miles away. Winta now lives with another woman who has a baby – and has been able to keep in touch with the support network she already had.
“I’m so pleased for her – they get on brilliantly,” says Jacqui. “I’m glad she was able to get the continuous support she needed.”
The Dignity In Pregnancy campaign
The Refugee Council has produced a short film about the risks facing pregnant women in the asylum system in the UK: Dignity in Pregnancy for Asylum Seeking Women.
Last year, in a post called
Saving Money for Local Government and NHS, I wrote about how we need to use the assets we have.
And this became the basis of a project. From November 2012, supported by the Department of Health’s Social Enterprise Investment Fund we looked at finding revolutionary ways of putting patient voices directly in line with national outcomes, using the latest digital technology – and sharing that with other organisations across the country.
So what was the project trying to achieve?
Our original aim was to replicate the Pregnancy Outreach Workers Service (POWs) into another area.
The POW service, developed from scratch and now seven years old, is efficient and effective. It has a clear role, with defined protocols, safeguarding and training all well established.
So we started by looking for organisations like ours in other parts of the country. We began sharing, leading and learning with other people in the third sector. When organisations work together, we can be stronger and make a better offer.
Data and Outcomes
We don’t think “data” has to be boring! The illustrations dotted around this post, drawn by the talented
Alex Hughes from Drawnalism throughout our event in Leeds last week, are an example of data that is accessible and engaging.
Better data works well for everyone; it increases efficiency. You can hear from your patients directly. You can hear from services directly and make decisions based on concrete evidence.
So we’ve been developing tools that allow us to gather data directly from clients and other organisations, and measure it against national outcome frameworks in different and interesting ways.
Our POW service uses three main data tools:
Podnosh Uniqueref Database – collects quantitative, statistical data. This is our clients’ personal information, including names and address, and information on their issues and risks The
Podnosh Impact Assessment App – collects the qualitative data. Outreach workers, using their smart phones, collect views from clients. This data is directly from our clients, in their own words, including statements and happiness ratings. The Outcomes Database – pulls together the outcome frameworks relevant to the ‘Starting Well’ phase of Marmot’s Life Course, against which we plot outcome data from us and from other organisations.
(Some of the terms that organisations use are different to the terms used by government – for example, our POWs would call someone living in a hostel “homeless” but according to the government they’re “in temporary accommodation” – so alongside the Outcomes Database we created a Data Dictionary to help us to compare and measure more accurately.) The findings
As we’ve come to the end of the project, we’ve realised that the priority for other organisations is to create and share data on their existing services rather than to replicate others. So we’re going to build on that.
We’re setting up an online forum to get the conversation going and we’ll be inviting providers and commissioners to join us in sharing and finding new ways to work.
Last week we ran an event in Leeds called
Measuring Outcomes – Producing Evidence – Demonstrating Outcomes to share our findings.
Here are the slides from the three presentations:
People who were not at the event were able to follow it on Twitter using the hashtag #mopedi.
View the tweets on Storify
View all the illustrations from Alex Hughes
The media has been full of people talking about how they
could live on £53 a week recently but, even if someone takes up the challenge, it will not prove a thing.
If anything, it will camouflage the reality of living in poverty and hardship.
Many people think that it’s possible to live on £53 a week. Those people generally don’t have to – but they are right, it is physically possible. After heating, lighting, phone and a few bus journeys there may be about £12 a week left for food – and, yes, with careful buying and home cooking it could be done, although there would be no cleaning or washing of clothes or people.
But all of this misses the point.
by Kate Hiscock
The message seems to be: if you live off the state then you have to live a joyless existence. And £53 a week, every week, is certainly joyless.
The real point, and the point the government seems to be trying to make, is: if you want nice things (or even just things) then you must earn your own money. This is where the stunt of living on £53 a week, a stunt that Iain Duncan Smith or others will inevitably pull, will camouflage the real issues.
Most people who can’t make ends meet, who struggle to feed their families first and themselves second, who are the most punished by these reforms, aspire to better things. The politicians who insinuate that people don’t want to work, and therefore deserve all they get, can never emulate the lives of real people in poverty.
In these times getting a job is not easy. Many more people are out of work and competition for work is high. To secure a job, you need – at the very least -:
A network of supportive friends and peers
Work experience opportunities
Experience of different places and people
Self-belief and confidence
Financial help at key times
The majority of the population (and almost certainly Iain Duncan Smith) have had most of these in their lives.
And the point is, if you have them, not only could you live on £53 a week, you could lift yourself out of poverty, get a job and reduce your benefit dependency.
But without them? Well, Iain Duncan Smith will never know.
We are running an event this month to share some of the exciting work we have been doing using technology to measure our impact. This has led to the development of some new and inspiring tools that help social enteprises and commissioners understand the needs of the local population.
Date: 24th April 2013
Place: Leeds Church Institute, LS1 6DG, Leeds
Time : 9.30am- 1.00pm
Click here to find out more and register for the event
As the gap between the rich and the poor grows wider, and as cuts to public services threaten to reduce the support available for our most vulnerable families, we have to target services where they are most effective.
Gateway Family Services are a Community Interest Company who have been providing family support services for many years. Like most organisations, we know the changes that people can make if they have the right support.
Recently we have been working with The Department of Health via The Social Investment Business to investigate how to replicate good projects that achieve real change for vulnerable families. A significant part of that work has been spent looking at how we measure outcomes, produce evidence and demonstrate the impact of our work.
In doing so we hope to help:
commissioners to understand what works and what the outcomes are from the services they commission, and
providers to receive feedback from people who use their services, to create evidence of the value of their work
We have been working with digital technology developers to create some new and exciting tools that:
Capture how organisations are supporting people
Listen to, and analyse people’s experiences
Align with multiple outcome frameworks
Our event will be an opportunity to hear about this work and to have an early look at the tools being developed.
Vicki Fitzgerald – Chief Executive – Gateway Family Services
Stephanie Futter-Orel – General Manager – Latin American Women’s Aid
Sarah Cowling – Chief Executive – HealthWORKS Newcastle
Simon Whitehouse – Digital Developer
There is a lot less money around at the moment, so what little there is needs to be spent wisely. One of the easiest options is to make cuts to preventative services for people who aren’t in the system… yet.
This may be a quick win for the government, but they’re in danger of leaving a much bigger hole than anyone seems to realise. Cuts to support services may provide a small saving in the short term but, long term, the figures just don’t add up.
Take one of Gateway’s recent clients. Sarah* was referred to Gateway when she became pregnant. Given her troubled background, and the lifestyle that she was leading at the time, it was expected that her new baby would have to be taken into care.
For nine months, during and after her pregnancy, a Pregnancy Outreach Worker helped Sarah to access help from a variety of sources. Homeless, with one child already in care, Sarah needed practical and emotional support. Her POW listened without judging, made it easier for her to attend her appointments, and helped her understand what was happening at case conferences.
We helped Sarah apply for crisis loans to get her through the pregnancy and first few months after the birth. She underwent anger management counselling and drug counselling. We helped her to find local authority housing.
Eventually, after a lot of hard work by both Sarah and her POW, she was able to show that she could provide stability and proper care for her own child. And so, when the baby was born, social services came to the decision that mother and baby would be better off staying together.
I’m not telling you this story in the hope of warming your heart. I’m telling you because:
The approximate cost of taking a child into care for 9 months is £28,000
The approximate cost of the combined preventative services that Sarah accessed over 9 months is £6,000
Preventative services have saved our economy over £20,000. And that’s just for one child.
This theory works across all services, not just for Gateway POWs. Fall prevention, for example – everything from installing grab rails to making little lifestyle changes so that someone uses the stairs less – minimises the chance of someone having a fall. The estimated cost for the first time a person falls is about £40,000, but that £40,000 could pay for fall prevention staff to go into around 200 homes. Yes, that’s £40,000 per person vs £200 per person.
Often there is a perception of voluntary/third sector organisations as “do-gooders”, but we’re not just in this to be nice. Of course there is a moral, emotional, argument that says “people need to be helped”, but there’s also a compelling economic argument: people who are better supported, who are cared-for
before their issues escalate into crises, simply don’t cost as much.
*names have been changed
Sources for figures:
Average cost of child in foster care: The Schools and Families Committee – 2008/9. £774 per week, so 9 months = £27,864. Costs of support services are estimated; based on Gateway FS’s POWs service, which is costed at £20 per hour. First falls costs: Birmingham Local Authority Strategic Shift to Prevention 2012.
Photo: Kriss Szkurlatowski, 12frames.eu
The last few weeks have seen Gateway staff go into overdrive collecting food and other essentials for our food banks. We’ve been overwhelmed by the generosity of our donors, including many of our partner organisations, like Narthex, Healthy Minds and Birmingham Registry Office, as well as our own staff and members of the public.
In the video below you can see how Gateway staff used many of the donations to put together personalised Christmas hampers for their clients. We also hear from Shanaz, with her new baby, talking about what the donations mean for her.
The hampers include food, but also essentials such as toiletries, nappies and baby clothes; and some small wrapped gifts, so that older children have something to open on Christmas day.
The arrival of a baby should be an exciting time and something to celebrate, but financial issues can make it a time of worry. For families below the breadline, having a baby puts a immediate pressure on already unmanageable finances, so we want to do what we can to ease these concerns. Whether the situation is short term or not, a one-off parcel like this provides food and other essential items to bridge a gap.
“Equality of opportunity” doesn’t just refer to having enough money or food; we think everyone has the right to be happy, too. We hope that by providing some practical help, along with the emotional support that our Pregnancy Outreach Workers already offer, we can take away some of the stress and give families the chance to enjoy bonding with baby.
Pregnancy Outreach Workers have been supporting women for many years. Over this time they have supported them with all sorts of problems. The key thing is that they are able to listen to what the real barriers are, help to overcome them and stay with them throughout – that is why the service is really led by the pregnant women themselves. We asked some of the women to share their experiences with us – their lives are complex and difficult and it’s important to hear another perspective.
I wrote about my involvement with Birmingham’s social inclusion process. As part of this process, I have been asked to comment on how Birmingham welcomes – or not – asylum seekers.
The way that Birmingham deals with new arrivals is covered in the section of the Green Paper titled:
2.3 Develop welcome centres and do more to support new arrivals in the city. But are welcome centres really the answer?
Tsighe is a refugee from Eritrea who struggled to know what to do or how to get help when she got here.
There are several main issues that these people struggle with when they arrive in Birmingham.
Language is the most obvious problem, and it’s one that impacts on all aspects of life for a new arrival.
In a city where over 180 languages are spoken, we have a good supply of interpreting services, but the ones Gateway get asked for the most are from the less well-established communities: Pushto, Arabic and Farsi.
In our view, this is one the biggest causes of inequality. Not having access to an interpreter can mean people don’t get registered at doctors or schools, or access other vital support services.
many of the people who use our service are leaving behind significant trauma. However, accessing mental health services in a country where you don’t speak the language is almost impossible.
Often, newly arrived people are sent to ESOL (English for Speakers of Other Languages) courses, but we have found that this is often too advanced – and people need to overcome their lack of confidence to get to any kind of course anyway.
Poverty is a key issue, and the one that probably makes families most vulnerable. Parents may have difficulty providing food, clothing and basic equipment for their families. Those with medical needs may have to walk miles to appointments as they have no money for transport. The women we work with are particularly vulnerable to exploitation by landlords and others.
While new arrivals wait for their status to be decided, many don’t have access to
public funds – meaning that their most basic needs aren’t even met - so there is an increasing need for food banks and other charitable support.
So how can Birmingham make life better for new arrivals?
At Gateway we first deal with the short term basics – shelter, food, warmth and safety – and then our support goes much further, for longer. We help by giving practical support to function independently, and motivation to stick with it – all the things a well-informed best friend or family member would do. And this is what Birmingham should be aiming to do as a city. To help new arrivals learn the language, become employable, to support their own family and to belong to their city.
We also know that connecting newly arrived communities with each other is really important. Training people to support their own communities means that they will have significant understanding of the issues future new arrivals have to overcome.
Health, Housing and Employment policy-makers need to listen to some of the issues people face when they move here BEFORE they decide the solution. Welcome centres are certainly one option, but we must be wary of creating more bureaucracy. I strongly feel that this is one policy that should be led by the people who work and live with the real issues. Those who experience daily the barriers to integrating and settling in a new city, country, culture and community. I urge Birmingham to allow this to happen – and to trust the people who really do know best.
Click here to download the Giving Hope Changing Lives Green Paper
Managing Type 2 Diabetes is closely linked with managing lifestyle. Helping people to lose weight and become active in Birmingham is one of the ways the Health Trainer service works with patients. It can’t be achieved overnight, but with commitment and support patients can live happy and active lives, even with a long term condition. Here Joy tells us how she has worked with Kieran Mckenzie on of our Health Trainers.
We are so impressed with Joy and Keiran (our Health Trainer) who have worked so hard and have made such a difference. Over 12 weeks Joy has lost an amazing two and a half stone and has the lowest blood pressure she has ever had.
Valerie was referred to us because she was unemployed and struggling to find work because of her disability. She had chronic back pain and was taking regular painkilling medication to manager her condition.
She was finding it hard to think about anything but her back pain and looking for work seemed a distant dream.
She was also overweight which was contributing to the problem. Her Physio suggested that she may get on well with a Health Trainer, so she was referred. Now eight months on, after lots of hard work and dedication from both Valerie and her Health Trainer Sean she’s almost two stone lighter. Better still the pain has gone and there’s no need for all those tablets!
Sean puts her weight loss down to a number of things. He helped her focus on making changes to her diet. For example she never ate fruit, but now she’s eating a piece of fruit instead of an unhealthy snack. She’s also taken advantage of the Lighten Up programme and has accessed 12 weeks of free group sessions.
We have never seen a more delighted client – It is worth watching the long version (3 and half minutes of infectious happiness)
Valerie longer version