- Out of the 578 women we were supporting last year 197 had given birth by the end of March.  This is the data set used.

- Ward figures are taken from the Birmingham Health Inequalities Action Plan 2012, Birmingham.

- “Birmingham” is an average of the rates achieved in Birmingham’s three former PCT areas.

– West Midlands figures are taken from Initiation, Uptake and Sustainability of Breastfeeding,  West Midlands Public Health Legacy Series, 2012,  Dept of Health.

- National figures are taken from the Infant Feeding Survey, 2010.

Why does POW support make a difference?

We think there are a number of reasons that support from a Pregnancy Outreach Worker results in an increased likelihood of a woman breastfeeding.

1. Practical advice and training before the birth

   Unlike other services, POWs support most of their clients for the best part of a year. It means that they have plenty of time pre-natally to talk about breastfeeding and, where necessary, persuade mum to give it a try.

   All our POWs are UNICEF Baby Friendly Initiative trained, so they can put on impromptu one-to-one or group training as required.  As they build relationships with their clients, they try and make sure that everything’s in place for the mother to be comfortable with the practicalities of breastfeeding well before she gives birth.

2. The POW can be there immediately after the birth, even in the hospital

   Pregnancy Outreach Worker Sylvia says, “if they don’t try and breastfeed in the hospital, straight away, it’s much more difficult to start”. Caroline, who works with teenage mums, agrees: “We try and do as much preparatory stuff as we can before the birth – because it all gets so much harder afterwards.”

   The POWs know when their clients’ babies are due, so they check in regularly with them around the time. They aim to speak to them as soon as possible after the baby arrives, so they are there to answer questions. Many go to visit while mum is still in hospital and frequently, whilst there, they will give practical breastfeeding support.

   Once mum and baby are home, POWs can continue to give practical, hands on advice. They’ve already built up a relationship with the mother, which makes it much easier to offer this kind of help. They can also also provide lots of advice over the phone and often do this out of hours.

3. Introducing clients to more support networks

   The ideal circumstances for a mother to breastfeed include the feeling that she has plenty of support from likeminded people. So POWs always  try and introduce their clients to the various networks and groups that are available to new parents – often taking them along to clinics themselves.

   Sharon, a POW, recently took a client to the Women’s Hospital breastfeeding workshop. Sharon says “It’s a good network to be part of – very informative and very pro-breastfeeding. At the drop-in clinic they can meet the breastfeeding co-ordinators and other mums for practical advice, and talk about their fears as well as the pros and cons of breastfeeding. They get the contact numbers of counsellors to phone for support. It gives them some structure as well as social support.”

This week is Volunteers’ Week, an annual campaign that celebrates the contributions of volunteers all over the UK. This year’s Volunteers’ Week focuses on saying ‘Thank You’ to the millions of volunteers who regularly contribute to society.

So what better excuse for us to say thank you to our brilliant Gateway volunteers.

Our volunteers are all befrienders. They take time out of their own lives to help people who need a bit of extra support in theirs.

At Gateway, clients are referred to our befrienders programme by the Support Staff working on our other services, as well as partner organisations and GPs. Clients are carefully matched with volunteers based on interests and relevant experience along with practical considerations like where they live and their availability.

Rose had been a client of Gateway’s Pregnancy Outreach Workers service, but when her POW finished in April, Rose needed a bit more help. A French speaker with few friends and family around her, she said at the time:

“I am alone in this country. I do not speak English and I need support like having someone to go out with me or to talk to.”

So Gateway matched Rose with a volunteer befriender – Judith, who also speaks French.

Rose’s feedback is full of thanks for the help that Judith gave her with the sort of everyday things that people take for granted – things like:

“You helped me to open my bank account. I didn’t know how to do it. I do not have worries any more.”

and

“You helped me with the bus. I’ll be able to go out without worrying too much now that I have that map.”

As the Volunteers’ Week website says: “Every year, millions of people help others in all sorts of ways, most of which they probably wouldn’t even think of as volunteering. This makes a crucial contribution to binding our communities, building cooperation and trust between individuals, and helping to make our communities better places to live and work.”

This type of support is invaluable. So – thank you, Judith, and thank you to all the volunteers who give their time for others.

Of course, we have our own annual event coming up at the end of June where we hope to be able to say “thank you” in style – our annual Gateway Gala. This year’s event will be a garden party, where we will celebrate the achievements of not just our volunteers but all of our staff and clients.

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’s story

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.

Derek’s story

Derek was referred to a Health Trainer by his GP seven months ago to get some help to lose weight.

“I wasn’t sure what to expect,” he says, “but Wayne was really good. Within an hour I had found out the best way forward with my eating habits.”

The main change for Derek was to start eating regular meals and getting into a routine that included breakfast, lunch and an evening meal. He cut out snacks and fizzy drinks and started including more fruit and vegetables in his meals.

“I lost 6 stone,” says Derek. “I’m a driving instructor and my seat was that far back, no-one could sit behind me. Now they can. I’m a big man, so this makes a huge difference to me.”

And it’s clear he’s happy with his new lifestyle.

“People stop me and say ‘are you on a diet?’ but I say ‘no, I’m healthy eating’. It’s nice for me – it gives me confidence and I feel really good at losing the weight.”

Gemma’s story

For Gemma, it was a question of motivation. She joined Slimming World at the end of November last year but, thanks to her Health Trainer, she’s kept at it.

In her final statement she said, “I can’t believe it! I joined Slimming World and lost 25 pounds in weight.”

Again, the benefits of the changes she’s made are obvious.

“I feel good – I was a size 20 and now I’m a 16,” she says. “My joints don’t ache half as much, I’ve got more energy and I’ve reduced my risk of long term health problems such as diabetes and heart disease.

“I have to say a big thank you to my health trainer, who has been amazing throughout. When I had a tough time, he was the one motivating me.”

So how can Gateway’s Pregnancy Outreach Workers Service help people to break this cycle?

Admitting that you need help is a really positive step, but you have to be prepared to work towards the life you want, too. So our POWs are trained not just to give practical advice, but to help women take control of their own lives in order to move forward.

Saira’s story

Saira was referred to the POW service by her midwife. She and her husband were living in a flat above a shop after having to move out of a shared house. But the flat was full of mice and cockroaches and its only access was via slippery fire escape steps.

Saira was clearly suffering from depression and low self esteem. In a recording made by her POW, Maria, it’s clear she didn’t believe she had any control over her situation. She says: “I’m pregnant; I have no family support. I don’t know what’s going to happen right now. It’s dangerous living here, but what can I do?” In a quiet voice, she asks, “Is there anyone out there who can help me?”

During Maria’s first visit, she explained to the couple how they would need to work together to sort things out. “I took them aside separately and said ‘we all need to work at this, and you will need a lot of patience, because it’s going to take time’,” Maria says. “No-one has a magic wand.”

Like many clients, Saira says she liked Maria because she felt that she wasn’t judging her. Maria’s help was practical and without prejudice.

“On the first visit, I phoned around and we started to apply for the various things that they were entitled to and needed to sort out,” Maria says. “For example, Saira had put off applying for income support because she thought it would affect her partner’s finances, so we worked that out, and got him to apply for working tax credit.”

But, as they unravelled some of the financial issues, Maria was also working towards raising Saira’s self-esteem.

For example, Saira was so self-conscious that she didn’t want to go to antenatal classes. She said she felt fat and didn’t want people to see her. Maria’s approach was to try and make her feel better about her body image in other ways. “I asked her to send me photos of herself on the days that I didn’t visit her – just for my benefit, so I could she she was OK,” she explains. “In the first few photos she sent, she’s looking down at the floor, but after a few weeks she’s smiling and looking into the camera. She’s starting to feel better about herself; she doesn’t mind the idea so much.”

They talked about the future. “I asked her to think about what she wants to achieve in life,” says Maria. “It’s something that many women forget to think about when so much else is going on. She told me lots of things, but I helped her to see that what it boils down to is taking more control. So we talked about that. I got her to realise that she is already very powerful – after all, she had carried a baby! – and we discussed how she must make sure to retain that feeling of power when she deals with everyday situations.”

Since Maria’s first visit, which was almost six months ago, Saira’s depression has started to lift. Now that they have split the practical issues into more manageable chunks, she is finding the confidence to ask for help with the things she needs. She asked a friend to help with the deposit on a better home – something she hadn’t wanted to do before. She’s making phonecalls herself. She takes her baby out and about to clubs and support groups and is even talking about going back to work.

“She doesn’t wait for permission as much as she used to,” Maria says; “she speaks out a bit more. And she’s gone from feeling tired, exhausted – and even threatened, worrying that her baby will be taken away – to realising that she is a good mom.”

In this audio clip, you can hear how Saira’s language has changed from where she was at the start. Rather than hoping that someone will step in, she talks about specific issues and sounds far more active. There’s still a lot to sort out, but she’s in control and – with support – she’s prepared to work for it.

listen to ‘Gateway Family Services: Saira’ on Audioboo

This year’s run will be on Saturday 20th July in Cannon Hill Park.

It’s a 5km course (that’s just over three miles) and everybody’s welcome, whatever your ability. You don’t even have to be able to run the course – you can walk it if you like.

Following the success of last year’s run, when around 70 people took part, we decided to make it an annual event. There were runners, walkers and even mums with buggies! Most people were linked to Gateway in some way – lots were current or past clients of our Health Trainer or Lighten Up services – but some were people who had just seen the adverts and turned up on the day.

The Gateway Fun Run is part of our ongoing work to provide a variety of easy and accessible ways to get active. This is just one option but this gives people the opportunity to do something as a group knowing they’ll draw support from each other.

Last year, Joan was the oldest participant at 80. Following a serious illness, she’d been working with one of our Health Trainers – and increasing her walking was something they’d been doing together. So they suggested she come along and take part, which she did as part of her recuperation. Joan said: “the best thing about today has been walking in company and, of course, the sense of achievement at the end”.

Charlene also took part. She came along with her slimming group, many of whom had signed up through the Lighten Up weight management scheme. She too had health issues, so decided to walk – but was delighted with herself for completing and said: “Coming here today has given me the boost to get out there and do more walking”.

Watch Charlene’s video:
www.youtube.com/watch?v=n0Cdvsa1wcU

If you’re looking for a way to get more active and you want some motivation, a fun run is a great thing to aim for.

As NHS Choices explains:

Running is free, you can do it anywhere, and it burns more calories than any other mainstream exercise. Regular running and walking can reduce your risk of chronic illnesses, such as heart disease, type 2 diabetes and stroke. It can also boost your mood and keep your weight under control.

If you’re interested in taking part in the Gateway fun run, give us a call on 0121 456 7821 or email maxine.brown@gatewayfs.org to register your interest.

We’ll then be able to tell you about the group training we have planned as a warm-up to the July run. We’ll be offering a weekly walking group and a running group to cover different abilities, to help you get into training. We’ll also put your name down for a goody bag!

Ideally, we hope that people who take part in the fun run will get a taste for it and perhaps think about joining the weekly Cannon Hill Parkrun. Around 200 people complete the Parkrun every week – why not you?

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?

Replication

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:

• The 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.

The event

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

For a while now we’ve been using translation agencies but we find that it doesn’t allow us to deliver as flexible a service as we’d like. We occasionally need to access interpreters with short notice; POWs need to spend time before an appointment giving an interpreter background information and explaining what they are trying to get out of the visit.

Luckily, we are often able to interpret for clients using the skills of our own staff and volunteers. For example, a client who was recently referred to our POWs service is from Democratic Republic of Congo and speaks French. Although none of our POWs speak French,  one of the Gateway volunteers is from Madagascar, so it’s her first language. With help from the volunteer, our POW was able to introduce herself and Gateway to the client. Between them, they were able to start giving the client the support she needs.

In this video, Pregnancy Outreach Worker Shazia explains how, by offering her skills as an interpreter, she can persuade women to attend important appointments that they wouldn’t otherwise have the confidence to.

So we’ve decided to fill the gap – and formalise things – by setting up a training scheme for interpreters.

The training will lead to a formal qualification – an OCN Level 2 in “community interpreting”. But, like the training we give our volunteers, it will also include things like confidentiality, safeguarding, and work on boundaries. As well as giving us more control, this will give trainees a load of extra transferable skills that we hope will be useful to other organisations, leading to further interpreting work for them.

Many of the trainees already signed up are former clients themselves, so they are very well placed to understand how the service works, as well as a natural empathy for the client. As well as providing a translation service, they will be able to act as an assistant to the POW.

We’re hoping the course will open up work opportunities for people who wouldn’t otherwise have them. The opportunity to gain a formal qualification, and to start earning money by working for us and other organisations could be the beginning of a new career.

Want to find out more?

Our first group of interpreters will start on Thursday 16th May 2013, but there are still some places available.

You don’t need any prior qualifications – just a willingness to learn! However, although English will probably be your second language, you need to be able to speak English well.

So if you speak French, Somali, Arabic, Bengali, Romanian, or any other language that is spoken in Birmingham, and think you could benefit from our scheme, get in touch.

So how does a POW begin to build a relationship with a complex client?

Flexibility, availability, consistency

One of the main benefits of the POW setup is its flexibility. Sarah Samersinghe, a POW who has had some memorably complex clients, explains:

“As a POW, I can go to the client – she doesn’t have to come to me. If it’s not appropriate for me to visit her at home, I can meet her elsewhere, or pick her up in the car and take her out. And I’m always available; I don’t expect to only speak to clients at appointed times.”

Consistency is very important, especially when clients have otherwise chaotic lifestyles. “It’s important to do what I say I’m going to do,” says Sarah. “If I say I’m going to be there, I’ll be there.”

Pitching it right

How does she attempt to connect with women who find it difficult to trust new faces? How does a POW help a frightened woman to make quite dramatic lifestyle changes?

“It’s about trying to read people,” Sarah says. “Pitch it right. Choose your moment. When someone’s ready, they’re ready – you’ll just know. The way I personally do this – and not all POWs do, of course – is to talk about my own family; to find elements of my own life that chime with theirs. It often allows me to identify with the client – to show that we’re human too.”

The flexibility of the role means that the POW isn’t necessarily restricted by a time limit for each case.

“Our aim is a healthy outcome for all concerned,” Sarah says. “So if I can justify it, I’ll keep the case open for as long as I feel is necessary to achieve that. For example, a social worker might have to close a case once a child is placed elsewhere, but I feel fortunate that my role allows me to stay with the mother.”

Case study: Hayley

One of Sarah’s most complex clients is Hayley (not her real name).

“Hayley’s had many issues but, when I met her, the main problem was housing. The flat where she lived was pretty much uninhabitable. It was cold and dark all the time and the building was infested with rats and mice. There was no gas supply, and the wiring was downright dangerous. There was no way of cooking, or even making a hot drink, and there was only cold water to wash in. Not good for anyone, but particularly not for a pregnant woman.”

However, the flat, owned by Hayley’s boyfriend, was her home – and it wasn’t easy for her to make the decision to move away. She was scared.

It took a long time for Sarah to persuade Hayley that she should apply for temporary accommodation elsewhere. One day she finally agreed, largely because the weather had become very cold.

In the video below, Sarah and Hayley are on their way back from the appointment with Housing Services to pick up Hayley’s ID and other paperwork she needed for the move to go through. Hayley reflects on how far she’s come. And, poignantly, she tells Sarah that she thinks this is the type of support she’s always needed.

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 -:

• Basic education and key skills

• Family support

• 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

• Role models

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.