After what seemed a positive meeting with Kent County Council, the Keep Kent Breastfeeding campaigners were heartened and positive that they had been heard and that the new consultation would take account of their key concerns.
However, when campaigners were allowed an advance copy of the new consultation, they were saddened and surprised to discover that very little had changed.
Please find below the letter that we sent, as a group, in response to the consultation. It’s long but involves all of the concerns that we have about the “new” consultation.
11th October 2017
Dear Alison,
Thank you very much for sending the new draft Infant feeding Consultation. We are grateful for the opportunity to view it, and comment on it before it becomes public. As you aware we are all very passionate about each baby’s right to receive human milk, and how vital it is for mothers and babies, and families, to have access to quality breastfeeding support.
We continue to be concerned by the proposals in the Consultation and feel, despite a very positive meeting in September, little has changed in the proposals, which is disappointing. We are also saddened that, despite a commitment from those present in the meeting, there has been no progress on visits to the current breastfeeding clinics. Canterbury’s local councillor Michael Northey has made the effort to visit the LC clinic in Canterbury, and found the visit very useful to really understand what Kent will lose if the changes go ahead. Cllr Northey wrote a very touching email to Paul Carter, Peter Oakford and Andy Scott-Clark asking them to please take account of his observations. We are disheartened that no one else has even attempted to visit and gain real insight into what the service currently offers families in Kent.
As a group, we have responded to several parts of the consultation below with our own thoughts and concerns. Statements in red are taken directly from the consultation and our responses/queries/comments are below each.
- What is the Supplementary Information document?
- There will be no reduction in the numbers of peer support volunteers. The Health Visiting service will provide peer support training and supervision.[Our response:a) PSB have developed a university accredited peer support programme, so we are interested in the programme the Health Visitors are planning to implement. (B) We are also concerned about who will be managing the volunteers; our understanding is that the present Peer Support Leads currently spend over 100 hours a week fulfilling these roles. Who will be performing this role?]
- In our proposed model this [breastfeeding counsellors] level of support will be provided by health visitors. The dedicated Breastfeeding Health Visitors at the 36 breastfeeding clinics represents an increase in this level of support because we were previously proposing that breastfeeding women and their babies would be seen in the Child Health Clinics that are open to all. In addition, should a need be identified, the Health Visiting service will contract breastfeeding counsellors and/or lactation consultants.[Our response: Both Breastfeeding Counsellors and Lactation Counsellors have a specialism in breastfeeding, after specialist training and experience. Unfortunately their breadth of knowledge can not be matched by a health visitor who is expected to have a wide range of knowledge and experience in child and family health. How will the need for Breastfeeding Counsellors be identified?]
- 36 breastfeeding drop-in groups with health visitor and peer supporters as described above. 4 appointment-only lactation consultant clinics. Total: 40 groups/clinics. The model compensates for a reduction in the number of specialist clinics with a considerable increase in the number of groups with an intermediate level of support (i.e. above that provided by peer supporters alone).[Our response: if mothers felt comfortable about approaching HVs for advice and information about breastfeeding surely they would already be doing this? PSB continues to receive referrals from HVs, in the last quarter there were 391 referrals, which suggests HVs are not currently confident in dealing with breastfeeding issues. Intermediate support is not comparable to specialist clinics.]
- Numbers of staff available to support breastfeeding women: 307 health visitors (236.24 whole time equivalent) 90 community nursery nurses (72.12 whole time equivalent).Total: 397 staff (308.36 whole time equivalent). It is planned that there will be 4 lactation consultants in the new model and 4 breastfeeding ‘champions’ in each District. If there is a need for breastfeeding counsellors they will be provided. Numbers of peer supporters will be maintained in the new model. [Our response:
- Consider the amount of time HVs are currently able to spend on families. A rough calculation has told us that PSB currently provide at least 286 hours per week dedicated to breastfeeding. Will the 307 health visitors be able to match these hours in order to ensure a smooth continuation of service? Also the difference in professional relationships between a Breastfeeding Specialist and a Health Visitor; a BF specialist can take the time to get to know a mother, and keep in touch easily.
- What qualifications does ‘breastfeeding champion’ have? Whilst waiting for Infant Feeding Leads to qualify as IBCLCs no higher qualifications than UNICEF BFI training which is only hours long.
- We again question the logistic management of coordinating and developing a team of Peer Supporters by already stretched HVs.]
- KCHFT will provide details of open access and duty telephone line services on its website. Social marketing: This is currently provided by Activmob, who have provided very useful information on the voice of service users and other stakeholders. This has informed and continues to inform service improvement.
[Our response: Who will be maintaining these, and handling the phone line queries?]
- Saving £404,000 by not recommissioning PS Breastfeeding, at a time when KCC can be confident that the Health Visiting Service will ensure that people using the services can continue to receive all appropriate support, will allow KCC to maintain other Public Health projects despite ongoing reductions in the Public Health Grant from central government.[Our response: Which other Public health projects? Which other public health matter can possibly be more of a worthwhile investment than providing breastfeeding support to women to ensure the future health of children and families?]
- The lead dietician at KCHFT is providing the IFLs with further education and support around more complex feeding issues within the infant feeding arena and referral processes.[Our response: Great that there is joined up working with other services!]
- It is proposed that initially there will be at least 4 Specialist clinics a week across Kent. This will involve one clinic in each of the following areas; East Kent (Maidstone, Swale and Canterbury) West Kent (Tunbridge Wells, Tonbridge and Malling and Ashford), North Kent (Dartford, Gravesham and Sevenoaks) and Kent Coastal (Shepway, Dover, Deal and Thanet). As KCHFT has access to 111 venues, these clinics will be flexible and will be held in the areas that have the highest number of referrals to reduce the amount of travel time for families. 24 a month.In West Sussex, which already has UNICEF accreditation and has half the number of new births as Kent, only 24 mothers are seen per month using their specialist service. Kent could therefore expect a need to provide specialist support to 48 mothers a month, so the 100 planned appointments represent a large amount of specialist provision compared with expected need.
KCC recognises that families value the support provided by PS Breastfeeding, however examination of other local authority activity and KCC’s ongoing service reviews strongly indicate that PSB are overproviding specialist care via their Lactation Clinics. The intermediate level support provided within KCC proposed model is expected to be able to address the majority of issues currently being managed by the existing specialist clinics.
It is proposed that this is kept under careful review to allow for changes to the level of provision depending on health needs.
Health Visitors in Kent currently see a minimum of 5,600 women a month.
[Our response:
- This is certainly a cut in service provision, and seems uncompromising to recently delivered mothers both with and without access to transport. Appointment services do not suit mothers with young babies.
- Last year PSB specialists saw an average of 115 dyads a week, there were 8000 contacts last year alone. In September 2017, 485 women accessed PSB’s specialist support.
- In comparison to West Sussex; West Sussex hospitals have BFI accreditation so breastfeeding dyads leave hospital with breastfeeding issues solved by midwifery. KCC are comparing differing services.
- PSB are barely meeting the minimum; women leave clinics unseen due to the demand for specialist support.It is proposed that this is kept under careful review to allow for changes to the level of provision depending on health needs. If there is a clearly demonstrated need to increase the provision KCC will do so.How will these reviews take place, and how will the service be monitored? What are KCC’s long term goals and KPI’s?. How much money will these changes save KCC?]
10. Women are concerned that they will not receive help quickly enough and there will be a waiting list
Women will be contacted within 24 hours Monday-Friday. The National breastfeeding helpline is open 09.30-09.30 every day. The National Childbirth Trust (NCT) and La Leche League, a group of voluntary sector organisations that promote breastfeeding and provide breastfeeding counsellors, also have a helpline.
[Our response: These services are volunteer led, surely if KCC wish the families of Kent to use these services, the services should be formally commissioned.]
Other concerns….
11) Links with midwifery. Who will be picking up the babies before day 10 that require bf support?
A huge number of PSB’s referrals come from midwifery, for women still under midwifery care, in the last quarter PSB has received 436. Under these proposals, referrals will be bounced back to community midwifery who do not have the capacity or expertise to deal with breastfeeding issues.
12) What are the questions on the consultations that KCC want responses to?
13) We are confused why little has changed in this consultation proposal, and why KCC do not seem to have heard what families are telling them about what they need from a breastfeeding service. From what we can see, apart from recognising mother’s need for privacy, little regard seems to have been given to the thoughts and concerns raised by the consultation responses and our meeting in September.
14) Many women need to return to clinics several times: repeat appointments will remove slots from other women. This is particularly true with babies with tongue ties, who need at least 2 consultations with a specialist in the current system. In East Kent there are 11 tongue tie frenulotomy appointments a week, who all require these extra consults. This represents 88 specialist consultations per month in East Kent alone. Under KCC’s proposals, there are simply not enough appointment slots. This is just one facet of specialist work, that has a referral pathway.
With this all said, we are understanding that KCC cannot continue to contract PSB, or any other outside service, so we need to all work together to develop and implement an effective system that will support families, and ensure women can meet their breastfeeding goals, and babies receive breastmilk.
We feel the consultation lacks ambition, and no scope for better outcomes for breastfeeding families in Kent.
What we think breastfeeding women in Kent need and what we should work towards is;
- Open access to specialist support in a close locality. Appointment slots do not work.
- Everyone should be able to access these clinics, triaged by a breastfeeding specialist
- Information given about breastfeeding by Health Visitors and Health Visitor Assistants should be consistent and evidence-based.
- Families should have access to efficient NHS/Local Authority services without having to rely on voluntary or private sectors.
We are very interested to hear your thoughts on the above points, and hope to hear from you soon.
Yours sincerely,
Hannah Croft on behalf of Keep Kent Breastfeeding Campaign
with the full support of:
Tannice Hemming
Katy Lockey
Rebecca Cluett
Asha Crocker
Caroline Mitford
Anna Le Grange