23/02/2016 Victoria Derbyshire


23/02/2016

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Hello it's Tuesday it's 9.15, I'm Joanna Gosling in for Victoria,

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Will giving pregnant women their own personal budget

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so they can choose their own maternity care help

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That's one of the reccomendations in a new review?

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I'm the chair of the maternity review for England and one of the

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things we are determined, is that our services should be safer; that

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runs right through the report, and part of that is giving women choice

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and continuity with the person looking after them.

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Really keen to hear your experiences this morning, do get in touch

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Also on the programme - calls from some gun owners to have

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firearms legislation in this country relaxed.

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I have absolutely no intention ever of using a gun in a bad way.

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What people jump to is I own guns for the illicit reason and it's

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frustrating for me that you tell someone you own a gun and you're

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And - fur is back - and has featured on most

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of the runways and catwalks at London Fashion Week.

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We'll talk to one woman who stripped off in protest.

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Hello, welcome to the programme, we're on BBC 2 and the BBC

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A passenger train has derailed in the Netherlands. Reports say it

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collided with a hydraulic crane. We'll keep you up-to-date on that.

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Get in touch on all the stories we are talking about. Don't forget,

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texts will be charged at the standard network rate. And you can

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watch the programme online wherever you are via the news app or on the

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website. The NHS in England is to offer

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pregnant women their own "personal budgets", worth at least ?3,000,

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so they can pick and choose Mums-to-be will be able to use it

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to pay for anything from one-to-one midwifery care to home births,

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the use of birthing It's part of a shake up of maternity

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care to try and increase Really keen to hear

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from you this morning if you're pregnant, or have

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recently given birth, how much control did you have over

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the care you recieved? Do tell us what you think

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about these proposals. Our health correspondent

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Nick Triggle is here to talk us Tell us why this report has been

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done and what the aim is? This report essentially sets out the

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strategy for England for the next five years. It covers two issues;

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choice and safety. On choice it says women aren't always giving birth in

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the way they would like to. Nearly nine in ten women give birth in

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hospitals, when only a quarter say that's where they would want to be.

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So, half of women can give birth outside of hospitals, research

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suggests. The strategy has come up with a plan to empower women to

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exercise choice. At the heart is the idea of creating personal birth

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budgets, a similar concept to a system that's been used for care of

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the elderly, disabled an long-term illness such as heart disease. The

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NHS has said it will start piloting this scheme next year and full roll

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out will follow if the pilots work out. The budgets could be as much as

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?3,000. Women will be able to use these to pay for one-to-one

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midwifery care, home births or to pay for a birthing pool if they

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wish. They could also be used to provide support after birth for

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breast-feeding or hypnotherapy to relieve anxiety. What about the

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safety issues, how safe is giving birth in England? The authors are

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clear, they say it's never been safer. The number of Ne-Yo natal

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deaths and stillbirths has fallen by a fifth over the past decade. There

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are still problems. In one in 17 births, there are incidents that

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cause harm to either the baby or mother, nearly half of maternity

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services are rated inadequate or requiring improvement by inspectors

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when it comes to safety and each year, the NHS spends over ?500

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million on clinical negligence claims. So the report says there's

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still some way to go before there's world class services for all women.

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They make a number of recommendations to improve this,

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including improving data collection, doesn't always happen in every

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hospital. Ensuring a speedier referral when problems arise too, an

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creating a nationally agreed system for investigating mistakes within

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they do happen. This review makes the point that

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women don't give birth in the way they would like.

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We can talk again now to Baroness Julia Cumberlege,

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the Chair of the NHS England Maternity Services Review.

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James Titcombe also joins us. Baroness, first of all, the two

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issues being addressed in the report, how does giving mums-to-be

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more choice improve safety? We are absolutely conrinsed that --

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convinced that mothers when they have the choice can really have a

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better birth, a birth that they are planning, and that will aid safety.

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The other thing is that, one of the choices will be continuity of the

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person looking after them. We have been all over England talking to

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women and we have heard them say that they have had different people,

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one had 42 different people attending to her before and after

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the birth. That is very, very difficult. That is unsafe. If you

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have the person that you trust, the professional who really knows you,

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your family, and professional who really knows you,

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are likely to have much, much safer care. The most recent research that

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we have seen actually shows that. How often is a failure of care an

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we have seen actually shows that. issue? Of course, it's a failure

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every time, and you've got James here who's really suffered over the

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years through the loss of here who's really suffered over the

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Joshua, and I'm really sorry about that, but one of the things that

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people are telling us and thank you James, you introduced us to all

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sorts of people who've suffered, and it's a scar for life,

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sorts of people who've suffered, and to get over having lost a baby,

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especially if you know that it could have been avoided.

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especially if you know that it could James what do you think about the

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report? James what do you think about the

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recommendations that I whole heartedly endorse. I have some

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concerns about the voucher scheme and around this push to increase

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community births. I think the evidence-base for that, and there

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are some questions about it, so my strong advice is if we are going to

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do that, it's important to measure the right outcomes so the services

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the women are commissioning really understand where their quality and

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safety is and understand where their quality and

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transparent. We cautiously and monitor the outcomes

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to make sure the safety is there. Would greater choice have made a

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difference for you? Well, this is my thing, I've had three children, been

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through the process three times, very sadly one of them isn't here

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and if you ask me what was my priority, it would have been that

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the local service was safe, it was available and it was a learning

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culture and we were safe when we went there. So I am sceptical about

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whether this particular scheme is going to improve safety, but at the

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same time, I respect the need for women to make informed choices. In

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the end, isn't it about really good local care and making sure everyone

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has that as the absolute priority? Of course it is. That's what we are

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aiming for. We've got a lot of recommendations in the report, and

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this one on personal budgets is actually NHS money spent on NHS

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services and it's voluntary. We are not pushing women to have home

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births or births in midwife-led units, it's their choice. But having

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this particular money which comes from the Health Service which would

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have been spent on them any how, is going to give them more clout and

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enable them to get the choices they want. You say it's not a push

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towards home births, but it's being reported in some places as being

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exactly that, a way of saving money by pushing people towards home

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births? No, it's not that at all. In fact, it's the women who're pushing

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us to try and give them more choice and so this is a mechanism that we

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think could work and James is right, we need to monitor it and see how it

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does work. How does saying to somebody, right, you've got ?3,000we

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are not giving you the cash but you have ?3,000 to spend on the type of

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birth you want, how does saying that to somebody change the reality,

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because there is choice in some areas, isn't there, but in other

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areas, it's just the reality that the services aren't there, that

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won't be addressed? It's not so much that the services aren't there, it's

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very often that women are told, and they have told us, we have been

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right round England talking to women and we have met thousands. They have

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told us that often they are given the choice of two on stoat trick

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units, two hospital births -- obstetric. When the women make the

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choice and get special continuity of the person looking after them, it's

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going to be a safe and better service for those women. Laura

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Dunning from Wirral on Merseyside, has two children, her first was born

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in her local NHS hospital, her second was a home birth which she

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much preferred. Laura, tell us what you think about the review, you

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obviously have experienced choice in your two experiences there?

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Yes. I'm fortunate enough that I've had obviously two babies, one in an

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NHS hospital and my second was born at home. I'm fortunate enough that

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the postcode lottery means that I had continuity of care with

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one-to-one midwives, so from about six to eight weeks in, I had one

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midwife, she had a buddy midwife if she was unavailable or away and I

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had her right through until six weeks postnatal check-up when she

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signed me off. She was so in tune with me that from me phoning her at

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11. 30 at night when my waters broke to her hearing me at 2. 30 in the

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morning when my husband phoned her, she knew how my labour progressed

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just from that relationship we built up. As it happened, I was at home,

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much more comfortable, I had a birthing pool which, had I gone into

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an NHS hospital, our local unit only has two pools and there's no

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guarantee you would get that. I obviously wanted that, not to

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necessarily deliver my baby in, but for pain relief because the one

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thing I was adamant about second time around was that I didn't want

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any drugs. First time round my daughter was born unresponsive as a

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result of me having quite a lot of pain relief. That was my one big

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goal second time around - no drugs. I would like it to have been at

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home. If that hadn't have happened, it wouldn't have been the end of the

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world but I knew that my midwife knew me, my family, she came in,

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made me feel so comfortable, reassured and literally 40 minutes

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after she walked through the door, our son was born and that to me was

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so special that she had been on that journey with us and she knew not

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just me but my family and knew what we needed and wanted. She delivered

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everything. As I said, I didn't even need any pain relief with being at

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home. Two paracetamol was all it took. When things go right, ensuring

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someone has the best experience possible is the best possible thing

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that the maternity services can do for somebody like Laura, the review

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was really triggered about where things went terribly wrong. Looking

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at stillbirth statistics, half of the pregnant women in one review of

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stillbirths found that half of the women whose babies died had told

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medical staff they were worried there was an issue, and the baby

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wasn't moving in the womb and in half of those cases there was either

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no investigation or warning signs were ignored. How does that change

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in what you are looking at? Elle well, it does change, we hope.

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You can write a very good report but what really matters is the

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implementation. So we are determined that that should happen. But you are

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right... Why is it happening? Why are people being ignored? People are

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not listening to what women want and it's not just women, it's their

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families as well. We've had a lot of interviews with dads. It's really

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interesting to find out what dads feel about this. It's a seminal

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occasion. But it's not just about what women want, it's about when

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there is an issue highlighting it and it not being picked up? Of

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course, and that is up to the professionals, to make sure you have

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really close team work. One of the things we are very keen on, is that

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when people work together, they should train together and learn

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together. This is what we found in Sweden. We went to Sweden, to

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Holland and Denmark. We just know that we can do a lot better. So it

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is about how you formed the teams, how they work together and the data

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that they produce, that it's accurate and we also want to see a

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much more electronic system. We want records that are electronic for

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companies to share with a lot of people, the woman and her family, so

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that everybody knows what is going on and that we have a proper

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investigation when things do go wrong that is open, honest,

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thorough, and that the family is brought in on it.

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Do you have confidence in open investigations going forward? I

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think this has been an issue that's gone back a very long time and if

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you go back to the Bristol Report in 2001, a reck men daiingts of that

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was we must have a standardised system for learning when things go

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wrong. So the NHS hasn't got a very good record of putting this right --

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the recommendations of that. In terms of data and transparency,

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there is the need for getting recommendations right, they have to

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be the right recommendations. They were similar to what Bill Kirk Hall

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made a year ago so it's taking a long time. Let's implement this and

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make sure the changes happen so we are not sat having a similar

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conversation in 12 months. Receive Sarah in a text message says a few

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days after a traumatic birth and I am still recovering. Another one

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says, I don't think I was given any choice over my antenatal care, I

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feel like it is my fifth child and not my first.

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Carol on Twitter says you can only have a choice in a system if there

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is spare capacity. Maternity units are turning people away because of

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the shortage of midwives. How is this gimmick rubbish supposed to

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help? There are about 2500 midwives on the maternity list, and nursing

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midwifery Council 's list. They are not practising and they are not

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working. Why is that? Some of them, it is family reasons and things like

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that, but a lot of them, they don't like working in the NHS and they

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don't have autonomy over their work. Whether it is good teamwork and it

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is not appreciated. A lot more would want to come back. We are also

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supporting maternity practices. What if they don't, is there going to be

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enough in terms of resources to make the difference? We have put in bids

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for some more funding, but we have to be more careful. At the moment,

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in maternity services, we are spending over 4.7 billion on

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maternity services. Nobody can tell me every single penny of that is

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well spent. I am sure if we had different ways of working, we can be

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much more efficient and also more caring, more professional and

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ensuring women get what they want. Thank you very much. Baroness and

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James, thank you for joining us. Later in the programme we will get

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more reaction to the review from new mums. So do get in touch.

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London Fashion Week has put fur and the debate over wearing it back

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The main news this morning. stripped off in protest.

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The NHS is being urged to give pregnant women in England a personal

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budget of around three thousand pounds to choose

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This could mean that women might pick a hospital near their work

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for routine scans, and a different one near their home to give birth.

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