The pattern has been the same throughout the pandemic. A simple explanation followed by a seemingly inevitable consequence “Due to rising COVID, visitor restrictions have been reintroduced”. Sometimes followed by an acknowledgement of how difficult this is for everyone concerned. What is often missing is a detailed explanation of how a decision has been reached. This should be of concern to us all.
Processes, policies and even job descriptions have been overwhelmingly orientated to one goal over the past fifteen months: stopping the spread of COVID. Infection control leads have been catapulted into the spotlight, acquiring more power than ever before. And rightly so, you may argue.
But this obscures a much more complicated reality. Health care providers are there to protect and promote our health in every sense of the word: physical yes but also psychological, spiritual, cultural. This is particularly the case in maternity services. Birth is a significant life event. Familiar support around this time has been shown to improve clinical outcomes. For the first time, Rachael Hunter’s analysis published in the Journal of Quality in Health Care and Economics this week, quantifies the impact of removing this support. And the figures are staggering: the cost of the pandemic in terms of perinatal depression will be £10.6bn and the cost of anxiety will be £6.9 billion. Crucially the figures don’t have to be that high. It is within the control of maternity services to reduce this gargantuan mental health burden. This is a responsibility that maternity services must wrestle seriously with.
It is never easy to come to a proportionate decision about the right changes to make to health services during a pandemic. And despite 15 months of experience, these decisions are more complicated than ever. Trusts and Boards face a situation where there are no legal restrictions in the outside world leading to pressure to remove restrictions in maternity units. Yet maternity professionals are concerned about the low levels of vaccinations amongst the pregnant population, and are concerned about their duty to protect the vulnerable. Over the last few weeks in particular, staffing has been a real challenge as increasing numbers of staff have to self-isolate or test positive themselves. But whenever decisions are taken that restrict our legal right to be with our family, it is our right to understand how decisions are reached.
At Birthrights, the risk assessments we have seen as a result of Freedom of Information requests have confirmed our suspicion that the impact of any restrictions on pregnant women and birthing people and their families are still not being explicitly considered. Other factors fall away before the altar of infection control. This inevitably leads to the situation we hear about through our advice line where women who have had suffered previous loss or trauma are left without the support they need, where individuals have to receive devastating news alone, and where someone who is recovering from a difficult birth also has to care for a sick baby on a ward where staff are already overstretched.
Trusts need to look again at the structures and processes underlying decision making to ensure that they comply with human rights law. There needs to be acknowledgment that the objective of health services is to protect and promote health and that this is more complex than minimizing the spread of COVID. Of course infection control and protecting vulnerable service users and staff are crucial concerns. But the huge impact of restrictions on families using maternity services must be an explicit consideration that is documented and quantified in any risk assessment. Maternity Voices Partnerships must be in the room on an equal footing to the infection control lead, and staff representatives. And risk assessments and minutes of discussions must be publicly available. Visiting restrictions have improved significantly over the last few months. As we find ourselves at a new tipping point, openness and transparency is key.