Health: Supporting Women, Reducing Harm Short Life Working Group minutes - 30 May 2024

Attendees and apologies

Attendees

• Emma Cashmore-Gordon, Co-chair, Perinatal Services Manager, Aberlour
• Iona Duckett, Co-chair, Senior Midwife, NHS Tayside
• Karis Deacon, SG, Secretariat 
• Claudette Day, SG, Secretariat 
• Anne McFadyen, SG, Perinatal and Infant Mental Health
• Catherine Clark, Specialist Midwife, NHS Highlands
• Emma Cashmore-Gordon, Co-chair, Perinatal Services Manager, Aberlour
• Hazel Inglis, Specialist Midwife for Drugs and Alcohol, NHS Highland
• Helen Sheriff, Perinatal Services Manager, Amma Birth Companions
• Katy Macleod, Research and Peer Engagement Programme Manager, SDF
• Lesley Sharkey, Director of Midwifery, NHS Tayside
• Linda Thompson, Head of Services, Women’s Support Project
• Marie-Claire Shankland, Programme Director, NHS Education for Scotland
• Gavin Philipson, Perinatal and Infant Mental Health Network Scotland
• Rowan Anderson, Programme Lead, CORRA Foundation
• Ruth Robin, Healthcare Improvement Scotland
• Shelley Arthur, Health Visiting Team Leader, NHS Forth Valley
• Joanne Smith, Policy and Public Affairs Manager, NSPCC Scotland
• Susanna Galea-Singer, Royal College of Psychiatrists in Scotland
• Lynn Gillies, Service Manager, Children & Families, Social Work, Fife Council
• Joanne Smith, Policy and Public Affairs Manager, NSPCC Scotland

Apologies

• Harriet Waugh, SG, official
• Kelsey Sclater, SG, official
• Kirstie Campbell, SG, official
• Carolyn Wilson, SG, Official
• Emily McLean, SG, official
• Roch Cantwell, SG, Perinatal and Infant Mental Health
• Donatella Olisterno, Service Manager, Harper House
• Maree Aldam, CEO, Birth Companions
• Marie Balment, Perinatal and Infant Mental Health Network Scotland
• Jaki Lambert, Director for Scotland, Royal College of Midwifes
• Jennifer Shields, Foetal Alcohol Advisory Support Training Team, Edinburgh
• Kirsten Horsburgh, CEO, Scottish Drugs Forum
• Lyndsey Turfus, Substance Use Sub-Group Chair, Social Work Scotland

Items and actions

Welcome and updates

The co-chairs welcomed group members to the third meeting and thanked everyone for attending.

Existing guidelines presentation 

Karis Deacon, Scottish Government, delivered a presentation on existing guidelines on substance use and pregnancy. Karis discussed key themes and recommendations from various substance use and pregnancy guidelines. Findings and gaps were summarised, followed by ten overarching principles aimed at improving support services and establishing clear expectations for women’s care.

Three themes of general guidance:

• joined up support and holistic care supported by information sharing
• improving staff training to help identify and support vulnerable women, also addressing stigmatising attitudes/language
• providing women with accurate information (citing potential impact of substance use) to involve them in the decision-making process and enable informed choices

        Identified gaps:

• harm reduction information is inconsistent, with abstinence being the only treatment
• women are often unaware of social work assessments being conducted
• family units and partners, who may also use substances, are often excluded from support services
• social determinants, such as poverty, trauma, homelessness and exposure to violence are neglected
• lack of continued support for women who have had their children removed

        Overarching principles:

• provide holistic, joined-up support across all services
• provide evidence-based support that is trauma informed, with kindness and compassion
• involve support from family/friends where appropriate
• ensure continuity of care for women and their babies
• meet women where they are
• involve lived and living experience in the design and delivery of services
• take a harm-reduction approach to substance use
• develop knowledge and skills in the workforce
• provide accurate and up-to-date information to support women’s choices
• ensure that women know what their care and support should look like

Following the presentation, the floor was opened up to the group for discussion. Key points included:

• consider the principles outlined in the NHS England ‘Involving and supporting partners and other family members in specialist perinatal mental services: good practice guide’.
• these principles could provide valuable insights as the group pushes forward
• NHS Highland guidance recently updated, reflecting two specialist midwives that have been appointed
• SDF completed piece report in 2021 around specialist midwife service and aftercare support that has relevance
• seek clinical input and oversight, ensuring guidance highlights key risks, such as abstinence in the context of early pregnancy
• equality impact assessment applied to overarching principles

Jamboard

The presentation was followed by a Jamboard activity to address the following three questions: what change do we want to see on the ground? how could a guide like this help you? what do you think of the guiding principles?

Suggestions included:

• women and children involved throughout the formulation process, resulting in clinical guidance that is distinct and relevant to their specific needs. A participatory approach ensures the guidance is not just about them but created with them.
• create a visual aid, such as a short animation or video, to make the information more accessible and help incorporate personal experiences
• merging some of the newly established guidance and evolved practices with current clinical guidelines e.g. Orange Book - this may allow the new guidance to become fully integrated into the system across the clinical community
• build accountability into the referral system by providing a key person/coordinator to ensure effective case management
• ​​​​​​​addressing prejudice and stigma must remain a priority
• ​​​​​​​ensuring consistency and high standard of advocacy

​​​​​​​Ensuring support for women remains in constant parallel with child protection, however removing a child from the care of a parent is not a comprehensive solution. The parent may have another child, perpetuating a cycle of child harm. Continued support for the mother is crucial alongside protective measures for the child.

​​​​​​​Disparity of care and access to services, particularly regarding transport in rural areas. NHS will not cover the cost of a partner attending appointment – which raises concerns about equitable access to support during medical treatment.

Actions and close

• Aberlour’s Mother and Child Recovery House will be invited to participate in future meeting. ​​​​​​​
• the Lived and Living Experience steering group seeking more members, particularly third sector representation. Participants will include women from both urban and rural communities, some of whom have experienced the removal of their children and babies.
• small drafting group seeking additional members, with calls taking place between main group meetings. If interested please email Karis for further information.
• co-chairs thanked members for attending and for their valuable input and closed the meeting.

Date of next meeting: 04 July 2024, 14:00 - 15:00