Across the world midwives providing relational continuity support is seen as beneficial for women, families and the midwives working in that model. In the UK creating continuity teams is in the Maternity transformation plans, but this is not new. Prior to, and into the 1990’s, midwives were working in group practices carrying caseloads, such as the acclaimed Albany Midwifery practice in SouthEast London. Becky Reed and Nadine Edwards share the story of their book, ‘Closure: How the flagship Albany Midwifery Practice, at the heart of its South London Community, was demonised and dismantled’.
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Our book Closure: How the flagship Albany Midwifery Practice, at the heart of its South London Community, was demonised and dismantled was published in May this year. This article describes the background to the story and introduces the book.
“The Albany Midwifery Practice was an inspired innovation. It put women at the heart of everything …” (Dr Kathryn Gutteridge)
Just over 30 years ago a group of midwives who were working in South East London, England, had a dream. They were all working independently (and supporting each other) offering continuity of carer to women. None of them were happy that the only way women could access true continuity was by paying their midwives to look after them: their vision was for their model of care to be available free to all within the NHS.
Following the 1993 government report Changing Childbirth (Dept Health 1993) in England, these midwives won a contract to set up a midwifery practice based in the community and funded by the Health Authority. The practice was known as the South East London Midwifery Group Practice (SELMGP) and ran for three years, with excellent outcomes and growing popularity. In 1997, the Health Authority funding ran out; however, the midwives were determined to continue and prove their model of care. They negotiated the first ever contract with a Healthcare Trust (King’s College Hospital), changed their name to the Albany Midwifery Practice (AMP), and became the first group of NHS midwives to work as a self-employed, self-managed practice, offering continuity of carer to an individual caseload of women.
The AMP midwives based themselves in a newly built Healthy Living Centre in Peckham, London, with a caseload of women referred to them by local general practitioners (GPs). They also took occasional self-referrals, and some referrals from consultant obstetricians at King’s. The model of care was well received by everyone. Women and their families, referring GPs, Health Visitors and the midwives themselves all loved it and could see its value. With great foresight the outcomes for the AMP women and babies had been collected and documented by the midwives from the very beginning. These showed among other things a remarkable perinatal mortality rate of less than half that of the local borough, a low intervention rate and an exceptionally high breastfeeding rate. As Andy Beckingham, Public Health Consultant commented:
“Here we had an evidence-based service model that achieved better clinical outcomes and much higher satisfaction among women than the standard NHS model. It was particularly effective among a highly disadvantaged and ethnically-mixed population.”
King’s College Hospital was also proudly promoting the AMP model of care. Just before the Practice’s 10 year celebration party a media release by King’s was headed: ‘LONDON HOSPITAL LEADING MIDWIFERY REVOLUTION CELEBRATES 10 YEAR MILESTONE’.
But unknown to the midwives, dark clouds were even then beginning to gather. In December 2008, just 17 months after the 10 year party, the midwives were called to a meeting with senior members of the maternity department where they were accused of practising dangerously, and shown a document (known as the ‘Case Series’) that purported to prove this. In that moment their world came crashing down. The ‘powers that be’ at the hospital had clearly convinced themselves that the midwives were somehow encouraging women to make dangerous choices, which according to the Case Series were resulting in a high rate of Albany babies being admitted to Special Care with HIE (Hypoxic Ischaemic Encephalopathy, a form of brain damage).
Despite the fact that all previous evaluations of the AMP had shown excellent outcomes for women and babies, and despite the model of care following government policy, the midwives were immediately put under compulsory ‘special measures’, with their practice from then on being closely monitored. Based on the inaccurate numbers in the Case Series, the hospital also commissioned an expensive external review and (at the midwives’ insistence) an internal audit to review their statistics. Both reviews were heavily criticised by researchers (Edwards & Davies 2010, Newburn & Dodwell 2010), and by two independent senior statisticians, one of whom, Professor Alison Macfarlane, had previously stated that it was ‘impossible to draw any inferences’ from the original Case Series.
In spite of the midwives’ and the community’s protestations, and good evidence to support both the safety and the value of the AMP, a decision was made by King’s at the end of 2009 to terminate the contract and close down the Practice. Unbelievably the midwives, who collectively were considered by King’s to be too dangerous to practise, were nevertheless offered jobs within the Trust. The view seemed to be that it was not the individual midwives who were dangerous, but the AMP model itself.
After the decision was made to close the Practice, one of the midwives (Becky) was referred by the Head of Midwifery to the Nursing and Midwifery Council with multiple allegations of dangerous practice. Her investigation lasted three and a half years with an eventual finding of ‘no case to answer’. No apology was ever received and no compensation offered.
Two years after her investigation ended, Becky contacted Nadine, who had been pivotal in the campaigns following the closure, and who was still closely involved in the ongoing quest for justice, with a proposal to work together on a book telling the story. Described by readers as a ‘page-turning story’, Closure has been widely acclaimed, and described as a ‘crucial part of the story of midwifery’.
The book is our attempt to make sense of why the events leading up to and during the closure of the Albany Practice unfolded as they did, and to try and understand how a well-loved midwifery practice achieving excellent, internationally acclaimed outcomes could be seen as dangerous. It follows the Practice from its early days until its closure and discusses the ensuing campaigns and wider support when many people in the local community and beyond took to the streets and used every avenue open to them to persuade King’s to reinstate the midwives.
Using a wide range of material, the book documents the injustices that affected so many people’s lives, especially the midwives working in the Practice at the time and the remarkable women and families who fought the closure and were involved in the ‘Save the Albany’ campaign.
Closure highlights some of the complex and distressing political failures of our times. The Albany story echoes other similar stories such as the ongoing Post Office scandal, outlining the lack of accountability within public institutions, the wilful blindness of senior people, and their refusal to engage with those they serve.
In the case of the Albany, flawed statistics took precedence over years of excellent outcomes. The women’s and midwives’ positive experiences, and the passionate campaigning of the local community, counted for nothing. Finally, in 2017, a paper was published documenting the statistics for all outcomes for Albany mothers and babies, vindicating the Albany model of care (Homer et al 2017).
“Every midwife […] should read this story. It is heart-wrenching in its truth, and you will shed tears for the women who have been left without the promise of midwife mother relationships. The outcomes of the Albany Practice were what any modern service should be aiming for.” (Dr Kathryn Gutteridge).
Reference
Department of Health . HMSO; London: 1993. Report of the Expert Maternity Group: Changing Childbirth (Cumberlege Report)
Newburn M, Dodwell M. 2010 NCT summary and critique of the review methodology for ‘The London Project – A confidential enquiry into a series of term babies born in unexpectedly poor condition’ by CMACE
Becky Reed [email protected]
Nadine Edwards [email protected]
October 2023
‘Closure: How the flagship Albany Midwifery Practice, at the heart of its South London Community, was demonised and dismantled’ is available from https://pinterandmartin.com/closure