29 July 2024

We, with more than 70,000 people who have signed our petition (an online version of the petition can be signed here), oppose these plans but we publish this letter so everyone can see all the details we have on the proposals.

We have been promised earnestly (!)and repeatedly in board meetings that our campaign would be consulted about plans for the future of Liverpool Women’s Hospital. What we got, however, was a leaked copy of a letter to staff written by the joint chief executive of Liverpool University Hospital Trust and Liverpool Women’s Hospital. We will publish our response shortly.

This is the letter

Dear colleagues,

As you will all know, the adult and specialist Trusts in Liverpool have a strong record of working together for the benefit of patients and their families across the city, and the region.

We have a lot to be proud of, for example the stroke pathway service between Liverpool University Hospitals NHS Foundation Trust and The Walton Centre NHS Foundation Trust, the cancer pathways across all Trusts, and improved diagnostics waiting times across the city.

In January 2023, a report called the Liverpool Clinical Services Review recommended we continue to build on this in several key areas to help create a healthier city. Since this report, good progress has been made towards ever further collaborative working across the system.

Next Steps for Collaborative Working in Liverpool

As the next step in this work, NHS Cheshire and Merseyside has asked the five adult acute and specialist Trusts in Liverpool to establish a joint committee. Its purpose is to create sustainable healthcare systems for the future with a clear focus on improving patient care and outcomes.

Staff in all Trusts work incredibly hard and care deeply about doing the right thing for patients. As we all know there are significant challenges facing the NHS – pressures every day, capacity, and funding. And this year is going to be the toughest yet.

We have been asked by NHS Cheshire and Merseyside to come up with a way to act more quickly, find solutions and have a simpler way of making decisions about things that involve us all with a clear focus on improving patient care and outcomes.

Adult Acute and Specialist Hospitals Joint Committee

The Chairs and Chief Executives of the five adult acute and specialist Trusts, outlined below, will sit on the joint committee:

• Liverpool Heart and Chest Hospital NHS Foundation Trust (LHCH),
• Liverpool University Hospitals NHS Foundation Trust (LUHFT),
• Liverpool Women’s NHS Foundation Trust (LWH),
• The Clatterbridge Cancer Centre NHS Foundation Trust (CCC), and
• The Walton Centre NHS Foundation Trust (TWC).

This will enable more streamlined decision making and help to build upon existing collaboration with a specific requirement to collectively manage the financial position across the Trusts, deliver economies of scale and manage vacancy controls

The focus of the joint committee will be to establish the new governance arrangements, meeting in shadow form (i.e no formal authority) in September 2024 and be in place formally (i.e. with authority to make decisions) by April 2025.

Over the coming weeks the detailed delivery plans are being developed. I am committed to ensuring colleagues are updated as more information on the joint committee plans becomes available.  Colleagues at the other Trusts are also receiving this information today.

Shared Board of Directors for Liverpool University Hospitals NHS Foundation  Trust and Liverpool Women’s NHS Foundation Trust

Additionally, LUHFT and LWH are building upon their existing joint board appointments and are working towards developing a shared Board of Directors. This supports Liverpool Women’s Hospital’s long-stated ambition to be aligned to a larger acute Trust to support the management of identified clinical risks.

Work is underway to develop the detailed plans for establishing the joint board by late Autumn 2024.

The Women’s Hospital Services in Liverpool Programme, commissioned by NHS Cheshire and Merseyside will continue to progress with developing proposals for safe, high-quality maternity and gynaecology services in Liverpool through public consultation and engagement.

These new governance arrangements will not impact on the delivery of services at the respective hospital sites or on this established programme of work.

Keeping you updated

We will keep you all informed as much as possible through regular Trust-wide communications and through your line managers. We know that many of you may have questions in relation to this subject. We have drafted some initial FAQs that you may find useful. ( this link is better: our edit)

If you have any further questions, please send them to communications@liverpoolft.nhs.uk – to help inform updates to the FAQs, further communications and briefings.

The author is James Sumner Chief Executive of Liverpool Universities Foundation Trust and of Liverpool Women’s Hospital

The Save Liverpool Women’s Hospital campaign will publish a detailed response as soon as we can do so with real consideration of the risks involved in these proposals. Meanwhile please keep campaigning to Restore and Repair our NHS so such dangers to our healthcare are removed.

For all our mothers, sisters, daughters, friends, lovers and every single baby, Save Liverpool Women’s Hospital. Restore and Repair the NHS

We can see the damage to our health care. What can we do about it?

We can

1. Understand what is happening. Check any information carefully as sections of the press are untrustworthy. Record our own experiences
2. Talk to other people. The value of one-to-one conversations with trusted friends cannot be underestimated. Such talk is the basis of all campaigns.
3. Know what we want for the health service instead of today’s chaos. We want the NHS without privatisation, fully staffed, fully funded with decent wages and working conditions. We do not want private companies, we do not want CIPs and closures, not long multi-million waiting lists or denial of treatment.
4. Organise to restore the NHS. How do we do this?

Conversations.

Organising together with other local or workplace campaigners producing and distributing leaflets, social media, meetings, demonstrations, pressure on politicians, industrial action, and popular education. We know what campaigns look like. We know such campaigns take work and effort but nothing worthwhile was ever won without one.
Shout out to the Suffragettes, the Tolpuddle martyrs, Equal Pay, the
Hillsborough Justice Campaign, the Abortion Rights Campaign, Equal Pay Campaign, the Shrewsbury parents, the Covid Bereaved Families, Anti-Apartheid, the Right to Food and Fans supporting Foodbanks and all the trade unions
They all fought and are still fighting long and loud. Sadly, that is what we must do now.

We know the health privatisation lobby funds politicians in all parties but some Conservatives have even written books about how the NHS should be privatised. They cannot deny it. Others are more shamefaced and should be shamed some more.

75 years ago a war-wrecked country started the NHS. It is time to win it back!
Restore and Repair the NHS on its 75th Anniversary!

75 years ago, the post-war government founded the NHS. For the first time every person, rich or poor, had access to world-class healthcare, free at the point of need. The government had responsibility for the health care of the entire population. The NHS helped the people and the whole country recover from the war and helped its children to grow up well and strong.
“It will provide you with all medical, dental and nursing care. Everyone – rich or poor, man, woman or child-can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.”

Who fought to set up the NHS? It was ordinary people. there were campaigns for healthcare through the early twentieth century. It was not given to us by the rich and powerful. Who fought for the NHS to be founded? Trade Unions, working-class Women, Socialists, The Socialist Medical Association, returning armed forces, and the Labour Party.

Let us go back to that tradition and once again fight for our NHS. Talk to your friends, family and workmates about this.

Who opposed the founding of the NHS? The Conservatives. 75 years later they are wrecking the NHS

We deserve better. We have the right to world-class speedy treatment and this government is taking it from us.
Greedy Conservative ministers say the economy cannot afford the NHS. On the contrary if the NHS crashes, the economy suffers. A poorer health system means lower life expectancy over time (and that is happening in the US) and more sickness in the workforce. That means fewer people are able to produce value and the productivity of those able workers not rising much. So, it means an economic slowdown.

How did the NHS develop once it was founded?

The NHS worked like this; the government was responsible in law for providing healthcare for its citizens.

• Healthcare was a national, publicly provided system.
• The NHS was for everyone, rich or poor young or old, citizen or visitor.
• All treatment was free at the point of need.
• The best available treatment was available to all.
• Staff were reasonably well paid and qualified.
• The NHS was a research institution so treatments could be evaluated.
• The  NHS was the world’s largest purchaser of drugs so could negotiate with the drug companies for better prices and safer drugs.

Everyone paid taxes and the Government funded healthcare and the NHS grew. Right from the start there were sniping attacks on the NHS but it was so popular politicians did not dare attack it openly. Bevan the founder of the NHS resigned as the Minister when prescription charges were introduced.
It remained, despite cuts, the best health service in the world until 2017, largely living on earlier investments. Then cuts and privatisation ramped up.

Privatisation began under Thatcher who privatised hospital cleaning, which lead to hospital-acquired infections like MRSA.

Her cabinet discussed full-scale privatisation, including bringing in health insurance to make people in work pay but did not dare implement it. She also started the privatisation of much of our elder care. Most care homes are now owned by big companies. Then Tony Blair introduced PFI . PFI remains a huge weight on many hospitals’ budgets. Blair and his government started propaganda for involving the private for-profit sector in the health service. Far from being more efficient, the for-profit sector has been damaging.

Carillion is just one example. The scandal of Carillion and the building of the Liverpool Royal Hospital will never be forgotten Privatisation has grown, especially under Coalition and Conservative governments who oppose the whole idea of the NHS and are privatising and breaking it to further open the way for big companies to profit at our expense.

What does NHS privatisation mean so far? ( Each of these initiatives means greater pain for patients.)

Before the pandemic, in 2019 privatisation was already eating into NHS resources, leaving it open to the catastrophe that followed
PFI – PrivateFinance Initiative – meaning that building new hospitals made a fortune for finance companies and huge debts for hospitals.
Outsourcing workers on lower pay and worse conditions
Contracts have been given to private companies to deliver some treatments, often at a lower quality than the NHS.
Hundreds of thousands of pounds are given to management consultants.
Services contracted out.
Government legal responsibility for healthcare has been removed.
There has been restructuring of the NHS into ICS so more of our tax money for health goes to private companies.
Patient data is included in trade deals.
Patients are being sent to private hospitals.
Migrants are being charged 150% of the cost of their NHS treatment meaning many people go without treatment or live in terrible debt.This policy has caused maternal deaths

The deaths of three pregnant women were directly linked to the Conservative government’s charging system in a major report that came out in December. The women died after delays in seeking help due to wrongly thinking they would have to pay for care.
Big Companies like Centene are taking over GP practices often reducing the level of care available.
Privatisation and cuts led to restricting treatments and creating waiting lists.
Hospitals, GP surgeries and maternity units were closed.
Mental health care is a tattered shadow of its former self.
Social care for people with disabilities and for our elders is privatised and charges service users.
Few NHS dental practices still function.
GPs are overworked and understaffed. Patients and staff are having to fight for their care.

“The UK spent around a fifth (18%) less on average than the EU14 on day-to-day health care costs” (the Health Foundation). The Government has decided not to adequately fund our NHS services. Seven million people are waiting for care and thousand are dying of preventable or treatable illnesses.
Staff in the NHS have seen their real terms pay decline for more than ten years, yet are overworked. The NHS is understaffed. We have fewer hospital beds than in similar countries and fewer doctors per head of population.

A system with fewer resources

The Kings Fund, a thinktank that has supported some recent “reforms”( and is certainly not left-wing) reported recently;

The UK has below-average health spending per person compared to peer countries. Health spending as a share of GDP (gross domestic product) was just below average in 2019 but rose to just above average in 2020 (the first year of the Covid-19 pandemic, which of course had a significant impact on the UK’s economic performance and spending on health services). The UK lags behind other countries in its capital investment, and has substantially fewer key physical resources than many of its peers, including CT and MRI scanners and hospital beds. The UK has strikingly low levels of key clinical staff, including doctors and nurses, and is heavily reliant on foreign-trained staff. Remuneration for some clinical staff groups also appears to be less competitive in the UK than in peer countries. 

The NHS is broken up into 40+ ICS boards. Our ICS area is Cheshire and Merseyside. That is why the coordinated campaigns against NHS cuts and privatisation operates across Cheshire and Merseyside. We are all the local trade union councils, Defend our NHS, Keep our NHS Public, Save Liverpool Women’s Hospital, Merseyside Socialist Health Association and more.
You can join any of these groups or just the local group close to you. Email us at TakebacktheNHS@proton.me
Even now the government is imposing further cuts on the NHS. This is madness.
We invite you to join the Resistance:
to NHS privatisation
to poor pay, to denial of care, to underfunding, to endless waiting lists, to being forced to pay twice, to hospital and GP closures

Every tax pound that goes directly to health care repays itself many times over in the health of the economy as well as through the health and happiness of the people. Underfunding healthcare causes harm to the economy.

The campaign to save Liverpool Women’s Hospital and for better funding and better staffing of maternity services nationally and locally is crucial in Cheshire and Merseyside.

Liverpool Women’s Hospital serves women across Merseyside and Cheshire and beyond. 8,000 babies a year are born there. The hospital is the regional maternal medicine centre
Save Liverpool Women’s Hospital March

October 7th,2023, 12.30
Join the March for the NHS!
From Liverpool Women’s Hospital to Labour Party Conference at Liverpool’s waterfront.
Save Liverpool Women’s Hospital!
Save all the Hospitals under threat!
Restore and Repair the NHS!
Back to Bevan!
Support NHS staff!
Improve women’s healthcare.
Improve maternity care nationally

Talk to people about the NHS. Answer the Government’s lies. Spread the resistance. Demand restoration of the NHS.

Speak out, speak up, and fight to restore our NHS. A mass campaign, like that to set up the NHS, like that of the suffragettes, can and will win back our NHS, fully funded. We need your involvement. If not now when?

We are putting out a call for further active support from the people and their organisations in Cheshire and Merseyside. The NHS is held together by the outstanding work of the healthcare workers, despite the Governments sabotage. We all need the NHS and we can see how it is being damaged by this government and their policies. Time to call Enough Is Enough. Restore and Repair the NHS. Help us raise the level of our campaign.

Our hospitals, our ambulances, our GP services, our maternity care, our mental health services, and our social services are all failing to provide the level of care we deserve, that we as an “advanced” and wealthy economy should expect.

This campaign defends Liverpool Women’s Hospital, the largest maternity hospital, and the only hospital dedicated to women’s health. We are involved in defending the healthcare system nationally but particularly locally in Cheshire and Merseyside. The two issues are interlinked.

The UK was much poorer when the NHS was founded yet the 1945 government managed it. Good health care is an investment in our people and in the economy. People are suffering and dying because of these Government policies which centre around privatisation (in its many forms), There has been bad workforce planning. leading to chronic shortages of staff. The Kings Fund, not a left-wing, think tank commented:

The people who work in the NHS are its greatest asset and are key to delivering high-quality care. This has been evident throughout the Covid-19 pandemic with staff demonstrating remarkable resilience and commitment. However, a prolonged funding squeeze between 2008 and 2018 combined with years of poor workforce planning, weak policy and fragmented responsibilities mean that staff shortages have become endemic. 

We also see lying, as when Boris Johnson promised more hospitals, and when in 2015 the Secretary of State for Health Simon Stevens promised us 6000 more GPs but we have been left with fewer than in 2015. We were promised Continuity of Carer in the maternity services without sufficient midwives to deliver it.

Donna Ockendon who conducted the review of baby deaths in Shropshire and is now working on the Nottingham Enquiry wrote “the review team has also identified 15 areas as IEAs that should be considered by all trusts in England providing maternity services. Some of these include:

the need for significant investment in the maternity workforce and multi-professional training

suspension of the midwifery continuity of carer model until – and unless – safe staffing is shown to be present

strengthened accountability for improvements in care among senior maternity staff, with timely implementation of changes in practice and improved investigations involving families“

The damage to the whole NHS is shown in cost-cutting and ideological opposition to the core NHS principles of a public national and comprehensive health service for need, (not profit) providing timely care, free at the point of need. This government prefers to run down the NHS and to divert funds to big corporations. The NHS is not the only victim of the policy of Austerity but it is a major victim. The people of the UK have suffered grievously with 300,000 dead, more than in many wars

The NHS is being held together by the outstanding work of NHS staff. Our nurses, midwives, doctors, allied medical professionals, porters, and site staff are underpaid and overworked. They have worked through the pandemic and acute shortages. Yet despite this they work, continuing to provide care and support for those using the NHS. Day after day we hear more demoralising stories. We the public must step up and challenge the Government over this. The staff cannot carry this burden alone

It does not have to be like this, the UK is wealthy, and even if it was poor the NHS model is far more cost-effective than the private model. This situation has been created by political decisions. Big companies are taking profit from the NHS. The administration of the NHS nationally and locally is deformed towards profit and towards the market.

The National Health Service was split into 42 areas by last year’s Health and Care Act, a profiteer’s charter. Campaigners nationally and here in Cheshire and Merseyside fought long and hard, but Boris Johnson’s government pushed it through

We continue to campaign, bringing together the different campaigning organisations in Cheshire and Merseyside. We are always looking for more organisations and individuals to join the struggle to restore and rebuild the NHS. Please do get in touch

The core problems in Cheshire and Merseyside are,

1. Waiting lists and waiting times, denial of care and having no choice but to pay for some treatments (like dentistry, but often for surgeries such as hips) and treatment provided by private companies with limited quality control)
2. Staff welfare, including pay, working conditions, pensions, unfilled vacancies, and frustration at not being able to provide for the need they see every day.
3. Funding, with “Cost Improvement Programmes expected at this time of increased need and high inflation The new ICB boards carried over all the financial problems of the previous system with additional admin costs.
4. Funding and staffing for maternity
5. Bed capacity and physical space in the hospitals in several high-profile cases
6. Privatisations/outsourcing and commissioning
7. Reorganisations designed to save money or reorganisations not properly planned or cost.
8. The persistence of the internal market,
9. Workforce planning,
10. The state of repair of hospitals

All of these are hitting patients through waiting lists, mix-ups and denial of care

Nurses, midwives and other health workers are balloting for strike action. They have our total support. They should never need to strike The responsibility lies with the Government. We speak to people regularly about the NHS and overwhelmingly, the people of our area want staff well paid and with sufficient staff to prevent overwork and burnout.

There are key crisis points now in Cheshire and Merseyside Health Service (formerly known as the NHS). These are a breakdown of services for patients, the need to organise public support for staff, Finances, Maternity, Hospital capacity including beds, staff and buildings, GP practices and primary care.  Mental Health is utterly inadequate. Discharge from hospitals is difficult because of disarray in the largely privatised social care system.

We also see the introduction of “Virtual” wards to allow patients to be treated at home But this is happening while we have GPs already under pressure, primary care under pressure and ambulances unable to respond in due time. This will put pressure on families to care, for the lucky ones who have families available. And who will pay to heat these “virtual wards”. Sick people need constant warmth.

The reorganisation of Liverpool Hospitals, financial and leadership problems at Countess of Chester,

and Covid There is also an attempt to build a private “GP” surgery on the roundabout by the entrance to Clatterbridge Hospital. ( What they offer is not GP services which would include being a family and community specialist and responsible for your primary care; these companies cannot offer that)

Covid is still a problem with increasing numbers of people in hospital and increasing the severity of other illnesses yet our ICB board meets without taking basic Covid precautions, whilst its agenda discusses these issues

Our health care system needs you! Our organisations include Trades Councils across the area, Unite Community Cheshire, Defend our NHS, Socialist Health Association, Prescott SOS NHS, Keep our NHS Public Merseyside and Keep our NHS Public Cheshire, Save Liverpool Women’s Hospital, Save Ormskirk and Southport Hospitals and more. Donations will go to the Save Liverpool Women’s Hospital Account

Please think of how you can help.

Could you put a poster up?

Could you leaflet your street?

Could you write to your MP and councillors?

Could you get your union branch to help financially? Could they affiliate with our campaign?

Could you get involved in the campaign?

Could you invite a speaker to a meeting?

Could you donate?

It is with great sadness that we read the findings from The Ockenden Review and we add our thanks to the families who fought so hard to bring their experiences to public attention. As midwives and campaigners for safe and compassionate maternity care we have a duty to reflect on the findings of this report and our thoughts are with the women, their families and staff working at The Shrewsbury and Telford Hospital NHS Trust. The Lancet commented that;

“The report found that around 200 babies and nine mothers would or might have survived if the trust had provided better care. The Royal College of Obstetricians and Gynaecologists (RCOG) called it a “dark day”. Criminal charges might still be brought against the Trust and individuals.”

Donna Ockendon gave great credit to the parents whose campaigning instigated the report;

“The work contained in this final report and the first report of the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust, came about from the exceptional efforts of parents Rhiannon Davies, Richard Stanton, and Kayleigh and Colin Griffiths, whose daughters died as a result of the care they received at the Trust.
The deaths of Rhiannon and Richard’s daughter Kate in 2009, and Kayleigh and Colin’s daughter Pippa in 2016 were both avoidable. Owing to their unshakeable commitment to ensure the precious lives of their babies were not lost in vain, this review has implementation of meaningful change, not only in maternity services at The Shrewsbury and Telford Hospital NHS Trust – but also across England. As we publish this final report, we want to acknowledge and pay tribute to Rhiannon, Richard, Kayleigh and Colin.“

Shrewsbury is not alone. There have been other maternity scandals in Morecombe Bay, Essex and Nottingham.

The crisis in maternity staffing in 2022 is worse than the period covered by this report. Many hospitals did manage against the odds to avoid some of the damage done in Shrewsbury. Shewsbury’s managers and senior clinicians have serious questions to answer. The context does not excuse their actions but it is crucial to understanding what was happening.

Understanding and appreciating the context in which these failures happened is a vital step in working towards any type of prevention. What is prominent throughout the review is the catastrophic shortages of midwives, medical staff and other maternity healthcare workers and the impact these shortages have had on care. For many years we have known of these critical shortages and the tragic damage this would cause. Now, sadly, we are seeing it.

With this shortage comes poor supervision and training of staff, in particular preceptorship programmes for newly qualified midwives (NQM). Without enough qualified midwives, it is impossible to provide supernumerary status with protected learning time for NQMs. This is crucial if we want to grow a competent and confident workforce.

Donna Ockendon says;

“It is absolutely clear that there is an urgent need for a robust and funded maternity-wide workforce plan, starting right now, without delay and continuing over multiple years. This has already been highlighted on a number of occasions but is essential to address the present and future requirements for midwives, obstetricians, anaesthetists, neonatal teams and associated staff working in and around maternity services. Without this maternity services cannot provide safe and effective care for women and babies. In addition, this workforce plan must also focus on significantly reducing the attrition of midwives and doctors since increases in workforce numbers are of limited use if those already within the maternity workforce continue to leave. Only with a robustly funded, well-staffed and trained workforce will we be able to ensure delivery of safe, and compassionate, maternity care locally and across England.“

Yet, how can a maternity service be safe and compassionate if there aren’t enough staff? How can staff give women their time, time to sit and talk, time to listen. It is impossible. It cannot be done. As a consequence, women will not be provided with the safe and compassionate care they so justly deserve, not because staff don’t care, but because there simply aren’t enough of them.

In July 2021 the report on the Safety of Maternity Services from the Parliamentary cross-party Health and Social Care Committee said;

“With 8 out of 10 midwives reporting that they did not have enough staff on their shift to provide a safe service, it is clear that urgent action is needed to address staffing shortfalls in maternity services. Evidence submitted to our inquiry estimates that as a minimum, there need to be 496 more obstetricians and 1,932 more midwives. While we welcome the recent increase in funding for the maternity workforce, when the staffing requirements of the wider maternity team are taken into account–including anaesthetists to provide timely pain relief which is a key component of safe and personalised care – a further funding commitment from NHS England and Improvement and the Department will be required to deliver the safe staffing levels expectant mothers should receive.” 

“We recommend that the budget for maternity services be increased by £200–350m per annum with immediate effect. This funding increase should be kept under close review as more precise modelling is carried out on the obstetric workforce and as Trusts continue to undertake regular safe staffing reviews of midwifery workforce levels.“.

Despite this recommended additional funding for maternity, the government produced only half of what the committee said was needed. The Government did not even respect a parliamentary committee.

A whole year has been lost that could have stopped the current situation from developing. That funding has still not been provided.

Donna Ockendon reported on maternal deaths, baby deaths and the injury to some of the babies. She wrote this of the Cerebral Palsy cases;

“All of the families in this group self-reported to the review. The diagnosis of cerebral palsy was often made some years following their maternity episode. On reviewing the medical records, where it was found that the neonatologists at the Trust had recorded a diagnosis of HIE [(hypoxic-ischaemic encephalopathy] in the early neonatal period, a small proportion of families were subsequently transferred to the HIE incident category. From the remaining cases of cerebral palsy, more than 40 per cent were identified to have significant or major concerns in maternity care which might have resulted in a different outcome.”

Mistakes will be made in any field of medicine, though few with such catastrophic results as mistakes, or carelessness, in maternity care. Lessons must be learned from every incident and changes implemented quickly. This failed disastrously in Shrewsbury and the fault is not with the midwives (though significant mistakes were made ), but with the hospital management.

The government has made and is still making appalling decisions in funding and managing the NHS and particularly in maternity. A quick check on MumsNet today found a mother refused an induction despite her concern about her near term baby’s reduced movements. We are told to Count the kicks yet even today after Ockendon has reported, women are not always heeded.

The bureaucracy of the NHS also bears responsibility, if only for failing to describe publicly the damages from Government policies including; the shortages of funds for the NHS, bad workforce planning, the closure of beds and maternity units, not calling out the disaster of the “internal market” and for “managing” the news around incidents. We saw a pretence that all was well, whilst embarking on expensive new initiatives, like Continuity of Carer, without adequate funding and thereby driving out still more midwives. A background of bullying and silencing staff is also important. The number of midwives quitting because they do not feel that the system is safe surely should have been a warning to all.

Donna Ockendon notes

“The key themes identified requiring improvement within maternity services at the Trust were:
• The poor quality of incident investigations
• Poor complaints handling
• Local concerns with statutory supervision of midwifery investigations
• Concerns with clinical guidelines and clinical audit

…the review team has identified the following concerns regarding governance in
maternity services at the Trust:
a) Incidents that should have triggered a Serious Incident investigation were inappropriately
downgraded to a local investigation methodology known as a High Risk Case Review (HRCR),
apparently to avoid external scrutiny.
b) When serious incident investigations were conducted many were of poor quality.
c) There was a lack of learning and missed opportunities to improve safety.
d) There was a lack of oversight of serious incidents by the Trust’s commissioners.
e) There were repeated persistent failings in some incident investigations as late as 2018-2019.

4.8 The review team has found a concerning and repeated culture at the Trust of not declaring adverse
outcomes as an SI in line with the national framework. Instead, they were inappropriately downgraded
and investigated by what the Trust termed a High Risk Case Review (HRCR). This method of investigating
incidents, created by the Trust, was less robust, varied considerably in quality and lacked the rigour and
transparency of an SI investigation. Notably, HRCRs were not reported to NHS England, the Clinical
Commissioning Groups (CCGs) or the Trust Board, and therefore avoided external scrutiny.“

The Review also importantly recognises the damming consequence of Cumberlege’s National Maternity Review and the Midwifery Continuity of Carer model. With such poor staffing, such a programme not only cannot but should not have been implemented. We welcome The Reviews Essential Action for the suspension of this provision unless Trusts can demonstrate safe staffing levels on all shifts. The Review acknowledges the unprecedented pressures that the model places on services, services already under significant strain and the impact of which compromised the safety of pregnant women and their babies. We support the need for robust evidence to assess if it is a model fit for future maternity care. Currently, that evidence does not exist.

What is evident from The Review is the harm mothers and babies suffered from what appears to be withholding the use of caesarean sections. We will watch with caution the end of total caesarean section percentages as a metric for maternity services, as potentially we could see rates escalate and we urge continued careful monitoring.  

Apparent in The Review, is the fear staff had to speak out about their concerns. There can be no transparency, and no openness to change if free speech is not allowed.

Save Liverpool Women’s Hospital Campaign has been working since 2016 to

1. Expose the flaws in the funding and structure of maternity provision and

2. To support all who continue to work in maternity despite the odds.

3. To demand excellent maternity care for all, (including migrant women, who face dreadful charges for maternity care).

4. To fight for women’s healthcare.

5. To protect our hospital, Liverpool Women’s Hospital, on its Crown Street site.

6. To campaign for the NHS to remain free at the point of need, funded by the government, providing universal and comprehensive care, publicly owned and publicly delivered.

A publicly provided, well funded, universal maternity service, free at the point of need is essential. There is no solution to the problems the NHS faces to be found in privatising it. Cuts, shortages, coverups of shortages, and bullying, cannot keep our mothers, sisters, daughters, friends and lovers and every precious baby, safe.

The figures for maternal deaths in the US privatised model quoted by The Commonwealth Fund, prove this:

“Key Findings: The U.S. has the highest maternal mortality rate among developed countries. Obstetrician-gynecologists (ob-gyns) are overrepresented in its maternity care workforce relative to midwives, and there is an overall shortage of maternity care providers (both ob-gyns and midwives) relative to births. In most other countries, midwives outnumber ob-gyns by severalfold, and primary care plays a central role in the health system. Although a large share of its maternal deaths occur postbirth, the U.S. is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period.

Conclusion: The U.S. has a relative undersupply of maternity care providers, especially midwives, and lacks comprehensive postpartum supports.“

Women were not heard or heeded in many of these tragic events, indeed some were themselves blamed by the hospital.

Importantly, we must not forget the blame for all of these lies squarely at the feet of the government. Continued cuts year on year are destroying maternity services and the NHS as a whole. Allowing chronic staff shortages, poor staff satisfaction, high staff attrition rates, and unsafe working conditions are all political choices made by this government. Now we see mothers and babies dying. These are all political choices.

Women have a right to excellent maternity services. It is the government’s responsibility to provide this. This is the contract between citizens and the government Women must have the right to choose how they have their baby. Women are entitled to have the best advice on these choices. Women have the right to expect emergency backup when this is required. Women have the right to be both heard and heeded, especially when things start to go wrong. Women have the right to be heard and to participate in all reviews of serious incidents. Ockendon will strengthen these rights.

There is a thread in the media saying that natural births were somehow to blame. There is nothing in Ockendon to say this. Ockendon does say that poor monitoring, failures to intervene early, failure to use cesarean sections when urgently needed, and failure to listen to mothers, were all faults.

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Midwives are a highly valued profession. Midwives can make mistakes, of course, but the faults described in Ockendon do not blame midwives as a profession. A service with a good supply of well trained, and well respected (and well paid) midwives, helps save lives.

The Royal College of Obstetrics and Gynaecology reported on staffing issues last year.

The NHS funding model included penalties for having too many cesareans in a hospital. Funding for maternity was already inadequate and complicated, relying, in many hospitals, on subsidies from other parts of the hospital budget.

Since “Austerity” started, Government funding for the NHS has been inadequate. Staff have kept the NHS afloat through hard work and determination. Staff are worn out. Too many midwives are leaving the profession because of working conditions.

The fight to found the NHS came in large part from the fight for universal maternity care. Let’s make the fight for excellent maternity care in the twenty-first century spur on all our campaigns to protect and improve the NHS

The government does not believe in the NHS. Look at what it is doing to maternity care. Since 2014 they have been working towards privatisation, a US-style model of healthcare. The loss of the NHS or further cuts and privatisation will affect women, babies and maternity. This is the future unless we campaign against it, please join our campaign group – as Nye Bevan said “The NHS will last as long as there’s folk with faith left to fight for it”

We would like to thank https://www.facebook.com/groups/marchwithmidwivesuk for some of these photographs.

See also our earlier blog post,

https://saveliverpoolwomenshospital.com/2022/02/23/weep-for-the-shrewsbury-babies/

We don’t remember Polio, you and me. When we look at our little ones running around, playing, making a mess of freshly tidied rooms, it’s about the furthest thing from our minds.

Maybe some of us older mums will have heard snippets of stories from our parents. “Jackie’s friend had it” or “Some lad who used to knock around with your Uncle.” But that’s all they are, stories from a time gone by that soon become vague memories. We never have to retell them ourselves.

Leg braces are a rare sight these days and Iron Lungs you only see in history books.The fight against Polio is still there with vaccines and vaccines that need updating. None of our kids will ever have to wake up alone and afraid on a ward encased in a machine that breathes for them because of Polio.

The fight against polio is still going on in Pakistan and Afghanistan

Polio won’t ever paralyse our babies or snatch their little lives from them too soon, because our parents and grandparents didn’t stand for it. And when it comes to Covid, neither should we.

There was no cure for Polio back in the day and even now with how far we have come, there still isn’t. The reason you don’t hear about it anymore is because our Parents and Grandparents got rid of it the same way we’re trying to get rid of Covid, by vaccinating us against it. Their bravery to take the first step made sure that disease today is only talked about in history books.

People are starting to see the long-term effects of Covid now and it’s easier to see in children. Up to 100 children a week end up in hospital, many in Intensive Care, with what’s being called Long Covid. 75% of the worst cases are in kids from Black, Asian and Ethnic Minority backgrounds. Doctors still don’t know if there’ll ever be a cure.

We have the chance to be as brave as they were and save hundreds of our kids . So lets take it.

Let’s get rid of Covid.

Come to our community meeting about getting rid of the virus. Its on Zoom but we hope to put it on facebool live too.

Speakers will discuss the virus, vaccines, public health measures, how to reach all sections of our communities , pregnant women and new mothers, long Covid and the effects of the pandemic on the NHS.

There will be plenty of time for Questions & Answer sessions and public discussion

During the pandemic, the upper echelons of the NHS and the Government haver been implementing a structural reorganisation. The reorganisation breaks the national part of the NHS and integrates private companies into the reorganisation. It is being done without laws going through parliament.

The deadline for the response is 8^th January, and the link to the consultation is https://www.engage.england.nhs.uk/survey/building-a-strong-integrated-care-system/

We have joined with other organisations to try to raise awareness of what is happening. Many people will be aghast that this is happening at all, but during the pandemic, when all eyes should be on the virus, is doubly scandalous.

We are reproduce here the letter from Keep Our NHS Public. Other organisations are circulating in essence the same message. What follows is from the material produced by Keep our NHS Public

Integrating Care: Why NHS England is getting it wrong

NHS England (NHSE) is consulting on their latest plans for ‘integrating care’, including changes to legislation.

The proposals include a top-down re-organisation of the NHS in England abolishing CCGs, replacing them with 42 Integrated Care Systems (ICSs), statutory bodies under tight financial control from the centre and with even less public accountability. The result will be massive new opportunities for the private sector through the ‘Health Systems Support Framework’ (HSSF). While ICSs will find it difficult to work in real partnership with others such as local authorities in addressing health inequalities, proposals will allow private companies representation on an ICS Board.

Despite the short notice we hope you can respond to the consultation, which has a deadline of 8^th January.

We attach a template response to the consultation giving a range of possible answers for you to adapt.

We also attach background papers from Keep Our NHS Public:

     * Our summary of what lies behind the “Integrating Care” proposals

ICSs are an organisational form adapted from the US health insurance market, and the HSSF is central to their development. This Framework has 83 NHSE-accredited companies, 22 of which are US-based. We expect legislation will result in a flood of contracts, much as the government has dished out thousands of Covid contracts, bypassing proper procurement.

     * KONP’s response to the legislative proposals

These include a deregulated market economy in healthcare where even the existing, limited safeguards to protect social, environmental and labour standards are removed, and where a bidder’s track record is not taken into account.

Further detailed critiques of Integrating Care are available on the KONP website. These include a critique of the proposed structure and management of ICSs as revealed in NHSE’s Health Service Support Framework; critique of NHSE’s proposal to bring social care under NHS management; and proposals for real democratic accountability in the planning and oversight of NHS services as well as links to recent articles on ICSs in OurNHS/Open Democracy and The Lowdown (see https://keepournhspublic.com).

The Government has yet to publish a Bill. Once it has, we look forward to your involvement in resisting this drive to disintegrate the NHS through financial mechanisms and increased corporate influence.

To reiterate, the deadline for the response is 8^th January, and the link to the consultation is https://www.engage.england.nhs.uk/survey/building-a-strong-integrated-care-system/

Please do not worry about creating a long academic response. Please just respond. Try to keep a copy of your response and send it to  savelwh@outlook.com

Respond even if it is late.

Please write to your MP and please try to make sure your members know about this

Dear —

Integrating Care: Why NHS England is getting it wrong

NHS England (NHSE) is consulting on their latest plans for ‘integrating care’, including changes to legislation.

The proposals include a top-down re-organisation of the NHS in England abolishing CCGs, replacing them with 42 Integrated Care Systems (ICSs), statutory bodies under tight financial control from the centre and with even less public accountability. The result will be massive new opportunities for the private sector through the ‘Health Systems Support Framework’ (HSSF). While ICSs will find it difficult to work in real partnership with others such as local authorities in addressing health inequalities, proposals will allow private companies representation on an ICS Board.

Despite the short notice we hope you can respond to the consultation, which has a deadline of 8^th January.

We attach a template response to the consultation giving a range of possible answers for you to adapt.

     * Our summary of what lies behind the “Integrating Care” proposals

ICSs are an organisational form adapted from the US health insurance market, and the HSSF is central to their development. This Framework has 83 NHSE-accredited companies, 22 of which are US-based. We expect legislation will result in a flood of contracts, much as the government has dished out thousands of Covid contracts, bypassing proper procurement.

     * KONP’s response to the legislative proposals

These include a deregulated market economy in healthcare where even the existing, limited safeguards to protect social, environmental and labour standards are removed, and where a bidder’s track record is not taken into account.

Further detailed critiques of Integrating Care are available on the KONP website. These include a critique of the proposed structure and management of ICSs as revealed in NHSE’s Health Service Support Framework; critique of NHSE’s proposal to bring social care under NHS management; and proposals for real democratic accountability in the planning and oversight of NHS services as well as links to recent articles on ICSs in OurNHS/Open Democracy and The Lowdown (see https://keepournhspublic.com).

The Government has yet to publish a Bill. Once it has, we look forward to your involvement in resisting this drive to disintegrate the NHS through financial mechanisms and increased corporate influence.

To reiterate, the deadline for the response is 8^th January, and the link to the consultation is https://www.engage.england.nhs.uk/survey/building-a-strong-integrated-care-system/

In solidarity,

Keep Our NHS Public

NHSE CONSULTATION: building a strong, integrated care system across England

Please amend and adapt the wording below in your response to avoid any batch rejection of critical responses

Keep Our NHS Public (KONP) Overview Response to Integrating Care – The next steps to building strong and effective integrated care systems across England1

Introduction In the midst of a massive Covid epidemic, NHS England (NHSE) is driving through a far-reaching topdown reorganisation of the NHS, based on proposals in the Long Term Plan (2019). They are consulting until January 8 on the details of new legislation which they expect the government to enact early this year to give legal legitimacy to changes which are already under way. We are concerned that the implications of these changes for the accountability, availability and access to services and values underpinning the management of services have been barely noted within a tumultuous 2020. Noting the serious concerns that have been raised by the Local Government Association and others, including NHS Providers, we are asking all politicians, from every party, to take a stand against these damaging proposals.

Restructuring of the NHS in England .

At the core of the re-organisation are Integrated Care Systems (ICSs), bodies described by NHS England (NHSE) as NHS organisations that work in partnership with local councils and others to take collective responsibility for managing resources and delivering NHS care. ICSs have been driven from the top by NHS England, and in many areas resisted at local level by councils, GPs and campaigners.

However a 39-page NHSE document “Integrating Care,” seeking new legislation allowing the whole of England’s NHS to be run through ICSs by 2022, claims they are “a bottom-up response.” The proposals reduce the number of commissioning organisations from almost 200 to just 42 new “Integrated Care Systems” (ICSs). This has required merging (and eventually abolishing) local Clinical Commissioning Groups (established as public bodies by the Health & Social Care Act 2012), and replacing the 44 ‘Sustainability and Transformation Partnerships’ (STPs) set up in 2016.

The mergers inevitably result in larger bodies, more remote from the needs and concerns of any local community, and therefore a loss of local accountability. This point has been powerfully argued by the all-party Local Government Association (LGA), which represents the leaders of 335 of England’s 339 local authorities. Their response states: “We are concerned that the changes may result in a delegation of functions within a tight framework determined at the national level, where ICSs effectively bypass or replace existing accountable, place-based partnerships for health and wellbeing…. 1

https://www.england.nhs.uk/integratedcare/integrated-care-systems/ 2

“Calling this body an integrated care system is to us a misnomer because it is primarily an NHS body, integrating the local NHS, not the whole health, wellbeing and social care system.”

The Health Service Journal, aimed at NHS managers, has also shown how vague the proposals are: “ICSs will be given a single pot of money from which to manage spending priorities. But there is no framework for how this will be spent that assures fairness, value for money and quality outcomes.”

29 of the proposed 42 ICSs have already been approved by NHS England – even though they lack any legal status, and almost all are functioning behind closed doors with no public accountability. The remaining 13 STPs2 are required to become ICSs by April, or face the intervention of an “intensive recovery support programme.”

The LGA calls for the establishment of alternative structures involving genuine partnership with local authorities and, through them, links to local authority services and responsibilities that are vital components of the wider determinants of health.

Keep Our NHS Public (KONP) has issued a response to the lack of public accountability inherent in ICS structures, and set out proposals for developing genuine public accountability. The Report is on the KONP website here. KONP also rejects the assumption, repeated frequently throughout ‘Integrating Care’, that social care might be managed through NHS ICS structures. KONP campaigns for a publicly provided national care, support and independent living service.

At local level, we argue it is essential that social care continues to be managed by local authorities, retaining essential links to wider local authority responsibilities such as housing, education and leisure. KONP’s critique of the approach to social care set out in Integrating Care is here.

New legislative proposals Integrating Care seeks new legislation that would provide the formal legal basis for ICSs that they currently lack, as well as changes to existing procurement requirements. KONP argues for the abolition of the commissioner-provider split, believing the NHS should be provided and managed directly as a public service, not through commercial contracts. However we argue that what is worse than a managed market in health is an unmanaged and unregulated market.

The failed £multi-billion Covid-related contracts, including those for PPE or Test and Trace, dished out with no proper procurement procedures, have revealed what this can mean in reality.

NHSE wants to scrap Section 75 of the 2012 Health & Social Care Act which requires significant contracts to be put out to competitive tender, and to remove contracts from Public Contracts Regulations.

The prospect of changing the law so that more and more large NHS contracts could be awarded without any due process or public scrutiny is seriously worrying. KONP’s detailed response to the legislative proposals in Integrating Care is here.

Values underpinning the management and direction of ICSs Under proposals for ICSs, all providers will be bound by a plan written by the ICS Board and financial controls linked to that plan. Private companies may support the Board and potentially have a place on the Board, as well as being contracted for services.

NHS England has established a Health Systems Support Framework (HSSF) to facilitate easy contracting by ICSs. The Framework consists of organisations accredited by NHS England to support the development of internal structure and management of ICSs, and, potentially, also to play a longterm role in direct management of ICSs. A quarter of the 83 organisations approved by NHSE to take on contracts with ICSs, and potentially also take seats on decision-making Boards of ICSs (as has happened in North East London) are American-based, offering expensive data-based systems designed to benefit US insurance companies and private hospital chains.

Research in the USA and experience in England has exposed the lack of evidence that data-led attempts at “population health management,” or targeting the small number of patients with complex medical and social needs, can either reduce demand or cut costs. However, such approaches do facilitate the development of private insurance pathways running alongside NHS care.

Digital technology and number-crunching are among the more lucrative areas in which private companies are seeking profitable NHS contracts, and this is a strong theme running through the HSSF. However digital and data are also areas of notorious recent private sector failures – including the Covid-tracking app, the privately-run test and trace system, Capita’s long delays in contacting professional staff offering to return to fight the pandemic, and the £10 billion saga of the NHS Programme for IT.

And while Integrating Care argues for the need to establish ICSs as “statutory bodies” with real powers, notably “the capacity to … direct resources to improve service provision,” there are real fears that NHS England sees ICSs and ‘system-wide’ policing of finances as a way of more ruthlessly enforcing cash limits and “control totals” limiting spending across each ICS, with growing lists of excluded “procedures of limited clinical value”. These approaches to structure and management of ICSs pose a major threat to the NHS, distorting and undermining the core values and ethos of the NHS.

Conclusion Integrating Care raises serious concerns for the future of the NHS and social care services, concerns that we set out in detail in papers available on the KONP website, along with proposals for alternative structures and why social care should remain the responsibility of local authorities. Our concerns, based on hard facts, are widely shared by councillors, senior NHS management, GPs and seasoned analysts. NHS England’s proposed changes threaten to make the NHS less locally responsive, less accountable, more dominated by US and other management consultants and contractors, and more focused on policing cash limits than meeting the needs of patients. NHS England’s priorities should be on strengthening the NHS in alliance with local government and communities, not creating new remote bodies or adopting systems meant to maximise profits of private health insurance. Keep Our NHS Public (KONP) January 2021 https://keepournhspublic.com/