Maternity Care is for the mother and baby, it is no place to be making profit.

Women can give birth at home in Liverpool using the NHS.

There is no sane case for commissioning another private for profit Maternity provider. This idea of bringing in yet another for profit provider was raised, in passing, at a health and social care select committee meeting in Liverpool this week. It follows the One to One company closing and causing significant hardship to pregnant women and to the midwives working for them.

Other bad ideas were raised at the meeting about restricting prescribing, and this took the attention at the meeting. The meeting was listening mainly to a presentation about digital innovations. The idea of another maternity provider was only mentioned in passing but it meant the Liverpool and Wirral CCG are looking at this crazy idea. Wirral CCG wrote “procurement exercise is ongoing to seek a new provider for this service”.

The idea of finding another provider was also mentioned in Warrington paperwork about the collapse of one to one. In this the letter from One to One it says

If a member of CNST becomes insolvent its membership will be terminated and, under the scheme regulations, its liabilities are treated as those of the commissioner. This is a very important provision, of which some commissioners may be unaware. It serves to demonstrate the importance of establishing the financial standing of organisations to which contracts are awarded, and also of understanding if any sub-contractors are to be used and their financial/professional standing. If insolvency occurs after the loss of NHS contracts, NHS Resolution will ask the commissioner to assume liability for claims under its own membership of CNST.”

So the NHS takes over all the liabilities of the company. The for profit company does not carry the risks at all.

The letter from One to One letter also says

As the CCGs have already given notice on the contract I understand that you will have your own exit strategy and as such One to One will continue to work with the CCGs on this until 5pm 31st July. Please ensure that your exit strategy is communicated as quickly as possible so that we can collaborate on the necessary steps within the timeframe available to us.

The NHS in Merseyside provides all kinds of  maternity care.

Home births

Midwife led units

Standalone midwife units

Obstetrician led care at several hospitals

Recently a private company operating under an NHS logo and commissioned by the local CCG abruptly stopped trading, leaving hundreds of pregnant women, new mothers and midwives in the lurch. They operated in

NHS Wirral
NHS Liverpool
NHS Warrington
NHS West Cheshire
NHS South Cheshire
NHS Vale Royal
NHS South Sefton
NHS Southport and Formby

An advert for the collapsed company

Liverpool Women’s Hospital and other NHS providers had to go into emergency mode to support the mothers and to recruit more midwives. Another company would mean this work is wasted. Job security for midwives would be again disrupted

The first home birth from the collapsed company’s list was supported by Liverpool Women’s hospital within 24 hours of the closure of the service.

Liverpool Clinical Commissioning Group who make such decisions wrote

A re-procurement exercise had already been ongoing for a number of months before this announcement, which will ensure that a new provider is in place for this service from 1 April 2020. “

So the CCG seems to have known about the company’s situation some considerable time before the collapse. Should the pregnant women not have been told?

The support mechanism for all the abandoned mothers registered with One to One was a major operation across Merseyside and Cheshire. Mothers’ notes were not available and extra scans had to be arranged.

We cannot have maternity care, or other key treatments used like this.There is only one chance of safe birth. Mistakes at birth can see life changing damage for mother and babies.Maternity has more insurance claims than any other field of medicine.

Already the UK has relatively poor outcomes for maternity, especially for poor mums and black and ethnic minority mums. We cannot have experiments to suit privatisers. We need public service ethos and for all maternity to be within the NHS research and professional education envelope and safety precautions.

Private providers operating by commission from the NHS have a history of quitting, but it is especially dangerous to have maternity in this mix. Our mothers and babies matter, not the shareholders and speculators. Commercial sensitivities should not override pregnant women’s rights to know what is happening.

We support the idea of an enquiry into what happened with One to One. No commissioning should happen before this enquiry.

We call for much better funding for the NHS maternity care, and better working conditions for midwives, with bursaries brought back and fully funded paid reentry schemes.

Continuity of care is used in the NHS with small teams and is used locally especially for homebirths and midwife lead units. Continuity of care is in no way exclusive to private providers, it is used also in the NHS. Many women were not aware of this and the collapsed company used it as a selling point

Continuity of care means that the same small team of midwives sees the woman all through pregnancy delivery and post natal care. Its not viable for allservices either in staffing terms or in finance but it is used in home births where possible.The private provider also had to change midwives when holidays, sickness ot women going into birth at unexpected times, happenned

Join us in camapigning for better maternity care across Britian on October 5th in Liverpool at the Save NHS Maternity Services National Meeting

Is Bridgewater being lined up for this contract? They have relationship with Liverpool and Warrington. Commissioning is so hidden few know. The Midwives and mothers deserve stability, not cloak and dagger action behind a screen of commercial confidentiality

September 2019 Bulletin

Save Liverpool Women’s Hospital September 2019 Bulletin

Save Liverpool Women’s Hospital. This is the largest maternity hospital in Europe, delivering thousands of babies each year. It also serves the health of the region’s women. It is in a pleasant building on a pleasant site within a mile of the largest acute hospital in Liverpool. It is well-loved by the community. Tens of thousands have signed petitions, online and on paper, and attended demonstrations and meetings to save Liverpool Women’s Hospital. This hospital is just one of many suffering under the NHS,  being starved of funding, seeing the effects of national staffing issues, and being used as a milk cow for private companies. Please sign our petition.  There are still plans to move the hospital.  These plans are mentioned in each set of minutes from the board. Yet while these plans are discussed millions are being spent on the new, and much needed,  neonatal unit. There  are few institutions  more bizarre than the current NHS national administration, 

We say

Fund the NHS to Western European levels at least

Write off all debts caused by the internal market and competition systems

Research and improve outcomes in pregnancy, for mothers and babies

Research and improve all women’s health issues.

Defend the NHS from Trump trade deals

Defend the NHS from Brexit disruption

Make the NHS once more a universal service for all.

Train more staff, bring back bursaries, defend the EU staff, and the Windrush staff

Stop accountable care plans, and all the STP chaos.

 Stop rationing care.

Fund maternity care better nationally and locally

Improve our hospital onsite

Austerity is coming out in the wash. “Fiscal Responsibility” that has left the NHS in tatters, staff underpaid, and admissions to hospital for malnutrition growing and life expectancy beginning to fall was not needed after all. All that was needed was a change of heart or some electioneering by the Conservative government. Sadly, the first set of money Johnson pledged to the NHS turned out to be doublespeak, for the money was already there! Money invested in good healthcare repays not just in health and happiness, but in increased economic wealth for the country. Money spent on good health care is an investment.

£9.2Billion was given to private companies in 2018. NHS should never be  for  profit, it should be for health, whilst key services are cut for ordinary people, making unnecessary pain discomfort and disability part of life

It will take a lot of work to get rid of the damage of Austerity in the NHS. The public and the staff must be involved in the rebuild. It should not be left to those who have supervised the damage
( The image is a 1910 advertisement for soap)

Defend the NHS from Trump and the big health corporations who want the NHS for many reasons. The NHS as the largest health care provider in the world can negotiate with the big pharmaceutical companies over the price of medicine and medical and surgical equipment. This negotiation becomes a base rate that other countries and hospitals can use to hold big pharma to account.  If the NHS becomes owned and run by the big health care corporations the price of Drugs can go higher globally. There is no stopping them. Johnson’s trade deal with Trump puts the NHS as the main item. For much more detail on this please listen to this podcast from Tax Justice

Universal health care for all, publicly provided, and government-funded is the most cost-effective and efficient form of health care in the world. The US has the least efficient and one of the cruellest. Yet this is the model being forced onto the NHS.

One case from the US. Defend the NHS! 44 million Americans are uninsured, and eight out of ten of these are workers or their dependents. No health insurance means no healthcare, or paying yourself and losing your house. Millions are in support of Bernie Sanders who advocates healthcare for all

Antavia died two years ago. She was a Type 1 diabetic and depended on daily doses of insulin to live. But she could no longer afford to pay for the life-saving hormone once she aged out of her juvenile medical assistance programme at 21. Antavia was working two jobs but her pay and limited insurance were not enough to cover the cost of the insulin and other crucial supplies, like test strips. She was paying between $1,200 and $1,300 for a 90-day supply of insulin. At times she got insulin from her sister Antanique, who also has Type 1 diabetes, at other times from her grandfather. But finally, she had to start the dangerous practice of rationing. Antavia died on April 26, 2017, from diabetic ketoacidosis. She was 22.

Liverpool Royal Hospital Crisis smoulders on. Liverpool Royal is set to ask the government for £300m to complete building works on a former Carillion hospital after engineers identified a series of problems with the structure. (HSJ).Meanwhile,

New_Royal_Liverpool_Hospital_under_construction_2
Photo from Roofing Today 

patients and staff struggle to get by in the old hospital. We have to send our thanks to all the Royal staff in this situation. They are so very good. Now, who will say we were wrong to oppose moving Liverpool Women’s Hospital to the Royal site, using a PFI to finance it? (The PFI option is in the published business case)

Keep our hospital onsite

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Liverpool Women’s Hospital in the rain. Keep it on-site, well funded with  investment like the investments in the neonatal unit

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image from the Independent

Privatisation in the NHS is not just about patients having to pay for their treatment, though that is part of it, one of the most unpalatable parts, and most difficult for politicians to “sell”  so it has been left till the last stage. Privatisation does mean all of these points

  1. Companies making a profit from  the NHS
  2. The NHS being changed to suit the private sector
  3. Services being cut to make the NHS look bad, so privatisation can be made more popular
  4. Private sector hospitals being funded by the NHS
  5. NHS staff being outsourced and losing pay and conditions
  6. Treatments and care being rationed to serve budgets built to help the corporations
  7. Charging some patients for some care. It starts with migrants, then goes to those who are denied treatments, like in Warrington, where we joined campaigners to get this “paused”
  8. Some Migrant women are charged for health care.
  9. The final stage would be that the whole system is run for profit and charges become the norm.

Liverpool Women’s is one mile from Liverpool Royal Hospital. The Royal Hospital site we believe is an inappropriate place for a maternity hospital and a Women’s Hospital. This is explained in earlier  posts

small maternity matters shotWe  have called  a national meeting to discuss the national crisis in maternity provision, to bring together campaigners across the country to defend NHS maternity services

We have  written more about these issues here

Please do register to attend if you care  about safe well funded well-staffed  woman-friendly maternity services

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Speak up even if your voice breaks

Speak out for the NHS. Speak out for proper funding, proper staffing, decent buildings and for democratic control. Democracy means the government of the people, for the people by the people, with the right to speak out and speak up. The NHS, it is said, will last as long as there are people prepared to fight for it. Good care is still provided in may aspects of the NHS but the system is suffering significant damage. If enough of us speak out and mobilise in our workplaces and communities, we can save and improve the NHS. This is no time for despair or helplessness.

Join a camapign to save the NHS, raise it in your union, talk to family and friends.

The NHS needs more doctors, midwives, nurses and other medical professionals and we need to treat those we have much better. The health of the nation and the health of our health workers both matter.  Good health care is good for our health, happiness, and well being. Good health care pays back expenditure three times over. We challenge anyone who still believes we as a county can’t afford good health care system to debate with us in public.

In Maternity care, we need much more work to be done to reduce stillbirths and miscarriages, to reduce maternal deaths and reduce unpleasant and painful labour and birth, to reduce birth injury, to provide much better postnatal care to mother and baby, improved support in breastfeeding and maternal mental health provision. We also need more democracy in the NHS, with the right to speak out and make a difference. So its much more than staff, funding, bricks and mortar but these are essential building blocks. It is from public support, good staffing, buildings and good admin that a great health service is born.

We need good well-maintained buildings and building projects that don’t cost a fortune

We need staffing planned over decades and we need urgent immediate action to retain the staff we have.

Speak out for the NHS because the people who gave us PFI and Carillion are running our NHS and can make just as big a mess of our health care as they have of the building of hospitals

We need a good capital programme to allow for refurbishments, improvements and rebuilds, planned over time and not involving the utterly scandalous waste on PFI as typified by the Royal Liverpool Scandal.

Public investment pays back into the economy in jobs and in its final product. Its not a waste and it can well be afforded.

Women’s health in this country must be improved. Women live longer than men but with many years of ill health, and this is getting worse and it is worst of all in poorer areas like Liverpool. “When compared with the earliest period 2009 to 2011, HLE ( Healthy Life Expectancy) at birth has increased by 0.4 years for males and reduced by 0.2 years for females in the UK.”

For all our babies. More babies are dying under one in Liverpool. Poverty is significant in this but quite well off babies die too. This is not neo natal deaths, but babies under one Neo natal deaths are rising too. Babies born to Black or Black British parents had a 50 per cent increased risk of neonatal death compared to babies of white ethnicity. according to Bliss

Babies are so precious . Speak out for good health care for every baby.

Investment in the NHS should come from government. PFI costs 40% more than using government investment and is costing the taxpayer hugely ” Taxpayers will be forced to hand over nearly £200bn to contractors under private finance deals for at least 25 years“,

Schools in Scotland built on PFI had major problems, and of course in Liverpool, we have the ghost school in Speke. We covered PFI scandals this in detail in another post and there is more here There is a font of information here too

Where was the supervision of these contracts from the NHS?

There is more to the PFI scandal than just money. The construction of the hospitals was not adequately supervised and major construction faults resulted. Carillion was far too big and badly managed to carry too many roles previously run by government bodies. When it collapsed, who was held to account? Who went to prison? Where are they working or “investing” now? We know that workers lost their jobs, lost pensions and apprenticeships.

There should have been clerks of work from the customer, the NHS, checking every stage. Clearly, this did not happen. A hospital company was even set up in Liverpool, but even then the scandal was not averted. One new Scottish hospital has huge structural problems and might need to be demolished.

When will the Liverpool Royal New Building actually open? Is it 2022 as mentioned at a board meeting?

Meanwhile, how can the old building be kept safe? How can the electricity be kept working, the water kept working? the heating and cleanliness sustained?

Liverpool’s Royal hospital is the epitome of this scandal, a PFI that campaigners warned about in detail, even to the extent of trying to stop it in court and then having labour councillors challenge their right to legal aid Veteran campaigner Sam Semoff was told to “Bog off Semoff” by Joe Anderson, Mayor of Liverpool on the front page of the Liverpool Echo

Sam camapigning with the junior doctors

Many hospitals are struggling with all of these problems, with revenue and capital funding and with staffing shortages and the poverty of their patients and many of their staff. The Health Service Journal reported  that a Trust in Cambridge, whose capital bid to improve its maternity services have been repeatedly turned down by government has been told by the Care Quality Commission to make urgent improvements to the obstetrics department after an inspection prompted by three serious incidents.

Pregnancy-and-loss-stats-Jan19
life and death issues

The national maternity crisis rumbles on. Shortages of doctors and midwives are significant problems These problems are well known and have been studied in detail.

There are solutions to these shortages but they will take time. A pay rise would be a good start. The end to the internal market to reduce utterly unproductive admin and competition would be a help in improving the staff shortages. Let’s try to retain the staff we have, and treat them well. This means Spanish staff being able to go home to see their mum without risking being stopped by paterls nonsense of the end of free movment. A democratic management structure in the NHS where people can speak out freely would also help.

Brexit, of course, is a major barrier to solving this by recruiting from the EU and Priti Patel’ s nonsense about not allowing migrants to come into the country if they earn less than £36 000 per year will rule out a fair few nursing posts. The NHS is trying hard to recruit new nurses from abroad but much as we welcome overseas nurses we must train and retain staff in the UK too

Bring back bursaries for midwives and nurses. We need fully paid re-entry courses for those who might want to return to nursing. We need a major recruitment and support programme for the staff who teach these courses

The NHS should be much better funded. Our very lives depend on it. How can any government committed to the needs of the people deny that? Already poverty is stalking the land, and life expectancy is falling. Poverty is well known to make people ill, less able to recover from illnesses, and the poor have worse access to health care.

Sadly our NHS is being shaped up to be handed over to global health care corporations on the US model and Trump doesn’t even mind us knowing that.

Simon Stevens head of the NHS worked for US health care before he came to the NHS and the model he is driving is based on that for-profit model No doubt he sincerely believes in the market model but it has resulted in an NHS in dire difficulties

Revenue and capital funding

There are two streams of money going into the NHS, one is revenue which is for day to day spending, and the other is for capital which is for longer-term building programmes like the multi-million-pound Neonatal Unit being built at Liverpool Women’s Hospital.

Since the demise of PFI and its thunder of profits running into private business, capital spending has been restricted in the NHS. Some hospitals have diverted smaller capital spends to day-to-day maintenance, but very many hospitals are physically run down. Some hospitals, unlike Liverpool Women’s, are a mish-mash of buildings some a century-old, some portakabins, some in very poor repair.

The poor physical buildings should not affect doctors numbers, but doubtless a nice environment helps staff as well as patients

Democracy and transparency in the NHS should be introduced. The current sytem is so complex and convoulted few lay people understand its structures. One thing most people know is that the Care Quality Commission inspects hospitals and other NHS bodies and care homes for safety. However one patient in Warrington was asked to leave her practice because she posted a public CQC report on facebook

NHS camapigns are already a social movment with its own newspaper but this social movment needs to grow. We need politicians to stand with us and to move legisaltion to reinstate the NHS, to refuse to cooperate with the formation of ACOs and othe privatisation structures at local level.

The Save Liverpool Women’s Hospital Campaign opposed the creation of a PFI to “rebuild” the Women’s hospital. We were absolutely correct to do this. We objected to the move to the Royal site. We were proven correct. That Royal building site will be a work in progress for years to come We want money spent on improving the buidling on site.

 Join us in camapigning for good maternity care across the country.

For fully funded NHS maternity care, publicly provided.

In this article, we are looking at care in pregnancy, delivery and post-natal care. The occasion for this article is the closure of One to One Midwives, a private, for profit company, contracted by the NHS.

Giving birth is a momentous occasion and one where the mother must feel she has good safe care, that she will be treated as a fully functioning adult, and that her wishes really do matter. It is within living memory that this was not available to working class mothers, and the outcome of this lack of adequate care was that giving birth was more dangerous than working in a coalmine.

We fundamentally oppose the for profit, private provider model of healthcare as bad for babies, bad for mothers, bad for staff, and bad for the taxpayer. The private provider model of care is not the same as the private health care model where the patient pays for each treatment (though that too is coming our way).

NHS has  provided fully funded home births with excellent hospital back up close by , as well as hospital and midwife lead units, with experienced midwives with full access to latest training and research . Homebirth is a superb idea for some mothers. It is not universally available but only a tiny proportion of mothers (2.1% in 2016) do chose this mode of giving birth. More women might consider it if the service was more widespread. However, that is not what One to One was about; it was about the private provider model.

It must be truly upsetting to be told that the midwife service you were using has suddenly closed. Many of the women involved had no conception that this was even a private company. They had been referred by their GP. The shock must have been serious. Equally, the midwives must have thought that they had some job security. A planned closure would have been better for all. Certainly, in Liverpool Women’s Hospital, plans have been in place for this eventuality for some time, so someone must have known what was happening. Wirral has plans in place As we write this, we do not know if other maternity hospitals had similar plans for this eventuality.

After this closure some of the one to one midwives are setting up as “independent midwives”  some offering services for free to ex-One to One customers nearly at the point of delivery. Users need to be  certain  that insurance is in place This could become another company bidding for NHS contracts. Let’s hope not.

There is a cohort of individual independent midwives who practice outside of the NHS, specialising in home delivery, where the family meets the whole cost. This is not the same as the for profit companies taking NHS money, and operating within the NHS budget.

How did it come about that a private company had this vital role, and what happened?

The maternity service is a bedrock of the NHS The whole NHS has been deprived of funds in the utterly spurious name of Austerity.

Britain has a significant shortage of midwives. This shortage has several causes. Ending the bursary has prevented older women with family responsibilities from training. The workload and lack of resources, stress levels, lack of respect and democracy at work, and poor pay have all added to this. Brexit has severely reduced the number of EU midwives coming to work in the NHS There is more detail on this here.

Some midwives saw the opportunity to work in what they thought would be a better atmosphere using the famed “Continuity” model and took jobs in the private provider.

The NHS has been offered out to private providers who take profit without responsibility. Currently, if you have an operation in a private hospital and there is a crisis you are blue lighted to the nearest NHS acute hospital. It is not a separate and discreet service.

The founder of One to One is Joanne Parkington, who is a strong advocate of for profit services in the NHS. One to One it seems was a franchise. It has ceased to trade with significant debts.

Funding for maternity is inadequate. The maternity tariff makes it virtually impossible for standalone maternity hospitals and units to manage financially, and most services in acute hospitals are subsidised by the main hospital budget. Many of these trusts are in deficit. They do not overspend; they are underfunded.

It is hardly surprising that a service that can scarcely fund the much more economical and efficient public provider model cannot also provide enough money for a private provider, who wishes to make profit on top of meeting the services costs.

Continuity model of care is supported by most of the theorists of childbirth, but there are not enough midwives to deliver it. It would require huge recruitment of midwives, which would take at least 5 years to come to fruition, to see this in place, and significantly more money injected into the service. We campaign vigorously for more staff, less workplace stress, more money, and more maternal choice. We somehow doubt that is the intention of the privateers running the NHS top management right now.

Continuity of care requires that the same midwife see the mother from the first meeting to post-natal care. Midwives though, need to sleep, take holidays, go on sick leave, and have professional training, so they cannot be available 24 hours a day, even if they had only one client. When they have more than one client, this becomes virtually unworkable. So a team of midwives is used, the mother will see midwives from the same team, and one or two of the team know her really well. Even this model is stressful for the midwives. If there is downtime and it is a quiet time on the team, the continuity midwives (operating in the NHS) may be diverted to other life-saving work, leaving them unavailable to the women they are primarily looking after.

The professional community of midwives and obstetricians. All NHS care statistics are supposed to be collected and critically examined to produce a clear picture of the best procedures and the procedures to avoid. At a personal level, a midwife working with colleagues having time to discuss and support each other also helps deliver safer services. The opportunity for NHS staff to engage in professional education and training is also crucial. The body of knowledge created by more than 70 years of NHS professional development is one of the golden nuggets the privatisers are coveting. Private providers cannot match this.

We oppose the privatised health care model

Better Births by Conservative Baroness Cumberledge, (which we have analyzed elsewhere on this blog, and which is demolished here) told a cosy unreal story of how good maternity care should be, with more homebirths and with the continuity model of care. It neglected to do anything to stop the utterly damaging deprivation of funds or the staffing crisis.

Using this model One to One bid for contracts to provide maternity care for the NHS. Most mothers were not aware it was a private contractor. The company popped up in many areas. At least one CQC report was appalling.

Previously “Ninja” privatisers were supported by the people reshaping our NHS in the model of the USA, as this article from 2015 shows. The One to One model is now out of date as a form of private for-profit intervention into the NHS. Once it was the darling of the privateers. It even had its name on an office the Seacombe Maternity base. However the 2019 model is that the commissioning model be restructured so that the major US and global health corporations can insert themselves into the NHS, not as small companies, but at regional STP or ICP level, controlling the whole shebang . The smaller privateers are no longer favoured.

The USA, on whose model the NHS is being restructured, has poor maternity outcomes. This article shows how both the US and UK need to improve their maternity care and the health of women, to reduce the deaths of mothers and babies

Nothing is more important than good maternity care. Maternity is the largest single reason for people to use NHS hospitals. Maternity Care provides care at the start of life and the onset of motherhood. Save Liverpool Women’s Hospital are committed campaigners for good health care for all. We are proud to be part of a large group of NHS defenders across the country. The focus of our campaign is care for women and babies. Women suffer years of unnecessary ill health because of life in Austerity Britain and poor health care. Internationally and nationally, medical research focusses on men.

The returns for Liverpool Women’s hospital show that the experience of very many of the women giving birth at Liverpool Women’s hospital, or with their home birth team, is positive. Our campaign is adamant about the need to keep the hospital on site, keep it focussed on women and babies and keep the hospital and maternity care in the NHS publicly funded and publicly provided.

Liverpool Women’s Hospital is the largest hospital in Europe exclusively caring for the health needs of women.

In 2017/18 the Trust:

• Delivered 8,497 babies (2016/17 8,891) – an average of 23 babies were born at Liverpool Women’s every day (2016/17, 24);

• Undertook gynaecological procedures on 5,469 women (2016/17, 5,551);

• Cared for 1,004 babies in the neonatal intensive and high dependency care units (2016/17, 1,038); and

• Performed 1,381 cycles of in vitro fertilisation (IVF) (2016/17, 1,413).

 Further Evidence of the need for improved provision for maternity services is available at Tommy’s charity

Crisis in Maternity Care

Save Liverpool Women’s Hospital campaign have called a national meeting on Sat 5th October to discuss the crisis in maternity in the NHS and how we can oppose the Tory government agenda for maternity. Tickets can be obtained here

Dr Rebecca Smyth, Senior Lecturer in Midwifery explains to Lesley Mahmood of Save liverpool Women’s Hospital Campaign

 I worry about the current situation of midwifery as well as the future. Having a shortage of 3,500 midwives without doubt impacts on the care midwives can give women. Poor and inadequate care due to the shortage of midwives leads to poor outcomes for women and their babies as shown in the recent MBRRACE-UK Perinatal Confidential Enquiry (2017). The report outlines how heavy workload and staff capacity issues can affect care provided, leading to delays in transfer to hospital, plans for induction of labour being postponed and difficulty in providing some elements of advanced life support when a baby requires resuscitation after being born. The report’s stark findings attribute some babies dying to staffing issues, including paediatric shortages, lack of hospital beds and high clinical activity.     

What changes have you seen in the last few years?

A consequence of poor staffing leads to midwives being overworked, which then results in midwives leaving the profession, either mid-career or retiring early. Midwifery was always a job for life, a vocation. However, so many midwives are at breaking point, I see my colleagues leaving the profession much earlier than they previously had and the reason they give is plain and simple; they are overworked, exhausted and feel dissatisfied with the quality of care they give. It is both sad and worrying; this was never the case in the NHS.

What concerns do you have about the current government agenda for Maternity?

Better Births, in particular Personal Budgets really worry me. The personal budget will be given to women for them to ‘buy’ care, care that is already provided in the NHS free of charge, so buying is not necessary, unless you are a government that wants to bring in payment / privatisation of healthcare. The budget would then be useful in opening the way to full-scale charging, and we know the poorest of society are in the most need of health care, often needing additional investigations and treatments linked with their poor health status.  

How can the shortage of midwives be overcome?

 The easy answer is train more midwives and as a consequence midwifery teaching departments at universities are being strongly encouraged to take more students. However, at present there are not enough clinical midwifery mentors, clinical placements, educational institutions or educators to facilitate this. Resources are lacking too, booking classrooms for a cohort of 75 students in many universities is impossible, meaning classes are split into two, therefore doubling the number of lecturers required. So it is not an easy fix.

As way of dealing with the lack of clinical mentors (caused by understaffing as well as increase in student numbers) the Nursing and Midwifery Council has revised the national standards and now the traditional Mentoring model has been replaced with a new Coaching model. So instead of student midwives having their own personalised mentor they now share this person with two other students. The rhetoric is that it encourages students to support each other and shares the responsibility of practice learning among the whole team. Or put it another way dumbs down clinical mentorship. Midwives learn to be midwives in the clinical area, the teaching in the clinical area is fundamental; if this goes, lives will be lost.    

Why come to the national maternity meeting in Liverpool on 5th October?

 The problems with the maternity services feel so overwhelming this is a chance to come together. On a day-to-day basis as a midwifery educator, I am reminded of the crisis we are in. I visit the clinical area to see my students and feel for the staff, you can often see the overcrowding of a labour ward, the noise of unanswered buzzes, the midwife grabbing a long needed bite to eat at the desk and others charging from one room to another. I know many midwives who have worked in this environment for many years and they have my upmost respect. Yet at times in the press, they are treated like uncaring incompetent beings. They cannot win. 

I myself feel completely overworked, I have a large group of personal students, which is an oxymoron really as you never get to know them on a personal level, you just fire fight with them in the hope their journey to becoming a midwife is successful, rewarding and enjoyable, just as mine was.

The nub of it all is the shortage of midwives, clinical and educators. Yet midwives say to me, there are easier jobs. The job was never easy, but we had enough staff to look after the women and our students. Enough staff to forge friendships, get to know each other in the quiet times, so when things got tough you knew your work colleague, she was your friend, and you all mucked in together. Working relationships, sharing the burden of a busy shift is a priceless component to good care. But without good staffing levels and a real acknowledgement by the government nothing will change.

Midwives I know are amazing people and we all know how privileged we are. Supporting a woman through pregnancy and particularly birth is an honour. At the last SLWH rally a woman came up to me. I had delivered her grandson. He’s now 24. You can’t beat that can you J    

Contact SLWH C/O News from Nowhere Book Shop, 96 Bold St, Liverpool L1 4HY

Facebook Save Liverpool Women’s Hospital

Email savelwh@outlook.com

Twitter @lwhstays

This article was first published in Health Campaigns Together

Images with the srtists permission from from The Birth Project and Cyrano Denn

Breast reduction is not of low clinical worth

Breast reduction is one of many operations the NHS is beginning to refuse to do on the basis that it is “of low clinical worth“. We challenge this. We believe this refusal is part of rationing of treatments, especially treatments for conditions where private health sector has been established. Moreover the My Choices scandal saw attempts to charge for these operations within the NHS itself. It is rationing care, funding the private sector and depriving those without funds of treatment that can stop pain and be life changing.

Sheila Altes reviews the evidence

Response to the 2017/2018 Revised Policy Position A14 Plastic Surgery

A14.1 Reduction Mammoplasty- Female Breast Reduction

The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) published a commissioning guide for breast reduction surgery(2014).

The guidance relates to patients that present with breast hyperplasia where breasts are large enough to cause symptom, infection, pain and effects quality of life. It goes on to say that the quality of life of patients undergoing breast reduction surgery will improve by amelioration of associated physical symptoms and they will be unlikely to present with further symptoms. There will also be an improvement in the patient’s psychological well being, self-esteem, willingness to engage in social activities and employment potential. They conclude that this is a low cost procedure which will gain patient improvement and reduce the need for primary care physical treatment.

They state that breast reduction surgery should be considered for patients who meet the following criteria:

* Are physically fit

* Have a body mass index (BMI) less than 27.5

* Excised breast weight of 500grams and upwards

* Are non-smokers

*If the patient is taking medication for other long term conditions eg. Diabetes

Have some OR all of the following signs and symptoms:

* Emotionally and socially bothered by having large breasts

* Low self-esteem

* Breast size limits physical activity

* Back, neck and shoulder pain caused by heavy breasts

* Has regular indentations from bra straps that support heavy breasts

* Has skin irritation, intertrigo beneath the breast crease

* Breasts hang low and has stretched skin

* Nipples rest below the breast crease when breasts are unsupported

* Enlarged areoles caused by stretched skin.

The 2017/2018 Revised Policy on breast reduction surgery, list eligibility criteria to meet before funding reduction mammoplasty that is similar to the guidance. However they stipulate that ALL of the criteria must be met.

BMI as a criteria for allowing the operation Particularly contentious are those relating to BMI, which they state should be less than 25 and cup size which must be size H or over.

To deny access to breast reduction surgery based on a patient having an ideal BMI and maintaining that  measurement for 12 months is not realistic in a country where 64% of adults are classed as overweight or obese (Health Survey 2017). There have been several studies on the incidence of complications in overweight or obese patients following breast reduction surgery.

In a study of 273 women in Finland (Setala 2009) the impact of body weight on post operative complications was recorded. Post operative complications were frequent but overall complication rate did not correlate with body weight, BMI, age, surgical technique or surgical experience. Results indicated that obesity did not increase the complication risk in breast surgery reduction to the extent  that access to reduction mammoplasty should be restricted based solely on body mass index.

The implications of obesity in the context of breast reduction surgery remain unclear. Several studies have demonstrated an increased risk of surgical site complications including delayed healing, infections and haematoma. However a large prospective multicentre trial demonstrated no association between obesity and complications (Simpson et al 2018). The study demonstrated that an increased BMI is independently associated with total complications, thus indicating that obesity affects local wound complications. However it is impossible to say whether increased local complications were due to impairment of wound healing resulting from obesity or from the surgical  management differences. Such differences could include differing operative techniques in obese individuals.

Complications following breast reduction surgery are uncommon and generally mild. It is important to weigh the potential risk against benefits when operating on patients with an elevated BMI. Coincident medical conditions may preclude surgery, but isolated obesity may represent an acceptable risk to both patient and practitioner.

A prospective evaluation on health after breast reduction concluded that breast reduction surgery reduced or removed disease associated pain (Lewin et al 2019). It improved or normalized perceived health and psychosocial self esteem in obese women and women of normal weight.

Although many studies have shown that breast reduction surgery is effective in reducing neck, back and lumbar pain, most of these studies are subjective evaluations that usually provide data through pain scales. A study was undertaken to objectively evaluate the radiologic effects of breast reduction surgery on the vertebral column (Findikcioglu et al 2013). The symptomatic relief of breast reduction surgery on the musculoskeletal system is widely accepted, the objective assessment of this relief will be beneficial in persuading those who think of this surgery as a purely aesthetic procedure.

Patients had lateral thoracolumbar radiographs taken before and three months after surgery. The impact of breast reduction surgery on posture was elevated according to the comparison of radiographs before and after surgery.

Many women with breast hypertrophy suffer back and neck pain because of the weight of  their breast tissue. Some women also find painful indentations and even scarring along their shoulders where bra straps dig into the skin. Compression of nerves along the shoulders can cause numbness and tingling in the fingers. Dr. Deborah Venesy, a medical spine specialist at Cleveland Clinic, USA- a non profit academic medical centre- does not believe that bras in themselves, even badly fitted ones, can cause pain anymore than they can prevent it. Research by the American Society of Plastic Surgeons (Parry 2011) found that half of women with breast sizes larger than DD had almost constant pain. Painkillers for back pain should not be intended as a long term solution. The revised policy for breast reduction surgery would have women attending their GP. Surgery for two years with history of musculo skeletal symptoms before considering breast reduction surgery and exclude women with a cup size of less than H.

According to the American Society of Aesthetic Plastic Surgery (Collins et al 2002), breast reduction was the eighth most common plastic surgery procedure in the US when compared with aesthetic procedures only. This underscores the fact that non-surgical interventions have not been shown to provide lasting relief of symptomatic breast hypertrophy. In addition numerous studies have demonstrated increased satisfaction and better quality of life following breast reduction surgery. Such studies demonstrate the importance of breast reduction surgery as a therapeutic option and not a cosmetic one (Miller et al 2005).

The criteria outlined by the Revised Policy Position on female breast reduction surgery are substantial. The stipulation that women should be at their ideal BMI and have participated in a trial period of exercise and physiotherapy is problematic for overweight or obese women. Pain and discomfort can be exacerbated for obese women, whereas some studies have shown that obese women have a greater ability to exercise and lose weight following breast reduction surgery ( Shah et al 2006).

In the largest study to date ( Singh et al 2011) comparing breast reduction complication rates and BMI, they found that surgical breast reduction is a safe procedure with a low risk of complications – even with patients with a high BMI. This supports the practice of performing reduction mammoplasty on patients who are overweight.

The eligibility criteria stated in the Revised Policy Position on female breast reduction surgery will exclude the majority of women with breast hypertrophy from receiving this procedure. NICE guidelines in their consultation document (2018) state that women should have had a full package of supportive care including physiotherapy assessment and not have to endure a two year history of musculoskeletal symptoms.

Breast size should be disproportionate to chest wall circumference and not dependent on a cup size H.

BMI of less than 27 and stable for 12 months and not less than 25 as stated in the Revised Policy, Although numerous studies state the importance of weight reduction before surgery they do not demonstrate that an isolated obesity is a reason to deny breast reduction surgery.

The Hierarchy of Goals, produced in the consultation document concerning evidence based interventions (2018), are to:

* Reduce avoidable harm to patients. With surgical intervention there is always a risk of complications and adverse effects which could be avoided.

* Save precious professional time, when the NHS is severely short of staff.

* Help clinicians maintain their professional practice in line with the changing evidence base.

* Create headroom for innovation. If we want to accelerate the adaption of new proven innovations, we need to reduce the number of least effective interventions performed.

* Maximise value and avoid waste. Ineffective care is poor value for money for the taxpayer and the NHS.

However research has shown that:

* Breast reduction surgery is a low risk cost effective procedure.

* The principles of commissioning referral decisions requires GPs and consultants to go through a time consuming referral process. If the referral is not routinely funded then the referring clinician has to go through another application for individual funding, hardly saving precious professional time. Further time is wasted on GP appointments as patients denied breast reduction surgery return time and again for symptom control related to breast hyperplasia.

* Subjecting experienced consultants, experts in their field, to bow to the decisions of a funding panel is hardly conducive to maintaining professional practice.

* Breast reduction surgery is proven to be effective in eliminating physical symptoms associated with breast hypertrophy and cannot be described as clinically ineffective.

* Breast reduction surgery is not of low clinical value nor a waste of taxpayers money as demonstrated by research.

The criteria stipulated in the revised policy for breast reduction surgery is too restrictive and does not meet national guidelines. It prevents women from having surgery which has been proven to limit pain and improve quality of life.

The revised policy also puts GPs under pressure as the very harsh criteria are almost impossible to be met. They then have to go through the lengthy process of applying for exceptional funding which will almost certainly be rejected. (Bristol Cable 2018), as well as dealing with the frustration of patients who are being denied treatment.

It is not acceptable to describe this policy as best practice as it denies access to a treatment which will limit pain and improve the quality of life to so many women.

Charging for NHS treatment in NHS hospitals
Warrington Hospital charging list. This policy has been “paused”

Save the Green Spaces on Upper Parliament Street

We are pleased  to publish here a letter written by veteran community campaigner, and staunch supporter of Save Liverpool Women’s Hospital Campaign, Maria Oreilly

MariaMaria writes to protest the idea of building,  on the grass area immediately opposite the hospital and building high flats on this narrow strip of land. Please give Maria and the local community your support

To whom it make concern

Re Parliament Street Planning Consent June 2019

I wish to raise objection to the decision to allow the high rise development on the grass verge, lined with eco-friendly trees, opposite the women’s hospital and on the same side as  Princes School the brain injuries unit , which is  overlooking the social housing estate of pensioners’ bungalows and multiracial young families social housing homes.

I believe this decision  is flying in the face of all the policy development the council is beginning to look at re climate change  environmental and clean air, in addition, the council’s responsibilities for the health and well-being of its citizens  is compromised  by this decision

This is a  multiracial area  set in a beautiful natural  environmental setting  which contributes immeasurably  to air quality and the impact of air pollution on residents young children   young newborn babies  at the women’s hospital and disabled children and  the brain injury disabled  residents

Parliament Street is a busy road which already has pollution from traffic travelling into the city, industrial sites Renshaw’s and  Parliament Business Park which adds to traffic accessing the sites it is the main thoroughfare for traffic and busy bus route into the city centre. This street coupled with Georgian residential buildings and tree-lined green space  is both attractive and contributes much to the air quality

In 2018  I submitted a report from American environmentalists to the then chair of neighbourhood and communities cabinet member Steve Mumby and Cllr  Natalie Nicolas which gave scientific evidence of the damage air pollution caused to the neurological development of children and the negative effects on the elderly and those with chest and heart and lungs problems.

I circulated this document as  I was concerned for the children at school on Laurence Road which( besides being open to passersby to converse with the children, which is a safeguarding issue, due to inadequate fencing)  has little tree or greenery to combat the constant air pollution caused by traffic which constantly travels within 5/6 foot of the playground

This  American report raised serious concerns for the neurological development of children and its findings showed that those areas most affected were areas  of deprivation and were predominately those of minority African American and Latino schoolchildren  were schooled

I understand Cllr Noakes now has clean air  responsibility and in a city with a confirmed health  threat already to our lungs  and the fact that a baby  born today in Liverpool will have thirteen years less good health than  a baby born in Richmond  we should be concerned

About building on a green space in this location on Parliament Street, removing mature trees and increasing pollution the city council planning permission awarded for this development, despite opposition from residents local councillors and the scientific evidence in the council’s possession. This flies in the face of good governance, and the logic of policy debate on climate change and doesn’t show joined-up thinking across Cabinet. One thing laughing at the other?

I also wonder, as a matter of equal treatment of its citizens,  if Liverpool City Council  had decided to grant planning permission in  Allerton, as an example, for a  high rise block to overlook a settled  homeownership community, on one of their  tree-lined grass verges, destroying trees, overlooking homes, invading privacy, increasing traffic next to a school and a brain injury unit, and opposite a maternity hospital,  thus  increasing air pollution,  would it have sailed through without call in? There would have been protest at that, even without the additional scientific aggravating factors of the effect of air quality and neurological damage on children etc

I doubt you would have even considered it!!!!!

I believe this needs an environmental health impact assessment given its location and proximity to those with disabilities and young children and this development’s potential  impact raises important social and health factors  so serious that an equality assessment  is needed urgently as  it raises  a poverty issue, disability and race equality issues

I understand the three councillors for the ward have objected and that  Cllr Emily Spurrell planning committee objected along with residents,   the issues I raise add to these objections and should be cause to reconsider and rescind this planning decision.

Yours faithfully

MariaMaria O’Reilly

 

 

Only with your efforts

In June 2019, the NHS is in significant danger. In 2015 we started the fight to protect the Liverpool Women’s Hospital. This struggle is and will be inseparable from the overall campaign to defend and improve the NHS locally and nationally.

Plans and events have come together to present a major opportunity for the privatisers. These very well paid people have been working assiduously, and with determination, to package the NHS into an organisation that works within the for-profit  US and multinational models, used by free trade international and especially US health care and insurance corporations.

The process has been underway for many years and is now almost complete.  This is more than the outsourcing we have seen previously but something comprehensive. It is at a regional level,  with accountable care organisations, merging of trusts, population budgets with rationed care, and the deep involvement already of the big US and multinational corporations. This has tied the NHS up in gift wrapping for privatisation on a whole new scale. 

 There are real crises in the NHS in the number of beds, of staff and of access to the best medications. All of these lie on the shoulders of those administering the NHS at the national level. It is widely reported that making the NHS unsatisfactory is a precursor to a major change.

Now we have a political crisis over Brexit, and demands for free trade deals to replace the EU, and the NHS openly discussed as being essential to a free trade deal with the US.

The US president, no less, says the NHS must be on the table in any free trade deal, and he is given a state welcome. A political party whose owner is committed to an insurance-based health care system has just won an election in the UK, albeit just the European one. Jeremy Hunt, pioneer privatiser, and Liam Fox free traders par excellence are bidding for the Conservative leadership. The roar of support from the crowd when Jeremy Corbyn spoke out in defence of the NHS   at the anti-Trump demonstration shows something of the huge potential support the NHS has but that support must be active, very widespread,  loud and insistent.

The warning sirens must sound across the land, voice by voice.

This morning Trump rowed back a bit on the “everything is on the table” position but that is not worth the air he used to utter it. The process is underway.

What you do and say on this issue will matter. Speak to your workmates and family, friends and colleagues, write to your MP, write to your councillor, write to your union nationally and locally, join a union if you have not already., raise it in any political party you are in, join an NHS defence campaign, ours, or another nearer you.

Only with your efforts will our NHS free at the point of need, publicly provided be saved. That NHS saves mothers lives and babies lives.

We will be raising with other campaigns what the next steps will be locally and nationally but we need you with us.

For all our mothers, daughters, friends and lovers, and for each and every baby, save the NHS.

 

Is this acceptable?

Is press and publicity manipulation aimed at Labour Party Conference a suitable use of NHS money and time?

The local management of the NHS and Liverpool Women’s Hospital want fundamental and unpopular change. They applied for money to rebuild the Hospital on the site of the benighted Royal Liverpool University Hospital. Unsuprisingly they did not get the money.

The team behind these plans includes the local STP, the CCG, and the Liverpool Women’s Hospital Trust. To push these plans they have used the media in many ways. They claim that their media intervention was successful in reducing the imapct of our demonstration to Labour Party Conference in September 2018. “The impact of the demonstration march was perceived to be less than the campaign group’s previous activities”.

The state of the NHS, with under funding, privatisation, reorganisations in favour of big corporations, outsourcing, low pay, cuts in services and rationing of care is profoundly political, but interevening to affect a demonstation to Labour’s Conference is hardly aceptable even in that context. It is a questionale use of NHS resources.

More than our campaign’s entire budget will have been spent on this media offensive. This is taxpayer money that should have been spent on patient care, in a city with really poor health oucomes and where nearly twice as many babies dying before the age of one than the national average.

Our Campaign to Save Liverpool Women’s Hospital has large and widespread public support, and our campaign fundamentally disagrees with this plan. We want to keep a women’s hospital and to keep it on its current low rise and green site. We object to spending more than £100million on the project when women and babies in Liverpool face major health issues.

Our petition has 46,000 signatories, online and many more on paper. Our campaign has gained support from Labour Party branches and even Labour’s conference. Diane Abbott MP, Emily Thornberry MP, and Jonathon Ashworth MP (Labour’s spokesperson on the NHS) have all spoken at our demonstrations. The campaign is now in its 4th year.

We support the work of Liverpool Women’s Hospital. It has remarkable successes and dedicated, hard working staff. Most of Liverpool’s Babies are born at Liverpool Women’s Hospital, and it has many excellent services. We are aware of problems and difficulties, but LWH is well worth protecting.

In the context of the Climate Emergency and major concerns about air quality, putting the birth of the the majority of Liverpool babies in an air polluted traffic islnd and highrise blocks seems frankly ridiculous.

In key documents at the Liverpool Women’s Hospital Board Meeting on 2nd May 2019, this document ‘Strategic Aims and our Corporate Objectives 2018/19’ was presented.

Included in he report were these sections.
“..the need for a move, more decisively, to a multidisciplinary hospital site within 5-10 years.”
Commissioner support retained despite lack of success in STP Capital bid, with plans for a way forward being developed.”

Recent developments of note where these key messages were used occurred during September 2018 in advance of the Labour Party Conference. The Trust referred to the key messages to counter a planned demonstration against the plans for the future by a local campaign group. The Trust’s key messages received significant media, online, social media and public exposure with an overall average reach/audience for TV/radio/printed news of over 410k and an average reach/audience for LWH social media and website posts of almost 40k. The impact of the demonstration march was perceived to be less than the campaign group’s previous activities due to our proactive factual messaging and anecdotally the Trust feels that stakeholder understanding about our future is now more clearly understood as a result.

The board claim that;

Dialogue is ongoing with NHSE, MPs, councillors and other stakeholders to ensure the case for change is well understood”

So in this context they feel it is acceptable to pay for whole page adverts in free sheets and in the Liverpool Echo? Is it right to be putting forward a whole major media intervention?

When the plan to “move” Liverpool Women’s Hospital was first launched they ran a story about how dangerous it was ro transfer women to other hospitals but now somehow the figures for transfers, the main plank of the earlier media message, have dramatically dropped to just one!

We don’t deserve 34 years of ill health.

Women’s Health matters.

Liverpool and Merseyside need a Women’s hospital, focussing on improving the lifetime health of women from the womb to the grave. We need a health service that recognizes the needs of women. We must improve the lives and health of women in this city. A well funded hospital with a committment to the health of women could lead the way for other hospitals. This hospital could link up others with the aim of improving women’s health across the nation. Women spend more of their life in ill health than men do.

This is not, in any way, acting against men

As we come marching, marching, we battle too, for men,
For they are women’s children and we mother them again
Our days shall not be sweated from birth until life closes, 
Hearts starve as well as bodies, give us bread, but give us rose
s”.

 It doesn’t have to be this way.

Women tend to look after their health more than men do, so the difference is not from risk taking or deliberately unhealthy lives, even if some do take risks. Though women live longer than men do, they live in worse health for more of their lives. Women from poorer areas, like Liverpool, endure 34 years more ill health (You would get less for murder!) than women from more affluent areas. Women from poorer areas have shorter lives, with more illness and this is getting worse. Within Liverpool, life expectancy is 10.2 years lower for men and 8.3 years lower for women in the most deprived areas of Liverpool than in the least deprived areas of the city. That’s just within the city. The differences with wealthy areas of the country is even greater

 ‘The gap in life expectancy between women living in the most and least deprived areas has also widened, falling for women in the most deprived areas and continuing to rise for those in the least deprived areas.”  Professor Danny Dorling

It does not have to be this way, This is a long term Governmental choice to make the poor pay for their policies. Even the UN has described it with horror Each person who speaks out against this impoverishment begins to turn this terrible tide.

In 2015 a World Health Organisation Report showed that Life Expectancy of women in the UK was is the second lowest in western Europe. The UK is ranked 14 out of 15 nations; we need a focus on women’s health.

Healthcare is just one way we can help women’s health. We have also to fight low pay ( especially for mothers ) poverty, expensive and poor quality childcare. bad housing, pollution, stress and abuse. But in this storm what we have, we hold; we will not surrender the benefits earlier genserations have won for us.

There are many aspects of health treatment that are specific to women.

Teenagers still have major problems with periods and acne, some very serious problems. No contraception is perfect and some have side effects.

Mesh, breast implants have been the source of many scandals caused by profit seeking at the expense of women’s health.

Mental health is a major health issue for women. The same numbers of women and men experience mental health problems overall, but some problems are more common in women than men, and vice versa. Twice the percentage of women in work suffer (or admit to) mental health issues than men do. Some mental health issues are related to hormones and reproduction, some to poverty

Endometriosis1.5 million women suffer from endometriosis but it takes 7 years on average to get a diagnosis. That’s one in ten women in debilitating pain.

Heart disease is a major killer of women, more so even than the horrible breast cancer that ends the lives of so many of our sisters.

Heart Disease, Cancer and Stroke are all diseases with distinct female issues.

We need research and focussed treatment. We need the research done at Liverpool Women’s hospital to be expanded. This hospital would give a great case for significant increases in investemnt if we can win the battle to get a government that respects its people.

We are in a politically driven storm of cuts, privatisation and destruction in the NHS. Full details can be found here. Having established the Internal market the privateers have now decided to privatise the service at the regional level. To garner the greatest profits for the large companies operating at this large scale, the NHS are bringing some services back in-house, so it will be more profitable from the very big US health care companies.

We are short of beds, short of doctors, nurses, midwives, and the myriad of professionals working in the NHS and the devoted ancillary staff. Poverty wages makes women ill, yet outsourced companies pay these wages to women and men who work in the NHS. Let’s hope the ancillary workers keep on fighting for better pay and conditions. They will have healthier lives and use the NHS less.

What we have we hold!

We must defend Liverpool Women’s Hospital and fight for more, much more investment in health. This is the sixth richest country on planet earth. There is wealth aplenty to fund the NHS.

What causes this extended ill health in women?

Poverty plays a part. Drug research based on men not women plays a part, the level of importance given to women’s health and unthinking sexism, also play a part. So do the physical facts of women’s hormones and of childbearing capacity, whether or not we have children.

We have specialist hospitals for many conditions; a hospital for women is deeply needed.

For all our mothers, sisters, daughters, friends, and lovers, we need a women’s hospital!

It’s for the babies too!

For each and  every one of our precious babies, we need an excellent world-class maternity hospital  In Liverpool. We must defend what we have and insist on improving it.

Liverpool’s infant mortality rate is at its highest level since 2010. ”Some 5.2 infants died per 1,000 live births between 2014 and 2016, significantly higher than the national average of 3.9 deaths per 1,000 births.”

IMR ( Infant Mortality Rate ) is used internationally as an indicator of the comparative wellbeing of nations. It is sensitive both to the socio-economic conditions affecting women of childbearing age and children; and the quality and accessibility of services for families. IMR continues to improve in most rich countries, with recent data showing that in countries such as Japan and Finland the IMR has dipped to only 2 per thousand.(3) In Liverpool, where some of us work, the infant mortality rate is now an unacceptable 6.8 – more than twice as high as London’s average.

In 2017 1 in every 225 births ended in a stillbirth. For every 1,000 babies born, 4.2 were stillborn, according to the Charity Tommy. Other babies die shortly after birth and still more have significant birth injuries.

 …mortality for the poorest infants in the UK is rising ( getting worse) every year since 2011. This is despite mortality continuing to improve in all other European countries, which often still benefit from very rapid improvements in health no longer seen in the UK.  The most recent rise in premature deaths is now leading to a situation where overall life expectancy could begin to fall for all groups. It is already falling in the poorest areas and for the poorest groups.

The Nuffield trust says “The UK has made less progress in reducing stillbirths and neonatal and infant deaths over the last two decades than many other developed countries”.

Sadly Liverpool Women’s Hospital has made saving on maternity this year despite this death rate “Maternity activity has reduced as anticipated and is expected to have deliveries in the region of 8,200 (2017/18 8,600). The service has reduced costs in terms of pay and non-pay and has also reviewed service income and costs as part of the “right size project” .

Is this the response we want to the news of increased deaths of babies? Surely the extra capacity could support women after birth far more effectively than they are supported now.

The NHS is not a democracy, nor is it socially or communally responsible. The NHS answers to Simon Stephens and to the requirements of their grand plans and privatisation. But camapigning does make some difference.

The big companies involved in the NHS have more and more say. Their purpose is profit.

The future of the  Liverpool Women’s Hospital is still unclear.Save Liverpool Women’s Hospital  campaigns for a fully funded NHS and for Liverpool Women’s Hospital to be upgraded on the Crown Street site.

The current management still favours a move that would cost at least £100 million. The April Board meeting said they were going to hold a clinical summit on this issue this summer. We call for a community summit too. The wishes of more than 50,000 petitioners cannot be ignored.

Liverpool Women’s hospital is inadequately funded by the NHS, as are many hospitals. Aintree, for example has major financial problems. There are underlying additional problems at Liverpool Women’s.

  1. The maternity tariff is still inadequate.
  2. The funding does not reflect the very specialist work that the hospital does. Birmingham CCG does recognize this for their women’s hospital, but not Liverpool.
  3. The NHS insurance system is difficult for all obstetric providers but Liverpool has a historic (and disgraceful) case, significantly inflating premiums.
  4. Most of these problems stem not just from inadequate funding, real though that is, but from the “Internal market” imposed on the NHS by wave 2 privatization.

The Liverpool Women’s Hospital makes decisions within the policies of the  Merseyside and Cheshire Sustainability and Transformation Plan (STP). This plan describes extreme reductions in spending.

It is our understanding that the budget of Liverpool Women’s Hospital is kept in balance by a subsidy from Transformation funding,“The control total now assumes receipt of £6.8m Provider Sustainability Funding (PSF) (including a £3.2m of bonus and incentive).which is dependent on the plan to move. Somehow we are meant to believe that the move will save money.

LWH also has to cope with damaging decisions like the withdrawal of bursaries from midwives and nurses training, and an inadequate number of training places for doctors in the whole country. Staff are consequently overworked and underpaid.

Women in the UK as elsewhere have a right to a long healthy life. But we are going to have to fight for it.