Ockendon Report and Safer Maternity Care

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.”

BBC Photograph

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 framewor
k. 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.


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,


The Dis-Integration of the NHS. No to the White Paper.

People change the world when they need to do so.

Deborah Harrington from Public Matters spoke to a meeting of campaigners and trade unionists across Cheshire and Merseyside, our local ICS area. We want the NHS back to the Bevan Model of healthcare, the most efficient, the most integrated service in the world, before the privatisers started leeching off it.

Health care should be

Free at the point of need

for everyone,

paid for by the government

and provided by public service , not by profit making companies

Another great Liverpool Woman who stood up for the poor and fought cholera.

It was women and trade unionists who fought to found the NHS a century ago and we will step in again now.

During the Pandemic, whilst doctors and nurses worked long hours in difficult conditions, the NHS bureaucrats have devoted money and man hours to a major reorganisation of the NHS, which puts into place much that has been planned through the STP. This will embed the role of big International for profit health care companies. These companies are there for profit.

It will reduce local accountability and stop using individual clinical need as its planning base

Would that instead of such plans, they had prevented in hospital transmission of Covid. Please watch and share the video. We will need the biggest campaign ever to stop this White Paper, and the campaign starts small but starts immediately.

We too can change hearts and minds and force change for the better

Women from the cooperative women’s guild demanded that maternity care be available for all free at the point of need. We don’t all want greed and capitalism

You may have heard of a big US corporation Centene taking over GP services, but these corporations are in the NHS nationally and in STPs/ ICS

They are advising the NHS on reorganisation on multinational corporation lines. Hancock has just brought in a top bureaucrat r for the NHS from a big US health care corporation. Please watch the video. Please ask for a speaker at a meeting. Please step up for our NHS.

We don’t remember Polio, you and me.

Public meeting Wednesday 17th February 2021

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

Please respond to this reorganisation of the NHS

Act to save our NHS

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 8th 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 8th 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 BillOnce 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 8th 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 8th 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 8th 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

 What is your name?  
 In what capacity are you responding?  
 Are you responding on behalf of an organisation?  
 Do you agree that giving ICSs a statutory footing from 2022, alongside other legislative proposals, provides the right foundation for the NHS over the next decade?
 Strongly disagree   comments or additional information: a)This is a very ‘top down’ exercise with little justification other than the hope it will allow tighter controls on spending. b) Claims that functioning ICSs have already demonstrated significant improvements in patient care are only wishful thinking and not evidence based. c) The plan for ICSs is not focussed on improving care for patients but on binding NHS organisations by financial controls and plans written by the ICS with advice from companies accredited under the Health Systems Support Framework. d) The NHS needs re-integration by abolishing the 2012 H&SC Act altogether and removing the competitive market and the purchaser-provider split. e) Facilitating even more contracting out of services and management structures including the private sector is not ‘integration’ but ‘dis-integration’. f) NHSE/I legislative proposals include the removal of Public Contracts Regulation safeguards over social, environmental and labour standards, and the ability to rule out bidders on the basis of their track record. It will expand the scope for scandals like the PPE contracts awarded without procurement to firms with no relevant experience. g) Other legislative proposals would embed “population health management” as a binding aim for all NHS organisations, without evidence that this will improve patient access to universal, comprehensive healthcare, free at the point of need, publicly provided and publicly accountable, funded through general taxation.  
 Do you agree that option 2 offers a model that provides greater incentive for collaboration alongside clarity of accountability across systems, to Parliament and most importantly, to patients?  
 Strongly disagree   comments or additional information: a) By “collaboration”, the plan includes collaboration with the private sector, which we oppose. b)  There is very little accountability built into the system and large organisations are inevitably far removed from the needs and concerns of local communities. CCG mergers reduce the opportunity for local public involvement; Option 2 goes even further. c) Any reorganisation of the NHS should be looking at increasing accountability and democratic control rather than weakening it.  
 Do you agree that, other than mandatory participation of NHS bodies and Local Authorities, membership should be sufficiently permissive to allow systems to shape their own governance arrangements to best suit their populations needs?  
 Strongly disagree   comments or additional information a) Allowing management consultants and private sector representatives to sit on governing bodies undermines the public sector ethos which is key to the NHS. b) ICSs as proposed will only facilitate top down control. c) The NHSE Health Systems Support Framework (HSSF) strongly prioritises financial savings over patient need. The HSSF is designed to implement systems of patient and data management needed for insurance-based systems rather than clinical priorities and local need. The majority of companies accredited through the HSSF are major corporates, including many involved in health insurance in the US and elsewhere. d) This approach is incompatible with what patients and communities want and need and with NHS founding principles and values.  
 Do you agree, subject to appropriate safeguards and where appropriate, that services currently commissioned by NHSE should be either transferred or delegated to ICS bodies?  
 Strongly disagree   comments or additional information Specialist services require national commissioning in order to ensure consistent standards across the country  

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/

What now with The Health and Care Act becoming law?

The effect of the passing of the Health and Care Bill will be harsh. It is now an Act and as such will be implemented creating forty-two distinct organisations. Ours is the Cheshire and Merseyside Integrated Care System (ICS). Exactly who sits on these boards has yet to be published. We do know their chairs and many other posts.

Our anger at what is happening is righteous and well informed. As we campaign we want people to focus their anger into action, not let that anger become, as the Conservatives wish, debilitating and without purpose.

We need people to help with the campaign to reinstate the NHS and to monitor what is happening locally. Please do get in touch if you can help even in the smallest way.

Each  ICS organisation will be expected to keep to a set financial limit, and any financial risk-sharing will be within each ICS. This financial structure, in reality, is unworkable but it will be used to excuse and implement harsh cuts, which in turn will inflict death, pain, and suffering. It will mean worse pay for staff too. This is unless, of course, we can build a  deep and wide protest movement. This has been done before. We need to do it now.

The ICS boards will control all spending in the Cheshire and Merseyside health area. Hospital trusts start this era in debt, not from being spend thrift, but because budgets were not adequate for the treatments they had to deliver.

The ICS system is supposed to insist on no overdrafts, and that any over spend has to come from other hospitals in the local system. Well that’s not going to work, is it? In fact, this system is very dangerous for maternity as many of the Trusts in Cheshire and Merseyside do not provide maternity care and may not therefore even have an Ockendon Rep on their boards. Donna Ockendon insisted that each hospital had a board member responsible for Maternity on their board because of the poor oversight in Shrewsbury We have found no Ockendon Rep on the ICS board, in the paperwork available to the public We would love to be proved wrong.

Maternity is in crisis as the Royal College of Midwives, somewhat belatedly, said recently and that crisis must be addressed, rather than cuts in spending enforced. This is the lives of mothers and babies and the working lives of maternity staff that we are talking about. What is more important than the lives of mothers and babies at birth?

Meeting all the Ockendon requirements for safety requires major investment not cutbacks, not just in the Liverpool Women’s Hospital, but in Arrowe Park Hospital, in Leighton, in the Countess of Chester, in Ormskirk, in Whiston and any other maternity service in Cheshire and Merseyside and beyond.

Liverpool Women’s Hospital Board Papers said

The Trust is in underlying deficit, and faces additional pressures to maintain levels of workforce recommended by the (first) Ockenden report. There is a significant increase in clinical negligence costs which have not yet been funded.

Financial impacts of the second Ockenden review, and any funding available to support this, are being assessed. There are other significant cost pressures which will be managed through an ambitious and challenging 3% cost improvement plan plus additional non recurrent mitigations. .”

When the Banks needed bailing out huge amounts of money were conjured up for them. Sajid Javid the health secretary was a banker in those crazy times. Hey! Sajid, health needs a big investment that will pay for itself many times over.

This money shortage is serious. Researchers have gathered the figures from board papers from local hospitals.

Mid Cheshire hospitals Trust wrote “The system has £183m less resource than in 2021/22, which is a 3% reduction in funding after inflation has been applied. There are several factors which are influencing the movement and some key risks to receiving the funding in full.

“1. Convergence: C&M funding levels are currently above its calculated target allocation by £338.5m, and has a target to reduce this over time, leading to the additional reduction of £51.67m…..”

The UK is experiencing high inflation, especially from fuel costs. This will affect the NHS too. So we need to add inflation to the cuts described above.

NHS pay has acted to keep NHS inflation below the national average for some years. Low paid NHS staff who stay in the job because they are committed to the NHS will feel the increase in inflation still more.

Although the Act is called the Health and Care Act it does little for the mostly privatised Care sector. This letter is not focusing on that important issue. (A separate article will cover that). This situation is looking at the breakup of the NHS.

The problems in social care are impacting badly on hospitals which at present cannot easily discharge patients to care homes. The shadow of the Covid deaths hangs long over the care home sector and the Covid virus is far from spent.

The New ICS system introduced by the Act has been present in shadow form for some time and regional control of budgets increased during the pandemic.

This model of healthcare finance and delivery is based on the US Accountable Care systems. Accountable here means “for accounting,” not “answerable to.” It is designed to make money for the private sector. Designed to give our tax money not to the sick or the hard-pressed underpaid staff but to the rich.

Plans for this have taken many years, back to Thatcher and more recently work at Davos, the working groups of the globally rich.

We have lost a  National Health Service. The national part of the health service is important for risk sharing, research sharing, national pay structures, and shared experience. These models will produce postcode lotteries and differential services. We can imagine that they will blame Merseyside for the effect of their cuts as they are now blaming Liverpool for the effect of 60% cuts in local government funding.

The huge health gaps in life expectancy will open wider. Remember more babies die in Liverpool under one year of age than anywhere else in the country. Working-class women have a life expectancy ten years less than those in rich areas. The Tory voting areas will get service though

If we can build a campaign we will deepen the commitment to the Bevan Model of the NHS in our areas.

In these new structures, the national part of our health service has gone. What we have now is more like a localised public-private partnership. We want to bring back a national health service.

Publicly delivered. We want to return to a national publicly delivered health service. Private companies are designed for profit, not for healthcare.

A health service, of sorts, is still functioning, hit and miss as to the treatment you get. Doctors, nurses, midwives, physios, scientists, porters. cleaners healthcare workers all continue to go to work, work hard and with skill, and many are delivering good services, but there are significant dangers. Some are wonderful services, but all are at risk. The Cheshire and Merseyside ICS has big problems with staff shortages, funding restrictions, poor organisation and the present major reorganisation but for now, for some a service is still there.

Major cuts in funding are underway. See the Lowdown  The Lowdown article referred to £219m deficit in the C&M budget – practically every single hospital in the area has a deficit. So, in other words, the ICS will continue by making more cuts and demanding more from an ever-shrinking workforce who are paying the price of this reorganisation. The staff risk having their pay negotiated locally. It is a major leap forward  for  privatisation and healthcare for profit

Staff are poorly paid, understaffed, and worn out. Covid is still a factor so there has been no time to recover. Waiting times are long and harsh. The pressure to pay to jump the queue is very real. The private health sector has been given huge amounts of Government money. This is likely to continue especially as these companies will be influential on the ICS boards.

So when the going gets tough, the tough get going. Join the campaign to fight for the health service locally and nationally. Don’t make the NHS a dim and distant memory.

What now for the English Health Service?

The NHS is both wonderful and damaged. Babies that stood but a slim chance of survival are saved and go on to live full lives despite the chaos of underfunding, understaffing and overwork. Yet at times birth can be a terrible experience and outcomes sad. This mix of awesome and appalling is seen in other services too. The passing of the Health and Care Bill causes real concern. You can see the detail of this here

Fantastic care and expert treatments are delivered by overworked and underpaid staff. This has kept the NHS afloat through a decade of cuts, underfunding, staff shortages, the pandemic, privatisations, and closures. However, as Ockendon showed, the damage being done is very real.

The Health Service Journal published an opinion piece saying;

However, even before the first ICSs emerge blinking into the light, the seeds of their potential destruction are being sown”.

Some wonderful people fought this Bill In Parliament, and far more out of Parliament, but it was not enough. Campaigners wanted far louder opposition from Labour and Lib-Dems too. Many people still do not know what is going on.

The structures set out in the Bill will be cumbersome, costly, and designed to facilitate private company involvement and profit. It is designed to limit the care available,

World-class, Universal Comprehensive care, free at the point of need is at risk. A post code lottery is inevitable.

Not one of the pressing problems of the NHS is addressed in this Bill. The NHS needs £20 billion in additional funding now, and then an increase above inflation each year.

As the Bill finished in parliament TV and radio adverts for private health insurance became more common.

The NHS needs better funding, more staff, better pay for the staff, and better conditions to retain the staff we have

Mental health, maternity, and social care are all in difficulties from poor funding, poor staffing, cuts and privatisation.

Many nurses opened their payslips to see their take-home pay fell in the month their pay rise was paid.

We now need a big campaign to monitor the NHS so cuts cannot happen out of sight in the forty-two new ICS areas. Ours is Cheshire and Merseyside.

Please help:

Please write to your MP

Please write to your councillor

Please join our campaign; message us at takebacktheNHS@protonmail.com

Please invite us to speak at your meetings

Campaigners worked hard to tell people about the Health and Care Bill, hoping we could together put pressure on Conservative (and Labour) MPs to vote against it. We did not shift the Conservatives and the vote went through. Nevertheless, they will face the ire of the people at the next elections. Let us make sure that by then we have reached millions more people.

This situation is partly because people don’t know about the Bill, partly because people really can’t believe the NHS would be harmed, but more and more people are waking up to the dangers.

The Bill causes real harm. Please see this for details.

Our campaigns will have to change focus to each of the 42 areas and their ICS boards. That’s going to be a bad thing for the NHS as a whole but in some ways easier for campaigners.

There has rarely been more chaos in parliament, but MPs must be held to account. If you have a Conservative MP please write to them. Labour MPs by and large voted against it but we feel they did not do enough, with some honourable exceptions including Margaret Greenwood MP and Justin Madders. Liverpool MPs worked closely with us too. Surely they had a duty to inform their constituents about this risk to our health care free at the point of need. We will publish a letter to Labour MPS soon.

The structure of the NHS in this new Bill is already out of date, cumbersome and costly.

Writing to your MP


Please fill in this form, sign it, post it / or give it in to your local Member of Parliament.

You can email instead of writing through this service

Dear Member of Parliament,

Our NHS is beloved by everyone throughout our countryside. Its underlying ethos that everyone is entitled to the same professional care and attention once they cross its threshold is a wonderful source of comfort and reassurance.

The NHS system is the envy of the world. It is important that it remains a public service, so that money can be spent on patient care, rather than going into the pockets of shareholders.

It continues to evolve and is nurtured by health care professionals who care deeply for the NHS.

However, the current Health and care Bill will fragment the NHS into 42 regions leading to a postcode lottery.

Representatives from private companies will be allowed to sit on decision-making boards and influence what services are provided. The government says it will prevent individuals with ‘significant interest’ in private health care from sitting on them. This is not good enough. Big businesses should not have a say in how public money is spent.

The bill provides for the NHS professions to be taken out of regulation – with implications for those who work in the NHS and the quality of care we can expect to receive.

The British Medical Association Has called for the bill to be rejected!

For the sake of the health and peace of mind of this and future generations, please vote against this bill.

Yours sincerely

Signature                                                                                                              Date                                        .





Post Code.                                         

The state of the NHS April 2022. Mend the broken heart of the NHS.

Mend the broken heart of the NHS

Immediate actions are required by the Government.

  1. Lift financial restrictions on hospitals, paramedics and GPs. This must include removing the ridiculous 5% savings and the suggestion of absolute cash limits. Financial restrictions imposed during this crisis will end up costing more lives and more money long term. Invest in our Health Service. It pays us back with health and wealth.
  2. Approve emergency funding of £20 billion to save lives
  3. Ensure maternity services have all the funds required to meet Ockendon’s recommendations.
  4. Thank the staff who have worked through such tough times.
  5. Discuss with frontline medical, nursing, midwifery, and ancillary staff about what they think would make an immediate difference. Find ways of making this consultation routine. Implement the most constructive suggestions. Put a full stop to bullying and silencing staff.
  6. Tell Hospital management to forget the Internal Market, the ICS system and other wasteful bureaucracy. Put more time and effort into patient safety and staff retention, especially personalising shift patterns.
  7. Pay patient-facing staff a premium rate pending full pay negotiations.
  8. Put in as much non-medical support (cleaners, catering and care staff) as possible both for staff and patients so there is someone to keep anxious patients safe in A+E and anywhere else where this would help.
  9. Provide excellent canteens so staff can eat well at work and, if tired, pick up a meal to take home.
  10. Pay childcare when staff are willing to work extra shifts.
  11. Recruit retired or qualified staff who have left, for regular short hours working.
  12. Pay, as if at work, staff who have left to retrain.
  13. Fund GP services and walk-in centres to provide more services to take pressure off A&E. Make sure these services can link directly by phone or video to expert advisors when necessary.
  14. Consult with patients and their families about how their immediate experience could have been improved.
  15. Introduce more Covid protections including encouraging mask use, improving mechanical ventilation in hospitals and schools, make use of public buildings to reduce class sizes. Provide excellent quality school meals.
  16. Reinstate free Covid tests, nationalise testing & fund local public health.
  17. Improve staff PPE.
  18. Take over private facilities required to improve NHS services.
  19. Nationalise care homes with existing staff protected. Make use of any suitable buildings to increase the provision.
  20. Pay home visit carers a decent wage and try to win back experienced and qualified staff who have left.
  21. Encourage migrant staff by lifting the NHS premiums.
  22. Work to recognise overseas training, or provide additional training for migrants already qualified in medical skills to meet NHS standards.
  23. Pay informal carers twice the current rate.
  24. Provide more adaptations for disabled people currently living at home.
  25. Tackle shortages of medicines such as HRT.
  26. Bring private contracts/outsourcing back in house.
  27. Fully fund & expand ambulance services, lift financial restrictions.
  28. Engage in proper pay negotiations with all NHS staff.
  29. Protect the NHS as a universal, comprehensive, publicly funded and run, health service.

Immediate actions are required to support the NHS through the April/May 2022 Crisis. We hear both through personal experience and through reports of the difficulties the NHS is facing. The situation must change.

AS true for the NHS as for Football clubs

These are some essential short term fixes. We need also to reverse the policies from the 2012 Act, ditch the Health and Care Bill, have a proper plan for the workforce and remove privatisation, the internal market and rationing of care.

Campaigns like ours will continue to fight for the NHS, including making it clear to Conservative MPs that the Health and Care Bill still being discussed in Parliament is utterly unacceptable. Detailed descriptions of the Health and care Bill and other privatisation issues have been covered in other blog posts. This is what needs to be done immediately. If you agree with us please send this to your MP and to your councillors. If you have suggestions as health or social care workers, patients or campaigners please let us know.

Break the Bias. Working for Women’s Health

Save Liverpool Women’s Hospital Campaign Group’s International Women’s Day Celebrations

8th March 2022

The following is the transcript from Dr Rebecca Smyth’s talk: ‘The Gender Data Gap’

Hello everyone,

Firstly, Happy IWD to you all!

Each year the IWD organisation identify a theme.

And this year the campaign theme is: BreakTheBias

Here is a quote from their website (IWD organisation), this is what they say: 


A gender-equal world.

A world free of bias, stereotypes, and discrimination.

A world that is diverse, equitable, and inclusive.

A world where difference is valued and celebrated.

Together we can forge women’s equality.

Collectively we can all BreakTheBias.

(https://www.internationalwomensday.com/theme March 2022)

I am going to talk for a few minutes about women and health, with a particular focus on bias, given this year’s theme. As we all know your sex has a significant impact on your health, so let’s see if we can start to better recognise this bias and think of ways to BreakTheBias. 

I think we all agree that roughly half the world is inhabited by women (49.6%), half by men (50.4%) (I’m excluding animals and plants here by the way), based on 2020 figures. However, that’s where the fairness of the divide ends.

In my talk I’m going to focus on the inequalities there are in access to healthcare and healthcare outcomes for women. I’m wanting to identify some of the bias that is present.

But before I do, I think we need to consider and acknowledge where the ‘evidence’ comes from / where our ‘knowledge’, where our ‘understanding’ comes from. Because recognising this goes some way to BreakTheBias, or we could call it unfairness or we should actually call it discrimination.

Most of our ‘knowledge’ about health, some would actually say pretty much everything we know uses data, and it is this data that is male-biased in other words the data favours men and does not reflect the true world we live in. So, our decision-making, healthcare treatments for example are based on data gathered from men and this is known as ‘the gender data gap.’ It is where a “one size fits all” approach has been used, however it has left gaps in our understanding of the experiences of women because it is male-biased. Women have basically been excluded. So, the upshot is that most of what we understand is skewed in the favour of men. It’s a male-default world we live and we need to Break this Bias.

If I can give you some examples. The one many of you will know and which is perhaps a little light-hearted, nevertheless annoying and one I think all of us can relate to is room temperature. I’m sure we know all about room temperature at home. And there is ample evidence that office environments are tuned to male biology. Air conditioning is often set according to a 1960s formula based on the metabolism of a 40-year-old man who weighs 11st. Previous studies have suggested that the average woman is most comfortable at about 25C, 3C higher than for men. Because women generally have a lower metabolic rate than men because of their body composition so they prefer warmer rooms and need less air conditioning. (Koch; National Geographic 2015). However, this has still not been corrected in many offices (or homes!).

Another light-hearted one… mobile phones.  Like the standard piano keyboard, smartphones have been designed for male hands and therefore may be affecting women’s health adversely. It is a relatively new field of study, but the research that does exist is not positive. Within the studies, women were significantly under-represented and the vast majority of studies do not break down the data by sex. The few that did report a statistically significant difference in the impact of phone size on women’s hand and arm health as well as physical comfort (Kwon 2016). Speech-recognition software is trained on recordings of male voices: Google’s version is 70% more likely to understand men (Criado Perez 2019).

Here’s another one for you demonstrating the gender data gap: we all know that women even when in paid work still do the majority of the housework (McNunn 2018, UCL Epidemiology & Health Care). Yet it is documented that fitness monitors underestimate steps during housework by up to 74% and calories burned during housework by as much as 34% (Criado Perez 2019).

So why should we think these are just light-hearted examples, why should we not consider that these types of bias play out in much more important aspects of our lives, health, work, politics and political decision-making. The ‘gender data gap’ is everywhere. Let’s Break this Bias.

Regarding health, let’s talk about heart attacks.

Early diagnosis of a heart attack is essential for treatment and survival. Research by the British Heart Foundation (BHF) has shown that women having a heart attack are up to 50% more likely than men to receive the wrong initial diagnosis. Women are also less likely to get a pre-hospital ECG also. And someone who has an incorrect initial diagnosis of heart attack has a 70% higher risk of death after 30 days compared to someone who receives the correct diagnosis straightaway. So, this is serious.

This is because of how we have been informed (and by we, I mean everyone, healthcare workers too) as to what the signs and symptoms of a heart attack are. That’s because we are basing our knowledge solely on the male experience, on what male symptoms are. In fact, over a ten-year period, more than 8,200 women died needlessly following a heart attack. They could have been saved if they had received the same quality of care as men. The BHF call this ‘Bias and Biology’. Here is a quote from a woman who suffered a heart attack. She says… “Doctors thought my symptoms were due to asthma, stress and anxiety at a time when I was changing jobs. But on holiday I had a heart attack and the very next morning I was sent for heart bypass surgery” (Simone Telford 2022). We need to Break this Bias.

Some symptoms of a heart attack do differ between the sexes (British Heart Foundation May 2022). A study by the BHF (May 2022) found more women had pain that radiated to their jaw or back and women were also more likely to experience nausea in addition to chest pain (33 per cent vs 19 per cent). Whereas, the less typical symptoms, such as epigastric pain (heartburn), back pain, or pain that was burning, stabbing or similar to that of indigestion, were more common in men than women (41 per cent in men vs 23 per cent in women). Important to know that women tend to wait longer before calling 999 after first experiencing heart attack symptoms. And we know any delay can dramatically reduce your chance of survival. Additionally, heart attacks are often seen as a male health issue, but more women die from coronary heart disease than breast cancer in the UK. So we really need to Break this Bias, because this misconception is leading to avoidable suffering and loss of life (Pearson, BHF Associate Medical Director 2022). (An interesting video for anyone concerned about heart attacks in women from NHS Scotland here)

Let’s talk about women in research…

Think of another example, Alzheimer’s. In the UK Alzheimer’s disease is almost twice as common in women compared to men. Now, why is it more common in women than men? Well for a long-time clinicians and researchers put it down to the fact that women live longer than men, and didn’t explore it any further. It is only more recently that researchers have begun looking past this assumption, and early discoveries indicate that the impact of biological underpinnings may contribute to the underlying brain changes. Evidence demonstrates that women with dementia have fewer visits to the GP, receive less health monitoring and take more potentially harmful medication than men with dementia, new UCL research reveals (Dayantis 2016). So, for many years bias was present, we need to Break this Bias.

The under-representation of women in clinical trials stems from the long-held assumption that the male perspective represents the norm. For those of you with clinical interest, you will know that medical education textbooks typically default to the male in case studies and anatomical drawings, while women are represented only in matters specific to reproductive biology (Liu 2016).

Differences in pharmacokinetics of drugs between the sexes can be related to body composition and size (Wizemann T, Pardue 2001). Women typically have a lower body weight than men, so when taking the same dose of a drug, results in a higher level of the drug (Parekh 2011, Wizemann 2001). That’s why we see an increase in adverse drug reactions in women. In fact, data suggests women experience adverse drug reactions nearly twice as often as men (Zucker 2020)

However, women have been excluded from pharmaceutical research for many reasons (Yakerson 2019). Now we can’t ignore the thalidomide tragedy of the 1960s which prompted a protectionary ban on pregnant women and women of child-bearing age from participating in clinical trials. Other obstructions are the perceived complexity and higher costs of studies if women are included, women’s unwillingness to participate, and the pervasive treatment of the male body as the norm (Yakerson 2019). They also viewed women as confounding and more expensive to research because of their fluctuating hormone levels (Wizeman 2001). Well, all I can say is we’d be extinct without our ‘fluctuating hormone levels!

It was only in 1993 (29 years ago) that the landmark US National Institutes of Health (NIH) Revitalization Act changed the model from excluding women to recommending their inclusion in phase III clinical trials (Zucker 2020). So improvements are being made however, the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH brings together regulatory authorities and the pharmaceutical industry) has not recognised the need for specific, standalone guidelines on the inclusion of women, continuing to refer to women as a special subgroup to be considered when appropriate (https://admin.ich.org/sites/default/files/2019-04/ICH_Women_Revised_2009.pdf). We need to Break this Bias.

Less than 2.5% of publicly funded research is dedicated solely to reproductive health (“UK Health Research Analysis 2014 (UK Clinical Research Collaboration, 2015) http://www.hrcsonline.net/pages/uk-health-research-analysis-2014”), despite the fact that one in three women in the UK (34%) will suffer from a reproductive or gynaecological health problem (https://www.gov.uk/government/news/survey-reveals-women-experience-severe-reproductive-health-issues 2018). Endometriosis affects one in 10 women, which means it is as common as diabetes in women. The proportion of funding that goes into diabetes far exceeds the levels of funding that goes into endometriosis.

For more info on endometriosis see the end of the article Image is from John Hopkins

There is five times more research into erectile dysfunction, which affects 19% of men, than into premenstrual syndrome, which affects 90% of women (Slawson 2019, https://www.theguardian.com/education/2019/dec/18/women-have-been-woefully-neglected-does-medical-science-have-a-gender-problem). I’ll leave it there. Let’s Break this Bias.

If I give an example of pregnant women in Covid research trials: The disparity in trial inclusion has been exacerbated in the covid-19 pandemic, in fact, pregnant women initially were not included in covid-19 vaccine trials. A recent review reported that of 927 trials related to covid-19, 52% explicitly excluded pregnancy, 46% did not mention pregnancy, and only 1.7% specifically included pregnancy (Smith 2020)

This initial exclusion evidently impacted the very slow uptake of the vaccine in pregnant women. In Dec 2021, the RCM and RCOG emphasised the urgency for pregnant women to receive the vaccine, that’s because at that time three-quarters of all ICU patients with Covid-19 were pregnant women. That’s the consequence of not Breaking this Bias.  The default position should be to investigate and treat pregnant and breastfeeding women in the same way as non-pregnant women unless there are clear reasons not to (Knight 2019).

Time has not allowed, but I think we should return to this another time about the appalling under-representation of minority ethnic groups in research as well as women from deprived areas / lower socio-economic groups (Redwood and Gill 2013). Lots more can be said about these issues.

I’ll just end on, if we are going to achieve any kind of equality, then it is essential we have equal participation and leadership of women in political and public life.  However, data shows that women are underrepresented at all levels of decision-making worldwide, and achieving equality in political life is far off. In our government, 35% of MPs in the House of Commons are currently women, and this, this is an all-time high. And in the House of Lords, it is 28% and around just 36% of local authority councillors in England are women.

If we are going to get anywhere with any of this we need to BreakTheBias

Rebecca Smyth 08/03/22

Endometriosis link <a href=”http://”>here

What is Happening in Parliament to the Health and Care Bill

This is a report back from Parliament about to where we are right now with this pernicious Bill.

Margaret Greenwood MP for Wirral West is our first speaker

Rebecca Smyth a midwife and midwife educator is our second speaker. Her information on the gender divide in healthcare is well worth the listen

Because it is on International Women’s Day we are going to celebrate the blindingly obvious that women might hold up half the sky but they hold up far more of the NHS, and that there is no women liberation without healthcare

We are part of a group of organisations campaigning for the NHS stretching from Southport to Chester Ellesmere Port and Crewe, from Sefton to St Helens. That is the area covered by the new NHS pro-privatisation structures the ICS Boards.

Burning Importance.

On Saturday 26th February 2022 Greg Dropkin, a long term campaigner for Keep Our NHS Public spoke at the SOS NHS event in Liverpool against the Health and Care Bill, which is being put into place ahead of the legislation being agreed.

Greg described one of the vicious changes to our health care that is being developed.

In an emergency, all of us expect to go to A&E and be seen, no matter who we are or where we’re from.
In law, Clinical Commissioning Groups must ensure that emergency care is provided for every person present in the area. But it’s changing. In September, a badly burned Rochdale nurse went to A&E and was
advised to go to Bury given the long delay in Rochdale. When she got there, staff told her “we don’t take patients from Rochdale”, due to a directive from the Northern Care Alliance.

(Image: UGC)

Lord Davies told this story when proposing an amendment to stop any provider from refusing treatment on the basis of which Integrated Care Board the patient belonged to. In response, government Minister Lord Kamall didn’t even# mention emergency care. He said no provider could be expected to provide treatment for which they were not funded, and each Integrated Care Board must be free to decide what treatment to commission. So it’s policy. Even in an emergency, funding flows will trump patient care. Bring an electricity bill and your passport to A&E.
The National NHS is being broken into around 40 separate financial systems. Their budgets will be set
with a new Payment Scheme. The cost of a treatment will depend on where it is given, who provides it, and who is being treated. And, providers including the private sector will be consulted on the prices to be
paid. This means a postcode lottery rigged to suit private firms. If the Integrated Care Board is going over
budget, NHS England can intervene to stop spending. With local budgets and a variable payment scheme, ICBs may say, why should staff in our area be paid the same as other places with better budgets? They may impose local pay and conditions for NHS staff in their patch. That would destroy national agreements, and unions should be screaming about this threat.
Who profits? Around 240 organisations, most of them private companies, are accredited by NHS England
to develop Integrated Care Systems through the Health Systems Support Framework. Several dozen are US transnational corporations supplying the health insurance market.

Operose, which controls dozens of GP surgeries, is wholly owned by US transnational Centene, a $100bn enterprise. Under the Framework,
Operose is accredited for 22 topics, like population health management and payment reform. Its former boss Samantha Jones became Boris Johnson’s Expert Advisor for NHS Transformation and Social Care.
She is now Permanent Secretary and Chief Operating Officer of 10 Downing Street.

The Framework aims to transform the NHS into a digital and data-driven system, where clinicians rely on algorithms, remote monitoring, big data, and artificial intelligence. Labour peer Lord Hunt of Kings Heath tabled 7 amendments to the Bill promoting digital transformation. One requires all NHS organisations to spend at least 5% of their budget on digital transformation. Hunt also chairs the Advisory Board of Octopus
Tenx Health, a health technology investment company. When Octopus took over, the Tenx Board included the husband of Samantha Jones. Tenx Health co-founder Joe Stringer stated at the start of lockdown that coronavirus could be the catalyst for the mass adoption of tech across the health system. He predicted venture capital funds would take it up.
Despite Government spin, the private sector is not barred from Integrated Care Boards. They can sit on committees and the provider collaboratives where private companies and NHS Trusts will come together
to carry out the functions of the ICB using delegated budgets.
New procurement regulations will allow ICBs to award contracts without competition. Just like the crony covid contracts were handed out, overpriced, some to firms with no relevant experience, or which failed
to deliver.

We should fight it all the way. But if the Bill becomes law, we want it repealed and the NHS restored as a universal, comprehensive service, publicly provided, publicly accountable, free at the point of need with decisions taken on clinical grounds, not ability to pay

You can read more about this here

Healthcare for Women and Babies at risk in Liverpool Hospitals Merger Proposals

There are discussions, reported in the Health Service Journal on February 24th 2022 to merge hospitals in Liverpool including Liverpool Women’s Hospital.

As we come up to International Women’s Day on March 8th, let’s raise our voices once again in support of this Women’s hospital. For all our mothers, sisters, daughters, friends and lovers and every precious baby.

The report says “The prospect of creating a £2bn ‘group’ of hospital providers in Liverpool is under formal discussion, senior sources have told HSJ. The sources said talks between six NHS trusts in the city were convened this month by the integrated care system leaders in Cheshire and Mersey. Discussions have so far focused on creating shared governance processes or organising capacity, workforce and patient flows, as well as finding ways to expand the city’s relatively limited healthcare research sector. HSJ understands the prospect of joint leadership or formal mergers are not on the agenda at this stage but could represent a natural progression in the longer term. David Dalton, interim chief executive of Liverpool University Hospitals Foundation Trust, has form in creating Hospital mergers and created one of the first by establishing the Northern Care Alliance, by bringing together Salford Royal FT and Pennine Acute Hospitals Trust, which have since formally merged”.

One of the comments in the health service journal rejoiced in the profit-making potential of this merger

A city-wide group is a great opportunity for private patient growth.
Working with many Trusts over recent years has demonstrated the commercial
opportunities and service benefits that a group can leverage. These include sharing operational and commercial leadership, reducing unit costs of back office overheads, co-branding and enabling consultants to work where the NHS 24/7 infrastructure can meet the particular private patient service gaps that cannot be offered by the independent sector.

Campaigners for women’s and children’s health will not stand idly by. We demand more funding for the NHS, a simpler management structure without the involvement of private profit. We have seen the loss of beds, of A and E departments, staff shortages and overwork. We will not tolerate further cuts. In this terrible time for the NHS, what we have, we hold!

We need a focus on the health and healthcare of women and babies. The national maternity scandals, the decrease in women’s life expectancy in good health, falling life expectancy, the long-term neglect of key issues in young and older women’s health, and the mass underfunding of maternity, all point to the need for a women’s hospital. There is a gender gap in healthcare in this country. There is a gender gap in medical research and in pharma research to suit women’s bodies. So, merging Liverpool Women’s Hospitals is not acceptable.

We are fighting against the Health and Care Bill and the Integrated Care System brought in ahead of the passing of the Bill. At the heart of the Bill and the ICS, project is rationing, denial of care, and introducing charging.

Women’s health care requires improvement nationally and locally. Too many women are left to live with debilitating illnesses and injuries because research and resources have been denied. Too many babies die at birth or in late pregnancy. Gender bias in healthcare is a critical, well-documented problem that endangers people’s lives and well-being. It is a component of sexism, which is a major cause of inequity worldwide, including health inequity. There is a gender bias in healthcare “Gender bias in healthcare is a critical, well-documented problem that endangers people’s lives and well-being. It is a component of sexism, which is a major cause of inequity worldwide, including health inequity.”

Black Asian and ethnic minority women are discriminated against in healthcare. Liverpool and Merseyside have one of the oldest Black communities in the UK. Liverpool women’s Hospital is far from perfect but it is seen as a safe place by many in the black communities.

The British Medical Association described the class inequalities in healthcare for women

There are clear and stark inequalities in health between women, which are related
to socio-economic status, ethnicity and geographic region.
–Across different stages of women’s lives there are different social and economic
factors which drive health and associated health inequalities; including experiences
during early childhood, education, family building and working life and through
retirement and into older age.
– The broad health workforce must take full account of the social and economic
factors which shape women’s lives and health at different stages of life

We will insist that the Cheshire and Merseyside NHS management does indeed take full account of women’s needs.

In the Ockendon report, Donna Ockendon needed to demand that every trust ensure that the trust had a board member responsible for maternity. What a scandal that it needed to be said. imagine a hospital that did its planning without reference to maternity!

Maternity care represents the health of two lives and must be given an elevated level of priority.

The Independent webinar on maternity shows the large problems in maternity as described by Donna Ockendon and the Royal College of Obstetricians and Gynaecologists (RCOG).

We support the staff of the NHS. We are forever in their debt for their work in the NHS. We honour the work they have done and continue to do in the pandemic, under-equipped, underpaid and overworked.

We do not, however, support the management of the NHS, either under the 2012 Act or in the ICS system. Let us recall just some of the local failures:

  1. The New Royal Hospital. Overdue, over budget, badly planned, with the construction company Carillion going bust with no one in Liverpool noticing (except the workers on site who kept reporting issues but who listens to building workers?) badly constructed and still not open. The scrutiny that the contract to build the hospital should have had, was simply not there. Has anyone been held accountable? The Echo reported the problems in the Royal here (with videos).
  2. The private midwife company that went bankrupt leaving mothers, staff and the hospitals that had to pick  up the pieces in the lurch, and worse, there were babies’ lives at risk.
  3. In-Hospital acquisition of Covid in the two branches of the Royal/Aintree merger saw a damning CQC report /

Liverpool University Hospitals NHS Foundation Trust has also exhibited a growing problem with probable HCAIs [Hospital Acquired Infections]. While the trust continues to show persistently high total numbers of new patients in hospital with COVID-19 – a 7-day average of around 40 per day – admissions from the community have slowly fallen from a peak of around 31 per day on the 7th of October. This general slow fall in community admissions has been masked in the aggregate, however, by an increase in probable HCAIs that began in early October, and peaked at around 13 per day in the most recent week of reporting. In the last week of reporting, probable HCAIs made up 27% of all new patients in hospital with COVID-19.” Remember at this point hospital visitors were not allowed.

Resources taken away in the pandemic, like health visitors, have not been returned. Nationally we have an acute shortage of midwives, nurses and doctors.

Liverpool Women’s Hospital focuses on the health of women and babies. Some men are treated there for breast cancer, genetics and fertility. It is a women’s place and we do not want to give it over to a mass merger, especially in a time of discrimination against women in healthcare, and when the NHS local management did not manage the earlier merger well at all. New resources at LWH like the neo natal unit, the new imaging provision, and the wonderful robot surgery can indeed improve women’s and babies’ health. This merger cannot.

There is no evidence that large scale management works better than smaller units. Specialisms, though, do work, and the Women’s is a specialist hospital, specialising in women.

Health care is an investment that repays every penny spent. Health spending should be determined by need. Poor health care is an expense to the individual, to families, to the community and to the economy. It has been estimated that the Government could save billions by improving the health of working-age adults. Being in work leads to better physical and mental health, and we could save the UK up to £100 billion a year by reducing working-age ill health.

Poor care at birth costs the baby, the mother, the family, the schools, the NHS, and society at large.

There is a class health gap in this country, there are serious health issues in Liverpool.” Liverpool is one of the most deprived areas of the country, with more than 4 out of 10 people living in the 10% most deprived neighbourhoods in England.  Deprivation is strongly associated with poor health outcomes, from childhood through to old age” One Liverpool).

We have had ten years or more of cuts, staff shortages and mergers. This has not improved healthcare. We cannot accept more moves to make “economies” when we need more money and better-quality services. The management of health in Liverpool has not been good. In this time of crisis and enforced change, we do not need another merger.

Nor do we accept preparation for privatisation

Women’s health care requires improvement nationally and locally. Too many women are left to live with debilitating illnesses and injuries because research and resources have been denied. Too many babies die at birth or in late pregnancy.

Weep for the Shrewsbury babies.

Weep for the babies, mums and dads affected by the Shrewsbury Baby Scandal.

Have sympathy too for all the midwives and doctors and neonatal nurses, most of whom tried their best against the odds in tough unwinnable circumstances.

Don’t just mourn. Organise for a better health service. Demand that the Government fund maternity to world-class standards. Recruit and retain more midwives and obstetricians

“The Weight of Grief” The artist Celeste Roberge conveyed the physical feeling of grief

The apologists for cuts in NHS funding and services have used a thousand sugared words and phrases to disguise the damage done, created dozens of fads and fashions to disguise the damage. The language used in reports by the NHS is opaque and coded. Austerity cuts to the NHS have been fatal. Panorama tonight made that clear about maternity in Shropshire. That said, there were many management faults, and doubtless faults by those on the front line as inevitably there will be. The point is to learn from those mistakes, but that was not done.

Jeremy Hunt MP, Health Secretary at the time, said yes the NHS was underfunded, understaffed but some hospitals managed! What he neglected to say was that it was inevitable some would fail.

The Panorama report on maternity in Shrewsbury Maternity Unit was so very sad.  Save Liverpool Women’s Hospital Campaign is for all our mothers, sisters, daughters, friends, and lovers and for every precious baby. We have been campaigning for maternity safety, for additional funding for maternity and for far more midwives and obstetricians and access for all mothers and babies to safe surroundings and access to emergency care.

Donna Ockendon

We are waiting to see the final Ockendon Report on Shrewsbury.

We also champion our NHS staff. The years of underfunding could only end this way. Hunt was allowed to say without challenge that the service was underfunded and that it caused problems, but he will not take the blame. This tragedy is far far more his fault than of any midwife.

Let’s be clear, both natural/vaginal births C-sections, planned and emergency, must be available.  Making a low level of interventions a core success criterion did not work, but that does not justify refusing women natural childbirth. Both need to be available and both need extra staffing.

Gentle hands

For a decade maternity has been underfunded, understaffed, treated disrespectfully by the government and some management. Overworked staff, deprived of respect, not listened to by management, will make mistakes, sometimes appalling ones. Some staff like all humans make their own mistakes but the culture of underfunding and bullying plays a huge part. Midwives must not be the fall guys. Join us in our campaign for better maternity services, for women to be heeded and treated as full partners in their care.

A big cheer for the mum who spoke about the damage to her vagina during birth and how she wanted other women to know they are not alone.

We will write more on this in the next few days.

Meanwhile don’t forget to stand up for a fully funded, fully staffed NHS at events across Merseyside this Saturday 26th February The nearest to the Hospital is at the Top of Bold Street by St. Lukes steps at 11.30am.

For all our mothers, sisters, daughters, friends, and lovers, and for every precious baby.