Lets celebrate one victory in the fight to save our NHS. Twenty five years since Liverpool Women’s hospital opened, five years since the threat of closure first reared its ugly head, and the hospital is still here. It is still not fully safe from closure, or relocation and dispersal but we celebrate where we are today.
If we fight for something sometimes we do win.
We wish Many Happy Returns to Liverpool Women’s Hospital! The new building is 25 years old. In February 1995 the first baby was born in the new purpose-built Crown Street site of the Liverpool Women’s Hospital. Since then about 200 thousand babies have been born there at a rate of 8,000 babies per year.
We thank all the staff for their work at this hospital, whatever their role.
Many women, many babies, and a few men and boys, have been treated there for many conditions other than childbirth. The genetics specialism is just one of the innovations Liverpool Women’s Hospital has developed for the area.
The old Liverpool Women’s Hospital on Catherine Street and two Victorian maternity hospital buildings, Oxford Street and Mill Road, merged at the new location. Local historian Mike Royden wrote a history of the old hospitals.
History of the old Hospitals written by local historian Mike Royden.
Liverpool Women’s serves not just Liverpool but the wider region and is a centre of expertise meaning it treats some of the most complex patients.
The hospital was built on land owned by Liverpool people, built by the skill of Liverpool builders, and staffed by workers from Liverpool and across the world. It is, like the NHS, the property of the people. The Crown Street site is low rise on a site set back from the road but walkable from the city centre and the Royal Hospital. It is one mile from the main acute hospital, Liverpool Royal, down a straight road. Despite this it is repeatedly described as “isolated” by those who wish to close it. Its not isolated at all.
The site for building the new hospital was provided by the city council. There had been council housing previously on the land. In that estate a young disabled man, David Moore was run down and killed by a police vehicle. The police were driving vehicles directly at protesting youth in the 1980s “riots” but David was just going into a family house. For more details of the causes of the riots see Loosen the Shackles First Report of the Liverpool 8 Inquiry Into Race Relations in Liverpool.
Unions and local activists were determined there would be no colour bar, no discrimination in the building of the site, determined that local black workers would be part of the project. It linked to Project Rosemary to make good the wrongs done to the area. Unions were successful in involving local labour in the construction. It is now a place were local Black and Asian women tell campaigners that they feel safe.
The hospital had state of the art buildings and equipment. It pleased patients with beautiful rooms, layout and equipment, It was a real contrast with the Victorian buildings it replaced.
More importantly, it was respectful of and celebrated the women and babies treated there. The staff were pioneers in developing respectful caring treatments. Old ladies, expert carers themselves, loved the atmosphere at the new Women’s Hospital. Women in Liverpool who needed care at that hospital received the best available care in the world.
Thousands of staff have been trained there and thousands work there; Staff were proud to be part of what became a world-class women’s hospital.
Liverpool Women’s Hospital was built without a PFI, so does not have that debt hung around its neck. It was built before the madness of the internal markets, PFI mortgages on hospitals and massive outsourcing of staff.
Despite the overwhelmingly positive outcomes from the hospital, there have been some problems at the hospital since it opened. It is not fairyland. Most of these problems, in common in the whole NHS, are caused by financial cuts and underfunding, by the internal market,( introduced by New Labour) cuts in the number of beds, outsourcing of ancillary staff, poor management decisions and more. There were some low points. One was a terrible case of a surgeon whose work caused dreadful harm to many women who suffer to this day. At one point there were not sufficient midwives employed. By 2015 Monitor, the NHS quality body at the time published this which basically gave the women’s a fresh start.
Liverpool Women’s Hospital remains a treasured possession for Liverpool women, and for nearly as many dads. As Julie Taylor from Merseyside Pensioners put it “In these troubled times, what we have we hold!” Campaigners want much more investment, much higher staffing ratios, better pay and conditions and more respect for the staff, better imaging and diagnostics, more research into many aspects of women and babies health, (all of which are described elsewhere in this blog) but we will not see Liverpool Women’s Hospital closed!
5 years ago a Panorama programme revealed plans to close one Liverpool Hospital, and our campaign to save this hospital started. The Liverpool Echo reported it with the headline “Exclusive Liverpool Women’s Hospital could close, city’s top NHS boss admits” and “Future of Liverpool Women’s Hospital uncertain after reports deem it “financially unviable” In 2017 the proposals were reported by the BBC and the Echotwice. It was also reported on labour net here.
The management of the NHS in Liverpool has been pushing for the end of the Crown Street site. They even produced documents listing PFI as an option. Fortunately, the scandal of PFI was crystal clear before they got the go-ahead. Most recently they have asked for a rebuild on the benighted Prescott Street site of the Royal, so badly built by Carillion.
We call for the existing site of Liverpool Women’s Hospital to be upgraded, and for the hospital to continue to work on the garden site. We want a Women’s Hospital as we have had in Liverpool for more than 100 years.
The disastrous Conservative health care “reforms”, were well underway by the time of the first announcement of the threats to Liverpool Women’s Hospital. There have been many closures and attempted closures of maternity units across the country since then, but so far we have saved Liverpool Women’s Hospital.
Liverpool Women’s Hospital is important as a specialist hospital for women’s health. Women endure many years of ill health, In the UK the average life expectancy in good health is only 62 years old. There is not enough appropriate research as to how this can be prevented. Women’s health matters and we need specialist women’s health care.
Chronic ill-health conditions also plague many young women. Endometriosis is just one example of a chronic debilitating illness that required major research to improve current treatment and let us live our lives in good health.
Heart disease in women is a major killer. The British Heart Foundation writes;
“Heart disease kills more than twice as many women as breast cancer in the UK every year and is the single biggest killer of women worldwide. Despite this, it’s often considered a man’s disease.”
Heart disease is a significant factor in maternal deaths in childbirth. All of this means that we need a women’s hospital to focus on our health issues.
Save Liverpool Women’s Hospital Campaign calls for major investment on the Crown Street Site, including in blood, labs and imaging, and longer term intensive care if that is truly needed. The completion of the neonatal unit is a good step in protecting the future of this hospital.
This is a hospital at the heart of Liverpool. Paul McCartney has added his voice to the thousands of people who have signed petitions and joined marches to save this hospital and will continue to fight for it. We have been part and parcel of the national fight for the NHS, for maternity rights, for better chances for babies, and for women’s health. As Nye Bevan said of the NHS, it will survive as long as there are people prepared to fight for it and so it is with Liverpool women’s Hospital.
Why is the UK still not in the top ten countries for infant mortality and for maternal deaths? Why? We are a rich country. We have an established high-quality health service. Healthcare is supposed to be accessible to all. How come babies and mothers die or are badly hurt at birth? How come Black and Ethnic minority babies suffer most? Why do poor areas have worse outcomes than wealthy areas? Why is infant mortality rising? (The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births. The neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. These are both common measures of health care quality, but they are also influenced by social, economic and environmental factors). Are there fundamental problems with core policy documents like the maternity review “Better births”? These are painful questions.
Our campaign wants real improvements for mothers and babies. This posting is not intended as a clinical paper, it is a discussion amongst activists and concerned citizens about where the problems lie. A key set of participants in this discussion are mothers who have given birth, including those who have lost babies, grandmothers and other birth partners, and women who could not conceive.
Our campaign published our Maternity Manifesto during the election but though well shared on Facebook, it did not get into any party’s manifesto.
What then are the factors that result in UK outcomes at birth worse than other advanced countries?
The answers include shortage of NHS funding, staffing shortages, poor management in some hospitals, staff in fear of speaking out, some policies and procedures, disrespect towards the women carrying the baby, and, as cited in the East Kent enquiry, a lack of practical understanding by staff and by mums of the need to “count the kicks” in the latter part of pregnancy. The introduction of charges for migrant women has also caused deaths. NHS material seems to centre the cause on mothers who smoke, or who are overweight. (Now smoking in pregnancy is plain stupid, it really is, and most mums would not do so if they were not addicted. Don’t do it!). However, other countries, Greece for example, who smoke more, have better outcomes in pregnancy than does the UK. Wider problems like obesity and diabetes, and even women giving birth older, are mentioned in the literature about this. Again, the age of the mother as a factor, but this is only partly true. Giving birth older is often safer than giving birth too young. Globally it is most often young girls who die in childbirth.
Answers may lie in the financially and emotionally vulnerable place that pregnant women occupy in our society, including poverty, violence and stress. Poverty and inequality are factors in infant mortality; “The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266).” (Our bold for emphasis).
The UK is a rich advanced country, with a long history of universal healthcare but we have rising infant mortality. “Rising infant mortality is unusual in high-income countries, and international data show that infant mortality has continued to decline in most rich countries in recent years” and “In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend“.
Poverty is not the sole cause of high Infant Mortality though, Cuba has good outcomes equal to the UK for infant mortality. Cuba is very poor indeed and the UK is one of the wealthiest economies (sadly Cuba does less well on maternal deaths).
“Research shows out of 700,000 births a year in England and Wales, around 5,000 babies are stillborn or die before they are a month old”. 5,000 babies each year. There have been major news stories about baby deaths in many hospitals, notably in Shropshire, East Kent and Morecombe Bay.
Maternal deaths. The UK is not in the top ten countries with the lowest infant mortality rate, neither is it the safest place to give birth. In 2015-17, “209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,280,451 women giving birth in the UK. 9.2 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.” In 2016 The UK ranked 24th in the world in Save the Children’s Mothers’ Index and Country Ranking Norway, Finland, Iceland, Denmark, Sweden, Netherlands, Spain, Germany, Australia, Belgium, Austria, Italy, Switzerland, Singapore, Slovenia, Portugal, New Zealand, Israel, Greece, Canada, Luxembourg, Ireland, and France, all did better than the UK. The situation in some other countries is massively worse than here but that is no excuse. But these baby and mothers’ deaths must stop. We cannot sit back and let these deaths continue.
Let’s be clear, the situation for women in pregnancy and childbirth is massively better than before the NHS, and is head and shoulders better than in the USA today. But maternal mortality is an issue here in the UK, and a huge issue in poorer countries, especially where women give birth without a trained professional being in attendance. Quite rightly professionals and campaigners in the UK participate in international endeavours to improve this situation. The NHS should be training and sending midwives to those countries, instead, it is recruiting midwives from poorer countries. In Europe we have cuts in healthcare through Austerity; in the global south, the same concept of cutting public services to the bone is called Restructuring.
Why is the UK, a rich country with (almost) universal health care not doing better by its mothers and babies? Look at just this case and see the problems in the provision of maternity care;
Archie Batten died on 1 September 2019, shortly after birth.
When his mother called the hospital to say she was in labour, she was told the QEQM maternity unit was closed and she should drive herself to the trust’s other hospital, the William Harvey in Ashford, about 38 miles away.
This was not feasible and midwives were sent to her home but struggled to deliver the baby and she was transferred by ambulance to QEQM where her son died. Archie’s inquest is scheduled for March. (BBC).
We know that temporarily “closing” maternity units because they are full is a common occurrence. Women then have to go to a different hospital. Induction of labour can be halted because the unit is full. It is not a pleasant situation for mothers. Some maternity units have closed permanently, meaning mothers have to travel further for treatment, at a time when the ambulance service is under great strain (though being in labour is not considered an emergency for the ambulance service!).
Shortage of Midwives and consequent overwork for the existing staff. The UK has a shortage of three thousand five hundred midwives. The midwife workforce is skewed towards older midwives who will retire soon.
Gill Walton, general secretary and chief executive of the Royal College of Midwives said “We know trusts are facing huge pressures to save money demanded by the government, but this cannot be at the expense of safety. We remain 3,500 midwives short in England and if some maternity units regularly have to close their doors it suggests there is an underlying problem around capacity staffing levels.
Training midwives is not just about recruiting new starters to university courses. There need to be sufficient training places in the Hospitals who are already working flat out, leaving little time for mentoring of students, as well as places in the Universities. Alison Edwards, senior lecturer in midwifery at Birmingham City University, who says: ‘It isn’t as simple as recruiting thousands more students as this requires the infrastructure to support it.
‘You need more tutors, more on-site resources and, perhaps more importantly, more mentors and capacity in placement areas – which is currently under immense strain.’
One student midwife wrote about her experiences in this letter, where she described very hard work without either pay or good quality mentoring.
The government and the NHS call for Continuity Care from Midwives. This means the same midwife or small team of midwives cares for the mother through her pregnancy, birth and postnatal period. We too believe this would be wonderful if it were possible. It is however impossible with the existing ratio of midwives to mothers. Providing continuity of care to the most vulnerable mothers is a good step. NICE have reduced this to the idea of each woman having a named midwife. One to One a private midwife company claimed to provide this but was unable to continue trading, and went bust leaving the NHS to pick up the pieces.
Nationally the NHS is underfunded and looks set to continue so. Much of the problem comes from a long period of underfunding. We spend less than 9.8 per cent of GDP on health. Switzerland, Germany, France, Sweden, Japan, Canada, Denmark. Belgium Austria Norway and the Netherlands all spend more. That places the UK 13th in the list of high spenders on health care. The US spends 16.9 %. (although a lot of that money is diverted from patient care to the big corporations and insurance companies). The NHS was the most cost-efficient health care service in the world.
Underfunding causes staff shortages. Some errors at birth come from staff being overworked and making mistakes.
Some, our campaign believes, flow from fundamental flaws in government policy such as in the Maternity Review, where the pressure is on staff not to intervene in labour.
Listen to the Mother. Some of the deaths are from women not being heeded in pregnancy and childbirth. This is backed up in reports from mothers, including some quoted in the big reviews mentioned above. However, overworked and tired staff who know labour like the back of their hand can easily stop heeding an inexperienced mother.
Poverty kills mothers and babies. As we said above, some deaths, poor baby health, and injuries come from growing maternal poverty and ill-health. Low-income families find it hard to afford good food. Food poverty affects a staggering number of children. The charity UNICEF estimates that “2.5m British children, or 19%, now live in food-insecure households. This means that there are times when their family doesn’t have enough money to acquire enough food, or they cannot buy the full variety of foods needed for a healthy diet. In addition, 10% of these children are also classified as living in severe food insecurity (the European average is 4%) and as a result, are set to experience adverse health.”
Studies show that;
“The Independent inquiry into inequalities in health (Acheson 1998) found that a child’s long term health was related to the nutrition and physique of his/her mother. Infants whose mothers were obese had a greater risk of subsequent coronary heart disease. Low birth weight (under 2500 g) was associated with increased risk of death in infancy and with increased risk of coronary heart disease, diabetes and hypertension in later life. Accordingly, the Inquiry recommended, ‘improving the health and nutrition of women of childbearing age and their children, with priority given to the elimination of food poverty and the reduction of obesity’. (NICE
A significant number of deaths of new mothers come from mental health issues that spiral out of control. Some of these will be newly developed conditions and some existing conditions made worse by pregnancy and childbirth. Mothers family and professionals must all be on the alert and intervene early. There are good ways to treat mental health in pregnancy.
Reducing the social and economic stresses around pregnancy would also help reduce the deaths and suffering
When Birth goes wrong it can be a dreadful experience for everyone involved. In most cases, the panic button brings in a well-drilled team of experts who can solve nearly every problem and do it calmly. At other times, it is dreadful, as described in the coverage of the birth and death of baby Harry Richford. Harry Richford was born at the Queen Elizabeth the Queen Mother Hospital in Margate in 2017 but died a week later. https://www.bbc.co.uk/news/uk-england-kent-51097200
Sands, the baby death charity explains that there are many causes of babies dying before birth. Crucially important is that mothers are heeded when they are concerned and that everyone Counts the Kicks
Press coverage. How does the press cover the NHS, and baby deaths? There are very real problems in the NHS and maternity care but the coverage in the press of these problems seems to switch on and off in strange ways, often to suit Conservative Party political requirements. The NHS and the Government are masters of propaganda and news manipulation. The public needs to learn to judge the news and to look both for actual problems and look out for bullshit and manipulation. Why was news of the arrest of the nurse from the Countess of Chester hospital headlines on the 70th Anniversary of the NHS? Why was the news of the understaffing there not given similar nationwide publicity? Why have we heard little or nothing since?
If the government can switch the blame to the professionals in the NHS (but not their mates the high admin of the NHS), then they seem to be happy to publicise the problems. In other cases, problems are swept under the carpet.
Professionals expect to (and do) take responsibility for their own actions. Mistakes will be made. It is impossible to go through life without some mistakes. When we are dealing with life and death mistakes can be catastrophic, even where there is no ill intent.
Malicious action is rare. There are the terrible cases of serial murderer Harold Shipman, and the convicted surgeon Ian Paterson who falsely told women, they had breast cancer and operated on them unnecessarily. The hierarchical system in the NHS and the lack of regulation in private hospital, which was described as “dysfunctional at almost every level” allowed that harm. We have not found such a case in maternity.
Unintentional bad practice, however, has also harmed babies. No one went to work intending to harm in the events publicised in the Morecombe Bay Enquiry into the deaths of 11 babies and one mother. It was said that “The prime responsibility for ensuring the safety of clinical services rests with the clinicians who provide them, and those associated with the unit failed to discharge this duty over a prolonged period. The prime responsibility for ensuring that they provide safe services and that the warning signs of departure from standards are picked up and acted upon lies with the Trust, the body statutorily responsible for those services.”
The Enquiry described what happens like this “In the maternity services at Furness General Hospital, this ‘drift’ involved a particularly dangerous combination of declining clinical skills and knowledge, a drive to achieve normal childbirth ‘whatever the cost’ and a reckless approach to detecting and managing mothers and babies at higher risk.”
The Furness General Hospital was pushing for Foundation Trust status at the time and was not exercising the necessary supervision.
“Maternity care is almost unique amongst NHS services: the majority of those using it are not ill but going through a sequence of normal physiological changes that usually culminate in two healthy individuals. In consequence, the safety of maternity care depends crucially on maintaining vigilance for early warning of any departure from normality and on taking the right, timely action when it is detected. The corollary is that, if those standards are not met, it may be some time before one or more adverse events occur; given their relative scarcity in maternity care, it is vital that every such occurrence is examined to see why it happened.“
So, many factors come into play in such incidents of harm to mother and baby. Professionals too can be emotionally wrecked by tragedy.
Huge personal and professional lessons can be learned from a detailed review of cases where mistakes are made. There is a whole literature about learning from mistakes. The worst such incidents are referred to as Never Events. This is just one article about such errors but there is a whole field of research devoted to it. Serious Mistake Reviews often happen at the end of shifts, and in the worst cases, may lead to long public enquiries.
NHS as a research organisation One of the great virtues of the NHS is the research base it offers professionals. What happens in the NHS which covers 62 million people is studied, evaluated, and researched. This is invaluable to staff and above all to patients. Sadly this research is also of interest to big business especially to those who sell health insurance and to the big corporations who have their ‘snouts’ in the NHS ‘trough’. Research for the common good is clearly different from research to make money. We see that regularly in big pharma. Cheap effective medicines do not make money for the companies. Yet the government is giving away our medical data to companies to make a profit.
There are also “errors” that happen when everyone is following accepted procedures and protocols; “untoward events, complications, and mishaps that resulted from acceptable diagnostic or therapeutic practice”. Procedures within the NHS can be robust and well researched, and problems still occur.
Research matters. Only by studying outcomes can these errors be revealed. A classic example is the once customary practice of episiotomy, cutting a woman to prevent tears to the perineal skin in childbirth, which is now no longer used except in an emergency. Research both formal and informal changed that practice. As another example of such research, Liverpool Women’s hospital has been involved in research about the benefits of leaving the baby attached by the cord if they are born unwell. NHS staff and other health professionals, academics and pressure groups are working hard to improve outcomes for mothers and babies. Each mothers death is reviewed in the MBRRACE-UK report
Never again. The tragedy of the death of a mother and or baby is felt by that whole extended family. Most families want to know it will never happen again. Cover-ups and lies mean it will happen again, so brutal honesty is needed.
The aftermath of medical treatment or neglect which causes real harm is complex. Whether the outcome is death, life long impairment, or long term physical and mental health issues, these are very significant events for all concerned.
If a baby is born with life-changing impairments, the baby is left facing catastrophic difficulties and the mother and family can face major heartbreak and hardship. The huge love we have for our kids (may it long continue), whatever their issues, does not prevent the financial, housing and employment issues families with disabled children face. Nor does it guarantee the best educational opportunities, SEN is being battered by cuts. but parents and teachers are fighting back.
The cost of financial “compensation” from an injury to a newborn is huge because it is life long. The cost of this “compensation” used to be carried by the government but the system changed to make hospitals “buy” insurance from a government body which is set up like an insurance company. The cost to the hospital is charged on the basis or earlier claims, like car insurance. Obstetrics make the highest claims of any section of the NHS.
Liverpool Women’s Hospital had a huge case (not about babies) some years ago, arising from a surgeon who left many women damaged after incontinence operations. Their total bill, over 5 years, according to the Echo, was £58.8 million. “The NHS trust has been forced to pay out £58.8m in the last five years for both recent and historic negligence cases.”
The limited work we do, as a campaign, in holding the hospital to account, leads us to believe lessons have been learned by the hospital. However, in every hospital, there are pressures which could lead to problems. These pressures include financial and organisational, problems of management ethos, and the potential for bullying, the distrust by the staff of their management, and disrespect for whistleblowers.
The NHS has gone through years of reorganisation after reorganisation. In that time the financial and government pressure has been to complete the re-organisation, or face catastrophic consequences so very many hours of admin and senior doctor time has been wasted on this process. That time could have been focussing on saving babies
At STP and national level, there are other problems. The NHS is intensely political. There are deep structural problems. (We believe the NHS should return to the Bevan Model of health care)
The NHS is not only deprived of adequate funding, but it has also been forced to implement many market-based changes, including the internal market, outsourcing and commissions of services to for-profit companies. These market-based structures are expensive.
The NHS has also seen dire staff shortages resulting from stupid decisions like removing bursaries, not training enough doctors and the hostile environment to migrant staff.
There are moral and financial issues in all cases of such errors. The hurt to the babies is our priority.
Baby deaths and severe injury at birth have complex roots. Though what happens in the hospital is crucial, it is not just what happens in the hospitals that matter. The stress, poverty and anxiety many mothers endure during pregnancy do sometimes affect the outcomes for the child. Many women are still sacked for being pregnant but families can rarely cope with just one wage (do fight back against sacking pregnant women!). See Maternity Action for details. Both mums and midwives can call Maternity Action for advice.
Low pay or the dreaded universal credit can make food heating and rent all too expensive. This can lead to food poverty. Women do not yet have real equal pay but mothers have the worst pay of all Benefits are no longer allowed for a third child. even though most claimants are working. Whether parents are working or not, every child has a right to food and shelter, be they first or 10th child. The child gets no choice!
Not every pregnant woman is in a stable caring relationship. Housing, especially private renting, becomes more difficult when women are pregnant. Who can forget the story of the homeless woman giving birth to twins in the street? Pregnancy is often the time when domestic violence is inflicted on a woman but it is the time when women are least able to walk away. Poverty kills babies too.
Please join us in campaigning for better outcomes for all mothers and babies in the NHS and across the globe. We want this to start a discussion, so please send us your views. and information
A woman’s right to choose in matters of abortion has been long fought and dearly-won. The fight for abortion rights is like housework in that it keeps needing to be fought for again and again. There is no freedom for women without the right to control their fertility. This short article is a quick summary of the issue, which has surfaced again in UK politics. No woman of childbearing age can say that she would never need an abortion. Savita (see below) didn’t go into hospital to have an abortion but she would have come out alive if she had been given one. Many women have died from being denied this basic right. Many different campaigns have been needed to achieve the limited rights we have now. Anyone who wants to restrict those rights will face a huge response from women. The right to choose to continue or terminate a pregnancy must be with the woman but she is entitled to the support of society if she chooses to have a baby. That support is severely limited. “It takes a village to raise a child.” Having a baby is an event for the whole society and for many decades to come. But the decision as to what goes on inside a women’s body is hers and hers alone.
Abortion happens in every culture and happened at every stage of history. Social, legal, religious and technological pressures prevented some women from accessing safe abortion, but there has never been a time when women did not seek abortion for thousands of different reasons. Most countries in the world allow abortion, but our rights are under threat from right-wing governments and from the US. Much health care in “developing” countries comes through NGOs. Current US policy is restricting the role of NGOs in supporting reproductive rights, through the global gag rule. So think on if you think all is well in the area of abortion rights. It is still a very live battle. The law in the UK is summarized here; “A pregnancy may only be terminated under section 1(1)(a) of the Abortion Act if it has not exceeded 24 weeks. The majority of abortions carried out in England, Scotland, and Wales take place within this time, over 90 per cent of which are carried out at 13 weeks or earlier. This percentage has remained relatively constant over the past decade. Early abortion is generally seen as medically preferable due to the lower risk of complication.” The-Law-and-Ethics-of-Abortion-2018. BMA
Until 2018 Ireland had very restrictive laws on abortion. Savita Halappanavar, a dentist, happily pregnant died on 22 October 2012 in Galway from sepsis, having been denied an abortion. This was a much-wanted pregnancy which had failed, but the hospital failed “to offer all management options to Ms Halappanavar who was experiencing an inevitable miscarriage of an early second-trimester pregnancy where the risk to her was increasing with time, from the time that her membranes had ruptured.” Savita died of septic miscarriage, having been refused an abortion because of the laws of Ireland that forbade it. Savita requested an abortion after the miscarriage started and could not be stopped. This was denied. Savita’s case prompted and publicised the huge campaign in Ireland to Repeal the 8th, which was put to a referendum and won with 66.4% of the vote.
Before this, over decades, many Irish women travelled to Liverpool Women’s Hospital to have an abortion. We believe this still happens in some cases because Irish Abortion law is still not comprehensive. Abortion rights were only won in Northern Ireland a few months ago, on 21st October 2019, and it was met with well funded and nasty opposition When it did go through the UK parliament. The MP who moved the Bill,, Stella Creasey, herself pregnant, featured in an obnoxious very personal anti-abortion campaign in her constituency.
Gruesome anti-abortion posters in Stella Creasey’s constituency when she moved for abortion rights in Northern Ireland and while she was pregnant.
The World Health Organisation reports that globally each year between 4.7% – 13.2% of maternal deaths can be attributed to unsafe abortion, and that “Almost every abortion death and disability could be prevented through sexuality education, use of effective contraception, provision of safe, legal induced abortion, and timely care for complications“.
Abortion is intensely political. Trump called for abortion to be punished in some way. It is inseparable from politics. In the US the Right-wing government in many states have seriously restricted women’s rights to access safe abortions. The US already has the worst maternal outcomes in the developed world. It’s important to remember that there are strong links between the high management of the NHS, huge US health corporations, and between Johnson and Trump, so what happens in the US is important to us. Fortunately, the women of the US are fighting back. On January 19th 2020 thousands of women gathered in an annual march to recall the enormous march of women when Trump was elected in 2017.
We support a woman’s right to choose to have a baby too, if humanly possible.
Save Liverpool Women’s Hospital Campaign supports abortion rights and also supports fertility rights. For too many women accessing fertility treatment is restricted on the NHS and involves eye-watering costs up to £5000 per cycle for treatment after NHS allocation has failed.
We support the rights of the mother and child to have support from the community. The right to have a child and the right to know that that child will be allowed to thrive is also important. There is no right to choose if dire poverty is the alternative to abortion. The third child rule which means that a woman who has a third child cannot claim benefits for that child is utterly foul and disgusting. Everyone in work pays national insurance and everyone who buys goods pays tax. We do this, so and we should be protected from dire poverty. This is a very rich country, but children should be protected in every country. The reactionary third child policy is a disgrace. Already many first and second babies go short in this cruel benefits system. More than 100,000 children live in poverty on Merseyside, most from families with at least one parent in work. Child Poverty Action Group CPAG reports that the families challenging the third child policy in court ; “Of the two claimant households that will be part of the Supreme Court case, one of the lone parents is on income support and suffers from various disabilities while the other is receiving the working tax credit. Neither of the mothers intended to get pregnant with the ‘additional child’, indeed one of them was on the pill at the time, but equally for moral reasons neither of them was prepared to consider terminating the pregnancy.” Child care When women return to work after having a baby child care is often too expensive or unavailable. Grandparents are playing a huge role in childcare so mums can work, even when the mums would prefer to be at home with tiny children. But returning to work does not give them equal pay with men. The maternity pay gap is a serious problem for women raising children. “Women’s increased education and greater continuity of employment have not been sufficient to eliminate wage penalties faced by mothers returning to work after having children. Scores of economics studies demonstrate that women’s improved human capital in many countries has not provided the necessary full protection from discrimination against mothers”. The maternal pay gap exists in most professions, even amongst doctors. Should disability affect the Abortion time limit? There is another debate is that the disability of a foetus should not be a reason for an extended time limit for abortions. We believe the choice is with the mother. That is the only safe and just position.
Some women do choose to continue a pregnancy even if there is a serious disability diagnosed before birth. It is her choice. We would call for full support for women making this decision too. It’s hard enough though, to adjust to the new emotional realities of life for a much-loved baby with disabilities, and the consequent changes for the family. This journey of adaptation can be life-affirming and give great joy, but it is often accompanied by dire financial hardship and inadequate social provision, exhaustion and family breakdown. “In order for Ben to be at nursery, he needs 1:1 care. His condition means he cannot move independently at all, feed himself or access toys or activities or play with his friends without support. Since he started at nursery we have tried three different funding pots to get 1:1 support for him. Now the nursery has to apply every 16 weeks for extra funding. It’s a source of major anxiety because every 16 weeks I face the fact that I might have to give up work with no notice period. Every 16 weeks, I face the possibility of us losing our home.” (Jennie, mum to Ben, who has quadriplegic cerebral palsy from Contact a Family) Whilst there are benefits available, they are generally regarded as inadequate. Our campaign believes disabled children should be cherished and well cared for. Sadly, they are more likely than average to be living in hardship. We believe women should fight like hell for better benefits and resources for disabled children and their families “There is evidence that disabled children are significantly more likely to grow up in poverty than those who are non-disabled (MacInnes et al. 2014). According to Read et al. (2012), financial disadvantage may be a result of higher costs of living with disability, reduced opportunities for adults in the household to undertake paid work, the inadequacy of state benefits to offset this, and barriers to benefit take-up, however, they also state that these factors may not offer a full explanation. Despite being well-reported, the reasons for the association between poverty and childhood disability are not yet fully understood (Read et al. 2012). Emerson et al. (2010) make the three following suggestions:
The presence of a child with a disability may increase the chances of a family descending into poverty and reduce the chances of them escaping from poverty
Growing up in poverty is associated with increased exposure to a range of factors, such as poorer nutrition and housing, that may increase the risk for health conditions or impairments
Save Liverpool Women’s hospital Campaign would add that society is not constructed to respect disabled children or adults; our society is disablist. We oppose governmental interference either to forbid abortion or to force it (either indirectly as through the two-child policy, or directly as through the damaging one-child policy in China until fairly recently). In a healthy society, women will have children if they so choose but policies can make it very hard, either way. Women have fewer children if they have better education, better rights and access to a decent job, health care and pensions. However, in “advanced” western counties, the birthrate rises if there is good provision for mothers and babies. Unicef studied advanced countries and recommended that ;
“Countries could improve their policies as follows: � Provide statutory, nationwide paid leave to both mothers and fathers, where it is lacking. � Remove barriers to the take-up of childcare leave, especially those faced by fathers. � Enable all children to access high-quality, age-appropriate, affordable and accessible childcare centres irrespective of their personal or family circumstances. � Fill the gap, where it exists, between the end of parental leave and the start of affordable and accessible childcare in centres so that children can continue their development without interruption. � Ensure that mothers can breastfeed both before and after they return to work by providing such things as guaranteed breastfeeding breaks, places to pump and store milk and quality childcare nearby. � Build the capacity of health professionals to provide breastfeeding support in hospitals and communities. � Collect more and better data on all aspects of family-friendly policies so that programmes can be monitored, policies compared, and countries held accountable.”
In contrast, where there is a low standard of living, no social security and no pensions, children are the only way to secure a family’s long term economic well being, so the pressure on women to have many children remains.
In many countries, where austerity has hit hard, there is now a #birthstrike on where women are refusing to have babies until violence against women is stopped and until social-political climate issues are solved. Reproductive rights are at the core of politics and women’s voices must be heard. There is plenty of scope for campaigners who want to reduce the number of abortions, in working to reduce poverty, to remove women’s pay gaps, in working to improve child care, to reinstate Special Educational Needs provision, and in supporting foetal medicine research to prevent damage to babies in the womb. SLWH will support and join in such campaigns.
Let us fight to save some of the very much wanted babies who die at birth or before. Tommy’s, the stillbirth charity say 1 in every 250 pregnancies ends in a stillbirth in the UK. That’s 8 babies every day. The Uk (according to some the 4th wealthiest country in the world), is not even in the top ten countries for women to give birth safely. We were ranked 23rd. So if your heart is moved to protect the unborn there is work for you to do without interfering with a women’s right to choose.
Family size in the UK nowadays does depend more on the mother’s choice. There is greater access to contraception and abortion. In the 1920s and 1930s, very large Liverpool families of ten or and twelve children were not uncommon. Few of these large families saw all the children reaching adulthood. Childhood illnesses, poor maternity care and poor access to healthcare killed many. Post-war, the condom and the cap allowed many families to be much smaller and generally, those children that were born, thrived. In the 1950s the average number of births per mother was 4.7. It is now declining to 2.4 children per mother internationally and 1.7 in the UK. “The number of children women are having is continuing to decline, to a record low of 1.89, according to the Office for National Statistics. Its study compared two groups of women: those born in 1972, who are now in their 40s, with those born in 1945, who had an average of 2.19 children. The numbers of families in England and Wales with just one child grew from 14% to 18%. Childlessness also increased in women, from 10% to 18%.” There are potential problems ahead for countries with low birth rates, as the number of older people needing care outstrips the young adults able to provide the care. If women are to feel safe and secure having children, this cruel system of unequal pay, poor child care, poor benefits, rationed healthcare and violence against women has got to be changed. It is for the pregnant woman and her alone to decide if she continues a pregnancy.
Have you heard of “procedures of low clinical benefit”? Don’t worry you will be hearing a lot more about them if we don’t do something to stop the privatisation and remodelling of our NHS based on the American private insurance model.
In June 2019, NHS campaigners became aware of a scheme called “My Choice” on offer locally and in other selected pockets around the country. Our local scheme was at Warrington & Halton Hospitals NHS Foundation Trust (“WHHFT). Their definition of My Choice is:
My Choice is By the NHS, For the NHS
”The major benefit is access to outstanding NHS treatments at a fraction of the cost of those undertaken by private providers. The procedures available are extensive and include everything from hip and knee replacement to cataracts, tonsillectomy to breast augmentation.”
We have all heard of private hospitals and people “going private”. Of people jumping the NHS queue” by paying privately. But this a new scheme altogether. A new and thoroughly terrifying development. This is asking patients to pay for operations which were previously done for free on the NHS and which are not available to them unless they pay, so its not just jumping the queue. They can’t have the operation at all unless they pay up. In the past, if you had problems with your knee, your GP referred you to a specialist consultant who examined you and decided if you needed a new knee and if necessary put the wheels in motion to organise your operation to be done free by the NHS either in an NHS hospital or at times of high waiting lists sometimes the NHS paid private hospitals to do the operation.
Now, in 2019, after 10 years of successive Conservative/Liberal Democrat coalition and then Conservative governments, the definition of what is provided on the NHS has been changed and restricted. So that many operations are now defined as of “low clinical benefit” and are therefore no longer available on the NHS.
This is the list of treatement of low clinical worth, recently published in the Guardian. Some trealtments do become outdated but this is not to do with outdated treatements but to do with rationing treatments to contain costs.
In My Choice there is a long price list which includes procedures for knee and hip replacements, cataracts and hernia operations among many others.
If it hasn’t affected these procedures in your local area yet, its only a matter of time. If your GP is really sure you need the operation, you can try arguing your case via an Individual Funding Request, where a board of medical and non-medical people decide if you are deserving enough.
For example, for hip and knee replacements doctors use a scoring system to assess how much discomfort and lack of mobility a patient has.
By increasing the bar at which a referral for an operation is made the NHS can help restrict the numbers getting treatment.
In the blurb for these schemes around the country, they repeatedly mention having to make “difficult decisions”. This is an oft heard Tory mantra since 2010 and the imposition of ideological austerity which apparently necessitates the poorest and most vulnerable having to be punished for the crimes of global bankers. The ordinary people in this country have taken this punishment for 9 years whilst bankers’ multi-million-pound bonuses have been restored, it doesn’t seem to me that is a fair settlement?
Under cover of austerity the Tories and Lib Dems attacked public services including the NHS. They cut funding, undermined it, basically carried out the tried and tested Tory privatisation process. Despite living in the 5th richest economy in the world and despite the £billions of public money still being ploughed into the NHS, services have been cut, beds closed, A&E and maternity departments closed and huge debts racked up but there are more managers and accountants than ever producing figures and targets which are mostly missed and yet patients can’t get a GP appointment.
More and more services are being provided by private profiteers such as Virgincare and yet more services have been drastically culled, so are no longer provided by the NHS. They are NHS was meant to be universally available regardless of wealth and connections. It was now provided in a haphazard manner by a hotchpotch of third sector providers. Bevan’s supposed to take away the worry about getting sick and the reliance on philanthropy and charity. And yet in 2019, that is exactly where our NHS is regressing to, a time pre 1948, pre the creation of the NHS.
So now back to “My Choice”, could you afford to pay over £7000 for a new knee or a new hip? More if you need both hips or both knees done? Or over £1600 for a cataract operation? Oh, and don’t forget the £180 consultation fee!
WHHFT produced their prices for a long list of treatments. I don’t think anyone would argue that procedures purely for cosmetic reasons (without accompanying psychological symptoms or disfigurement) should be paid for from your own pocket, if that’s what a person chooses to spend their disposable income on that’s up to them. However, it’s another thing entirely to expect a person to find over £7000 for a new hip to keep them mobile. That’s what is happening already. We have already explained how breast reduction is not an unnecessary operation
The hospital trust tried to defend its decision to impose charges and insisted patients would not jump the queue, that they would be added to NHS waiting lists, be seen by NHS staff in NHS wards and operated on in NHS theatres using “spare capacity”.
How often do the media headlines scream out that waiting lists are getting longer, targets are being missed, including cancer targets, people are waiting for scans, to see consultants, that there are 100,000 staff short in our NHS, that we are all somehow “abusing the NHS” by using it too much, that the population has increased and that the elderly are apparently a big cause of these problems due to “bed blocking”?? And yet Warrington & Halton Hospital FT had “spare capacity”! Presumably there are no waiting list backlogs for surgery in Warrington and Halton hospitals and surgeons are sitting around twiddling their thumbs waiting for work?
Also, what ever happened to the ethical code for doctors and health professionals? The mantra of “first do no harm”. If a GP or consultant or CCG has decided your bad hip doesn’t need replacing because it would be of low clinical benefit to you, and therefore has decided you do not qualify to have it done on the NHS, why then does it suddenly become of sufficient clinical benefit if you pay for the operation yourself? Is this ethical? Either you need the operation in which case it should be done on the NHS according to need, or you don’t need it and therefore no self-respecting surgeon should be willing to do an unnecessary operation whether or not you are prepared to pay for it?
After a few weeks of sustained pressure from NHS campaigners, setting up demonstrations outside the hospitals, handing out 5000 leaflets all over the Liverpool City Region at music festivals, parks, hospitals, NHS stalls etc and having hundreds of conversations with the public plus getting thousands of signatures on petitions, the Trust was forced to “pause” the My Choice scheme.
It was even discussed by Sir Simon Stevens, the head of NHS England and the architect of NHS privatisation imposing the US healthcare model on our NHS. He mentioned it in a parliamentary committee and said that the “marketing” of My Choice was Misguided”. Note he wasn’t saying the scheme should not have been put in place or that patients shouldn’t have to pay. Just that they got the “marketing” wrong. The reason for this is that Mel Pickup the CEO at Warrington was doing exactly what the Tory government and NHS England plan for all of us. She just didn’t bank on NHS campaigners cottoning on to the experiment. It will be un-“paused” at some point when they think the dust has settled. However,, Ms Pickup announced she was leaving the Trust and was also leaving her post as head of the Cheshire & Merseyside STP. Had she been successful in rolling this scheme out quietly in Warrington, it would soon have been rolled out across the whole of the STP footprint.
Why are some treatments not routinely offered by the NHS? There may be some cases where a treatment is not available because there is limited evidence for how well it works or because it is very high cost and doesn’t offer good value for money for taxpayers and the NHS. If there is a reason to change this recommendation then it goes to a panel for discussion
A fully funded NHS pays for itself in the health of the population and their capacity to continue to work and to care for others. It also contibutes to the general health and happiness of society, The Bevan model of universal health care, free at the point of need, paid for by general taxation,and publicly provided is the most cost efficient model of health care in the world.
The NHS is worth voting for.
Author: Mary Whitby NHS campaigner who first exposed the My Choice scandal
This is the fourth of a series of blog posts intended to share the current issues facing Liverpool Women’s Hospital.The posts are based on a report to the Board meeting held in public on 7th November 2019. The earlier posts are about Maternity, Gynaecological Oncology, and the age profile of the medical staff at LWH. This post is about LWH working in partnership with the large acute hospital, Liverpool University Hospitals NHS Foundation Trust, which includes the Royal, Broadgreen and Aintree. The proposals are for ways LWH can work with the Liverpool University Hospitals NHS Foundation Trust
As with the earlier posts, the purpose of publicising these papers is to make these important discussions accessible to the concerned lay woman and to medical, midwifery and nursing staff who do not have easy access to the main papers, which can be found here. Publishing them does not imply support, nor is this a critique. Such a critique will follow when our supporters have had the opportunity to discuss the options. We are all too aware that the NHS is monstrously underfunded and overworked and that policy changes since 2010 have done great harm.We are aware that life expectancy for women in poor areas is slipping and that many people have died from the impact of Austerity. Our campaign to Save liverpool Wiomen’s hospital goes on. Our petition is here.
Following discussions between the respective CEOs of LWH and LUH, an MoU (Memorandum of Understanding) has been created for the formation of a Partnership Board between the two trusts. This group will be accountable to the respective Boards of Directors via the executive bodies and will have operational, medical and nursing/midwifery representation. It will further develop and formalise the ‘virtual bridge’ linking the two organisations with respect to the provision of clinical care.
In addition to details given above around the provision of gynaecological oncology, the Partnership Board will examine the following:
· Partnership working for HDU provision at LWH which may include joint nursing and anaesthetic appointments, rotation across sites and support at LWH from LUH intensivists
· Consideration of the pattern of critical care outreach services that could feasibly be provided on the LWH site
· Formalisation of the working arrangements that allow for the provision of urgently needed specialist care from non-women’s specialists on the LWH site · Formalisation of the working arrangements that allow for the provision of urgently needed care from women’s specialists on the LUH sites
· Review of the present pattern of delivery of maternal medicine services in the light of national drivers for change
· Establishment of a gynaecological nursing and midwifery presence on the LUH sites
· Formalisation of pathways for access to imaging and diagnostics on a seven day basis, with consideration of providing CT and extending other imaging facilities at the LWH site; including image generation and timely reporting
· Partnership working to provide staffing for a proposed new blood bank and extended lab facilities at LWH with 24/7 delivery of urgent services
· Formalisation of pathways surrounding access to seven day service requirements with respect to therapies, dietetics, pain management and tissue viability services
Consideration of the potential for the use of the LWH site for LUH clinical activity where clinically appropriate, if this is needed to enable gynaecological activity on the LWH to be moved onto LUH sites
· Exploration of the use of digital technologies for the sharing of clinical information across sites to advance patient safety
· Formalisation of the process of safe repatriation of patients from LUH to LWH sites, taking into account the available services and facilities available at the LWH site
· Provision of oversight wrt (with regard to) the transfer of sick patients from LWH to LUH, reducing delayed transfer and minimising the risks associated with the transfer itself.
LWH has also suggested that NHSE/I and Liverpool CCG join that Partnership Board, which would then also report into (a) the One Liverpool place based care leadership group and (2) the Acute Sustainability Board for C&M. This would provide all parts of the system with continued sight until such time as the trust’s clinical problems have been fully resolved.
Recruitment and RetentionThe Trust is finding it difficult to recruit and retain consultants with the skills to maintain and develop its adult services. The problem has been highlighted above with respect to gynaecological oncologists but there have also been difficulties recruiting consultant anaesthetists and consultant gynaecologists with advanced skills in complex benign laparoscopic surgery.
In future, obstetricians trained in maternal medicine may also prefer to work elsewhere as LWH is unable to meet the essential MMC criteria. This will have a negative impact upon the trust’s prestige.
In principle, there are two ways in which the trust can maximise its potential for recruitment and retention and these are now being considered as a separate workstream by the Director of Workforce and Communication’s team:
Optimise the professional offer
· Increased access to facilities off site (eg) multidisciplinary teams, robotic surgery
· Improved facilities on-site (eg) imaging, blood bank, digital
· Bespoke job plans to prioritise each consultant’s professional preferences
· Attractive terms for study leave
· Overseas recruitment
· Promote the LWH brand.
Optimise the personal offer
· Part time working and job shares
· Annualised working hours
· Off site delivery of non clinical duties
· Leeway in holiday provision
· Attractive remuneration with respect to recruitment
· Attractive remuneration with respect to retention.
The establishment of a Partnership Board with LUH and the forging of closer working relationships may help with some of the ‘professional offer’ issues as it will provide LWH clinicians with access to a greater range of facilities and multidisciplinary expertise. Similarly, an expansion has been seen in the number of joint consultant anaesthetist posts with LUH and this is likely to continue but the services provided by LWH are otherwise highly specialised and the same opportunity is unlikely to be found in the trust’s other clinical services.
Without relocation, the recruitment and retention of consultants is likely to be problematic for the foreseeable future “
The issues discussed here affect Doctors’ training nationally and need consideration in that way too. Women’s health care matters and requires specialist input. Specialist hospitals exist in the NHS alongside the large acute hospitals. The acute hospital model is not the only option.
The Age Profile of Consultant Medical Staff. Full document here
Doctors pursuing a career as a specialist in the UK must follow nationally recognised training pathways to gain relevant clinical experience and to obtain their advanced professional qualifications. These pathways have evolved over the years. The Calman reforms in the 1990s and Modernising Medical Careers in 2005, for example, funneled doctors into their chosen specialty at an early stage in their careers while the European Working Time Directive in 1998 reduced the year-on-year volume of clinical work that doctors were exposed to while working towards consultant status.
These changes may have improved consultants’ specialised knowledge and skills but they have also made them more reliant upon cross-specialty working when dealing with patients with multiple medical or surgical co-morbidities.
Put simply, consultants who were born before 1970 could be described as being ‘multi-skilled’ whereas consultants who were born in 1970 or later could be described as being ‘hyper-specialised.’
In obstetric, gynaecological and anaesthetic practice, an increasing number of women with significant medical and surgical co-morbidities are now presenting for care who would not previously have done so. In a medical environment populated by hyper-specialised rather than multi-skilled consultants, patient care must therefore be delivered by a range of specalists in a co-ordinated manner, yet this cannot be provided on LWH’s Crown Street site.
This In 2018, 24/47 consultants in the trust’s three acute adult specialties (just over 50%) could have been described as multi-skilled rather than hyper-specialised. In a simplistic model of recruitment and retention, if we accept that one hyper-specialised Consultant will be recruited each time a multi-skilled Consultant retires in coming years, then: · By 2023 around 40% of our consultants will be multi-skilled · By 2028 around 20% of our consultants will be multi-skilled · By 2033 none of our consultants will be multi-skilled. The data show that in the absence of relocation onto an adult acute site, the shifttowards a hyper-specialised consultant workforce will add to the clinical risk associated with the trust’s physical isolation in an incremental manner in coming years.
In the absence of relocation, a partial solution to the conundrum of a changing skill set amongst the trust’s consultant workforce would be to increase the opportunities for the trust’s clinical activities to take place in a multidisciplinary environment: (a) Switching work that we presently do at Crown Street onto an adult acute site (b) Bringing specialists from other disciplines onto the Crown Street site. The CEOs of LWH and LUH have agreed to form a Partnership Board in order to address the trust’s accumulating clinicial risk, including the element of risk posed by its changing consultant profile. Details about the proposed Partnership Board model have been provided below, with elements of (a) and (b) above included. Similarly germane, the trust’s ability to recruit new consultants and to retain its present consultants has also been considered later in this paper.
This is the second of four blog posts about plans currently being made by the management of the Liverpool Women’s Hospital for the future of the hospital.This hospital is much valued by the people of the area and by all women who want to see a more women centred future for the NHS, a future that would hopefully see women live lives without chronic illnesses, for many more years than they do now. The expertise of the hospital in terms of women’s health should not be underestimated nor undervalued. The blog posts are split into these sections so lay camapigners can more easily access the reports.
This post is about the significant challenges facing LWH in delivering Gynaecological Oncology (cancer treatment).
LWH has, since 2015, been involved in attempts to fundamentally change the hospital. This, coupled with misleading press comments about the safety of the Hospital, made in support of the CCG plans, has probably made recruitment more difficult. This for example in the Liverpool Echo “Health chiefs say women and babies would be safer in a new building as they would no longer have to be taken across the city to be treated for medical complications.” The number of women moved out of LWH is very small and in none of the plans published would babies have stopped moving to Alder Hey Children’s Hospital but such misleading statements abound. LWH has had difficulties recruiting Gynacological oncologists, for many different reasons
Whilst the flawed plans to move the LWH to the Liverpool Royal Site have gone on for so long, some key necessary modernisations have been missed. Our campaign has called for imaging, diagnostics and blood services to be improved. We have also expressed concern at the staff satisfaction scores recorded at the hospital. LWH could clearly be made a better place to work. National issues too impact of the nature of the Gynaecological work force and this too is of interest to all concerned with women’s health.
What follows is the report to the board on November 7th 2019. The full paper work for the board is here
Gynaecological Oncology The gynaecological oncology service at the LWH is under significant pressure at the present time, with a high level of activity required yet a low number of consultants with subspecialist skills available to deliver the clinical work. Of the 6.0 WTE budgeted subspecialist consultant posts, the trust currently has 4.0 WTE in post and of these, one is currently on long term sick leave and one will be leaving the trust for Manchester within the next month.
In recent years, recruitment to these posts has proven to be extremely challenging. This has in part been due to the fact that there are more posts available across the UK than there are subspecialist trainees to fill them. LWH does not present itself as an attractive prospect to candidates, however, because of its isolated position on Crown Street. Modern gynaecological oncologists expect to work in a facility with full access to multidisciplinary care, access to robotic surgery and access to an ITU since these services are necessary for the best clinical outcomes to be achieved
Partly as a consequence of senior staffing shortages, the trust is not currently meeting its 31 and 62 day referral to treatment cancer targets and activity is underperforming against plan. In mitigation, the job plans of the trust’s remaining gynaecological oncologists have been re-written with all benign gynaecological commitments now removed. In addition, a (non-subspecialist) consultant gynaecologist with an interest in oncology has been appointed, who is providing clinical support and who is helping to co-ordinate clinical activity. The drive to recruit subspecialists, however, continues.
In order to make these senior posts more attractive to potential candidates and simultaneously to improve our clinical services, an increased level of access to operating lists at LUH has been achieved. These consist of one all day list at Aintree University Hospital each week and one extended (10 hour) all day list at The Royal Hospital each fortnight, each with colorectal support and access to the respective ITUs. Discussions about the future provision of surgery at LUH are on-going but the present aim is to achieve:
· One all day list for open surgery at either The Royal or Aintree each week
· One all day list for robotic surgery at The Royal each week
· Each with access to critical care and ward accommodation for LWH patients · Protected multidisciplinary team working from all relevant specialties
· Formal pathways to be established around access to specialist pre-operative testing
· Establishment of gynaecological nursing support on the LUH sites for LWH patients
· Improved access to imaging and diagnostic services
· Improved access to therapies and support services
These matters are being pursued individually by the MD at LWH and DMD at LUH but they will also be formalised as part of the Partnership Board’s workstream once it has been established, described in more detail below.
Repatriating Gynaecological Oncology The option of repatriating the gynae oncology workload has been considered. There are three options. The first option would be to discontinue the service at LWH and recommission it at either Preston or Manchester, both of which are presently active in the field. This option has been excluded to date in part because of geographical constraints – the patients using the service live across the Cheshire and Mersey footprint but most live in Liverpool.
Equally pertinent is the fact that it is highly unlikely that either Preston or Manchester would have the physical or operational capacity to deal with the increased volume of work that would accompany the change. The option remains under consideration but is presently seen as impractical.
The second option would be to discontinue the service at LWH and recommission it at the newly formed Liverpool University Hospitals trust, either at the Royal or the Aintree site. In this scenario, all relevant staff would transfer to LUH and out-patient, ward and theatre activity would follow suit. The work would be commissioned with LUH and LWH would simply refer patients with newly diagnosed gynaecological cancers into that service. This option has been excluded to date because an on-site presence would be required 24/7 from suitably skilled O&G trainees for the safe care of the patients.
This would not be possible at present because a 20% rota gap rate is the norm for O&G trainees across Cheshire and Mersey. This would be negatively impacted by the introduction of an additional clinically active site.
The subspecialist Consultant Gynae Oncologists do not believe that either ANPs or trainees from a non-O&G specialty would have the knowledge and expertise required to provide safe care to the gynae cancer in-patient population, in place of cover from O&G trainees, on either the Royal or Aintree sites.
In both of the above options, the loss of Consultant Gynaecological Oncologists from the LWH workforce would have a significant detrimental effect upon the rest of the service. Specifically, massive postpartum haemorrhage is a key risk in the obstetric services and life-saving surgical rescue in the most extreme cases is provided primarily by the gynae oncology team.
Caesarean hysterectomy is performed around six times per year at LWH in response to rapid, massive blood loss and the deterioration in on-site surgical expertise accompanying the repatriation of gynae oncology services would clearly increase the risk of exsanguination in these patients.
The third option is for LWH to retain its gynaecological oncology services but to perform an increasing volume of work at neighbouring adult acute sites as describe above, both for women with advanced disease and for women with multiple medical or surgical co-morbidities.
Of note, this third option could have a positive impact upon recruitment and retention although this remains to be tested.
None of the above options provides the same impact against safety as the relocation of LWH in its entirety onto an adult a
Gynaecological Oncology The gynaecological oncology service at the LWH
is under significant pressure at the present time, with a high level of
activity required yet a low number of consultants with subspecialist skills
available to deliver the clinical work. Of the 6.0 WTE budgeted subspecialist
consultant posts, the trust currently has 4.0 WTE in post and of these, one is
currently on long term sick leave and one will be leaving the trust for
Manchester within the next month.
In recent years, recruitment to these
posts has proven to be extremely challenging. This has in part been due to the
fact that there are more posts available across the UK than there are
subspecialist trainees to fill them. LWH does not present itself as an
attractive prospect to candidates, however, because of its isolated position on
Crown Street. Modern gynaecological oncologists expect to work in a facility
with full access to multidisciplinary care, access to robotic surgery and
access to an ITU since these services are necessary for the best clinical outcomes
to be achieved
Partly as a consequence of senior staffing
shortages, the trust is not currently meeting its 31 and 62 day referral to
treatment cancer targets and activity is underperforming against plan. In
mitigation, the job plans of the trust’s remaining gynaecological oncologists
have been re-written with all benign gynaecological commitments now removed. In
addition, a (non-subspecialist) consultant gynaecologist with an interest in
oncology has been appointed, who is providing clinical support and who is
helping to co-ordinate clinical activity. The drive to recruit subspecialists,
In order to make these senior posts more
attractive to potential candidates and simultaneously to improve our clinical
services, an increased level of access to operating lists at LUH has been
achieved. These consist of one all day list at Aintree University Hospital each
week and one extended (10 hour) all day list at The Royal Hospital each
fortnight, each with colorectal support and access to the respective ITUs.
Discussions about the future provision of surgery at LUH are on-going but the
present aim is to achieve:
· One all day list for open surgery at either The
Royal or Aintree each week
One all day list for robotic surgery at The Royal each week
Each with access to critical care and ward accommodation for LWH patients · Protected multidisciplinary team working from
all relevant specialties
Formal pathways to be established around access to specialist pre-operative
· Establishment of gynaecological nursing support
on the LUH sites for LWH patients
· Improved access to imaging and diagnostic
Improved access to therapies and support services
These matters are being pursued
individually by the MD at LWH and DMD at LUH but they will also be formalised
as part of the Partnership Board’s workstream once it has been established,
described in more detail below.
Repatriating Gynaecological Oncology The option of repatriating the gynae oncology
workload has been considered. There are three options. The first option would
be to discontinue the service at LWH and recommission it at either Preston or
Manchester, both of which are presently active in the field. This option has
been excluded to date in part because of geographical constraints – the
patients using the service live across the Cheshire and Mersey footprint but
most live in Liverpool.
Equally pertinent is the fact that it is
highly unlikely that either Preston or Manchester would have the physical or
operational capacity to deal with the increased volume of work that would
accompany the change. The option remains under consideration but is presently
seen as impractical.
The second option would be to discontinue the
service at LWH and recommission it at the newly formed Liverpool University
Hospitals trust, either at the Royal or the Aintree site. In this scenario, all
relevant staff would transfer to LUH and out-patient, ward and theatre activity
would follow suit. The work would be commissioned with LUH and LWH would simply
refer patients with newly diagnosed gynaecological cancers into that service.
This option has been excluded to date because an on-site presence would be
required 24/7 from suitably skilled O&G trainees for the safe care of the
This would not be possible at present because
a 20% rota gap rate is the norm for O&G trainees across Cheshire and
Mersey. This would be negatively impacted by the introduction of an additional
clinically active site.
The subspecialist Consultant Gynae
Oncologists do not believe that either ANPs or trainees from a non-O&G
specialty would have the knowledge and expertise required to provide safe care
to the gynae cancer in-patient population, in place of cover from O&G
trainees, on either the Royal or Aintree sites.
In both of the above options, the loss
of Consultant Gynaecological Oncologists from the LWH workforce would have a
significant detrimental effect upon the rest of the service. Specifically,
massive postpartum haemorrhage is a key risk in the obstetric services and
life-saving surgical rescue in the most extreme cases is provided primarily by
the gynae oncology team.
Caesarean hysterectomy is performed around six
times per year at LWH in response to rapid, massive blood loss and the
deterioration in on-site surgical expertise accompanying the repatriation of
gynae oncology services would clearly increase the risk of exsanguination in
The third option is for LWH to retain its
gynaecological oncology services but to perform an increasing volume of work at
neighbouring adult acute sites as describe above, both for women with advanced
disease and for women with multiple medical or surgical co-morbidities.
Of note, this third option could have a
positive impact upon recruitment and retention although this remains to be
None of the above options provides the
same impact against safety as the relocation of LWH in its entirety onto an
adult acute site.
Please read this inconjuction with the other linked posts. Your comments are very welcome.
For all our sisters,mothers, daughters and babies.