For fully funded NHS maternity care, publicly provided.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We oppose the privatised health care model

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

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

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

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

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

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

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

In 2017/18 the Trust:

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

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

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

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

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

Crisis in Maternity Care

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

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

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

What changes have you seen in the last few years?

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

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

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

How can the shortage of midwives be overcome?

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

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

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

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

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

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

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

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

Facebook Save Liverpool Women’s Hospital


Twitter @lwhstays

This article was first published in Health Campaigns Together

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

Breast reduction is not of low clinical worth

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

Sheila Altes reviews the evidence

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

A14.1 Reduction Mammoplasty- Female Breast Reduction

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

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

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

* Are physically fit

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

* Excised breast weight of 500grams and upwards

* Are non-smokers

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

Have some OR all of the following signs and symptoms:

* Emotionally and socially bothered by having large breasts

* Low self-esteem

* Breast size limits physical activity

* Back, neck and shoulder pain caused by heavy breasts

* Has regular indentations from bra straps that support heavy breasts

* Has skin irritation, intertrigo beneath the breast crease

* Breasts hang low and has stretched skin

* Nipples rest below the breast crease when breasts are unsupported

* Enlarged areoles caused by stretched skin.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

However research has shown that:

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

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

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

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

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

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

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

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

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

Save the Green Spaces on Upper Parliament Street

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

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

To whom it make concern

Re Parliament Street Planning Consent June 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

Yours faithfully

MariaMaria O’Reilly



Only with your efforts

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

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

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

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

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

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

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

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

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

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

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

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


Is this acceptable?

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

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

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

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

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

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

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

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

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

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

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

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

The board claim that;

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

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

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

We don’t deserve 34 years of ill health.

Women’s Health matters.

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

This is not, in any way, acting against men

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

 It doesn’t have to be this way.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What we have we hold!

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

What causes this extended ill health in women?

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

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

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

It’s for the babies too!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The NHS, though battered and bruised, is still worth the fight.

Staff keep the NHS going despite the privatisers, and despite the government.

Campaigners are winning some battles.

The strikers at LWH won, well done.

Well done to all who are fighting for the NHS, and especially to the victory in Ealing where plans for major closures have been withdrawn!  Let us hope these victories give courage to all who support the NHS and better the pay and working conditions for staff. Let Ealing’s victory give courage to all who fight for our hospitals. Campaign groups for the NHS are   growing. Come and join us!

The privatisation model this government and the NHS national administrators are working on is not just of making the sick pay for their individual treatment. That “patient pay system” is is starting in various ways, including charging migrants. Patient pay and refusal to treat without payment will get the biggest backlash. Right now, their kind of privatisation is more diverting the huge taxpayer spend on health into the pockets of big business.

Just one example of the shift from public wealth to private gain was seen in 2017 when NHS plasma supplies were sold off by Tories for £230 million, then sold on to a Chinese company for £820 million. Nearly £500million profit that was yours and mine, but went into private pockets.

The biggest privatisation of the NHS is underway. The break up of the national NHS into 44 STP or accountable care areas is a precurser to the privatisation of the whole system, a step further in the privatisation process than the contracts given out previously, huge though they were. Campaigners and trade unions face their biggest battles ever, Increasingly workers in outsourced companies are taking action against the privatising companies who are not meeting NHS pay levels, (and NHS pay is are low enough already).

We send solidarity to the strikers at HMRC cleaners and to AFG care workers whose nightwork pay has been cut.

The NHS was founded to be

  • Free at the point of need
  • Funded from taxation
  • A national service
  • Not for profit
  • A service for everyone; a truly universal service
  • A comprehensive service, providing the best available treatment for all

This original model of health care is the most cost effective and most
efficient form of healthcare service delivery in the world. It was responsible for dramatically improving women’s lives and reducing infant and maternal mortality. It is much less expensive, and more effective to the nation than the US insurance model. We cannot afford this government and the NHS national administrators who are closely linked to private companies. Out sourcing, PFI and financially unstable outsourcing firms like Interserve, are only good for the international health corporations.

There are real dangers in the cuts in funding that reaches the hospitals and primary health care;
The UK has also slipped down international league tables for infant mortality and is now 15th out of 19comparable countries”

In a recent study that compared access to and quality of health care in 195 countries by analysing ‘health care-amenable mortality’ – ie, mortality rates from causes that should not be fatal if effective health care is in place – the UK is ranked 30th out of 195 countries – its overall score was similar to Portugal and Malta but lower than comparable countries like Germany, The Netherlands, Spain and Sweden.

We also have fewer doctors per head of population than other comparable EU countries.

The number of beds in the NHS is dangerously low, as many readers will have seen with their own eyes;
The UK, for example, has 2.7 hospital beds per 1000 population compared to an EU average of 5.2 – far lower than Germany (8.2) and France (6.2) but similar to Ireland (2.6) and Sweden (2.5). Although this might be seen as a sign of efficiency (indeed the declining number of hospital beds in the UK has been partly due to medical advances that have shortened length of stay in hospital and a shift in the model of care that means people with learning disabilities, mental illness and the longer-term care of older people occurs in community settings) there are significant concerns about high levels of bed occupancy in hospitals and the problems this causes.”

Every NHS hospital in the land, and all public and community health services, require major new investment for day-to-day running.  Meanwhile much needed money is being squandered on outsourcing, PFI and privatisation.

Please get involved and fight for the NHS, fight against privatisation, for keeping NHS funding for the NHS, not letting it leak out to the private sector.

Defend your GP services

(This is shared from Defend Our NHS and 999 Call for the NHS).

Dear friend of the NHS

Please urgently help to annul the Dept of Health’s stealth changes to legislation about how GPs work

Please will you help to stop the government from bypassing MPs as it sneaks in big changes to the way GPs work?

All it takes is to ask your MP to support National Health Service Early Day Motion #2103.

You can download this template letter to MPs and change it in any way you like. You can find your MP’s contact details here.

Regulatory changes that bypass MPs’ scrutiny and debate

NHS England knows that 999 Call for the NHS has applied for permission to appeal to the Supreme Court against the contentious Integrated Care Provider contract (formerly called the Accountable Care Organisation contract).

But the NHS Long Term Plan has announced that the NHS England quango will make the contract available for use in 2019.

To enable this, on 13th February the Department of Health sneakily introduced big changes to the way GPs work, without giving MPs any say in the matter. It did this through Statutory Instrument 2019 No. 248 – The Amendments Relating to the Provision of Integrated Care Regulations 2019.

Statutory Instrument 2019 No. 248 makes major changes to the existing contractual arrangements for providing GP Primary Care services. These changes are to enable Integrated Care Providers (formerly called Accountable Care Organisations) to run a whole range of hospital, primary care and community health services for their given area and its population.

Now Jeremy Corbyn, Jon Ashworth and other MPs are sponsoring a Prayer Motion (National Health Service EDM #2103) that calls for the Statutory Instrument’s annulment:

“That an humble Address be presented to Her Majesty, praying that the Amendments Relating to the Provision of Integrated Care Regulations 2019 (S.I., 2019, No. 248), dated 13 February 2019, a copy of which was laid before this House on 13 February 2019, be annulled.”

Please will you call on your MP to support this PRAYER MOTION?

Time is short. The deadline for the Prayer Motion is 24 March. The Statutory Instrument is due to take effect on 1 April.

Please visit this web page to find out more.

The last time a “prayer” was answered was in 2000. If it succeeded then it can succeed again. But it needs us all to push it, so that it has wide support from MPs.

Please get in touch if you need any further help or information.


Statutory Instrument 2019 No. 248 makes major changes to the existing contractual arrangements for providing GP Primary Care services.

It would enable new Integrated Care Providers (formerly called Accountable Care Organisations) to directly employ GPs to deliver a model of primary, mental health and community health care that would radically change patients’ (and GPs’) experience of the NHS. This is likely to damage an area’s NHS organisations AND the health needs of the public.

Recent reports by the National Audit Office and the Nuffield Trust say there is no evidence that this new model would meet the intended aims of reducing costs and improving quality of patient care. And the Chair of the BMA has told GP members they‘should not feel pressured into entering an Integrated Care Provider contract as to do so could leave their patients worse off.’

We must take this seriously. We feel strongly that these major changes should not slide through Parliament in secondary legislation without any oversight by MPs.


Getting this Prayer Motion passed is a long shot. But we hope you’ll agree it’s worth trying. The stakes are high and we should seize any chance of stopping this undemocratic move by the Dept. of Health and NHS England.

If a Prayer Motion succeeded in 2000, then it can succeed again.

The Integrated Care Provider contract aims to “manage demand” for NHS care

This means it could threaten patient safety standards and restrict patients’ access to treatments.

Standards of NHS care are already under pressure, and all of us will have begun to see restricted access to a full range of high quality health care in our local areas.

The Integrated Care Provider contract is set to make this worse.

In and out of the courts, we continue to oppose its introduction.

Thanks and best wishes on behalf of Defend Our NHS

Obstacles to Health Care 2019

Women need the NHS, for themselves, for the babies, and for their communities.

Women of the Labour movement fought hard for decades to found a National Health Service. Despite the huge difficulties, and after decades of struggle, in 1948, with the great reforming Labour Government, they succeeded. Some of these women recounted being mocked for demanding health care free at the point of need for all, but they fought on.

Now The NHS is being dismantled before our eyes. Fight like your grandmothers and great grandmothers, fight like hell to win back the NHS. You can make a difference. Get in touch with campaigns or set up one yourself. You will find lots of help.

The Women’s Cooperative Guild fought for a health service more than a century ago

Profit, not human need, is driving NHS cuts. Some of the wealthiest corporations in the world are involved, invited in by this government.

Building blocks of the NHS

The NHS was founded to be a national service. A national service shares the risks of more than 66.02 million people. It provides a huge base for research, data and professional education.

The NHS was founded to be  

  • Free at the point of need
  • Publicly provided
  • Available for everyone
  • A comprehensive service
  • Funded from general taxation (So the bosses pay too, not just the workers).

Using this model, the NHS became the world leader in health care. We saw nearly 70 years of consistent investment, of professional training and great returns in money invested and women’s lives improved, babies survived.

The NHS was far from perfect, the UK did not and does not top the charts for women’s health or for babies health. Campaigners are realistic about the problems. But, we can afford a decent NHS.

Health care is a great investment. Every pound invested returns £3 to the economy. Poor health care means pain and worry, unfit people, less competent workers, more people giving up work to care for family members who are ill, and lower GDP.

Health care spending at Western European levels would give us a good NHS, we don’t need a money tree.

There are two distinct waves of deliberate disruption, privatization, and marketization of the NHS, and each wave is damaging our health and the service itself. Step one started with Blair legislation but comes now from the Coalition’s Health and Social Care Act, 2012. It is cruel and vicious.

These changes are wrapped in the sugary language of “progress”, “efficiency” “consultation”, and “personalization”. In cold reality, they mean:

  • Deliberate shortage of money and resources
  • Bad planning of staff training, recruitment, and  retention so we are short of doctors, nurses, midwives, and other health professionals
  • Cuts in the number of hospital beds
  • The internal market and the Hospital Trust system which sets hospitals up to compete, significantly increasing costs and administration
  • The Commissioning model, which massively increased private providers moving into the NHS, and is inefficient and wasteful.
  • The NHS is no longer for everyone. Many are charged –   especially if their skin is not white. (Please see our blog or Docs not Cops for more on migrant charging)
  • Not all services are now provided
  • Maternity services are inadequate
  • Mental health care has been wrecked, especially for children
  • The involvement of financial consultants from huge corporations, supporting the involvement of profit-making bodies.

Social care

Every human society has to care for its elders. Yet since Thatcher, our elder care has been privatized. Whilst it started as small often family enterprises, they have now been consolidated into big corporations

Privatization, speculation, underinvestment and inflated private profit, from hedge funds and others over many years, has damaged social care for our elders, whilst disabled adults have been the hardest hit in cuts to services supporting independence (see Reclaim Social Care campaign).

Social care is means-tested and badly funded. Staff less well paid, with less professional development than in the NHS. Social care is in deep crisis. None of the NHS changes addresses these issues. Heath and social care working well together is an admirable aim, but the Integrated Care system does not address this at all. It is an accountancy measure.

Maternity faces closures of units and hospitals, as well as half of them,  being so full they have turned mothers away, sending them to other units; such is “choice” in this situation. There is a profound and increasing shortage of midwives, shortages of obstetricians and related professionals. Postnatal care is especially hard hit.

In NHS newspeak, every issue is supposedly to do with a mother’s choice, but somehow, not if that choice is to give birth in her own town or city, or the maternity unit she has chosen. No, these cuts and closures, we are told, are essential! Continuity midwife services much vaunted in the propaganda would require at least fifty percent more midwives to implement nationwide One NHS spokesman claimed it was fine to travel for four hours to access obstetric care. It is not just maternity though. All services for women matter. Any improvement in women’s health has halted thanks to austerity and NHS cuts. UK women on average endure 18 years of ill health. The gap in life expectancy between women and men is closing downwards. Austerity is shortening our lives. Liverpool Women’s Hospital is always in peril in this system.

2019 wave of privatization is happening now in every area of England. The NHS and social care are being reorganized. It looks like this

Find out more, spread the word.!

Step 2 looks like this;

Not even all councillors know what is happening, yet councillors can have a say in this through health and well being boards.

Campaigners can alert the public. Councillors can intervene to oppose this at Health and Well-being boards; they can shine a spotlight on the issue and rouse public opposition. Councillors can challenge it. Telford and Wrekin Councillors have done just that. The ICO is slightly different in each area, but is all to the same end.

Hospitals, A and E, Maternity care, GP services, prescribing policies, urgent care, Ambulances mental health, children’s mental health, are all at risk.

Across the country local campaigns are working to thwart these plans, a whole social movement is developing. We need ever-growing campaigns, and to win a Labour government who will return the NHS to its original model.

Save Liverpool Women’s Hospital Campaign works with other campaigns across the UK. There are dozens to get involved with, including KNOP, Health Campaigns Together,Defend our NHS and Socialist Health. Get a speaker to your branch and get outside your hospitals.