Today across the world women are demanding equality and our rights. The bread symbolises our right to a good living and Roses our rights to arts and beauty.
This has been the demand since International Women’s day was founded. There are celebrations and demonstrations across the world. Liverpool Women are joining in.
Healthcare is essential to women’s rights. Demand world-class healthcare for women, girls and babies. Save Liverpool Women’s Hospital. Restore and repair the health service in the UK. We say we can’t have equality without good healthcare.
Celebrate the essential work of our mothers, sisters, friends and lovers. There are 15.6 million women workers in the UK. A new generation has entered the struggle.
Women are more than half the workforce of NHS, Education, Care, Retail, and the Civil Service. We also work at home in vital caring and child-raising roles, yet we often do not get paid enough to live well. Women still do not earn as much as men in wages or pensions. Women hold 60% of all jobs that pay below the real living wage.
We have strength in our unions. Women are 56.8 per cent of union members, despite being 49.8 per cent of total workers. We are demanding decent wages for all and equality. We are demanding democratic active unions.
Our public services and wages are under attack. One in four children is in food poverty. Austerity has aimed its hurt at women and children. Working women can fight back, for better pay and services. We demand full restoration of women’s pensions
A new generation has entered this struggle, linking to the long history of women across the world, and in Liverpool, fighting for their rights
We want equality and we want freedom from violence aimed at women and girls.
Our struggle to save Liverpool Women’s Hospital, the struggles to repair maternity services locally and nationally, to recruit and retain more midwives, to fight for safe birth, to restore and repair the national health service, to make health care open to all women, to fight poverty in pregnancy and early childhood all come together in our fight for Liverpool Women’s Hospital and the NHS.
Liverpool Women’s Hospital muststay, for all our mothers, sisters, daughters, friends and lovers and the thousands of babies born there.
Speak out, speak up, and fight to restore our NHS. A mass campaign, like that to set up the NHS, like that of the suffragettes, can and will win back our NHS, fully funded. We need your involvement. If not now when?
We are putting out a call for further active support from the people and their organisations in Cheshire and Merseyside. The NHS is held together by the outstanding work of the healthcare workers, despite the Governments sabotage. We all need the NHS and we can see how it is being damaged by this government and their policies. Time to call Enough Is Enough. Restore and Repair the NHS. Help us raise the level of our campaign.
Our hospitals, our ambulances, our GP services, our maternity care, our mental health services, and our social services are all failing to provide the level of care we deserve, that we as an “advanced” and wealthy economy should expect.
This campaign defends Liverpool Women’s Hospital, the largest maternity hospital, and the only hospital dedicated to women’s health. We are involved in defending the healthcare system nationally but particularly locally in Cheshire and Merseyside. The two issues are interlinked.
The UK was much poorer when the NHS was founded yet the 1945 government managed it. Good health care is an investment in our people and in the economy. People are suffering and dying because of these Government policies which centre around privatisation (in its many forms), There has been bad workforce planning. leading to chronic shortages of staff. The Kings Fund, not a left-wing, think tank commented:
The people who work in the NHS are its greatest asset and are key to delivering high-quality care. This has been evident throughout the Covid-19 pandemic with staff demonstrating remarkable resilience and commitment. However, a prolonged funding squeeze between 2008 and 2018 combined with years of poor workforce planning, weak policy and fragmented responsibilities mean that staff shortages have become endemic.
We also see lying, as when Boris Johnson promised more hospitals, and when in 2015 the Secretary of State for Health Simon Stevens promised us 6000 more GPs but we have been left with fewer than in 2015. We were promised Continuity of Carer in the maternity services without sufficient midwives to deliver it.
Donna Ockendon who conducted the review of baby deaths in Shropshire and is now working on the Nottingham Enquiry wrote“the review team has also identified 15 areas as IEAs that should be considered by all trusts in England providing maternity services. Some of these include:
the need for significant investment in the maternity workforce and multi-professional training
suspension of the midwifery continuity of carer model until – and unless – safe staffing is shown to be present
strengthened accountability for improvements in care among senior maternity staff, with timely implementation of changes in practice and improved investigations involving families“
The damage to the whole NHS is shown in cost-cutting and ideological opposition to the core NHS principles of a public national and comprehensive health service for need, (not profit) providing timely care, free at the point of need. This government prefers to run down the NHS and to divert funds to big corporations. The NHS is not the only victim of the policy of Austerity but it is a major victim. The people of the UK have suffered grievously with 300,000 dead, more than in many wars
The NHS is being held together by the outstanding work of NHS staff. Our nurses, midwives, doctors, allied medical professionals, porters, and site staff are underpaid and overworked. They have worked through the pandemic and acute shortages. Yet despite this they work, continuing to provide care and support for those using the NHS. Day after day we hear more demoralising stories. We the public must step up and challenge the Government over this. The staff cannot carry this burden alone
It does not have to be like this, the UK is wealthy, and even if it was poor the NHS model is far more cost-effective than the private model. This situation has been created by political decisions. Big companies are taking profit from the NHS. The administration of the NHS nationally and locally is deformed towards profit and towards the market.
At the ICB meeting in August
The National Health Service was split into 42 areas by last year’s Health and Care Act, a profiteer’s charter. Campaigners nationally and here in Cheshire and Merseyside fought long and hard, but Boris Johnson’s government pushed it through
We continue to campaign, bringing together the different campaigning organisations in Cheshire and Merseyside. We are always looking for more organisations and individuals to join the struggle to restore and rebuild the NHS. Please do get in touch
The core problems in Cheshire and Merseyside are,
Waiting lists and waiting times, denial of care and having no choice but to pay for some treatments (like dentistry, but often for surgeries such as hips) and treatment provided by private companies with limited quality control)
Staff welfare, including pay, working conditions, pensions, unfilled vacancies, and frustration at not being able to provide for the need they see every day.
Funding, with “Cost Improvement Programmes expected at this time of increased need and high inflation The new ICB boards carried over all the financial problems of the previous system with additional admin costs.
Funding and staffing for maternity
Bed capacity and physical space in the hospitals in several high-profile cases
Privatisations/outsourcing and commissioning
Reorganisations designed to save money or reorganisations not properly planned or cost.
The persistence of the internal market,
Workforce planning,
The state of repair of hospitals
All of these are hitting patients through waiting lists, mix-ups and denial of care
Nurses, midwives and other health workers are balloting for strike action. They have our total support. They should never need to strike The responsibility lies with the Government. We speak to people regularly about the NHS and overwhelmingly, the people of our area want staff well paid and with sufficient staff to prevent overwork and burnout.
There are key crisis points now in Cheshire and Merseyside Health Service (formerly known as the NHS). These are a breakdown of services for patients, the need to organise public support for staff, Finances, Maternity, Hospital capacity including beds, staff and buildings, GP practices and primary care. Mental Health is utterly inadequate. Discharge from hospitals is difficult because of disarray in the largely privatised social care system.
We also see the introduction of “Virtual” wards to allow patients to be treated at home But this is happening while we have GPs already under pressure, primary care under pressure and ambulances unable to respond in due time. This will put pressure on families to care, for the lucky ones who have families available. And who will pay to heat these “virtual wards”. Sick people need constant warmth.
and Covid There is also an attempt to build a private “GP” surgery on the roundabout by the entrance to Clatterbridge Hospital. ( What they offer is not GP services which would include being a family and community specialist and responsible for your primary care; these companies cannot offer that)
Covid is still a problem with increasing numbers of people in hospital and increasing the severity of other illnesses yet our ICB board meets without taking basic Covid precautions, whilst its agenda discusses these issues
Our health care system needs you! Our organisations include Trades Councils across the area, Unite Community Cheshire, Defend our NHS, Socialist Health Association, Prescott SOS NHS, Keep our NHS Public Merseyside and Keep our NHS Public Cheshire, Save Liverpool Women’s Hospital, Save Ormskirk and Southport Hospitals and more. Donations will go to the Save Liverpool Women’s Hospital Account
Please think of how you can help.
Could you put a poster up?
Could you leaflet your street?
Could you write to your MP and councillors?
Could you get your union branch to help financially? Could they affiliate with our campaign?
It is with great sadness that we read the findings from The Ockenden Review and we add our thanks to the families who fought so hard to bring their experiences to public attention. As midwives and campaigners for safe and compassionate maternity care we have a duty to reflect on the findings of this report and our thoughts are with the women, their families and staff working at The Shrewsbury and Telford Hospital NHS Trust. The Lancet commented that;
“The report found that around 200 babies and nine mothers would or might have survived if the trust had provided better care. The Royal College of Obstetricians and Gynaecologists (RCOG) called it a “dark day”. Criminal charges might still be brought against the Trust and individuals.”
BBC Photograph
Donna Ockendon gave great credit to the parents whose campaigning instigated the report;
“The work contained in this final report and the first report of the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust, came about from the exceptional efforts of parents Rhiannon Davies, Richard Stanton, and Kayleigh and Colin Griffiths, whose daughters died as a result of the care they received at the Trust. The deaths of Rhiannon and Richard’s daughter Kate in 2009, and Kayleigh and Colin’s daughter Pippa in 2016 were both avoidable. Owing to their unshakeable commitment to ensure the precious lives of their babies were not lost in vain, this review has implementation of meaningful change, not only in maternity services at The Shrewsbury and Telford Hospital NHS Trust – but also across England. As we publish this final report, we want to acknowledge and pay tribute to Rhiannon, Richard, Kayleigh and Colin.“
Shrewsbury is not alone. There have been other maternity scandals in Morecombe Bay, Essex and Nottingham.
The crisis in maternity staffing in 2022 is worse than the period covered by this report. Many hospitals did manage against the odds to avoid some of the damage done in Shrewsbury. Shewsbury’s managers and senior clinicians have serious questions to answer. The context does not excuse their actions but it is crucial to understanding what was happening.
Understanding and appreciating the context in which these failures happened is a vital step in working towards any type of prevention. What is prominent throughout the review is the catastrophic shortages of midwives, medical staff and other maternity healthcare workers and the impact these shortages have had on care. For many years we have known of these critical shortages and the tragic damage this would cause. Now, sadly, we are seeing it.
With this shortage comes poor supervision and training of staff, in particular preceptorship programmes for newly qualified midwives (NQM). Without enough qualified midwives, it is impossible to provide supernumerary status with protected learning time for NQMs. This is crucial if we want to grow a competent and confident workforce.
Donna Ockendon says;
“It is absolutely clear that there is an urgent need for a robust and funded maternity-wide workforce plan, starting right now, without delay and continuing over multiple years. This has already been highlighted on a number of occasions but is essential to address the present and future requirements for midwives, obstetricians, anaesthetists, neonatal teams and associated staff working in and around maternity services. Without this maternity services cannot provide safe and effective care for women and babies. In addition, this workforce plan must also focus on significantly reducing the attrition of midwives and doctors since increases in workforce numbers are of limited use if those already within the maternity workforce continue to leave. Only with a robustly funded, well-staffed and trained workforce will we be able to ensure delivery of safe, and compassionate, maternity care locally and across England.“
Yet, how can a maternity service be safe and compassionate if there aren’t enough staff? How can staff give women their time, time to sit and talk, time to listen. It is impossible. It cannot be done. As a consequence, women will not be provided with the safe and compassionate care they so justly deserve, not because staff don’t care, but because there simply aren’t enough of them.
In July 2021 the report on the Safety of Maternity Services from the Parliamentary cross-party Health and Social Care Committee said;
“With 8 out of 10 midwives reporting that they did not have enough staff on their shift to provide a safe service, it is clear that urgent action is needed to address staffing shortfalls in maternity services. Evidence submitted to our inquiry estimates that as a minimum, there need to be 496 more obstetricians and 1,932 more midwives. While we welcome the recent increase in funding for the maternity workforce, when the staffing requirements of the wider maternity team are taken into account–including anaesthetists to provide timely pain relief which is a key component of safe and personalised care – a further funding commitment from NHS England and Improvement and the Department will be required to deliver the safe staffing levels expectant mothers should receive.”
“We recommend that the budget for maternity services be increased by £200–350m per annum with immediate effect. This funding increase should be kept under close review as more precise modelling is carried out on the obstetric workforce and as Trusts continue to undertake regular safe staffing reviews of midwifery workforce levels.“.
Despite this recommended additional funding for maternity, the government produced only half of what the committee said was needed. The Government did not even respect a parliamentary committee.
A whole year has been lost that could have stopped the current situation from developing. That funding has still not been provided.
Donna Ockendon reported on maternal deaths, baby deaths and the injury to some of the babies. She wrote this of the Cerebral Palsy cases;
“All of the families in this group self-reported to the review. The diagnosis of cerebral palsy was often made some years following their maternity episode. On reviewing the medical records, where it was found that the neonatologists at the Trust had recorded a diagnosis of HIE [(hypoxic-ischaemic encephalopathy] in the early neonatal period, a small proportion of families were subsequently transferred to the HIE incident category. From the remaining cases of cerebral palsy, more than 40 per cent were identified to have significant or major concerns in maternity care which might have resulted in a different outcome.”
Mistakes will be made in any field of medicine, though few with such catastrophic results as mistakes, or carelessness, in maternity care. Lessons must be learned from every incident and changes implemented quickly. This failed disastrously in Shrewsbury and the fault is not with the midwives (though significant mistakes were made ), but with the hospital management.
The government has made and is still making appalling decisions in funding and managing the NHS and particularly in maternity. A quick check on MumsNet today found a mother refused an induction despite her concern about her near term baby’s reduced movements. We are told to Count the kicks yet even today after Ockendon has reported, women are not always heeded.
The bureaucracy of the NHS also bears responsibility, if only for failing to describe publicly the damages from Government policies including; the shortages of funds for the NHS, bad workforce planning, the closure of beds and maternity units, not calling out the disaster of the “internal market” and for “managing” the news around incidents. We saw a pretence that all was well, whilst embarking on expensive new initiatives, like Continuity of Carer, without adequate funding and thereby driving out still more midwives. A background of bullying and silencing staff is also important. The number of midwives quitting because they do not feel that the system is safe surely should have been a warning to all.
Donna Ockendon notes
“The key themes identified requiring improvement within maternity services at the Trust were: • The poor quality of incident investigations • Poor complaints handling • Local concerns with statutory supervision of midwifery investigations • Concerns with clinical guidelines and clinical audit
…the review team has identified the following concerns regarding governance in maternity services at the Trust: a) Incidents that should have triggered a Serious Incident investigation were inappropriately downgraded to a local investigation methodology known as a High Risk Case Review (HRCR), apparently to avoid external scrutiny. b) When serious incident investigations were conducted many were of poor quality. c) There was a lack of learning and missed opportunities to improve safety. d) There was a lack of oversight of serious incidents by the Trust’s commissioners. e) There were repeated persistent failings in some incident investigations as late as 2018-2019.
4.8 The review team has found a concerning and repeated culture at the Trust of not declaring adverse outcomes as an SI in line with the national framework. Instead, they were inappropriately downgraded and investigated by what the Trust termed a High Risk Case Review (HRCR). This method of investigating incidents, created by the Trust, was less robust, varied considerably in quality and lacked the rigour and transparency of an SI investigation. Notably, HRCRs were not reported to NHS England, the Clinical Commissioning Groups (CCGs) or the Trust Board, and therefore avoided external scrutiny.“
The Review also importantly recognises the damming consequence of Cumberlege’s National Maternity Review and the Midwifery Continuity of Carer model. With such poor staffing, such a programme not only cannot but should not have been implemented. We welcome The Reviews Essential Action for the suspension of this provision unless Trusts can demonstrate safe staffing levels on all shifts. The Review acknowledges the unprecedented pressures that the model places on services, services already under significant strain and the impact of which compromised the safety of pregnant women and their babies. We support the need for robust evidence to assess if it is a model fit for future maternity care. Currently, that evidence does not exist.
What is evident from The Review is the harm mothers and babies suffered from what appears to be withholding the use of caesarean sections. We will watch with caution the end of total caesarean section percentages as a metric for maternity services, as potentially we could see rates escalate and we urge continued careful monitoring.
Apparent in The Review, is the fear staff had to speak out about their concerns. There can be no transparency, and no openness to change if free speech is not allowed.
Save Liverpool Women’s Hospital Campaign has been working since 2016 to
Expose the flaws in the funding and structure of maternity provision and
2. To support all who continue to work in maternity despite the odds.
3. To demand excellent maternity care for all, (including migrant women, who face dreadful charges for maternity care).
4. To fight for women’s healthcare.
5. To protect our hospital, Liverpool Women’s Hospital, on its Crown Street site.
6. To campaign for the NHS to remain free at the point of need, funded by the government, providing universal and comprehensive care, publicly owned and publicly delivered.
A publicly provided, well funded, universal maternity service, free at the point of need is essential. There is no solution to the problems the NHS faces to be found in privatising it. Cuts, shortages, coverups of shortages, and bullying, cannot keep our mothers, sisters, daughters, friends and lovers and every precious baby, safe.
The figures for maternal deaths in the US privatised model quoted by The Commonwealth Fund, prove this:
“Key Findings: The U.S. has the highest maternal mortality rate among developed countries. Obstetrician-gynecologists (ob-gyns) are overrepresented in its maternity care workforce relative to midwives, and there is an overall shortage of maternity care providers (both ob-gyns and midwives) relative to births. In most other countries, midwives outnumber ob-gyns by severalfold, and primary care plays a central role in the health system. Although a large share of its maternal deaths occur postbirth, the U.S. is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period.
Conclusion: The U.S. has a relative undersupply of maternity care providers, especially midwives, and lacks comprehensive postpartum supports.“
Women were not heard or heeded in many of these tragic events, indeed some were themselves blamed by the hospital.
Importantly, we must not forget the blame for all of these lies squarely at the feet of the government. Continued cuts year on year are destroying maternity services and the NHS as a whole. Allowing chronic staff shortages, poor staff satisfaction, high staff attrition rates, and unsafe working conditions are all political choices made by this government. Now we see mothers and babies dying. These are all political choices.
Women have a right to excellent maternity services. It is the government’s responsibility to provide this. This is the contract between citizens and the government Women must have the right to choose how they have their baby. Women are entitled to have the best advice on these choices. Women have the right to expect emergency backup when this is required. Women have the right to be both heard and heeded, especially when things start to go wrong. Women have the right to be heard and to participate in all reviews of serious incidents. Ockendon will strengthen these rights.
There is a thread in the media saying that natural births were somehow to blame. There is nothing in Ockendon to say this. Ockendon does say that poor monitoring, failures to intervene early, failure to use cesarean sections when urgently needed, and failure to listen to mothers, were all faults.
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Midwives are a highly valued profession. Midwives can make mistakes, of course, but the faults described in Ockendon do not blame midwives as a profession. A service with a good supply of well trained, and well respected (and well paid) midwives, helps save lives.
The Royal College of Obstetrics and Gynaecology reported on staffing issues last year.
The NHS funding model included penalties for having too many cesareans in a hospital. Funding for maternity was already inadequate and complicated, relying, in many hospitals, on subsidies from other parts of the hospital budget.
Since “Austerity” started, Government funding for the NHS has been inadequate. Staff have kept the NHS afloat through hard work and determination. Staff are worn out. Too many midwives are leaving the profession because of working conditions.
The fight to found the NHS came in large part from the fight for universal maternity care. Let’s make the fight for excellent maternity care in the twenty-first century spur on all our campaigns to protect and improve the NHS
The government does not believe in the NHS. Look at what it is doing to maternity care. Since 2014 they have been working towards privatisation, a US-style model of healthcare. The loss of the NHS or further cuts and privatisation will affect women, babies and maternity. This is the future unless we campaign against it, please join our campaign group – as Nye Bevan said “The NHS will last as long as there’s folk with faith left to fight for it”
Deborah Harrington from Public Matters spoke to a meeting of campaigners and trade unionists across Cheshire and Merseyside, our local ICS area. We want the NHS back to the Bevan Model of healthcare, the most efficient, the most integrated service in the world, before the privatisers started leeching off it.
Health care should be
Free at the point of need
for everyone,
paid for by the government
and provided by public service , not by profit making companies
Another great Liverpool Woman who stood up for the poor and fought cholera.
It was women and trade unionists who fought to found the NHS a century ago and we will step in again now.
During the Pandemic, whilst doctors and nurses worked long hours in difficult conditions, the NHS bureaucrats have devoted money and man hours to a major reorganisation of the NHS, which puts into place much that has been planned through the STP. This will embed the role of big International for profit health care companies. These companies are there for profit.
It will reduce local accountability and stop using individual clinical need as its planning base
Would that instead of such plans, they had prevented in hospital transmission of Covid. Please watch and share the video. We will need the biggest campaign ever to stop this White Paper, and the campaign starts small but starts immediately.
We too can change hearts and minds and force change for the better
Women from the cooperative women’s guild demanded that maternity care be available for all free at the point of need. We don’t all want greed and capitalism
You may have heard of a big US corporation Centene taking over GP services, but these corporations are in the NHS nationally and in STPs/ ICS
They are advising the NHS on reorganisation on multinational corporation lines. Hancock has just brought in a top bureaucrat r for the NHS from a big US health care corporation. Please watch the video. Please ask for a speaker at a meeting. Please step up for our NHS.
We don’t remember Polio, you and me. When we look at our little ones running around, playing, making a mess of freshly tidied rooms, it’s about the furthest thing from our minds.
Maybe some of us older mums will have heard snippets of stories from our parents. “Jackie’s friend had it” or “Some lad who used to knock around with your Uncle.” But that’s all they are, stories from a time gone by that soon become vague memories. We never have to retell them ourselves.
Leg braces are a rare sight these days and Iron Lungs you only see in history books.The fight against Polio is still there with vaccines and vaccines that need updating. None of our kids will ever have to wake up alone and afraid on a ward encased in a machine that breathes for them because of Polio.
Polio won’t ever paralyse our babies or snatch their little lives from them too soon, because our parents and grandparents didn’t stand for it. And when it comes to Covid, neither should we.
There was no cure for Polio back in the day and even now with how far we have come, there still isn’t. The reason you don’t hear about it anymore is because our Parents and Grandparents got rid of it the same way we’re trying to get rid of Covid, by vaccinating us against it. Their bravery to take the first step made sure that disease today is only talked about in history books.
People are starting to see the long-term effects of Covid now and it’s easier to see in children. Up to 100 children a week end up in hospital, many in Intensive Care, with what’s being called Long Covid. 75% of the worst cases are in kids from Black, Asian and Ethnic Minority backgrounds. Doctors still don’t know if there’ll ever be a cure.
We have the chance to be as brave as they were and save hundreds of our kids . So lets take it.
Speakers will discuss the virus, vaccines, public health measures, how to reach all sections of our communities , pregnant women and new mothers, long Covid and the effects of the pandemic on the NHS.
There will be plenty of time for Questions & Answer sessions and public discussion
During the pandemic, the upper echelons of the NHS and the Government haver been implementing a structural reorganisation. The reorganisation breaks the national part of the NHS and integrates private companies into the reorganisation. It is being done without laws going through parliament.
We have joined with other organisations to try to raise awareness of what is happening. Many people will be aghast that this is happening at all, but during the pandemic, when all eyes should be on the virus, is doubly scandalous.
We are reproduce here the letter from Keep Our NHS Public. Other organisations are circulating in essence the same message. What follows is from the material produced by Keep our NHS Public
Integrating Care: Why NHS England is getting it wrong
NHS England (NHSE) is consulting on their latest plans for ‘integrating care’, including changes to legislation.
The proposals include a top-down re-organisation of the NHS in England abolishing CCGs, replacing them with 42 Integrated Care Systems (ICSs), statutory bodies under tight financial control from the centre and with even less public accountability. The result will be massive new opportunities for the private sector through the ‘Health Systems Support Framework’ (HSSF). While ICSs will find it difficult to work in real partnership with others such as local authorities in addressing health inequalities, proposals will allow private companies representation on an ICS Board.
Despite the short notice we hope you can respond to the consultation, which has a deadline of 8th January.
We attach a template response to the consultation giving a range of possible answers for you to adapt.
We also attach background papers from Keep Our NHS Public:
* Our summary of what lies behind the “Integrating Care” proposals
ICSs are an organisational form adapted from the US health insurance market, and the HSSF is central to their development. This Framework has 83 NHSE-accredited companies, 22 of which are US-based. We expect legislation will result in a flood of contracts, much as the government has dished out thousands of Covid contracts, bypassing proper procurement.
* KONP’s response to the legislative proposals
These include a deregulated market economy in healthcare where even the existing, limited safeguards to protect social, environmental and labour standards are removed, and where a bidder’s track record is not taken into account.
Further detailed critiques of Integrating Care are available on the KONP website. These include a critique of the proposed structure and management of ICSs as revealed in NHSE’s Health Service Support Framework; critique of NHSE’s proposal to bring social care under NHS management; and proposals for real democratic accountability in the planning and oversight of NHS services as well as links to recent articles on ICSs in OurNHS/Open Democracy and The Lowdown (see https://keepournhspublic.com).
The Government has yet to publish a Bill. Once it has, we look forward to your involvement in resisting this drive to disintegrate the NHS through financial mechanisms and increased corporate influence.
Please do not worry about creating a long academic response. Please just respond. Try to keep a copy of your response and send it to savelwh@outlook.com
Respond even if it is late.
Please write to your MP and please try to make sure your members know about this
Dear —
Integrating Care: Why NHS England is getting it wrong
NHS England (NHSE) is consulting on their latest plans for ‘integrating care’, including changes to legislation.
The proposals include a top-down re-organisation of the NHS in England abolishing CCGs, replacing them with 42 Integrated Care Systems (ICSs), statutory bodies under tight financial control from the centre and with even less public accountability. The result will be massive new opportunities for the private sector through the ‘Health Systems Support Framework’ (HSSF). While ICSs will find it difficult to work in real partnership with others such as local authorities in addressing health inequalities, proposals will allow private companies representation on an ICS Board.
Despite the short notice we hope you can respond to the consultation, which has a deadline of 8th January.
We attach a template response to the consultation giving a range of possible answers for you to adapt.
* Our summary of what lies behind the “Integrating Care” proposals
ICSs are an organisational form adapted from the US health insurance market, and the HSSF is central to their development. This Framework has 83 NHSE-accredited companies, 22 of which are US-based. We expect legislation will result in a flood of contracts, much as the government has dished out thousands of Covid contracts, bypassing proper procurement.
* KONP’s response to the legislative proposals
These include a deregulated market economy in healthcare where even the existing, limited safeguards to protect social, environmental and labour standards are removed, and where a bidder’s track record is not taken into account.
Further detailed critiques of Integrating Care are available on the KONP website. These include a critique of the proposed structure and management of ICSs as revealed in NHSE’s Health Service Support Framework; critique of NHSE’s proposal to bring social care under NHS management; and proposals for real democratic accountability in the planning and oversight of NHS services as well as links to recent articles on ICSs in OurNHS/Open Democracy and The Lowdown (see https://keepournhspublic.com).
The Government has yet to publish a Bill. Once it has, we look forward to your involvement in resisting this drive to disintegrate the NHS through financial mechanisms and increased corporate influence.
NHSE CONSULTATION: building a strong, integrated care system across England
Please amend and adapt the wording below in your response to avoid any batch rejection of critical responses
What is your name?
In what capacity are you responding?
Are you responding on behalf of an organisation?
Do you agree that giving ICSs a statutory footing from 2022, alongside other legislative proposals, provides the right foundation for the NHS over the next decade?
Strongly disagree comments or additional information:a)This is a very ‘top down’ exercise with little justification other than the hope it will allow tighter controls on spending. b) Claims that functioning ICSs have already demonstrated significant improvements in patient care are only wishful thinking and not evidence based. c) The plan for ICSs is not focussed on improving care for patients but on binding NHS organisations by financial controls and plans written by the ICS with advice from companies accredited under the Health Systems Support Framework. d) The NHS needs re-integration by abolishing the 2012 H&SC Act altogether and removing the competitive market and the purchaser-provider split. e) Facilitating even more contracting out of services and management structures including the private sector is not ‘integration’ but ‘dis-integration’. f) NHSE/I legislative proposals include the removal of Public Contracts Regulation safeguards over social, environmental and labour standards, and the ability to rule out bidders on the basis of their track record. It will expand the scope for scandals like the PPE contracts awarded without procurement to firms with no relevant experience. g) Other legislative proposals would embed “population health management” as a binding aim for all NHS organisations, without evidence that this will improve patient access to universal, comprehensive healthcare, free at the point of need, publicly provided and publicly accountable, funded through general taxation.
Do you agree that option 2 offers a model that provides greater incentive for collaboration alongside clarity of accountability across systems, to Parliament and most importantly, to patients?
Strongly disagree comments or additional information:a) By “collaboration”, the plan includes collaboration with the private sector, which we oppose. b) There is very little accountability built into the system and large organisations are inevitably far removed from the needs and concerns of local communities. CCG mergers reduce the opportunity for local public involvement; Option 2 goes even further. c) Any reorganisation of the NHS should be looking at increasing accountability and democratic control rather than weakening it.
Do you agree that, other than mandatory participation of NHS bodies and Local Authorities, membership should be sufficiently permissive to allow systems to shape their own governance arrangements to best suit their populations needs?
Strongly disagree comments or additional information a) Allowing management consultants and private sector representatives to sit on governing bodies undermines the public sector ethos which is key to the NHS. b) ICSs as proposed will only facilitate top down control. c) The NHSE Health Systems Support Framework (HSSF) strongly prioritises financial savings over patient need. The HSSF is designed to implement systems of patient and data management needed for insurance-based systems rather than clinical priorities and local need. The majority of companies accredited through the HSSF are major corporates, including many involved in health insurance in the US and elsewhere. d) This approach is incompatible with what patients and communities want and need and with NHS founding principles and values.
Do you agree, subject to appropriate safeguards and where appropriate, that services currently commissioned by NHSE should be either transferred or delegated to ICS bodies?
Strongly disagree comments or additional information Specialist services require national commissioning in order to ensure consistent standards across the country
Keep Our NHS Public (KONP) Overview Response to Integrating Care – The next steps to building strong and effective integrated care systems across England1
Introduction In the midst of a massive Covid epidemic, NHS England (NHSE) is driving through a far-reaching topdown reorganisation of the NHS, based on proposals in the Long Term Plan (2019). They are consulting until January 8 on the details of new legislation which they expect the government to enact early this year to give legal legitimacy to changes which are already under way. We are concerned that the implications of these changes for the accountability, availability and access to services and values underpinning the management of services have been barely noted within a tumultuous 2020. Noting the serious concerns that have been raised by the Local Government Association and others, including NHS Providers, we are asking all politicians, from every party, to take a stand against these damaging proposals.
Restructuring of the NHS in England .
At the core of the re-organisation are Integrated Care Systems (ICSs), bodies described by NHS England (NHSE) as NHS organisations that work in partnership with local councils and others to take collective responsibility for managing resources and delivering NHS care. ICSs have been driven from the top by NHS England, and in many areas resisted at local level by councils, GPs and campaigners.
However a 39-page NHSE document “Integrating Care,” seeking new legislation allowing the whole of England’s NHS to be run through ICSs by 2022, claims they are “a bottom-up response.” The proposals reduce the number of commissioning organisations from almost 200 to just 42 new “Integrated Care Systems” (ICSs). This has required merging (and eventually abolishing) local Clinical Commissioning Groups (established as public bodies by the Health & Social Care Act 2012), and replacing the 44 ‘Sustainability and Transformation Partnerships’ (STPs) set up in 2016.
The mergers inevitably result in larger bodies, more remote from the needs and concerns of any local community, and therefore a loss of local accountability. This point has been powerfully argued by the all-party Local Government Association (LGA), which represents the leaders of 335 of England’s 339 local authorities. Their response states: “We are concerned that the changes may result in a delegation of functions within a tight framework determined at the national level, where ICSs effectively bypass or replace existing accountable, place-based partnerships for health and wellbeing…. 1
The Health Service Journal, aimed at NHS managers, has also shown how vague the proposals are: “ICSs will be given a single pot of money from which to manage spending priorities. But there is no framework for how this will be spent that assures fairness, value for money and quality outcomes.”
29 of the proposed 42 ICSs have already been approved by NHS England – even though they lack any legal status, and almost all are functioning behind closed doors with no public accountability. The remaining 13 STPs2 are required to become ICSs by April, or face the intervention of an “intensive recovery support programme.”
The LGA calls for the establishment of alternative structures involving genuine partnership with local authorities and, through them, links to local authority services and responsibilities that are vital components of the wider determinants of health.
Keep Our NHS Public (KONP) has issued a response to the lack of public accountability inherent in ICS structures, and set out proposals for developing genuine public accountability. The Report is on the KONP website here. KONP also rejects the assumption, repeated frequently throughout ‘Integrating Care’, that social care might be managed through NHS ICS structures. KONP campaigns for a publicly provided national care, support and independent living service.
At local level, we argue it is essential that social care continues to be managed by local authorities, retaining essential links to wider local authority responsibilities such as housing, education and leisure. KONP’s critique of the approach to social care set out in Integrating Care is here.
New legislative proposals Integrating Care seeks new legislation that would provide the formal legal basis for ICSs that they currently lack, as well as changes to existing procurement requirements. KONP argues for the abolition of the commissioner-provider split, believing the NHS should be provided and managed directly as a public service, not through commercial contracts. However we argue that what is worse than a managed market in health is an unmanaged and unregulated market.
The failed £multi-billion Covid-related contracts, including those for PPE or Test and Trace, dished out with no proper procurement procedures, have revealed what this can mean in reality.
NHSE wants to scrap Section 75 of the 2012 Health & Social Care Act which requires significant contracts to be put out to competitive tender, and to remove contracts from Public Contracts Regulations.
The prospect of changing the law so that more and more large NHS contracts could be awarded without any due process or public scrutiny is seriously worrying. KONP’s detailed response to the legislative proposals in Integrating Care is here.
Values underpinning the management and direction of ICSs Under proposals for ICSs, all providers will be bound by a plan written by the ICS Board and financial controls linked to that plan. Private companies may support the Board and potentially have a place on the Board, as well as being contracted for services.
NHS England has established a Health Systems Support Framework (HSSF) to facilitate easy contracting by ICSs. The Framework consists of organisations accredited by NHS England to support the development of internal structure and management of ICSs, and, potentially, also to play a longterm role in direct management of ICSs. A quarter of the 83 organisations approved by NHSE to take on contracts with ICSs, and potentially also take seats on decision-making Boards of ICSs (as has happened in North East London) are American-based, offering expensive data-based systems designed to benefit US insurance companies and private hospital chains.
Research in the USA and experience in England has exposed the lack of evidence that data-led attempts at “population health management,” or targeting the small number of patients with complex medical and social needs, can either reduce demand or cut costs. However, such approaches do facilitate the development of private insurance pathways running alongside NHS care.
Digital technology and number-crunching are among the more lucrative areas in which private companies are seeking profitable NHS contracts, and this is a strong theme running through the HSSF. However digital and data are also areas of notorious recent private sector failures – including the Covid-tracking app, the privately-run test and trace system, Capita’s long delays in contacting professional staff offering to return to fight the pandemic, and the £10 billion saga of the NHS Programme for IT.
And while Integrating Care argues for the need to establish ICSs as “statutory bodies” with real powers, notably “the capacity to … direct resources to improve service provision,” there are real fears that NHS England sees ICSs and ‘system-wide’ policing of finances as a way of more ruthlessly enforcing cash limits and “control totals” limiting spending across each ICS, with growing lists of excluded “procedures of limited clinical value”. These approaches to structure and management of ICSs pose a major threat to the NHS, distorting and undermining the core values and ethos of the NHS.
Conclusion Integrating Care raises serious concerns for the future of the NHS and social care services, concerns that we set out in detail in papers available on the KONP website, along with proposals for alternative structures and why social care should remain the responsibility of local authorities. Our concerns, based on hard facts, are widely shared by councillors, senior NHS management, GPs and seasoned analysts. NHS England’s proposed changes threaten to make the NHS less locally responsive, less accountable, more dominated by US and other management consultants and contractors, and more focused on policing cash limits than meeting the needs of patients. NHS England’s priorities should be on strengthening the NHS in alliance with local government and communities, not creating new remote bodies or adopting systems meant to maximise profits of private health insurance. Keep Our NHS Public (KONP) January 2021 https://keepournhspublic.com/
Warning flags against the proposals to close, merge or disperse Liverpool Women’s Hospital. (This is a short read for those with little time or head space to read our more detailed posts which have all the links).
1. Women’s health and babies’ health matter more than money. This is a unique hospital for women and babies. Do not close it in the midst of this health crisis. Demand proper NHS funding and kick out the privatisers. Ten years of privatisation and underfunding have caused these problems and the government is hell-bent on pushing on with these policies. Restore and repair the whole NHS. Improve Liverpool women’s Hospital. Pay the staff well.
2 There is a health care crisis with 7 million people waiting for treatment and Gynaecological waiting lists are appalling. Women’s health is deteriorating.
3 Every baby matters and they all come out of awomb; bad care for mothers damages the next generation. Women living in poverty and under great stress see declines in their own health and that of their babies. Black mothers and babies suffer the most. We do not need to write reports on women’s healthcare. They are already written. Violence against women is real. Save our hospital.
4. There is a shortage of midwives and poor management of midwife numbers and work pressures at the national level. There is a shortage of obstetricians and gynaecologists and other staff. There has been poor workforce planning, and a system where doctors are very specialised, making dual symptom care harder. These are national problems.
5 We were told years ago we needed fewer Hospital beds. That reduction in hospital bed numbers has been disastrous. The closure of A and E departments and the closure of maternity units have gone badly.
The bridge between Birmingham Women’s Hospital and the main hospital
6 There is no bridge, and there is no money for a new build hospital. There is no money for extra staff. Yet LWH management advocates the move based on this twin dream of a new building, and a bridge giving access to Intensive Care and doctors with other specialisms. To make that move without those extra resources would be dangerous. We would lose what we have now.
7. Liverpool Women’s is so close to the Royal that it is quicker to walk from Liverpool Women’s than to get a car out of parking and park it up when you get to the Royal. It is much closer to the Royal than either Broadgreen or Aintree
9. It is hard to merge hospitals. The staff at the Royal, Aintree and Broadgreen work amazingly hard and keep good caring relationships with patients. We thank them for all they do and supported them on their strike. (When you look down this street outside the Royal Liverpool Women’s is at the end of the road by where the trees are on the left)
10 The Royal, Aintree, Broadgreen merger has been difficult. The Liverpool University Hospitals Foundation Trust is in special measures. It has been described as a “troubled trust” managing any hospital is tough in this system and with this government. The Royal Aintree and Broadgreen Trust cannot absorb the Liverpool Women’s Hospital safely. We fight also against the cuts likely to be imposed at Liverpool by Mr Flory ex-national finance chief sent in to sort out its finances
Please sign our petition here or at the street stalls
Our campaign to Save Liverpool Women’s Hospital has a petition with over 60 thousand signatures, more than 40 thousand on line https://you.38degrees.org.uk/petitions/save-liverpool-women-s-hospital.We have more than 20,000 signatures on our paper petition. We presented a copy of this paper petition to the last ICB meeting. We are still collecting more signatures.
We have been campaigning for a fully funded, fully staffed Liverpool Women’s hospital on the Crown Street site, campaigning for maternity rights, and women’s and babies’ health for many years.
The Liverpool Women’s Hospital website tells us “Each year we deliver over 7,500 babies, carry out over 49,000 gynaecological inpatient and outpatient procedures, care for over 1,000 poorly & preterm newborns, perform around 1,000 IVF cycles and have over 4,000 genetic appointments taking place. We believe that this along with a strong dedication to research & innovation makes us the specialist health provider of choice in Europe for women, babies and families.“
Liverpool Women’s Hospital building on Crown Street was opened in 1995. It is a low-rise building on a garden site. A twenty-million-pound neonatal unit was recently added. Our fight to save and improve this hospital goes on.
There have been plans to move or close Liverpool Women’s hospital for several years. There was talk that there were too many hospitals in Liverpool and one had to go. This was s reported on the BBC panorama programme and quoted widely in the local press. We wrote about this in a previous post.
The Pandemic and the chaos around the building of the new Royal Hospital held up the plans for a few years. Then last year a company called Carnall Farrar were commissioned to write a report on the issues around Liverpool Women’s Hospital, referring back to the original plans. We wrote to Carnall Farrar asking to be included in their consultations but they wrote back declining to do so.
We intend to put out our case to Save Liverpool Women’s Hospital in detail in future blog posts but it is important that the background to the issue is clear and in the open.
The discussions about the future of the Liverpool Women’s Hospital take place against the background of the greatest crisis yet in healthcare in England. We have a severe shortage of staff, a shortage of hospital beds, declining health especially amongst those less well off, huge waiting lists, the lasting impact of the pandemic and an inadequate social care system. We urgently need to recruit and retain more midwives so women’s experience of giving birth begins to improve. The Royal College of Midwives last year said there were 2,600 midwife vacancies and that is against the present staffing level a level which we feel is itself inadequate.
Staff and supporters on the picket line for better pay and working conditions in 2023
Healthcare goes on in the NHS day after day, babies are born, many people get treatment. Seven million people though are on the waiting lists. Health is deteriorating partly from poverty, and the pandemic, but also from lack of appointments and procedures from the NHS. Pioneering work on endometriosis is provided at Liverpool Women’s Hospital. But the whole health service is in trouble. The NHS is like a huge ocean liner leaking and listing lacking essential maintenance and investment and the staff are jumping ship. Nurses are on the picket line not just for pay but because of the state of the service. Staff leave not because they hate the job but because they cannot do it properly. The NHS system is underfunded and some of the money we do have is wasted on the market system. Extra funding is much needed but it must not be diverted into the for-profit sector. The market system introduced in the last 20 years has caused severe damage. The NHS needs more funds but above all to revert to a fully public service model of health care. so the money goes to healthcare not to profit. The NHS can be fixed but not if it is also expected to make profit for healthcare corporations,
There is also a shortage of money to build new hospitals and repair existing ones. It has been made very clear that there is no money to rebuild Liverpool Women’s Hospital, it is not even on the mythical 40 Boris hospitals list.
The Health and Care Act 2022 set up 42 Integrated Care Boards to run health care in England. We objected to this model from the start, modelled as it is on the US Accountable Care System. The Act was passed and is now being implemented. Our local ICB is the Cheshire and Merseyside ICB
The Carnell Farrar report to the Cheshire and Merseyside ICB makes suggestions which recommend putting women’s services into a big acute hospital (and that means the Royal.) It does not discuss where the babies should go. We will go into much greater detail on this report in future posts.
The Carnall Farrar Report makes it clear why the report matters not just to Liverpool but to the whole of Cheshire and Merseyside. The government, we are told in the report, intends the ICB in Cheshire and Merseyside to cut £350 million!
Liverpool has the greatest extent of deprivation in England as measured by the Index of Multiple Deprivation (IMD), with two in three people living in deprivation, and eight in every hundred people living 4th in the most deprived one percent of the country. With respect to income, Liverpool is the most deprived5thlocal authority, and the most deprived with respect to employment and living environment.
“Much of this morbidity and mortality is avoidable and despite significant improvement over the last 20 years, the rate of avoidable mortality in Liverpool has remained consistently 50% above the national rate.
This represents an additional 740 people dying every year in Liverpool with the leading causes of these deaths being cancer, cardiovascular disease, and respiratory disease.” Our emphasis
This background to the discussions around Liverpool Women’s Hospital is important. We are not discussing how best to spend an abundance of funding. We have had a decade of underfunding, privatisation, understaffing, and problems with staff retention and pay. Nationally we have a record of declining health for women. The government itself issued a report on this. Maternal deaths nationally are also a problem, as are the deaths of babies at birth. Women’s experience of giving birth is deteriorating; the experience of “being with women” giving birth is also getting worse for midwives. Moving the hospital solves none of this.
Austerity policies helped cause this decline in women’s health. These problems happened during major reorganisations of the NHS, all focussing on bringing in a market-based model, with many different kinds of privatisation.
The various kinds of privatisation are:
Outsourcing
Commissioning
Paying financial consultants and companies like Carnall Farrar whose report cost £130,000, (enough to pay for a midwife for at least two years)
The HSSF arrangements are where certain companies are listed to be given NHS contracts.
The agency staff companies
Giving our data to the likes of data giant Palantir
The use of the US model, the “Integrated Care System” is designed to restrict treatment and make money for the big health corporations. This we believe was at the heart of the Health and Care Act 2022
Giving money to private hospitals to do NHS operations, and sometimes giving them money even if they did not do operations for the NHS
Giving money to Spec Savers to provide eye checks and hearing checks.
Developing waiting lists that create a market for private medicine.
We need a public service model, not a market-based one. The US market-based model of health care has poor health outcomes, especially for working-classpeople and most especially for women. Thirty million people in the United States have no healthcare cover. The US system does however make a ton of profit for their big health corporations many of whom are now involved in the NHS. Prime Minister Sunak recently held talks with these companies and such companies are embedded into NHS planning. Simon Stevens who used to head up the NHS previously worked for the United Health Group. Wikipeadia says “UnitedHealth Group is the world’s seventh largest company by revenue and the largest healthcare company by revenue, and the largest insurance company by net premiums”
We need that money currently diverted to the private sector resources back into a fully funded NHS. We need to plug that drain.
The Maternity Crisis This does not get due consideration in the report
Nationally and locally the NHS needs many more midwives and midwives’ conditions of work need to improve Please see our other blog posts on this. We have report after report saying maternity must improve, we have reports saying gynaecology has the longest waiting lists, and reports about how women’s life expectancy and life expectancy in good health are deteriorating, especially for poorer and for black women. This is national, not just local. Having a stand-alone hospital has not caused these chronic problems.
Specialist HospitalsLiverpool has several specialist hospitals. The specialist organisations within the scope of this review were:
• Alder Hey Children’s NHS Foundation Trust
• Clatterbridge Cancer Centre NHS Foundation Trust
• Liverpool Heart and Chest NHS Foundation Trust
• The Walton Centre NHS Foundation Trust
Specialist hospitals are funded directly from the national centre unlike the acute general hospitals and take their patients from a wide area. Liverpool Women’s Hospital has about one-third of its funding as a specialist hospital as it takes referrals from a wide area, as does Alder Hey Hospital. The specialist hospitals are not yet within the control of the integrated care board and might not be for another year.
What does Carnell Farrar say about Liverpool Women’s Hospital?
In their statement to stakeholders, Carnall Farrar says their priorities are.
1) Solving the clinical sustainability challenges affecting women’s health in Liverpool.
2) Improving outcomes and access to emergency care, making optimal use of existing co-adjacencies at the Aintree, Broadgreen and Royal Liverpool Hospital sites.
3) Significant opportunities to achieve economies of scale in corporate services.
Why is Liverpool Women’s a priority given all the other issues facing the NHS? We can see no grounds to believe that closing moving or dispersing Liverpool Women’s Hospital would be an improvement for women’s health. To do so in this climate of cuts shortages waiting lists and staff shortages would make things much worse.
The Liverpool Women’s Hospital does need some further improvements (as do other hospitals) including a better blood bank. It needs some more diagnostics systems, it needs more staff and close cooperation with other hospitals, as do the other specialist hospitals.
We will write further about the ongoing fight to save Liverpool Women’s Hospital and the NHS and NHS staff pay in other posts
Our campaign will continue to fight for the NHS, for women’s health and for each and every baby. Please support us in this.
Yes, we need to Save Liverpool Women’s Hospital again!
The future of Liverpool Women’s Hospital was mentioned at the ICS board on 4th August 2022. The Integrated Care Board is the new structure which will manage the Conservative designed health system in Cheshire and Merseyside. The item is on page 39. It refers to a decision to commission a report on all the hospitals in Liverpool.
“The review needs to address thelongstanding issue and position of Liverpool Women’s Hospital NHS Trust, whichhas been subject to clinical review, however, a solution is yet to be agreed. There are areas of outstanding practice and service which should be identified and builtupon”.
The review will be based on the One Liverpool report which was started in about 2015 and concluded that Liverpool Women’s hospital should move to the Royal “including a preferred option: a new hospital for women’s and neonatal services on the new Royal Liverpool Hospital campus, which was seen to offer the greatest number of benefits for patient care”.
Now however there is no money for a new hospital. This is stated categorically in the minutes of the shadow ICS board quoted later in this article and was repeated at the ICS board on 4th August.
It needs to bring absolute clarity to the capital question. We are not expecting a new hospital in the next six years and this needs to be stated.” (page 23 of shadow ICB minutes)
The review of course is being conducted by a private company Carnall Farrar ( HSSF Lot 6)
Our campaign aim is clear. No more cuts. Fully fund our hospital. Keep it on its Crown Street Site as a hospital dedicated to Women and Babies.
We will report in another article about the full ICS meeting on the 4th August.
Some of the Campaigners at the ICS board meeting in St Helens on 4th August
Liverpool Women’s Hospital is essential to the healthcare of women and babies in Liverpool and beyond. This is the largest maternity hospital in the country and is much loved by the people of Merseyside and beyond. About 8,000 babies are born at Liverpool Women’s every year. There was a huge campaign to keep it open last time it was threatened (from 2015) and the Hospital stayed at Crown Street. Major investments were made at the site including a 20 million pound neonatal unit. Now we face a renewed threat. Let’s make sure we build a similar campaign this time. Our online petition is here. We also have a paper petition. Please do ask friends to sign it
Paul McCartney gave us his full support when last we were fighting for Liverpool Women’s Hospital
The current threats to the Liverpool Women’s Hospital must be opposed with all our strength. Health care across the UK is in trouble. This is the worst time for more cuts. We need more staff and resources in healthcare, not more cuts and reductions in services. Neither will we sacrifice care for women and babies to fit arbitrary financial limits set by the new health boards (ICB). Healthcare is an essential investment. It makes us all healthier, happier and wealthier.
The Integrated Care Board is the new organisation imposed by the awful Health and Care Act 2022.
Proposals, which we consider to be very damaging for Liverpool Women’s Hospital, were made public on Friday 1st July, at the first meeting of the Cheshire and Merseyside Integrated Care Board. Minutes of the Shadow Integrated Care Board Thursday 9th June 2022 – 10:00 to 11.30 were included in the paperwork. On Page 19 there is a discussion of the future of Liverpool Women’s Hospital. More detailed discussions took place at the Liverpool Women’s Hospital Board meeting on the 7th of July 2022 (At the ICB there was also a discussion of plans for, in effect, merging all the hospitals in Liverpool).
There is no “capital” (money to pay for buildings and very large equipment) available, so no new building but all other options are on the table, from the dispersal of services to other hospitals to a merger, and moving other services into the Crown Street site.
Liverpool Women’s Hospital is a tertiary service. The NHS defines this as “highly specialized medical care usually over an extended period of time that involves advanced and complex procedures and treatments performed by medical specialists in state-of-the-art facilities”.
One reason given for the proposed changes is the lack of long-term intensive care at Liverpool Women’s Hospital. We were assured some time ago that short-term Intensive care is available but patients who need long-term care need to be transferred to the Royal, one mile from Liverpool Women’s Hospital. Ormskirk Hospital has a similar situation. We say, if a unit is required at Liverpool Women’s Hospital, then that should be provided. It is unlikely to be heavily used at Liverpool Women’s Hospital but could provide spare capacity against times of need as we saw in the first two waves of the pandemic.
It is our understanding that Broadgreen Hospital also transfers intensive care patients to the Royal site which is much further away than Liverpool Women’s Hospital.
Patients are transferred into Liverpool Women’s Hospital from miles away, including the Isle of Man. More patients are transferred into Liverpool Women’s Hospital than are transferred out (according to earlier board papers). Every hospital transfers patients between hospitals.
Babies born at Liverpool Women’s Hospitals must sometimes be transferred a day after birth to Alder Hey Children’s Hospital for surgery and they are then sent back to the neo-natal unit at Liverpool Women’s Hospital.
We want the local hospitals to cooperate with each other without losing focus on their core tasks. The core business of Liverpool Women’s Hospital is the health of women and babies. The Ockendon report showed how maternity can be overlooked in an acute hospital. We do not want services dispersed. We need the focus on women’s health.
We don’t want staff stretched across many hospitals. Staff form a team, and that team needs to know each other, needs to know the equipment and the building. It is teamwork that gets the best out of any workplace.
We have had two demonstrations to Save Liverpool Women’s Hospital and we will do so again if needed
Once the UK had the best health service in the world. According to The Commonwealth Fund Report 2021 today UK health care is now fourth in the world of the top ten wealthiest countries following years of Austerity. The American corporations brought in to advise on such matters come from the worst such health service “The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcome...”
There are still world class services being delivered in parts of healthcare in England. We have to protect those parts that still deliver a good service and fight for restoration and repair in the damaged and privatised sections It is not just Liverpool Women’s Hospital under threat, people are having to fight for hospitals across the country. There are campaigns around the country to save Hospitals, Save Ormskirk and Southport Hospital, Save Chorley A+ E, St Heliers in London and many more are running a big campaign too,
Midwives too need our support in their campaigns for more resources.
The staff at Liverpool Women’s Hospital go above and beyond what they are paid. We do regular stalls in the street to Save Liverpool Women’s Hospital and we never fail to find warm gratitude to the staff for their skilled care and kindness. The hospital is far from perfect and many staff express dissatisfaction with the workload and lack of time to do the job they want to do. We campaign for more resources, more staff and proper consultation with the staff ( not prearranged to fit the ICS plans) as to what is needed to let them do the very best for the patients they care for.
Support for breastfeeding mums has suffered in the austerity nationally and locally yet we know it helps babies’ health
Babies’ health is important! This is so, especially in Liverpool, where child poverty is such a problem. We should do our very best for the babies, but our babies are very much at risk.
IMR (Infant Mortality Rate) 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. 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.
We demand a safe space for women to give birth. One in three women have experienced sexual violence, and pregnancy is a key time for domestic violence to begin. Liverpool Women’s Hospital is a women’s place, where women’s needs are given priority. Why should we surrender this asset?
Women’s healthcare is damaged.Women’s health is important.
“Female healthy life expectancy at birth in the most deprived areas was 19.3 years fewer than in the least deprived areas (from) 2018 to 2020; females and males living in the most deprived areas of England saw a significant decrease in life expectancy between 2015 to 2017, and 2018 to 2020.
In 2018 to 2020, females living in the most deprived areas were expected to live less than two-thirds (66.3%) of their lives in good general health, compared with more than four-fifths (82.0%) in the least deprived areas.
There were significant decreases in female disability-free life expectancy at birth in both deprived and less deprived areas between 2015 to 2017 and 2018 to 2020; sizable reductions of almost two years occurred in Decile 2 and Decile 7.”
Nationally we are all affected by these issues, be they in maternity, the ambulances, GP services, mental health provision or on waiting lists. Women’s healthcare is particularly damaged. Surrendering services for women will not help other patients one jot. Tackling these problems must be prioritised.
“In England, the number of women waiting over a year for care is at its highest point ever in gynaecology. This has increased from just sixty-six women in February 2020 to over 28,800 at the end of April 2022, leaving women living with symptoms including extreme pain, heavy menstrual bleeding, and incontinence for far longer than they should.”
This move will hurt the poorest of us the most.
Liverpool Women’s Hospital is in Liverpool and Merseyside which already suffers from poverty and deprivation and the hospital is in one of the poorest areas of the city. The immediate area around Liverpool Women’s Hospital is home to some of the most deprived people, those who have poor outcomes in pregnancy and are most likely to experience ill health.
Women from Black ethnic groups are four times more likely to die in pregnancy than women from White groups, and women from Asian ethnic backgrounds are almost twice as likely.
Pregnant women living in the most deprived areas are twice as likely to die than those living in the most affluent areas.
Even the bus service connecting Liverpool Women’s Hospital, Alder Hey Hospital, and Broad Green Hospital, is due to have its frequency cut from one every half-hour, to one an hour.
This hospital is woven into the life stories of our families.
Liverpool Women’s Hospital provides not just gynaecology but also maternity care This is where most Liverpool babies are born, and where complex cases are cared for. Many families treasure this hospital because it is here that their babies were born, and where babies’ lives are saved. Many families speak warmly of the care they received after the death of a baby. Every public campaign stall we do we hear praise for the staff at Liverpool Women’s Hospital.
Nationally and locally staff and patients are aware of the ongoing damage to our healthcare from austerity policies. We can see A&E crammed and waiting long hours there, too few beds to admit patients in need of care, ambulances unable to attend all the calls that they should, long waiting lists for key operations and privatisation in its many forms.
In Liverpool, we have seen hospital mergers that have not been well prepared or executed, and we see the new Liverpool Royal Hospital, massively and wastefully expensive but still not open in July 2022, so let’s pretend that all is well. All this is documented in Care Quality Commission reports
The National Health Service was founded as this country was recovering from an all-out war. Our grandparents fought for and won universal, comprehensive public service healthcare. We need to win it back. This country cannot afford to neglect healthcare. We need to restore and repair the National Health Service, fully funded and publicly deliver without privatisation and continuing cuts
For all our mothers, sisters, daughters, friends, and lovers and for all our babies, Save Liverpool Women’s Hospital.
The papers cited here can be found below but here are key quotes
We will cover other aspects of these proposals in other posts
This video which is included in the paperwork of the Liverpool Women’s Hospital Board explains more. Lynn Greenhalgh is the medical director of LWH. Lynn asks staff to consider which hospital their service could be dispersed to.
Also
“AMA felt that there was an option to take a pragmatic approach and improve the current situation by moving staff around sites or swapping services over using existing sites. JLE confirmed that these options are all included in the new Optional Appraisal. JLE informed the board that consideration had been given to splitting Obstetrics and Gynaecology and assessing the risks associated with this” (Page 21 of the shadow minutes)
And
It needs to bring absolute clarity to the capital question. We are not expecting a new hospital in the next six years and this needs to be stated.” [page 23 of shadow ICB minutes
A demonstration to Save Liverpool Women’s Hospital the first time the Hospital was threatened
Amanda Greavette is an artist who paints maternity and who allows us to use her materials for our campaign to Save Liverpool Women’s Hospital
We have held regular stalls since 2015 to Save Liverpool Women’s Hospital. WE have great support and learn about people’s experiences of the Liverpool Women’s Hospital
Protest targets private sector roles in NHS plans Health campaigners will target private company involvement in local NHS plans and threats to emergency care at the first meeting of the Cheshire & Merseyside Integrated Care Board (ICB) in Liverpool this Friday. The ICB will manage £4.8bn of NHS finances for the entire region, with realterm cuts. “We are outraged that a company director will sit on the ICB and US-owned corporations could be involved in reviewing Liverpool hospitals,” says Keep Our NHS Public Merseyside. “The new Health and Care Act fails to ensure emergency care for everyone present in our area. Patients and NHS staff, Councillors and MPs should demand this is guaranteed in the ICB Constitution.” Warrington GP Dr Raj Kumar is designated as one of two Primary Care directors for the ICB. Dr Kumar is also a Director of Kleyn Imaging Limited, providing ultrasound, MRI, and digital radiology as the “imaging arm” of Kleyn Healthcare Limited. Dr Kumar resigned as a director of Kleyn Healthcare on 27 June, but retains a controlling interest in Sycamore Corporation Limited which holds over 75% of shares in Kleyn Healthcare. Kleyn’s website proclaims “Welcome to a world of innovation, enterprise and transformational leadership in healthcare.” A secretive review of Liverpool hospitals is being commissioned through the Health Systems Support Framework. The cost is “commercially confidential”, and the public cannot view the specifications. The Framework accredits over 200 companies including US transnational corporations and their subsidiaries. Operose, owned by $111bn-a-year Centene Corporation, featured in a recent BBC Panorama investigation of GP surgeries using “Physician Associates” without proper supervision by fully trained GPs. Palantir, founded by Trump supporter Peter Thiel, hopes to be contracted for a system to underpin all NHS data. “Operose, Palantir and other Framework firms should have no say in reviewing Liverpool hospitals, and the public must be able to see the terms and cost,” says Keep Our NHS Public Merseyside. Notes to Editors
Campaigners from Keep Our NHS Public Merseyside, Save Liverpool Womens Hospital, and Defend Our NHS (Wirral) will lobby the ICB from 10am Friday 1 July outside the old Lewis’ building on Renshaw St. ICB papers: https://www.sthelensccg.nhs.uk/media/4887/220701-icbpapers. pdf
Again we are revisiting the work we did in the earlier years of the proposals for the future of the Liverpool Women’s Hospital. This was written in response to Future Generations publications. Since this was written, the disaster of the PFI model for building hospitals is clear. Liverpool still waits for the Carillion Hospital Further details of PFI can be found here
FINANCES
LCCG ( Liverpool Clinical Commissioning Group) recognises that significant capital is required to re-locate LWH to the site of the new Royal Hospital. Of the various potential funding options, they see a Public-Private Partnership( PPP) as the most viable option.
Following the collapse of Carillion, Philip Hammond, in the 2018 Budget pledged not to sign any new Private Finance Initiative contracts (PFI).
“In financing public infrastructure I remain committed to the use of PPPs. We will establish a centre of excellence to actively manage these contracts in the taxpayers interest starting with the health sector.”
The PFI was a way of creating PPPs where private firms are contracted to complete and manage public projects. It is widely believed to be used by governments simply to place a great deal of debt “off-balance sheet”. In other words another expensive, disastrous financing model.
There has been very little said about what would become of the existing building at the Crown Street site. The PCBC (page 312) states that it is “likely to remain a site for NHS services”.
The Naylor Review( 2017) examines how the NHS in England can raise cash from its premises. Its findings were in line with the requirements set out in the Sustainability and Transformation Plans (STP)s which were introduced in December 2015 to fast forward NHS England’s Five Year Forward View (5YFV). The focus from STPs has evolved from Accountable Care Systems(ACS) to Accountable Care Organisations (ACO)s to Integrated Care Providers (ICP)s. ( Now called ICS) An ICP brings together a number of providers to take responsibility for the cost of care for a defined population within an agreed budget. This will force the NHS into an alliance with social care which is private and means-tested.
Two things underpin the thinking behind the review:
a) the need to free up public land and build much-needed housing to solve the housing crisis
b) the new models of care described in the 5YFV have different infrastructure requirements so surplus land can be disposed of and the profits used as an incentive for Trusts to meet targets imposed by STPs.
It appears that dispersing public assets into private hands is the objective behind these plans and not the long-term benefit to the public service. Private developers own between them enough land to build 600,000 new homes, so there is no critical need to release any public sector land. However, the release of public sector land would increase profitability for the private sector, especially if the sites are in prime locations. Liverpool Women’s Hospital (LWH) is situated adjacent to the Georgian Quarter of Liverpool, one of the most sought-after residential areas in the city. The building is owned outright by the Trust and the freehold is owned by the city Council.
Naylor emphasises the contribution of sales of existing estates and the introduction of private finance to create new builds as key to changing the estate to meet “the new models of care” set out in the 5YFV.
NHS Commissioners and regulators have considerable authority to insist premises be fit for purpose. These powers can be used to force the pace of investment in or exit from inadequate premises eg.by reducing payments for properties not meeting future service strategy to encourage moves. Section 7.4 of the review recommends
(Recommendation 10) “STP estates plans and their delivery should be assessed against targets informed by benchmarks set against the review. STPs and their providers which fail to develop sufficiently stretching plans should not be granted access to capital funding, either through grants, loans or private finance until they have agreed plans to improve performance against benchmarks.”
The guidance for STPs says transformation funding which is necessary to deliver key service changes and new models of care will “only be available to systems whose operational plans meet their required control total and performance trajectories.”
Naylor who write this report
Relocation of LWH to the site of the new Royal hospital would force another expense onto taxpayers in the form of a PPP. It would also pave the way for the sale of the present hospital and land to property developers or to private companies eager to get their hands on a modern, functioning hospital. If relocation were to take place and the existing building used for NHS services the likelihood is that those services would be tendered out and fall into the hands of the private sector. This should never be allowed to happen.
Land sales and commercial rents being forced onto Foundation Trusts and Gps are not a way of securing the NHS’ future. The Naylor Review recommended that HM Treasury should provide additional funding to incentivise land disposals through a “2 for 1” offer in which public funds match disposal receipts. A bribe to encourage the sell off of NHS properties and should the bribe not succeed
there will be a penalty imposed for holding on to assets. The reality of the Naylor Review is another move to privatise public assets. Property developers stand to make a profit from land acquired on the cheap.
By deeming LWH “not fit for purpose” and by presenting a clinical case for change LCCG has put LWH and the land on which it stands in danger of being developed for housing, none of which will be “affordable housing” due to the soaring house prices in the area.
The selling of land just to raise money will not meet the demands of the Naylor Review, only changes of uses of existing services will do. The authority to change the use of an existing building lies with the City Council Planning Office. It would be timely to remind them of the significant investment of the NHS in LWH as a deliberate attempt of the then Dean of Liverpool to invest in the Liverpool 8 area through his Project Rosemary following the Toxteth Riots. The LWH is a much loved hospital, a specialist hospital dedicated to the care of the women and babies of Liverpool and surrounding areas and should remain so.
We are revisiting some of the work we did when the proposals to close the Crown Street Site were first raised. The article was written some years ago. These ideas are still relevant.
ENVIRONMENT
Liverpool Women’s Hospital is a specialist hospital dedicated to the care of women, babies and their families in a safe friendly environment. It opened in 1995 and is located on Crown Street, Toxteth in a modern landmark building (NHS Choices).
In 2013 a new development of the reception area incorporated a comfortable seating area, cafe, shop and a play area for children. It opens up onto a landscaped courtyard with seating, a herb garden was planted for use by the hospital chefs and a memorial garden was opened to offer bereaved families a private space within the hospital grounds.
Another garden “The Garden of Hope and Serenity” was opened in 2016.
“This garden is a lovely area where our women, families and staff can relax in the sunshine and escape life on the wards”
(Kathryn Thomas, Chief Executive at LWH).
The idea for this garden came from nurses at the gynaecology unit who recognised that women and families visiting the Emergency department would benefit from a space away from but near to the department to have an area of calm to process their thoughts and feelings.
There is a wealth of literature that confirms the importance of trees and gardens for patient recovery and should not be ignored. A much-cited study, published in 1984, by environmental psychologist Roger Ulrich was the first to use the standards of, modern medical research to demonstrate that gazing at a garden can sometimes speed healing from surgery, infections and other ailments.
Although it is clear that this will not cure disease, it has been proven that just five or six minutes spent looking at views dominated by trees, flowers or water can begin to reduce levels of anger, anxiety, stress and pain. This can allow other treatments to help healing and induce relaxation that can be measured in physiological changes in blood pressure, muscle tension or heart and brain activity.
Studies have shown that loud sounds, disruptive sleep and other chronic stressors can have serious physical consequences and hamper recovery (Ulrich,1994).
Henry Marsh, the celebrated neurosurgeon and writer has stated:
“……… these big hospital are horrible places really, the very last thing you get in an English hospital is peace, rest or quiet which are the very things you need the most”. He goes on to say that the garden he created at St. George’s Hospital,” ….. is probably the thing I am proudest of.” (The Observer).
Not all gardens are equally effective. A study found that tree lined vistas of fountains or other water features, along with the greenery of mature trees and flowering plants appealed the most. The more greenery versus hard surfaces the better (Cooper Marcus and Barnes 1994).
The plan for the new Royal hospital includes a landscaped garden. According to Brian Zeallear from NBBJ:
“Through creating smaller buildings around the periphery and having public roads and pedestrian corridors through the site, we can stitch back the existing city. The centre will feel like a public square. The hospital is in a dense urban area but once the landscaping is done….it should make you feel you are in nature through the manicured grass, trees and water features”.
However sitting in a public square surrounded by public roads is hardly the restorative qualities of greenery, flowers and other nature content envisaged by Ulrich.
Liverpool Women’s Hospital is at present situated in a quiet, landscaped and safe environment. Although it is in a fairly central location it is protected from the sounds and pollution of traffic.
There is now substantial evidence on the adverse effects of air pollution on different pregnancy outcomes and infant health. The evidence for the impact of air pollution on infant mortality, primarily due to respiratory deaths in the post natal period seems to be solid (WHO 2005). There is now new evidence that shows air pollution particles from traffic affects the health of unborn babies ( Miyashita & Liu 2018).
Less consistent though still suggestive of a causal link to air pollution are lower birth weight, a higher incidence of preterm births and intrauterine growth retardation. Moreover, the evidence shows clearer relationships between particulate matter and traffic-related air pollution than other pollutants.
The intrauterine, perinatal and early childhood periods, during which the lungs are developing and maturing are very vulnerable times. These are times when the lungs are more susceptible to injury by air pollutants. Exposure during these periods reduces the maximal lung functional capacity achieved in adult life and can lead to increasing susceptibility, in adulthood, to infections and the effects of pollutants such as tobacco smoke and occupational exposures (Vierira 2015). Also there is sufficient evidence of a causal relationship between exposure to lead to neurobehavioural deficits in children in terms of cognitive impairment (WHO2005).
While it is impossible to avoid all air pollutants, advice from many sources include, remaining indoors when air pollution is high and even when air pollution is low it is best to avoid polluted roads (Greenpeace 20017). Campaigns to avoid exposure to air pollutants include moving school entrances from busy roads and the use of pram covers to protect babies from being exposed to harmful particles.
In the face of all the evidence of the harmful effects of air traffic pollutants on neonates, it is inconceivable that the environmental effects of building a hospital for women and babies in the middle of one of the most traffic-dense areas of the city have not been considered.
Liverpool City Council will discuss the new health service configuration called the ICS for the first time since we lost the battle against the Health and Care Bill in Parliament. The battle for our healthcare will now take a different more urgent form, and councils have a part to play. We list below some key issues Councillors should raise.
Mental health, CAMHS, maternity, dentistry, GP services, Accident and Emergency, waiting lists waiting times, staff pay, staff retention, and staff working conditions are all under dreadful stress. Covid is simmering away and we have to prepare for a further outbreak or a big winter of flu. This huge restructuring to favour the private sector adds fuel to the fire.
Liverpool Council will discuss the implementation of the Integrated (not) Care System on Wednesday (25 05 22). All the other Cheshire and Merseyside Councils will be having similar discussions.
The Cheshire & Merseyside ICS is item 16 on the agenda at the city council.
Life expectancy has fallen. Life expectancy in good health has fallen (figures from before the pandemic which caused further falls) Our people are dying and getting ill earlier and not just because of a badly managed pandemic, but because of austerity and the decline in the NHS under Conservative and ConDem governments. It is on their watch. They carry the responsibility.
The NHS has many intertwined crises that this reorganisation does not address. Please see below for more on these urgent health care issues.
Councillors can significantly help protect healthcare in our area by adopting these immediate demands, drawn up by health campaigners across England.
Immediate issues. Councils are the only democratically elected organisations with any direct influence on these new ICS structures. Councillors can report directly to their electorate to put these policies under the spotlight.
ICB Constitution. Each integrated Care Board must write its constitution.
We are asking councillors to please ensure the following commitments are written into the ICS constitution:
That the ICS in Cheshire and Merseyside will maintain a comprehensive health service, free at the point of need, accessible to everyone living in the area – including homeless people – at the time when they need health care or treatment.
That anyone needing emergency or urgent services while present in the ICS’s geographical footprint will receive the necessary treatment, whether or not they are registered with, or permanently reside within, the ICS area.
That ICSs should not include private sector representatives on any ICS boards or committees or any bodies with delegated powers from the ICB.
Privatising is a multilayered process. See this for a working definition.This new system is designed to limit care, and make a profit for private providers. However, this is rarely said in public. Privatising healthcare is still extremely unpopular. Government and NHS chiefs do not like discussing it. The Public does not want this to happen. Councillors though answer to their electorate and must speak up for them.
That NHS providers are the default providers of health services, care and treatment, and that as contracts with private sector companies come up for renewal the default position is that they will be awarded to NHS providers.
That if any contracts do continue to be awarded to the private sector, there must be vigorous scrutiny to ensure that this is conducted in a transparent and accountable manner.
That the Integrated Care Board include a councillor from each local authority covered by the ICS, not just one representative covering all the local authorities in an area.
That the Integrated Care Board must include representatives of professionals from Mental Health, Community Health, Maternity, Primary Care and Public Health, as well as from Acute services.
A commitment that maternity care will meet every aspect of Donna Ockendon’s report, including the required staffing
That Integrated Care Boards, Integrated Care Partnership body, place-based bodies, committees and sub-committees will include representatives of patients’ groups and of NHS staff trade unions.
That it be ensured that before a patient is discharged from the hospital, it is safe to do so and that any unpaid carers expected to look after the patient are both willing and capable of doing so, and that the operation of the discharge policy will be audited.
That nationally agreed pay, terms and conditions, including pensions, as negotiated with the NHS staff unions, will apply to all staff employed by any NHS provider within the ICS area.
That there must be a discussion with NHS staff unions about safe staffing levels and what is needed to ensure they can be implemented.
In item 16, there appear to be no councillors on the IC Board, only two executives from across the 9 Cheshire & Merseyside local authorities. These people will not be there to represent local authorities’ policies. Is this acceptable to Councillors?
The ICS structure has been tried in pilots and found wanting. The model has major faults.
Liverpool Policy
Liverpool City Council policy has been to oppose the introduction of the 40+ separate health systems (ICS=Integrated Care Systems) through the Health & Care Bill, now the Health & Care Act. This Act deliberately breaks up a national health service into these separate units, whose shadow structures (ICS) were set up ‘extra-legally’ before the Act became law.
Multiple Crises in Healthcare in May 2022
This new system starts with cuts. They talk the sweet words of Transformation but it is a brutal change they are implementing. Our hospitals, GP services, maternity, mental health and dentistry services are all struggling to cope, and at times failing. We are already so understaffed that maternity cannot provide one midwife to one woman giving birth.
Local mental health patients in crisis are being sent to distant cities just to get a bed.
Staff costs cover 46.6% according to The Kings Fund. Other surveys put it much higher. So, all cuts would hit staffing.
“Every health system has seen their core recurrent funding reduce in real terms in 2022-23, analysis by HSJ reveals;
An increase in recurrent allocations wiped out by inflation
The situation is likely to be worse than official figures suggest
Every health system subject to real terms cut in core spending per head”
The Government has come up with some more money or some services but by robbing Peter to pay Paul, not producing real increases
HSSF
The HSSF is a list of companies that can be given NHS work without the normal bidding and scrutiny process
“Huge US transnationals are accredited by NHS England through the Health Systems Support Framework, to gain NHS contracts.”
Hospital Closures
The Act allows the Secretary of State to interfere early to decide on local ‘reconfigurations’ including hospital closures, thwarting public consultation, and weakening the say local authorities and councillors have on NHS plans in their area.
“Moving specialised services commissioning from NHS England to integrated
care systems risk fragmenting provision, creating postcode lotteries and diluting quality and expertise” a group representing some of the largest tertiary trusts has told NHS England.
We have had enough of closures, reduction in bed numbers and the chaos of the Liverpool Royal Carilion building.
Public Questions
The public will have no right to ask questions and get answers from the ICB or its committees and can be excluded from meetings. Who will see if health care treatment is just adequate and fair?
The report on the ICS Joint Health & Scrutiny Arrangements recommends the setting up of a Joint Health Scrutiny Committee across all nine local authorities in the Cheshire & Merseyside area.
Questions that need answering:
Thanks to Black Lives matter demonstrators for this image Its just as true for the NHS
How can Ockendon’s report on Maternity failings be tackled if large cuts are involved before the system is even legally launched? How can it tackle the Mental Health crisis, the GP crisis, the A+E crisis, the workload and workforce crises and Ambulance crises with fewer funds? We weep for the babies who died unnecessarily yet allow the situation to deteriorate beyond what it was when Ockendon investigated. Already this city has the worst deaths under one year old, and that does not include stillbirths.
How is Maternity represented on the ICS? Who on the ICS will be responsible? Every hospital must now have an ‘Ockendon rep,’ but not the ICS?
How will the Council’s Social Care Budget be impacted? The Act gives the ICS significant powers that need to be clarified, if necessary, in law.
How will the ICS ensure probity in allocating services to the companies on the HSSF list
How will the ICB ensure no health worker is denied decent pay?
The ICS model is based on a specific US model designed to make money for the private sector, ration patient treatment, and reduce staff pay. It has widened health inequalities. These organisations are now being used to privatise even Medicaid in the US.
The effect of the passing of the Health and Care Bill will be harsh. It is now an Act and as such will be implemented creating forty-two distinct organisations. Ours is the Cheshire and Merseyside Integrated Care System (ICS). Exactly who sits on these boards has yet to be published. We do know their chairs and many other posts.
Our anger at what is happening is righteous and well informed. As we campaign we want people to focus their anger into action, not let that anger become, as the Conservatives wish, debilitating and without purpose.
We need people to help with the campaign to reinstate the NHS and to monitor what is happening locally. Please do get in touch if you can help even in the smallest way.
Each ICS organisation will be expected to keep to a set financial limit, and any financial risk-sharing will be within each ICS. This financial structure, in reality, is unworkable but it will be used to excuse and implement harsh cuts, which in turn will inflict death, pain, and suffering. It will mean worse pay for staff too. This is unless, of course, we can build a deep and wide protest movement. This has been done before. We need to do it now.
The ICS boards will control all spending in the Cheshire and Merseyside health area. Hospital trusts start this era in debt, not from being spend thrift, but because budgets were not adequate for the treatments they had to deliver.
The ICS system is supposed to insist on no overdrafts, and that any over spend has to come from other hospitals in the local system. Well that’s not going to work, is it? In fact, this system is very dangerous for maternity as many of the Trusts in Cheshire and Merseyside do not provide maternity care and may not therefore even have an Ockendon Rep on their boards. Donna Ockendon insisted that each hospital had a board member responsible for Maternity on their board because of the poor oversight in Shrewsbury We have found no Ockendon Rep on the ICS board, in the paperwork available to the public We would love to be proved wrong.
Maternity is in crisis as the Royal College of Midwives, somewhat belatedly, said recently and that crisis must be addressed, rather than cuts in spending enforced. This is the lives of mothers and babies and the working lives of maternity staff that we are talking about. What is more important than the lives of mothers and babies at birth?
Meeting all the Ockendon requirements for safety requires major investment not cutbacks, not just in the Liverpool Women’s Hospital, but in Arrowe Park Hospital, in Leighton, in the Countess of Chester, in Ormskirk, in Whiston and any other maternity service in Cheshire and Merseyside and beyond.
Liverpool Women’s Hospital Board Papers said
“The Trust is in underlying deficit, and faces additional pressures to maintain levels of workforce recommended by the (first) Ockenden report. There is a significant increase in clinical negligence costs which have not yet been funded.
Financial impacts of the second Ockenden review, and any funding available to support this, are being assessed. There are other significant cost pressures which will be managed through an ambitious and challenging 3% cost improvement plan plus additional non recurrent mitigations. .”
When the Banks needed bailing out huge amounts of money were conjured up for them. Sajid Javid the health secretary was a banker in those crazy times. Hey! Sajid, health needs a big investment that will pay for itself many times over.
This money shortage is serious. Researchers have gathered the figures from board papers from local hospitals.
Mid Cheshire hospitals Trust wrote “The system has £183m less resource than in 2021/22, which is a 3% reduction in funding after inflation has been applied. There are several factors which are influencing the movement and some key risks to receiving the funding in full.
“1. Convergence: C&M funding levels are currently above its calculated target allocation by £338.5m, and has a target to reduce this over time, leading to the additional reduction of £51.67m…..”
The UK is experiencing high inflation, especially from fuel costs. This will affect the NHS too. So we need to add inflation to the cuts described above.
NHS pay has acted to keep NHS inflation below the national average for some years. Low paid NHS staff who stay in the job because they are committed to the NHS will feel the increase in inflation still more.
Although the Act is called the Health and Care Act it does little for the mostly privatised Care sector. This letter is not focusing on that important issue. (A separate article will cover that). This situation is looking at the breakup of the NHS.
The problems in social care are impacting badly on hospitals which at present cannot easily discharge patients to care homes. The shadow of the Covid deaths hangs long over the care home sector and the Covid virus is far from spent.
The New ICS system introduced by the Act has been present in shadow form for some time and regional control of budgets increased during the pandemic.
This model of healthcare finance and delivery is based on the US Accountable Care systems. Accountable here means “for accounting,” not “answerable to.” It is designed to make money for the private sector. Designed to give our tax money not to the sick or the hard-pressed underpaid staff but to the rich.
Plans for this have taken many years, back to Thatcher and more recently work at Davos, the working groups of the globally rich.
We have lost a National Health Service. The national part of the health service is important for risk sharing, research sharing, national pay structures, and shared experience. These models will produce postcode lotteries and differential services. We can imagine that they will blame Merseyside for the effect of their cuts as they are now blaming Liverpool for the effect of 60% cuts in local government funding.
The huge health gaps in life expectancy will open wider. Remember more babies die in Liverpool under one year of age than anywhere else in the country. Working-class women have a life expectancy ten years less than those in rich areas. The Tory voting areas will get service though
If we can build a campaign we will deepen the commitment to the Bevan Model of the NHS in our areas.
In these new structures, the national part of our health service has gone. What we have now is more like a localised public-private partnership. We want to bring back a national health service.
Publicly delivered. We want to return to a national publicly delivered health service. Private companies are designed for profit, not for healthcare.
A health service, of sorts, is still functioning, hit and miss as to the treatment you get. Doctors, nurses, midwives, physios, scientists, porters. cleaners healthcare workers all continue to go to work, work hard and with skill, and many are delivering good services, but there are significant dangers. Some are wonderful services, but all are at risk. The Cheshire and Merseyside ICS has big problems with staff shortages, funding restrictions, poor organisation and the present major reorganisation but for now, for some a service is still there.
Major cuts in funding are underway. See the Lowdown The Lowdown article referred to £219m deficit in the C&M budget – practically every single hospital in the area has a deficit. So, in other words, the ICS will continue by making more cuts and demanding more from an ever-shrinking workforce who are paying the price of this reorganisation. The staff risk having their pay negotiated locally. It is a major leap forward for privatisation and healthcare for profit
Staff are poorly paid, understaffed, and worn out. Covid is still a factor so there has been no time to recover. Waiting times are long and harsh. The pressure to pay to jump the queue is very real. The private health sector has been given huge amounts of Government money. This is likely to continue especially as these companies will be influential on the ICS boards.
So when the going gets tough, the tough get going. Join the campaign to fight for the health service locally and nationally. Don’t make the NHS a dim and distant memory.
For all our sisters,mothers, daughters and babies.
Save Liverpool Women's Hospital 