September 2017

Plans to “move” the Liverpool Women’s Hospital might be about to be announced; or they might not. This is a long limbo. Meanwhile fundamental changes are being planned for the whole maternity service in the UK, and Merseyside and Cheshire are “early adopters” of these changes. So in all this confusion think of two big issues; what’s happening to the Liverpool Women’s Hospital and what’s happening to maternity services? They are equally important.

(Of course behind it all, is the crisis in the NHS as plans to shift it to a privatised cut back model continue)

Normally we think of the main players being the Liverpool Women’s Hospital Trust, the CCGs and the Local Authorities but now we have two more players the NHS early adopters Maternity Review Vanguard (NHS Early Adopters in Maternity Services – Cheshire and Merseyside) and the Sustainability and Transformation Boards.

20160401_125901What’s Happening to The Liverpool Women’s Hospital?

The plans have been published (“The Review of Services Provided by Liverpool Women’s NHS Foundation Trust, Pre-Consultation Business Case”) in draft form for some eight months, but it looks like they may now be fully published for formal consultation. Elections, including the Mayoral and then the general election, were cited as reasons to postpone the consultation. These have now passed.

However, there is nothing in writing about the plans in the papers published for the September 1st Board meeting.

The Liverpool Clinical Commissioning Group is in some bother with a legal notice from NHS England and several senior resignations.

A Liverpool City Council meeting to discuss whether they should discuss the plans (yes, it is that convoluted) has been scheduled for early October.

“to receive further information on proposed changes to Future Women’s Services provided by the Liverpool Women’s Hospital. The same information will be received by Sefton and Knowsley Councils. In the event that two or more of the three local authorities determine that any proposed changes represent a substantial variation of service, a Joint Authority Scrutiny Committee will be established.”

A freedom of information request to the Liverpool CCG gave us this response, which boils down to “Well. we are getting ready”.

Question for Governing Body of Liverpool CCG Meeting of 8 August 2017

It has been seven months since Liverpool CCG published the Review of Services Provided by Liverpool Women’s NHS Foundation Trust, Pre-Consultation Business Case.

Thus, I would wish to ask the following:

1) Can you give some indication when the public consultation will begin?

We anticipate that the NHS England assurance process will resume in September as the additional information required regarding the financial case and an independent clinical review of the options should be completed by the end of August. 

The assurance process could take up to two months which would mean the earliest start date for consultation would be November 2017, but a decision may be taken to commence after the Christmas period. However, consultation could only take place if NHS England is assured about the clinical and financial case and if support is given by a joint North Mersey Overview and Scrutiny Committee.

2) Is there any information in the public domain on the format for the public consultation?

Planning for a public consultation is at a very early stage and a draft consultation plan is currently in development. 

We hope to update the three North Mersey OSCs on an outline approach to consultation in meetings to be scheduled for September.

3) The format for the consultation may indeed be determined by rules and guidelines laid down by various statutory bodies. However does the CCG have flexibility in the enforcement of these rules such as allowing public input into designing the format of the consultation? 

There are statutory requirements for a formal public consultation which are set out in a number of documents, including: 

https://www.engage.england.nhs.uk/survey/strengtheningppp/supporting_documents/ppppolicystatement.pdf-1

https://www.england.nhs.uk/wp-content/uploads/2015/10/plan-ass-deliv-serv-chge.pdf

In addition to OSCs, the CCG would engage with and seek input from organisations such as Healthwatch and existing patient engagement groups such as the Liverpool CCG Patient Engagement Group and the Sefton Consultation and Engagement Standards Panel in the design of the consultation process.

4) Does the format for the consultation have to be approved by the Joint Scrutiny Committee before it can begin?

Yes, commissioners would seek approval for the consultation plan from the joint OSC of North Mersey local authorities. 

Money is a major part of the delay, as NHS England have to agree the capital money for the rebuild or the improvements on site (Our campaign’s preference is to improve on site). It is probably £140 million pounds for the CCG preferred option of a rebuild at the Royal published in the Review of Services Provided by Liverpool Women’s NHS Foundation Trust, Pre-Consultation Business Case. Such sums are not often forthcoming in this Government’s cuts scenario , unless there is a way as in PFI that big business can get a handsome profit.

national-maternity-review-hdrWhat is  happening to maternity services?

There are two other issues going on, less publically:

One is the ‘Five Year Forward View’ and the linked implementation of the 44 Sustainability and Transformation plans nationally. Liverpool is part of the most complex STPs, Merseyside and Cheshire, which is attempting huge cuts, service rationing and preparation for the US style re structure into Accountable Care Organisations. The purpose of this is to make the NHS more accessible to US style ‘for profit’ healthcare companies.

The other is the Maternity Review, of which our area is a vanguard area, and the implementation of which is a real threat not to the existence of the Liverpool Women’s but to the structure of its services.

Maternity services are at risk across the country from STPS and the whole ethos of the Maternity Review

Our area is an Early Adopter of the misnamed “better births programme”. Catherine McClennan from this programme says “The majority of our women give birth in Hospital, we want to change that”. (at about one minute in on the video). They also speak of “popup” maternity units and greater ‘choice’.

We do need better births. We need fewer still births. Fewer maternal deaths. We need better ways to induce babies, we need more time with midwives, we need better ways to help breast feeding mothers and better mental health provision. We need happy, heathy mums and happy, heathy midwives, doctors and all the related professions. None of the stuff published under this heading is helping this at all.

Those implementing the Maternity Review seem to assume diversity of provision means greater choice, when it does not. ‘Diverse provision’, and ‘other providers’, are not the same thing as choice.

Cumbria maternityAcross the country the loudly expressed choice of thousands of women to protect their local maternity services are being ignored, as services are closed willy-nilly. The choice of most of our local women is to give birth in hospital. Women giving birth can already use the midwife lead unit at the Liverpool Women’s Hospital, but that doesn’t count to the “reformers” because it is an ‘alongside’ unit, not a remote one. A remote unit obviously carries more risk, as one in four mothers giving birth in a midwife led unit has to be transferred to hospital. so the further away it is the greater the risk. Three out of four deliver happily and safely in such a midwife led unit.

A hospital or an alongside midwife led unit can be very homely and happy. Home births from the hospital midwives are also possible. Home births do not have to come from for profit companies outsie the NHS.

Where a remote midwife service exists in other parts of the country, and is safe, it should be protected. But that is not  the issue here. This restructuring is not to do with saving babies or making labour any happier for mothers. Just look at  some of the nonsense reported to the Women’s Hospital trust board;(Sept meeting minutes from ealier meeting)

The Director of Nursing and Midwifery explained that the Trust would be focused on specific areas:

  1. Identification of hubs in suitable locations where services could be delivered from including
    1. ultrasound imaging,
    2. obstetric clinics,
    3. antenatal education
    4. and other support services such as smoking cessation and other public health message support;
  2. Increasing the number of community births including homebirth and exploring freestanding birth centres;

(In other words, they are continuing to further the removal of services from the Women’s Hospital site, despite the consultation not having started…)

  1. equitable access to an enhanced midwifery service providing support for vulnerable women experiencing complex health social factors such as perinatal mental health issues, substance misuse and child protection service input;
  2. Consistency of breast-feeding support across the areas;
  3. Offering contemporary antenatal education provision tailored to meet the needs of the women and families;
  4. Examination of the New born provided in a timely manner in the most appropriate setting;
  5. Provision of a model of continuity of carer within smaller teams promoting normality in pregnancy and birth whilst also coordinating care for women with additional risk factors;
  6. Improvement in the Information Technology provision

We could critique this ‘till the cows come home, but should he really be doing this when we have babies to save? when mortality staistics still show  concerns? When ninety-four of the sites where Hospital staff already work do not have risk assessments in place as the health and safety report in the same minutes shows?

 Choice will be funnelled

However, the system that they are planning in this maternity vanguard programme will be able to funnel “choice” as the managers wish, through a single point of access – which will be a telephone service guiding women as to their options. Not your GP, or your local midwife, but a telephone system with the midwife giving advice (probably from a script and menu,) see one minute twenty three seconds into this video). This system will fit very well into the cost planning for a US style accountable care organisation,

Over worked staff

Then there is the huge problem of over worked midwifes and the pressures on them in the current climate of cuts. The Royal College of Midwives has made this very plain when commenting on the closure of the training bursaries scheme.

We are dealing with a profession that is already overworked, understaffed and under paid. The Government should be doing all it can to make midwifery and working in the NHS as attractive as possible rather than deterring those by cutting public funding to train frontline staff

The inadequate amount of money allocated to the maternity in the national maternity tariff means midwives will continue to be over worked and underpaid. This is unacceptable.

Our choices are

  • Save Liverpool women’s hospital and keep all of its services on the much-loved site.
  • Improve the Maternity Tariff – fund adequately for safe and happy births for all.
  • Bring back the training bursaries.
  • Give mothers more time with their midwives before, during, and after birth.
  • Make both midwife led units and consultant led units fully funded and safe.
  • Prioritise work to stop still births and maternal deaths.
  • Stop cuts and privatisation.
  • No to the US model of care.

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