A pop up maternity Unit? Really? In the middle of the crisis in the NHS? During a crisis in ambulance attendance times? During a crisis in Midwife recruitment and workload ? During a financial crisis for the NHS?

We would ask:

Why is this safe?

Who will oversee its safety?

How will its work and its staffing be planned?

Will it be staffed day and night?

Where is the risk assessment?

Where is the Equalities assessment?

Who will manage its policies? Stringent policies in a maternity units save lives. The Morecambe Bay scandal proved that; for a critical view of Morecambe read this

What ambulance stand by is planned? Ambulances on the Wirral right now are not exactly speedy.

The Merseyside and Cheshire Women and children’s Vanguard have made a very strange decision to open a pop up midwife unit in a children’s centre in Seacombe, on the Wirral.

What is going on?

We need better births, greater care for women and babies, fewer still births, fewer maternal deaths.Women should have more care in pregnancy, in labour, after the birth and in the baby’s first year of life.

We need many more midwives, working under less pressure, more obstetrician, more neo natal nurses and all the related professions.

We need more pediatrics (baby and children’s) doctors and nurses.

We need much better mental health support around pregnancy and early motherhood.

We need breastfeeding support to be expanded funded and staffed by well-trained and well paid staff, linking with volunteers who are themselves breastfeeding.

We need support for infant nutrition for bottle feeding mum’s, not leaving this to big business who exist to make a profit.

We need good public health, removing environmental hazards like traffic, traffic pollution,unhealthy food products and stress.

So we do need a lot from our NHS maternity and pediatric services

The Maternity Review and Better Births is a long-term plan from the government, led by Conservative peer Baroness Cumberlege

It is slathered in words about choice, that women must have choice about the way they give birth.

The context of crisis cuts and massive underfunding in the NHS and its multi faceted privatisation deprives the maternity review of any credibility.

Under the banner of the Maternity Review the national NHS have set up Vanguards or pilot schemes to develop their plans. One of these Vanguard areas is Merseyside and Cheshire

If this seems to good to be true, it is too good to be true.

Whilst in other areas maternity units are closed against the wishes of local women, and while we need many more midwives, and junior obstetrician, this government conducts expensive experiments about which kind of midwifery unit is required.This is not in response to local requests but as part of a national plan.

Women in many parts of the country are fighting to save local maternity services. Save Liverpool Women’s Hospital Campaign went to Barnsley to help their protests at not being able to have babies in Barnsley. Personalisation does not go as far it seems as keeping maternity services local

Maternity Campaigns across the country are objecting to long journeys to give birth. A man from the NHS said it was ok to travel for 4 hours in labour.

We have significant lack of choice in real life.

There is also the spread of a for profit private midwifery contractor commissioned by the NHS in Merseyside and Cheshire.

Many services in the NHS have already been put out to private contractors.

Cheshire and Merseyside and Children’s Vanguard is doing some good, in that it is commissioning some additional mental health support for new mothers and we can see this at Liverpool Women’s Hospital

However some of what it is doing is of serious concern. Some background is required to make this clear.

Kinds of Places to give Birth

There are a number of places where women can give birth. These places are:

In an obstetric unit where there are specialist Doctors and where doctors are being trained and where research is being carried out. Midwives work here also.

More complex cases are dealt with in obstetrics units.These units operate as a resource and centre for other providers, when births which were expected to be straightforward become complicated.It is here that planned and emergency Cesarian sections take place, and where women can have epidural anaesthesia

One alternative is a midwife led unit alongside an obstetrics unit.This is staffed by midwives, not doctors, and is intended for women who are likely to have straightforward labour. If there are difficulties in labour mother’s can be transferred to the obstetrics unit.These units (and certainly the one at Liverpool Women’s Hospital) allow a more homely, less medical approach to childbirth.

Some areas of the country have a midwife led unit not attached to an obstetrics unit.These are called free-standing midwife led units.They have the advantages of an alongside Midwife led unit in that they are less medical, but are without the down the corridor access to the obstetrician.If there is a need to refer to an Obstetric team the woman would be transferred in an ambulance.In some parts of the country this is the main kind local provision.

Then there are home births using NHS midwives. For very low risk mother’s this is a great service. Again if things get complicated the women in labour can be transferred to the obstetrics unit by ambulance.

Another option is birth with a private independent midwife, where a qualified self-employed midwife works directly to the woman in pregnancy, in labour and after the birth and is paid by the mother not the NHS. Again if there are problems the woman is transferred to the hospital.

(We are not aware of any independent midwives working in our area but would love to talk to them if they are around.)

There is also a for profit company, contracted by the NHS, employing midwives not in the NHS to provide home births.The NHS pays for the service but it is not part of the NHS, it is a contractor.

If the woman in labour has difficulty the woman is transferred by ambulance to the obstetrics unit, but the private midwife has to hand over all care to the hospital.

A very few wealthy women use private maternity hospitals mainly in London.

Some of the poorest women without recognised residency rights in the UK but living and often working here have no right to free maternity care.How they cope varies from woman to woman but is rarely good for mum or baby.

So we have an array of services.

The Merseyside and Cheshire Women and Children’s Vanguard wants to set up an additional free-standing midwife lead unit in this area because they say women must have this additional choice.There is no free standing Midwife led unit in the area. So in their wisdom they are setting up a pop up centre, in a children’s centre in Seacombe. run out of Arrowe Park Hospital but not on the hospital site. Incredibly it has been described as somewhere which will not be staffed until the woman phones a midwife, says she is in labour and arranged to meet the midwife there.We think this is peculiar.

‘Pop up’ birthing centre offers new choice to pregnant women

A nationally pioneering ‘pop up’ birthing unit based in Wirral’s Seacombe Children’s Centre will provide enhanced choice to expecting mothers in the area. Containing facilities for women to give birth, the community unit will be open from March 2018 and offer women a safe alternative to hospital birth in a more family-friendly environment closer to home. Based at the local children’s centre, the unit will encourage women with a low risk of complications (something established clinically during discussions between a woman and her midwife) to give birth in a non-medicalised setting where wrap around services are also available to support families postnatally and beyond. As the first birthing centre nationally to launch in a multi-purpose community setting, the new facility will provide key insight into the cultural effectiveness and uptake of more community-focused birthing options. The facility will be run by experienced, highly skilled midwives from Wirral University Teaching Hospital NHS Foundation Trust (WUTH), and if successful, could inspire the development of permanent freestanding midwifery led units (FMLUs) across the Cheshire and Merseyside region. The Seacombe pop up is opening in response to NHS England’s Better Births Report (2016), which identifies that the 87% of women nationally will give birth in a hospital, but only 25% of women would choose that as their first choice. This is backed up by guidance provided by the National Institute for Health and Care Excellence (NICE), which states that freestanding midwifery units are “associated with a higher rate of spontaneous vaginal birth” compared with births in other settings. Catherine McClennan, Programme Director for the Improving Me Cheshire and Merseyside Women’s and Children’s Services Partnership (the NHS programme driving the initiative), said: “We have been working with local women and healthcare providers to explore new models of care that provide meaningful choice to families. Our pop up birthing unit based at Seacombe Children’s Centre is the first of its kind nationally, and has been driven by the voice of women. I’m delighted that we’ve been able to lead the way in offering people a more personalised pregnancy journey.” By supporting women to give birth in a community setting, the unit aims to offer a more relaxed and familiar ‘home from home’ experience. They are also more likely to be looked after by a midwife that has helped them throughout their pregnancy and remain in a private space (with their partner/family welcome to stay with them) throughout the duration of the birth. Debbie Edwards, Associate Director of Nursing /Head of Midwifery at Wirral University Teaching Hospital, said: “We welcome the opportunity to be involved with the roll out of the Birth Centre, which will make a big difference to the choice that women have regarding their place of birth. The unit will provide women and their families with an optimum birth environment.” Cllr Bernie Mooney, Wirral’s Cabinet Member for Children and Families, said: ‘‘I am really proud that Seacombe children’s centre will be home to the first community-based birthing unit nationally. The unit will provide women with a real choice about where they can give birth safely and comfortably and that is a huge step forward for families in Wirral.’’ Improving Me is a partnership of 27 NHS organisations across Cheshire and Merseyside aiming to improve the experiences of women and children. The Partnership is one of NHS England’s Vanguard New Care Model initiatives and an Early Adopter for the Better Births recommendations. ENDS Follow @WirralCouncil on Facebook & Twitter Contact us at: pressoffice@wirral.gov.uk or tel: 0151 691 8039/8089/8445

“The unit will provide women and their families with an optimum birth environment.”

What does this even mean? The women who might use such a service are the very very low risk mothers, those suitable for home births. So not first time mothers, not anyone with diabetes or epilepsy or is over weight. Is it safer than an obstetric unit? Safe than an alongside midwifery unit?

Is it home? with all the benefits of home birth?

No its an experiment funded as part of the process of deciding the cost the government will pay for maternity care.

Personal Budgets

Another peculiarity of the Vanguard is the idea of personal budgets.The review suggested a personal budget of £3000, somewhat less than the cost of a complex caesarean section and more than an uncomplicated vaginal delivery. The Personal budget concept only makes any sense if it is preparing for privatisation where mother’s would” buy’ different bits of care from different private providers. However women are not that daft.

There is another kind of privatisation, that which involves all of a city regions health and care services being put into an ACO and that ACO being put up for bids from global for profit corporations

To build the personal budget figure, women at Liverpool Women’s Hospital and other places are trialling choosing a menu of extras (that should not be extras) like extra breastfeeding support, or hypno-birthing classes.These costs are minor compared to delivering a comprehensive maternity service.

There is much to be concerned about.First of all maternity is a service not a production line which has each little action costed.

A comprehensive service is less expensive than a lengthy menu of choices, and should give room for choice.Money is wasted by having these market systems

The Obstetric unit needs to be there in the background to assist all the other options. It should not be costed just by the number of births it hosts. Other services are made safer by its existence. It could be a sign of success if these units were used less because women had had easier labours.That success, were it to be achieved, should not be a reason for cuts

Giving birth at home is supposed to be the cheap option but for home births to be safe there is a need for ambulance and Obstetrics back up services.

In couple of years time the maternity tariff ( how much maternity services are paid by government) is supposed to be reviewed. Supposedly, the menu of choices being offered to women trialling the personal maternity budgets will feed into these decisions.

We think these “additional services” should be standard.

Another thread in this tapestry of peculiarity is that of hubs.

In Liverpool maternity services through the Vanguard, the CCG, Healthy Liverpool and more, are planning maternity hubs not for labour but for ante natal and post natal services.

This is part of integrating health and social care services.Health visitors have already transferred to social services At present community midwives for pre and post natal care are linked to 29 GP practices

They are to move to hubs in certain areas, we are told to put them in pram pushing distance.Now how can 5 places be in pram pushing distance in a city? Is it not more likely that 29 GP surgeries would take less pram pushing?

Health Visitors are no longer employed by the NHS and are employed by the Council.

Once a service is provided by social services the patient has significantly less rights than they have as an NHS patient.Social services can be charged and the “client” does not have automatic rights to the service.

Women need to be telling their MPs now that the maternity tariff should be generous, not inadequate and destructive as it is now.

Sustainability and Transformation plans are being run out across England. Local population level medical and social care systems are being constructed.These systems are solar to US models. The system is put out to contract which can be bid for by some company or body, not necessarily the NHS. Health and Social care are being integrated, even across local government boundaries.The NHS is free at the point of need, paid for from taxation, and providing the best available treatment.

Social care is means tested and has no obligation to provide the best treatment or care.Staff do not have the same education training, obligations or working conditions or trade union recognition.

Health care is free at the point of need.Social care is not.

Providing population level care with a fixed budget must mean rationed medical care. This rationing of services has already started for example rationing fertility treatment, hearing aids, cataracts and more is underway in some areas.
Maternity is the most common reason to use the NHS.Costing maternity for accountancy purposes, and reducing that cost it is essential to the Accountable Care system.The courts have defacto stopped this move to ACOs untill it has been discussed in Parliament, thanks to a crowd funded legal case by campaigners

Integration of health with social care is essential to that system.

“National” matters. Huge benefits are found in our National system, benefits in research, professional education, in maintenance of standards, in regulating treatments and much more.

The right to access to the “best available treatment”is essential especially on giving birth, for mother and baby.This would be under threat in a city region population level care contract or ACOs.

Local Maternity Systems

The maternity review wants to deliver a local maternity system just like the accountable care systems. If anyone ever doubted that this was part of the national plan to regionalise the NHS, and break its national system, to cost it so as to be attractive to international bids then they should read this

“The learning from the process for Pioneers, to get to a position to be able to offer a PMCB, provides some key experience and lessons for other LMS, looking at the Better Births ambition for all women to have a personalised care plan in place for their whole maternity pathway. It has also flagged areas for wider development to support this transformation in the system. In response to this, we are developing a number of national tools that will be available for all LMS:

• A model service specification for maternity services
• A model qualification criteria, to support the procurement process
• A decision aid for women on the standard pathway, to support their place of birth decision, and accompanying professional guidance
• A checklist for quality information for women
• A minimum standard for clinical governance and safety protocols across an LMS
• Case studies on lessons learnt from Pioneers and wider developments.

We hope these tools will support LMS in their transformation plans and we are excited to work with LMS who want to drive forward the personalisation agenda, both through the bespoke support offers that are being developed, and through direct discussion on the tools and experience that we can share with systems as they develop their plans.

As maternity systems begin to deliver real personalisation of services, we are excited to share and learn from the excellent local initiatives already in place across the system. If you would like to know more about how we might support your LMS or share your experience or challenges with us, please get in touch: england.maternitypioneers@nhs.net

Women want, and say so daily, a fully funded National Health Service, local maternity care, including fully supported home births, local alongside Midwife lead units and safe Stand Alone midwife units.

We most definitely do not went wholesale privatisation, as we would see in an ACS or a privatisable local maternity system

A further blog post will go into this in more detail.