Speech for the Pop up Maternity Unit public meeting 28 03 18
Thank you for coming
Nearly three years ago I read of the threat of closure over Liverpool Women’s Hospital, I set up a Facebook page and an electronic petition which got and still gets thousands of signatures and page likes. For all or mothers, sisters, daughters, friends and lovers and the babies

So why are we worried? We totally endorse the right of women to choose the kind of setting where they will give birth. We also support their right to keep and improve existing services. It is crucial that such choices are based on safety of mother and baby. We also support the choice of hospital birth either in an obstetric lead unit or an alongside unit, the choice the overwhelming number of mothers make in 2018, and a choice which is denigrated in many reports.

There are four kinds of birth settings used in England; the hospital, an alongside maternity unit which is co-located at a hospital and a Free Standing maternity unit which is located some way away from a hospital. Then there is home births. They are all currently considered safe for low risk mothers having a second or subsequent baby, but access to an obstetric hospital in an emergency is crucial for all. A Pop up maternity unit is one that has been set up as an experiment, a pilot without the normal capital investment and planning. The pop up in Seacombe is in a room in a children’s centre that housed a Sure Start centre before the cuts.

We campaign in a tradition of women fighting for decent care at birth that goes back, here on Merseyside, to the early 20th century. The Women’s Cooperative Guild published a book called Maternity. Letters from Working Women
The petition and Facebook page started a journey in understanding and becoming truly angry about what was happening to the NHS, to women’s services and to maternity services. I have children and grandchildren so had seen the NHS in action, good and bad.
A short while later I had a phone call from junior paediatric doctors asking for help in their campaigns and found out about the shortage of such doctors, nurses and related professionals and lack of investment.
We were joined in our campaign by longer-term campaigners who had fought (and failed) to stop the 2013 Health and Social care act and the spread of PFI. They did though raise real awareness of the issues Across the UK tens of thousands of people are fighting to defend the NHS and their numbers are growing.
So why are so many NHS campaigns worried?
• Because the NHS is starved of funds and much of those funds are diverted to profit making contractors who make £871 million profits
• Because the national health service is being fundamentally changed though accountable care programmes now renamed integrated partnerships
• Because this regime has resulted in an appalling crisis this winter, but next year’s will be worse and it is not accidental. It is fully avoidable. We will have avoidable deaths next winter if policies continue as they are now.
• Because this crisis is being used to pave the way for privatisation
• Government policies have been linked to 120, OOO unnecessary deaths of deaths especially following cuts to health and social care in UK since 2010
https://fullfact.org/health/austerity-120000-unnecessary-deaths/
The additional deaths are not just in hospital. There were Ten Thousand additional deaths not caused by flu or any other measured indicator.
The hospitals are inadequate to cope with the population. The number of beds per head has been consistently reduced, to the lowest in comparable countries, deliberately and by policy. The number of doctors is inadequate, and that is the result of government training numbers. Are these NHS gurus now saying they got it wrong? Are they apologising? Are they resigning? Far from it. It is part of Conservative long-term plans
Before I turn to maternity and paediatrics let me look briefly at the worst hit service, mental health.
Mental health

has been starved of resources. You may have heard of the 2 million pound damages awarded to parents whose adult children had died from neglect in mental hospitals but now the situation is worse.
“Mental health trusts left with less funding than 2012 due to government cuts, new analysis reveals
Income for mental health trusts £105m lower in 2016-17 than five years earlier in real terms”
Many in patients are now sent to private providers one of whom boasted how they did well out of NHS shortages
“Cuts to mental health services have led to a situation where there is enormous demand, with little capacity to meet the need. In the five years up to 2016, mental health trusts in England had £600 million (US$751 million) slashed from their budgets. Meanwhile the number of people seeking mental health community help has jumped by almost 500,000 a year, to 1.7 million, since 2010”.
Therefore, we have every reason, when we consider maternity, to be worried.
Maternity is the most common reason to use the NHS. The current administration want to see that change and for more mothers to give birth at home. Since the introduction of the NHS, giving birth has become much safer. Maternal Deaths dropped from 500 per 100,000 births to less than one in 7,000
Nine out of 10 mothers give birth in Hospitals and for many that is their choice but it is a choice the current admins of the NHS want to change
Costs by planned location of birth
Home – £1,066
Freestanding midwifery unit – £1,435
Alongside midwifery unit – £1,461
Obstetric units – £1,631
They are also preparing for personal budgets for maternity, which could adapt to patients buying care from private contractors or the US model of population based funding.
Funding good care in pregnancy, at birth and in the first two years of life is an investment well worthwhile and one that pays off in economic as well as health and happiness. Investment in good maternity care makes the whole country better off.
– Published factors that raise the risk of maternal death include:
• Being over 35
• Obesity
• High blood pressure or heart disease
• Anaemia
• Foetal abnormalities
We add to this list the great risk of poverty. The still birth rate doubles for poor mums and we live in a poor area. This pop up is in a poor area, it is in the bottom 2% of areas for wealth in the country
https://www.npeu.ox.ac.uk/birthplace

We have followed the maternity Review, the Merseyside, Cheshire Women, and Children’s Vanguard
We know the following
They want to reduce the number of hospital births
The NHS is short of midwives, midwives are over worked. Staff stress has become a risk factor Maternity units had to close their doors to women on 382 occasions last year.
The maternity tariff is inadequate
An NHS spokesperson said it was ok to travel for four hours in labour.
There is a push to close maternity facilities“ to regionalise obstetric care because of the shortage of obstetricians, from 147 to as few as 118,
The NHS focus of “choice” not safety in their publications though good work on safety goes on through MBRACE
The Maternity Review favours including private providers. It also favours giving women a choice of four versions of place of births but not which city they give birth in if the NHS decides to close a maternity facility
We have a private contractor working here in the Wirral, and there are concerns from CQC reports. But according to the internet, it runs a clinic, Bidston and St James children’s Centre in Birkenhead already. So we were especially concerned when we heard that the local CCG were intending to set up an accountable care system using this private company
The purpose of a company is to make a profit. The purpose of the NHS is to provide health care
NHS spending on care provided by private companies has jumped by £700m to £3.1bn with non-NHS firms winning almost 70 per cent of tendered contracts in England last year.
Private care providers were awarded 267 out of a total of 386 contracts made available in 2016-17, including the seven highest value opportunities, worth £2.4bn.
Richard Branson’s Virgin Care scooped a record £1bn worth of contracts last year, meaning the company now has over 400 separate NHS contracts, making it the dominant private provider in the NHS market
https://www.independent.co.uk/news/health/nhs-privatisation-contracts-virgin-care-richard-branson-jeremy-hunt-a8134386.html

On Wednesday 7th March 2018 we raised our concerns about the pop up maternity unit and plans to create an accountable care maternity model using One to One midwives, a private company, with Catherine McClellann and Simon Banks of Wirral CCG
We asked about the section from the minutes of the CCG

“The implementation of the National maternity services review is on track and continues to progress with putting into place the recommendations of the report. Wirral is in the process of piloting an Accountable Care Maternity model with the acute provider subcontracting to ONE to One Midwives to deliver the full range of services included in the Better Births report. The Improving Me team (Vanguard site) has chosen Wirral to also pilot a “pop up” midwifery led unit within the community”

Mr Banks at first denied this had been said but we were able to show him the document.
He said that accountable care is parked/stalled because of the legal challenges
He said that the pop up would be run by Wirral University Hospital Trust (Arrowe Park)
It would not be a run by the company One To One Midwives
The midwives will be using a “case load model”. These are not extra midwives. It is a “redesign” of the Community Midwife team providing “continuity of care”. We think caseload model this is difficult in a situation where there is a shortage of midwives. It will remain an aspiration until resources are provided, and training midwives can take years
The pop up will he said be covered by the Clinical negligence scheme for trusts
Mr Banks reported on improvement in stillbirth figures (These figures really do need to improve)
Mr Banks said there were arrangements for rapid transfer as used for home births. We asked about Ambulance response times, which we have seen as problematic. He did not see this as a problem.
We asked about lone working for the midwives. Mr Banks said there would be other staff there during the day. The team will do antenatal and post-natal care from the Seacombe centre.
There is only space for one mother at a time in the pop up unit
It will be accessible 24/7, open 12 hours a day
There will be a loop system to divert cases to the hospital if the midwife is not available at the pop up or it is already in use.
We asked what would happen when the mother goes into labour. The mother will phone the midwife. The midwife will go down to the pop up (this has since been changed to the midwife will go to the home initially and see if transfer to the birth centre will be feasible)
We asked about the central phone information system mentioned in the vanguard video
https://www.youtube.com/watch?v=-5Yj_jxDByI
(See about one minute 22 seconds in) We were told the single point of access booking in system would not function at present. We are concerned that this system could direct women to options that they would otherwise not consider. Choice of birth setting is highly influenced by initial advice.
We asked to see the consultation they had undertaken, they said they would forward it.
We asked about personalised budgets, which are a feature of the Maternity Review? Catherine Mc Clellan replied that they do not want midwives involved in such calculations, in costing each intervention and procedure.

We asked about the One to One company. We were informed the company were under High surveillance ((or something similar), they can provide ante natal and post-natal care.
He said they have to work to national agendas
Mr Banks suggested we looked at this
We had seen this previously and consider it to be methodologically questionable and without a solid evidence base.
We asked where the capital money had come from for this pop up unit. He said none had been spent apart from a small grant for decorating. The council had provided the building, equipment was from the hospital. If there was a call for this kind of a service then perhaps, the NHS might do some capital investment but the NHS had no capital to invest, (this was his meaning if not his exact words)

We asked could the pop up do instrumental delivery or ventouse? The answer was no.
We asked could they do pain relief or epidurals? The answer was no.
We then visited the children’s centre and met the midwives, who are lovely, as expected.
We do not think that the size of the team is realistic for the service advertised, even with all the good will in the world is applied by the midwives. Sleep, self and family care, holidays and sickness mean this is a very small team to provide 24-hour cover.
So what is the situation This expresses some major concerns.

We do support women’s choice in child birth but it needs to be a well informed personal choice not one pushed by appalling policies as listed above.

We will continue to monitor the situation locally and nationally.

Why no extra staff for an extra service?

We will continue to question the situation
We suggest those who want to know more nationally read this also