These are the key points made about the future of the Liverpool Women’s Hospital, as set out in the One-Liverpool-Operational-Plan, published by Liverpool Clinical Commissioning Group in May 2018.

In the document, these points are set out as a table. We have extracted and answered each point in text form.

Introduction to their document

The reconfiguration of women’s and neonatal services currently delivered by LWH at the Crown street site to address issues with clinical standards and service co-dependencies  This phase of the project is to conduct a public consultation on proposals and to develop and gain approval for  Decision making business case.”

This sentence omits the word “maternity” yet this crucial to the role of the Liverpool Women’s Hospital. Let us hope that maternity is included in the overall term of “women’s services”

20151204_094642

Each of the points in the document from the CCG refers to the idea that the Crown Street site should close and another building be put on the Royal Liverpool Site. (The number of beds involved is not mentioned, nor are the plans to persuade mothers to give birth at home).

The plans are brought to you by the CCG team that brought you

So please do not approach these plans thinking they are just to do with wanting a better hospital. The individuals may or may not be charming, but the CCG system does not work. (If you want to read an outline of what commissioning is try this. It is quite pro commissioning but it gives a good picture of the system)

 Section one of the CCG document. (Numbering is ours.)

The safety of women’s and neonatal services provided by the Trust will be improved, via:

  1. Services which meet national and local clinical guidelines.

There is no issue here. Liverpool Women’s hospital is safe now. Guidelines cannot be met in every hospital and are not met in every hospital because they are guidelines, not absolute rules. The ideal situation according to NHS guidelines would be to have Alder Hey, the Women’s and an acute hospital on 1 site. That is not going to happen.

In addition, we in our campaign call for a greater focus on many more aspects of Women’s health care and women’s and babies’ safety than these guidelines discuss. For instance, having a separate Women’s hospital is, we think, safer for women who face domestic violence as pregnancy can make women vulnerable.

“Does it happen in pregnancy?

Sadly, pregnancy can be a trigger for domestic abuse. This is because men who abuse women do it when they see an opportunity and when the woman is vulnerable. For some, pregnancy is the perfect time because they think their partner is powerless to escape now that they’re expecting a baby.

Tragically, domestic violence during pregnancy sometimes puts both the mum-to-be and her baby’s life at risk. Here are some of the facts:

  1. Almost a third of domestic violence cases start during pregnancy.
  2. Women who are already in abusive relationships often report that abuse gets worse when they are pregnant.
  3. Pregnant women who are abused are more likely to experience serious pregnancy complications, such as miscarriage, high blood pressure and premature birth. They are also more likely to suffer emotional and mental health problems, such as depression.
  4. Pregnant women who experience domestic violence are also more likely to have a baby who is stillborn. Blows to the tummy, pregnancy complications and irregular attendance at antenatal check-ups all increase the risk.
  5. Sometimes, domestic violence spirals out of control. Between 2006 and 2008, domestic abuse was reported in 12 per cent of maternal deaths. https://www.babycentre.co.uk/a563127/domestic-violence”.

 

Anyone who has been in the Royal A + E at night, and in the Liverpool Women’s at night, knows which one feels safer, in which one a violent man would feel more familiar, more competent.

 

Liverpool Women’s Hospital provides a range of services as well as maternity, each of which is important and the whole package is stronger by being delivered together.

  1. Reduction in clinical risk

One of the issues raised by the advocates of the closure of the Crown Street site, centres on  needing colorectal surgeons to be available in complications arising in some gynaecological operations. Various ways have been tried to overcome this.

Cooperation between and across specialisms in the NHS Hospital system has become more difficult since the introduction of the internal market. Each hospital has to pay another hospital, and has to charge other hospitals, if they share facilities or staff. This wasteful system will still operate after the proposed move. We need some joint appointments to both hospitals. We need some staff to work across both hospitals. It is not rocket science, it is just blocked by the internal market (Please see our ‘No Clinical Case’ response document) and shortage of doctors nationally.

  1. Reduction in number of transfers

Eighteen women per year are transferred, according to the figures published by the Liverpool Women’s hospital. This is a low number of transfers for a major hospital. Transfer to other specialist hospitals is s routine procedure in the NHS. The Royal transfers patients to Broadgreen and Walton regularly. That is how the system of Specialist, rather than the old “General” hospital is supposed to work.

Many more women are transferred in to the Women’s, than are transferred out.

  1. Reduction in over-occupancy in the neonatal unit

Major work on this is long overdue. It is now underway. It is a disgrace it has been left for so long. Moving to the Royal Site with its appalling air quality is not good for babies.

  1. Improved staff satisfaction regarding the delivery of services;

Staff satisfaction at LWH is poor anyhow on published figures. People want to work there, but dislike the way management behave with them. This needs sorting out, but not by moving the whole hospital.

  1. Improved clinical outcomes for patients.

There is no evidence provided, that this would happen, where is it? If we thought this would be the outcome, if we would not be opposing the CCG’s plans – nothing we see in the CCG’s case even seriously suggests this as an outcome. The huge risk to babies from air pollution is not even referred to

  1. Reduction in staffing and transport costs relating to patient transfers

Really? Transferring 18 people per year merits building a whole new hospital? Birmingham women’s hospital transfer their patients, we are told, by ambulance to the acute hospital on the same campus because transferring by ambulance is safer than pushing a patient a long way through corridors and bridges.

  1. Reduction in backlog maintenance risks.

In the NHS in 2018, with cancelled operations, PFI scandals, outsourcing scandals, staff overworked on poor wages, this proposal suggests spending about £150 million to reduce backlog maintenance problems? It is like saying we have to move house, to a massive new house, with a huge mortgage; because in this one the garden needs tidying and we need new windows! Perhaps a few working class women should show them how to budget.

 Section two of the CCG document.

The quality of women’s and neonatal services provided by the Trust will be improved, via:

  1. Increased patient satisfaction

Patient satisfaction is already high. The hospital is far from perfect but patients value it very highly in NHS surveys and in responses to our campaign and on our petition. Patient satisfaction is already excellent, one of the best in the whole of the NHS. Moving the hospital will not help this.

  1. Increased staff satisfaction

Liverpool Women’s Hospital fortunately is a popular place to work. It does not have a problem recruiting staff. However, we need to retain staff, and make LWH a less stressful place to work. More midwives and a more collegial management style would do more for this, more quickly, and more measurably, than spending over £100 million on an unnecessary move.

The following table from the annual staff survey required by NHS indicates a problem with staff confidence to report at the LWH;staff survey 2

The Liverpool Women’s Hospital needs to improve the level trust between the staff and the management, so staff feel free to report concerns and whistle blowers feel safe. There is a dark history here. There were concerns raised nearly a decade ago about a surgeon employed and managed by the LWH, but operating at Aintree.  Cases arising are now costing the Hospital considerable extra premiums for insurance. Many women went through hell.

Work has been done by LWH to improve staff confidence in being supported if they raise concerns, but it remains quite low in published figures above.

  1. A reduction in regulatory oversight and intervention

It is unclear how this would be so, what does this mean?

  1. Improvements in the CQC rating at the Trust

The latest CQC report is good.

In the past the main CQC criticisms in 2014 were about in sufficient midwives,

However, inspectors also found that the Trust was failing to meet national standards relating to staffing levels, complaints management and assessing and monitoring the quality of service provision. Inspectors were concerned that staff shortages were impacting on the Trust’s ability to ensure that patients’ needs were fully met. This was particularly evident within maternity services where some women were not able to have their preferred choice of pain relief (epidural) during labour, and others experienced delays in induction of labour due to shortages of midwives. A review of records relating to complaints found that only 64 per cent of complaints had been responded to with the timescales set by the Trust. In addition, there was limited information available for patients offering guidance on how to complain. While inspectors saw that systems for monitoring service quality were in place, they found that these systems were not sufficiently robust to ensure all risks were identified and managed effectively. Nor did these systems serve to find themes, trends and areas for improvement. As a result of the inspection, CQC has issued two formal warnings to the Trust, requiring improvements in the assessment and monitoring of the quality of service provision and staffing. The Trust has also been told that action is required to address shortfalls in complaints management”.

In 2007 a surgeon was reported for causing significant harm to patients. There may have been more recent issues but we have not seen them reported to the board, nor have they been reported by the CQC. Again, it is hard to see how a move would help this. To our knowledge, there are no other major issues.

diagnostics

  1. Improved diagnostic capabilities

There are issues around some diagnostic facilities. However, some of these diagnostic facilities are already shared with the Royal Liverpool and other hospitals. They still cause problems. Some imaging facilities do need to be developed ay Liverpool Women’s Hospital. They will need to be bought whether or not the hospital moves.

Blood and cancer testing are already shared and still cause problems. These need to be improved for all Liverpool Hospitals.

  1. Improved ward facilities which meet national standards

We know of problems in the space available in the neo-natal area. That has now been granted major investment. There is plenty of space on the Crown Street site to add wards.

  1. Increased parental accommodation

Parental accommodation is required, but it would be far easier to build or develop it on the spacious Crown Street site than what will be a very cramped Royal site. The Crown street site is a far more relaxing and reassuring place to be than a high-rise block, or anywhere on Prescott Street.

  1. Optimised patient flows

The term ‘patient flow’ refers to the ability of healthcare systems to manage patients

effectively and with minimal delays as they move through stages of care”

We could find only one reference to maternity in this document, and this was to exclude maternity from one of its procedures. We think some mothers would prefer to stay longer in the hospital to get to know their baby in a quiet safe place. It is our link , not in the document

It is hard to see how patient flow this will be improved by the very expensive move, but we will be interested to hear what the advocates of the move say.

Section three of the CCG document.

NHS workforce

(Picture from BBC)

The financial sustainability of the Trust will be improved, via:

  1. Rationalisation of optimisation of corporate workforce

How are lay people (anyone?) expected to know what this means? It is not even English. Cutting back office staff?

There are core issues on the finance at Liverpool Women’s Hospital,

  1. The maternity tariff – the sum of money paid out by the government for maternity care nationally – is inadequate. It does not pay out enough to employ sufficient midwives to provide the kind of service women want, and babies need.
  2. The specialist care LWH provides is not subsidised by Liverpool CCG, as we believe Birmingham CCG subsidies Birmingham Women’s hospital, to support their specialist complex cases.
  3. The insurance premium, which arises from historic negligence cases in Gynaecology, is a financial burden
  4. What LWH does not have at present, is a costly mortgage, but the CCG and the management of LWH seem anxious to acquire one for some reason. A PFI new build would involve a charge, which would, in law, be the first call on hospital funding. PFI funding is causing major problems for hospitals. Liverpool Women’s Hospital will get no extra money after a move but will have to pay its existing bills, plus the PFI mortgage.

high court

(Picture from The independent)

2. Avoidance of an increase in CNST premiums required to be paid by the Trust

(NOTE: CNST is the Clinical Negligence Scheme for Trusts; our note).

An National Childbirth Trust report explains “A significant cost for the health service is payments for clinical negligence claims. At the RCM Legal Birth conference in July this year, John Mead, the NHS Litigation Authority’s technical claims director, reported that the number of obstetric cases receiving a compensation pay-out represents 20.58% of all claims. Much more startling is the fact that these represent 60.9% of the value of all compensation awards.NCT

It is hard to see how moving would affect this, unless they intend to merge with the Royal, Broadgreen and Aintree Trusts and share the risk. The huge claim against the Liverpool Women’s Hospital , though, came not from the maternity side, but from Gynaecology.

Our campaign wants to see the end of this insurance system, which has been remodelled to share insurance companies’ model. It is not good for parents when they are claiming. It is a field day for ambulance chasers. We think perhaps a New Zealand model of insurance would be better, coupled with fair but stringent professional standards and discipline. The current system makes it very difficult for a hospital to recover from a major case and recover they must for all the patients’ sake ( picture from The Independent)

  1. More efficient use of space within the hospital

We cannot see how anyone can compare an existing building with one that is not yet even designed. The significant problems the new Royal is having are lesson enough, that a new hospital is an unknown quantity.

Doubtless, more will be published as the consultation gets underway this autumn.

 Summary of our response

There are two streams of money into the NHS. Money for running day-to-day services and money for buildings Currently the government uses a very expensive system to “borrow”  for buildings and major works referred to as Capital spending. The governemtn does not need to borrow. It could finance the build directly if it chose to do so but the PFI system makes huge profits for big corporations. It must go.

The government, and the privateers who guzzle on NHS funds, are considering removing CCGs and Hospital Trust status. This could cause  further issues for this move. The government and the privateers hope they can facilitate the next steps towards accountable care organisations, which are even easier to milk for  money for the private sector, and even harder to use for the delivery of effective, efficient, universal health care. Meanwhile across the country people are fighting for their hospitals and for the NHS.

We want the original NHS model

  • Universal health care free at the point of need,
  • Paid for by taxation,
  • Not for profit,
  • To the best available standard of care,
  • Publicly provided.
  • A national service to share all the risks.

Please come and join the campaign for a fully funded Liverpool Women’s hospital, a fully funded NHS, with staff paid well and with a decent workload, and an end to the internal market and an end to privatisation.

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