In this article, we are looking at care in pregnancy, delivery and post-natal care. The occasion for this article is the closure of One to One Midwives, a private, for profit company, contracted by the NHS.
Giving birth is a momentous occasion and one where the mother must feel she has good safe care, that she will be treated as a fully functioning adult, and that her wishes really do matter. It is within living memory that this was not available to working class mothers, and the outcome of this lack of adequate care was that giving birth was more dangerous than working in a coalmine.
We fundamentally oppose the for profit, private provider model of healthcare as bad for babies, bad for mothers, bad for staff, and bad for the taxpayer. The private provider model of care is not the same as the private health care model where the patient pays for each treatment (though that too is coming our way).
NHS has provided fully funded home births with excellent hospital back up close by , as well as hospital and midwife lead units, with experienced midwives with full access to latest training and research . Homebirth is a superb idea for some mothers. It is not universally available but only a tiny proportion of mothers (2.1% in 2016) do chose this mode of giving birth. More women might consider it if the service was more widespread. However, that is not what One to One was about; it was about the private provider model.
It must be truly upsetting to be told that the midwife service you were using has suddenly closed. Many of the women involved had no conception that this was even a private company. They had been referred by their GP. The shock must have been serious. Equally, the midwives must have thought that they had some job security. A planned closure would have been better for all. Certainly, in Liverpool Women’s Hospital, plans have been in place for this eventuality for some time, so someone must have known what was happening. Wirral has plans in place As we write this, we do not know if other maternity hospitals had similar plans for this eventuality.
After this closure some of the one to one midwives are setting up as “independent midwives” some offering services for free to ex-One to One customers nearly at the point of delivery. Users need to be certain that insurance is in place This could become another company bidding for NHS contracts. Let’s hope not.
There is a cohort of individual independent midwives who practice outside of the NHS, specialising in home delivery, where the family meets the whole cost. This is not the same as the for profit companies taking NHS money, and operating within the NHS budget.
How did it come about that a private company had this vital role, and what happened?
The maternity service is a bedrock of the NHS The whole NHS has been deprived of funds in the utterly spurious name of Austerity.
Britain has a significant shortage of midwives. This shortage has several causes. Ending the bursary has prevented older women with family responsibilities from training. The workload and lack of resources, stress levels, lack of respect and democracy at work, and poor pay have all added to this. Brexit has severely reduced the number of EU midwives coming to work in the NHS There is more detail on this here.
Some midwives saw the opportunity to work in what they thought would be a better atmosphere using the famed “Continuity” model and took jobs in the private provider.
The NHS has been offered out to private providers who take profit without responsibility. Currently, if you have an operation in a private hospital and there is a crisis you are blue lighted to the nearest NHS acute hospital. It is not a separate and discreet service.
Funding for maternity is inadequate. The maternity tariff makes it virtually impossible for standalone maternity hospitals and units to manage financially, and most services in acute hospitals are subsidised by the main hospital budget. Many of these trusts are in deficit. They do not overspend; they are underfunded.
It is hardly surprising that a service that can scarcely fund the much more economical and efficient public provider model cannot also provide enough money for a private provider, who wishes to make profit on top of meeting the services costs.
Continuity model of care is supported by most of the theorists of childbirth, but there are not enough midwives to deliver it. It would require huge recruitment of midwives, which would take at least 5 years to come to fruition, to see this in place, and significantly more money injected into the service. We campaign vigorously for more staff, less workplace stress, more money, and more maternal choice. We somehow doubt that is the intention of the privateers running the NHS top management right now.
Continuity of care requires that the same midwife see the mother from the first meeting to post-natal care. Midwives though, need to sleep, take holidays, go on sick leave, and have professional training, so they cannot be available 24 hours a day, even if they had only one client. When they have more than one client, this becomes virtually unworkable. So a team of midwives is used, the mother will see midwives from the same team, and one or two of the team know her really well. Even this model is stressful for the midwives. If there is downtime and it is a quiet time on the team, the continuity midwives (operating in the NHS) may be diverted to other life-saving work, leaving them unavailable to the women they are primarily looking after.
The professional community of midwives and obstetricians. All NHS care statistics are supposed to be collected and critically examined to produce a clear picture of the best procedures and the procedures to avoid. At a personal level, a midwife working with colleagues having time to discuss and support each other also helps deliver safer services. The opportunity for NHS staff to engage in professional education and training is also crucial. The body of knowledge created by more than 70 years of NHS professional development is one of the golden nuggets the privatisers are coveting. Private providers cannot match this.
We oppose the privatised health care model
Better Births by Conservative Baroness Cumberledge, (which we have analyzed elsewhere on this blog, and which is demolished here) told a cosy unreal story of how good maternity care should be, with more homebirths and with the continuity model of care. It neglected to do anything to stop the utterly damaging deprivation of funds or the staffing crisis.
Using this model One to One bid for contracts to provide maternity care for the NHS. Most mothers were not aware it was a private contractor. The company popped up in many areas. At least one CQC report was appalling.
Previously “Ninja” privatisers were supported by the people reshaping our NHS in the model of the USA, as this article from 2015 shows. The One to One model is now out of date as a form of private for-profit intervention into the NHS. Once it was the darling of the privateers. It even had its name on an office the Seacombe Maternity base. However the 2019 model is that the commissioning model be restructured so that the major US and global health corporations can insert themselves into the NHS, not as small companies, but at regional STP or ICP level, controlling the whole shebang . The smaller privateers are no longer favoured.
The USA, on whose model the NHS is being restructured, has poor maternity outcomes. This article shows how both the US and UK need to improve their maternity care and the health of women, to reduce the deaths of mothers and babies
Nothing is more important than good maternity care. Maternity is the largest single reason for people to use NHS hospitals. Maternity Care provides care at the start of life and the onset of motherhood. Save Liverpool Women’s Hospital are committed campaigners for good health care for all. We are proud to be part of a large group of NHS defenders across the country. The focus of our campaign is care for women and babies. Women suffer years of unnecessary ill health because of life in Austerity Britain and poor health care. Internationally and nationally, medical research focusses on men.
The returns for Liverpool Women’s hospital show that the experience of very many of the women giving birth at Liverpool Women’s hospital, or with their home birth team, is positive. Our campaign is adamant about the need to keep the hospital on site, keep it focussed on women and babies and keep the hospital and maternity care in the NHS publicly funded and publicly provided.
Liverpool Women’s Hospital is the largest hospital in Europe exclusively caring for the health needs of women.
In 2017/18 the Trust:
• Delivered 8,497 babies (2016/17 8,891) – an average of 23 babies were born at Liverpool Women’s every day (2016/17, 24);
• Undertook gynaecological procedures on 5,469 women (2016/17, 5,551);
• Cared for 1,004 babies in the neonatal intensive and high dependency care units (2016/17, 1,038); and
• Performed 1,381 cycles of in vitro fertilisation (IVF) (2016/17, 1,413).
Further Evidence of the need for improved provision for maternity services is available at Tommy’s charity