The NHS comes from the People and belongs to the People

A year ago Save Liverpool Women’s Hospital Campaign held our second demonstration. We campaign for our mothers, daughters, sisters, friends and lovers and for each and every baby. We campaign for a fully funded NHS, for improved healthcare for women and babies and for the hospital to remain open and on its existing garden site.

The response the demonstration was given as we walked through town was fantastic. “What are they marching for ?” “Its the Womens” “Good on you” ” Lets join in” They cheered they clapped and they joined in. We thank each and every person who came and marched with us. The mood was wonderful. We marched from the hospital to the Albert Dock where Labour’s Conference was assembling. Many speakers, local and national greeted the demonstration, including Emily Thornberry MP, and Jonathon Ashworth MP, Labour’s spokesperson on Health. Our campaign tries to avoid direct party politics, having supporters from many parties. Never the less, 81.9 percent of those people who voted in Liverpool, voted Labour. It was very important for the campaign, therefore, to win the support of the conference, which we did.

We had collected many tens of thousands of signatures to Save Liverpool Women’s Hospital. We had held meetings, stalls and spoke at many places across the area. We produced leaflets, produced a “No clinical case” document with supportive clinicians and produced this blog to make our case.

The work done by the staff of Liverpool Women’s Hospital is outstanding. All of our camapigns are to support and improve the work of the hospital.

The management of the Liverpool Women’s Hospital attempted to intervene to thwart success of the demonstration. They paid a great deal of money for a page in the Metro, and had a media blitz to try to damage our demonstration. They failed, but nevertheless boasted in their report to the Board that our demonstration had been smaller because of their intervention. Quite how they justify spending money in this way is difficult to understand. It was most certainly the overstepping of a previously respected mark . Intervention by a hospital trust in community and political campaigns around health care is questionable.

Our campaign is one of many such campaigns to defend hospitals and NHS services across the country. Some campaigns, like Lewisham, have succeeded in keeping their hospital. Lewisham still campaign because until the NHS is safe, no hospital is safe. Damaging changes have been introduced first by the Labour government with PFI, then the Coalition Government, with the 2012 act and the crucifying cuts in funding levels and then by the Conservatives with structural changes to faciliate system level private for profit involvement of big corporations, all have have caused immense damage.

The success of our demonstration was just the start of the next stage of our campaign. We have just ended another summer of campaigning where we spoke with thousands of people whose support is overwhelming.

There are several different aspects to health systems, the medical side, public health, health economics and the politics of health. The politics of health includes the representatives of the communities served by the health service, representatives of interest groups like the interests of women, disabled people, poor people, people of colour and the representatives of the workforce. There are charities and campaign groups, as well as elected party politicians. Each facet is important and in a democratic society each of these aspects or components respects the others. Sadly the current NHS management at national level seems to respect only the one, the cost cutting, privatising, bed cutting, staff shortage creating Government and Simon Stephens, their close friend.

Liverpool is a city of struggle, but still a city with significant poverty, real problems of women giving birth before term, and increase in child deaths

We have to fight otherwise women’s health care, the care of our babies at birth and all we have gained in the nhs is at risk

Women have had to fight monumental struggles to gain safety for their babies and respect in the process of child birth. These gains were not donated simply by doctors. There are doctors too in countries that do not have these benefits. It was common two generations ago for women to lose many children at birth or in infancy. That has improved, but is again worsening as poverty spreads. The office for national statistics reports that:

  • The infant mortality rate decreased from 12.0 deaths per 1,000 live births in 1980 to a record low of 3.6 deaths per 1,000 live births in 2014; since then it has increased to 3.9 deaths per 1,000 live births in 2017.
  • The infant mortality rate was highest in the most deprived areas of England at 5.2 deaths per 1,000 live births and lowest in the least deprived areas at 2.7 deaths per 1,000 live births; rates in both areas have decreased compared with 2008 but the rate in the most deprived areas has decreased more, by 23.5%.
  • The infant mortality rate was highest among low birth weight babies (under 2,500 grams) at 34.7 deaths per 1,000 live births in 2017, an increase of 5.8% from 2016.
  • Britain does not have good infant mortality for an advanced economy

Fifty years ago, women giving birth were bossed around, routinely shaved, like it or not, given enemas, episiotomies, not allowed a partner with them at the birth, given little say over the birth process, had the baby taken away and sent to a dormitory, and had to fight to be allowed to breast feed. Organisations like the National Childbirth Trust founded in 1956 fought for women’s voices in childbirth. Leading clinicians, like Wendy Savage joined the fight. She opposed the medicalisation of childbirth and the over use of cesareans even when mothers did not want them. It was not an easy fight for mothers, or the clinicians who supported them.

By the time Liverpool Women’s Hospital was founded it seemed to be that some of the battles for women’s choices had been won. Women were encouraged to have birth plans, partners were welcome – even expected – at the birth, babies were kept with mothers, cesareans were given only when medically required or when mothers requested, abortion was legal and safely provided, help was available for those who needed assisted conception and specialist support available for difficult pregnancies. The hospital was clearly for women and a culture of care and respect seemed apparent to all who came to the hospital. Not one of those issues were won without a fight, without campaigns from groups like ours. It is especially sad that this hospital is now under threat.The hospital will put its latest scheme to consultation soon they say. We say improve the hospital on site, keep it as a women’s hospital and invest in the care of women and babies,

Paul made public his support for our campaign in the run up to the demonstration in 2018

The United Nations reports on how important women’s health care is to human rights and some great progress has been made over the years, but in country after country the rise of the political right has put women’s right to healthcare at risk again. “Approximately 25% of the world’s population lives in countries with highly restrictive abortion laws, mostly in Latin America, Africa and Asia”. But in the USA there is a growing threat to women’s health care, to abortion rights and the health of the babies.

We live in an era where inadequate attention is given to female healthcare, even in the richest countries. Women can still expect many years of ill health (however well they look after themselves) many well known conditions like really bad period pain and endometriosis are not well treated.

The NHS and the women and men who work in it have withstood the storm of cuts and crazy policies, such as inadequate funding, cutting beds, outsourcing , private companies getting contracts they don’t fulfill, inadequate numbers of staff being trained, and staff salaries being restricted. The staff have been the bulwark that has preserved out NHS against the odds. The staff of the NHS have mightily confounded those who wanted to see the system fully privatised by now, by working so hard they have kept the ship afloat, damaged though it is. Overworked staff eventually leave, either through ill health or from frustration. The lie about Austerity was applied to the wages in the NHS, so standards of living have fallen, whilst big business have taken big profits from the NHS.

The structure of the NHS is opaque. Decision making does not rest with the Doctors Nurses Midwives and other professions. It rests with the Government and the NHS structures such as the Trusts, the CCGs, and the regional and national structures. Within these structures the use of languge has become a dark art of obfuscation, where choice means private providers, and clinical case means the needs of the privatisers. However in each area there are administrators set on implementing the crazy policies. Just look at the situation with beds and with staff shortages. Everyone is appalled with the situation with the hospital bed admin telling clinicians there are no more beds available so operations must be cancelled, and emergencies must stay on trolleys. The frightening situationhas arisen this year that in the North West hospitals are already using their emergency beds in September. These policies have bee n implemented under the NHS policies.

Lets shout out though for those who do the truly necessary NHS administration.

Of course doctors and Nurses are part of the political campaigning aspect of health economics. Our camapign is supported by some of the very best. Dr Jacky Davis, fellow founder member of KONP, said of Professor Wendy Savage when she was awarded the ‘Outstanding Contribution to health and healthcare in the UK’ at a ceremony held by the British Medical Journal on 10th of May 2019;

[Wendy] has achieved what she has by challenging the medical establishment. She will speak truth to power. To me she is heroic. She stood alone in the face of criticism where other people would have crumbled.

The junior doctors fought hard against the government imposed contracts many doctors have put their careers and personal money on the line to oppose whats going on in the NHS.

The NHS began with people like us campaigning for good quality health care free at the point of need, funded by the government, for all the people, providing the best available treatment. Some local communities like Neston and Tredegar, where Anuerin Bevan came from, had already set up local societies that paid for health care for anyone who joined their organisations. In war time Government had taken over health care. However it was our grandmothers and great grandmothers, especially in the Women’s Cooperative Guild, who campaigned for health care and baby clinics locally and especially fought for safe maternity.

The Women’s Coperative Guild banner in the Museum of Liverpool Life

To illustrate just how the politics of health care makes a difference to the kind of healthcare provided we can look at Bismark in Germany. As Germany industrialised, Bismark introduced health care through Insurance, jointly paid for by the workers and their employers. This was because healthcare pays for itself in increased productivity, keeps more of the workforce at work, and prevents the spread of infectious diseases, especially in heavily industrialised towns. At the same time in the UK it was mainly charities and people paying directly, where they could pay, for treatment. This, plus the poor food, and dreadful housing available to the poor, was one of the reasons why in 1914 so few British men volunteering for war service were healthy enough. Between 40 and 60 percent of those willing to enlist were rejected as unfit.

The founding of the NHS by the 1945 Labour government established a national health service providing universal care, with the best available treatment for everyone, paid for from Government funds. The vast bulk of these services were provided by the NHS itself, not private, for profit companies, though the pharmaceutical industry remained in private hands. The NHS model is immensely efficient and effective, the best in the world

Should we just leave it to the doctors and midwifes to decide such things? We were asked this on the radio by a commentator. Far from it. There are three fields of knowledge in this endeavour. The first is the medical field (including the surgical/obstetric, midwifery and all the related professions). If you want an operation, a diagnosis or a baby delivered you definitely need a doctor surgeon or midwife, which ever is appropriate. In no health system though, are the decisions about what kind of health care is provided just left just to the medics. There are many more groups within society whose input is essential.

The second field is health economics. Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking.

The third sector influencing the shape of health care includes the political and financial decision makers. We oppose utterly the involvement of companies in health care to make a profit, but they have an ever larger role in the current system, not just in the US, but here too. The huge difference in the health care system in the US and in the UK show how profoundly different health systems are. People decide, through their political involvement including through voting and campaigning what kind of healthcare they want. Our NHS is there to serve the people, the US health system is there to serve the big health corporations, insurance companies and the pharmaceutical companies. Senator Bernie Sanders who campaigns for universal health care in the US, and who campaigns to change their health system to one more like the NHS, asked people to send him the most ridiculous health charges they had experienced. Evan far more dangerous is the fact that millions have no health cover at all. ‘Obama care’ did improve the situation but under Trump uninsured figures rose.

The cost of medicines in the US are also surging beyond people’s means so people die of treatable illnesses. People are dying because they cannot afford Insulin. People travel across the border to Canada to buy drugs more cheaply. The story of the company massively inflating the price of the epipen, shows just how foul a system this is.

The UK has valued the NHS since it was first set up and it became the most cost effective health care system in the world. The NHS is a universal service (well it was until recently when they introduced charges for some – see this article for the extent of the damage from charging). The NHS is a comprehensive service delivering the best available service for all. This model is massively popular. It has been describes as the closest thing to a religion in the UK .The

Kings Fund reported that;

  • Seventy-seven per cent of the public believe the NHS should be maintained in its current form. This level of support has remained consistent over almost two decades despite widespread social, economic and political change.
  • Around 90 per cent of people support the founding principles of the NHS, indicating that these principles are just as relevant today as when the NHS was established.
  • A clear majority (66 per cent) of adults are willing to pay more of their own taxes to fund the NHS, underlining growing support among the public for tax rises to increase NHS funding.

Neither doctors nor midwives are trained in heath economics or the politics of public health. Midwives, Nurses, doctors, physio-therapists, and ancillary staff often do get involved in health campaigns right across the country, and offer valuable advice, but this is as individuals not in their medical role. The workload level does not give NHS staff currentlythe time or energy to.positively engage much in the community camapigns for healthcare.The unions representing the health professionals are also important.

Damaging health economics decisions have been made nationally and on Merseyside. The reduction in the number of hospital beds has been a significant error. Not training sufficient doctors, nurses and midwives was a policy error. Not protecting NHS staff in Brexit was vandalism. The introduction of “competition” into the NHS by the creation of the “internal market” saw a mushrooming of costs and no clinical benefit. Some decisions taken by doctors in adminsitering the health service are not clinical decisons but decisions of health economics. Some decisions taken by adminsiters respond to the immediate political decisions of the government and not to medical need, much as they are cloaked as such.

The private finance initiative and the far too cosy relationship between the commissioning side of the NHS and companies like Carillion have given us the monster problem of the new Royal Liverpool University Hospital Building, which is faulty and needs repair work even before it is open. It is not the only such problem but it is enough to show that health economics and health politics are complex issues outside of the medical field.

The commissioning process which was set up by the 2012 act was ostensibly to give power to the GPs in the area but it was clear they had neither the time not the expertise to manage it, and big companies were introduced to “advise” them, and this advice itself has become big business, and big business has profited considerably from this and from privatisation and outsourcing.

We now have another round of highly questionable decisions being made by the NHS systems set up by the Conservative governments since 2012, including hospital closures and amalgamations and the merger of CCGS, all leading to the creating of ACOs and integrated care partnership..

This is part of a wider reorganisation based on establishing population based health care funding, major rationing, the introduction of charging and the preparation of the NHS for intervention in trade deals with Trump.

Shock Doctrine Economics, best seen in the actions of Trump and Johnson who , now in 2019, do not care if they break good services, they care for quick profit made without without years of investment. In this climate we need the community and workforce involvement in campaigns to save and democratise the NHS.

Our next step is to convene a meeting of women and men also camapigning for or concerned about the very real problems maternity is facing across the county. Please so come to this meeting on October 5th at The Quaker meetingHouse in School Lane Liverpool Eventbrite tickets can be found here

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