Maternity

In a long campaign from the 1960s, women fought for birth to be seen as a normal human process with the women in charge. 

We want to keep a Women’s Hospital. Our hospital, from its early days in the 1990s, developed as a wonderful women’s space, where women felt valued, safe and respected. That too must be retained.

Maternity nationally is underfunded and understaffed both nationally and in Liverpool Women’s Hospital. Women’s health is not given the same level of priority as given to men. This has been consistently reported by reports of great authority. We are fortunate to have such reports. So our contentions in this article are not just from our own experiences, not just an assertion of our campaign, they are, terrible though it is to see, the established facts.

We insist that these reports are considered when making decisions about the future of Liverpool Women’s Hospital.

The many reports on safety in maternity.

The Ockendon report, the  Kirkup report, the Parliamentary Subcommittee on the Safety of Maternity Services, the Women’s Health Strategy, the All Parliamentary Group on Baby Loss and many more have enquired into and reported on the problems in maternity and women’s health.

“A new report from the All-Party Parliamentary Group (APPG) on Baby Loss finds that staffing shortages are having significant impacts across services provided before and during birth and the neonatal period including bereavement care. The report….. finds a “bleak picture” for maternity and neonatal services that “are understaffed, overstretched and letting down women, families and maternity staff, alike”.” (Sands.org)

One of the signatories to this All Party Parliamentary Report is Jeremy Hunt, the current Chancellor of the Exchequer, who is declining to fund these services to the level required to improve maternity care.

“NHS Providers, as cited in the recent Select Committee report, has estimated the cost of full expansion of the maternity services workforce to be £200m – £350m. We endorse and support this view.”  https://www.ockendenmaternityreview.org.uk/

Organisations like AiMs do detailed work on maternity from the standpoint of the mothers, who are the service users. Pregnant then Screwed, Maternity Action FiveXMore and Sands are just some of the organisations working on these issues.

The Care Quality Commission (CQC) wrote in 2022 “Despite the greater national focus on maternity in recent years and the welcome improvements it has led to, the pace of progress has been too slow and action to ensure all women have access to safe, effective, and truly personalised maternity care has not been sufficiently prioritised to mitigate risk and help prevent future tragedies from occurring.”

The CQC also said “Addressing inequalities in access and tailoring maternity services to best meet the needs of the local population is a critical area for action and something that good services are prioritising. “

All of this evidence supports the call to save Liverpool Women’s Hospital and to improve its funding and staffing.

Maternity care should be respectful of the women giving birth, respectful of the babies, and their families. Birth plans are important and help the birthing mother maintain understanding and control over her experience. There can be unpredicted difficulties in any birth. When these difficulties arise good hospital maternity care must be available. Traumatic birth can have long-term physical and mental health issues for the mother and baby. Care is also needed after the birth.

Underfunding, understaffing (and the kind of management that comes from underfunding and understaffing), the internal market and years of austerity, have led to baby deaths and all the loss and misery that goes with such bereavements.

(If you or someone close needs help with these issues please do contact Tommy’s or the wonderful Honeysuckle team at Liverpool Women’s Hospital or Sands).

If these facts make you weep with anger, join our campaign.

Poverty and discrimination also cause problems in pregnancy, birth and in the post natal period

“…the neonatal mortality rate increases according to the level of deprivation in the area the mother lives in, with almost twice as many babies dying in the most deprived areas compared with the least deprived areas (12 compared with 22 per 10,000).”

Liverpool Women’s Hospital serves some of the poorest areas in England, being set in the most income-deprived areas of the country.

“Overall, 32.7% of households in Liverpool are deprived in one way. The neighbourhood of the city (and across Merseyside) with the highest level is Chinatown, St James & Georgian Quarter, where 37.4% of households are deprived in one dimension, with areas around Hampton Street, the Baltic Triangle and Mill Street particularly hard hit.” Some of these areas are over 50 per cent in deprivation.

Poverty and privatisation are a deadly mix. 86% of the burden of austerity has fallen on women. Poverty, austerity and cuts in health spending make this a triple whammy against the poor.

“The analysis suggests that a 1% decrease in healthcare spend will generate 2484 additional deaths.  So the ‘loss’ of 13.64% in healthcare spend between 2010-11 and 2014-15 will have caused 33,888 extra deaths, calculate the researchers.”

The long-term health of babies is also at risk.

“Each year, 35 million newborns worldwide are born preterm (<37 weeks of gestation) or small-for-gestational-age, and may be low birthweight (<2500 g). These small vulnerable newborns (SVNs) have markedly reduced survival chances, with more than half (55·3%) of the 2·4 million neonatal deaths in 2020 attributed to being a SVN. The survivors are vulnerable to health problems throughout their life course, including poor neurodevelopmental outcomes, low educational achievement, and increased risks of adulthood non-communicable diseases, such as hypertension, ischaemic heart disease, and stroke. Indeed, this effect is also intergenerational. For society, there are important human capital, economic, and productivity losses as well as costs such as health-care related costs.“

The proposals for Liverpool Women’s Hospital are happening in a time of health underfunding, the reorganization into ICBs and increasing poverty. The Liverpool Women’s Hospital must be protected and improved, not moved, dispersed or anything else. The local health bosses must not be allowed to use Women’s and Babies’ health to make savings or profit.

We are all too aware of the cost of living crisis and of inflation hitting the poorest hardest. The third child born to a family claiming benefits is not given financial support because of the two child rule introduced under Teresa May’s Government. About one in three families have three children. Half of all households in the UK claim some kind of benefit.Poverty is getting worse according to the Joseph Rowntree Foundation

It’s not just underfunding and understaffing, it’s poverty too. Our hospital serves a multi-cultural, multi-ethnic, multi-racial community in Merseyside. Our women face all these well-recorded problems. We must retain and repair our hospital.

Hospitals, including Liverpool Women’s Hospital, are expected to make cuts even during this crisis.

LiverpoolWomen’s Hospital was expected to make 5% CIPs (CIP is NHS speak for cuts) in 22-23 and 6% on 23-24. In addition to this spending to make good staffing levels criticised by the CQC report has pushed the Hospital into a greater deficit and could push it to a situation where outsiders come in and decide where cuts should be made. The structure of the health service, especially since the 2012 Health and Care Act, meant hospitals had to use market models. Hospitals are not markets, they are services.

The British Medical Association said as far back as 2018 that “The internal market has turned our public hospitals into businesses in which, when there is a conflict between financial health and patients’ health, financial health trumps”. For further information on the internal market, this is a good information sheet.

Maternal deaths, baby deaths, maternal injury and baby injury are made worse by political decisions to underfund healthcare and especially women’s healthcare, and by the ongoing reorganisation of health services to favour the private company profit.”The gradual privatisation of the NHS may be a complex subject, but it is there – quiet and deliberate”.

Regulations are no substitute for staff.

The Government responds not by implementing these multiple reports but by issuing page after page of regulations for maternity. In the introduction to the All Parliamentary Group on Baby Loss, there are weasel words, a get out, in the statement:

“While there is no escaping the fact that maternity and neonatal services require substantial and sustained investment, a view echoed by most respondents, many of the measures advocated by respondents could be implemented quickly and with little additional expense.” This contradicts the weight of evidence from their own report and gives them a get out for not providing the “substantial and sustainable funding” that is needed.

Similarly, the government, by relying on lengthy new regulations, attempts to present system failure as staff failures. These regulations will improve matters only if midwives have time for in-service education, good unpressured induction into the profession, a decent work-life balance and fully staffed, fully qualified and experienced staff in the delivery suite, on the wards, in the clinics and in the community. For these regulations to work we also need sufficient obstetricians and anaesthetists.

Midwives matter to women giving birth and have done through the ages. It is crucial to protect this ancient profession. There is a petition here. “Midwife” means ‘with woman’. The profession wants to work with the natural and powerful processes of the woman’s body as she gives birth, seeing it as natural and normal. That process can take time and is not as easy for hospitals to manage as planned caesarian sections, nor as easy as the 1970s nightmare of women being told when they will be induced, like it or not.

Staff shortages.

Shortages of midwives, obstetricians and anaesthetists are a national problem.

 Evidence from the Royal College of Obstetricians and Gynaecologists suggested that a 20% increase of obstetricians and gynaecologists on maternity units would be necessary (to meet need), which NHS Providers estimated to be an extra 496 consultants.

Midwives are being driven out of the NHS by understaffing and fears they can’t deliver safe care to women in the current system, according to a new survey of its members by the Royal College of Midwives (RCM).

The College is warning of a ‘midwife exodus’ as it publishes the results of its annual member experiences of work survey.

The Guardian reported on pain relief problems for women giving birth because of staffing issues amongst Anaesthetists.

Mothers giving birth are suffering damage to physical and mental health because of underfunding, understaffing, poor management and poor staff training. These are all cited in the reports mentioned above.

Summary of the issues reported in MBRRACE as Increasing since 2012-2014

•          Deaths during pregnancy & up to 6 weeks after, are 24% higher than in 2017-19 (MBRRACE Report).

•          Causes:

Maternal Mortality nationally

Direct: Thrombosis/thromboembolism, then suicide, sepsis, haemorrhage. Indirect (52% of all):  Cardiac disease.

•          1:9 women who died had severe multiple disadvantage (mental health diagnosis, substance use, domestic abuse).

•          2020: women three times more likely to die by suicide (during pregnancy & up 6 weeks after) compared with 2017-19.

•          Suicide: the leading cause of direct deaths within the year after pregnancy.

•          Mental ill-health & heart disease are on an equal footing as the cause of maternal deaths, representing 30% of maternal deaths during or up to six weeks after pregnancy.

 ( Figures from MBRRACE)

The Lancet also recently published this article about how poverty affects pregnancy.

We say maternity must be well-funded. That is where the battle lines between the people and the government must be drawn. Fund maternity. staff maternity. pay the staff well. Stop unnecessary baby deaths, and stop hospitals from having to scrimp and save to fund an understaffed service.

The Governments Response to the Maternity Crisis; Fine words without resources.

Staffing problems in maternity are a national issue. In response to pressure about the Maternity Crisis, the government has produced a three-year recovery plan for maternity (don’t hold your breath).

It says, “This plan sets out how the NHS will make maternity and neonatal care safer, more personalised, and more equitable for women, babies, and families.”

 It lays out four main points:

• Listening to and working with women and families, with compassion.
• Growing, retaining, and supporting our workforce.
• Developing and sustaining a culture of safety, learning, and support.
• Standards and structures that underpin safer, more personalised, and more equitable care.

But the document leaves out tackling underfunding, understaffing and overwork, and poor pay. Again it is not just our campaign making these criticisms of the government’s plan.

The Royal College of  Obstetricians and Gynaecologists said “We support the objectives set out in this delivery plan, and welcome its simplified focus on key areas that matter most to women and NHS staff, and where the greatest difference can be made.

However, maternity services are in dire need of investment. Without it, we are concerned that an already overstretched NHS will not be able to implement this plan. This will be another missed opportunity to ensure compassionate, personalised and safe maternity care for everyone.

We therefore repeat our call for the Treasury to commit to funding the improvements needed, including through a fully funded long-term workforce plan.”

(Our emphasis).

The Royal College of  Paediatrics and Child Health commented “What we need now is real investment from the government, to enable regular workforce planning at a local, regional and national level to ensure a sustainable, appropriately funded, multidisciplinary workforce that safely meets the needs of women and their babies. 

In reality, while the delivery plan is a start, the task now turns to local implementation and coordination, but they cannot do this alone. It is disappointing that the review has not adopted our recommendation for a national neonatal safety champion, who could oversee the progress and adoption of all these recommendations. We will continue to make this call.“

Liverpool Women’s is a relatively small hospital though a large maternity unit, probaly the largest in the country. Relocating such a service would be very complex and expensive as well as unnecessary

The Nuffied Trust comments that “The financial problems presented by minimum staffing levels are exacerbated by the fixed costs of providing the physical infrastructure of maternity services, which have a relatively large footprint and are resource-hungry. The current reimbursement system, which is often based on payment-by-results, does not reflect the actual costs of providing the service, where, among other pressures, staff cover is required 24/7“

Problems when the core issues of staffing and underfunding are ignored.

Continuity of Carer. There is a pattern that the government will try all kinds of fashions and regulations to avoid the necessary investment in maternity. At one point i maternity care was planned on the basis that women would be giving birth at home or at tiny birthing centres, meanwhile, maternity units were being closed because of cuts or shutting temporarily.

More recently the Government threw all its weight behind introducing Continuity of Carer. This was also hailed as the answer to racism and discrimination in childbirth ( It isn’t!). Every hospital had to work in this way, being financially penalised when it was not implemented.

Continuity of Carer is a wonderful idea, when, and only when, we have a well-staffed midwifery service. Gill Walton from the RCM described it as “the clashing of truths“.

The concept of Continuity of Carer is that the pregnant woman sees one person through antenatal, delivery and post-natal services. Clearly, as midwives have to sleep, eat, look after their families, go on holiday, be off ill and study, such care is not possible from one person, so a team approach was used. Without adequately staffed teams, this cannot work.

The CoC teams still require the backup of specialist teams, so can only work when thereis good staffing.

It is great for a woman coming into Hospital or giving birth at home to have a familiar and trusted face come into the room and work with her during the delivery. Some midwives love to work this way. CofC cannot be and did not prove to be an answer to the chronic understaffing and underfunding crises.

Trying to deliver Continuity of Carer in a time of staffing crisis resulted in the break up of established specialist teams and patterns of care, and much unhappiness. Some midwives left the profession over the disruption this caused. This exacerbated the staffing crisis and the unhappiness in the profession. In 2022 the RCM welcomed the removal of targets for Continuity of Carer and Ockendon said it should stop until the staffing allows it.

Women’s health is underfunded and not given due consideration. Again this is a matter of record not just our assertion.

Gynaecological waiting lists are amongst the worst in the county and are long at Liverpool Women’s Hospital. The basics for women are in short supply. Many women have had difficulty accessing HRT medication.

Women need a decent health services, including major gynaecological services, screening, and the recognition of different symptoms for women in common diseases. Access to control over our fertility is incredibly important. Our campaign is hearing of women finding it difficult to access contraception and smear tests. The GUM department at The Royal has the contract to supply contraception, sexual health (STI testing) and HIV services for Liverpool, Knowsley, Warrington, Halton, East Cheshire and HIV for Wirral. They have given the service the brand name Axess.

We have heard of women finding it hard to get appointments for all types of contraception including emergency contraception and especially coils. Cytology (smear tests) also have very limited appointments. GP practices seem to often no longer deliver these services. Handing these services over to high street pharmacists is no answer, especially as pharmacies are closing (except when people campaign)

Rowlands, the company involved in the attempted closure of the pharmacy in Lodge Lane is quoted in the Echo as saying:

“The community pharmacy network in England is in crisis as a result of real-term funding cuts of around £750m in the last few years. We’re told there will be further real-term funding cuts in the coming years. It is estimated up to 75% of pharmacies are in financial distress leading to closures. The government in England (unlike Scotland) is not prepared to invest in keeping them open.”

This is backed up here. However, pharmacies are private companies funded by the NHS. As a private company, its first purpose is to make a profit. It is another example of why we need a fully funded, fully staffed, properly planned public service providing our healthcare.

Midwives need a decent pay rise to keep up with inflation and to make up for the years when real pay value fell. Otherwise, the rate of midwives quitting will only increase. Midwives also need respect and the chance to practice their vital profession in dignity

The universities that train midwives are also facing staff issues as their staff leave in disgust at what is happening in the service.

This article was written to underline the need to preserve and enhance Liverpool Women’s Hospital. March with us on October 7th.

We demand that we keep Liverpool Women’s Hospital on-site and that it is funded to succeed.