May 2023

What is happening with the Liverpool Women’s Hospital in May 2023?

We are both out campaigning and following the meetings that might determine the future of the hospital.

Here are the key points as we understand them as of May 2023. These points are aspects of the same problem we face in the once great but now viciously wounded National Health Service.

We have published a linked article focussing on the maternity crisis as it affects Liverpool Women’s Hospital.

We continue to gather petition signatures to add to the existing more than forty thousand online signatures, and twenty thousand paper signatures. We held a workshop on the campaign for the hospital recently and had reports from the many aspects of the tasks we face to win this campaign.

We are spreading our campaign widely, and are asking for help to make these issues well known.

We accuse the government of deliberate, political, damage to the NHS. We demand the re-nationalisation of the health service.

We campaign with Cheshire and Merseyside Defend our NHS, Keep our NHS Public, SHA, the Unite Community branches, the Trades Councils in Cheshire, Liverpool, Knowsley , Warrington and Halton, and offer solidarity to the NHS Trade Unions the local Food pantries, and other struggles. If I have forgotten anyone apologise. We link up whenever we can with national campaigns too

Our NHS was created and developed as a publicly owned, government-funded, publicly provided, not-for-profit, national system based on universal treatment, free at the point of need. As such it enhanced the lives of two or more generations of women. The government is now creating a second-rate system that increasingly denies care and forces people to pay or go without.

The working-class women of Liverpool organised, as in the Women’s Cooperative Guild campaign, for free maternity care more than a century ago. We are fighting in that tradition.

More than seven million people are waiting for care, women’s health especially is suffering, life expectancy is falling, especially in poorer areas like Merseyside, and parts of Cheshire, years of life in good health are deteriorating, and care at birth is deteriorating. While this happens, £billions are going to private companies, and the new structures are designed to make the new neo-privatisation work well for big international companies.

A report by the consultants Carnall Farrar was recently presented to the ICB board about the future of Liverpool Women’s Hospital. The Liverpool Place section of the ICB will make recommendations to the ICB when proposals are finalised.

The threat to the future of the hospital comes from years of restructuring on market lines, underfunding in the NHS, and the many market-based “reforms” instituted since 2010. This includes selling off NHS-owned land and buildings, after the Taylor report, without the money being returned to the NHS. It also includes closing hospitals, maternity units and hospital beds. This has all done real damage to the NHS and the care we receive. The recent Health and Care Act and the 44 ICS units across the country are set to make things worse. They are built on a failing US model, called Accountable Care. pressure from campaigners is preventing some of the potential harm but billions of our healthcare pounds are being siphoned off to private profit.

There are cuts as well.

The NHS structures are distorted by marketisation, privatisation, underfunding and understaffing. Adding insult to injury, the government (we are told in the Carnall Farrar report) intends the ICB in Cheshire and Merseyside, to cut £350 million(!) in addition to the Cost Improvement Programme (CIP). CIPs are cuts in funding and were about 5% in 2022-23. In 23-4, the CIP will take even more money out of the system.

In 2023-24 NHS bodies face an average efficiency [cuts] rate of nearly 6 per cent, “significantly harder” than previous years. NHSE says savings are needed to “remove additional capacity” introduced during covid. NHS Providers chief executive Sir Julian Hartley said: “The efficiency challenge for 2023-24 is significantly harder than 2022-23. Trusts relied on non-recurrent funding in 2022-23 to help balance their positions, but inflation is now making it more difficult for trusts to identify sustainable recurrent efficiency savings…“The challenge for 2023-24 will be how to sustainably offset cost growth by improving productivity while continuing to meet the demand for services and deliver national performance targets.

Cheshire and Merseyside face additional cuts. “The Cheshire & Merseyside ICS [funding ] allocation per head to NHS organisations… [is] due to decrease by c.£300 million over the coming years.”

“Alongside this, the new Specialised Commissioning allocation will mean that Cheshire and Merseyside will be allocated £50 million less income from specialised commissioning.”

“Local government in Liverpool and across Cheshire and Merseyside has also seen one of the largest decreases in real terms spending power since 2010 with a decrease of £700 per head of the population.”

(Carnall Farrar report).

Background

Crucial services are delivered at Liverpool Women’s Hospital. Day after day, night after night, babies are delivered at Crown Street. Antenatal appointments and scans happen. Cancers are treated. Gynaecological operations happen, and the new robotic surgery for endometriosis saves women from long-term pain and post-operative pain. Outpatient appointments go on, the neonatal unit thrives, the genetics team advise families, the Honeysuckle team helps bereaved families, and the community midwives work outside the hospital.

The hospital has just been declared a maternal medicine centre. Women and babies from across  Cheshire and Merseyside use the hospital for complex cases. Babies from the Isle of Man and Wales are often sent to Liverpool Women’s Hospital. Liverpool Women’s has its problems, and there is much to be done there to restore and repair its services, as in the wider NHS.

Research goes on to improve the survival of women and babies, the research team at LWH was the first of its kind.  A major new study hopefully involving ten thousand children is about to start, led by Liverpool University in conjunction with Liverpool Women’s Hospital. The study “Children Growing Up in Liverpool” (C-GULL) is the first large-scale birth cohort study in the Liverpool City Region and will track 10,000 firstborn babies and their families from early pregnancy through childhood and beyond.

The Liverpool Women’s Hospital building on Crown Street is less than 30 years old and has had a major multi-million-pound development of neo-natal care in the last few years. It has pioneered robotic surgery for endometriosis. It is the hospital that deals with complex cases and, crucially, thousands of babies are born there each year. It is a much-loved hospital on a pleasant garden site. The Hospital’s immediate area serves some of the most deprived but vibrant communities in the ICB area. It is a vitally needed resource for the neighbourhood, the city and the wider region.

We fight to keep Liverpool Women’s Hospital and we fight for it to be much better funded and have much better staffing.

We support other similar campaigns around the country.

We support the Staff in their pay disputes and recognise that they are fighting for the safety of patients as well as a decent wage for themselves.

‘Where would men be without women? Scarce boy, mighty scarce’. (Mark Twain).

The detail of the situation facing Liverpool Women’s Hospital in May 2023.

This is our understanding of the situation facing Liverpool Women’s Hospital in May 2023, and the background to our ongoing campaign to Save the Hospital, to restore and repair the NHS, and to fight for better healthcare for women and babies.

Key points

There is an ICB working party on the future of  Liverpool Women’s Hospital, following the publication of the Carnall Farrar Review (page 147) in January 2023.

These meetings have not been in public nor have minutes been published.  As can be seen in the diagram below there is a subcommittee of the ICB  under the title “Liverpool Women’s Services” including Liverpool University Hospital Trust Liverpool Women’s Hospital, Alder Hey Children’s Hospital and  Clatterbridge. It is supposed to meet monthly but we have not been allowed access to its minutes, nor have meetings been held in public.

We presented just some of the 62,000 signatures on the petition to Save Liverpool Women’s Hospital and succeeded in gaining a decision to note rather than to “accept” the review document. This was covered in local media and here.

Nonetheless, all the processes recommended in the review appear to be underway exactly as if we had not succeeded in getting the review noted, rather than accepted.

Quotes from the Review

The review stated as its point 6  page 156.

“Overwhelmingly the most important challenge stakeholders identified as needing to be addressed was the clinical sustainability of services for women and the clinical risk in the current model of care.

Specifically,  seven of twelve co-dependencies for maternal medicine centres and therefore for consultant-led obstetric services are not currently met at the Crown Street site. This results in fragmentation of services for women and babies, with some requiring ambulance transfer to other providers to receive the care they need. This, given the clinical circumstances necessitating the transfer, carries an inherent risk, and results in mothers and babies being separated.  There is an imperative opportunity and shared will amongst the acute and specialist providers to respond to the current case for change, developing a future care model to ensure the best possible care for women and babies across Liverpool.

Our campaign has responded to this elsewhere but a few points are worth repeating.

We totally approve of collaboration and cooperation between hospitals. The internal market, introduced as part of the marketisation of the NHS, which set hospitals up as separate organisations competing with each other has been an unmitigated disaster, one of many since 2010. Cooperation between hospitals is important. However, the resources required must be made available to allow this to happen without increasing the existing inequalities and underfunding. In a time of cuts, we don’t fall for sweet words from this government.

Ambulance transfers are a normal part of the NHS. The ambulance service must be improved and staff must be better paid and have better working conditions. We can all remember when this was so. Suppose a patient presents with a stroke at Liverpool Royal. In that case, they are transferred to Aintree, with major trauma, they are transferred to Aintree, with significant heart issues to the Heart and Chest, brain injuries to the Walton Centre, complex cancer to Clatterbridge, and obstetric problems to Liverpool Women’s Hospital. If there is immediate risk to the patient a specialist from the other hospital comes across to the sending hospital. Patients from Wirral and other areas are also transferred to the specialist provisions in Liverpool. Transfers between Liverpool Women’s and the Royal site are the shortest distance of transfers in Liverpool, except transfers between the New Royal and the New Clatterbridge Centre. We are told doctors working between the two sites generally walk as it is too short a distance to drive. It is about  1.3 miles down a straight road.

“The most important challenge stakeholders  identified was ….” But the most important stakeholders are the women of Liverpool, Merseyside and Cheshire. We were not asked, so who are these stakeholders? We literally do not know!

The Crown Street site “Specifically  seven of twelve co-dependencies for maternal medicine centres and therefore for consultant-led obstetric services are not currently met at the Crown Street site.” Despite apparently not meeting the criteria for being a maternal medicine centre the Hospital has been given that status, and will operate as such from July. It is already a leading obstetric centre for the whole ICB area and beyond.

Sick Mothers and babies being separated is obviously heart-wrenching and creates problems with bonding. It is quite rare. Such separations should be minimised, though a mother in a high-dependency unit cannot care for her baby. One of the examples of unacceptable practice quoted was a receiving hospital not having a fridge to store breast milk. That is unacceptable but not a reason to close a whole hospital, a critical facility for women’s health. Saving lives comes first. Babies are also routinely transferred to Alder Hey Children’s Hospital for life-saving surgery. There is a plan to take some neo-natal nurses to form a joint neo-natal post-operative centre in Alder Hey. However, for years babies have been successfully sent from Liverpool Women’s to Alder Hey for surgery and brought back to the Liverpool Women’s neonatal unit, recently rebuilt and extended at the cost of £20 million.

Why are they talking about a new building? The ICB ( the organisation that runs the health service In Cheshire and Merseyside after the latest Health and Care Act) has said, categorically, there is no capital, i.e. no money available for a rebuild, yet the plans put forward constantly cite the plan for a rebuild of Liverpool Women’s hospital, on the Royal site. The story of the 40 new hospitals promised by Boris Johnson, but still nowhere to be found, shows how much faith we can put in that.

The favoured solution, we have long been told, is one huge hospital including a general acute hospital, a Women’s Hospital and a Children’s Hospital but after the new buildings at Alder Hey and at Liverpool Royal that will simply not happen.

The Leeds example. Leeds had a promise of a new children’s hospital backing 2018. It has never materialised and now all that is promised is a wing of a new hospital

We want Liverpool Women’s Hospital to stay on the existing  Crown Street site and to be well-funded and well-staffed. We won’t be fobbed off by the dispersal of the services on the promise of a new hospital at some point in the future. We learn from what has happened in Leeds. Leeds was promised two new hospitals. Now it is promised two new hospital wings and there is little progress on them.

Leeds Teaching Hospitals NHS Trust operates seven hospitals across five sites: St James’s Hospital, Leeds General Infirmary, Leeds Children’s Hospital, Chapel Allerton Hospital, Seacroft Hospital, Wharfedale Hospital and the Leeds Dental Institute. The children’s services are far too dispersed being provided at various sites The hospital’s website says “Most of our services are provided from the Clarendon Wing of Leeds General Infirmary. On occasion, however, you may be asked to go to one of our other sites.

• Bexley Wing, St James’s Hospital for radiotherapy treatment
• The Neonatal Unit at St James’s Hospital
• The Diabetes Centre at St James’s Hospital
• Wharfedale Hospital, Chapel Allerton Hospital or St James’s Hospital for outpatient services”

Empty promises and delays. In September 2019 at the Conservative Party conference, an extra 40 new hospitals were announced, including Leeds. £2.7 billion was allocated. The Institute for Fiscal Studies (IFS) said the cost of the 40 hospitals could reach £24bn. In the Health Infrastructure Plan Leeds was down for rebuilding by 2025. In 2020 the Department of Health announced 40 hospitals would be built. The money allocated was 3.7 billion (The list included the Liverpool Royal as a new hospital!).

Leeds was on the list but now included Leeds Children’s Hospital in one project with the acute hospital. £3.7 billion was considered too little money for 40 hospitals.

 Full facts commented “The majority of the projects are either replacements for existing hospitals, new wings or buildings for existing hospitals, or refurbishments. The government defines all these projects as “new hospitals”, but critics of the programme disagree.”

The Nuffield Trust as reported on BBC said “There won’t be “40 more hospitals” by 2030. The projects that do involve building entirely new general hospitals are designed to coincide with the closure of old hospitals. And they were both due to open before the government made its hospitals pledge.

In August 2022 Health and Social Care Secretary Steve Barclay said:  “We’re taking steps to support our NHS with 40 new hospitals in England, and the planned developments in Leeds will provide a state-of-the-art acute specialist facility alongside a new home for the Leeds Children’s Hospital, providing better care for young and old alike.” So far the only funding has been to clear the site. The hospitals were due to be opened in 2025.

The hospital found itself at the centre of an election campaign debate after the Yorkshire Evening Post reported on the case of a four-year-old boy with suspected pneumonia who was forced to sleep on the floor due to a lack of beds. Mr Puntis from Keep our NHS Public said: “Leeds Infirmary is one of these ‘new hospitals’ but in reality, this turns out to be two new wings – one a unit for adult outpatients, intensive care and day case procedures, and the other a building to bring together current children’s beds under one roof. The four-year-old boy’s plight highlighted in the national media was a stark reminder of the chronic pressures on hospital beds. Despite an obvious shortage in Leeds, the new ‘children’s hospital’ will not increase the overall bed base, to the frustration of medical staff who grapple with the problems of bed shortages on a daily basis including frequent cancellation of elective surgery.”

We hope Leeds does quickly get its new Children’s Hospital wing and services can be improved, but we we won’t hold our breath…

The Government is using promises of new hospitals as a public relations exercise. “Please remember that all press notices still need clearance from DHSC“.

The National Health Service in England is a huge enterprise. Rebuilding and repairing the buildings of that organisation should be routine, planned over decades and centrally funded by the Government. Every urbanised, advanced economy requires a healthcare structure to continue its normal existence. That health structure requires government investment and the investment is repaid many times to the wealth and health of the people and the economy. In many different ways, recent governments have offered sections of our healthcare system to private companies as an opportunity to make money. The PFI failure at Liverpool Royal shows just what harm that has done.

We want resources put into making LWH  well-funded and well-connected to other hospitals whilst staying on the same site.

What’s happening with this review?

The Carnall Farrar report also says “A set of principles have been proposed for partners to observe within the scope of Liverpool Clinical Services Review. Once these are agreed they will be shared.” This set of principles has not been shared with the public.

There are other Liverpool specialist hospitals included in Carnall Farrar review sub-committees; Liverpool University Hospital Trust with the Walton Centre, Liverpool University Hospital Trust with the Heart and Chest, and Liverpool University Hospital Trust with  Clatterbridge.

The recommendations in the Carnall Farrar report about Liverpool Women’s Hospital are a rehash of the Future Generations plans, first published years ago, and are aimed at closing the existing Crown Street site and relocating/dispersing the service.

When we presented just some of the sixty thousand plus signatories on our petition, we said, “Listen to the Women”. The ICB has had one meeting with us. This is not consultation, this is not listening.

Staff have been told the Hospital is moving. People working at Liverpool Women’s Hospital report that they are being told the hospital is going to move, not told that there may be proposals on which the public can have a say, but that the hospital will move. This hospital is not a private business, it’s a public service and the people, the patients, the families and the staff must have a say.

We have fewer doctors per head of population than most of the richer European countries and fewer hospital beds. Our health service is impoverished. Yet investment in healthcare returns wealth to the economy A poor health service is not only painful and possibly fatal to the individual, it makes the economy weaker.

Hospitals and the ICB working as a system not as competitiors.

The ICS and the Trusts are now supposed to be working as a “system” rather than a group of competing institutions as in the 2012 Act. The ICS (Integrated Care System) is headed by the ICB (Integrated Care Board) which holds most of the purse strings but the hospital trusts still have legal responsibilities and their own priorities. Monies the trusts have accumulated are supposed to be available to the system. Within Cheshire and Merseyside, for historical, geographic and economic reasons, Liverpool has greater need and greater debts. This does not mean that the other areas have plenty of resources. Indeed Crewe has real difficulties and patterns of unequal access to health care are stark. The ICS is an attempt to build a system where all the providers work together within one budget and share resources.

A review of three early ICBs stated that “There remain significant challenges regarding agreeing governance, accountability and decision-making arrangements which are particularly important”. ICBs have been chosen not based on evidence but on the model from the US Accountable Care.

Chunks of our NHS money go off to private companies. Millions of pounds are being spent by ICBs on private contractors.

“From July to February, nearly 2900 private companies received over £3.9bn, as shown by the available monthly spending reports from 40 ICBs. The biggest winner, Circle Health Group Ltd, received nearly £169m from 36 ICBs. Yet Circle was already notorious for its failed takeover of Hinchingbrooke Hospital in 2011 and exit in 2015, and the under-utilisation of capacity block-booked for Covid in 2020.”

Cuts in real terms funding

Every hospital in Cheshire and Merseyside is expected to make CIPs (Cost Improvement Plans, otherwise known as cuts) in this time of waiting lists and multiple NHS crises.

“The system has delivered the financial position at the end of the year comprising a £42.4m deficit on the provider side, offset by a £12.7m surplus on combined CCG/ICB side.” (Page 56 of the ICB papers)

The Countess of Chester, Liverpool Women’s NHS Foundation Trust, the Mid Cheshire Foundation Trust and Wirral University Teaching Hospitals NHS Foundation Trust are all noted as being in even greater deficit than expected (page 61 of the ICB papers).

Liverpool University Hospital Trust (The Royal Aintree and Broadgreen) has one of the largest financial problems. It is at  Level 4, the highest level of difficulty. Liverpool Women’s Hospital is also having a very difficult year financially. Therefore, the problems at the Royal do not indicate that a merger with the Royal would solve any financial problems for Liverpool Women’s Hospital. Maternity in acute hospitals is normally subsidised by the main budget. Liverpool  Universities Hospital Trust is in no position to do that.

Maternity nationally is underfunded and understaffed including in Liverpool Women’s Hospital. This has been consistently reported.

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

The funding structure is a major cause of problems for Liverpool Women’s Hospital. Our campaign said this was the core problem years ago. It still is.

Liverpool Women’s Hospital is a smaller-than-average hospital and provides necessarily expensive services. It is a Foundation Trust and as such has to have a high level of management services.

Liverpool Women’s Hospital has been working towards having a senior consultant on site all night. This should have happened years ago. This year’s financial state means they will have to postpone this plan. This is a disgrace.

The staffing situation is a major problem for Liverpool Women’s Hospital. The government sets the number of midwives needed by a formula called birth rate plus. It clearly is not adequate but that’s what the hospital is funded to provide. LWH appears not to have always met this staffing ratio. How the staff are deployed is a hospital decision and management’s responsibility. Not only is birthrate-plus inadequate so is the National Maternity Tarrif, the core funding for maternity.

Doctors, nurses’ midwives and other health workers are warning us about the state of the NHS. We must heed their warnings. For more than ten years their effort over and above what they are paid to do has kept the NHS afloat. NHS staff are underpaid and overworked and over-stressed.

Repairing and Restoring Liverpool’s health care must start with removing the private companies who are distorting the public service model. We are paying companies to deny us care.

The health service must work on retaining and recruiting staff, paying them well, making work manageable and stopping bullying management tactics.

• The Liverpool Women’s Hospital and the neonatal service save many babies lives but there are some issues of concern. The survival rate for very prem does not match Manchester’s. LWH is an “outlier “ on this and work is underway to find out the reasons.
• Too many agency workers are used because of recruitment, retention and sickness issues in the staff.
• The staffing issues mean that well-established teams have been broken up, and secondments recalled. The midwife-led unit has frequently been closed and staff redeployed to the delivery suits.
• Backlogs in gynaecological treatment and cancer are being tackled in part through an outside company, using the hospital’s theatres and equipment.

 How do we win this battle to both Save Liverpool Women’s Hospital and Restore and Repair NHS?

The NHS was founded by ordinary people, not by great lords. They had to campaign just as we are campaigning now. Despite the impoverishment of the county after World War 2, we won it. We had health care for all, the best treatments available free at the point of need. The NHS has had an amazing effect on the health of our families and especially our children.

We need to keep Liverpool Women’s Hospital and we are looking for support from women and men in the area and nationally to do so.

We need to Repair and Restore the NHS to its original model; Government funded, publicly delivered, universal, free at the point of need, a public service.

We must end migrant charges which have cost a 4-year-old cancer patient £76,000.

We need rid of the profiteers, the huge international companies and the market idealogues around whom the government is remaking our NHS.

We need more funding. Investment in healthcare repays the county in many ways

We need better pay and conditions for staff.

An efficient workforce plan to ensure recruitment and retention.

An end to the multiple kinds of privatisation, and charging.

A high-quality buildings programme with sustainability at its heart.

An end to the internal market in the NHS and full cooperation between hospitals.

All of this requires a huge campaign because this government has shown its attitude to the NHS. Labour needs to see that we will not support them in continuing any of this government’s policies.

This campaign is like the suffragettes’ movement, the recent Irish abortion rights movement, the movement for women’s rights, the poll tax movement, and the fight for the 8-hour day and rights at work. It has to come from the people. W have to be prepared to fight for it for the NHS.

Support the campaign. Sign the petition. Get involved in the campaign. Come and help. Help organise for the anniversary of the founding of the NHS. Help our October 7th demonstration.