Every single human gets born. Maternity is the universal service.

This is the text of a speech about the state of maternity care and the campaign to improve it, delivered at a Keep Our NHS Public Meeting, called “NHS Crisis, Who Profits?” held in Liverpool on July 12th. The meeting was part of the Anniversary of the NHS. Other speeches included ICBs and Privatization, what the Labour Party should do, The current state of the NHS here and the Hewitt Review. Further links, including an excellent contribution from Patients not Passports, will be provided shortly.

The NHS is being radically damaged. I am going to speak about how ;

Maternity was key to the founding of the NHS and is key to its future.

How the state of Maternity is part of the attack on women and our communities.

What’s happening to the NHS?

The fight back nationally for maternity.

The arrogance of NHS planners:

Liverpool Women’s Hospital and our campaign

Fighting for the NHS

Maternity is the only service where two humans are routinely treated in tandem.

Birth is a fundamental part of human societies.

How is it that this vital service is in such a state in the NHS, following years of austerity and yet the movement in defence of this service is sadly lacking?

Let us welcome the industrial action from the staff and the earlier activity around midwives. Yes, there are charities doing excellent work on maternity. But we need a mass movement on this, one that does not have the same constraints imposed on charities.

The same dominating ideas that let women carry 86 % of the burden of austerity and have let our children suffer poverty on a scale unseen since the start of the welfare state. So that even the very stature of our children is suffering, they will carry a burden of ill health throughout their lives,

“Inequalities have changed little, and the difference in stillbirth rates between those living in the least and most deprived areas have increased since 2010, the reports says. In 2020, there were 4.3 stillbirths for every 1,000 births in the most deprived parts of the UK compared with 2.6 in the least deprived areas. The report notes that around five hundred babies would survive if stillbirth rates in deprived areas fell to match wealthy areas. Black babies are still more than twice as likely to be stillborn as white babies.” https://www.theguardian.com/lifeandstyle/2023/may/14/babies-dying-nhs-failings-poverty-inequality-charities-warn

Those ideas which hide and minimise the damage to women and to children must be challenged by the organised labour movement and by the feminist movements and by all who fight for a better world.

History

Maternity campaigns were some of the drivers towards establishing the NHS. Cooperative Women’s Guild. Working Class Wives, campaigns for baby clinics and for access to contraception, here in Liverpool.

The introduction of the NHS dramatically improved infant mortality.

In 1929 76.3 babies in every thousand live births died in the first year of life.

In 1948 when the NHS was founded 36 babies in every thousand live births died in the first year of life.

In 1956 23 in every thousand live births died in the first year of life.

In 2020 3.8 in every thousand live births died in the first year of life.

NHS has been significant in providing fundamental changes to women’s lives and children’s lives, and to their liberties.

We need to remember that the NHS was not gifted to us by great ladies or lords but by the campaigning of women and of Trade Unions.

Women hold up half the sky but 80%  (77.7%) of NHS. Don’t underestimate us.

However, this government is getting away scott-free with what it is doing to our mothers and babies. Even the big  NHS campaigns forget to mention the issue. Labour did some good work on it, in the last General Elections.

Polly Toynbee wrote about the poverty of children and their families this week.

Our Maternity Health System is suffering sustained and cruel attacks.

The poor, migrants, people of colour,  Gypsy Roma and Traveller mothers, and mothers who have illnesses, mental and physical, are getting the worst of it.

Women’s reported experience of childbirth is getting worse. This matters to the women and their loved ones and to the long-term well-being of their children.

Many high-profile reports have described the problem and prescribed solutions. The Government issues only platitudes. The problems are getting worse. The more that we let the government and the managers of the NHS get away with damaging our very babies, the more they will continue to wreak their damage.

Major reports include

Morecambe Bay

Shrewsbury ( Ockendon 1 and 2)

Essex

Nottingham ( full report still pending)

The Parliamentary Committee

The Women’s Health Commission

 The reports are researched, evidence taken, they are written up, they are published, they are discussed in the media, task lists sent out to the hospitals but they are not respected, not implemented by the government. They are serving, despite the good intentions of their respected authors, to normalise failure, to normalise unnecessary baby deaths, maternal deaths and injuries to mothers. This process also normalises the poor conditions of work and professional practice that midwives face day in and day out.

Since Ockendon 1 report on the Shrewsbury baby deaths, the Care Quality Commission has inspected many maternity Units, but many of them are failing that inspection. The wake-up call was not heeded, because the resources are not there.

21 Maternity Units are substandard; inadequate, needing improvement or shut over safety concerns, two-thirds of those inspected had insufficient staffing, including some units labelled as good.

“failure to engage with and listen to the needs of the women“.

“Report after report has made a direct connection between staffing levels and safety, yet the midwife shortage is worsening. Midwives are desperately trying to plug the gaps – in England alone we estimate that midwives work around 100,000 extra unpaid hours a week to keep maternity services safe. This is clearly unsustainable and now is the time for the chancellor to put his hand in the Treasury pocket and give maternity services the funding that is so desperately needed.” RCN

(Since the meeting when this speech was delivered this incident has come to light. The East Kent Hospital, the centre of one of the  Kirkup Report, in 2022, less than a year ago, has just been reported for failing safety standards. A visit this March by the then Health Education England – now part of NHS England –  found senior doctors in training were covering both obstetrics and the PPCI lab and could receive trauma, paediatric emergency and cardiac arrest calls.“

Even the prestigious St Mary’ Manchester hospital has been criticised for failings in Maternity.

Reports mean nothing without resources and goodwill to implement them. The government grant neither.

The Nuffield Department of Population Health reported.

As in earlier reports ethnic origin continues to have a significant impact on mortality rates:

Stillbirth rates for Black and Black British babies were over twice those for White babies, whilst neonatal death rates were 45% higher.

For babies of Asian and Asian British ethnicity, stillbirth and neonatal death rates were both around 60% higher than for babies of White ethnicity.

The stillbirth rate was 1 in 295 for White babies; 1 in 188 for Asian babies and 1 in 136 for Black babies.

“…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).” https://www.bliss.org.uk/research-campaigns/neonatal-care-statistics/neonatal-mortality-in-the-uk-how-many-babies-die-in-their-first-28-days-of-life

Liverpool Women’s Hospital is in one of the poorest areas of Liverpool and in one of the most ethnically mixed areas. We have more mothers in the bottom 10% of deprivation than other maternity units. Yet the powers that be dare to threaten this hospital.

Poverty racism and privatisation are a deadly mix. Eighty-six per cent 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.”

There can be long-term damage to those babies who are born preterm or low weight or deprived of warmth food and shelter in infancy.

“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 an 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.“

(One of the audience, in the meeting raised with he the longitudinal study of the babies born in 1944 during the terrible Dutch Winter of Hunger which confirms the long-term damage of poor maternal nutrition)

The attack on maternity is linked to the neo liberal attacks on the welfare state and to Austerity. Maternity was one of the worst hit services following the Lansley Acts and Austerity.

There are too few midwives, too few obstetricians, and too few anaesthetists.

Hospital budgets are under too much stress. The budgets are inadequate and then they are expected to make cuts

The Maternity Tariff is far too low.

Birthrate plus ( the safe staffing ratio) is too low.

The Insurance System for medical damage in maternity costs more than the service itself.

NHS England spends £3 billion annually on maternity and neonatal services, a board paper published in March confirmed. Times reported“We spend more on the cost of harm when we could be spending more on prevention,” said James Titcombe, a bereaved father and campaigner at the Baby Lifeline charity.  ( Quote from the Times article above)

The total cost of harm from clinical negligence was £13.6 billion in the 2021-22 reporting year, according to an annual report from NHS Resolution, the arm of the Department of Health and Social Care that handles litigation. Sixty per cent of the cost of harm was for maternity claims, amounting to £8.2 billion for the year. NHS England spends £3 billion annually on maternity and neonatal services, a board paper published in March confirmed.

Statistics are showing declining safety.

Staff are keeping the system afloat with unpaid overtime and high-pressure working.

Those controlling health care money are deliberately underfunding and denying us access to services.

Maternity units, like A & Es and hospital beds, have been closed since 2010. This means longer journeys and more babies born en route. Women in huge pain are expected to make long journeys.

Privatisation

 There have been failed attempts at privatisation but the direction of travel is still there.

One to One; We were told they had direct links to the Cabinet There was a policy of “Encouraging Ninja privatisers”

Other preparations for privatisation, denial of service and reduced provision includes personal budgets, the push for home births and the use of tatty birthing centres, and financially penalising hospitals for birth interventions.

Other speakers tonight have shown the depth of the privatisation in the NHS and the huge wealth that can be taken from our NHS by the big corporations.

There are no shortcuts. The NHS maternity service needs

Finance

Staffing

Goodwill and refusal to compromise from hospital and system management.

and

Greater respect for women.

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,( and freedom from student debt)

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. LWH is not able to provide 24 /7 on site consultant care because of cost-cutting imposed on them. In a maternal medicine centre, this is scandalous. Underfunding maternity does not work for the population.

Threat to Liverpool Women’s Hospital

Liverpool Women’s Hospital is a 1990s building in good grounds, in good condition, close to an acute hospital. It is the maternal medicine centre and a tertiary hospital serving not just local women and babies but the wider region for complex cases.

 In 2015 there was a Panorama programme about Liverpool Hospitals “One hospital has to go” one of the strategists for the NHS said on that programme. Very shortly afterwards it was named as Liverpool Women’s Hospital.

It is the largest maternity hospital in Europe. There is no existing alternative capacity to provide LWH’s maternity services, let alone other services such as gynaecology, genetics, fertility and terminations. Please see our blog for details on Carnall Farrar report.

We are fighting back. Our earlier campaigns made some difference. The chaos at Liverpool Royal hindered the earlier plans to close or disperse the services. The pandemic put much on hold but the plans are Live again now following the commissioning and publication of the Carnall Farrar report

By raising the campaign issues in the community, we build defence for the NHS. We build understanding. We must take people with us. By involving tens of thousands of people we strengthen the whole case for the NHS, for the  Liverpool Women’s Hospital and for maternity care in the NHS.

Our petition now has more than 60,000 signatures, 43,675 online and the rest on paper.

Our street campaigning, our leaflets, our close monitoring of the trust and the ICB, our lobbying, are all part of the campaign.

Working in the communities, at street stalls and at big events where women gather we have taken the fight to the communities. We are taking the community with us in this fight. Our next big push is building up to our demonstration on October 7^th. 12.30  pm starting outside Liverpool Women’s Hospital, Crown Street Liverpool L8 7SS

We need your help, as a supporter of the NHS, as a supporter of women’s rights and children’s rights, as a Trade Unionist or as a campaigner, or crucially as an ordinary woman or man,  in an ordinary job, in an ordinary street. We can fight as our grandparents did for the founding of the NHS and like them, we can win. It is not going to be easy but it is possible.

“you’re doing it wrong, if you’re not allowing space for people to go on their own journey of seeing and making the connections,” because “you can’t just tell people, [they] have to feel it in their gut”. James Skinner Patients Not Passports

We offer our respect to the staff of the NHS who, as we speak, are working with women who want to get pregnant, who are delivering babies, helping mothers and babies after birth. They are working in really tough conditions. Respect to the midwives, respect to the Obstetricians and Gynaecologists, the neo-natal nurses and all the staff in our once great maternity services. The fight for the future of the NHS lies with the people.

For all our mothers, sisters, daughters, friends and lovers and for all our babies, fight for the NHS, fight for maternity services nationally and fight for Liverpool Women’s Hospital.