Decisions about Liverpool Women’s Hospital are in the hands of the Cheshire and Merseyside Integrated Care Board. The Integrated Care Board for Cheshire and Merseyside meets on Thursday, 27 July 2023.

(We have written a detailed report on the paperwork for this meeting here, covering the wider Health service issues.) The meeting papers we refer to can be found here

Liverpool Adult Social Care and Health Scrutiny Committee expect to receive a report on the future of Liverpool Women’s Hospital for their November meeting ( Adult Social Care & Health Scrutiny Committee 2023/24 Draft Work Plan ). However, there are only a few references to Liverpool Women’s Hospital in this month’s paperwork. There is no report from the Women’s Committee that is supposed to be working on the future of Liverpool Women’s Hospital. If a report is to be ready for November, work must be progressing on the future of Liverpool Women’s Hospital. Where is this happening?

We presented some of our petition signatures to the Board earlier this year when the Carnall Farrar report was discussed at the ICB board. Given the scale of the support for saving the Hospital, we hoped that the decision-making would be open and transparent, yet there are no minutes of the Women’s Committee on these or any earlier meetings. There are some passing mentions (see below). We have written to the board asking about this. Such serious issues cannot be prepared for November if there has been no previous discussion. Do the people having these discussions think local people, local women, and local families have no contribution to make? This is our hospital, paid for by our taxes, owned by our health service. It is not a private decision. This is where most young people, born in Liverpool, were born. It is part of the fabric of our lives. Given the state of the NHS after years of cuts and privatisation, we are right to be worried. We emailed the Liverpool Place address asking for the link to the minutes of their meetings and were told these were only available to the public via a Freedom of Information procedure. Hospital minutes and ICB minutes are open to the public so this is strange.

In the past, we have had promises of support for our campaign to Save Liverpool Women’s Hospital from Liverpool City Council. Many councillors do still support us, but the Council is part of the One Liverpool Strategy along with local NHS bodies. A statement appears in this document. It is a reiteration of the previous CCG’s position. It does not mention the key financial situation, nor the maternity crisis, and perpetuates the myth that huge finance for re-build on the Royal site is possible. If you live anywhere in Cheshire or Merseyside, please contact your councillors.

The future of Liverpool Women’s Hospital affects the whole region

For Liverpool, the hospital is the local maternity and women’s health hospital. For the region, it is the maternal medicine centre, the hospital where complex cases are referred. Any reduction in scale at the hospital will severely affect the region. The original plans for the rebuild were in a smaller unit, with fewer beds and less space. We know that Boris Johnson’s 40 new hospitals are not reality, and Liverpool Women’s Hospital does not even feature on that list. The minimum cost would be £150 million and probably much more. We fear the same fate as Leeds Children’s Hospital which was dispersed and demolished on the promise of a rebuild. That promise has not been kept, although there is a further promise of a new wing!

Liverpool Women’s Hospital should be improved onsite. Staffing must be improved. The fundamental funding of the national maternity tariff should be addressed. The expensive governance structures involved in the Foundation Trust System should be addressed, and the expensive insurance model should be reformed. The Hospital must have a clear future. Above all the staffing must be funded to ensure safety, as must all Maternity Units.

Liverpool Women’s Hospital does have significant problems based on the national maternity tariff and other financial issues arising from national underfunding, understaffing and staff shortages. This is not mentioned in the papers for the meeting either. Yet multiple authoritative reports have been published on these national maternity problems. Liverpool Women’s Hospital is the largest maternity hospital in England, possibly in Europe.

The Carnall Farrar Report (also referred to as LCSR) was very expensive. This company have been paid £386K by the ICB. The average pay scale for a midwife is £34 to £38 thousand. If we add 50% on-costs, employing one midwife costs £57,000, so the report cost the equivalent of 6 midwives for one year. Those six midwives would have made a huge difference at Liverpool Women’s Hospital, perhaps averting the recent poor CQC report

“Staff did not consistently assess risks to women and birthing people nor act on them. Frequent staff shortages increased risks to women and birthing people across the maternity service.” (our emphasis)

The service did not always have enough maternity staff to keep women safe from avoidable harm and to provide the right care and treatment. Staffing levels did not always match the planned numbers.”

Carnall Farrar reiterated earlier plans for the future of Liverpool Women’s Hospital. We believe it did not reflect the current maternity position, the recent reports on the state of women’s health in the UK, or the long Gynaecology waiting lists.

We searched through the papers for progress on the future of Liverpool Women’s Hospital and on the state of maternity across Merseyside and Cheshire and have listed such as we can find here.

There is a reference to Liverpool Women’s Hospital on page 170 in the Board Assurance Framework.

“The Liverpool Clinical Services Review (LCSR)( the Carnall Farrar Review) identified significant clinical risks for Women’s, Maternity and Neonatal Services both locally in secondary care services provided to the population of Liverpool and North Mersey and for specialist tertiary services provided to the whole C&M population, due to the configuration of hospital services in Liverpool. (our emphasis)

There is no new information here and we have written before that we do not accept that there are significant clinical risks due to the configuration of hospital services in Liverpool. There are significant financial risks and risks (and lived experience) of understaffing because of financial pressures. There are organisational pressures from LWH being a relatively small hospital, because of pressures to marketise hospitals and make them compete with each other. There are not however “major clinical pressures” arising from being a mile from the Royal. Other parts of Liverpool University Hospital Trust, like Aintree and Broadgreen, are many more miles away, and some sites of some hospitals are in different towns. These minutes mention that “The committee discussed the impending transaction of Southport & Ormskirk Trust to St. Helens & Knowsley Trust” (Page 269). There are 20 miles between these hospitals.

The future of all hospitals lies in cooperation not competition and, fortunately, there is some tiny progress in that direction with hospitals now working to some extent as part of a local system (We are aware that system working has its own problems for some staff and can reduce essential spare capacity).

So why, in the context of multiple reports of failings in maternity services nationally, a well-reported shortage of midwives and obstetricians and obstetric anaesthetists, the number of poor CGC reports on maternity units, including local ones, does this matter not gather more attention from the ICB? It is as though the Ockendon reports had never been written!

Why when more than 60,000 people have signed petitions to Save Liverpool Women’s Hospital is the matter not publicly and coherently reported? Given the promises we had of consultation on this matter, why have we heard nothing?

We are left to gather snippets.

On page 33 in the Decision log 22-24, it says”27 April Briefing on the national maternity and neonatal services delivery plan. The Integrated Care Board noted the report and endorsed the terms of reference for the Women’s Committee“

We could find no other mention of the Women’s Committee. These are the mentions of LWH we could find:

1. The start of an electronic patient record (EPR) is mentioned on page 44.

2. The Hospital is copied into a letter from NHS England about how cuts must be implemented (page 195).

3. It is mentioned in a table about Elective Recovery Fund -Value weighted activity (page 226).

4. There is a chart about key performance indicators with waiting lists probably the worst issue (on page 251).

5. There is a report that the hospital is at level 3 in the Oversight Framework Segmentation (this is its financial state, in this system 1 is the top and 4 the worst). This financial trouble is based on the inadequacy of the national maternity tariff.

Our campaign has long said that the main issue with Liverpool Women’s Hospital is financial, caused by national underfunding of maternity.

6. There were many sad mentions of women’s health inequalities which we have discussed in the sister post to this one.

7. In the Board Assurance framework (on page 135), there is an indirect reference. Amongst various risks facing the ICB “The ICB is unable to resolve current provider service sustainability issues resulting in poorer outcomes for the population due to loss of services. Mitigated from high (12) to high (8) through the transformation programmes in Liverpool, East Cheshire, and Sefton and for women’s services and clinical pathways” We wait to hear what this means.

8. A further cryptic statement says (on page 144), “ICB Women’s Services Committee oversight of LCSR -Planned”

9. On page 172 in a list again of risks

There are significant service sustainability challenges across the Cheshire and Merseyside System.

10. A further mention of Liverpool Women’s Hospital is on page 284″4 Trusts have requested cash support from the ICS: LWH, COCH, Southport and Ormskirk and Mid Cheshire”.

11. There is a missed target in providing services for women accessing specialist community perinatal mental healthcare.

“The exceptions are the Access Target for Perinatal Mental Health (PMH), (Target
2729: Plan 2357 (85%)) and Zero Inappropriate Out of Area Placements Bed
Days (Plan 900). The ICB is however planning for improvement in both
measures.” (page 186), and “Operational plans for 2023/24 have focused on maintaining contact with people with severe mental illness (SMI), the reduction of out of area (OOA) placement bed days, improving access to NHS Talking Therapies (IAPT), community perinatal mental health (PNMH) and dementia diagnosis.“

and

No. of women accessing specialist community perinatal mental health services

Organisation Feb-23 Mar-23 Apr-23
Cheshire and Merseyside 2,235 2,265 2,345
North West 6,190 6,080 6,050
England 47,805 48,085 48,150
Note: Data is a 12 month rolling position

12. In a section called Maternity Report (page 268) , it was reported that;

“Maternity Report
The committee received its monthly assurance report from the Local Maternity and Neonatal Services (LMNS) lead. The committee received assurance as to how the monitoring of triage and risk assessment was taking place across the seven maternity providers in C&M and how greater standardisation of monitoring performance was aiding oversight.
The committee received an update that Maternity services at Wirral University Teaching Hospital (WUTH) were still awaiting the formal outcome of the inspection of their maternity services in April 2023, and once known, the committee would receive a fuller update.
The committee received assurance as to the work taking place to ensure there was an equitable and standardised approach for the commissioning of the Maternity Voices Partnerships across C&M that allows for the population’s voice to be better heard. The committee received an update following an NHSE convened visit to the maternity unit at East Cheshire Trust and the positive assurances received as to the Trust’spreparation and planning for the re-opening of services on the 26th June 2023. The Trust received advice as to how they could better strengthen their plans which were being implemented prior to opening.”

So our campaign will continue. Please sign our petitions, write to your councillors and MPs, deliver leaflets for us, raise the issue in your union branch or other group and come to our demonstration on October 7th.