Author: Mary

Encouraging and collating discussion about workers' struggles and struggles for socialism locally, nationally and internationally

The Most Serious Threat Yet to the Future of Liverpool Women’s Hospital

Yes, we need to Save Liverpool Women’s Hospital again!

The future of Liverpool Women’s Hospital was mentioned at the ICS board on 4th August 2022. The Integrated Care Board is the new structure which will manage the Conservative designed health system in Cheshire and Merseyside. The item is on page 39. It refers to a decision to commission a report on all the hospitals in Liverpool.

The review needs to address the longstanding issue and position of Liverpool Women’s Hospital NHS Trust, which has been subject to clinical review, however, a solution is yet to be agreed. There are areas of outstanding practice and service which should be identified and built upon”.

The review will be based on the One Liverpool report which was started in about 2015 and concluded that Liverpool Women’s hospital should move to the Royal “including a preferred option: a new hospital for women’s and neonatal services on the new Royal Liverpool Hospital campus, which was seen to offer the greatest number of benefits for patient care”. 

Now however there is no money for a new hospital. This is stated categorically in the minutes of the shadow ICS board quoted later in this article and was repeated at the ICS board on 4th August.

It needs to bring absolute clarity to the capital question. We are not expecting a new hospital in the next six years and this needs to be stated.” (page 23 of shadow ICB minutes)

The review of course is being conducted by a private company Carnall Farrar ( HSSF Lot 6)

Our campaign aim is clear. No more cuts. Fully fund our hospital. Keep it on its Crown Street Site as a hospital dedicated to Women and Babies.

We will report in another article about the full ICS meeting on the 4th August.

Some of the Campaigners at the ICS board meeting in St Helens on 4th August

Liverpool Women’s Hospital is essential to the healthcare of women and babies in Liverpool and beyond. This is the largest maternity hospital in the country and is much loved by the people of Merseyside and beyond. About 8,000 babies are born at Liverpool Women’s every year. There was a huge campaign to keep it open last time it was threatened (from 2015) and the Hospital stayed at Crown Street. Major investments were made at the site including a 20 million pound neonatal unit. Now we face a renewed threat. Let’s make sure we build a similar campaign this time. Our online petition is here. We also have a paper petition. Please do ask friends to sign it

Paul McCartney gave us his full support when last we were fighting for Liverpool Women’s Hospital

The current threats to the Liverpool Women’s Hospital must be opposed with all our strength. Health care across the UK is in trouble. This is the worst time for more cuts. We need more staff and resources in healthcare, not more cuts and reductions in services. Neither will we sacrifice care for women and babies to fit arbitrary financial limits set by the new health boards (ICB). Healthcare is an essential investment. It makes us all healthier, happier and wealthier.

The Integrated Care Board is the new organisation imposed by the awful Health and Care Act 2022.

Proposals, which we consider to be very damaging for Liverpool Women’s Hospital, were made public on Friday 1st July, at the first meeting of the Cheshire and Merseyside Integrated Care Board. Minutes of the Shadow Integrated Care Board Thursday 9th June 2022 – 10:00 to 11.30 were included in the paperwork. On Page 19 there is a discussion of the future of Liverpool Women’s Hospital. More detailed discussions took place at the Liverpool Women’s Hospital Board meeting on the 7th of July 2022 (At the ICB there was also a discussion of plans for, in effect, merging all the hospitals in Liverpool).

There is no “capital” (money to pay for buildings and very large equipment) available, so no new building but all other options are on the table, from the dispersal of services to other hospitals to a merger, and moving other services into the Crown Street site.

Liverpool Women’s Hospital is a tertiary service. The NHS defines this as “highly specialized medical care usually over an extended period of time that involves advanced and complex procedures and treatments performed by medical specialists in state-of-the-art facilities”

One reason given for the proposed changes is the lack of long-term intensive care at Liverpool Women’s Hospital. We were assured some time ago that short-term Intensive care is available but patients who need long-term care need to be transferred to the Royal, one mile from Liverpool Women’s Hospital. Ormskirk Hospital has a similar situation. We say, if a unit is required at Liverpool Women’s Hospital, then that should be provided. It is unlikely to be heavily used at Liverpool Women’s Hospital but could provide spare capacity against times of need as we saw in the first two waves of the pandemic.

It is our understanding that Broadgreen Hospital also transfers intensive care patients to the Royal site which is much further away than Liverpool Women’s Hospital.

Patients are transferred into Liverpool Women’s Hospital from miles away, including the Isle of Man. More patients are transferred into Liverpool Women’s Hospital than are transferred out (according to earlier board papers). Every hospital transfers patients between hospitals.  

Babies born at Liverpool Women’s Hospitals must sometimes be transferred a day after birth to Alder Hey Children’s Hospital for surgery and they are then sent back to the neo-natal unit at Liverpool Women’s Hospital.

We want the local hospitals to cooperate with each other without losing focus on their core tasks. The core business of Liverpool Women’s Hospital is the health of women and babies. The Ockendon report showed how maternity can be overlooked in an acute hospital. We do not want services dispersed. We need the focus on women’s health.

We don’t want staff stretched across many hospitals. Staff form a team, and that team needs to know each other, needs to know the equipment and the building. It is teamwork that gets the best out of any workplace.

We have had two demonstrations to Save Liverpool Women’s Hospital and we will do so again if needed

Once the UK had the best health service in the world. According to The Commonwealth Fund Report 2021 today UK health care is now fourth in the world of the top ten wealthiest countries following years of Austerity. The American corporations brought in to advise on such matters come from the worst such health service “The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcome...”

There are still world class services being delivered in parts of healthcare in England. We have to protect those parts that still deliver a good service and fight for restoration and repair in the damaged and privatised sections It is not just Liverpool Women’s Hospital under threat, people are having to fight for hospitals across the country. There are campaigns around the country to save Hospitals, Save Ormskirk and Southport Hospital, Save Chorley A+ E, St Heliers in London and many more are running a big campaign too,

Midwives too need our support in their campaigns for more resources.

The staff at Liverpool Women’s Hospital go above and beyond what they are paid. We do regular stalls in the street to Save Liverpool Women’s Hospital and we never fail to find warm gratitude to the staff for their skilled care and kindness. The hospital is far from perfect and many staff express dissatisfaction with the workload and lack of time to do the job they want to do. We campaign for more resources, more staff and proper consultation with the staff ( not prearranged to fit the ICS plans) as to what is needed to let them do the very best for the patients they care for.

Support for breastfeeding mums has suffered in the austerity nationally and locally yet we know it helps babies’ health

Babies’ health is important! This is so, especially in Liverpool, where child poverty is such a problem. We should do our very best for the babies, but our babies are very much at risk.

IMR (Infant Mortality Rate) continues to improve in most rich countries, with recent data showing that in countries such as Japan and Finland the IMR has dipped to only 2 per thousand. In Liverpool, where some of us work, the infant mortality rate is now an unacceptable 6.8 – more than twice as high as London’s average.

We demand a safe space for women to give birth. One in three women have experienced sexual violence, and pregnancy is a key time for domestic violence to begin. Liverpool Women’s Hospital is a women’s place, where women’s needs are given priority. Why should we surrender this asset?

Women’s healthcare is damaged. Women’s health is important.

Female healthy life expectancy at birth in the most deprived areas was 19.3 years fewer than in the least deprived areas (from) 2018 to 2020; females and males living in the most deprived areas of England saw a significant decrease in life expectancy between 2015 to 2017, and 2018 to 2020.

In 2018 to 2020, females living in the most deprived areas were expected to live less than two-thirds (66.3%) of their lives in good general health, compared with more than four-fifths (82.0%) in the least deprived areas.

There were significant decreases in female disability-free life expectancy at birth in both deprived and less deprived areas between 2015 to 2017 and 2018 to 2020; sizable reductions of almost two years occurred in Decile 2 and Decile 7.

Nationally we are all affected by these issues, be they in maternity, the ambulances, GP services, mental health provision or on waiting lists. Women’s healthcare is particularly damaged. Surrendering services for women will not help other patients one jot. Tackling these problems must be prioritised.

In England, the number of women waiting over a year for care is at its highest point ever in gynaecology. This has increased from just sixty-six women in February 2020 to over 28,800 at the end of April 2022, leaving women living with symptoms including extreme pain, heavy menstrual bleeding, and incontinence for far longer than they should.”

This move will hurt the poorest of us the most.

Liverpool Women’s Hospital is in Liverpool and Merseyside which already suffers from poverty and deprivation and the hospital is in one of the poorest areas of the city. The immediate area around Liverpool Women’s Hospital is home to some of the most deprived people, those who have poor outcomes in pregnancy and are most likely to experience ill health.

Women from Black ethnic groups are four times more likely to die in pregnancy than women from White groups, and women from Asian ethnic backgrounds are almost twice as likely.

Pregnant women living in the most deprived areas are twice as likely to die than those living in the most affluent areas.

Even the bus service connecting Liverpool Women’s Hospital, Alder Hey Hospital, and Broad Green Hospital, is due to have its frequency cut from one every half-hour, to one an hour.

This hospital is woven into the life stories of our families.

Liverpool Women’s Hospital provides not just gynaecology but also maternity care This is where most Liverpool babies are born, and where complex cases are cared for. Many families treasure this hospital because it is here that their babies were born, and where babies’ lives are saved. Many families speak warmly of the care they received after the death of a baby. Every public campaign stall we do we hear praise for the staff at Liverpool Women’s Hospital.

Nationally and locally staff and patients are aware of the ongoing damage to our healthcare from austerity policies. We can see A&E crammed and waiting long hours there, too few beds to admit patients in need of care, ambulances unable to attend all the calls that they should, long waiting lists for key operations and privatisation in its many forms.

In Liverpool, we have seen hospital mergers that have not been well prepared or executed, and we see the new Liverpool Royal Hospital, massively and wastefully expensive but still not open in July 2022, so let’s pretend that all is well. All this is documented in Care Quality Commission reports

The National Health Service was founded as this country was recovering from an all-out war. Our grandparents fought for and won universal, comprehensive public service healthcare.  We need to win it back. This country cannot afford to neglect healthcare. We need to restore and repair the National Health Service, fully funded and publicly deliver without privatisation and continuing cuts

For all our mothers, sisters, daughters, friends, and lovers and for all our babies, Save Liverpool Women’s Hospital.

Please sign our petition. https://you.38degrees.org.uk/petitions/save-liverpool-women-s-hospital

The papers cited here can be found below but here are key quotes

We will cover other aspects of these proposals in other posts

This video which is included in the paperwork of the Liverpool Women’s Hospital Board explains more. Lynn Greenhalgh is the medical director of LWH. Lynn asks staff to consider which hospital their service could be dispersed to.

Also

AMA felt that there was an option to take a pragmatic approach and improve the current situation by moving staff around sites or swapping services over using existing sites. JLE confirmed that these options are all included in the new Optional Appraisal. JLE informed the board that consideration had been given to splitting Obstetrics and Gynaecology and assessing the risks associated with this” (Page 21 of the shadow minutes)

And

It needs to bring absolute clarity to the capital question. We are not expecting a new hospital in the next six years and this needs to be stated.” [page 23 of shadow ICB minutes

2022-07-07-public-board-pack.pdf (liverpoolwomens.nhs.uk)

A demonstration to Save Liverpool Women’s Hospital the first time the Hospital was threatened
Amanda Greavette is an artist who paints maternity and who allows us to use her materials for our campaign to Save Liverpool Women’s Hospital
We have held regular stalls since 2015 to Save Liverpool Women’s Hospital. WE have great support and learn about people’s experiences of the Liverpool Women’s Hospital

Protest at the first meeting of the ICS board for Cheshire and Merseyside

Protest targets private sector roles in NHS plans
Health campaigners will target private company involvement in local NHS plans and threats to emergency care at the first meeting of the Cheshire & Merseyside Integrated Care Board (ICB) in Liverpool this Friday. The ICB will manage £4.8bn of NHS finances for the entire region, with realterm cuts.
“We are outraged that a company director will sit on the ICB and US-owned corporations could be involved in reviewing Liverpool hospitals,” says Keep Our NHS Public Merseyside. “The new Health and Care Act fails to ensure emergency care for everyone present in our area. Patients and NHS staff, Councillors and MPs should demand this is guaranteed in the ICB Constitution.”
Warrington GP Dr Raj Kumar is designated as one of two Primary Care directors for the ICB. Dr Kumar is also a Director of Kleyn Imaging Limited, providing ultrasound, MRI, and digital
radiology as the “imaging arm” of Kleyn Healthcare Limited. Dr Kumar resigned as a director of Kleyn Healthcare on 27 June, but retains a controlling interest in Sycamore Corporation Limited which holds over 75% of shares in Kleyn Healthcare. Kleyn’s website proclaims “Welcome to a world of innovation, enterprise and transformational leadership in healthcare.”

A secretive review of Liverpool hospitals is being commissioned through the Health Systems Support Framework. The cost is “commercially confidential”, and the public cannot view the
specifications. The Framework accredits over 200 companies including US transnational corporations and their subsidiaries. Operose, owned by $111bn-a-year Centene Corporation,
featured in a recent BBC Panorama investigation of GP surgeries using “Physician Associates”
without proper supervision by fully trained GPs. Palantir, founded by Trump supporter Peter Thiel, hopes to be contracted for a system to underpin all NHS data.
“Operose, Palantir and other Framework firms should have no say in reviewing Liverpool hospitals, and the public must be able to see the terms and cost,” says Keep Our NHS Public Merseyside.
Notes to Editors

  1. Campaigners from Keep Our NHS Public Merseyside, Save Liverpool Womens Hospital, and
    Defend Our NHS (Wirral) will lobby the ICB from 10am Friday 1 July outside the old Lewis’
    building on Renshaw St. ICB papers: https://www.sthelensccg.nhs.uk/media/4887/220701-icbpapers.
    pdf
  2. Health Service Journal (26 April) “Every health system to face real-terms funding cut in 2022-
    23” https://www.hsj.co.uk/finance-and-efficiency/exclusive-every-health-system-to-face-real-termsfunding-
    cut-in-2022-23/7032346.article. Real term cuts in funding will be higher than the estimates
    in this article as RPI was already 11.7% in May.
    https://www.ons.gov.uk/economy/inflationandpriceindices/timeseries/czbh/mm23
  3. Previously, Clinical Commissioning Groups were required to ensure the provision of emergency
    care for everyone present in the area. See (1C) in
    https://www.legislation.gov.uk/ukpga/2006/41/section/3
    The new Health and Care Act does not mention emergency care.
    https://www.legislation.gov.uk/ukpga/2022/31/pdfs/ukpga_20220031_en.pdf
  4. Dr Raj Kumar’s appointment is announced in the Board papers and is to be confirmed at the ICB
    meeting on 1 July: https://www.sthelensccg.nhs.uk/media/4887/220701-icb-papers.pdf
    Dr Kumar is the lead GP at the Eric Moore Partnership, Tanners Lane, Warrington
    https://www.ericmoorepartnership.co.uk/
    LinkedIn account https://uk.linkedin.com/in/rajkumaruk
    Dr Kumar: https://find-and-update.company-information.service.gov.uk/officers/
    _BYMb7MBcxpDNrObrNeDR2FPg24/appointments
    Kleyn Imaging Limited: https://www.kleynimaging.co.uk/ and https://find-and-update.companyinformation.
    service.gov.uk/company/08029182
    Kleyn Healthcare Limited: https://www.kleynhealthcare.co.uk/index.aspx and https://find-andupdate.
    company-information.service.gov.uk/company/05945184/persons-with-significant-control
    Sycamore Corporation Limited:
    https://find-and-update.company-information.service.gov.uk/company/12180802/persons-withsignificant-
    control
  5. Liverpool Health and Wellbeing Board responded to questions from Keep Our NHS Public on 16
    June. See questions 6 – 10. https://councillors.liverpool.gov.uk/documents/b52488/Public
    %20Questions%20Responses%2016th-Jun-2022%2014.00%20Liverpool%20Health%20and
    %20Wellbeing%20Board.pdf?T=9. Despite the answer to question 6, the review is not mentioned in
    the ICB Board papers.
    Details of the NHS England Health Systems Support Framework are at https://www.england.nhs.uk/
    hssf/ with accredited suppliers at https://www.england.nhs.uk/hssf/supplier-lists/
    BBC Panorama (13 June) reported on Operose https://www.bbc.co.uk/news/health-61759643
    The FT (9 June) reported on Palantir: https://www.ft.com/content/3f6f24f8-9e5c-42c3-8ae6-
    bfef5f953524
  6. Keep Our NHS Public is a non-party-political organisation campaigning against the privatisation
    and underfunding of the NHS, with supporters in a network of over 70 local health campaign
    groups. See https://keepournhspublic.com/about-us/. It campaigned against the Health and Care Bill
    and calls for an NHS for people, not for profit:
    https://keepournhspublic.com/wp-content/uploads/2022/06/An-NHS-for-people-not-profit-1.pdf

Update! Dr Kumar is not taking up his appointment!!

The finances of the proposed move of Liverpool Women’s Hospital; early proposals

Again we are revisiting the work we did in the earlier years of the proposals for the future of the Liverpool Women’s Hospital. This was written in response to Future Generations publications. Since this was written, the disaster of the PFI model for building hospitals is clear. Liverpool still waits for the Carillion Hospital Further details of PFI can be found here

FINANCES

LCCG  ( Liverpool Clinical Commissioning Group) recognises that significant capital is required to re-locate LWH to the site of the new Royal Hospital. Of the various potential funding options, they see a Public-Private Partnership( PPP) as the most viable option.

Following the collapse of Carillion, Philip Hammond, in the 2018 Budget pledged not to sign any new Private Finance Initiative contracts (PFI).

“In financing public infrastructure I remain committed to the use of PPPs. We will establish a centre of excellence to actively manage these contracts in the taxpayers interest starting with the health sector.”

The PFI was a way of creating PPPs where private firms are contracted to complete and manage public projects. It is widely believed to be used by governments simply to place a great deal of debt “off-balance sheet”. In other words another expensive, disastrous financing model.

There has been very little said about what would become of the existing building at the Crown Street site. The PCBC (page 312) states that it is “likely to remain a site for NHS services”.

The Naylor Review( 2017) examines how the NHS in England can raise cash from its premises. Its findings were in line with the requirements set out in the Sustainability and Transformation Plans (STP)s which were introduced in December 2015 to fast forward NHS England’s Five Year Forward View (5YFV). The focus from STPs has evolved from Accountable Care Systems(ACS) to Accountable Care Organisations (ACO)s to Integrated Care Providers (ICP)s. ( Now called ICS) An ICP brings together a number of providers to take responsibility for the cost of care for a defined population within an agreed budget. This will force the NHS into an alliance with social care which is private and means-tested.

Two things underpin the thinking behind the review:

a) the need to free up public land and build much-needed housing to solve the housing crisis

b) the new models of care described in the 5YFV have different infrastructure requirements so surplus land can be disposed of and the profits used as an incentive for Trusts to meet targets imposed by STPs.

It appears that dispersing public assets into private hands is the objective behind these plans and not the long-term benefit to the public service. Private developers own between them enough land to build 600,000 new homes, so there is no critical need to release any public sector land. However, the release of public sector land would increase profitability for the private sector, especially if the sites are in prime locations. Liverpool Women’s Hospital (LWH) is situated adjacent to the Georgian Quarter of Liverpool, one of the most sought-after residential areas in the city. The building is owned outright by the Trust and the freehold is owned by the city Council.

Naylor emphasises the contribution of sales of existing estates and the introduction of private finance to create new builds as key to changing the estate to meet “the new models of care” set out in the 5YFV.

NHS Commissioners and regulators have considerable authority to insist premises be fit for purpose. These powers can be used to force the pace of investment in or exit from inadequate premises eg.by reducing payments for properties not meeting future service strategy to encourage moves. Section 7.4 of the review recommends

(Recommendation 10) “STP estates plans and their delivery should be assessed against targets informed by benchmarks set against the review. STPs and their providers which fail to develop sufficiently stretching plans should not be granted access to capital funding, either through grants, loans or private finance until they have agreed plans to improve performance against benchmarks.”

The guidance for STPs says transformation funding which is necessary to deliver key service changes and new models of care will “only be available to systems whose operational plans meet their required control total and performance trajectories.”

Naylor who write this report

Relocation of LWH to the site of the new Royal hospital would force another expense onto taxpayers in the form of a PPP. It would also pave the way for the sale of the present hospital and land to property developers or to private companies eager to get their hands on a modern, functioning hospital. If relocation were to take place and the existing building used for NHS services the likelihood is that those services would be tendered out and fall into the hands of the private sector. This should never be allowed to happen.

Land sales and commercial rents being forced onto Foundation Trusts and Gps are not a way of securing the NHS’ future. The Naylor Review recommended that HM Treasury should provide additional funding to incentivise land disposals through a “2 for 1” offer in which public funds match disposal receipts. A bribe to encourage the sell off of NHS properties and should the bribe not succeed

 there will be a penalty imposed for holding on to assets. The reality of the Naylor Review is another move to privatise public assets. Property developers stand to make a profit from land acquired on the cheap.

By deeming LWH “not fit for purpose” and by presenting a clinical case for change LCCG has put LWH and the land on which it stands in danger of being developed for housing, none of which will be “affordable housing” due to the soaring house prices in the area.

The selling of land just to raise money will not meet the demands of the Naylor Review, only changes of uses of existing services will do. The authority to change the use of an existing building lies with the City Council Planning Office. It would be timely to remind them of the significant investment of the NHS in LWH as a deliberate attempt of the then Dean of Liverpool to invest in the Liverpool 8 area through his Project Rosemary following the Toxteth Riots. The LWH is a much loved hospital, a specialist hospital dedicated to the care of the women and babies of Liverpool and surrounding areas and should remain so.

This article gives background to the Naylor report

This explains how the NHS sells off land

The Hospital Environment Matters. Revisiting some earlier ideas

By Sheila Altes

We are revisiting some of the work we did when the proposals to close the Crown Street Site were first raised. The article was written some years ago. These ideas are still relevant.

ENVIRONMENT

Liverpool Women’s Hospital is a specialist hospital dedicated to the care of women, babies and their families in a safe friendly environment. It opened in 1995 and is located on Crown Street, Toxteth in a modern landmark building (NHS Choices).

In 2013 a new development of the reception area incorporated a comfortable seating area, cafe, shop and a play area for children. It opens up onto a landscaped courtyard with seating, a herb garden was planted for use by the hospital chefs and a memorial garden was opened to offer bereaved families a private space within the hospital grounds.

Another garden “The Garden of Hope and Serenity” was opened in 2016.

“This garden is a lovely area where our women, families and staff can relax in the sunshine and escape life on the wards”

(Kathryn Thomas, Chief Executive at LWH).

The idea for this garden came from nurses at the gynaecology unit who recognised that women and families visiting the Emergency department would benefit from a space away from but near to the department to have an area of calm to process their thoughts and feelings.

There is a wealth of literature that confirms the importance of trees and gardens for patient recovery and should not be ignored. A much-cited study, published in 1984, by environmental psychologist Roger Ulrich was the first to use the standards of, modern medical research to demonstrate that gazing at a garden can sometimes speed healing from surgery, infections and other ailments.

Although it is clear that this will not cure disease, it has been proven that just five or six minutes spent looking at views dominated by trees, flowers or water can begin to reduce levels of anger, anxiety, stress and pain. This can allow other treatments to help healing and induce relaxation that can be measured in physiological changes in blood pressure, muscle tension or heart and brain activity.

Studies have shown that loud sounds, disruptive sleep and other chronic stressors can have serious physical consequences and hamper recovery (Ulrich,1994).

Henry Marsh, the celebrated neurosurgeon and writer has stated:

“……… these big hospital are horrible places really, the very last thing you get in an English hospital is peace, rest or quiet which are the very things you need the most”. He goes on to say that the garden he created at St. George’s Hospital,” ….. is probably the thing I am proudest of.” (The Observer).

Not all gardens are equally effective. A study found that tree lined vistas of fountains or other water features, along with the greenery of mature trees and flowering plants appealed the most. The more greenery versus hard surfaces the better (Cooper Marcus and Barnes 1994).

The plan for the new Royal hospital includes a landscaped garden. According to Brian Zeallear from NBBJ:

“Through creating smaller buildings around the periphery and having public roads and pedestrian corridors through the site, we can stitch back the existing city. The centre will feel like a public square.  The hospital is in a dense urban area but once the landscaping is done….it should make you feel you are in nature through the manicured grass, trees and water features”.

However sitting in a public square surrounded by public roads is hardly the restorative qualities of greenery, flowers and other nature content envisaged by Ulrich.

Liverpool Women’s Hospital is at present situated in a quiet, landscaped and safe environment. Although it is in a fairly central location it is protected from the sounds and pollution of traffic.

There is now substantial evidence on the adverse effects of air pollution on different pregnancy outcomes and infant health. The evidence for the impact of air pollution on infant mortality, primarily due to respiratory deaths in the post natal period seems to be solid (WHO 2005). There is now new evidence that shows air pollution particles from traffic affects the health of unborn babies ( Miyashita & Liu 2018).

Less consistent though still suggestive of a causal link to air pollution are lower birth weight, a higher incidence of preterm births and intrauterine growth retardation. Moreover, the evidence shows clearer relationships between particulate matter and traffic-related air pollution than other pollutants.

The intrauterine, perinatal and early childhood periods, during which the lungs are developing and maturing are very vulnerable times. These are times when the lungs are more susceptible to injury by air pollutants. Exposure during these periods reduces the maximal lung functional capacity achieved in adult life and can lead to increasing susceptibility, in adulthood, to infections and the effects of pollutants such as tobacco smoke and occupational exposures (Vierira 2015). Also there is sufficient evidence of a causal relationship between exposure to lead to neurobehavioural deficits in children in terms of cognitive impairment (WHO2005).

While it is impossible to avoid all air pollutants, advice from many sources include, remaining indoors when air pollution is high and even when air pollution is low it is best to avoid polluted roads (Greenpeace 20017). Campaigns to avoid exposure to air pollutants include moving school entrances from busy roads and the use of pram covers to protect babies from being exposed to harmful particles.

In the face of all the evidence of the harmful effects of air traffic pollutants on neonates, it is inconceivable that the environmental effects of building a hospital for women and babies in the middle of one of the most traffic-dense areas of the city have not been considered.

Councillors fighting for the NHS

Liverpool City Council will discuss the new health service configuration called the ICS for the first time since we lost the battle against the Health and Care Bill in Parliament. The battle for our healthcare will now take a different more urgent form, and councils have a part to play. We list below some key issues Councillors should raise.

Mental health, CAMHS, maternity, dentistry, GP services, Accident and Emergency, waiting lists waiting times, staff pay, staff retention, and staff working conditions are all under dreadful stress. Covid is simmering away and we have to prepare for a further outbreak or a big winter of flu. This huge restructuring to favour the private sector adds fuel to the fire.

Liverpool Council will discuss the implementation of the Integrated (not) Care System on Wednesday (25 05 22). All the other Cheshire and Merseyside Councils will be having similar discussions.

The Cheshire & Merseyside ICS is item 16 on the agenda at the city council.

Life expectancy has fallen. Life expectancy in good health has fallen (figures from before the pandemic which caused further falls) Our people are dying and getting ill earlier and not just because of a badly managed pandemic, but because of austerity and the decline in the NHS under Conservative and ConDem governments. It is on their watch. They carry the responsibility.

The NHS has many intertwined crises that this reorganisation does not address. Please see below for more on these urgent health care issues.

Councillors can significantly help protect healthcare in our area by adopting these immediate demands, drawn up by health campaigners across England.

Immediate issues. Councils are the only democratically elected organisations with any direct influence on these new  ICS structures. Councillors can report directly to their electorate to put these policies under the spotlight.

ICB Constitution. Each integrated Care Board must write its constitution.

We are asking councillors to please ensure the following commitments are written into the ICS constitution:

That the ICS in Cheshire and Merseyside will maintain a comprehensive health service, free at the point of need, accessible to everyone living in the area – including homeless people – at the time when they need health care or treatment.

That anyone needing emergency or urgent services while present in the ICS’s geographical footprint will receive the necessary treatment, whether or not they are registered with, or permanently reside within, the ICS area.

That ICSs should not include private sector representatives on any ICS boards or committees or any bodies with delegated powers from the ICB.

Privatising is a multilayered process. See this for a working definition.This new system is designed to limit care, and make a profit for private providers. However, this is rarely said in public. Privatising healthcare is still extremely unpopular. Government and NHS chiefs do not like discussing it. The Public does not want this to happen. Councillors though answer to their electorate and must speak up for them.

That NHS providers are the default providers of health services, care and treatment, and that as contracts with private sector companies come up for renewal the default position is that they will be awarded to NHS providers.

That if any contracts do continue to be awarded to the private sector, there must be vigorous scrutiny to ensure that this is conducted in a transparent and accountable manner.

That the Integrated Care Board include a councillor from each local authority covered by the ICS, not just one representative covering all the local authorities in an area.

That the Integrated Care Board must include representatives of professionals from Mental Health, Community Health, Maternity, Primary Care and Public Health, as well as from Acute services.

A commitment that maternity care will meet every aspect of Donna Ockendon’s report, including the required staffing

That Integrated Care Boards, Integrated Care Partnership body, place-based bodies, committees and sub-committees will include representatives of patients’ groups and of NHS staff trade unions.

That it be ensured that before a patient is discharged from the hospital, it is safe to do so and that any unpaid carers expected to look after the patient are both willing and capable of doing so, and that the operation of the discharge policy will be audited.

That nationally agreed pay, terms and conditions, including pensions, as negotiated with the NHS staff unions, will apply to all staff employed by any NHS provider within the ICS area.

That there must be a discussion with NHS staff unions about safe staffing levels and what is needed to ensure they can be implemented.

In item 16, there appear to be no councillors on the IC Board, only two executives from across the 9 Cheshire & Merseyside local authorities. These people will not be there to represent local authorities’ policies. Is this acceptable to Councillors?

The ICS structure has been tried in pilots and found wanting. The model has major faults.

Liverpool Policy

Liverpool City Council policy has been to oppose the introduction of the 40+ separate health systems (ICS=Integrated Care Systems) through the Health & Care Bill, now the Health & Care Act. This Act deliberately breaks up a national health service into these separate units, whose shadow structures (ICS) were set up ‘extra-legally’ before the Act became law.

Multiple Crises in Healthcare in May 2022

This new system starts with cuts. They talk the sweet words of Transformation but it is a brutal change they are implementing. Our hospitals, GP services, maternity, mental health and dentistry services are all struggling to cope, and at times failing. We are already so understaffed that maternity cannot provide one midwife to one woman giving birth.

Local mental health patients in crisis are being sent to distant cities just to get a bed.

Staff costs cover 46.6% according to The Kings Fund. Other surveys put it much higher. So, all cuts would hit staffing.

NHS hospitals, mental health services and community providers reported a shortage of 84,000 FTE staff. 38,000 are nursing vacancies, that is 1 in 10 posts. The immediate workforce shortfall is so severe it requires at least 5,000 nurses a year to be recruited from overseas.

“Every health system has seen their core recurrent funding reduce in real terms in 2022-23, analysis by HSJ reveals;

  • An increase in recurrent allocations wiped out by inflation
  • The situation is likely to be worse than official figures suggest
  • Every health system subject to real terms cut in core spending per head”

The Government has come up with some more money or some services but by robbing Peter to pay Paul, not producing real increases

HSSF

The HSSF is a list of companies that can be given NHS work without the normal bidding and scrutiny process

“Huge US transnationals are accredited by NHS England through the Health Systems Support Framework, to gain NHS contracts.”

Hospital Closures

The Act allows the Secretary of State to interfere early to decide on local ‘reconfigurations’ including hospital closures, thwarting public consultation, and weakening the say local authorities and councillors have on NHS plans in their area.

“Moving specialised services commissioning from NHS England to integrated

care systems risk fragmenting provision, creating postcode lotteries and diluting quality and expertise” a group representing some of the largest tertiary trusts has told NHS England.

We have had enough of closures, reduction in bed numbers and the chaos of the Liverpool Royal Carilion building.

Public Questions

The public will have no right to ask questions and get answers from the ICB or its committees and can be excluded from meetings. Who will see if health care treatment is just adequate and fair?

The report on the ICS Joint Health & Scrutiny Arrangements recommends the setting up of a Joint Health Scrutiny Committee across all nine local authorities in the Cheshire & Merseyside area.

Questions that need answering:

Thanks to Black Lives matter demonstrators for this image Its just as true for the NHS
  • How can Ockendon’s report on Maternity failings be tackled if large cuts are involved before the system is even legally launched? How can it tackle the Mental Health crisis, the GP crisis, the A+E crisis, the workload and workforce crises and Ambulance crises with fewer funds? We weep for the babies who died unnecessarily yet allow the situation to deteriorate beyond what it was when Ockendon investigated. Already this city has the worst deaths under one year old, and that does not include stillbirths.
  • How is Maternity represented on the ICS? Who on the ICS will be responsible? Every hospital must now have an ‘Ockendon rep,’ but not the ICS?
  • How will the Council’s Social Care Budget be impacted? The Act gives the ICS significant powers that need to be clarified, if necessary, in law.
  • How will the ICS ensure probity in allocating services to the companies on the HSSF list
  • How will the ICB ensure no health worker is denied decent pay?

The ICS model is based on a specific US model designed to make money for the private sector, ration patient treatment, and reduce staff pay. It has widened health inequalities. These organisations are now being used to privatise even Medicaid in the US.

For further information about how this has worked out for other areas see this from Calderdale

https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/integration/integrated-care-systems-icss

There are already talks of further reorganisation in Liverpool, according to the HSJ, including merging all the hospitals.

Remember how amazing the NHS was and could be again

Please email us for further details at TakebacktheNHS@protonmail.com

Follow the QR code to a digital version of this article

What now with The Health and Care Act becoming law?

The effect of the passing of the Health and Care Bill will be harsh. It is now an Act and as such will be implemented creating forty-two distinct organisations. Ours is the Cheshire and Merseyside Integrated Care System (ICS). Exactly who sits on these boards has yet to be published. We do know their chairs and many other posts.

Our anger at what is happening is righteous and well informed. As we campaign we want people to focus their anger into action, not let that anger become, as the Conservatives wish, debilitating and without purpose.

We need people to help with the campaign to reinstate the NHS and to monitor what is happening locally. Please do get in touch if you can help even in the smallest way.

Each  ICS organisation will be expected to keep to a set financial limit, and any financial risk-sharing will be within each ICS. This financial structure, in reality, is unworkable but it will be used to excuse and implement harsh cuts, which in turn will inflict death, pain, and suffering. It will mean worse pay for staff too. This is unless, of course, we can build a  deep and wide protest movement. This has been done before. We need to do it now.

The ICS boards will control all spending in the Cheshire and Merseyside health area. Hospital trusts start this era in debt, not from being spend thrift, but because budgets were not adequate for the treatments they had to deliver.

The ICS system is supposed to insist on no overdrafts, and that any over spend has to come from other hospitals in the local system. Well that’s not going to work, is it? In fact, this system is very dangerous for maternity as many of the Trusts in Cheshire and Merseyside do not provide maternity care and may not therefore even have an Ockendon Rep on their boards. Donna Ockendon insisted that each hospital had a board member responsible for Maternity on their board because of the poor oversight in Shrewsbury We have found no Ockendon Rep on the ICS board, in the paperwork available to the public We would love to be proved wrong.

Maternity is in crisis as the Royal College of Midwives, somewhat belatedly, said recently and that crisis must be addressed, rather than cuts in spending enforced. This is the lives of mothers and babies and the working lives of maternity staff that we are talking about. What is more important than the lives of mothers and babies at birth?

Meeting all the Ockendon requirements for safety requires major investment not cutbacks, not just in the Liverpool Women’s Hospital, but in Arrowe Park Hospital, in Leighton, in the Countess of Chester, in Ormskirk, in Whiston and any other maternity service in Cheshire and Merseyside and beyond.

Liverpool Women’s Hospital Board Papers said

The Trust is in underlying deficit, and faces additional pressures to maintain levels of workforce recommended by the (first) Ockenden report. There is a significant increase in clinical negligence costs which have not yet been funded.

Financial impacts of the second Ockenden review, and any funding available to support this, are being assessed. There are other significant cost pressures which will be managed through an ambitious and challenging 3% cost improvement plan plus additional non recurrent mitigations. .”

When the Banks needed bailing out huge amounts of money were conjured up for them. Sajid Javid the health secretary was a banker in those crazy times. Hey! Sajid, health needs a big investment that will pay for itself many times over.

This money shortage is serious. Researchers have gathered the figures from board papers from local hospitals.

Mid Cheshire hospitals Trust wrote “The system has £183m less resource than in 2021/22, which is a 3% reduction in funding after inflation has been applied. There are several factors which are influencing the movement and some key risks to receiving the funding in full.

“1. Convergence: C&M funding levels are currently above its calculated target allocation by £338.5m, and has a target to reduce this over time, leading to the additional reduction of £51.67m…..”

The UK is experiencing high inflation, especially from fuel costs. This will affect the NHS too. So we need to add inflation to the cuts described above.

NHS pay has acted to keep NHS inflation below the national average for some years. Low paid NHS staff who stay in the job because they are committed to the NHS will feel the increase in inflation still more.

Although the Act is called the Health and Care Act it does little for the mostly privatised Care sector. This letter is not focusing on that important issue. (A separate article will cover that). This situation is looking at the breakup of the NHS.

The problems in social care are impacting badly on hospitals which at present cannot easily discharge patients to care homes. The shadow of the Covid deaths hangs long over the care home sector and the Covid virus is far from spent.

The New ICS system introduced by the Act has been present in shadow form for some time and regional control of budgets increased during the pandemic.

This model of healthcare finance and delivery is based on the US Accountable Care systems. Accountable here means “for accounting,” not “answerable to.” It is designed to make money for the private sector. Designed to give our tax money not to the sick or the hard-pressed underpaid staff but to the rich.

Plans for this have taken many years, back to Thatcher and more recently work at Davos, the working groups of the globally rich.

We have lost a  National Health Service. The national part of the health service is important for risk sharing, research sharing, national pay structures, and shared experience. These models will produce postcode lotteries and differential services. We can imagine that they will blame Merseyside for the effect of their cuts as they are now blaming Liverpool for the effect of 60% cuts in local government funding.

The huge health gaps in life expectancy will open wider. Remember more babies die in Liverpool under one year of age than anywhere else in the country. Working-class women have a life expectancy ten years less than those in rich areas. The Tory voting areas will get service though

If we can build a campaign we will deepen the commitment to the Bevan Model of the NHS in our areas.

In these new structures, the national part of our health service has gone. What we have now is more like a localised public-private partnership. We want to bring back a national health service.

Publicly delivered. We want to return to a national publicly delivered health service. Private companies are designed for profit, not for healthcare.

A health service, of sorts, is still functioning, hit and miss as to the treatment you get. Doctors, nurses, midwives, physios, scientists, porters. cleaners healthcare workers all continue to go to work, work hard and with skill, and many are delivering good services, but there are significant dangers. Some are wonderful services, but all are at risk. The Cheshire and Merseyside ICS has big problems with staff shortages, funding restrictions, poor organisation and the present major reorganisation but for now, for some a service is still there.

Major cuts in funding are underway. See the Lowdown  The Lowdown article referred to £219m deficit in the C&M budget – practically every single hospital in the area has a deficit. So, in other words, the ICS will continue by making more cuts and demanding more from an ever-shrinking workforce who are paying the price of this reorganisation. The staff risk having their pay negotiated locally. It is a major leap forward  for  privatisation and healthcare for profit

Staff are poorly paid, understaffed, and worn out. Covid is still a factor so there has been no time to recover. Waiting times are long and harsh. The pressure to pay to jump the queue is very real. The private health sector has been given huge amounts of Government money. This is likely to continue especially as these companies will be influential on the ICS boards.

So when the going gets tough, the tough get going. Join the campaign to fight for the health service locally and nationally. Don’t make the NHS a dim and distant memory.

What now for the English Health Service?

The NHS is both wonderful and damaged. Babies that stood but a slim chance of survival are saved and go on to live full lives despite the chaos of underfunding, understaffing and overwork. Yet at times birth can be a terrible experience and outcomes sad. This mix of awesome and appalling is seen in other services too. The passing of the Health and Care Bill causes real concern. You can see the detail of this here

Fantastic care and expert treatments are delivered by overworked and underpaid staff. This has kept the NHS afloat through a decade of cuts, underfunding, staff shortages, the pandemic, privatisations, and closures. However, as Ockendon showed, the damage being done is very real.

The Health Service Journal published an opinion piece saying;

However, even before the first ICSs emerge blinking into the light, the seeds of their potential destruction are being sown”.

Some wonderful people fought this Bill In Parliament, and far more out of Parliament, but it was not enough. Campaigners wanted far louder opposition from Labour and Lib-Dems too. Many people still do not know what is going on.

The structures set out in the Bill will be cumbersome, costly, and designed to facilitate private company involvement and profit. It is designed to limit the care available,

World-class, Universal Comprehensive care, free at the point of need is at risk. A post code lottery is inevitable.

Not one of the pressing problems of the NHS is addressed in this Bill. The NHS needs £20 billion in additional funding now, and then an increase above inflation each year.

As the Bill finished in parliament TV and radio adverts for private health insurance became more common.

The NHS needs better funding, more staff, better pay for the staff, and better conditions to retain the staff we have

Mental health, maternity, and social care are all in difficulties from poor funding, poor staffing, cuts and privatisation.

Many nurses opened their payslips to see their take-home pay fell in the month their pay rise was paid.

We now need a big campaign to monitor the NHS so cuts cannot happen out of sight in the forty-two new ICS areas. Ours is Cheshire and Merseyside.

Please help:

Please write to your MP

Please write to your councillor

Please join our campaign; message us at takebacktheNHS@protonmail.com

Please invite us to speak at your meetings

Campaigners worked hard to tell people about the Health and Care Bill, hoping we could together put pressure on Conservative (and Labour) MPs to vote against it. We did not shift the Conservatives and the vote went through. Nevertheless, they will face the ire of the people at the next elections. Let us make sure that by then we have reached millions more people.

This situation is partly because people don’t know about the Bill, partly because people really can’t believe the NHS would be harmed, but more and more people are waking up to the dangers.

The Bill causes real harm. Please see this for details.

Our campaigns will have to change focus to each of the 42 areas and their ICS boards. That’s going to be a bad thing for the NHS as a whole but in some ways easier for campaigners.

There has rarely been more chaos in parliament, but MPs must be held to account. If you have a Conservative MP please write to them. Labour MPs by and large voted against it but we feel they did not do enough, with some honourable exceptions including Margaret Greenwood MP and Justin Madders. Liverpool MPs worked closely with us too. Surely they had a duty to inform their constituents about this risk to our health care free at the point of need. We will publish a letter to Labour MPS soon.

The structure of the NHS in this new Bill is already out of date, cumbersome and costly.

Writing to your MP

REJECT THE GOVERNMENT’S HEALTH AND CARE BILL

Please fill in this form, sign it, post it / or give it in to your local Member of Parliament.

You can email instead of writing through this service

Dear Member of Parliament,

Our NHS is beloved by everyone throughout our countryside. Its underlying ethos that everyone is entitled to the same professional care and attention once they cross its threshold is a wonderful source of comfort and reassurance.

The NHS system is the envy of the world. It is important that it remains a public service, so that money can be spent on patient care, rather than going into the pockets of shareholders.

It continues to evolve and is nurtured by health care professionals who care deeply for the NHS.

However, the current Health and care Bill will fragment the NHS into 42 regions leading to a postcode lottery.

Representatives from private companies will be allowed to sit on decision-making boards and influence what services are provided. The government says it will prevent individuals with ‘significant interest’ in private health care from sitting on them. This is not good enough. Big businesses should not have a say in how public money is spent.

The bill provides for the NHS professions to be taken out of regulation – with implications for those who work in the NHS and the quality of care we can expect to receive.

The British Medical Association Has called for the bill to be rejected!

For the sake of the health and peace of mind of this and future generations, please vote against this bill.

Yours sincerely

Signature                                                                                                              Date                                        .

Surname.

Forename.

Address                                                                                                                                                               

                                                                                                                                                                                

Post Code.                                         

The state of the NHS April 2022. Mend the broken heart of the NHS.

Mend the broken heart of the NHS

Immediate actions are required by the Government.

  1. Lift financial restrictions on hospitals, paramedics and GPs. This must include removing the ridiculous 5% savings and the suggestion of absolute cash limits. Financial restrictions imposed during this crisis will end up costing more lives and more money long term. Invest in our Health Service. It pays us back with health and wealth.
  2. Approve emergency funding of £20 billion to save lives
  3. Ensure maternity services have all the funds required to meet Ockendon’s recommendations.
  4. Thank the staff who have worked through such tough times.
  5. Discuss with frontline medical, nursing, midwifery, and ancillary staff about what they think would make an immediate difference. Find ways of making this consultation routine. Implement the most constructive suggestions. Put a full stop to bullying and silencing staff.
  6. Tell Hospital management to forget the Internal Market, the ICS system and other wasteful bureaucracy. Put more time and effort into patient safety and staff retention, especially personalising shift patterns.
  7. Pay patient-facing staff a premium rate pending full pay negotiations.
  8. Put in as much non-medical support (cleaners, catering and care staff) as possible both for staff and patients so there is someone to keep anxious patients safe in A+E and anywhere else where this would help.
  9. Provide excellent canteens so staff can eat well at work and, if tired, pick up a meal to take home.
  10. Pay childcare when staff are willing to work extra shifts.
  11. Recruit retired or qualified staff who have left, for regular short hours working.
  12. Pay, as if at work, staff who have left to retrain.
  13. Fund GP services and walk-in centres to provide more services to take pressure off A&E. Make sure these services can link directly by phone or video to expert advisors when necessary.
  14. Consult with patients and their families about how their immediate experience could have been improved.
  15. Introduce more Covid protections including encouraging mask use, improving mechanical ventilation in hospitals and schools, make use of public buildings to reduce class sizes. Provide excellent quality school meals.
  16. Reinstate free Covid tests, nationalise testing & fund local public health.
  17. Improve staff PPE.
  18. Take over private facilities required to improve NHS services.
  19. Nationalise care homes with existing staff protected. Make use of any suitable buildings to increase the provision.
  20. Pay home visit carers a decent wage and try to win back experienced and qualified staff who have left.
  21. Encourage migrant staff by lifting the NHS premiums.
  22. Work to recognise overseas training, or provide additional training for migrants already qualified in medical skills to meet NHS standards.
  23. Pay informal carers twice the current rate.
  24. Provide more adaptations for disabled people currently living at home.
  25. Tackle shortages of medicines such as HRT.
  26. Bring private contracts/outsourcing back in house.
  27. Fully fund & expand ambulance services, lift financial restrictions.
  28. Engage in proper pay negotiations with all NHS staff.
  29. Protect the NHS as a universal, comprehensive, publicly funded and run, health service.

Immediate actions are required to support the NHS through the April/May 2022 Crisis. We hear both through personal experience and through reports of the difficulties the NHS is facing. The situation must change.

AS true for the NHS as for Football clubs

These are some essential short term fixes. We need also to reverse the policies from the 2012 Act, ditch the Health and Care Bill, have a proper plan for the workforce and remove privatisation, the internal market and rationing of care.

Campaigns like ours will continue to fight for the NHS, including making it clear to Conservative MPs that the Health and Care Bill still being discussed in Parliament is utterly unacceptable. Detailed descriptions of the Health and care Bill and other privatisation issues have been covered in other blog posts. This is what needs to be done immediately. If you agree with us please send this to your MP and to your councillors. If you have suggestions as health or social care workers, patients or campaigners please let us know.

Break the Bias. Working for Women’s Health

Save Liverpool Women’s Hospital Campaign Group’s International Women’s Day Celebrations

8th March 2022

The following is the transcript from Dr Rebecca Smyth’s talk: ‘The Gender Data Gap’

Hello everyone,

Firstly, Happy IWD to you all!

Each year the IWD organisation identify a theme.

And this year the campaign theme is: BreakTheBias

Here is a quote from their website (IWD organisation), this is what they say: 

Imagine

A gender-equal world.

A world free of bias, stereotypes, and discrimination.

A world that is diverse, equitable, and inclusive.

A world where difference is valued and celebrated.

Together we can forge women’s equality.

Collectively we can all BreakTheBias.

(https://www.internationalwomensday.com/theme March 2022)

I am going to talk for a few minutes about women and health, with a particular focus on bias, given this year’s theme. As we all know your sex has a significant impact on your health, so let’s see if we can start to better recognise this bias and think of ways to BreakTheBias. 

I think we all agree that roughly half the world is inhabited by women (49.6%), half by men (50.4%) (I’m excluding animals and plants here by the way), based on 2020 figures. However, that’s where the fairness of the divide ends.

In my talk I’m going to focus on the inequalities there are in access to healthcare and healthcare outcomes for women. I’m wanting to identify some of the bias that is present.

But before I do, I think we need to consider and acknowledge where the ‘evidence’ comes from / where our ‘knowledge’, where our ‘understanding’ comes from. Because recognising this goes some way to BreakTheBias, or we could call it unfairness or we should actually call it discrimination.

Most of our ‘knowledge’ about health, some would actually say pretty much everything we know uses data, and it is this data that is male-biased in other words the data favours men and does not reflect the true world we live in. So, our decision-making, healthcare treatments for example are based on data gathered from men and this is known as ‘the gender data gap.’ It is where a “one size fits all” approach has been used, however it has left gaps in our understanding of the experiences of women because it is male-biased. Women have basically been excluded. So, the upshot is that most of what we understand is skewed in the favour of men. It’s a male-default world we live and we need to Break this Bias.

If I can give you some examples. The one many of you will know and which is perhaps a little light-hearted, nevertheless annoying and one I think all of us can relate to is room temperature. I’m sure we know all about room temperature at home. And there is ample evidence that office environments are tuned to male biology. Air conditioning is often set according to a 1960s formula based on the metabolism of a 40-year-old man who weighs 11st. Previous studies have suggested that the average woman is most comfortable at about 25C, 3C higher than for men. Because women generally have a lower metabolic rate than men because of their body composition so they prefer warmer rooms and need less air conditioning. (Koch; National Geographic 2015). However, this has still not been corrected in many offices (or homes!).

Another light-hearted one… mobile phones.  Like the standard piano keyboard, smartphones have been designed for male hands and therefore may be affecting women’s health adversely. It is a relatively new field of study, but the research that does exist is not positive. Within the studies, women were significantly under-represented and the vast majority of studies do not break down the data by sex. The few that did report a statistically significant difference in the impact of phone size on women’s hand and arm health as well as physical comfort (Kwon 2016). Speech-recognition software is trained on recordings of male voices: Google’s version is 70% more likely to understand men (Criado Perez 2019).

Here’s another one for you demonstrating the gender data gap: we all know that women even when in paid work still do the majority of the housework (McNunn 2018, UCL Epidemiology & Health Care). Yet it is documented that fitness monitors underestimate steps during housework by up to 74% and calories burned during housework by as much as 34% (Criado Perez 2019).

So why should we think these are just light-hearted examples, why should we not consider that these types of bias play out in much more important aspects of our lives, health, work, politics and political decision-making. The ‘gender data gap’ is everywhere. Let’s Break this Bias.

Regarding health, let’s talk about heart attacks.

Early diagnosis of a heart attack is essential for treatment and survival. Research by the British Heart Foundation (BHF) has shown that women having a heart attack are up to 50% more likely than men to receive the wrong initial diagnosis. Women are also less likely to get a pre-hospital ECG also. And someone who has an incorrect initial diagnosis of heart attack has a 70% higher risk of death after 30 days compared to someone who receives the correct diagnosis straightaway. So, this is serious.

This is because of how we have been informed (and by we, I mean everyone, healthcare workers too) as to what the signs and symptoms of a heart attack are. That’s because we are basing our knowledge solely on the male experience, on what male symptoms are. In fact, over a ten-year period, more than 8,200 women died needlessly following a heart attack. They could have been saved if they had received the same quality of care as men. The BHF call this ‘Bias and Biology’. Here is a quote from a woman who suffered a heart attack. She says… “Doctors thought my symptoms were due to asthma, stress and anxiety at a time when I was changing jobs. But on holiday I had a heart attack and the very next morning I was sent for heart bypass surgery” (Simone Telford 2022). We need to Break this Bias.

Some symptoms of a heart attack do differ between the sexes (British Heart Foundation May 2022). A study by the BHF (May 2022) found more women had pain that radiated to their jaw or back and women were also more likely to experience nausea in addition to chest pain (33 per cent vs 19 per cent). Whereas, the less typical symptoms, such as epigastric pain (heartburn), back pain, or pain that was burning, stabbing or similar to that of indigestion, were more common in men than women (41 per cent in men vs 23 per cent in women). Important to know that women tend to wait longer before calling 999 after first experiencing heart attack symptoms. And we know any delay can dramatically reduce your chance of survival. Additionally, heart attacks are often seen as a male health issue, but more women die from coronary heart disease than breast cancer in the UK. So we really need to Break this Bias, because this misconception is leading to avoidable suffering and loss of life (Pearson, BHF Associate Medical Director 2022). (An interesting video for anyone concerned about heart attacks in women from NHS Scotland here)

Let’s talk about women in research…

Think of another example, Alzheimer’s. In the UK Alzheimer’s disease is almost twice as common in women compared to men. Now, why is it more common in women than men? Well for a long-time clinicians and researchers put it down to the fact that women live longer than men, and didn’t explore it any further. It is only more recently that researchers have begun looking past this assumption, and early discoveries indicate that the impact of biological underpinnings may contribute to the underlying brain changes. Evidence demonstrates that women with dementia have fewer visits to the GP, receive less health monitoring and take more potentially harmful medication than men with dementia, new UCL research reveals (Dayantis 2016). So, for many years bias was present, we need to Break this Bias.

The under-representation of women in clinical trials stems from the long-held assumption that the male perspective represents the norm. For those of you with clinical interest, you will know that medical education textbooks typically default to the male in case studies and anatomical drawings, while women are represented only in matters specific to reproductive biology (Liu 2016).

Differences in pharmacokinetics of drugs between the sexes can be related to body composition and size (Wizemann T, Pardue 2001). Women typically have a lower body weight than men, so when taking the same dose of a drug, results in a higher level of the drug (Parekh 2011, Wizemann 2001). That’s why we see an increase in adverse drug reactions in women. In fact, data suggests women experience adverse drug reactions nearly twice as often as men (Zucker 2020)

However, women have been excluded from pharmaceutical research for many reasons (Yakerson 2019). Now we can’t ignore the thalidomide tragedy of the 1960s which prompted a protectionary ban on pregnant women and women of child-bearing age from participating in clinical trials. Other obstructions are the perceived complexity and higher costs of studies if women are included, women’s unwillingness to participate, and the pervasive treatment of the male body as the norm (Yakerson 2019). They also viewed women as confounding and more expensive to research because of their fluctuating hormone levels (Wizeman 2001). Well, all I can say is we’d be extinct without our ‘fluctuating hormone levels!

It was only in 1993 (29 years ago) that the landmark US National Institutes of Health (NIH) Revitalization Act changed the model from excluding women to recommending their inclusion in phase III clinical trials (Zucker 2020). So improvements are being made however, the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH brings together regulatory authorities and the pharmaceutical industry) has not recognised the need for specific, standalone guidelines on the inclusion of women, continuing to refer to women as a special subgroup to be considered when appropriate (https://admin.ich.org/sites/default/files/2019-04/ICH_Women_Revised_2009.pdf). We need to Break this Bias.

Less than 2.5% of publicly funded research is dedicated solely to reproductive health (“UK Health Research Analysis 2014 (UK Clinical Research Collaboration, 2015) http://www.hrcsonline.net/pages/uk-health-research-analysis-2014”), despite the fact that one in three women in the UK (34%) will suffer from a reproductive or gynaecological health problem (https://www.gov.uk/government/news/survey-reveals-women-experience-severe-reproductive-health-issues 2018). Endometriosis affects one in 10 women, which means it is as common as diabetes in women. The proportion of funding that goes into diabetes far exceeds the levels of funding that goes into endometriosis.

For more info on endometriosis see the end of the article Image is from John Hopkins

There is five times more research into erectile dysfunction, which affects 19% of men, than into premenstrual syndrome, which affects 90% of women (Slawson 2019, https://www.theguardian.com/education/2019/dec/18/women-have-been-woefully-neglected-does-medical-science-have-a-gender-problem). I’ll leave it there. Let’s Break this Bias.

If I give an example of pregnant women in Covid research trials: The disparity in trial inclusion has been exacerbated in the covid-19 pandemic, in fact, pregnant women initially were not included in covid-19 vaccine trials. A recent review reported that of 927 trials related to covid-19, 52% explicitly excluded pregnancy, 46% did not mention pregnancy, and only 1.7% specifically included pregnancy (Smith 2020)

This initial exclusion evidently impacted the very slow uptake of the vaccine in pregnant women. In Dec 2021, the RCM and RCOG emphasised the urgency for pregnant women to receive the vaccine, that’s because at that time three-quarters of all ICU patients with Covid-19 were pregnant women. That’s the consequence of not Breaking this Bias.  The default position should be to investigate and treat pregnant and breastfeeding women in the same way as non-pregnant women unless there are clear reasons not to (Knight 2019).

Time has not allowed, but I think we should return to this another time about the appalling under-representation of minority ethnic groups in research as well as women from deprived areas / lower socio-economic groups (Redwood and Gill 2013). Lots more can be said about these issues.

I’ll just end on, if we are going to achieve any kind of equality, then it is essential we have equal participation and leadership of women in political and public life.  However, data shows that women are underrepresented at all levels of decision-making worldwide, and achieving equality in political life is far off. In our government, 35% of MPs in the House of Commons are currently women, and this, this is an all-time high. And in the House of Lords, it is 28% and around just 36% of local authority councillors in England are women.

If we are going to get anywhere with any of this we need to BreakTheBias

Rebecca Smyth 08/03/22

Endometriosis link <a href=”http://”>here