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What on earth is going on with our GP services?
The fight to save the Tuebrook GP practice

When Save Liverpool Women’s Hospital campaign are out and about people often ask about GPs. Why can’t they get appointments? Why don’t we know our GPs like we used to do? Why are some practices closed? Which bits are privatised? Why are some doctors unable to get work? Why are so many people who are not doctors employed at GP practices? Why, when need is increasing, are there fewer GP practices in England than at any time since 2016? Why are GPs in dispute with NHS England? Why are GPs so overworked? Why when people are less healthy do we have less healthcare?Why is less spent on GP practice than in 2018? If we want to Restore and Repair the NHS we need to know what has already happened to this much loved and very valuable service, what is happening now, what the privatisers have in store for us next and knowing all this we need to talk about how we can win it back.

Sheila Altes answers some of these questions. We welcome contributions to this discussion. The condition of the NHS means that many more patients and their families and friends need to know more.

General Practices

General Practitioner (GP) practices are not private companies, they are independent contractor organisations set up to deliver NHS services for the NHS. Staff working in general practice are usually employed directly by the GP practice and not by the NHS.

Every partnership of GPs must hold an NHS GP contract to run an NHS commissioned general practice. These set out mandatory requirements and services for all general practices as well as making provisions for several types of other services that practices may also provide if they choose to.(The Kings Fund 2020).

There are 3 types of contracts in England:

General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS).

The majority of GP practices hold GMS or PMS contracts.

General Medical Services (GMS)

GMS contracts are negotiated nationally every year between NHS England and the British Medical Association’s (BMA) General Practitioners Committee (GPC England). The GMS contract is then used by the commissioner to contract GP services in a geographical area to deliver ‘core’ medical services.

Personal Medical Services ( PMS)

This is another form of contract. Similar to the GMS but negotiated and agreed locally by the commissioner with a practice. It is soon to be phased out.

The core general practice contract sets out the geographical area the practice will cover. They must have a register of patients and provide the essential medical services set out in the contract. There are other requirements such as standards of premises and workforce and key roles and responsibilities including complaint procedures, insurance, liability and governance. They must provide essential services for registered patients and temporary residents who are or believe themselves to be:

*ill with a condition from which a recovery is expected

*terminally ill

*suffering from chronic disease.

They must provide ongoing treatment and care.

Alternative Provider Medical Services (APMS)

This new type of contract for the provision of NHS services was introduced in 2004. This allowed the contract to be held by a private company or a not- for- profit organisation; the contract no longer had to be between a named GP or GP partners and the NHS.

This effectively opened up primary care to private companies owned by directors and shareholders. So instead of GPs who had worked in an area for years, who knew their patients, primary care could be delivered by a private company who employed salaried GPs.

APMS contracts were advertised with a fixed amount of payment over a long term usually 10 years. As long as mandatory services were met and any services covered in the contract, then any money not spent was profit for the company and its shareholders. If the company or organisation held several contracts then economies of scale come into play (Lowdown 20/3/21). Further profits were made by down- skilling and reducing the workforce. These efficiency savings (cuts) don’t go to the NHS but to the shareholders.

This gave rise to the entrepreneurial GPs who set themselves up as directors of these companies and made huge sums of money. SSP Health comes to mind. In 2013 they took over the management of 22 surgeries in Liverpool. One of these surgeries was Princes Park Health Centre. Under their management it went from being a flagship model of primary care to being ranked in the bottom 300 out of 8000 GP surgeries in the country. A campaign by Keep Our NHS Public Merseyside focused on the difficulties of the patients at Princes Park. This campaign forced SSP Health out of Liverpool and their contracts for all but 2 of the surgeries were awarded to other providers. However they are still active in the North West and manage over 40 surgeries. Details of the KONP campaign can be found on:

www.labournet.net/other/1502/konp1.html

Even though the majority of GPs are independent contractors, the use of APMS contracts attracted many private companies who began to take over primary care.

Funding

GPs who hold a GMS or PMS contract are paid for services provided, both mandatory and additional services, where they have been agreed. Additional income is generated by the Quality Outcomes Framework (QOF). This is an incentive scheme that allows practices to earn points for performance of good practice, Achievement is measured for indicators in 4 areas known as ‘domains’: Clinical Domain, Organisational Domain, Patient Experience Domain and Additional Services Domain.

In the clinical domain, there are approximately 20 areas where points can be achieved. For example, registers of patients with long term conditions such as : asthma, chronic obstructive pulmonary disease, chronic renal disease, cardiovascular disease, hypertension, diabetes etc. If a certain percentage of these patients are reviewed annually and are found to be on the appropriate medication for their condition or if control of their condition is achieved within guidelines set out by NICE, then points are awarded and payments made.

The system is open to abuse and can become a box- ticking exercise. Unscrupulous practices can manipulate the registers remotely.

This system is operational in England, Northern Ireland and Wales. Changes to the framework for 2023/24 were imposed by NHS England but rejected by GPC England and NHS England has committed to a review of the system. More information can be found at:

Quality and outcomes framework (QOF) www.bma.org.uk

Money is also paid based on the size of the practice population and “weighted” according to certain criteria. The average payment per” weighted patient” was £104.73 in 2023 (NHS England).

“Weighted” list size is a measure of workload on the basis that it represents a measure of time expected to be spent on consulting. Certain types of patients place a higher demand on practices than others, for example: elderly patients, patients with mental health issues, non-English speaking patients, or if the practice is in a deprived area where patients are more likely to have complex conditions.

The practice must pay all its salaried employees and the running costs of the practice. The partners do not get a salary but get paid out of the practice income. They are also liable for any losses made by the practice.

Further funding was made available to general practices if they became part of a Primary Care Network.

Primary Care Networks (PCN)

PCNs were introduced in England as part of the NHS Long Term Plan published in February 2019.

A PCN consists of several general practices working together, so instead of a general practice caring for a few thousand patients a PCN will have between 30,000 and 50,000 patients on its list. Each PCN will have its own Clinical Director, who doesn’t have to be a GP. Governance structures will be determined locally and recorded as part of a Network Agreement. Funding will be made available to GP practices in PCNs via the Network Contract Directed Enhanced Service (DES).The contract will be in addition to existing GMS,PMS and APMS The contract will be between the commissioners and the individual practices and the money will be channelled through a single bank account directed by the network.

Additional staffing will be required to deliver the seven National Service specifications of the DES. They are:

*structured medication reviews

*enhanced health in care homes

*anticipatory care (support that focuses on people with long term conditions with the aim of reducing the risk of their condition worsening that would result in a hospital admission)

*personalised care ( patients have more choice in the way their care is planned)

*supporting early cancer diagnosis

*cardiovascular disease case finding

*action to tackle inequalities.

The additional staff needed included physician associates, first contact physiotherapists, social prescribing link workers and clinical pharmacists. Funding is given for these via the Additional Roles Reimbursement Scheme (ARRS). Underfunded and understaffed general practices cannot use these funds to employ other GPs, with the result that many salaried GPs and locums cannot find employment.

Digital -first primary care became a new option for every patient, they would have the right to choose telephone or on- line consultations instead of face- to- face consultations. This could be with their own practice or a digital provider. A framework was created for digital suppliers to offer their services to networks on standard NHS terms. This represented a golden opportunity for software companies to jump on the bandwagon and also to access patient data, invaluable to health insurance companies.

The Long Term Plan was published in February 2019 and PCNs were to be formed by June 2019. Forcing successful and struggling practices into networks in such a short time did not give them the support needed to deliver priorities: all part of the plan. NHS England then published a list of approved suppliers of support and development available on the Health Services Support Framework. They included: Centene, Virgin Care, Optum, KPMG, Deloitte, Ernst & Young, PwC, McKinsey, Cerner, Atos and many more global corporations. This proves the intention is to stream NHS public funds into these corporations (Green,J.,2019)

The aim was to cut GP appointments and also the number of GPs needed to care for patients. Only patients with complex needs will see a GP, the rest will be sign posted by a “care navigator” to less skilled clinical staff.

Investment and Impact Funding (IIF) is another source of funding linked to networks rather than practices. The fund is an incentive scheme focusing on supporting PCNs to deliver high quality care; there are indicators that focus on where PCNs can achieve this. In 2023, the number of indicators was reduced from 32 to 5. Payments were made if the PCN achieved a certain percentage of people receiving flu jabs, learning disability health checks, fast track referrals for lower gastrointestinal cancer and patients being seen within 2 weeks of booking an appointment. This reduction in indicators freed up funds to be moved to the Capacity and Access Payments. to facilitate the Same Day Access scheme.

In this scheme, when a patient phones the GP practice, they will be put through to a centrally controlled system. If they want a same day appointment the call will be transferred to a Same Day hub where a ‘care coordinator’, not a doctor, will triage the patient on to someone else at the hub, also not a doctor, who will decide how to deal with the request. Each hub will be staffed by physician associates and only one senior supervising GP.

This caused serious concerns in North West London, where the scheme was being forced on the PCN from 1st April 2024. They were concerned that the plan could potentially cause serious threats to patient safety and could lead to the replacement of fully trained GPs by cheaper, less well trained staff (GP Direct. February, 2024). Patients could be sent anywhere within the group of networks, which would make continuity of care difficult. There is increasing evidence that a high level of continuity of care results in better health outcomes (NICE. February 2019)

The plan had been designed by KPMG, one of the 4 big accountancy multinationals, paid to design it and to train GPs how to use the service.  No patients, residents and a minority of GPs were consulted. After a huge backlash the North West London ICB were forced to retreat but did not abandon the plan, only to introduce it more cautiously (Health Campaigns Together, Spring 2024).

PCN Incorporation.

PCNs are not legal entities. They cannot hold contracts, employ staff or own property. This means there is no corporate model, it is the practices themselves that have to enter these arrangements on behalf of the network. Rather than have a lead practice employing staff and managing funds on behalf of the other practices, a corporate vehicle can be used to manage PCN activity and funding between members.

Forming a corporate vehicle involves merging the PCN practices into a single practice. In this way they can become  limited companies with shareholders. Once the corporation vehicle is formed, assets, staff and contracts can be transferred into the corporate vehicle.

The corporate vehicle may provide administrative activities or could sub-contract responsibility for clinical services delivered under the DES contract. It can enter contracts in its own right, own property and be responsible for employing staff.

If networks are forced to merge, as outlined in the North West London plan for Same Day Access hubs, then a company can be formed via a corporate vehicle. This is an attractive opportunity for private equity firms to invest in the company as income from the NHS is virtually guaranteed.  In order to make a profit, private equity companies invest in companies for a limited period, they then restructure it and make efficiency savings, usually by reducing services, cutting corners and reducing staff. They fund the investment partly with their own investors’ money and by borrowing. Once the contract ends, they share the profits with their investors and pay off the debt. Depending on the contract they often leave the debt with the company invested in. Private equity companies don’t have shareholders so there is little transparency.

The responsibilities of GPs in the UK have increased, partly due to the austerity imposed by the Government in the last 10 years. Income inequality affects health, and poor health puts a greater demand on healthcare. The reduction of bed capacity in secondary care, causing ever increasing waiting lists adds more pressure on GPs as they care for patients awaiting hospital treatments (Pulse 4/10/2023).

The extra administrative work necessary to obtain funding adds to the pressure on GPs .The new GP contract proposal for 2024/25 will see an uplift of only 1.9%, while, according to local intelligence, overheads have increased by 15%.

Dr. Katie Bramall-Stainer, chair of GPC England, states in response to the new GP contract proposal:

“They know as well as we do, that can only mean practice closures, staff redundancies, loss of the GP workforce, fewer GP Nurses, reduced activity, reduced access and an unacceptable experience for patients” ( BMA 28/2/2024)

By understaffing, underfunding and overstretching primary care, it is little wonder that the numbers of GPs has fallen. There needs to be a recruitment and retention of GPs, adequate funding and an end to private providers in the NHS. We need to continue with our campaigning to restore our NHS to its original founding principles of a universal health service, funded by taxation and based on need and not the ability to pay.    

Sheila Altes April 2024.

REFERENCES

British Medical Association (BMA) 28th February 2024

Responding to the new GP contract for 2024/25

www.bma.org.uk

British Medical Association

Quality and Outcomes Framework (QOF)

Changes to the framework in England 2023/24

www.bma.org.uk

GP Direct

Same Day Access Hub Proposal- February 2024

www.gpdirect.co.uk

Green, J. 2019

Large scale integrated primary care networks.

http//:calderdaleandkirklees999callforthenhs.wordpress.co

Health Campaigns Together – Spring 2024

Row over exclusion of GPs from ‘improved’ GP services in NW London.

GPs across the world- why do GPs have the most stress despite not working the most time.

Pulse 4th October 2023

www.pulse.today.co.uk

NHS England

Health Systems Support Framework

www.england.nhs.uk

NHS England

Managing regulatory and contract variations.

www.england.nhs.uk

National Institute for Health (NIH)

Calculating adjusted weight list sizes

www.ncbi.nim.nih.gov

The King’s Fund – 11th June 2020

GP funding and contracts explained.

www.kingsfund.org.uk

The Lowdown -6th October 2023

Private equity investing in UK healthcare

Homepage

The National Institute for Health and Care (NICE) 2019

Continuity of Care and Support.

www.nice.org.uk

Liverpool Women’s Hospital. Great work and great problems.
This banner in Liverpool Life museum is from one of the campaign groups for women’s health in the early twentieth century

Women and babies in Liverpool are entitled to the highest standard of healthcare. Our grandparents and great grandparents fought to found the NHS and left us this as their legacy. The NHS was a national service providing excellent healthcare, publicly provided and government funded. The new NHS did magnificent work for infant and maternal mortality.

In the last twenty years though, there have been years of cuts and privatisation in healthcare and years of poverty and subsequent ill health in Liverpool. A report to Liverpool city council this year said that, without change, “The life expectancy of women will fall by one year, and they will be in good health for 4.1 fewer years than they are currently.”

It is time to demand better.

Campaigning for the whole NHS

We are campaigning to Save Liverpool Women’s Hospital and to restore and repair the NHS. We want to see improved funding and staffing and to see the whole NHS move back to its original model of a national public service, publicly provided, providing universal comprehensive and timely care for everyone free at the point of need and funded by Government. If you have not yet signed our petition please do so.

Healthcare staff have worked way beyond what should have been needed to keep some good services going. Every day people are grateful for their work, their kindness and humour but sheer human effort cannot compensate for inadequate funding and too few staff.

Liverpool Women’s Hospital provides some excellent services but it has some serious difficulties too.

The Liverpool Women’s Hospital board meeting on 9/05/2024 reported some excellent staff work, including improved methods of helping premature and very premature babies survive and thrive. It also reported the success of moving early pregnancy loss to its own area, a development much valued by the mothers involved. Previous meetings have seen patients reporting their experiences too. In April there was a very positive report from a patient about her experience of the care she received from the Rainbow Clinic as a previously bereaved mum. We have also seen excellent presentations about the pioneering work on endometriosis and menopause at different meetings. The Hospital website says Every day on average, 24 babies are born in Liverpool Women’s Maternity Unit and another three babies are born prematurely and cared for in our Neonatal Unit.  Most of Liverpool’s babies are born at Liverpool Women’s Hospital and sick and tiny babies are cared for in the beautiful new NICU ( Neo Natal Intensive Care Unit)

Entrance to the NICU

The Liverpool Women’s Hospital is undertaking a major anti-racism drive to improve outcomes for patients and staff. We very much welcome this initiative. It is essential to save lives.

The core problem for Liverpool Women’s Hospital is under funding. This underfunding stems from the national underfunding of maternity as well as the general under funding of the NHS. This longterm underfunding has meant years of cuts. The NHS organisational changes from 2012 to create Trusts and Foundation Trusts also wasted many resources that should have gone to patient care.

Liverpool Women’s Hospital also has a long waiting list for cancer patients and waiting lists for gynaecology appointments. Some more staff have been appointed and hopefully the list will be dramatically reduced.These waits cost lives and health. The Chief executive reported that

“NHS England’s tiering process for cancer performance is designed to provide accountability and additional central support for trusts that are most at risk of missing national cancer targets. Trusts are categorised into tiers based on their performance, with Tier 1 being the most challenged and requiring the most support. Trusts may move between tiers based on their performance improvements or deteriorations.
In a letter received on 26 April 2024 from NHS England, it was confirmed that following a review of cancer performance, and in agreement with the regional team, the Trust will be in Tier 1 for Cancer from the week commencing 29 April 2024. The move to Tier 1 will involve regular meetings to discuss delivery progress and any required support from the relevant parts of NHS England.

Last year the hospital had a poor Care Quality Commission report for maternity and it has taken work to improve on this.New management is in place and they have plans to ensure that improvements are happening.

Our babies, our mothers, deserve much more.Every mother every baby treated at Liverpool women’s deserves the very best. Poverty from low wages, low benefits and poor housing is costing lives, and causing long term ill health. Inadequate health services are part of this.The Care Quality Commision report last year showed how much harm has been done by this underfunding and under staffing. The management must also be responsible for some of the damage mentioned in the Care Quality Commission reports.

The funding issues at Liverpool Women’s means that to meet the current level of service it needs twenty five percent more funding. Money is spent very carefully but for basic safety to be met, that extra spending is essential. At present the required money is being spent and temporary support funding has been made available, by the ICB or national NHS. However this situation puts the hospital into whats called Level 3 of the National Oversight Framework which could bring in management decisions not based on the needs of staff and patients, as the government clamps down on public spending.

Many studies show that money spent on good healthcare repays for itself many times over. At birth this is especially so as bth injuries can last a lifetime.

Neither merging the hospital nor dispersing its services will change that fundamental financial situation. Only an improvement of maternity funding will make a real difference.

Screen shot from page 52 of the LWH Board meeting 9 05 24

The underfunding of maternity leads to staff overwork and reduced services. Government safety figures for staffing are met but we say these safety figures are inadequate. The Government funding does not provide sufficient staff to deliver the kind of service patients and staff require. yet money is squandered on private companies and financial consultants.

There are national problems with maternity services described in many prestigious reports, as well as the Ockendon and Kirkup reports. No report has yet managed to shift the Government’s policies. We believe we need a huge campaign to win back the NHS.

A large part of Liverpool Women’s Hospital Maternity spend is on the maternity Incentive scheme, a government owned insurance system, run on a business model. Liverpool Women’s Hospital meets all the requirements of this scheme and so gets a refund from hospitals that do not meet all the safety requirements. This is an unbelievable situation..

Payouts from the fund are higher than the funding for maternity.If maternity were well funded fewer babies would be damaged and have to claim through the courts from this insurance fund.

In this crazy situation the hospital is still expected to make cuts (CIPs).

Our demonstration last October.

We have written before about how planned Cheshire and Merseyside ICB funding will not repair the situation patients experienced last winter. This poor experience was seen in many aspects, including A and E, care in corridors, access to GPs, access to NHS dentistry, and inadequate mental health provision. It will be worse next winter.

It was no surprise to hear there will be no new Hospital built in the next decade, nor does Liverpool Women’s require a new building. we believe that the new building idea was floated to make the idea of merging Liverpool Women’s Hospital into the big acute hospital more palatable. The existing building is less than thirty years old.However the drive to make fundamental changes remains, with merger or dispersal being the most likely recommendations. WE want to keep a distinct women’s hospital.

In the April Board meeting of Liverpool Women’s Hospital it was reported that work is in progress for major changes.

“the Women’s Hospital Services in Liverpool Programme. As part of the roadmap, the initial phase of the programme had been outlined, with an emphasis on the importance of openness, transparency, and continuous engagement with the public.
The development of a clinical case for change was scheduled for the spring and summer of 2024, with publication expected later in the same year. Feedback from this engagement phase, gathered during the winter of 2024/25, would then inform the approach to designing future services, with further development of potential options anticipated to commence in early 2025.” So the threats to Liverpool Women’s Hospital are still very real.

A meeting has been held with other Liverpool hospitals about the future for Liverpool Women’s Hospital and women’s health in the other hospitals in Liverpool.We have not yet been able to see which issues the other hospitals raised. Public consultation is promised this year.

No hospital can exist in a vacuum. Every hospital should be working in a mutually supportive system. The NHS was founded to be a national service, not a collection of competing hospitals. System working was damaged by the 2012 Act and the drive to privatisation. Cooperation and system working is required for the future of the other specialist hospitals in Liverpool, like the Heart and Chest and the Walton Centre.

Our campaign to Save Liverpool Women’s Hospital and to restore and repair the NHS has huge public support and is growing steadily.

The future of Liverpool Women’s Hospital is no safer this week.

Save Liverpool Women’s Hospital News May 2024.

Liverpool Women’s Hospital will not get a new building on the Royal Site. This announcement has been expected for some time. The BBC covered the story this week. On Radio Merseyside our campaign was asked to comment. We said that we were not surprised . The Hospital should stay on the Crown Street site and that what matters is proper funding, staffing, and resources because our babies deserve the best.

Our huge petition says.

Save the Liverpool Women’s Hospital.

No closure. No privatisation. No cuts. No merger.

Reorganise the funding structures, not the hospital.

Our babies and mothers, our sick women, deserve the best.

What’s happening with the  Liverpool Women’s Hospital?

There has been a press announcement that there will be no new women’s hospital built on the Royal site in the near future.

This announcement does not mean the future of Liverpool Women’s Hospital is safe, far from it. Public consultation about its future will be launched shortly.

The announcement is not a surprise to anyone who has followed the story of Liverpool Women’s Hospital or the story of broken promises from the Government about building new hospitals, even those in dire physical conditions.

For example in Leeds, the people were promised a new Children’s Hospital. In the meantime, services were dispersed to different hospitals to allow demolition. Now the new Hospital is not going to happen.

Nationally, maternity is underfunded and understaffed and has seen terrible scandals. We have written much about this in other posts.  Just this week there was a report about delayed induction of labour across the country (and this also has been seen in Liverpool Women’s Hospital). The Care Quality Commission reported “The quality of maternity, mental health and ambulance services has seen a “notable decline” over the last year, which is contributing to “unfair care” and worsening health inequalities,”

The Neonatal Unit at Liverpool Women’s Hospital

The Health Service Journal  also reported that

“families whose babies died and whose mothers were harmed – in some cases dying – in the East Kent maternity scandal were still having to prove legal liability to get any compensation. This is despite Bill Kirkup’s report, published around 18 months ago, having already looked at their cases in detail and reached conclusions on whether better care could have led to different outcomes.

But NHS Resolution, which handles the NHS’s clinical negligence claims, says causation and a breach of duty of care will need to be proved in each case. This may mean families have to engage not just lawyers but also experts in midwifery, obstetrics, and neonatal care.”

In such a national maternity crisis we must protect the services we have in the area. We say women and babies will be harmed if the Liverpool Women’s Hospital is forced into a merger with the huge general hospital. The focus on women and babies will be lost. The great maternity scandals of our age have happened where there was no real focus on women and babies.

The government and the NHS bureaucracy have wanted to close one hospital in Liverpool since 2015. Liverpool Women’s Hospital was chosen. This is to do with saving money not patient care.

Liverpool Women’s Hospital sits on a great site on Crown Street. The official opening was on 7th November 1995 and the building is in good condition. A £20million pound neonatal unit was recently added to the hospital. It does not need a rebuild.

Liverpool Women’s Hospital does need more staff and additional resources like a proper blood service, an improved emergency medicine service, a 24/7 consultant obstetric presence. It needs to tackle the long waiting list for Gynaecology treatment,  and improved intensive care. All of this requires funding and support from the national health service and government funding but without that funding our babies and mothers will suffer. The money must be provided.

Our Saturday stall n Bold Street

All hospitals should be run in a cooperative system with other hospitals but specialisms should be protected.

Liverpool Women’s Hospital, along with the whole of the UK, needs to improve infant mortality, maternal mortality and injuries to women and babies and to tackle gross inequalities.

Serious damage has been done to our health care. We see it in the terrible waiting times in Accident and Emergency, in the 14,000 preventable deaths caused by those A and E problems, we see it in dentistry, in the GP service, in mental health and in maternity. We see it in the eight million people on waiting lists. We see it in the exhausted staff.

The experience women have giving birth is getting worse because of these underlying, national problems and the day-to-day stress this brings into the hospital.

Liverpool Women’s Hospital is damaged too by the business model imposed on the hospitals. The drive to privatise and to move away from a service model in the NHS has caused problems all this century.

The new Chief Executive (James Sumner) and Chair of Liverpool Women’s Hospital (David Flory) are also the Chief Executive and Chair of the Royal, Aintree and Broadgreen Hospitals (Liverpool University  Hospitals Foundation Trust). Neither man is a specialist in maternal or infant health. The Health Service Journal has said these joint appointments are likely to lead to a merger of Liverpool Women’s with the big hospital. We say no to a merger, and a big yes to cooperation between all the hospitals in the area. Such cooperation is anathema to the privatisers. We need continued support from the people of Liverpool to win this fight and we need to link up with other maternity campaigners.

Please help Save Liverpool Women’s Hospital. Sign the petition, talk to friends family and workplaces about this, join the discussion, and help with leafleting and social media.

Invite us to speak to your organisation.

 Send us a donation.

 For all our mothers, sisters, daughters, friends, and lovers and for every baby

The Future of Liverpool Women’s Hospital, Spring 2024

Save Liverpool Women’s Hospital.

The future of Liverpool Women’s Hospital has been under threat for nine years now. The petition which is at the heart of the Save Liverpool Women’s Hospital Campaign says “No closure. No privatisation. No cuts. No merger. Reorganise the funding structures not the hospital. Our babies and mothers our sick women deserve the very best.

In the Liverpool Women’s Hospital Board papers 11.04. 2024, it was announced that “An indicative programme plan had been developed and this reflected the unlikelihood that a new hospital building, co-located with an adult acute site, would be built within a five-to-ten-year timescale.

( In plain English this means they will not get a new Hospital)

 And that

 “… discussions were held on alternative solutions for citywide women’s healthcare.

Our opponents promised the public that a new smaller hospital on the Royal site would improve services. We always said that such a plan was magical thinking and that even if they got the money for a new building the existing problems would still be there. We said moving the Liverpool Women’s Hospital from the Crown Street site would be bad for women and babies.

Now we are in the horrible position that the bribe of a new hospital has evaporated but the core financial and organisational problems remain. We well remember the Panorama programme many years ago when it was announced that they wanted to close one hospital in Liverpool, and that clearly was Liverpool Women’s Hospital.

There are serious problems for Liverpool Women’s Hospital not to do with the Hospital site.

The Board of Liverpool Women’s Hospital has made it clear that safe services require extra funding. We demand that this money be provided.

Liverpool Women’s Hospital has a grave shortage of funds for crucial services. The fault for this lies with the last four governments but especially the current government who are very much aware of the damage they are doing to maternity care. There have been numerous high-profile reports on this, not least of these reports, being the work of Donna Ockendon. Donna Ockendon is now working on another maternity report, this time from Nottingham.

There are five reasons this national problem impacts on Liverpool Women’s Hospital

  1. Healthcare in the UK is badly funded and badly organised, wasting money and resources on privatisation.
  2. Eighty per cent of Liverpool Women’s Hospital’s budget comes through maternity funding, mainly the Maternity Tariff. The maternity tariff nationally is inadequate. No other hospital relies quite as much on maternity funding as the Liverpool Women’s Hospital does.
  3. The costs of the Clinical Negligence Scheme weigh particularly hard on this, the largest maternity hospital. The Government scandalously spends more on compensation than it does for the whole maternity service.
  4. The hospital is a Foundation Trust, which is an expensive management model for a small hospital.
  5. The model of healthcare from this, and some earlier governments, saw hospitals as competing businesses rather than a cooperating system. A small hospital could not thrive in such a scenario. This model is changing but the new ICB model also poses serious problems. We call for a return to the original Bevan model of the NHS, where a fully funded national, publicly owned and delivered health system based on cooperation not competition, sees ongoing improvement in maternity services.

Liverpool Women’s Hospital lacks crucial services because of these funding issues.

Our petition, now with more than 40,000 signatures online and more than 20,000 on paper, says “Save the Liverpool Women’s Hospital. No closure. No privatisation. No cuts. No merger. Reorganise the funding structures not the hospital. Our babies and mothers our sick women deserve the very best.”

Our campaign wants to improve the whole maternity journey for women and babies, every aspect of it, safety, respect and celebration of birth. We campaign for maternity everywhere in the UK. It is not possible to solve the fundamental problems of Liverpool Women’s Hospital without solving national funding and staffing issues but we can stop projects that make things worse. There are many and detailed reports about how the experience of maternity has worsened in recent years.

Our campaign wants midwives, nurses, obstetricians, CSWs and other staff to feel safe, and respected at work, free from undue stress, with access to ongoing education and training and with the opportunity to eat well, go to the toilet and have proper breaks at work, both day and night.

Our campaign wants to see maternity well-funded and protected from privatisation and protected from trendy, untried innovations.

We want those running maternity services to remember that as medics they have a duty of candour, to tell the truth about funding and staffing issues.

Since 2010 there has been damage done to all maternity and women’s health services nationally, and Liverpool Women’s Hospital has not escaped that damage. Underfunding, understaffing, and lack of key equipment and services have all had an effect.

We campaign for the whole of the NHS, not just maternity

Why do we want a women’s hospital?

We want excellent healthcare for women and babies. Our babies, our mothers, deserve the best. It is that simple.

However, that is not what this and previous governments have provided. We want to keep the focus on the needs of women and their babies. The scale and depth of the maternity scandals in other big multi-site, multi-specialism hospitals is a testament to how important this is. There have been many prestigious reports published about how bad the damage has been to Maternity and to women’s health. One in seven maternity units have closed during the period of cuts and this wave of closures has not stopped.

Cuts in NHS funding are part of the Austerity project. Austerity cuts have hit women and children and the working class very badly whilst the rich get ever richer. In this situation, we must protect what we have and not let it go. Maternity in England has suffered grievously under austerity. Maternal deaths are the highest in 20 years.

Ockendon’s reports have painted a grim picture of the failings of the system. Our campaign has fought hard for national as well as local funding and held two conferences on this matter. None of these hospitals involved in the big maternity scandals were standalone  Women’s Hospitals like Liverpool Women’s Hospital and their failings were not blamed on being a standalone Women’s Hospital. Yet the standalone character of Liverpool Women’s Hospital was what all the case for change was based on.

When Donna Ockendon did her first report on the Shrewsbury baby deaths it was revealed that many hospitals providing maternity care did not even have a member of their board charged with Maternity care, so board papers could go with nary a mention of maternity. Bad Care Quality reports were not given due consideration by the Shrewsbury board.

  • “The Trust board did not have oversight or a full understanding of issues and concerns within the maternity service, resulting in neither strategic direction and effective change, nor the development of accountable implementation plans.“

Most of Liverpool’s babies are delivered at Liverpool Women’s Hospital. The hospital delivers roughly 8,000 births per year. The Hospital also provides maternity care from a wider region for complex pregnancies and very premature or very sick newborn babies. It is a Maternal Medicine Centre, one of three within the Northwest Maternal Medicine Network. The Hospital also provides Gynaecological treatments,  Fertility services, Genetics services, Cancer care and termination of pregnancy, when that requires surgical intervention. The hospital also has a reputation as being a safe and caring place for women (though that has faltered a little in recent years). For all these reasons,  Liverpool Women’s Hospital is considered to be especially important by the people of Liverpool and beyond, but not considered so important by the Government or NHS England. For the last nine years, the future of Liverpool Women’s Hospital has been under ongoing threat.

We ask the people of Liverpool to continue to support our campaign for a fully funded, fully staffed, fully equipped hospital on the Liverpool Women’s Hospital Crown Street Site and for a fully funded, fully staffed, publicly owned and delivered national health service.

The NHS. Back to the Future.

by Deborah Harrington

I am sure you will all have seen the NHS described as not fit for purpose because it is ‘a 1948 structure trying to deal with 21st-century problems’. Politicians say it, health ‘think tanks’ like the King’s Fund say it, the IEA and health ministers say it. Even NHS campaign groups say it!!

I would say that we don’t HAVE a 1948-style NHS anymore and haven’t for a long while, so whether or not it is or would be ‘fit for purpose’ is a moot point.

The 1948 NHS had a clear set of principles. It had a basic organisational structure designed to put those principles into action. Hospitals were very haphazardly located pre-1948 according to local charity or local authority available funds and inclination. Rich areas had more hospitals than poor ones, although the distribution of illness meant poor areas should have had more. Many hospitals were completely unfit for purpose.

The public service NHS set about doing something that no other health service did or does. It started a 20+ year programme of redistributing and modernising hospitals to try to provide the same easy access to high-quality care for everyone, regardless of issues of rurality or urban deprivation. The private, voluntary and even local government sectors don’t have the power to do that kind of national planning.

It never reached its optimal distribution because after 24 years of gradual change and development to meet its ambition, it ran into major political opposition in the 1970s (up til then both Labour and Conservative governments carried on the programme, after the mid-70s neither did).

GPs were also badly distributed and although they originally all (well, 96% of them) signed up to the NHS immediately and continued in their own locales, a more equal (although again never quite equitable) distribution was achieved by the 1960s. This was partly as a result of Enoch Powell importing a lot of Indian and Pakistani doctors in the early 60s (all already GMC registered) to put into the under-doctored poorer areas where white middle class doctors couldn’t be persuaded to work.

Universities were linked with major teaching hospitals and the NHS and British Universities were at the forefront of cutting edge medical technology and healthcare innovation.

In the 1970s, for lots of reasons, the political climate changed and the very principle of a planned health service which was fully publicly funded was no longer flavour of the month.

And we have had nearly 5 decades of a slow assault on both the founding principles and the structures designed to provide them as a result.

In addition we have to a large extent dismantled the welfare state which was designed to support and promote good health in the population.

The NHS is now run along entirely different lines. In the ‘paradox of productivity’ although it is run on commercial imperatives with finance in the driving seat this produces worse outcomes for more money. We have closed down entirely, or downgraded, District General Hospitals particularly in poorer and more remote locations on the grounds of ‘financial sustainability’ leading to decreasing life expectancy. We have removed essential social support and exhort the poor to take better care of themselves instead. We pretend that the problem is too many over-qualified staff (our staffing ratio is poor in international comparisons) and use ‘different skills mixes’ which saves money but not lives. We have driven GPs out of the service by making their working lives untenable.

And we no longer have 1 NHS. We have 42 Integrated Care Systems built along US Medicare lines run by boards which are staffed by McKinsey clones and US health insurance ex-executives or private healthcare representatives. The intention of NHS England is to shift our NHS model of a whole population risk pool assumed by the government to a risk-and-reward sharing system where the ICS will be given a fixed, non-negotiable, capitated payment from which they will bear the profit or loss themselves.

Absolutely not the 1948 system. Nothing like it.

( Deborah has asked us to change the title as she does not want people to “make instant assumptions about starched sheets and matrons! (And they will….) So now this post is called Back to the Future,

Deborah is co-director of Public Matters, a policy partnership which has provided the secretariat for an APPG ( all Parliamentary Group)and produces articles, videos and briefings on public policy, particularly the NHS.

Next, listen to Maxine Peake on the damage to our NHS

Maxine Peake laments the damage to the NHS in her own special way.

Go back to Bevan

The National Theatre is showing Nye, a play about the founder of the NHS, seventy-five years ago. The play is being live-streamed to many cinemas. So it’s appropriate for us to republish a local leaflet written advocating a return to the system of healthcare designed by Nye Bevan.

We face a Healthcare Disaster.

Take back the NHS. Go back to Bevan.

We cannot wait as the damage in healthcare escalates still further.

Nye Bevan, in the post-war Labour Government, set up a world-beating healthcare system that served us well for decades.

It was a national service – not a business. It was publicly provided by the nationally owned service – it responded to need not profit.

It provided all the treatments when we needed them – including GPs, mental health, elder care and dentistry. No to waiting lists! No to profits for private providers. It was a Health Service open to every human in the country – no migrant charges. The Health Secretary then was legally obliged to provide health care but no longer. It was free at the point of need – no charging.

Bevan’s system had capacity; it did not run at a panic level like today.

The Bevan Model of Universal Public Health care is cheaper, more cost-effective and more equitable than the vandalised service we now have. The for-profit business model costs more and delivers less.

We need immediate action on maternity, mental health, the GP service and dentistry. Action in hospitals, sort out budgets. More beds in the NHS not fewer. Invest, do not cut.

Restore the Public Health System. Plan effectively for epidemics and natural disasters

Address Women’s Healthcare needs. When the NHS started, women’s health improved; now under the semi-private system, it is declining. Even Maternity is unsafe.

Everyone working in health should be employed by the NHS on proper terms and conditions – no outsourcing, no commissioning. Demand good pay for all NHS staff – an immediate pay rise. Respect the staff. End bullying and lying to them. Win back staff who have left in disgust. Plan the workforce training.

We do not want and cannot afford the big corporations’ involvement in our NHS. Abolish the so-called Integrated Care System where all sectors are incentivised to cut and deny care. Bring back national, publicly owned and provided, comprehensive healthcare, free at the point of need.

Beware the corporate health lobby groups in all the political parties. Human needs should dictate our level of care, not Big Business and its failed ideology. The NHS privatisers are like vandals smashing and grabbing profit, albeit hidden behind a veil of lies and public relations gobbledegook.

End all privatisations: outsourcing, commissioning, reliance on private companies’ reports, staffing agencies, population health management, the rationing and denying of services, running down services, and using charities as substitutes for real NHS capacity.

Power concedes nothing without a demand. The NHS was a great social victory won by the generation that defeated Hitler. Let us make our demands as loud and long as those of our grandparents. No one else will save the NHS. It must be a mass campaign.

If the reader wants to read more about Bevan please read, a chapter from Nye Bevan’s book.

Organise in each ICS area to challenge the cuts, challenge the syphoning-off of our healthcare finances by private companies. Mobilise the unions and the communities. Demand world-class publicly owned and provided social care. Renationalise the NHS! Lobby all MPs and Councillors

This leaflet was produced by Cheshire and Merseyside Coordinated  Healthcare Campaign, which involves local Trades Councils, Union branches, Health Campaign Groups, including Save Liverpool Women’s Hospital, Defend our NHS, Keep our NHS Public, (both Merseyside and Cheshire) and individuals. We work with many other campaigns nationally.

“I incite this meeting to rebellion!”

This blog post comes from a speech at a meeting held at the Quaker Meeting House Liverpool on Monday 11th March, 2024, for International Women’s Day. Other speeches were about child poverty, NHS privatisation, the situation in the big hospitals in Liverpool, and the situation for Hospitals in Gaza. We will publish those speeches too.

Mrs Pankhurst ended a famous meeting with the words “I incite this meeting to Rebellion!”. We follow in the footsteps of campaigning women over the years as we fight for maternity care, for the NHS, for women’s rights and against poverty.

We are campaigning for safe, respectful healthcare and maternity care for all women and babies. Giving birth can be a truly wonderful experience.

The wonderful artist amandagreavette shows us how wonderful birth can be.

“We meet here in Liverpool to mark International Working Women’s Day 2024. We meet to salute the women who have fought and won much in the past, to send sisterly greetings to all women around the world especially to those in struggle, those in war, and those damaged by the climate crises.

I want to talk about women’s health and maternity, locally, nationally and internationally. No one is safe until we all are safe. Change is possible. In living memory, we have seen huge improvements nationally and globally. In more recent memory we have seen significant damage done to these services again both nationally and globally, but the damage is most severe where government policies of Austerity or “Restructuring” have been imposed. Restructuring is what  Austerity is called in the Global South when countries are forced by the IMF to cut services because economic problems drive them to turn to it for aid.

“Between 2014-18 resources spent on public services dropped by more than 18 per cent in Latin America and the Caribbean, and by 15 per cent in Sub-Saharan Africa. Looking ahead, the International Monetary Fund (IMF) predicts that this trend will continue in all regions.”

It is always the women who carry the weight of such cuts and this is reflected in maternal deaths and infant mortality. Sadly, for the UK, we have experienced some of the worst damage amongst the richest countries. But as Governments imposed that damage, governments could repair and restore that damage. Meanwhile, it is our babies, our women who pay the price.

I will look in a minute at the most damning figures, those showing the deaths of mothers and of babies. We mark these deaths with respect and will both mourn and organise to improve this situation.

Our World in Data says “For most of human history, around 1 in 2 newborns died before reaching the age of fifteen. By 1950, that figure had declined to around one-quarter globally. By 2020, it had fallen to 4%. But while humanity has made much progress, there is still a lot of work to do.”

Look at the figures for infant mortality at birth. Twenty-seven other countries have better figures than ours, yet ours is one of the richest countries globally.

“The UK is fifth from the bottom among 27 European countries for infant mortality. The rate stalled in the UK between 2013 and 2018 at 3.9 per one thousand live births. In England and Wales, the rate is more than twice as high in the most deprived areas (5 per one thousand) compared with the least deprived areas (2.7 per one thousand).” (4 Mar 2020)

The latest figures from MBRRACE-UK (who report on maternal and baby deaths in the UK over time) show that the number of women dying in the UK during or soon after pregnancy has increased to levels not seen since 2003-05.

In 2020-22 there were 13.41 deaths in every 100 000 maternities, significantly higher than the maternal death rate of 8.79 deaths per 100 000 in 2017-19 and similar to 2003-05 (13.95 per 100 000).

We stop for a minute to mourn the death of two African women at Liverpool Women’s Hospital.

We do not accept the term “cultural bias.” It is racism and it must end. We recognise the increased risk for Black and Asian women in the maternity services as they are working today. We mourn these sisters and we will fight on to repair these terrible damages. We will be difficult to the government and to the NHS bosses in their names.

Internationally

Globally, every day in 2020, approximately eight hundred women died from preventable causes related to pregnancy and childbirth – meaning that a woman dies around every two minutes.

South Sudan had 1223 deaths per 100,000 women giving birth.

Belarus has 1.1 deaths per 100,000 women giving birth.

The UK has 13.41 deaths in every 100,000 women giving birth.

“In 2020-22 there were 13.41 deaths in every 100,000 maternities, significantly higher than the maternal death rate of 8.79 deaths per 100,000 in 2017-19 and similar to 2003-05 (13.95 per 100,000).”

Statistics released by MBRRACE-UK show that the maternal death rate in the UK has increased significantly over the past few years. Between January 2020 and December 2022, the rate was 13.41 per 100,000 maternities, up 53% from 8.79 per 100,000 in the previous three-year period from 2017-2019. This rate is the highest it has been in almost 20 years.

This is worse than Albania and Turkmenistan, yet this country has one of the largest economies in the world, and we used to have the best healthcare system in the world. The UK is fifth from the bottom among 27 European  Countries for infant mortality

The situation is so serious that parents of babies who died or who were injured in maternity care are demanding a public enquiry. There have been many detailed and authoritative reports, often commissioned by the Government or by Parliament, on maternity services, but the government response has been appalling.

Maternity safety matters; building national links.

We are working with other campaigns including Keep our NHS Public with whom we have produced this fact sheet. We would be delighted to hear from other campaigns with whom we have not yet made contact.

We say that this government does not care about maternity deaths, does not care about the poor experience of giving birth, that poor funding and poor staffing numbers inflict on women. The government does not care about, indeed prides itself, on women’s poverty. Let me emphasise that. This is not governmental ignorance. The government are not ignorant of the damage they have done and are doing. It is a conscious choice. The Government have all the reports, they commissioned some of the reports, they have the evidence and they choose not to act to ameliorate the situation. It prefers to serve the very rich. It would rather pay damages for babies damaged at birth than sort the situation out. The cost of compensating mothers and their families for harm caused by NHS maternity services is more than double what the health service spends on such care each year, analysis shows.

This situation is manageable, and it could be changed. Money invested in patient care and staffing leads to a richer economy, not a poorer economy.

Change is possible and change is necessary.

While we mourn our dead, it is also important to consider the lesser injuries, and the other bad experiences women and babies are enduring because of the state of the service and because of poverty inflicted by Austerity. These damages are real and important whether we are talking of physical or mental injury. This situation could be repaired. Neither deaths nor lesser injuries are inevitable.

Save Liverpool Women’s Hospital Camapign is far from alone in calling out the damage being done. There are a host of charities and the Royal College of Midwives making the same point.

The Royal College of Midwives (RCM) is calling out the Government’s record on maternity funding which leaves some NHS trusts and boards basing midwifery staffing levels on what they can afford, not on women and baby’s needs.

Birte Harlev-Lam, Executive Director, Midwife at the RCM said: “Women and their safety are still not being put at the centre of care. If this were the case, we would see significant amounts of additional funding and real efforts to support, retain and recruit staff, and we are not. There is a black hole in the centre of our maternity services where more money and staff should be. I have no doubt this is undermining maternity staff efforts to deliver the safest and best possible care for women and their babies.

Some avoidable maternal deaths and maternal injuries are due to NHS understaffing, under equipment and understaffing. There is another factor in these deaths. The extreme inequality in the UK, and the cruel impact of austerity on women and on women’s health, on children and on children’s health arising from government policies and priorities, also affect maternal and infant mortality. Poverty causes extreme stress, poor nutrition, poor housing and poor health. Poor mental health after birth leads to deaths, especially amongst the poor, and Black women, yet maternal mental health services are badly damaged, and health visitor numbers have not recovered from the pandemic.

The impact on staff wellbeing, on workload and staff retention is also important. Working under constant pressure is extremely damaging to the health of staff. Neither giving birth, nor having treatment for Gynaecological issues, is routine or ordinary. It is staff vigilance that leads to safety. How someone can be vigilant at the end of a very busy 13-hour shift is beyond me. Many people working in the NHS do not feel free to speak out, and those running the show, plod on making the cuts or CIPS without informing the public of the damage being done, nor describing the damage done in earlier years of austerity.

“This is all having an impact on the safety and quality of care for women and also means many women with more complex needs such as mental health problems are not getting the care they need and deserve. This is also leaving staff exhausted, overwhelmed, fragile and feeling massively undervalued” warns the Royal College of Midwives.

Maternity is underfunded and hospitals are not even spending what the government allocate to maternity (according to the RCN) because they can’t balance their books without using that money for other things.

There is an ongoing shortage of midwives. The BBC reports a shortage of about 2,500 midwives on the ratios that the Government describes as safe for maternity care. We would say that these Government figures for provision of midwives are themselves too low for what is required. So, 2,500 is the minimum extra required.

Our struggle is part of the campaign to restore the NHS, to renationalise it, to turn it once again into a publicly delivered, comprehensive, national service, to make it safer for women and babies. Our campaign is part of the campaign for safety in maternity, part of the campaign for better pay and conditions for staff. It is also part of the campaign for women’s rights, and intrinsic to the rights of women are the rights of the child.

Inequality and poverty affect women’s health and the health of their children.

Campaigning in the street

There are fourteen million children (aged up to 18) in the UK. Reports this week drew out the terrible extent of childhood poverty in the UK. Meghan Meek-O’Connor, senior child poverty policy adviser at Save the Children UK, said: “Today 4.3 million children are being failed. It is an outrage that 100,000 more children are in poverty – they are being forgotten.

Britain in the 1970s was one of the most equal of rich countries. Today, it is the second most unequal, after the US (27 Nov 2023).

Stewart Lansley, the author of The Richer, the Poorer and The Cost of Inequality, said it was “an acute paradox of contemporary capitalism that as societies get more prosperous, rising numbers are unable to afford the most basic of material and social needs.” He also said: “In Britain, child poverty has doubled in 40 years. Yet few modern tycoons go without private jets, luxury yachts, even private islands.”

In a meeting in Liverpool recently  it was reported that;

“Inequality has no more powerful expression than in children’s health, and children in our region get a particularly bad deal,” before pointing out that Liverpool’s infant mortality rate remains above the national average and that, every year, around twenty-six infants in the city do not reach their first birthday.

They reveal how poor health in mothers of the next generation can lead to ingrained health inequalities, adding: “Babies born small or early because of poor maternal health have the worst possible start to life and a health trajectory which culminates in a shorter life expectancy and more years lived in ill health.”

For those babies who survive, there is an uncertain future ahead with current trends predicting that by 2040, Liverpudlians will live more than a quarter of their lives in ill health.”

Keeping kids in uniform and shoes is hard enough.

Our campaign will fight on about this as well as fighting for the restoration of the NHS.

Poverty amongst women.

“Women living on low incomes in England are at increased risk of experiencing poor health during pregnancy. Our recent review of the evidence found that women and babies living with socioeconomic disadvantages had a 40% increased risk of worse pregnancy outcomes including stillbirth, low birth weight and babies being born early. Women may also experience mental health issues following pregnancy, birth or in the first year after birth. Women with lower access to financial, educational, social and health resources engage less in care during pregnancy – called antenatal or maternity care.”

Mersey Pensioners fighting for fully qualified staff for all.

Save Liverpool Women’s Hospital Campaign started in 2015 to try to stop the closure of Liverpool Women’s Hospital. The assault on the NHS and on working class living standards was well under way by 2015 and closing one more hospital was small beer to the bureaucrats of the NHS and our city council at the time. We had already seen the scandal of Prince’s Park Medical Centre (See this article or this book for the history) and the fight to stop PFI in this city, so we were able to mobilise for Liverpool Women’s Hospital and to build our petition and awareness in the city. 

The banner of women who fought for healthcare more than a century ago. Their banner is in the Museum of Liverpool Life. Solidarity to the staff who are now on strike.

 Liverpool Women’s Hospital is still here, still short of money and staff, and still threatened with merger, dispersal, and de facto closure. We will publish a more detailed report on the situation for Liverpool Women’s Hospital shortly.

We saw enormous improvements in infant mortality and maternal mortality following the introduction of the NHS. We can see such improvements once again if the NHS is reinstated.

So, we will persist, as women do.

We send special greetings to the Home Based Women Workers’ Trade Union of Pakistan with whom we have exchanged greetings each year of our campaign. They have built a powerful trade union amongst women who work at home in various trades. They inspire us to continue in our campaign. We send greetings to the women working to unionise the uranium mines in  Namibia. We send greetings to women around the world fighting for better maternity care.

As always we look to how women in the past have won gains  in rights and services, we remember the women who fought for the vote, the women who fought for baby clinics and maternity care and contraception here in Liverpool, the women of the sixties and seventies who fought for women’s rights in childbirth, for those who fought for  women to be able to choose contraception  without their husbands permission, for abortion rights, for equal pay, with a special shout out to the machinists in Fords In Speke,  for women’s economic independence, for the end to the marriage bar in teaching and other jobs for the fight for the Women’s Hospital in London and many more

We campaign, we organise, we agitate, we consult,  we build links, we challenge and we demand. We can win but only as we grow ever bigger.

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

Please support our campaign Please sign our petition ( unless you have already signed)

lobbying the Integrated Care Board

Public meeting for International Women’s Day 2024

As part of marking International Women’s Day, the Save Liverpool Women’s Hospital Campaign is organizing a public meeting on March 11th in the  Quaker Meeting House in School Lane Liverpool (behind Primark) at 7 pm. We will provide a Zoom link for people who want to go and can’t make it in person.

We can do it! International Women’s Day 2024, Inspire + Struggle – fighting for maternity and the NHS, the situation in Gaza for pregnant women & health workers, ceasefire now. This will be a hybrid meeting so you can join by Zoom

email savelwh@outlook.com or contact by this blog

We need to campaign – and the history of International Women’s Day reminds us that campaigns can win. 

We can do it!
Thanks to Anjali027 for this picture.

Campaigning works. The campaign to Save Liverpool Women’s Hospital has marked International Women’s Day for eight years now. We have fought hard to save the hospital in a time of great damage to the NHS and damage to the maternity services nationally.

Donna Ockendon with just one of her damning reports on maternity care.

These damages have been described in prestigious reports yet still the government closes its ears. The hospital has been damaged by cuts, poor staffing, and bad policy decisions, but the hospital is still there, still under threat, still underfunded and understaffed, but still there. Campaigning works. We have miles to go before we have the hospital we need but at least what we have has not (yet) been taken away

Grief in Gaza

On this International Women’s Day, our hearts break and our voices are raised for the plight of pregnant women and their babies in Gaza, giving birth now without any medical attention being available as every hospital is destroyed. Food and water are in very short supply. This damage to mothers and babies is sickening. We share the feeling of dread as the horrid Israeli threat of an attack at the start of the holy month of Ramadan approaches. We demand a ceasefire and a just peace where the children of Palestine and Israel can grow up in peace justice and harmony.

Retired midwife Rebecca speaking in Liverpool about the plight of women giving birth in Gaza

Our thoughts go to the women of Ukraine, and those from Ukraine now living in this city. Our thoughts to the women of Yemen, Sudan, and Haiti all caught in the maelstrom of crises and war. We send solidarity to the women of Russia organizing against the odds for peace, and to all the women of the peace movement across the world

We celebrate the victory of women in France who now see the right to abortion written into the constitution.

We send greetings to all the US women who are fighting a terrible reaction in politics generally, but especially in their rights to control their fertility. This is in a country that does not provide decent maternity leave, and with ten times the maternal death rate of Australia, Austria, Israel, Japan, and Spain. Eighty-four percent of reviewed maternal deaths were described as preventable.

We send greetings to the women of the Kurdish community here in Liverpool and to the Kurds fighting for respect and peace in their homelands.

Picture from the camp in Cox’s Bazaar in Bangladesh

Our hearts go out to the women and girls of the Rohingya community, driven from their homeland and living now in a million-strong refugee camp in Bangladesh.

We live in a time of genocide and war. We look to the generations of women who have worked for peace, including those from Greenham Common

Liverpool, once the second city of the British “Empire”( and all the racism that involved), and because of the trade links, is home to a black community dating back hundreds of years and one of the oldest Chinese communities outside of China.

From a mural outisde Liverpool Women’s Hospital entrance.

Sadly though we now mourn two black women who have died at Liverpool Women’s Hospital from complications in pregnancy or birth. In their honour, we rejoin our efforts to campaign for better safer maternity services, better staffing ratios, and well-paid staff with more time to think and plan, with more support top-down, to tackle blame culture & reduce tensions. This must be accompanied by more investment in staff. Managed decline has led to half the staff with double the workload. Paperwork is now all online so more admin and less time with patient contact. The culture needs to change. This will take a lot of work as there is still also a massive issue with hierarchy and bullying. More investment, and more support, will ultimately improve the work environment which will subsequently give women better experiences as tensions lessen.

Liverpool Women’s Hospital has a history of anti-racism but that, like many other great provisions, can be severely damaged by austerity cuts. This tradition of anti racism needs to be enthusiastically revived but overworked burnt out staff are hardly in a good position for this. A good indicator of a safe environment for Black and Ethnic Minority patients is ethnic minority staff reporting that they do not experience racism and discrimination. Sadly, a report to the board described the opposite. However, in a recent webinar about migrant women giving birth, Liverpool was highly praised for the support midwives gave to one of the speakers. The specialist teams supporting vulnerable women do great work.

Image from MBBRACE

We join with others in demanding action to make it safer for all mothers to give birth and demand action to reduce the particular risk to Black Asian and poor women of all races. In the UK, the rates of baby death and stillbirth among Black and Asian mothers are double those for white women. We have written about the higher number of deaths among black babies.

In one of these maternal deaths, investigators from the national body the Maternity and Newborn Safety Investigations (MSNI) were called in after the woman died. They reported that “The investigation into her death found hospital staff had not taken some observations because the patient was “being difficult”,( our emphasis) according to comments in her medical notes. “…ethnicity and health inequalities impacted on the care provided to the patient, suggesting that an unconscious cultural bias delayed the timing of diagnosis and response to her clinical deterioration”. “This was evident in discussions with staff involved in the direct care of the patient“.

“She was being difficult”. These words have sparked fear and anger in many women. This sister would have been in a strange environment, far from home, with people speaking a language she did not speak. She would have been full of hormones from her miscarriage. She had had babies before and would have known what she was feeling was not right. And she was ill and in pain. Because she was being “difficult” she was not monitored as she should have been and this cost her the chance of life. Now two babies are motherless and a family bereft.

The wider impact of this death.

In the aftermath of this death, and the publicity it gained, Melissa Sigodo (@melissasigodo), a Zimbabwean and British community reporter from the Daily Mirror, held a Twitter (X)Space meeting with 90 mainly black women, from across the country, discussing the case. The experiences of these women were heartbreaking. This case had reawakened their fears.

There is no room for racism in maternity care.  

The safety of women giving birth is the responsibility of the service, not the individual. Every woman matters. Liverpool Women’s has had a good reputation for anti-racism. This reputation must be regained. Most midwives, health care assistants, and obstetricians would agree. Developing a safe place for every woman to be treated and to work takes time and effort. We echo the words and determination of the suffragettes, in saying “There must be deeds, not words” on this matter.

The hospital is changing its systems to support patients who are rapidly deteriorating and we welcome this.

Liverpool Women’s Hospital was built on Crown Street site as part of Project Rosemary, to help heal the injustices which had led to the uprising in Toxteth in 1981. Black building workers were employed in the construction of the hospital. The hospital now serves a great ethnic mix of people, for example in Princes Park Ward non-White English/ British resident population range is 59%, and in nearby Picton is 52%. Racism at this Hospital would be particularly offensive.

Mary Seacole Pioneering nurse and heroine of British soldiers inthe Crimean war

We can do it!

Let us remember the work of the great nurse Mary Seacole and all the women of the Windrush generation who so wonderfully staffed the early NHS. Liverpool Women’s Hospital must be a pioneer in antiracist women’s healthcare so no black woman fears using the service nor working in this or any other hospital.

We need to campaign – and the history of International Women’s Day reminds us that campaigns can win. 

On March the 8th and the few weeks that follow it we celebrate International Women’s Day. Women’s lives have been improved and much has been achieved since the founding of International Working Women’s Day. The gains made for women over the last 150 years are significant. The Fawcett Society published a list of these gains a few years ago. The women who won these gains did so despite the difficulties they faced.

Women today are potentially much more powerful than previous generations. We too can organize to improve our lives. So many of us are in employment that we have real power there, that could be organized much more effectively through trade unions. We can more easily campaign across the world. Remember the Women’s Strike in Iceland.

Fans supporting food banks provides practical help and campaigns against food poverty

Today we face real problems and worsening conditions so there is a greater need than ever for women to organise. We can take courage from the past for the very serious obstacles women face today. Those obstacles are serious and becoming ever more so.

Clinical support workers at Arrowe Park Hospital ion strike in the snow.

We salute all the NHS staff who have taken industrial action. We salute them also for working on in the terrible conditions imposed by this government. This shows the strength we have. War, austerity, climate, and economic crises make this era extremely dangerous but never have women been more equipped to demand and force change for the better.

“Whether they are older women suffering loneliness and isolation, single parents with additional caring responsibilities, or simply working mums trying to stretch household budgets to feed their families, the survey shows that women are significantly more likely to need food support from charities and community groups.”

There is much to do to improve women’s lives and many of the gains made are being eroded. The Cost-of-Living crisis hits women hardest. 75% of people accessing food support from Fare Shares a food charity are women.

https://www.stylist.co.uk/money/the-motherhood-penalty/502277

It is great that women are in work but not good that male and female pay is far from equal. It’s great that sex discrimination is illegal but it still happens, less openly perhaps. It’s great that equal pay law exists but women still earn less than men and the gap widens over a working life.

The motherhood penalty kicks in.  Forty-four percent of women are earning less now than they were before they had children. The employment rate was higher for mothers than either women or men without dependent children and has been since 2017.

Women are described as “the shock absorbers of poverty”, managing family bills and compensating for the government’s neglect and austerity policies.

Image credit to CADTM

What is happening in the UK is mirrored in other countries. Oxfam International’s report shows that while the richest 1 percent captured 54 percent of new global wealth over the past decade, this has accelerated to 63 percent in the past two years. $42 trillion of new wealth was created between December 2019 and December 2021.

“While ordinary people are making daily sacrifices on essentials like food, the super-rich have outdone even their wildest dreams. Just two years in, this decade is shaping up to be the best yet for billionaires —a roaring ‘20s boom for the world’s richest,” said Gabriela Bucher, Executive Director of Oxfam International 2021”

Not one thing that women have gained has been won without organisation, agitation, campaigning and struggle. So, it is today. Let our inspiration be in how women  have  struggled for a better life in the past and  in the great campaigns today.

“Inspire Inclusion” is 2024s International women’s Day slogan. We want to inspire women’s inclusion in the drive to improve the lives of working-class women and children.

It wasn’t wealthy women who led the earlier struggles of the women working in mills, tobacco factories, or  as domestic servants. Our inspiration is with the women who fought for all women,  and founded International Women’s Day

Bread
and Roses

In the words  the women’s anthem  Bread and Roses ( credit to Unison) we say

“As we go marching ,marching we battle too for men for they are women’s children and we mother them again”

In the tradition of the suffragettes,Let’s Inspire or incite women to rebellion, or even incite women to organise for a better life for locally nationally and internationally.

Solidarity  with Clinical Support Workers at Arrowe Park and Clatterbridge  Hospitals on the Wirral.

Today Wednesday 7th February 2024 is the last day of this phase of an epic strike.

A fresh vote is required, in law, for the strike to continue, and that strike ballot is underway.

Why is it important way beyond Wirral or even beyond Cheshire and Merseyside?

NHS pay is far worse in real terms than before austerity policies began.This is true for every kind of NHS worker.

The strike at Arrowe  Park and Clatterbridge is about banding and back pay.Clinical Support Workers should be paid band 3 but this group had been paid band 2 for a long time.

These are the healthworkers who work very closely with patients tending to personal care, feeding,  minor medical issues and making patients feel cared for and helping  the patients laugh and so recover.

It looked at one point like an agreement was in sight and staff would be regraded and back pay allowed.

Then, the deal was seen to exclude many of the workers,so the strike continued.

Why does it matter to the public?

1.Regulated pay, conditions, qualifications, and inhouse professional development are all essential to a safe workforce.Casualised,low paid, high turnover work, as we see in other industries and sections of privatised social care is very bad for patients,costly to the taxpayer and bad for the workers.It also wrecks the health of the workforce.

2 The NHS is supposed to be an Anchor Institution, one that provides good  pay and conditions for its workforce and, in so doing, improves life in the area it serves. The theory is that as a significant section of the community has decent pay, and working conditiond, the community as well as the individual will be healthier.Other employers will (the theory goes) have to  match those conditions to be able to recruit.So downgrading staff pay and conditions affects not just NHS staff but the wider communities

3. This is largely a women’s  workforce. ( Big cheers to all the fellas  on the picket line, too). These workers provide care, an essential of human life in all its glories, all its ups and downs, at all ages and traditionally provided by women, so underpaid.Care matters.Care is important, life affirming workHowever, care is really unde valued and underpaid in this society, by this government and by bosses.It’s up to the community to champion care.So lets support these workers

4. The NHS is being stripped to the bone by this government  and their big business cronies. A cheaper workforce is a huge gift to them but real damage to patients, workers, and the communities.So lets help these workers win.

5. A trade union is when workers come together to improve their conditions and pay.This is an epic trade union struggle.These women and men at Arrowe Park and Clatterbridge have stood together in solidarity over a long time, in sunshine rain and snow determined to protect and improve their wages, their working conditions.They are quietly demanding  the respect due to them from their bosses and the wider employer.In  so doing that they  defend far more people than their own union branch.

Picketing in the rain!

6. In striking and picketing for so long, in such numbers, these are a warning to the  NHS and other employers.They have made history.

7. The picket had fun with music dancing and more.

8.Unison have supported their members well in this dispute. Other unions could learn from them

When the  current ballot closes, the strike can restart, or the bosses could pay up.Either way  celebrate and support these care workers.

Lobbying the Integrated Care Board
What is a union?
Come rain or shine
People came from far and wide to offer support
The strike timetable for this round
Not even snow stopped this lot
Perseverance in the snow