Report on Charging Women for Maternity Care in UK 2021

Talk at Liverpool.


This talk is based on a recent report for Maternity Action ‘What Price Safe Motherhood?: Charging for NHS Maternity Care in England and its Impact on Migrant Women’

Maternity care charging is a limited part of NHS charging but it’s significant because maternity care is usually regarded as special, so charging for it with no concession to its special status in relation to women’s and children’s rights  makes the UK govt’s approach to it particularly problematic – and worth questioning.

NHS charging is a very significant part of bringing the border into everyday life.  This is often called the ‘hostile environment’ – a shorthand for hostile environment for undocumented migrants, but actually creating a nightmare for all migrants as shown by the Windrush scandal.

Today I want to focus on what charging for mat care means in practice for the individuals it affects – and if time to explore a bit more its implications.  In the workshops we can discuss ways of campaigning about charging and where mat. care might sit in such a campaign.

I will focus on 3 aspects of charging for maternity care in England as there are some differences in rest of UK

  1. Who is charged
  2. Charging procedures and practices
  3. Impact on women affected


  1. Who is charged

People with visitor visas, UDMs, expats. – people not ‘ordinarily resident’ in the UK.    All other migrants who do not have ILR have to pay an Immigration Health Surcharge of £200 per year (doubling in December).  This is paid in full in applying for a visa, so it’s £500 per person for 2½ years (£1000 in December) on top of visa charges of £1033.

Our study did not include expats but our advice service has had requests from women who were deemed not to be ordinarily resident because they worked abroad, or had been living abroad for some time.  So we interviewed women on visitor visas and women who had overstayed earlier visas.

NB We interviewed 16 women – average length of residence –  over 6 years before their last pregnancy.

  • 2 women on visitor visas but both had British partners and were waiting to obtain spouse visas – so just in terms of the assumptions that a visitor is a tourist – this was not the case.
  • 2 women were EU cits/ dependants – wrongly charged
  • Some had come on student or visitor visas and become overstayers, and some were refused asylum seekers, some were very likely trafficked – one certainly was. Some who had overstayed their visas were trying to make further applications for leave, but this is difficult because not eligible for legal aid, and because of UD status had no money.

All those in this situation were very poor, and among the single women, often destitute as the following example shows.


Ayesha came to the UK for an arranged marriage. She had not met her future husband but he was ‘nice and caring’ when she spoke to him on the phone. They stayed together for about 4 months but she fled from him because he turned out to be violent and abusive. At that time she could not speak English and knew nothing about the UK. She survived by helping out different women she met in her mosque who offered her shelter in return for help with housework and childcare. When she became pregnant a family took her in for a longer period but made it clear she would not be able to continue to stay once she had her child. She was afraid to go back to her home country because she had run away from her husband, and she was also worried that her family would force her daughter to have FGM. She applied for asylum just before she was due to give birth.

She became pregnant while sofa surfing (often a euphemism for sex in exchange for accommodation). She did not stay with the father of her child. Ayesha’s story is a good example of how a woman’s immigration status can be dependent on their relationship. It also shows how irregular immigration status for women can give rise to a precarious personal situation in which women can be very vulnerable to abusive behavious by men.

In our study, only 5 of 16 participants continued to be in a relationship with the father of their last baby.

5 women were abandoned when they told their partner they were pregnant

3  – no information about partner (may have also been abandoned or may have been a brief relationship)

3 – separated from abusive partners during or after child was born.


  • Women were charged who had lived here several years, sometimes had other children born here, or had British partners, or were incorrectly charged.
  • Undocumented women without partners are particularly vulnerable to destitution and exploitation by men.
  • Immigration statuses are fluid and changeable. Ayesha came as a visitor, became an overstayer, then claimed asylum


  1. b) Charging procedures

We did expect the women we interviewed to be very poor and living in difficult circumstances.  But we also learnt from the study how harsh the charging regime is.

The charging rules

  • Charges to migrants are levied at 150% of tariff charged to CCGs. So current maternity charges are £6993.63 for full package including antenatal  care, delivery, and postnatal care. £1353 for termination. (Maternity care to CCG is £4662.42).
  • Failure to repay £500 or more within 2 months results in being reported to the HO and can result in refusal of subsequent immigration applications  or to re-enter the UK.
  • Maternity care is considered Immediately Necessary – this means must not be delayed or refused if a woman cannot pay.  But charges must now be levied in advance.


Charging practice

When operating the charging rules it is very important to consider the position of vulnerable overseas visitors, including those unlawfully resident in our communities, both those who are exempt from charge and those who are chargeable.

“Overseas Visitor Managers (OVMs), and other NHS staff are strongly encouraged to speak to their safeguarding leads if, in the course of their work, they are concerned aboutthe welfare of any patient. It can also be helpful for OVMs to build constructive relationships with local agencies which support people in various types of need, or to seek advice and information from relevant national agencies and organisations.” (DH Charging Guidance p53)

  • Some women asked for information and were not given it.
  • 2 women were wrongly charged and needed legal help to cancel charges.
  • Some women were billed for previous births which took place years ago after they were billed for the most recent birth. This is now very common.  Home Office officials are now often embedded with social services when they are asked for support by undocumented migrants. The Home Office then inform hospitals that someone had given birth there and was chargeable.
  • Most women were not told anything about charging prior to receiving a letter or invoice.
  • Subsequently they were harrassed with letters and phone calls, often from debt collection agencies. If English wasn’t their first language they could often not understand what people were saying on the phone.

The following are extracts from letters demanding payment which women had received:

Example 1


Dear Sir/Madam

We wish to notify you that if this account is not settled within 7 days of this letter it will be referred to a debt collection agency and you may face litigation.

Furthermore, under immigration rules 320, 321, 321A and 322, a person with outstanding debts of over £1,000 for NHS treatment which are not paid within three months of invoicing, may be denied a further immigration application to enter / remain in the UK. If full settlement is not made, information relating to this debt will be provided to the UK Border Agency and may be used by them to apply the above immigration rules.

NB  The demand about repayment of £1000 was out of date and inaccurate.  The letter threatens litigation and provides no invitation to talk to hospital)

Example 2

One woman was told that as she had not paid

“the required deposit an invoice will be sent to the address you have given us. Please be aware that failure to pay this invoice may result in future appointments being cancelled.”

NB The letter made no reference to the fact that maternity care is designated as Immediately Necessary.

  1. c)   Impact of charging on women
  • Deterrence from attending care – women refused to attend further antenatal appointments. Natasha, on leaflet, would not go back for a checkup to find out why she had a miscarriage.  One woman with high blood pressure went to hospital just before delivery after refusing to go to more antenatal appointments. One woman – the only one who paid in full, refused to go to NHS for anything. Even those who did go were scared.

“Whenever I’m going to the midwife I’m really scared to go. I’m not happy about going there now. I’m always scared. I don’t know what’s going to happen whenever I have an appointment with the midwife. I don’t know what I’m going to hear from them. Maybe they will stop me from getting care. In the hospital I was so scared.”

  • Mental health– charging has a really bad effect on women’s mental health, increasing their stress and impacting  on the family as a whole.

“When they were calling me and saying I have to pay, I have to do this, there was a point I felt like just dying. And my son was crying, I’m like, shut up! You know what I mean? I just screamed at him like, shut up! It’s just… It does have an impact (on the child) because I shouted at him when I wasn’t meant to. Because he was just a baby then, he was a crying baby. So the whole thing was just too much for me.”


  1. d) Conclusion
  • This isn’t about recouping money for the NHS Of the 16 women interviewed, only 1 paid in full.  1 has 45 year repayment plan! 1 not charged because she claimed asylum. None of the others will be able to pay.
  • It is well known and acknowledged by the government that mental health, poverty, homelessness, and being a migrant adversely affects pregnancy outcomes. So why are they not excluding maternity care from charging?  In my view it’s racism in immigration policy combined with misogyny and hostility to family formation and reproduction among foreigners. e.g. Anwar Ditta case and the Primary Purpose rule in the 1980s and 90s.
  • Also the approach to maternity deeply misogynistic. It sees women having babies in the UK only as maternity tourism, and refuses to see women as students, spouses, workers etc.
  • The implementation of the charging policy is decentralised and not monitored and so is not consitent. There are no audits of the health impact of charging on women or its impact on deterring them from care.
  • Failure to properly examine immigration status of chargeable people let alone their social and financial circumstances as advised by guidance gives rise to mistakes and undoubtedly to racial profiling e.g. in our study two Latin American women  with EU rights were charged.
  • Charging has an insidious impact on NHS.  Divisions between entitled and unentitled become normalised, for example banners in hospitals saying “NHS Hospital Treatment is Not Free for Everyone”   “The NHS is a Residency based provider and is not free for everyone.


Credit for images to Maternity Action and “noahs birth” by Kala Bernier is licensed underCC BY 2.0


Emily Thornberry Speaks at demonstration to Save Liverpool Women’s Hospital in September 2018

Last September, Emily Thornberry MP spoke at the end of our great demonstration to save Liverpool Women’s Hospital.


Emily is a senior  Labour MP who speaks on foreign affairs for Labour  in Parliament. She is the shadow foreign secretary. Last time we had our friend  Diane Abbot M.P,  speaking for the campaign so we have had good support from Labour’s women’s team.We were delighted to have her with us that day, and delighted to have Labour’s health spokesperson  John Ashworth M.P. with us too.

It should now be clear that Labour is committed to saving this hospital. The battle though is not yet won. Plans to open consultation on the unacceptable  plan to move to the Royal are still in place. PFI is probably dead, but the money makers and privatisers can still try to find another ripoff scheme.

The video  has been made for us by Hazuan Hashim. It is lovely and important record of a great step in our ongoing campaign. We still haven’t won but we have made great strides and the hospital is still here.

Our fight and that of other hospitals, walk in centres and services goes on.The NHS has been stripped to the bone and only the good will and hard work of the staff keeps it going

The local and national campaigns for the NHS needs your help..

Integrated Care or Integrated Risk?

Integrated Care Partnerships are  being developed across the country. There is a particular danger posed by chains of care homes owned by hedge funds and speculators gaining  a say in our social services and our NHS. There are real risks involved with Integrated Care Partnerships. Only  small section of health and social care professionals know about them but they will affect us all. This is not about day to day healh care or social care which clearly needs some level of integration.

“It’s integration of management systems, of financial purses, and
organisations, and it’s at the expense of the integration of true delivery of coordinated care that’s been going on and did not need Simon Stevens or Jeremy Hunt to tell us to do it.” 

Do Labour Councillors and MPs  and trade unions representing the workers, really want to go down that road? Can they please learn from the PFI scandal, step away from Integrated Care Partnerships? Can Trade Unions, Campaigners and elected representatives together put pressure on the government  to fully fund NHS and  fully fund social care and to drop the  multi faceted privatising agenda?

Justin Madders MP, one of Labour’s Health team and a local MP, has published a criticism of Integrated Care Partnerships, especially their implementation without legislation going through Parliament or public consultation. The process  of forming Integrated Care Partnerships fundamentally changes Social Services and the NHS. They gives the private sector still more access to the taxes we pay to fund our care. They reduce public and patient accountability and invite the hedge funds into the planning of our publicy funded health and social care. Profit is invited in to planning for our most vulnerable.

Hedge Funds are “an offshore investment fund, typically formed as a private limited partnership, that engages in speculation using credit or borrowed capital.” Hedge Funds   are for speculation. Some of our readers will remember hedge funds speculation in Liverpool FC.

Now a chain of care homes is  under crisis again and not  a crisis through social care funding but from exposure to speculation. The Guardian reports

“US hedge fund puts Britain’s biggest care home operator up for sale

Four Seasons failed to pay off a portion of debt owed to H/2 Capital Partners”


The Care Home sector is attractive to capitalist speculators because it has an assured source of funding.  The profit motive has not helped  social care at all, despite the free market rhetoric. It’s not like a shop or other  kinds of investment, this one has long-term government or local authority  funding. Cash flow is secure. The funding that comes from patients and families  is reasonably secure too because local authorities often help administer this.  The cost  to the older person and their families can be huge. 

Families  can  be desperate not to have disruption. Changing a nursing home is a complicated task. On the basis of this very  secure funding stream, it would appear, the speculators  have  borrowed on these businesses to invest elsewhere. In Integrated Care Partnerships NHS and  Local Authority Social Care are being integrated  with other providers, so the private  sector are  involved in the ICPs.  The Kings Fund  reported that “Integrated Care Partnerships can include hospitals, community services, mental health services and GPs, while Social care and independent and third sector providers may also be involved”.

There are four  main players,  in ICPs, the NHS, Local Authorities, voluntary sector organisations  and the private sector. The  sectors become more and more integrated. The private care home sector get a seat at the table, knees under the table, a strategic say in the funding and structures, and therefore a still more secure stream of funding for its speculators. Meanwhile our beloved elders are pawns in this game.

Public money and decision-making  going into the private sector is not safe,  a sector owned by hedge funds, who have no obligation to the public good. These homes can close when they want to. Regulation on peremptorily closing such homes is very weak. Local Authorities  generally have to find new places for the residents. Many care homes have precarious financial situations Now the Guardian  has posted the story of  a hedge fund ordering the sale of  the largest chain of elder care homes

The weight of the obligations to the elders in these homes must be on the owners and their backers. The full force of the law must be used to make them face their responsibilities but the laws are, as yet, weak. But once Integrated Care partnerships  are in place it will be a shared risk. Investment is supposed to carry risk, tax funded services should not. The care home owners, US hedge funds, will be the partners in ICPs. We,  the public, will share the hedge fund risks.

The NHS is free at the point of need and is supposed to provide all the treatments a patient needs There is more on this  conflict here. The NHS is short of beds, the number has halved and this has contributed to the “winter” crisis.  The Winter crisis  is not caused  by too many old people. After all, we have known about these people since their birth was registered, up to 112 years ago.  We have known about increased life expectancy for years. Not planning for our elders is a sin of neglect on the part of governement. Its not  surprise.

It is a joy and an honour as a society to have our elders live long and happy lives.

The winter crisis  caused by  shortage of beds and shortage of  funds for social services. Social care is indeed in crisis. Unlike health care, Social Services provision  is  means tested until the person has lost nearly all their assets. Unlike the NHS there is no  obligation to provide comprehensive  services. Its a priced menu. You get what you can pay for.  Private sector provision is  planned  for what makes a profit. The main function, such as elder care,  can be subverted if there are  better ways of making money. Southern Cross proved this but scandals  have been swept under the carpet.

Many are familiar with the situation of older people needing medical care for age related illnesses, getting that from NHS but being charged for care for dementia because that does not count as medical need, but a social  need.

Despite dementia being a medical condition, the needs of people with dementiaare often seen as social care rather than healthcare needs. … Second, the design of the NHS continuing care system is not appropriate for people with dementia”.

This blurred boundary causes hardship It is reasonable to assume such blurring of boundaries will get worse under ICPs

There is a crisis in social care. It must be solved. But the money to solve that crisis must not come from hardpressed NHS budgets. It should come from general taxation, not NHS budgets.

Despite headlines that say  Austerity is over, Local Authority social care budgets  face the worst cuts yet .

An analysis by the Local Government Association (LGA) reveals that, overall, councils will have suffered a 77 per cent decrease in the government funding between 2015/16 and next year, dropping from £9,927m in 2015-16 to £2,284m in 2019-20.”

Social care is short of money. Social Care  Homes for the elderly were largely privatised many years ago. The iconic  image of the time  was of a little care home that a local GP might have set up,  but this has long been bought up by the big chains. Some people will remember Southern Cross,  where a whole chain went bust. Care homes can just close. Much of the private  care sector  funds come from Local Authority Social Services budgets, on a  patient means tested basis.  Other funds come directly from the old person and the family. The quality of care varies from brilliant to appalling

Care workers can be overworked under paid and over whelmed by the job. Full unionization and collective bargaining  to represent the interests of staff are long over due. A well paid, well-respected staff, who are allowed some say in how the care is delivered make for good experiences for the elders  in their care. When there are cut backs in funding the first people to suffer are the care workers

“the care workers absorbed the effects of the erosion in job quality and protected residents from its adverse effects” (p. 1001)

Much focus is on social care for the elderly but social care encompasses care services for children, and younger adults with physical disabilities or chronic illnesses. An activist and trade unionists conference  on the whole issue of social care  is planned in November

The system of care homes is not working in so many ways. Our campaign calls for a national care service fully funded from taxation but not to bail out the speculators

Care in the community for people with learning difficulties, and a variety of mental health issues have also been subjected to major funding shortages, and are largely outsourced, with all that means for staff  wages, training, professional education  and job security.

The staff of care homes, and in home care, are trained, managed and paid in a fundamentally different way from the NHS. Many of their staff have come from the NHS either by the original services being privatised or because they have chosen to move across. The staff development, which is the jewel in the NHS crown, is sadly lacking. Some staff perform duties, including  giving out medication, well above their pay grade and their education/ professional qualification level.

It is the efforts and dedication of the staff which has kept the NHS and the care system afloat, though the boat is now leaking. The workers in the private homes are by and large doing their very best. Those with elected power have a responsibility to  provide good care, quietly calmly and efficiently.

image Hedge Fund by Nick Youngson CC BY-SA 3.0 Alpha Stock Images



Emily Thornberry MP to speak at Save Liverpool Women’s Hospital Demo on 22nd September.

Please come to  our demo, show your support for Saving Liverpool Women’s Hospital, on site,

Please support  the call to fix the Royal Hospital!

Will you stand up to save  the NHS?

What will you be able to say that you did about the attacks on our NHS? Will you get on your feet and show support for our NHS and our hospitals, our doctors nurses and midwives.

Our speakers are great but its the marchers who are the stars!

Come and hear our fantastic speakers

  • Emily Thornberry MP,
  • Dan Carden MP,  who is committed to the reinstatement of our NHS, and is campaigning for the Royal Hospital to be fully funded and fully repaired
  • Professor Wendy Savage, life long fighter for the rights of women and babies in healthcare and in giving birth,
  • Doctor Alex Scott Samuel, from Socialist Health Association,
  • Rebecca Smyth who lectures in midwifery
  • Julie Ward MEP,  who has helped the campaign for the  successful Irish Repeal the 8th
  • Jenny Hurley from Save Chorley Hospital,
  • Sheila Coleman, Hillsborough Justice  Campaigner
  • Natalie Denny, local  campaigner for  sexual health for young people, and to making sure every woman can access sanitary products

Outstanding-Contribution-to-Health-687x458Wendy Savage has been given the prestigious award for ‘Outstanding Contribution to health and healthcare in the UK’  Wendy’s presence puts out campaign in a long line of struggles for women’s health and for maternity rights.

natalie-denny-a3198930Natalie Denny campaigns for young people’s sexual health, and for the homeless period

Sheila Coleman is a fine example of a woman who never gives up, is never intimidated and fights for the rights of ordinary people, as does our campaign


Rebecca-SmythRebecca  Smythe has worked at Liverpool Women’s Hospital and now lectures in Midwifery. Rebecca is part of our campaign and can reflect the concerns of midwives in health reorganizations




routeMarch 22nd sept

sonia's graphic

What is going on?

Why are we trying to Save Liverpool Women’s Hospital while the hospital puts out statements claiming all is well

As in Marvin Gayes’ version  of “What’s going on”,  it is very troubling. Our campaign to Save Liverpool Women’s Hospital has now been going since 2015 and  has done much  street campaigning. We have also done  research and  detailed studies of their plans. Not that it takes a genius to work it out.

sonia's graphicThe plans which are presented as being all fine and dandy. The plans are part of what’s going on in the NHS,  and  some of which   is downright dangerous.  Sugar coated, press releases just don’t fool people anymore. We see the crisis. People are dying when they should not have died. The NHS is in crisis., and that crisis is manufactured by government policy.

  • The NHS  does not have enough money because the government made the decision to underfunded it.If it were funded to match similar countries it would not have this problem. The money the NHS does have is frittered away to the private contractors  who won 70 per cent of clinical commissions  under the current flawed system. This cost the NHS, from which they made £831 million profit
  • The NHS does not have  sufficient beds because planners decided to close them as part of Government policy
  • The NHS does not have enough staff because of government policies.
  • Huge amounts of money have been wasted on PFI (PFI stands for Private Finance Initiative. It has been the dominant way of financing new hospitals since the late 1990s. As a result, the NHS spends £2 billion in PFI charges every year for its PFI hospitals in repayment and service charges. (That is £3,700 every minute).)
  • Every PFI hospital has a huge mortgage round its neck to pay before it pays anything else. The Liverpool Women’s Hospital has no such mortgage.
  • Money spent on NHS building projects  gives millions to the builders and the financiers through PFI and the like. That huge investment has lacked scrutiny so major faults  have  been found in these big projects, not just at Liverpool’s  flawed and unfinished Royal hospital. So PFI hospitals are  scandalously expensive.  Many PFIs  are flawed and  quite dangerous. “Site sources claim the cracks in the supporting beams stem from underlying issues with part of the building’s foundations
  • The NHS lacks doctors and nurses because of government  planning, by policy not by mistake. The Royal College of Physicians  claims the government doesn’t even know how many doctors it needs Back in 2012 the government decided to train fewer doctors to prevent a “glut”.
  • The LWH trust has a financial problem based on underfunding and a national problem with the maternity tariff. This will not change with the move. Indeed the PFI mortgage would exacerbate it
  • The LWH shares many services with the Royal now. There are already problems with these shared services. The Royal cannot afford to subsidise the LWH.
  • The team from LWH can and does operate at the Royal when  there is a likelihood that long-term intensive care will be needed after the op. This quite common in the NHS.
  • Nothing in these plans would stop babies being sent to Alderhey  for operations.

The Government handed major control of the NHS  from the secretary of state to the  barons of the NHS, themselves ideologically and personally linked to major private health companies. Making money became a priority, moving the NHS into the “market” has caused further problems. Free trade agreements already threaten the NHS.

The decision to cut bursaries for nurses and midwives was damaging and difficult to explain if stability in the workforce was an aim. Many midwives will retire in next ten years  as  one in three midwives are in their fifties or sixties. This is one factor  an even bigger gap, with more leaving than joining.

No privatisationThe overwork, stress and under payment of staff makes spending £140 million on  this seems even more unacceptable

There are two funding streams for the NHS,  revenue which pays for salaries and day-to-day expenses, and capital which pays for buildings. Buildings surrendered because they are no longer needed are subject to the Naylor Review. The site would not be safe.Unless Naylor was revoked the site would be sold.

We believe the move to the Royal will enrich builders, enrich land speculators who would love the plot the Women’s now occupies, and do nothing to help the women and babies.

The Royal site is in the midst of a traffic hotspot and traffic pollution harms babies more than anyone, in the womb and when newly born. Travelling to and from such a highly polluted spot id not acceptable, even if filters were built into the air supply.

A landscaped green site is positively good for patients. Why should we lose that for our babies?

Maternity  is an expensive sector for the NHS. “Admission to hospital to give birth is the single largest cause of admission to NHS hospitals in England”
Women’s health is a significant factor in the NHS with women on average experiencing 19 years of ill-health, and one-third having serious problems with reproductive health.

clean airWe also value the calmness and kindness which is the ethos of the hospital .Giving birth in a calm quiet and caring place is great for the mother, the baby and the family. Patients who have been treated there for other conditions also speak highly of the ethos and care

The statement, and the plans published,  make much of the safety gains of having the other hospital a bridge away. However in Birmingham women’s hospital which has such an arrangement, very ill women are still transferred by ambulance because that is safer than a trolley push.18 women were transferred last year out of the hospital and at least as many transferred into Liverpool Women’s Hospital. LWH is one mile from the new hospital. Broadgreen Hospial which is part of the Royal  is much further away yet cooperation is not a problem there.

Recent CQC reports give the existing Women’s  a good safety report. We reject the plans  which reflect the maternity review,  written by Conservative Peer  Cumberledge, which is now increasingly  discredited.

We need a hospital that focusses on women’s health, because we are not the same as men, much as we love some of them. We want to keep all the services together and not have them dispersed to the “community” where they are much more likely to be closed down quietly

In times of trouble we hold what we have, we do not let the good things go.

Save Liverpool Women’s Hospital

Fix the Royal

March for the NHS 22nd September 2018, 12 noon outside the hospital.

They say “Our preferred option for the future is to build a new Liverpool Women’s Hospital which will be physically joined to the new Royal Liverpool Hospital”.

We say no.

(This is the statement from the hospital/CCG)

Who decides the future of Liverpool Women’s Hospital?

March for Liverpool Women’s hospital 2018 4

” We must save it”. Save Liverpool Women’s Hospital  campaign has spoken with over 4,000 people this summer of campaigning.

helen and pam carrrying the bannerSome people have asked us questions about how and why  the “relocation” of the hospital is being proposed.  This then is an attempt to answer some of those questions.

In a cash strapped NHS, should £140 million pounds be spent “relocating” a perfectly good hospital less than a mile down the road?

Should we be suspicious if this is in an area being gentrified?

Should a  modern low-rise hospital in landscaped grounds, set back from the traffic, be replesley at Run event

laced by a high-rise in the middle of some of the densest traffic in the city?

Should such a move be pushed on the false basis that the move would save money?

Should we take the risk  of losing an exceptional hospital in a time and an  environment so hostile to the NHS, in a situation of crisis, spring, summer, autumn and w

inter in the NHS? Or should we  say, like the Merseyside Pensioners Association say “What we have we hold!”


Liverpool Women’s Hospital  is explicitly safe. The CQC report indicates this and all sources confirm this. If you want more detail please see here

The day-to-day problems of funding for Liverpool Women’s Hospital  come from the underfunding of the NHS nationally, and from an inadequate maternity tariff. The idea that savings from sharing some services  at the Royal can bridge that gap or even pay for the £140 million move  is not  credible. Recruitment at Liverpool Women’s Hospital is traditionally good because it is a world-famous hospital.

The main decisions about the Liverpool Women’s Hospital are,  officially,  made by  the Board of Directors of the Liverpool Women’s Hospital and the Liverpool Clinical Commissioning Group.  Liverpool City Council Health and Wellbeing board has a say too. Liverpool City Council is working with other organisations  as part of  plans to integrate health and social care. This larger group could have a say too, though not immediately.

Just to be clear, it’s not the doctors, midwives and neo natal nurses making the decisions. Not here, not anywhere in the NHS. There are few doctors on the board. Clinical directors do not often attend the board meetings. Relationships between the hospital upper management and the staff are not always sweetness and light as the annual NHS survey indicates.

Liverpool Women’s Hospital has a regional role too. It provides services for  women, babies and some men from across the region,  into North Wales, and the Isle of Man. These services include the treatment of complex cases.  Plans  for the future of this hospital go to the other  Merseyside Councils, in a joint committee  for approval too.

neo natal 2Liverpool Women’s hospital’s role as a neonatal centre has just been  further developed by a grant of £15m funding to improve and upgrade its existing Neonatal Unit. Th re have been other improvements too in Outpatients department, and  in  the refurbished Gynaecology Unit.

Merseyside and Cheshire have an Sustainability and Transformation Plan area  that is  supposed to plan NHS provision in its area (and make further huge cuts of almost £1billion across the area), and  parallel to that is the Women and Children’s Vanguard , which nationally  answers to the Maternity Review

The Maternity Review  is pro privatisation, both in the use of for profit providers, encouraging dispersing services from hospitals  and in developing costing mechanisms through the  personalised budget system.The  safety and effectiveness of the maternity review is called into question here .

Already many women  have been charged for NHS maternity care based on their migration status even if they are living and working here, or if they are UK citizens returning here the costs are enormous.

TBirth chairhe pressure to use private providers, (one such organisation has been placed on enhanced surveillance) and to encourage home births  are also part of the maternity review. Maternity  care  should respect the mother’s wishes AND must always be safe for mother and baby. Some of the ideas that over  promoted natural child-birth by criticising provision that used interventions in childbirth, have already been rolled back since our campaign started in 2015. Home births for those who want them and for those for whom it is safe, are great, but the vast majority of women choose the safety of the hospital.

Many NHS budget crises, including that in Liverpool Women’s Hospital  are temporarily supported by what’s called Transformation or Sustainability funds; it’s not quite the same thing as the STP  areas, but came in at about the same time.

The  NHS nationally   must be  formally consulted too about major expenditure. The NHS national structure is s complex.  There is a set of slides available here but there have been changes since this was written. The laws changed in 2013 with the health and social care act and another major change is under way at present.

Consultations with the national NHS bodies are detailed and the ones about the Liverpool Women’s Hospital have been back and forth a few times,  according to  reports to the board.

£Two streams  of money go into the NHS, Revenue for day-to-day spending and capital for major projects. Capital funding is  the permission to spend money on long-term projects like new builds,  refurbishment, major equipment and the like. NHS capital funding is not doing very well, falling for three years in a row ( Capital spending does well for the big corporations making a packet from it)

A bid for capital funding needs to be made if the current plans for a “relocation” are  to go ahead. The plan is  to relocate Liverpool Women’s Hospital to the traffic island that is the new Royal site (Prescot St, Liverpool L7 8XP)

There is a  problem that this, and the last, government  wanted to keep big capital expenditure off their books. They falsely believe that borrowing for investment can lead to a financial crisis. Its plain nonsense, details here. Keeping big borrowing off the government books has given big corporations like Carillon the chance to make a fortune from Private Finance Initiative which have resulted in hugely expensive and often badly built hospitals and schools.

At present there is no  published source for the money for the Liverpool Women’s Hospital Boards plans. Unless there is a major turn in Government policy the money for this relocation will come via PFI, or possibly a loan from Liverpool City Council,. who will themselves have to borrow the money. Liverpool city council has its own major financial problem thanks to appalling austerity cuts from this government.

june 30thThe abominable chaos that is the new Royal  Liverpool  build has to be sorted out at huge cost. The full cost is not yet known, nor who will bear that  cost. Never the less we are expected to believe that this will have no impact on decisions about money to relocate Liverpool Women’s hospital at the  projected cost of  over £140million on  the same site.

Policy issues are decided by government and by their appointees in the NHS, like Simon Steven.They are not the polices the people of liverpool generally support.

There are two professional disciplines involved in planning health care, one is medicine which is the patient facing care and the other is health economics. The health economics planning in the last ten years have been disastrous, and politically committed to the privatisation and US model.

Lets look as some of the errors this group have made

1. Hospital beds numbers  have been closed down but are desperately needed.

2. The internal market introduced to make hospitals compete has been an expensive  disaster.

3. Staff shortages. Insufficient doctors , nurses and midwives have been trained. This is a planning failure, not an accident

4.  Bursaries have been  stopped.

7. Outsourcing  and commissioning private companies to deliver health care has been costly and ineffective.  Private companies made £831m profit from such contracts.

Doctors Nurses and Midwives  and the related professions correctly want to be able to co-operate across hospitals, across disciplines. What stops this is not the physical placement of the buildings, but the trust system and the internal market.

Broadgreen Hospital  and the Royal constitute one trust and are talking of merging also with Aintree . These buildings  are much further apart than Liverpool Women’s Hospital and The Royal Liverpool University Hospital. Talk of an “isolated site” in this situation is a nonsense.

Long term intensive care at level 3 is not available at Liverpool Women’s Hospital. Short term intensive care is  available at LWH. Those who need long-term intensive care are transferred to the Royal. 6 minutes away, by ambulance. This is less time than it would take to push a patient through areas of some hospitals. It would cost a lot less than £140m to upgrade the service at LWH. Services which do cause problems are ones that the hospitals already share.

Christine jonesOur campaign is very realistic about the strengths and weaknesses of Liverpool Women’s Hospital. We heard some breath-taking  stories whilst we were campaigning, some of wonder at lives started and others saved and some less happy. We met so many happy babies, and lovely children born there. Some of you we spoke to might like to share your stories on our Facebook page or in reply to this.

More than 40,00 people have voiced their opposition to these proposals. Our campaign wants

  1. to keep our  hospital focussing on women’s health, the average British woman has 19 years of ill health.
  2. to keep maternity provision safe and away from traffic fumes and particulates
  3. to obtain better funding for the NHS and especially for maternity.
  4. to pay staff well, recruit, train and retain more staff.
  5. to oppose privatisation and PF.
  6. to end the rationing of care.

main poster jpegPlease march with us on September 22nd 2018  at 12 noon to Save Liverpool Women’s Hospital and Save the NHS. This is the next stage in our campaign Fight like your grandmother did to get the NHS


March for Liverpool Women’s Hospital 22nd September 2018

main poster jpeg

For all our sisters, mothers, daughters, friends and lovers.

Fund maternity services properly, nationally and locally

Protect and improve health care for women.

The NHS needs you. Bring the family. March for the National Health Service:

Fully funded. Publicly provided, not for profit. Free at the point of need and providing a comprehensive service. End the PFI scandal.

Repair and finish the new Royal Liverpool Hospital. Kick out the privatisers.

Pay the staff well. Bring back bursaries Tackle work-load

Please send solidarity greetings to use on the march and in the build up to the march

Follow us on face book Save Liverpool Women’s Hospital, twitter @ lwhstays, blog Save Liverpool Women’s Hospital

sonia's graphic

March for the

Liverpool Women’s Hospital

22nd September
12 noon Liverpool L8 7SS, to Albert Dock, through town.

Deepest Sympathy

Our hearts and thoughts go out to the  families  of babies who died at the Countess of Chester Hospital Waiting, hoping and praying that  a very sick new-born will come through leaves a permanent  memory in the minds of the whole family. Thankfully many babies do make it through and grow into healthy children and adults.

Sadly some babies don’t make it and  hearts break.  How incredibly hard it must be for parents and families who also find that their baby’s death is possibly a murder. The emotional  pain must be extreme.

Our thoughts go also to the staff who work in the hospital who have worked hard and professionally.

This has been a long chain of investigations some of which we have reported. We do not know and cannot comment on the guilt or otherwise of the case against the arrested nurse. That must go through the courts.

We do know that the NHS needs to reduce workload and increase the democracy in the management  of staff, making more staff more confident  to raise concerns.

The chain of events looks something like this. The numbers of deaths  looked wrong. A report was commissioned. Then there was a follow up report, admissions  of the most complex cases were restricted,  the police were involved and now an arrest has been made. What happens now will be decided in the courts.

A year ago the Countess Of Chester Hospital published the following statement here

 “The Countess of Chester Hospital has requested the input of Cheshire Police into its ongoing review of neonatal services.
In February this year we published the findings from an independent, clinical review into neonatal services at the Countess carried out by the Royal College of Paediatrics and Child Health. This report pointed to 24 recommendations for improvement which are now underway. It included a further detailed case note review by an independent neonatologist that has been unable to answer all of the questions regarding the cause of death for a number of babies.
The Trust and its doctors have continuing concerns about the unexplained deaths and are very keen to understand that everything possible has been done to help determine the causes of death in our neonatal unit between June 2015 and June 2016.
As a hospital we have taken the clinical review as far as we can. We have now asked for the input of Cheshire Police to seek assurances that enable us to rule out unnatural causes of death.”
 Since the 2017 report  Chester stopped providing for these most complex cases until the concerns had been addressed.
A major report by MBRACE  started the chain of investigation. From this there has been a chain of events that lead to the arrest.
Neo natal care is a  very skilled, very intense and caring part of hospital life. It is also very high-tech and involves cutting edge science. Babies  are alive today who just a few years ago would have died. It is an important service and most of us know very dedicated staff involved in this care.
The deaths in Countess of Chester is a terrible story especially as the care offered to these babies matters so much to everyone and especially to the mums, dads and  families.
Our campaign sends sympathy to all who mourn.

Will medicine banks join the food banks and the clothes banks?

G.P.s  have been told not to write  prescriptions for some conditions. This is a cost cutting project. It will save £100million pounds,  or so the NHS national management claim.  This £100 million will only hurt the poor, and we have plenty of  poor people amongst us.

The NHS national management have made some  damaging decisions in the past, like cutting  far too many hospital beds and privatising many mental health beds. This is another bit of  nastiness.

This policy will be fine for people with money to spare, as the prescription charge  could well cost more than buying medicine over the counter. However  in Britain this year 4 million people used food banks, 4.1 million children are now living in relative poverty  accounting for more than 30 per cent of children. Liverpool and Merseyside  have  high rates of child poverty. Most of these children come from families with at least  one working parent. A fifth of the UK workers earn less than the living wage. Families headed by working mothers  can be hardest hit because mothers on average are the worst-paid. In Liverpool last summer thousands of schools uniforms were collected and donated to those who could not afford them.

food banksSo how are people who can’t afford food or school uniform, or to keep the house really warm in winter,  going to afford these medicines?

Knowing the medicine might not be available might stop people going to  the doctors and serious illnesses not being spotted. Better 10 trips to the doctor for minor ailaments than  one serious illnesses not being spotted.Haemorrhoids and Diarrhoea are minor problems  but can be symptoms of worse.

Are we going to be having to ask football fans to bring medicines to the match to put in collections? Who  would  be responsible for keeping medicines safe?  The idea is ridiculous. In a city with a street drugs problem, this would be  dangerous.

sun burn 2 Without these simple treatments  people with little money will get more ill, will have longer off work and will long-term cost the NHS more.A mum with conjunctivitis will find it hard to go to work. Children should wear sun screen. Is it ok for poor kids to get sun burnt? What does a mum do if her child has awful colic or  bad  nappy rash or oral thrush?  Do they not understand just how carefully many mums have to budget?

It’s not just the people directly affected. Imagine children in a class where some mums can’t get hold of head lice treatments, or  Verrucae treatments.

The NHS needs decent funding and the money is there to pay that funding. Only the United States of America and China are home to more billionaires than the UK, while the combined wealth of the (very rich) list has increased 10% since 2017.  We are lucky if we get a 2% pay increase. This is the fifth largest national economy in the world. Our government can fund the NHS properly but we must make it  louyd and clear that  a fully funded NHS is essential

The NHS protects us from  some  ill health caused by poverty and most  poverty caused by ill health, but we  need to stop the rot, stop policies that only hurt the poor.

The World Bank says ” Poverty is a major cause of ill-health and a barrier to accessing health care when needed. This relationship is financial: the poor cannot afford to purchase those things that are needed for good health, including sufficient quantities of quality food and health care.


“Ill health, in turn, is a major cause of poverty. This is partly due to the costs of seeking health care, which include not only out-of-pocket spending on care (such as consultations, tests and medicine), but also transportation costs and any informal payments to providers.


Pulse a GP newspaper commented “The guidance also does not apply to long-term or more complex conditions who will continue to get their usual prescriptions”

But it does point out that “people who receive free prescriptions will not automatically be excluded from the new guidance” So the poorest will be hit.

“Conditions for which over the counter items should not routinely be prescribed in primary care:

The conditions are these

  • Acute sore throat
  • Infequent cold sores of the lip
  • Conjunctivitis
  • Coughs, colds and nasal congestion
  • Cradle cap (seborrhoeic dermatitis – infants)
  • Haemorrhoids
  • Infant colic
  • Mild cystitis
  • Mild irritant dermatitis
  • Dandruff
  • Diarrhoea in adults
  • Dry eyes/sore tired eyes
  • Earwax
  • Excessive sweating (hyperhidrosis)
  • Head lice
  • Indigestion and heartburn
  • Infrequent constipation
  • Infrequent migraine
  • Insect bites and stings
  • Mild acne
  • Mild dry skin
  • Sunburn due to excessive sun exposure
  • Sun protection
  • Mild to moderate hayfever/seasonal rhinitis
  • Minor burns and scalds
  • Minor conditions associated with pain, discomfort and fever
  • Mouth ulcers
  • Nappy rash
  • Oral thrush
  • Prevention of dental caries
  • Ringworm/athlete’s foot
  • Teething/mild toothache
  • Threadworms
  • Travel sickness
  • Warts and verrucae

The British Medical Association has said”‘However as there has been no change to the regulations that govern GP prescribing, this guidance cannot be used by CCGs to ban all such treatments. GPs must continue to treat patients according to their individual circumstances and needs, and that includes issuing prescriptions where there are reasons why self-care is inappropriate. This guidance does make it clear that such requirements continue to apply in individual situations.”

and RCGP chair Professor Helen Stokes-Lampard said 

‘We are very pleased that NHS England have listened to our concerns and that GPs will retain the ability to use our expert medical judgement and clinical skills to prescribe medicines that are also available to buy over the counter in certain circumstances. It is also welcome that limitations will not affect patients living with longer-term and more complex conditions.’

So if you need  these medicines and can’t afford them, ask for  them , and quote that advice. Tell your GP what the BMA says

And please tell your MP what you think of this.

If you are keen to help the NHS come to London on June 30th to join our ceklebrate and

june 30th

defend the NHS demo. Contact our facebook page for details of tickets. £20 waged £10 unwaged. Further concessions in cases of need.


Don’t let the vultures in.

The NHS must not go the way of the Care Home sector.

A CQC report on Liverpool’s Health Care is advising the NHS and the Liverpool Council to work in financial and planning partnership with the private nursing home sector, and other private providers. Haven’t we had enough with Carillon? This is to be discussed at the Health and Wellbeing Board. The Liverpool Integrated Care Partnership Group, would include this sector and other private providers in an integrated planning organisation. Further details of the whole plan canbe found here

old people crossingThe elderly care home sector is very seriously flawed. The system is dominated by big business including hedge funds. A hedge fund is “an offshore investment fund, typically formed as a private limited partnership, that engages in speculation using credit or borrowed capital”. Football fans will have heard of them.

Private sector homes for the elderly now have a combined market value of £11.9 billion; five times that of Local Authority Homes. About half of residents get some Local Authority funding, and some get NHS funding, but most residents have to pay a lot themselves.

The system is run for profit by Big Business and has a poor record.

There are four major companies, owning what often appear to be independent care homes.  Companies that appear independent can be owned by other companies. Three of the big four, HC-ONE, Four Seasons and Care UK, are owned by private equity companies, complete with debts, according to the Financial Times. Private nursing homes are  owned by big business out to make a profit

Four Seasons Health Care has been in deep financial crisis, of its own making, resulting in a crisis in Widnes last year. This is not a crisis from lack of funding from the Government or local authority but from the financial model they use. Many of them are owned by hedge funds, are financially insecure, and can close because of bad debt arising from speculation.

In Widnes, the Millbrow Home had to be rescued from a near financial collapse by the public sector at the end of 2017. This model of care takes a profit, but does not take responsibility. The responsibility seems always to drop back onto the public sector.

Remember Southern Cross?

“Southern Cross Healthcare (Group plc) was a private provider of health and social care services, predominantly through the provision of care centres for elderly and some younger people. The group was the largest provider of care homes and long-term care beds in the United Kingdom, operating over 750 care homes, 37,000+ beds and employing around 41,000 staff. Following rapid expansion financed by the sale of leases of its homes, its shares fell 98% from early 2008 to early 2011, reducing its market value from £1.1bn to around £12m. The company had severe financial problems in 2011 and declared insolvency the following year”. (


This sector could be voting on plans and allocation of our Local Authority and NHS resources

This is out of order…

Image: Yui Mok/PA WireThe men and women in the homes have the right to respect and the best available care, including medical care. The law and organisation of the Care Home System is not fit for purpose.  It shows all the very worst elements of privatisation.

The staff working in social care can be fantastic, kind and loving but are overworked and underpaid. Many are so overworked they are leaving or having breakdowns. Care on the cheap does not work.

Unison quoted a worker”I have seen many good workers leave frustrated at the poor pay and the way zero hours contracts are used by way of punishment and reward. If you turn down a shift, hours you were depending on can be taken and given to others, sometimes with only hours’ notice. I have seen how many use this as a way to simply force out staff who may have complained about quality of care. Is this acceptable? Duty of care means that we have to raise concerns, yet many are too scared of the implications financially if they do.”

unison nurseWe need residential and nursing home care for  some our growing numbers of older and ill people. No one wants people kept in hospital for longer than they need to be there. Although if  so many  hospital beds had not been closed it would be less difficult to keep people in hospital a little longer.

The profit driven private care home sector though, must not have a say in Liverpool’s Health Service or in Council funding decisions. No to an integrated system!

The CQC report lists three sets of local social care providers as part of the local system:

“Adult social care”

49 active residential care homes:

  • One rated outstanding
  • 35 rated good
  • 10 rated requires improvement
  • One rated inadequate
  • Two currently unrated

41 active nursing care homes:

  • 16 rated good
  • 15 rated requires improvement
  • Six rated inadequate
  • Four currently unrated

72 active domiciliary care agencies:

  • Two rated outstanding
  • 34 rated good
  • 11 rated requires improvement
  • 25 currently unrated

This sector, with this local and national record, should have a say in our NHS, our Local Authority Care. Really? What about due diligence?

board2We need good social care

Hospitals negotiate daily with the private sector to accommodate people in need of a care home placement. It is  both routine and difficult because there is not a comprehensive universal service as there should be. What we have is a patchwork of services, some good, and some bad. Significant parts of the service are owned by big companies there to make a profit.

The care home system is inadequate, run for profit, and privately owned and should have no say in how the NHS or Local Authorities are run.

The market does not work in public service. It is inefficient and ineffective. The problems in the sector are not to do with shortage of cash, but to do with maximizing profit through hedge funds.  The needs of our elders come second to profit. The sector needs to be reformed. We have to use the system until the next government acts or Local Government finds a way to take it back in-house.  Do not let them take charge. This system must not be allowed to taint our NHS.

Care homes were one of the first sectors to be privatised

“In the 1980s a significant shift from the public sector provision of elderly care to private sector homes occurred, with the proportion of private facilities increasing from just 18% in 1980 to 85% by the end of the century.[2]

We need to nationalize the care home service, cut out the hedge funds and their speculation, and set some decent standards.

We need publicly owned, publicly provided care homes, with reliable funding and good levels of investment, effective monitoring and good planning, like the NHS used to have.

We need a full regulatory and training system. We need staff with secure jobs, who go home fit to raise a family, to enjoy their leisure, not tired to the bone.

Cruel and disgusting Government cuts

Liverpool City Councils funding has been mercilessly slashed and this has damaged funding for social care. Out sourcing and reducing the working conditions for staff has solved nothing. It has made things worse. The private sector is not efficient at providing public services.

Liverpool Echo reported in 2017 “Since the coalition Government came to power in 2010 and began an era of austerity and swingeing cuts to local councils, Liverpool’s authority has had to make total budget reductions of £330 million.

In 2010, the council received £523.72 m in Government funding, compared with the £243.90m it will receive this (2016) year. That figure will drop even further to less than £215m by 2019/20 meaning the council will have to find more ways to make savings and raise vital cash

We urgently need a better care system. A detailed report in 2015 described some of the difficulties vulnerable patients faced when discharged without good care. Delayed discharge figures were at the forefront of NHS managers’ minds during the winter/spring beds crisis in the NHS. Patients can be discharged only to come back into hospital shortly afterwards. There is a need to improve medical care in the care home sector.The private sector must not be given any kind of decision-making role, whatsoever, let alone sharing risk and gain.

Labour is committed to a national care service. A Labour Council should not be dancing with the devil, but should be preparing to implement its party policy.