Not sufficient at all

Hello fellow midwives,

Have any of you seen the message to RCM members by CEO Gill Walton. Here is the link for you if need:

I find it hard to put into words how this makes me feel, but utterly disgusted and outraged by the attitude of GW is a start.

Where is the support from our union? Other unions including the BMA and Unison are asking their members to let them know about COVID related issues in the workplace – PPE for example. These discussions need to be had out loud in the public arena not stifled by our union or our hospitals with fear of reprisal. Let’s speak out. Together we are strong. Let’s support those staff members that do.

If any of you want to tell me anything in confidence please private message me. Some know me already and I hope trust me, others who don’t please message and talk with me.

We need to do this to protect each other, our families, the women and patients we look after.



If midwives wish to contact R we will forward your message

Issues from the maternity services front line. Protect maternity in the virus crisis

Since we posted our last blog we have been hearing from people directly involved with maternity care locally. Merseyside camapigners for good maternity care are not alone in sharing concerns about how maternity should be treated during the crisis. The Royal College of Midwives has published its concerns, saying “Help us deliver safe care for Pregnant Women.

This is the link to Liverpool Women’s Hospital public information as on 31st March 2020

Even without the crisis, too many babies nationally die at birth or shortly afterwards or sustain brain injury. It is right that we raise concerns at a time when staff are under great pressure.

Here are some of the issues raised locally during this crisis which is still in its early stages. We have raised these issues directly through questions to the board of the Liverpool Women’s Hospital. The Board is not meeting in public but we have submitted questions.

  1. Discharging babies

Delivery suite are needing to discharge women as soon as ossible after birth, for obvious reasons. However, each baby is required to have an Examination of the New-born prior to discharge. Pre the COVID-19 outbreak this was always performed in the community but that is now not possible, therefore it is now the responsibility of delivery suite midwives. However, most midwives are not trained in this. Delivery suite midwives are also needing to complete all the discharge paperwork. It would help the situation if staff who were trained in the Examination of the New-born were allocated to the delivery suite to do all the discharge work. Questions are being asked as to how can delivery suite (d/s) midwives be supported with this extra workload? For mums discharged home before having their baby examination completed they are bringing their babies back to LWH clinic to do this examination, but more staff are needed to do this.

2. Infants who would usually go to SCBU/NICU; because they need 3 hourly feeds / true blood glucose checks are now staying on the delivery suite and therefore the responsibility of the staff there. However, there is not the workforce on the delivery suite to do.

3. COVID-19 / COVID-19 suspected women are cared for on the delivery suite and looked after by the 1 clinician, this ensures social distancing as much as possible. Staff are to care for the women in 4hrly intervals but in reality, staff are working their full 12.5hr shifts with no break/relief. This ensures as few clinicians as possible are coming into contact with the women, however, this way of working is not sustainable long-term.

4 Personal Protective Equipment (PPE) is needed for staff looking after COVID-19 / COVID-19 suspected women. At present only flimsy plastic aprons, paper face marks and the usual plastic gloves are being provided. Staff are to remove all ‘PPE’ when they come out of a clinical room and return with a fresh lot of on. However there is not enough stock, particularly the paper masks, so the same face masks are being re-used when re-entering rooms and used for hours on end. Staff are not getting measured up for the proper COVID-19 protected masks, at present only for theatre staff where a woman/patient is COVID-19 positive are wearing them.

5. On Delivery at present, there is only 1 COVID-19 designated/converted room, a second one is getting sorted. It is important to know how many is the hospital planning on converting? Staff need to know how many pregnant COVID-19 women are they expecting over the next coming months based on Public Health England data.

6. The Clinical staff need to know how many babies are contracting COVID-19 from their mothers in the immediate post-natal period? What are the UK / local stats?

7. For women undergoing a general anaesthetic for a caesarean section when COVID-19 positive – what additional care is provided? Will it always be a consultant who anaesthetises the woman? Are consultant anaesthetists required to be on-site out of hours throughout the pandemic?

8. Staff until recently went home in their ‘dirty’ uniforms. Now this being stopped (thankfully) but not adequate changing room space/showers are available at LWH. There is 1 small locker room (far away from the delivery suite entrance) that staff are required to use, which means they have to walk the full length of the delivery suite in their ‘clean’ outdoor clothes to access the room. Only 1 shower is available, so staff cannot shower before leaving work. Also, the room is far too small for 13 or so members of staff to change all at once. More locker/changing room space needs to be provided for clinical staff.

9. Are Trust cleaning staff available to deep clean the clinical area/consultations rooms after a suspected/confirmed COVID-19 pregnant woman has attended? This is particularly problematic in clinic situations as the cleaning staff only usually attend after hours. Midwives at one Trust have been instructed to leave these rooms free for 20 minutes ‘let the dust die down’ (!), then perform 20 minutes of cleaning, then allow 20 minutes for the room to dry, other Trusts are instructing staff to leave rooms vacant for 4 hours.

Has there been any increase in cleaning staff and what training regarding the cleaning of clinical areas have Sodexo staff had re COVID-19? Particularly, given the long period that the virus is thought to remain active on plastics/wood/cloth. What are the procedures in place to reassure the public this is happening?

10. We hear that LWH is planning on suspending the home birth team, This would mean more women will be coming into the hospital, which is not a good move in this climate. Additionally, ambulances are under pressure but we are also hearing of other maternity units in the northwest being closed and the premises given over to Corvid treatment. Where possible home births should continue.  

11. Staff  are not clear who is eligible for COVID-19 testing – is it all staff or only those in contact with a confirmed COVID-19 patient? When will staff testing begin? And in what order of staff? Will it include ancillary staff?

12. At present, 60 staff (midwives/doctors)  are off – mostly related to COVID. Last week it was 42.

13. Regarding staff; what are LWH numbers of COVID-19 confirmed cases, suspected cases, staff returned to work cases, self-isolating because of a high-risk group, and come into contact with COVID-19 person?  

14. For patients what are numbers of confirmed/suspected cases?

15. How is patient crockery/cutlery being dealt with for COVID-19 patients?  There need to be disposable versions used. Midwives are taking responsibility for the cleaning of this.

16. Student midwives are remaining in clinical practice: Why?

a. There is mounting evidence that the clinical area is not a safe place i.e. not the required standard PPE for all staff or the optimum (even by pre-COVID-19 standards) staff: patient ratio, already the workforce is down / out of practice (self-isolating).

b. Medical students have been pulled from practice, why not student midwives (& nurses)

c. How is the Trust dealing with mentoring/ supporting students? We are hearing from the students that they are not getting adequately supported/mentored in practice, even already.  It has always been the case that students are taken out of clinical areas where this is happening. Why is this now not happening? The situation will worsen regarding supervision/mentorship. We are not yet at the peak of the crisis

d. Most midwives find mentoring students an extra responsibility. Is this necessary now? Is it not possible to pause all clinical learning and focus on theory only, this would be a far better option than putting students in an at-risk environment. Universities could front-load their learning with theory. Have the Trust considered this? In particular to ‘save’ the future workforce

17. Birth partners are essential for patients emotional and mental health support for every mum in labour. We know from the MBRRACE Report and our BAME community that given the raised risk for BME women the presence of support is essential. Yes, partners too might carry COVID-19. This is another reason to make maternity a key area for staff, patient (and partner) testing. It’s not a reason to leave a woman on her own giving birth in this high-stress time. The RCM supports birth partners being present. However severely restricting other visitors seems semsible and appropriate to keep everyone safe.

18.  Children seem  to be less susceptible to the coronavirus than older people There  is a detailed article on this here,  It is interesting that this work is being led in Liverpool.

There is only one chance at birth. Each birth involves two human lives. Defend maternity services, defend maternity staff, defend all our mothers, sisters, daughters, friends, and lovers during this crisis.

One chance at birth. Protect maternity services in the crisis.

Maternity care and women’s health require an excellent response to the Coronavirus outbreak. Virus or no virus, there is only one chance of birth. Two human lives are involved in each birth. There should be no short cuts during this crisis. Services for women and babies were already in trouble before the virus. The Royal College of Midwives has called on NHS leaders to ”protect the safety of pregnant women by ring fencing maternity services in the current crisis

While other areas of the health service can postpone and cancel procedures, there is still an ongoing need for maternity services. Women are still pregnant, still having babies, and they need the care and support of properly resourced maternity services. We have to ensure that midwives and maternity support workers are ringfenced from any redeployment to ensure that women continue to receive safe care.

Over a fifth (22 per cent) of survey respondents also reported that local midwife-led maternity units had been closed, with more than a third (36 per cent) of areas also either stopping (32 per cent) or restricting (four per cent) homebirths. In 11 cases the midwife-led unit has been closed to provide facilities to assess or care for coronavirus patients.

We need careful professional responses, careful supervision of new and inexperienced staff, and good supplies of personal protective equipment and good supplies of ventilators and we need testing of staff and patients for the virus. We need meticulous recordkeeping so long term effects can be traced

The response of NHS front line staff, of volunteers and returnees to the professions has been outstanding. They are saving thousands of lives by their response. It is right that the nation clapped them on Thursday!

NHS staff kept the NHS afloat through years of cuts. Staff worked a million hours per week of unpaid overtime. Their last pay deal was such a disaster that the RCN apologised for advising staff to accept it. More than a million volunteers also helped out in the NHS even before the recent call-out

Even before the virus there was a dire shortage of midwives. The Guardian is reporting that the midwife shortage has doubled as NHS staff are diverted to tend to Corvid patients.

Reports have come in of the first deaths from the virus working surgeons in the NHS. The NHS staff are putting themselves on the line for all of us. We must protect them too, by demanding better equipment and more testing.

Sadly, the main organisation of the NHS, in contrast to the workforce, has been found seriously wanting. “When this is all over, the NHS England board should resign in their entirety.Lancet  The culture of doublespeak and the use of soundbites has not changed. Staff still fear to disagree with management, whistleblowing procedures are poor. Annual surveys show staff unsure of their managements. In some hospitals, we hear of bullying by management happening even as the virus rages

The most up to date advice for pregnant women found whilst writing this article for pregnant women and pregnant NHS professionals are found here for professionals and here for parents. “ Our advice remains that if you feel your symptoms are worsening or if you are not getting better you should contact your maternity care team or use the NHS 111 online service / NHS 24 for further information and advice.”

The Lancet voice has a useful podcast on Corvid Virus and pregnancy. In this podcast doctors dealing with pregnant women and new babies speak from the virus outbreaks in China, Italy, Spain and other counties sharing their experiences.

In Italy, Spain and France numbers of the dead are growing and medics are amongst the dead. We send our solidarity and sympathy but know we are not far behind if the virus continues in the same way here.

Current research shows that Pregnant women are not more severely affected by the virus. There is no evidence of vertical transmission from other to baby, so far. Mothers in labour are still advised to bring a birth partner but only one. Visiting has been restricted to reduce the amount of virus coming into the hospital Advice from Liverpool Women’s hospital is to be found here

Pregnant women over 28 weeks are advised to self-isolate

Save Liverpool Women’s Hospital is a campaigning organisation trying to save Liverpool Women’s Hospital, to campaign for better health care for women and babies and to defend and win back the NHS. We have been campaigning for five years and learned a lot about how the NHS works now, how it used to work before 2012 Act, how the NHS was originally designed to work, and how it has been damaged.

At the last local CCG meeting, one of our campaigners tried to persuade them to take more time to plan the Corona Virus crisis but was unable to do so. They discussed the reorganisation of the CCG instead. When our campaigner raised the issue of migrant access, she was told there was no problem with people being afraid of charging. She then raised the example of the three mums dead from fear of migrant charges. Still, no action was suggested. You can hear a detailed report in the second part of this podcast here

The role of CCGs seems to change quickly. All commissioning for the crisis was taken off the last week but now some claim to be trying to source PPE. And some are gaining praise for their efforts. What is happening?

Fundamental changes in the CCG network have been underway with mergers and changes to adapt to the new STP/ Integrated Care networks 44 areas of the NHS. A summary of changes can be found here

A huge amount of money is allocated each year to the NHS. That pipeline of money is siphoned off by business and financial consultants who are restructuring the NHS on US models The process of making the NHS reflect the US model is well underway and must be reversed. Infant and maternal mortality in the USA is dreadful

Testing, Testing, Testing .In this crisis, we need testing for mothers and staff. A gaping hole in the UK response is the lack of testing, mapping, tracking and isolation.Maternity is the largest reason for healthy people to use hospital facilities, yet neither staff nor patients are tested for the virus. Personal protective equipment is as short in maternity hospitals as anywhere else. It is impossible to know who carries the virus in the non-testing environment.

The experience of giving birth safely and happily is a human right and one our campaign will always defend.

Different parts of the country are experiencing different levels of infection. The most up to date figures are here Liverpool is still not a leader in the infection but the Northwest is a growing hotspot behind London and the West Midlands. The public good, not private profit must drive this response.

Public good and public service is the best way to provide health care. It is more efficient and efficacious than for-profit companies. PFI was and is a disaster.  It is important to remind people of Carillion’s nonsense, remind people how campaigners fought to prevent the PFI and the contract being given to Carillion. Liverpool faces this crisis with a broken half-built hospital because those who run the local NHS allowed PFI and then let contractors work unchecked. Remember all the outsourcing nonsense? Carillion, Interserve etc.? All the reduced wages and reduced service levels, reduced sick pay rights? Remember companies who took on services they failed to effectively deliver, remember the cut wages and sick pay?  Remember the companies like Carillion who either went bankrupt or restructured their debt

An Interserve Executive is being given the task of organising mass testing for Corvid 19, the Corona Virus. Interserve! Not public health, not even the NHS, Interserve. In this current Corona Crisis, who would you want to administer widespread testing when it finally is ready? Would you give it to a skilled, well educated public health service, or would you give it to an outsourcing company recently in dire financial trouble

We welcome any increase in testing but it has to be conducted well under rigorous conditions. The CV of the woman chosen, comes from Interserve? Really? Not a professor of public health? Not a public health practitioner? Not an epidemiologist?

 Women are at the heart of this crisis in the communities.

Women are at the heart of the social crisis around this virus. Most key workers are women, many of whom have young children and are many single parents. Many have caring responsibilities for older family members too. Contact out in the community is going to increase the key workers viral loading as they meet more people. Only the most obviously ill patients are being treated in hospital, so most of the virus is in the community, including in care homes and mental health facilities.

 Most of the additional informal care at home is falling to women in the community. With one in five workers expected to get sick, the pressure on women will be immense. Domestic violence  is increasing under the lockdown internationally. Pregnancy sadly is a peak time for domestic violence, All services must be aware of this and the government should intervene as the Spanish government has done. Disgustingly a UK boxer even filmed a tutorial telling men how  to hit their girlfriends during the lockdown

The Coronavirus is an equal opportunity killer but men are slightly more likely to die from Corona. Most people who have died are older rather than younger and most have other illnesses. Multiple illnesses amongst older people are itself a result of poverty and inadequate health care. People who live in poor areas have 19 years more ill-health than those in poorer areas and this is reflected in maternity outcomes too

The building sites across the country who are still working, not respecting safe distancing, are not going to help the figures for male illnesses. These men by and large will go home taking their acquired virus load with them.

Our concerns around the virus extend to babies and young children. Babies and young children seem to resist the virus better than older people but many children are already weakened by poverty. Liverpool has far too many underweight babies born reflecting the poverty of the area. Child poverty in Liverpool is a scandal but one that will get worse in this crisis Far too many babies in Liverpool are dying under one year old with at least one in three directly attributable to poverty

Mothers and babies in the UK have not had the best possible service from the NHS and life expectancy and healthy life expectancy for women have been falling

The worsening of Infant mortality over the last number of years is spelt out, in detail, by Danny Dorling

These developments mean that the UK as a whole now has one of the worst IMRs in Western Europe, falling behind the EU average of 3.6 per 1000, and ranking 25th of the 42 countries with available data for 2017.16 This is a marked change since 1990 when the UK had the seventh best neonatal mortality record in Europe and was even better, relatively, before that.17

Women are at the heart of the  family money issues in this crisis.

 “Making the household budget stretch even further when there is less money and more mouths to feed more hours of the day”

Many women are caught in low pay in the economy at large and in the low paid end of self-employment.  Women comprise 34% of self-employed workers, most of them on the low paid end of the pay structures and will be dealing with all the complications of this.

We heard (Shock! Horror!) that in Italy, such is the extent of the epidemic that patients are being treated in corridors. We were in this situation even before Corona fully hit us. A situation caused by policies like closing beds and hospitals, like diverting much-needed funds to for-profit companies, like not training enough doctors, nurses, and midwives and making the burn out rate soar in the NHS.

The NHS was woefully underprepared for this crisis. All the years of cuts, understaffing, burnt-out staff, bed closures and post-2012 reorganisations were bad enough.

The lack of preparation for a pandemic was even more unacceptable The Lancet, the doctors’ paper agrees with us “The NHS could have prevented “chaos and panic” had the system not been left “wholly unprepared for this pandemic”, the editor of a British medical journal has said.

The shortage of materials for NHS staff is directly down to political and financial decisions the Guardian reported here.

The NHS used to have a national procurement body but it was outsourced and run in some way by DHL, who has since lost the contract despite the boasts in this posting. Jobs the national health service could do, the private sector failed. A new supply chain body was set up in April 2018, making grand claims of new efficiencies but somehow its got this crisis all wrong.

The NHS was woefully short of beds and staff

The Kings Fund reports that

The total number of NHS hospital beds in England, including general and acute, mental illness, learning disability, maternity and day-only beds, has more than halved over the past 30 years, from around 299,000 in 1987/88 to 141,000 in 2018/9, while the number of patients treated has increased significantly.

We need old fashioned public health services. Dr. John Ashton, a Liverpool based  public health expert has gained publicity for his challenge to the government over this crisis. He  wrote in 2016 ” The state of public health services in England – why hospital physicians should be worried”

In this Coronavirus Crisis, we urgently need (but are being denied) old fashioned public health measures deliver by skilled experts. Much of public health has been decimated by local government cuts in this era of Austerity.  In 2017 John Middleton wrote” There is a high burden of preventable disease and unacceptable inequalities in England” Across the world, and for two centuries it has been recognised that humans living in close proximity to each other, need well organised public health services.

In Liverpool, we rightly commemorate the work of Kitty Wilkinson who set up the first wash house during the 1832 Cholera epidemic in the city. Similar solidarity action today, across the area, is providing formal and informal support within our communities in the crisis of hunger and poverty and this new  virus crisis. If Kitty could intervene all those years ago should not pandemic precautions have been in place today?

Picture from Liverpool Express

Our campaign calls for testing in the population. We agree with the WHO. The World Health Organisation, (WHO) say “Test, Test, Test”. Using the WHO recommendations, some countries have defeated the virus at least in its early presentation. What happens when the virus crops up again we still do not know, we do not know how long immunity to the virus will last or how the virus will react in different seasons. But for now, China, South Korea and Singapore appear to have defeated the virus .unlike the UK and Europe.

Maternity services need widespread coordinated public testing as much if not more than any other section of the NHS. Public testing could dramatically reduce the number of infected cases and let staff know when they are dealing with someone with the virus, even if they are  symptom-free. Testing and isolating reduces the number of infections

Aggregating across all individuals and under the optimistic assumption that all the contact tracing can be performed rapidly, we expect contact tracing to reduce the basic reproductive ratio from 3.11 to 0.21—enabling the outbreak to be contained,” they write. “Rapid and effective contact tracing can, therefore, be highly effective in the early control of covid-19, but places substantial demands on the local public health authorities.”

Professor Allyson Pollock quotes this in this article where she argues for widespread testing

Universal healthcare for all .As well as calling for testing we call for universal access to healthcare. For the NHS to be safe for all it needs to be available to all.

Think of the three mums who, thinking they could not afford NHS treatment for maternity, died last year from lack of care. Even today across Merseyside hospitals posters warn patients they might not be eligible for free NHS treatment

Will everyone who fears the virus dare to go for treatment? Mum and baby and everyone they meet are at risk, unless healthcare is universal.

The Government have said all Covid treatment has to be available to all

This means, as, for any other infectious disease in Schedule 1, there can be no charge made to an overseas visitor for the diagnosis, or, if positive, treatment, of this coronavirus.

  • No charge applies to a diagnostic test even if the result is negative. No charge can apply to any treatment provided for suspected COVID-19 up to the point that it is negatively diagnosed. t is very important, for public health protection, that overseas visitors are not deterred from seeking treatment for COVID-19. Please ensure that overseas visitors are not charged, or informed that charges may apply, for the diagnosis or treatment of the coronavirus
  • : patients that are known to be undergoing testing and treatment for coronavirus only are not subject to Home Office status checks

Portugal has offered to treat all migrants as residents during the crisis. The UK should do the same

Can we keep maternity hospitals free of the virus?

In Italy, doctors have described key tasks for the hospitals

Over the last fortnight, Italian hospitals rapidly restructured to achieve complete segregation of covid-19 positive and negative patients. Using designated “clean” and “contaminated” areas, this flow is maintained from presentation to discharge.

It is hard to see how this Italian model can work in maternity without testing of staff and patients. The assumption is that the maternity hospital is a “clean” area and the Corvid will be kept out as much as possible, but while Corvid in the population, corvid is in the maternity wards.

The nation clapped the NHS workers who are struggling to prevent both huge numbers of deaths and to stop the NHS being overwhelmed. The NHS is, just about weathering the storm of Corona (as this is written) but at a dire cost Crucial life-improving, pain-relieving, surgery, like that for endometriosis, and in some cases even cancer treatment are being postponed or cancelled to allow the NHS to manage a pandemic, that was well predicted and whose numbers could have been far better managed..

This pandemic was not a bolt from the blue. Serious scientists, who should have been heeded, predicted it. The literature showing that the pandemic was predicted and that proposals to address it were prepared is extensive but this is a useful summary This also gives detail on international discussions

Nor is this pandemic non-political. It was political choices that landed us in this situation. We had six weeks lost in preparation thanks to this inept government. Testing, mapping, tracing and an earlier lockdown of the population could have saved many lives.

The issue of understaffing in maternity and other areas of the NHS had caused political uproar. Many different enquiries in to maternal and infant deaths have been held See our detailed article here. It is good that more NHS staff were beginning to be recruited even before the crisis and great that that thousands of doctors and nurses have come back to the NHS to help.

The NHS met this pandemic under-funded, understaffed and under-equipped Basic commissioning of equipment and services has failed in the current NHS structure

Personal Protective Equipment is lacking so our NHS staff are at risk from, and present a risk to, patients Personal protective equipment should have been both stockpiled and immediately recommissioned once the WHO warning came out 6 weeks ago. There are small clothes making factories even in Merseyside who could have been commissioned to produce materials

Midwives too have reported shortages of PPE. One report was of midwives being told at what stage of Labour they are to use PPE. The nursing and midwifery council have added their voices calling for PPE for nurses and midwives.

The futile palaver over the shortage of ventilators, over losing an email offering EU cooperation, and getting newly designed ones created from Dyson is more public schoolboys playing games. There is an existing model. Reproduce that at scale or make minor improvements if necessary.

The decision not to buy in advance, not to stockpile was political. It was a political decision coming out of a political context of shaping the NHS as a commercial operation designed for the well being of big corporations.

Each huge accountancy and consultancy organisation in the UK “advised” the NHS and was well paid to do so in the run-up to the car crash that is pandemic preparedness. Breaking the NHS into 44 areas, into local CCG areas has all contributed to the mess.

Reports from China showed no enhanced risk to pregnant women or their babies from the virus, though there were slightly more premature births. There are some reports from the US  who are now reporting larger numbers of virus sufferers, of women giving birth in unusual rooms and of inductions to free up space.

Those with existing family responsibilities are more likely to have exposure to the virus. Women present in the hospital to have babies as the largest cohort of healthy people to use the NHS.

Personal distancing between staff and delivering mum is not possible in the Labour Ward or the delivery suite. All the virus that staff carry can be transferred to the mum, all that the mum carries to the staff. In normal times no one wants a midwife dressed as a spaceman with huge PPE but right now PPE is needed.

Staff and patients in maternity should be tested for the virus, and records should be kept.

Student midwives in their final year are being brought into hospitals to help with staffing levels. The shortage of midwives, of course, predates this crisis and will remain after it. Our campaign has long called for, full bursaries, and full pay whilst training, more training place for midwives. We want no reduction in the quality or quantity of midwife training and education, but a steady ramping up of provision. Student midwives and inexperienced midwives need supervision as they practice, as they work with the mums. That is how the skills are honed. We need too to retain the young obstetricians and gynaecologists. Up to 40% of young doctors were “taking a break at the end of foundation training”

It will be tough for everyone coping through this virus.

Let’s build an NHS without the privatisation, without the financial consultants, one fit for all our babies. One where what NHS administrators say is not from a spin-doctor but from reality,  An NHS without bullying. An NHS were young and old midwives are happy to work, one where young doctors feel valued and well cared for.

For all our mothers, daughters friends and lovers and for every baby. Let’s build the NHS afresh from this crisis.

Campaigning for Women’s Rights.International Women’s Day 2020

Fighting for excellent healthcare for all our mothers, sisters, daughters, friends and lovers and for each and every baby

Women need healthcare at every stage of our lives. Too many babies die at birth, too many babies in Liverpool are dying before they are one year old. Still mothers die giving birth, or shortly afterwards. Many more Black mothers and babies die.

Too many older women have complex health issues. Mental health support for women and men is stripped to the bone. Every mother in the UK must get access to free maternity care in the UK! Stop the migrant charges that killed three women last year. Stop all migrant charges. The Windrush scandal killed people through denial of care.

Women’s illnesses are not adequately researched, nor treated. Life expectancy, and healthy life expectancy are falling, especially for poor women. Our right to control our fertility is still under threat from the right.

The NHS is starved of resources. Only the efforts of its staff keep it afloat. We need many more midwives, and more doctors specialising in women’s health. The NHS must be fully funded, and the private companies dismissed. Bursaries and grants must come back. The NHS must become an excellent employer for women, with workload and pay improved. The NHS must be funded sufficiently to be able to respond well to crises; no more corridor treatment! No more rationing! Stop cutting public health programs that helps keep us from falling ill.


 We call for the right to live free from rape and to organise against rape and sexual assault.

Rape prosecutions are at their lowest in a decade, yet more rapes are being reported. Together we can change this. We must organise on the streets and in the communities to eradicate violence against women. But don’t think it will be easy.

We need fully funded health care support for sexual crisis. Women need fully funded support for those who wish to leave abusive relationships.

Whatever we wear, wherever we go, yes means yes, and no means no!

Women must speak out against rape culture. Men must stop it.

The right to control our own fertility and the right to abortion are at risk across the world. Those who oppose abortion don’t have to have one, but the decision must always be that of the mother. Liverpool Women’s Hospital provides both safe terminations and fertility treatments in a women friendly environment. Both these services need to be protected. LWH provides support to Gay and Trans people’s fertility and sexual health in very practical ways.

The NHS publications frequently places the blame for ill health on the patient rather on the causes of ill health in society. We are all for taking care of ourselves, but the issues are much bigger than the individual.

You can make a difference by joining our campaigns. Power never conceded anything without a demand. We demand great healthcare for all. Healthy people make the country wealthier and happier. Ill health make us all poorer. Invest in health!

International Women’s Day in Liverpool 2020

The right to breathe clean air and to live in a viable climate

Good health requires air we can breathe, food that is free from contamination, and a planet with a viable future, for all humanity.


The right to clean air for all is essential for good health. Liverpool youngsters have been out on the streets asking us to take notice and to save the planet. Climate and environmental health are all essential to women’s health.Save Liverpool Women’s Hospital Campaign calls for Liverpool Women’s hospital to remain on its green site on Crown Street away from the heavy traffic of the Prescott Street site by the Liverpool Royal Hospital. Babies in the womb are very susceptible to damage from traffic fumes. We should not be sending babies into heavily polluted areas. Liverpool already has an issue with lung diseases like asthma in young children. Thousands of babies every year are born at Liverpool

Join the Save Liverpool Women’s Hospital Campaign, and fighting the NHS free at the  point of need, fully funded and not for profit, nationally provided and planned, and available to everyone. We have fought for five years to Save Liverpool Women’s Hospital so the hospital is still there – but it’s not safe yet. It is a tough fight to win back a decent NHS, but one that must be won. Each extra campaigner helps. Sign our petition on line Follow us on facebook or come to our meetings and get involved

The coronavirus means we need the NHS still more. The NHS has been cut to the bone by Government policy. Big companies have made fortunes from the NHS, while staff go short. We all need our NHS staff. Let’s roll up our sleeves, wash our hands, and fight for the NHS, for Liverpool Women’s Hospital, for excellent maternity care, and for vast improvements in women’s health!

Fighting internationally for women’s rights at work and for health care.

Across the globe, women are fighting for our rights at work. Good health requires good living and working conditions, decent wages, and decent housing.

The right to decent wages, secure employment in safe conditions, and trade union rights are important to improving the health of women and children across the globe.

  • We support the right to welfare support where women (or men) need to care for children or other people.
  • We demand the right to support in raising all our children and excellent affordable childcare. We demand the right to decent pension at 60 years old.
  • We demand an end to austerity and deliberately created poverty. Kick out Universal Credit. End the third child block on benefits. Give us our rights!
  • Women need control over their own reproductive rights and the right to their own income.
  • The right to access support for their children from the community at large is crucial. It takes a village to raise a child.
  • Poverty wages must go both in the UK and across the globe.
  • Global supply chains should mean global rights for women workers.

The Fedration of Home Based workers of Pakistan send greetings each year to Liverpool’s International Women’s Day.

This year they faced threats to their right to match but marched anyhow.

International women’s day was founded as a day when working class women fought for their rights, demanding Bread (meaning decent wages to pay for food and necessities) and Roses (meaning the good things in life) too. Bread and Roses is now an anthem of workingclass women That fight has spread across the world.

 Paying women well makes healthier women. Poverty must end. Girl babies must be cherished, girls must be educated.. Women workers across of the world should support each other. Fight femicide! Fight for education for all girls! End patriarchy . Young women today can change the world

The Fedration of Home Based workers of Pakistan send greetings each year to Liverpool’s International Women’s Day.
Our two new women MPs Kim Johnson and Paula Barker speaking at IWD really in Liverpool 2020 speaking

Twenty-Five years old.

Lets celebrate one victory in the fight to save our NHS. Twenty five years since Liverpool Women’s hospital opened, five years since the threat of closure first reared its ugly head, and the hospital is still here. It is still not fully safe from closure, or relocation and dispersal but we celebrate where we are today.

If we fight for something sometimes we do win.

We wish Many Happy Returns to Liverpool Women’s Hospital! The new building is 25 years old. In February 1995 the first baby was born in the new purpose-built Crown Street site of the Liverpool Women’s Hospital. Since then about 200 thousand babies have been born there at a rate of 8,000 babies per year.

We thank all the staff for their work at this hospital, whatever their role.

Many women, many babies, and a few men and boys, have been treated there for many conditions other than childbirth. The genetics specialism is just one of the innovations Liverpool Women’s Hospital has developed for the area.

The old Liverpool Women’s Hospital on Catherine Street and two Victorian maternity hospital buildings, Oxford Street and Mill Road, merged at the new location. Local historian Mike Royden wrote a history of the old hospitals.

History of the old Hospitals written by local historian Mike Royden.

It was not until later that Fazackerly Maternity Unit also moved to the new site.

Liverpool Women’s serves not just Liverpool but the wider region and is a centre of expertise meaning it treats some of the most complex patients.

The hospital was built on land owned by Liverpool people, built by the skill of Liverpool builders, and staffed by workers from Liverpool and across the world. It is, like the NHS, the property of the people. The Crown Street site is low rise on a site set back from the road but walkable from the city centre and the Royal Hospital. It is one mile from the main acute hospital, Liverpool Royal, down a straight road. Despite this it is repeatedly described as “isolated” by those who wish to close it. Its not isolated at all.

The site for building the new hospital was provided by the city council. There had been council housing previously on the land. In that estate a young disabled man, David Moore was run down and killed by a police vehicle. The police were driving vehicles directly at protesting youth in the 1980s “riots” but David was just going into a family house. For more details of the causes of the riots see Loosen the Shackles First Report of the Liverpool 8 Inquiry Into Race Relations in Liverpool.

Unions and local activists were determined there would be no colour bar, no discrimination in the building of the site, determined that local black workers would be part of the project. It linked to Project Rosemary to make good the wrongs done to the area. Unions were successful in involving local labour in the construction. It is now a place were local Black and Asian women tell campaigners that they feel safe.

The hospital had state of the art buildings and equipment. It pleased patients with beautiful rooms, layout and equipment, It was a real contrast with the Victorian buildings it replaced.

More importantly, it was respectful of and celebrated the women and babies treated there. The staff were pioneers in developing respectful caring treatments. Old ladies, expert carers themselves, loved the atmosphere at the new Women’s Hospital. Women in Liverpool who needed care at that hospital received the best available care in the world.

Thousands of staff have been trained there and thousands work there; Staff were proud to be part of what became a world-class women’s hospital.

Liverpool Women’s Hospital was built without a PFI, so does not have that debt hung around its neck. It was built before the madness of the internal markets, PFI mortgages on hospitals and massive outsourcing of staff.

The new neo natal unit opens this year.

Despite the overwhelmingly positive outcomes from the hospital, there have been some problems at the hospital since it opened. It is not fairyland. Most of these problems, in common in the whole NHS, are caused by financial cuts and underfunding, by the internal market,( introduced by New Labour) cuts in the number of beds, outsourcing of ancillary staff,  poor management decisions and more. There were some low points. One was a terrible case of a surgeon whose work caused dreadful harm to many women who suffer to this day. At one point there were not sufficient midwives employed. By 2015 Monitor, the NHS quality body at the time published this which basically gave the women’s a fresh start.

Liverpool Women’s Hospital remains a treasured possession for Liverpool women, and for nearly as many dads. As Julie Taylor from Merseyside Pensioners put it “In these troubled times, what we have we hold!” Campaigners  want much more investment, much higher staffing ratios, better pay and conditions and more respect for the staff, better imaging and diagnostics,  more research into many aspects of women and babies health, (all of which are described elsewhere in this blog) but we will not see Liverpool Women’s Hospital closed!

5 years ago a Panorama programme revealed plans to close one Liverpool Hospital, and our campaign to save this hospital started. The Liverpool Echo reported it with the headline “Exclusive Liverpool Women’s Hospital could close, city’s top NHS boss admits”  andFuture of Liverpool Women’s Hospital uncertain after reports deem it “financially unviable” In 2017 the proposals were reported by the BBC and the Echo twice. It was also reported on labour net here.

The management of the NHS in Liverpool has been pushing for the end of the Crown Street site. They even produced documents listing PFI as an option. Fortunately, the scandal of PFI was crystal clear before they got the go-ahead. Most recently they have asked for a rebuild on the benighted Prescott Street site of the Royal, so badly built by Carillion.

The option for using a PFI is in this document.

We call for the existing site of Liverpool Women’s Hospital to be upgraded, and for the hospital to continue to work on the garden site. We want a Women’s Hospital as we have had in Liverpool for more than 100 years.

The disastrous Conservative health care “reforms”, were well underway by the time of the first announcement of the threats to Liverpool Women’s Hospital. There have been many closures and attempted closures of maternity units across the country since then, but so far we have saved Liverpool Women’s Hospital.

Liverpool Women’s Hospital is important as a specialist hospital for women’s health. Women endure many years of ill health, In the UK the average life expectancy in good health is only 62 years old. There is not enough appropriate research as to how this can be prevented. Women’s health matters and we need specialist women’s health care.

The crowd gathered for out last big demonstration.

Chronic ill-health conditions also plague many young women. Endometriosis is just one example of a chronic debilitating illness that required major research to improve current treatment and let us live our lives in good health.

Heart disease in women is a major killer. The British Heart Foundation writes;

Heart disease kills more than twice as many women as breast cancer in the UK every year and is the single biggest killer of women worldwide. Despite this, it’s often considered a man’s disease.”

Heart disease is a significant factor in maternal deaths in childbirth. All of this means that we need a women’s hospital to focus on our health issues.

Save Liverpool Women’s Hospital Campaign calls for major investment on the Crown Street Site, including in blood, labs and imaging, and longer term intensive care if that is truly needed. The completion of the neonatal unit is a good step in protecting the future of this hospital.

This is a hospital at the heart of Liverpool. Paul McCartney has added his voice to the thousands of people who have signed petitions and joined marches to save this hospital and will continue to fight for it. We have been part and parcel of the national fight for the NHS, for maternity rights, for better chances for babies, and for women’s health. As Nye Bevan said of the NHS, it will survive as long as there are people prepared to fight for it and so it is with Liverpool women’s Hospital.

Make the UK the safest place to have a baby!

Why is the UK still not in the top ten countries for infant mortality and for maternal deaths? Why? We are a rich country. We have an established high-quality health service. Healthcare is supposed to be accessible to all. How come babies and mothers die or are badly hurt at birth? How come Black and Ethnic minority babies suffer most? Why do poor areas have worse outcomes than wealthy areas? Why is infant mortality rising? (The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births. The neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. These are both common measures of health care quality, but they are also influenced by social, economic and environmental factors). Are there fundamental problems with core policy documents like the maternity review “Better births”? These are painful questions.

Our campaign wants real improvements for mothers and babies. This posting is not intended as a clinical paper, it is a discussion amongst activists and concerned citizens about where the problems lie. A key set of participants in this discussion are mothers who have given birth, including those who have lost babies, grandmothers and other birth partners, and women who could not conceive.

Our campaign published our Maternity Manifesto during the election but though well shared on Facebook, it did not get into any party’s manifesto.

We also called a national meeting on issues in maternity care.

What then are the factors that result in UK outcomes at birth worse than other advanced countries?

The answers include shortage of NHS funding, staffing shortages, poor management in some hospitals, staff in fear of speaking out, some policies and procedures, disrespect towards the women carrying the baby, and, as cited in the East Kent enquiry, a lack of practical understanding by staff and by mums of the need to “count the kicks” in the latter part of pregnancy. The introduction of charges for migrant women has also caused deaths. NHS material seems to centre the cause on mothers who smoke, or who are overweight. (Now smoking in pregnancy is plain stupid, it really is, and most mums would not do so if they were not addicted. Don’t do it!). However, other countries, Greece for example, who smoke more, have better outcomes in pregnancy than does the UK. Wider problems like obesity and diabetes, and even women giving birth older, are mentioned in the literature about this. Again, the age of the mother as a factor, but this is only partly true. Giving birth older is often safer than giving birth too young. Globally it is most often young girls who die in childbirth.

Answers may lie in the financially and emotionally vulnerable place that pregnant women occupy in our society, including poverty, violence and stress. Poverty and inequality are factors in infant mortality; “The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266).” (Our bold for emphasis).

The UK is a rich advanced country, with a long history of universal healthcare but we have rising infant mortality. “Rising infant mortality is unusual in high-income countries, and international data show that infant mortality has continued to decline in most rich countries in recent years” and “In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend“.

Poverty is not the sole cause of high Infant Mortality though, Cuba has good outcomes equal to the UK for infant mortality. Cuba is very poor indeed and the UK is one of the wealthiest economies (sadly Cuba does less well on maternal deaths).  

Research shows out of 700,000 births a year in England and Wales, around 5,000 babies are stillborn or die before they are a month old”. 5,000 babies each year. There have been major news stories about baby deaths in many hospitals, notably in ShropshireEast Kent and Morecombe Bay.

Maternal deaths. The UK is not in the top ten countries with the lowest infant mortality rate, neither is it the safest place to give birth. In 2015-17“209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,280,451 women giving birth in the UK. 9.2 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.” In 2016 The UK ranked 24th in the world in Save the Children’s Mothers’ Index and Country Ranking Norway, Finland, Iceland, Denmark, Sweden, Netherlands, Spain, Germany, Australia, Belgium, Austria, Italy, Switzerland, Singapore, Slovenia, Portugal, New Zealand, Israel, Greece, Canada, Luxembourg, Ireland, and France, all did better than the UK. The situation in some other countries is massively worse than here but that is no excuse. But these baby and mothers’ deaths must stop. We cannot sit back and let these deaths continue.

Let’s be clear, the situation for women in pregnancy and childbirth is massively better than before the NHS, and is head and shoulders better than in the USA today. But maternal mortality is an issue here in the UK, and a huge issue in poorer countries, especially where women give birth without a trained professional being in attendance. Quite rightly professionals and campaigners in the UK participate in international endeavours to improve this situation. The NHS should be training and sending midwives to those countries, instead, it is recruiting midwives from poorer countries. In Europe we have cuts in healthcare through Austerity; in the global south, the same concept of cutting public services to the bone is called Restructuring.

Why is the UK, a rich country with (almost) universal health care not doing better by its mothers and babies? Look at just this case and see the problems in the provision of maternity care;

Archie Batten

Archie Batten died on 1 September 2019, shortly after birth.

When his mother called the hospital to say she was in labour, she was told the QEQM maternity unit was closed and she should drive herself to the trust’s other hospital, the William Harvey in Ashford, about 38 miles away.

This was not feasible and midwives were sent to her home but struggled to deliver the baby and she was transferred by ambulance to QEQM where her son died. Archie’s inquest is scheduled for March. (BBC).

We know that temporarily “closing” maternity units because they are full is a common occurrence. Women then have to go to a different hospital. Induction of labour can be halted because the unit is full. It is not a pleasant situation for mothers. Some maternity units have closed permanently, meaning mothers have to travel further for treatment, at a time when the ambulance service is under great strain (though being in labour is not considered an emergency for the ambulance service!).

Shortage of Midwives and consequent overwork for the existing staff. The UK has a shortage of three thousand five hundred midwives. The midwife workforce is skewed towards older midwives who will retire soon.

Gill Walton, general secretary and chief executive of the Royal College of Midwives said “We know trusts are facing huge pressures to save money demanded by the government, but this cannot be at the expense of safety. We remain 3,500 midwives short in England and if some maternity units regularly have to close their doors it suggests there is an underlying problem around capacity staffing levels.

Training midwives is not just about recruiting new starters to university courses. There need to be sufficient training places in the Hospitals who are already working flat out, leaving little time for mentoring of students, as well as places in the Universities. Alison Edwards, senior lecturer in midwifery at Birmingham City University, who says: ‘It isn’t as simple as recruiting thousands more students as this requires the infrastructure to support it.

‘You need more tutors, more on-site resources and, perhaps more importantly, more mentors and capacity in placement areas – which is currently under immense strain.’ 

One student midwife wrote about her experiences in this letter, where she described very hard work without either pay or good quality mentoring.

The government and the NHS call for Continuity Care from Midwives. This means the same midwife or small team of midwives cares for the mother through her pregnancy, birth and postnatal period. We too believe this would be wonderful if it were possible. It is however impossible with the existing ratio of midwives to mothers. Providing continuity of care to the most vulnerable mothers is a good step. NICE have reduced this to the idea of each woman having a named midwife. One to One a private midwife company claimed to provide this but was unable to continue trading, and went bust leaving the NHS to pick up the pieces.

Nationally the NHS is underfunded and looks set to continue so. Much of the problem comes from a long period of underfunding. We spend less than 9.8 per cent of GDP on health. Switzerland, Germany, France, Sweden, Japan, Canada, Denmark. Belgium Austria Norway and the Netherlands all spend more. That places the UK 13th in the list of high spenders on health care. The US spends 16.9 %. (although a lot of that money is diverted from patient care to the big corporations and insurance companies). The NHS was the most cost-efficient health care service in the world.

Underfunding causes staff shortages. Some errors at birth come from staff being overworked and making mistakes.

Some, our campaign believes, flow from fundamental flaws in government policy such as in the Maternity Review, where the pressure is on staff not to intervene in labour.

 Listen to the Mother. Some of the deaths are from women not being heeded in pregnancy and childbirth. This is backed up in reports from mothers, including some quoted in the big reviews mentioned above. However, overworked and tired staff who know labour like the back of their hand can easily stop heeding an inexperienced mother.

maternity-picturePoverty kills mothers and babies. As we said above, some deaths, poor baby health, and injuries come from growing maternal poverty and ill-health. Low-income families find it hard to afford good food. Food poverty affects a staggering number of children. The charity UNICEF estimates that “2.5m British children, or 19%, now live in food-insecure households. This means that there are times when their family doesn’t have enough money to acquire enough food, or they cannot buy the full variety of foods needed for a healthy diet. In addition, 10% of these children are also classified as living in severe food insecurity (the European average is 4%) and as a result, are set to experience adverse health.”

Studies show that;

The Independent inquiry into inequalities in health (Acheson 1998) found that a child’s long term health was related to the nutrition and physique of his/her mother. Infants whose mothers were obese had a greater risk of subsequent coronary heart disease. Low birth weight (under 2500 g) was associated with increased risk of death in infancy and with increased risk of coronary heart disease, diabetes and hypertension in later life. Accordingly, the Inquiry recommended, ‘improving the health and nutrition of women of childbearing age and their children, with priority given to the elimination of food poverty and the reduction of obesity’. (NICE

mental healthA significant number of deaths of new mothers come from mental health issues that spiral out of control. Some of these will be newly developed conditions and some existing conditions made worse by pregnancy and childbirth. Mothers family and professionals must all be on the alert and intervene early. There are good ways to treat mental health in pregnancy.

Reducing the social and economic stresses around pregnancy would also help reduce the deaths and suffering

When Birth goes wrong it can be a dreadful experience for everyone involved. In most cases, the panic button brings in a well-drilled team of experts who can solve nearly every problem and do it calmly. At other times, it is dreadful, as described in the coverage of the birth and death of baby Harry Richford. Harry Richford was born at the Queen Elizabeth the Queen Mother Hospital in Margate in 2017 but died a week later.

count the kicks poster

Sands, the baby death charity explains that there are many causes of babies dying before birth. Crucially important is that mothers are heeded when they are concerned and that everyone Counts the Kicks

Maternity is not the only area of the NHS that suffers. There have been serious mistakes in NHS planning including closing far too many beds. The NHS closed 17,000 beds and now is working beyond safe bed occupancy. There are 100,000 staff vacancies. Waiting times in A and E are dreadful, as are waiting times for cancer treatment. NHS managers and the Government have taken the NHS far from the Bevan model of healthcare (for history read this).

Press coverage. How does the press cover the NHS, and baby deaths? There are very real problems in the NHS and maternity care but the coverage in the press of these problems seems to switch on and off in strange ways, often to suit Conservative Party political requirements. The NHS and the Government are masters of propaganda and news manipulation. The public needs to learn to judge the news and to look both for actual problems and look out for bullshit and manipulation. Why was news of the arrest of the nurse from the Countess of Chester hospital headlines on the 70th Anniversary of the NHS? Why was the news of the understaffing there not given similar nationwide publicity? Why have we heard little or nothing since?

If the government can switch the blame to the professionals in the NHS (but not their mates the high admin of the NHS), then they seem to be happy to publicise the problems. In other cases, problems are swept under the carpet.

Professionals expect to (and do) take responsibility for their own actions. Mistakes will be made. It is impossible to go through life without some mistakes. When we are dealing with life and death mistakes can be catastrophic, even where there is no ill intent.

Malicious action is rare.   There are the terrible cases of serial murderer Harold Shipman, and the convicted surgeon Ian Paterson who falsely told women, they had breast cancer and operated on them unnecessarily. The hierarchical system in the NHS and the lack of regulation in private hospital, which was described as “dysfunctional at almost every level” allowed that harmWe have not found such a case in maternity.

Unintentional bad practice, however, has also harmed babies. No one went to work intending to harm in the events publicised in the Morecombe Bay Enquiry into the deaths of 11 babies and one mother. It was said that “The prime responsibility for ensuring the safety of clinical services rests with the clinicians who provide them, and those associated with the unit failed to discharge this duty over a prolonged period. The prime responsibility for ensuring that they provide safe services and that the warning signs of departure from standards are picked up and acted upon lies with the Trust, the body statutorily responsible for those services.”

The Enquiry described what happens like this “In the maternity services at Furness General Hospital, this ‘drift’ involved a particularly dangerous combination of declining clinical skills and knowledge, a drive to achieve normal childbirth ‘whatever the cost’ and a reckless approach to detecting and managing mothers and babies at higher risk.”

The Furness General Hospital was pushing for Foundation Trust status at the time and was not exercising the necessary supervision.

“Maternity care is almost unique amongst NHS services: the majority of those using it are not ill but going through a sequence of normal physiological changes that usually culminate in two healthy individuals. In consequence, the safety of maternity care depends crucially on maintaining vigilance for early warning of any departure from normality and on taking the right, timely action when it is detected. The corollary is that, if those standards are not met, it may be some time before one or more adverse events occur; given their relative scarcity in maternity care, it is vital that every such occurrence is examined to see why it happened.

So, many factors come into play in such incidents of harm to mother and baby. Professionals too can be emotionally wrecked by tragedy.

Huge personal and professional lessons can be learned from a detailed review of cases where mistakes are made. There is a whole literature about learning from mistakes. The worst such incidents are referred to as Never Events. This is just one article about such errors but there is a whole field of research devoted to it. Serious Mistake Reviews often happen at the end of shifts, and in the worst cases, may lead to long public enquiries.

NHS as a research organisation One of the great virtues of the NHS is the research base it offers professionals. What happens in the NHS which covers 62 million people is studied, evaluated, and researched. This is invaluable to staff and above all to patients. Sadly this research is also of interest to big business especially to those who sell health insurance and to the big corporations who have their ‘snouts’ in the NHS ‘trough’. Research for the common good is clearly different from research to make money. We see that regularly in big pharma. Cheap effective medicines do not make money for the companies. Yet the government is giving away our medical data to companies to make a profit.

There are also “errors” that happen when everyone is following accepted procedures and protocols; “untoward events, complications, and mishaps that resulted from acceptable diagnostic or therapeutic practice”. Procedures within the NHS can be robust and well researched, and problems still occur.


Research matters. Only by studying outcomes can these errors be revealed. A classic example is the once customary practice of episiotomy, cutting a woman to prevent tears to the perineal skin in childbirth, which is now no longer used except in an emergency. Research both formal and informal changed that practice. As another example of such research, Liverpool Women’s hospital has been involved in research about the benefits of leaving the baby attached by the cord if they are born unwell. NHS staff and other health professionals, academics and pressure groups are working hard to improve outcomes for mothers and babies. Each mothers death is reviewed in the MBRRACE-UK report


Never again. The tragedy of the death of a mother and or baby is felt by that whole extended family. Most families want to know it will never happen again. Cover-ups and lies mean it will happen again, so brutal honesty is needed.

The aftermath of medical treatment or neglect which causes real harm is complex. Whether the outcome is death, life long impairment, or long term physical and mental health issues, these are very significant events for all concerned.

Campaigners in Liverpool campaign for SEN funding to be returned. 2019

If a baby is born with life-changing impairments, the baby is left facing catastrophic difficulties and the mother and family can face major heartbreak and hardship. The huge love we have for our kids (may it long continue), whatever their issues, does not prevent the financial, housing and employment issues families with disabled children face. Nor does it guarantee the best educational opportunities, SEN is being battered by cuts. but parents and teachers are fighting back.

The cost of financial “compensation” from an injury to a newborn is huge because it is life long. The cost of this “compensation” used to be carried by the government but the system changed to make hospitals “buy” insurance from a government body which is set up like an insurance company. The cost to the hospital is charged on the basis or earlier claims, like car insurance. Obstetrics make the highest claims of any section of the NHS.

Liverpool Women’s Hospital had a huge case (not about babies) some years ago, arising from a surgeon who left many women damaged after incontinence operations. Their total bill, over 5 years, according to the Echo, was £58.8 million. “The NHS trust has been forced to pay out £58.8m in the last five years for both recent and historic negligence cases.

The limited work we do, as a campaign, in holding the hospital to account, leads us to believe lessons have been learned by the hospital. However, in every hospital, there are pressures which could lead to problems. These pressures include financial and organisational, problems of management ethos, and the potential for bullying, the distrust by the staff of their management, and disrespect for whistleblowers.

The NHS has gone through years of reorganisation after reorganisation. In that time the financial and government pressure has been to complete the re-organisation, or face catastrophic consequences so very many hours of admin and senior doctor time has been wasted on this process. That time could have been focussing on saving babies

its their NHS we fight forAt STP and national level, there are other problems. The NHS is intensely political. There are deep structural problems. (We believe the NHS should return to the Bevan Model of health care)

The NHS is not only deprived of adequate funding, but it has also been forced to implement many market-based changes, including the internal market, outsourcing and commissions of services to for-profit companies. These market-based structures are expensive.

The NHS has also seen dire staff shortages resulting from stupid decisions like removing bursaries, not training enough doctors and the hostile environment to migrant staff.

There are moral and financial issues in all cases of such errors. The hurt to the babies is our priority.

Baby deaths and severe injury at birth have complex roots. Though what happens in the hospital is crucial, it is not just what happens in the hospitals that matter. The stress, poverty and anxiety many mothers endure during pregnancy do sometimes affect the outcomes for the child. Many women are still sacked for being pregnant but families can rarely cope with just one wage (do fight back against sacking pregnant women!). See Maternity Action for details. Both mums and midwives can call Maternity Action for advice.

Low pay or the dreaded universal credit can make food heating and rent all too expensive. This can lead to food poverty. Women do not yet have real equal pay but mothers have the worst pay of all  Benefits are no longer allowed for a third child. even though most claimants are working. Whether parents are working or not, every child has a right to food and shelter, be they first or 10th child. The child gets no choice!

Not every pregnant woman is in a stable caring relationship. Housing, especially private renting, becomes more difficult when women are pregnant. Who can forget the story of the homeless woman giving birth to twins in the street? Pregnancy is often the time when domestic violence is inflicted on a woman but it is the time when women are least able to walk away. Poverty kills babies too.

Please join us in campaigning for better outcomes for all mothers and babies in the NHS and across the globe. We want this to start a discussion, so please send us your views. and information

A Woman’s Right to Choose


A woman’s right to choose in matters of abortion has been long fought and dearly-won.  The fight for abortion rights is like housework in that it keeps needing to be fought for again and again. There is no freedom for women without the right to control their fertility. This short article is a quick summary of the issue, which has surfaced again in UK politics. No woman of childbearing age can say that she would never need an abortion. Savita (see below) didn’t go into hospital to have an abortion but she would have come out alive if she had been given one.
Many women have died from being denied this basic right. Many different campaigns have been needed to achieve the limited rights we have now. Anyone who wants to restrict those rights will face a huge response from women. The right to choose to continue or terminate a pregnancy must be with the woman but she is entitled to the support of society if she chooses to have a baby. That support is severely limited.
It takes a village to raise a child.” Having a baby is an event for the whole society and for many decades to come. But the decision as to what goes on inside a women’s body is hers and hers alone.

1987 camapigns for abortionn rights
Fighting for abortion rights in the 1980s

Abortion happens in every culture and happened at every stage of history. Social, legal, religious and technological pressures prevented some women from accessing safe abortion, but there has never been a time when women did not seek abortion for thousands of different reasons. Most countries in the world allow abortion, but our rights are under threat from right-wing governments and from the US. Much health care in “developing” countries comes through NGOs. Current US policy is restricting the role of NGOs in supporting reproductive rights, through the global gag rule. So think on if you think all is well in the area of abortion rights. It is still a very live battle.
The law in the UK is summarized here; “A pregnancy may only be terminated under section 1(1)(a) of the Abortion Act if it has not exceeded 24 weeks. The majority of abortions carried out in England, Scotland, and Wales take place within this time, over 90 per cent of which are carried out at 13 weeks or earlier. This percentage has remained relatively constant over the past decade. Early abortion is
generally seen as medically preferable due to the lower risk of complication
.” The-Law-and-Ethics-of-Abortion-2018. BMA

Savita who died when a necessary abortion was denied. “She had a heartbeat too”.

Until 2018 Ireland had very restrictive laws on abortion. Savita Halappanavar, a dentist, happily pregnant died on 22 October 2012 in Galway from sepsis, having been denied an abortion. This was a much-wanted pregnancy which had failed, but the hospital failed “to offer all management options to Ms Halappanavar who was experiencing an inevitable miscarriage of an early second-trimester pregnancy where the risk to her was increasing with time, from the time that her membranes had ruptured.” Savita died of septic miscarriage, having been refused an abortion because of the laws of Ireland that forbade it. Savita requested an abortion after the miscarriage started and could not be stopped. This was denied.
Savita’s case prompted and publicised the huge campaign in Ireland to Repeal the 8th, which was put to a referendum and won with 66.4% of the vote.


Before this, over decades, many Irish women travelled to Liverpool Women’s Hospital to have an abortion. We believe this still happens in some cases because Irish Abortion law is still not comprehensive.
Abortion rights were only won in Northern Ireland a few months ago, on 21st October 2019, and it was met with well funded and nasty opposition When it did go through the UK parliament. The MP who moved the Bill,, Stella Creasey, herself pregnant, featured in an obnoxious very personal anti-abortion campaign in her constituency.

Gruesome anti-abortion posters in Stella Creasey’s constituency when she moved for abortion rights in Northern Ireland and while she was pregnant.

The World Health Organisation reports that globally each year between 4.7% – 13.2% of maternal deaths can be attributed to unsafe abortion, and that “Almost every abortion death and disability could be prevented through sexuality education, use of effective contraception, provision of safe, legal induced abortion, and timely care for complications“.

Abortion is intensely political. Trump called for abortion to be punished in some way. It is inseparable from politics. In the US the Right-wing government in many states have seriously restricted women’s rights to access safe abortions. The US already has the worst maternal outcomes in the developed world. It’s important to remember that there are strong links between the high management of the NHS, huge US health corporations, and between Johnson and Trump, so what happens in the US is important to us. Fortunately, the women of the US are fighting back. On January 19th 2020 thousands of women gathered in an annual march to recall the enormous march of women when Trump was elected in 2017.

The campaign for abortion rights has been called anti-catholic. However between 1985 and 2016 Catholic support for allowing abortion if a woman doesn’t want the child almost doubled, from 33% to 61%, and Catholic Ireland voted overwhelmingly to repeal the 8th. We disagree with some of the Catholic clergy, not with Catholic women. This campaign is a campaign  for all for women’s rights.

We support a woman’s right to choose to have a baby too, if humanly possible.

Save Liverpool Women’s Hospital Campaign supports abortion rights and also supports fertility rights. For too many women accessing fertility treatment is restricted on the NHS and involves eye-watering costs up to £5000 per cycle for treatment after NHS allocation has failed.

We support the rights of the mother and child to have support from the community. The right to have a child and the right to know that that child will be allowed to thrive is also important. There is no right to choose if dire poverty is the alternative to abortion. The third child rule which means that a woman who has a third child cannot claim benefits for that child is utterly foul and disgusting. Everyone in work pays national insurance and everyone who buys goods pays tax. We do this, so and we should be protected from dire poverty.  This is a very rich country, but children should be protected in every country. The reactionary third child policy is a disgrace. Already many first and second babies go short in this cruel benefits system. More than 100,000 children live in poverty on Merseyside, most from families with at least one parent in work. Child Poverty Action Group CPAG reports that the families challenging the third child policy in court ;
“Of the two claimant households that will be part of the Supreme Court case, one of the lone parents is on income support and suffers from various disabilities while the other is receiving the working tax credit. Neither of the mothers intended to get pregnant with the ‘additional child’, indeed one of them was on the pill at the time, but equally for moral reasons neither of them was prepared to consider terminating the pregnancy.”
Child care When women return to work after having a baby child care is often too expensive or unavailable. Grandparents are playing a huge role in childcare so mums can work, even when the mums would prefer to be at home with tiny children. But returning to work does not give them equal pay with men. The maternity pay gap is a serious problem for women raising children.
Women’s increased education and greater continuity of employment have not been sufficient to eliminate wage penalties faced by mothers returning to work after having children. Scores of economics studies demonstrate that women’s improved human capital in many countries has not provided the necessary full protection from discrimination against mothers”.
The maternal pay gap exists in most professions, even amongst doctors.
Should disability affect the Abortion time limit? There is another debate is that the disability of a foetus should not be a reason for an extended time limit for abortions. We believe the choice is with the mother. That is the only safe and just position.

Some women do choose to continue a pregnancy even if there is a serious disability diagnosed before birth. It is her choice. We would call for full support for women making this decision too. It’s hard enough though, to adjust to the new emotional realities of life for a much-loved baby with disabilities, and the consequent changes for the family. This journey of adaptation can be life-affirming and give great joy, but it is often accompanied by dire financial hardship and inadequate social provision, exhaustion and family breakdown.
In order for Ben to be at nursery, he needs 1:1 care. His condition means he cannot move independently at all, feed himself or access toys or activities or play with his friends without support. Since he started at nursery we have tried three different funding pots to get 1:1 support for him. Now the nursery has to apply every 16 weeks for extra funding. It’s a source of major anxiety because every 16 weeks I face the
fact that I might have to give up work with no notice period. Every 16 weeks, I face the possibility of us losing our home.” (Jennie, mum to Ben, who has quadriplegic cerebral palsy from Contact a Family)
Whilst there are benefits available, they are generally regarded as inadequate. Our campaign believes disabled children should be cherished and well cared for. Sadly, they are more likely than average to be living in hardship. We believe women should fight like hell for better benefits and resources for disabled children and their families
There is evidence that disabled children are significantly more likely to grow up in poverty than those who are non-disabled (MacInnes et al. 2014). According to Read et al. (2012), financial disadvantage may be a result of higher costs of living with disability, reduced opportunities for adults in the household to undertake paid work, the inadequacy of state benefits to offset this, and barriers to benefit take-up, however, they also state that these factors may not offer a full explanation. Despite being well-reported, the reasons for the association between poverty and childhood disability are not yet fully understood (Read et al. 2012). Emerson et al. (2010) make the three following suggestions:

  • The presence of a child with a disability may increase the chances of a family descending into poverty and reduce the chances of them escaping from poverty
  • Growing up in poverty is associated with increased exposure to a range of factors, such as poorer nutrition and housing, that may increase the risk for health conditions or impairments
  • “Third factors”, such as poor parental health or parental intellectual disability, leading independently to an increased risk of both family poverty and child disability

Save Liverpool Women’s hospital Campaign would add that society is not constructed to respect disabled children or adults; our society is disablist.
We oppose governmental interference either to forbid abortion or to force it (either indirectly as through the two-child policy, or directly as through the damaging one-child policy in China until fairly recently).  In a healthy society, women will have children if they so choose but policies can make it very hard, either way. Women have fewer children if they have better education, better rights and access to a decent job, health care and pensions.  However, in “advanced” western counties, the birthrate rises if there is good provision for mothers and babies. Unicef studied advanced countries and recommended that ;

“Countries could improve their policies as follows:
� Provide statutory, nationwide paid leave to both mothers and fathers, where it is lacking.
� Remove barriers to the take-up of childcare leave, especially those faced by fathers.
� Enable all children to access high-quality, age-appropriate, affordable and accessible childcare centres
irrespective of their personal or family circumstances.
� Fill the gap, where it exists, between the end of parental leave and the start of affordable and
accessible childcare in centres so that children can continue their development without interruption.
� Ensure that mothers can breastfeed both before and after they return to work by providing such things as guaranteed breastfeeding breaks, places to pump and store milk and quality childcare nearby.
� Build the capacity of health professionals to provide breastfeeding support in hospitals and communities.
� Collect more and better data on all aspects of family-friendly policies so that programmes can be monitored, policies compared, and countries held accountable.”

In contrast, where there is a low standard of living, no social security and no pensions, children are the only way to secure a family’s long term economic well being, so the pressure on women to have many children remains.

In many countries,  where austerity has hit hard, there is now a #birthstrike on where women are refusing to have babies until violence against women is stopped and until social-political climate issues are solved. Reproductive rights are at the core of politics and women’s voices must be heard. There is plenty of scope for campaigners who want to reduce the number of abortions, in working to reduce poverty, to remove women’s pay gaps, in working to improve child care, to reinstate Special Educational Needs provision, and in supporting foetal medicine research to prevent damage to babies in the womb. SLWH will support and join in such campaigns.

Let us fight to save some of the very much wanted babies who die at birth or before. Tommy’s, the stillbirth charity say 1 in every 250 pregnancies ends in a stillbirth in the UK. That’s 8 babies every day. The Uk (according to some the 4th wealthiest country in the world), is not even in the top ten countries for women to give birth safely. We were ranked 23rd. So if your heart is moved to protect the unborn there is work for you to do without interfering with a women’s right to choose.

Family size in the UK  nowadays does depend more on the mother’s choice. There is greater access to contraception and abortion. In the 1920s and 1930s, very large Liverpool families of ten or and twelve children were not uncommon. Few of these large families saw all the children reaching adulthood. Childhood illnesses, poor maternity care and poor access to healthcare killed many. Post-war, the condom and the cap allowed many families to be much smaller and generally, those children that were born, thrived. In the 1950s the average number of births per mother was 4.7. It is now declining to 2.4 children per mother internationally and 1.7 in the UK. “The number of children women are having is continuing to decline, to a record low of 1.89, according to the Office for National Statistics. Its study compared two groups of women: those born in 1972, who are now in their 40s, with those born in 1945, who had an average of 2.19 children. The numbers of families in England and Wales with just one child grew from 14% to 18%. Childlessness also increased in women, from 10% to 18%.”
There are potential problems ahead for countries with low birth rates, as the number of older people needing care outstrips the young adults able to provide the care. If women are to feel safe and secure having children, this cruel system of unequal pay, poor child care, poor benefits, rationed healthcare and violence against women has got to be changed.
It is for the pregnant woman and her alone to decide if she continues a pregnancy.

Charging NHS patients in NHS hospitals for core treatments

“MYCHOICE” -is “No” Choice for most of us

Have you heard of “procedures of low clinical benefit”? Don’t worry you will be hearing a lot more about them if we don’t do something to stop the privatisation and remodelling of our NHS based on the American private insurance model.

In June 2019, NHS campaigners became aware of a scheme called “My Choice” on offer locally and in other selected pockets around the country. Our local scheme was at Warrington & Halton Hospitals NHS Foundation Trust (“WHHFT). Their definition of My Choice is:

My Choice is By the NHS, For the NHS

”The major benefit is access to outstanding NHS treatments at a fraction of the cost of those undertaken by private providers. The procedures available are extensive and include everything from hip and knee replacement to cataracts, tonsillectomy to breast augmentation.”

We have all heard of private hospitals and people “going private”.  Of people jumping the NHS queue” by paying privately. But this a new scheme altogether. A new and thoroughly terrifying development. This is asking patients to pay for operations which were previously done for free on the NHS and which are not available to them unless they pay, so its not just jumping the queue. They can’t have the operation at all unless they pay up.  In the past, if you had problems with your knee, your GP referred you to a specialist consultant who examined you and decided if you needed a new knee and if necessary put the wheels in motion to organise your operation to be done free by the NHS either in an NHS hospital or at times of high waiting lists sometimes the NHS paid private hospitals to do the operation.

Now, in 2019, after 10 years of successive Conservative/Liberal Democrat coalition and then Conservative governments, the definition of what is provided on the NHS has been changed and restricted. So that many operations are now defined as of “low clinical benefit” and are therefore no longer available on the NHS. 

This is the list of treatement of low clinical worth, recently published in the Guardian. Some trealtments do become outdated but this is not to do with outdated treatements but to do with rationing treatments to contain costs.

In My Choice there is a long price list which includes procedures for knee and hip replacements, cataracts and hernia operations among many others.

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My Choice from Warrington’s website
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If it hasn’t affected these procedures in your local area yet, its only a matter of time.  If your GP is really sure you need the operation, you can try arguing your case via an Individual Funding Request, where a board of medical and non-medical people decide if you are deserving enough.

For example, for hip and knee replacements doctors use a scoring system to assess how much discomfort and lack of mobility a patient has.

By increasing the bar at which a referral for an operation is made the NHS can help restrict the numbers getting treatment.

In the blurb for these schemes around the country, they repeatedly mention having to make “difficult decisions”. This is an oft heard Tory mantra since 2010 and the imposition of ideological austerity which apparently necessitates the poorest and most vulnerable having to be punished for the crimes of global bankers. The ordinary people in this country have taken this punishment for 9 years whilst bankers’ multi-million-pound bonuses have been restored, it doesn’t seem to me that is a fair settlement? 

Under cover of austerity the Tories and Lib Dems attacked public services including the NHS. They cut funding, undermined it, basically carried out the tried and tested Tory privatisation process. Despite living in the 5th richest economy in the world and despite the £billions of public money still being ploughed into the NHS, services have been cut, beds closed, A&E and maternity departments closed and huge debts racked up but there are more managers and accountants than ever producing figures and targets which are mostly missed and yet patients can’t get a GP appointment.

More and more services are being provided by private profiteers such as Virgincare and yet more services have been drastically culled, so are no longer provided by the NHS. They are NHS was meant to be universally available regardless of wealth and connections. It was now provided in a haphazard manner by a hotchpotch of third sector providers. Bevan’s supposed to take away the worry about getting sick and the reliance on philanthropy and charity. And yet in 2019, that is exactly where our NHS is regressing to, a time pre 1948, pre the creation of the NHS.

So now back to “My Choice”, could you afford to pay over £7000 for a new knee or a new hip? More if you need both hips or both knees done? Or over £1600 for a cataract operation? Oh, and don’t forget the £180 consultation fee!

WHHFT produced their prices for a long list of treatments. I don’t think anyone would argue that procedures purely for cosmetic reasons (without accompanying psychological symptoms or disfigurement) should be paid for from your own pocket, if that’s what a person chooses to spend their disposable income on that’s up to them. However, it’s another thing entirely to expect a person to find over £7000 for a new hip to keep them mobile. That’s what is happening already. We have already explained how breast reduction is not an unnecessary operation

When NHS campaigners wrote to the Liverpool Echo and to local MPs, they were outraged, and the story was also picked up by the Daily Mirror.

The hospital trust tried to defend its decision to impose charges and insisted patients would not jump the queue, that they would be added to NHS waiting lists, be seen by NHS staff in NHS wards and operated on in NHS theatres using “spare capacity”.

How often do the media headlines scream out that waiting lists are getting longer, targets are being missed, including cancer targets, people are waiting for scans, to see consultants, that there are 100,000 staff short in our NHS, that we are all somehow “abusing the NHS” by using it too much, that the population has increased and that the elderly are apparently a big cause of these problems due to  “bed blocking”?? And yet Warrington & Halton Hospital FT had “spare capacity”! Presumably there are no waiting list backlogs for surgery in Warrington and Halton hospitals and surgeons are sitting around twiddling their thumbs waiting for work?

Also, what ever happened to the ethical code for doctors and health professionals? The mantra of “first do no harm”. If a GP or consultant or CCG has decided your bad hip doesn’t need replacing because it would be of low clinical benefit to you, and therefore has decided you do not qualify to have it done on the NHS, why then does it suddenly become of sufficient clinical benefit if you pay for the operation yourself? Is this ethical? Either you need the operation in which case it should be done on the NHS according to need, or you don’t need it and therefore no self-respecting surgeon should be willing to do an unnecessary operation whether or not you are prepared to pay for it? 

After a few weeks of sustained pressure from NHS campaigners, setting up demonstrations outside the hospitals, handing out 5000 leaflets all over the Liverpool City Region at music festivals, parks, hospitals, NHS stalls etc and having hundreds of conversations with the public plus getting thousands of signatures on petitions, the Trust was forced to “pause” the My Choice scheme.

It was even discussed by Sir Simon Stevens, the head of NHS England and the architect of NHS privatisation imposing the US healthcare model on our NHS. He mentioned it in a parliamentary committee and said that the “marketing” of My Choice was Misguided”. Note he wasn’t saying the scheme should not have been put in place or that patients shouldn’t have to pay. Just that they got the “marketing” wrong. The reason for this is that Mel Pickup the CEO at Warrington was doing exactly what the Tory government and NHS England plan for all of us. She just didn’t bank on NHS campaigners cottoning on to the experiment. It will be un-“paused” at some point when they think the dust has settled. However,, Ms Pickup announced she was leaving the Trust and was also leaving her post as head of the Cheshire & Merseyside STP. Had she been successful in rolling this scheme out quietly in Warrington, it would soon have been rolled out across the whole of the STP footprint.

Why are some treatments not routinely offered by the NHS? There may be some cases where a treatment is not available because there is limited evidence for how well it works or because it is very high cost and doesn’t offer good value for money for taxpayers and the NHS. If there is a reason to change this recommendation then it goes to a panel for discussion

A fully funded NHS pays for itself in the health of the population and their capacity to continue to work and to care for others. It also contibutes to the general health and happiness of society, The Bevan model of universal health care, free at the point of need, paid for by general taxation,and publicly provided is the most cost efficient model of health care in the world.

The NHS is worth voting for.

Author: Mary Whitby NHS campaigner who first exposed the My Choice scandal

Liverpool Women’s Hospital working with the large Acute Hospital trust

This is the fourth of a series of blog posts intended to share the current issues facing Liverpool Women’s Hospital.The posts are based on a report to the Board meeting held in public on 7th November 2019. The earlier posts are about Maternity, Gynaecological Oncology, and the age profile of the medical staff at LWH. This post is about LWH working in partnership with the large acute hospital, Liverpool University Hospitals NHS Foundation Trust, which includes the Royal, Broadgreen and Aintree. The proposals are for ways LWH can work with the Liverpool University Hospitals NHS Foundation Trust

As with the earlier posts, the purpose of publicising these papers is to make these important discussions accessible to the concerned lay woman and to medical, midwifery and nursing staff who do not have easy access to the main papers, which can be found here. Publishing them does not imply support, nor is this a critique. Such a critique will follow when our supporters have had the opportunity to discuss the options. We are all too aware that the NHS is monstrously underfunded and overworked and that policy changes since 2010 have done great harm.We are aware that life expectancy for women in poor areas is slipping and that many people have died from the impact of Austerity. Our campaign to Save liverpool Wiomen’s hospital goes on. Our petition is here.

Partnership Board

Following discussions between the respective CEOs of LWH and LUH, an MoU (Memorandum of Understanding) has been created for the formation of a Partnership Board between the two trusts. This group will be accountable to the respective Boards of Directors via the executive bodies and will have operational, medical and nursing/midwifery representation. It will further develop and formalise the ‘virtual bridge’ linking the two organisations with respect to the provision of clinical care.

In addition to details given above around the provision of gynaecological oncology, the Partnership Board will examine the following:

 · Partnership working for HDU provision at LWH which may include joint nursing and anaesthetic appointments, rotation across sites and support at LWH from LUH intensivists

· Consideration of the pattern of critical care outreach services that could feasibly be provided on the LWH site

 · Formalisation of the working arrangements that allow for the provision of urgently needed specialist care from non-women’s specialists on the LWH site · Formalisation of the working arrangements that allow for the provision of urgently needed care from women’s specialists on the LUH sites

 · Review of the present pattern of delivery of maternal medicine services in the light of national drivers for change

· Establishment of a gynaecological nursing and midwifery presence on the LUH sites

· Formalisation of pathways for access to imaging and diagnostics on a seven day basis, with consideration of providing CT and extending other imaging facilities at the LWH site; including image generation and timely reporting

 · Partnership working to provide staffing for a proposed new blood bank and extended lab facilities at LWH with 24/7 delivery of urgent services

 · Formalisation of pathways surrounding access to seven day service requirements with respect to therapies, dietetics, pain management and tissue viability services

Consideration of the potential for the use of the LWH site for LUH clinical activity where clinically appropriate, if this is needed to enable gynaecological activity on the LWH to be moved onto LUH sites

· Exploration of the use of digital technologies for the sharing of clinical information across sites to advance patient safety

· Formalisation of the process of safe repatriation of patients from LUH to LWH sites, taking into account the available services and facilities available at the LWH site

· Provision of oversight wrt (with regard to) the transfer of sick patients from LWH to LUH, reducing delayed transfer and minimising the risks associated with the transfer itself.

 LWH has also suggested that NHSE/I and Liverpool CCG join that Partnership Board, which would then also report into (a) the One Liverpool place based care leadership group and (2) the Acute Sustainability Board for C&M. This would provide all parts of the system with continued sight until such time as the trust’s clinical problems have been fully resolved.

 Recruitment and Retention The Trust is finding it difficult to recruit and retain consultants with the skills to maintain and develop its adult services. The problem has been highlighted above with respect to gynaecological oncologists but there have also been difficulties recruiting consultant anaesthetists and consultant gynaecologists with advanced skills in complex benign laparoscopic surgery.

 In future, obstetricians trained in maternal medicine may also prefer to work elsewhere as LWH is unable to meet the essential MMC criteria. This will have a negative impact upon the trust’s prestige.

 In principle, there are two ways in which the trust can maximise its potential for recruitment and retention and these are now being considered as a separate workstream by the Director of Workforce and Communication’s team:

 Optimise the professional offer

 · Increased access to facilities off site (eg) multidisciplinary teams, robotic surgery

· Improved facilities on-site (eg) imaging, blood bank, digital

· Bespoke job plans to prioritise each consultant’s professional preferences

· Attractive terms for study leave

 · Overseas recruitment

· Promote the LWH brand.

Optimise the personal offer

· Part time working and job shares

· Annualised working hours

 · Off site delivery of non clinical duties

· Leeway in holiday provision

· Attractive remuneration with respect to recruitment

 · Attractive remuneration with respect to retention.

The establishment of a Partnership Board with LUH and the forging of closer working relationships may help with some of the ‘professional offer’ issues as it will provide LWH clinicians with access to a greater range of facilities and multidisciplinary expertise. Similarly, an expansion has been seen in the number of joint consultant anaesthetist posts with LUH and this is likely to continue but the services provided by LWH are otherwise highly specialised and the same opportunity is unlikely to be found in the trust’s other clinical services.

 Without relocation, the recruitment and retention of consultants is likely to be problematic for the foreseeable future

The Age Profile of Consultant Medical Staff at Liverpool Women’s Hospital

This is the third of four blog posts about the current issues facing Liverpool Women’s Hospital. The two ealier posts were about the Maternity Services and Gynaecological Oncology The fourth post is about partnership working with Liverpool Univesity Hospitals NHS Foundation Trust

The issues discussed here affect Doctors’ training nationally and need consideration in that way too. Women’s health care matters and requires specialist input. Specialist hospitals exist in the NHS alongside the large acute hospitals. The acute hospital model is not the only option.

The Age Profile of Consultant Medical Staff. Full document here

Doctors pursuing a career as a specialist in the UK must follow nationally recognised training pathways to gain relevant clinical experience and to obtain their advanced professional qualifications. These pathways have evolved over the years. The Calman reforms in the 1990s and Modernising Medical Careers in 2005, for example, funneled doctors into their chosen specialty at an early stage in their careers while the European Working Time Directive in 1998 reduced the year-on-year volume of clinical work that doctors were exposed to while working towards consultant status.

These changes may have improved consultants’ specialised knowledge and skills but they have also made them more reliant upon cross-specialty working when dealing with patients with multiple medical or surgical co-morbidities.

Put simply, consultants who were born before 1970 could be described as being ‘multi-skilled’ whereas consultants who were born in 1970 or later could be described as being ‘hyper-specialised.’

In obstetric, gynaecological and anaesthetic practice, an increasing number of women with significant medical and surgical co-morbidities are now presenting for care who would not previously have done so. In a medical environment populated by hyper-specialised rather than multi-skilled consultants, patient care must therefore be delivered by a range of specalists in a co-ordinated manner, yet this cannot be provided on LWH’s Crown Street site.

This In 2018, 24/47 consultants in the trust’s three acute adult specialties (just over 50%) could have been described as multi-skilled rather than hyper-specialised. In a simplistic model of recruitment and retention, if we accept that one hyper-specialised Consultant will be recruited each time a multi-skilled Consultant retires in coming years, then: · By 2023 around 40% of our consultants will be multi-skilled · By 2028 around 20% of our consultants will be multi-skilled · By 2033 none of our consultants will be multi-skilled. The data show that in the absence of relocation onto an adult acute site, the shift towards a hyper-specialised consultant workforce will add to the clinical risk associated with the trust’s physical isolation in an incremental manner in coming years.

In the absence of relocation, a partial solution to the conundrum of a changing skill set amongst the trust’s consultant workforce would be to increase the opportunities for the trust’s clinical activities to take place in a multidisciplinary environment: (a) Switching work that we presently do at Crown Street onto an adult acute site (b) Bringing specialists from other disciplines onto the Crown Street site. The CEOs of LWH and LUH have agreed to form a Partnership Board in order to address the trust’s accumulating clinicial risk, including the element of risk posed by its changing consultant profile. Details about the proposed Partnership Board model have been provided below, with elements of (a) and (b) above included. Similarly germane, the trust’s ability to recruit new consultants and to retain its present consultants has also been considered later in this paper.