So what is going on with Maternity at the end of 2017?

We write this from the standpoint of the campaign to Save Liverpool Women’s Hospital but in reality it is a much wider issue

Liverpool Women’s hospital is a large maternity hospital which also provides gynaecological care and a range of other services .

In this analysis of the issues facing NHS users, we are focussing on the maternity aspect but start with the wider context. This sia first draft of an article we are likely to amend

Context

The UK is a very rich country. Far poorer countries spend a greater proportion of their wealth on health.

The NHS was founded and ran for decades as a service

funded directly from taxation,

publicly provided,

free at the point of need,

providing the best available treatment

and

as a comprehensive service so the overwhelming majority of the population used it as their health care.

What is happening now?

1. The NHS does not get enough money from the government. The UK uses less of its annual wealth (GDP) to pay for health than other advanced countries do. This is policy not accidental.
2. The NHS is a very cost efficient way of organising health care but these efficiencies cannot compensate for the overall lack of funds
3. Large parts of the NHS funds from the government are diverted from patient care to pay for Capital building costs through PFI
4. Staff have worked way beyond their stated duties to stop the service crashing, but this is unsustainable long term. It is damaging for staff and patient care. Staff wages and pensions have been deliberately held back
5. The internal NHS market created under Labour Government has also proved very wasteful of money and of staff time. The creation of Trusts to run hospitals has made vital cooperation between hospitals very expensive and distorted staffing patterns.
6. Attempts by hospitals to share services have themselves been complicated by privatisation, and the breaking up of services into so called discreet parts, for example bloods.In Liverpool one service covers the city but it is a stand alone company.
7. The structure created by the 2013 Act of Clinical commissioning Groups and bundling services into commissioned packages has proved very expensive
8. The use of private companies to deliver services has been more costly than NHS delivering in house, and scarce money has gone to private companies to make profit.
9. Staff planning has been disastrous. Not enough doctors, nurses, midwives have been trained, and the reliance on overseas recruitment for doctor’s nurses and other health care workers is now especially in the Brexit situation, caused serious problems. The withdrawal of bursaries is likely to make this worse. There are not sufficent midwives coming through to replace those retiring and leaving the profession
10. The plan for the NHS is called the Five Year Forward View, but even this is not a steady picture but one that is ever changing
11. There has been fluctuations in medical fashion between local general hospitals, specialist hospitals and big acute hospitals, The conversation about which is the correct model has been largely within professional circles without popular democratic involvement and has been circumscribed by available resources and dominant political views.
12. A propaganda point that we need fewer beds has proved woefully wrong.
13. Staff training appears to be coming more specialised and less general/ holistic
14. A new system is being developed which, it appears, might remove the trust CCG model and replace it with Accountable care systems. We use the term “it appears” because nothing has gone through Parliament ot other democratic processes, but that is the way it looks now.
15. The ACO system is designed for private profit, for rationed service not patient care
16. The parallel crises in funding for social care and elder care are also impacting on and being impacted on by NHS problems
17. The crisis in Local Authority funding is caused by the years of Austerity.
18. The ACOs appear to be bringing all three sectors into one underfunded and for profit umbrella
19. Co-payment is being suggested so people will pay more for less services. Free at the point of need is at risk.

So where does maternity fit into this?

Maternity is the most frequently used service in the NHS

Maternity is commissioned by CCGs

The maternity tariff, the money paid by the government to providers of maternity care is insufficient to provide the service our babies deserve

There is no future for the human race without babies. Babies are a huge source of joy to the world.

UK maternity services are certainly better than prior to the NHS, better than the USA but not as good as the best in the world, in terms of outcomes for maternal mortality and health or for the numbers of stillbirths and babies born with health issues

There is a shortage of midwives, obstetricians and neo natal nurses and linked professionals. Those we have are over-worked, in some cases to burn out. The replacement by newly trained staff cannot match those leaving.

The plan for Maternity is called the Maternity Review.

The maternity review describes enhanced choice for mothers in the kind of place they give birth, yet across the country places to give birth are being closed. Four hours travel in labour is seen to be safe. Closures of maternity provision is rampant.

For profit providers are being brought into the maternity service; locally one to one midwives are the private pioneers

The model for maternity supposedly employed in the NHS is set out in the Better Births

Huge priority is given in the words of the maternity review to mothers’ choices but that is in strong contrast to the reality of maternity unit closures across the country. You can choose if you want extra maternity classes but not to give birth in your own town!

Maternity vanguards, or women and children’s vanguards, do not answer to local structures but are super-imposed on them.

There is an ongoing problem of resources in the system and units temporarily closing to mothers in labour is becoming common. Such closures are short term while the mothers already there are delivered. What happens to the mothers in labour turned away is another story.

https://www.ifs.org.uk/uploads/publications/bns/BN215.pdf

“MUs also face pressure from daily fluctuations in demand. This is an inevitable feature of maternity service provision. Occasional closures are probably unavoidable, unless the NHS is prepared to operate with excess capacity for much of the time. However, the patterns we observe in closures by day of the week and month of the year suggest that, in some instances, closures could be foreseen and avoided through improved planning. Whether the costs of that improved planning and additional resources exceed the costs to mothers in labour of units closing is another question”.

The women in labour turned away face major problems

Prof Mary-Ann Lumsden, vice president of the Royal College of Obstetricians and Gynaecologists (RCOG), said the UK remained a safe place to give birth. “However, the pressures on maternity services are growing, which could compromise the experience for women and their families. Stretched and understaffed services also affect the quality of care provided to both mothers and babies,” she said. “Unit closures may be due to insufficient midwifery, obstetric or paediatric staff, as well as inadequate capacity. If the UK governments are serious about improving the safety of maternity services, these staffing and capacity issues must be addressed as a matter of urgency.”Lumsden said it could be distressing for a woman in labour being turned away from a hospital, although stressed that closures were “relatively unusual”. She said units worked as part of a network that could help provide alternative care at a nearby hospital – “though this is less than ideal”.The RCOG has produced recommendations on how units can have medical staff available at all times in the face of changed working patterns, reduced trainee availability and financial constraints.

For profit maternity providers, commissioned by the NHS but nor supervised within or employed by the NHS, are operating locally and nationally.

There are 4 major kinds of maternity provision around actual delivery of the baby;

• The Obstetrician/ Consultant led services in hospitals
• Midwife lead units alongside Obstetrician led services
• Stand alone midwife units
• Home births

Some home births are assisted by NHS midwives, some by midwives employed by for profit companies and some independent self employed midwives.

A few wealthy women give birth in private hospitals like the Portland in London

Liverpool Women’s Hospital

There is a determination to close one hospital in Liverpool as an infamous Panorama programme made clear.

LWH has and will have a problem financially until the maternity tariff is improved

The Merseyside Women’s and Children’s Vanguard appears to have the ability to make decisions not made by either the Liverpool Women’s Hospital or the Clinical Commissioning Group.

The Sustainability and Transformation partnership (?)for the Merseyside and Cheshire Region also impacts on decisions about maternity care, linking to the Vanguard

Issues to do with national staffing planning and consequent shortages, funding structures, Trust structures and the internal market impact on the LWH’s ability to employ consultants in all the fields they would like. Long term lack of investment in the neo natal unit and City wide problems with organisation of blood services all present problems

Current thinking seems to be that the Women’s hospital should be co- located with an acute hospital and the children’s hospital but given that Alder Hey Children’s Hospital and the Royal are new build hospitals such expenditure seems unlikely.

The Royal site which is favoured by the CCG and the LWH board is miles from the children’s hospital. We think its important that babies in intensive care are close to their mothers. We want to neo natal intensive care to stay at Liverpool Women’s Hospital. We are less keen on the idea of babies still needing care being discharged earlier from neo nate units

The Royal is also in a traffic hot spot, likely to get worse in terms of traffic as the Clatterbridge unit and the life sciences buildings come into operation on the site

The precious safe space element of the women’s hospital is largely ignored yet violence against women and children is a feature of our society and sadly of pregnancy.

Charging   Migrants for NHS;thin end of the wedge?

Women and babies suffer first from health service cuts, so Save Liverpool Women’s Hospital Campaign is very concerned about cuts and about charges. A real life case brought this to life in our campaign meeting.

The  plans to introduce direct charging to patients is one of the most feared aspects of the Government plans for the NHS.We are seeing the early steps in this and need to say NO!

The National Health Service is funded directly from  the tax ordinary people pay, be it income tax, VAT or one of the myriad of other taxes.

The NHS was founded in 1948, in the debris of war. It was founded to be free at the point of need, funded by taxation, not for profit,  a universal service providing the best available care

We do pay personally for prescriptions and for dentistry and for opticians, costs that once were included in the NHS. We also have the mixed up mess of  paying for care for the elderly, sometimes even if they are too unwell to care for themselves. Social care remains a part private responsibility, part social services, and part NHS mess. Social care for the elderly can  be personally very costly. We need a similar funding system to the NHS.

However no-one using the NHS is asked to fork out tens of thousands for Cancer care or for transplants or complex care for  very poorly babies Medical treatment is still free at the point of need

We are not alone in being concerned at this.  Many doctors  are concerned at charging being  brought in

So in 2017, we see that some services have been transferred to the private sector and  we find ourselves having to pay for some services. This was from earlier waves of privatisation. A huge wave of privatisation is growing in the NHS which will be described in a different  posting. But worry about  privatisation pales against the time when we may be forced to pay for treatment or go without treatment, if we cannot afford to pay

Our service is very different from the US model. It is not a service to sell, or an insurance based system. It is a universal service funded by taxation.

In some other countries most notably the USA people get health care according to how much health insurance they or their employers buy. No insurance, no treatment, or treatment at huge cost. Sometimes  the insurance refuses to pay and people lose their homes and cars to pay for it, or, rather than risk their family becoming homeless, people accept a preventable death or long-term damage. The insurance system operates a de-facto rationing system for care.

Charging some people has been in the NHS for some years but the system has just changed

It started with  charging Migrant women for maternity, hence the link with our campaign.This has been damaging to pregnant women  as described in the British Medical Journal article linked here.  Lots of articles were put in the press to support the government claims of rampant health tourism but the statistics do not back this up. Now the government is  spreading the net.

It is simply not true that Health Tourism is a big cost to the NHS.The most reliable estimate is 0.38% of the budget. Compare that to the cost of PFI hospitals where the profit on one hospital is more than 10 times the cost (see earlier article)  and it’s a tiny amount. Collecting the fees will cost more than the  treatment so no extra money will feed back into the NHS.

It is a smokescreen and a dangerous one. It is laying the groundwork for charging more and more groups of people. Women and babies suffer first from health service cuts so Save Liverpool Women’s Hospital Campaign is very concerned about both cuts and charging.The  plans to introduce direct charging to patients is one of the most feared aspects of the Government plans for the NHS.

So in 2017 we see that some services have been transferred to the private sector and  we find ourselves having to pay for some services. This was from earlier waves of privatisation. A huge wave of privatisation is growing in the NHS which will be described in a different  posting. But the many forms of privatisation pale in insignificance against the time when we may be forced to pay for treatment or go without treatment, if we cannot afford to pay

Our service is very different from the US model. It is not a service to sell, or an insurance based system. It is a universal service funded by taxation.

In some other countries most notably the USA people get health care according to how much health insurance they or their employers buy. No insurance no treatment, or treatment and then a bill which the insurance refuses to pay and people lose their homes and cars to pay for it, or, rather than risk their family becoming homeless, people accept a preventable death or long-term damage

Charging some people has been in the NHS for some years but the system has  recently changed

 

Migration

Migration means to move to a different country for  one of many different reasons. It is not tourism where people come for a holiday. During the  misnamed Irish Famine huge numbers of Irish  people moved to Liverpool and beyond. Whole Welsh communities moved to Liverpool too. A community of Welsh miners migrated to Patagonia where the Welsh language survives there still.. When the Scots were forcibly driven from the Highlands  to make room for sheep farming, the Highland clearances,  whole communities moved to England, Canada, the US and Australia. More recently tens of thousands of UK people moved to Australia and New Zealand

A Migrant is someone who lives here. Not a visitor. Some are mega rich and live in million pound pads in London but most are working people, doctors, nurses, carers,  engineers, social workers, hotel staff, scientists,cleaners. Some migrants have full legal status here. Some have interim leave to remain and some are still applying. Some are from Europe, some are not. They are needed in large numbers in the NHS and the care sector.

The poorest are the most likely to have difficulties with their papers and migrant women are amongst the poorest.

Someone working and paying taxes here in the UK should not be charged additionally for health care. Health care is paid for through  general taxation

If they end up with an outstanding bill for health care on their records, getting their papers or citizenship can be much harder and the threat of deportation hangs over them.

The NHS is funded directly from taxation and provides a universal service, that is a service for everyone.The NHS is recognised as a wonderful public service across the world and its seventieth birthday next year will be celebrated across the world. It is the most cost efficient  health service in the world https://www.theguardian.com/society/2017/jul/14/nhs-holds-on-to-top-spot-in-healthcare-survey

Taxes

Taxes in the UK come not just from income tax but from indirect taxes like VAT. Indirect taxes raise more money than income tax.Everyone who buys anything except food and children’s clothes pays VAT and other taxes

Other health care systems spend huge amounts of money recouping money from patients but the NHS does not need to do this because it is funded from taxation. Employing people to chase other people to get payments or to refuse to pay out on an insurance policy or to tell people they are not eligible for treatment, really does help to curing sickness or protecting health.

Health in the UK is delivered to all people just as our beaches and open spaces, roads and street lighting  are open to all.This public  health provision system is cheap in comparison to other countries and is efficient, both in money-saving and in saving lives and promoting health.

Sick or infectious people who are NOT treated are a cost to themselves, their families, their community, people they meet and the wider society. A country functions better with  universal health care.It manages epidemics more efficiently and it allows research that leads to better health outcomes. More people keep fit and healthy and able to be employed or to study or to take care of others.

Wasteful use of resources. Damaging to health.

Employing people to chase up charges is not an efficient use of resources.The USA is a fine example, they pay much more of their National wealth on health care, its one of the biggest bills families face, yet their health care outcomes are not as good as the publicly funded NHS and it costs much more

It makes more sense to  train those people as doctors nurses or some other useful role in the NHS.

Any sick person with an untreated illness is eventually costly to society. Any infectious disease not treated a threat to the whole society. TB used to be a real threat to the health of this city. Universal health care has turned it into a rare illness, or at least not a dangerous epidemic, here in Liverpool

But this is much more so for pregnant women. Denying care in this situation  damages two people who can be hurt the baby and the mum, and the rest of the family can suffer too.We are only two generations away from the time when more women died in childbirth, than men died in the mines. We are only two generations away from women losing many babies in childbirth.

The NHS has a long way to go before it is really good at saving babies but t is a world better than generations past and a lot better than the USA.

This government and the previous one have been following some unpleasant policies and ones that damage health and health care.

It appears to be true that we are moving towards an US style  health system where people might have to pay directly according to the treatment, they need which raises the question what of those who can’t pay.

Let’s nail some of their propaganda on this

• A payment system is not  more efficient. It is wasteful and inefficient.
• It pays the money to  insurance companies and to admin which should go to the treatment of ill-health and protection of good health.
• It puts people off seeking early and therefore cheaper treatment
• The UK is not poor. It is very rich. It can well afford to spend 11% of its GDP on the  health service.
• The US spends much more for much worse outcomes because it wastes money on the charging and rationing system it uses.

 

Some of the very rich don’t pay their taxes.

This government’s policies have resulted in real wages falling more than any other country except Greece  since 2008. This government operates as a global economy  more answerable to global corporations than to its own poor. Meanwhile the very rich are taking huge profit from the NHS. The wealthy in this country hide their money in many offshore accounts and invest massively abroad.

The Government should put more money into the NHS. Much of the money which it  pays in now is wasted in privatisation projects.

Many people who have come here to work, work in the NHS. The migrant workforce in the NHS is not replaceable.

The UK should have trained more doctors and should be training more nurses, midwives and related professions, but instead  they have cancelled bursaries for nurses and midwives which shuts those professions off from older women and those from less well off families. Their planning for doctor numbers is a full failure.

Many people who live here either as workers or as carers within families  have to pay a premium on their visa to cover NHS care. They also pay just as the rest of us do through taxation.The new charging system could affect some people who have lived here for many years as we have seen in other home office blunders threatening to deport  and even deporting Grandmothers who have children and grandchildren here and have lived here their adult lives

Migrants tend to be younger and healthier than the average UK resident.

Some migrants can be here totally legitimately, yet not have the correct paper work because of delays in the home office. Migrant women living here need maternity services yet some women were the first to be denied  free NHS Care.The results of this are best described by the Royal College and Maternity Action reports attached. It we made posts of some of their reports, we doubt that we would be believed, so please take it from them, instead.These are the reports by the Maternity Action and the Royal College of Midwives. 

Claiming medical care

Medical records are  crucial to safe treatment. The  standard booking in procedure at a hospital  pulls up the patient’s record, if they have one. Very healthy people, people who are not registered with a GP or people whose records cannot be found are those who will be challenged.

At this point it is not just eligibility for treatment but what happens if they are deemed ineligible and what happens if they can’t pay.

The decision on delivering the treatment or not should still be that of the doctor treating the patient based on need, not an admin person from the hospital. Unless admin respect this, these mistakes will be costly in terms of health as people put off going to the hospital until they are really ill. It will also be expensive in terms of administration and litigation problems  which are going to occur for everyone. And then there are the bailiffs going after some of the poorest people in the country because they went to hospital Many UK families do not have Thousands of pounds  in the bank.

Liverpool Royal Broadgreen Hospital Trust posted on our Facebook page a link to their charging forms

Our campaign, along with many other NHS defence campaigns, across the country want a return to the original NHS  system of a universal service  funded by taxation.

If such a service is restored and continues to thrive other  people in other countries will campaign for a similar service in their own country, as Bernie Sanders and Socialists do in the US.

Just as we have suffered major cuts in service through austerity many countries in Africa and the global south  had forced vicious cuts especially to Maternity  through “restructuring”. This gives a summary of the problem.

Let’s keep campaigning for

• a return to a fully publicly funded NHS
• treatment according to need
• full bursaries for NHS staff in training
• For more doctors to be trained
• For health care to be funded to the same level as other advanced European nations
• For an end to privatisation.
• For the UK to invest in preventing stillbirths and maternal deaths

Save Liverpool Women’s Hospital will cooperate with other health campaigners to stop charging for health care in the NHS service for everyone.

 

#eachoneofwomanborn. #born in the NHS.

We ask that this manifesto for maternity be shared and discussed by all maternity and NHS campaigners. We welcome discussion.

A manifesto for mothers and babies in the NHS

1. Increase the maternity tariff. The existing maternity tariff, the money the government allocates for each birth does not pay for sufficient midwives for safe births, let alone for happy births
2. Bring back bursaries for midwives and nurses
3. Make full maternity care available to all mothers, no exceptions
4. Ditch the sweet talking Maternity Review. No personal budgets. No loss of beds. We want a fully funded NHS maternity system, not a choice of private providers.
5. Respect women’s choices in labour. Listen to the mother.
6. Home birth, midwife unit or hospital birth, they all need to be in in the NHS with NHS staff fully supervised and in the training loop.
7. Make obstetric care available in our local hospitals. No four hour journeys for women in labour.
8. No pressure to give birth at home. Home birth must be a free choice, with full hospital back up available
9. Full NHS insurance for all NHS home births. No handing over responsibility. No home births on the cheap.
10. Give women more time with their midwives. More midwives per mother.
11. No cuts in maternity beds
12. No woman to be left alone in labour
13. Help women with breast feeding. Mums need support after birth too. Breast feeding is far too low in UK, yet women want to breast feed for their babies.
14. Support mums in the early days with baby.
15. Invest in the start of life
16. Support maternal mental health
17. Train more paediatric doctors and nurses.
18. Research reasons for premature birth
19. Improve pediatic intensive care
20. Staff our labour wards so no forced emergency closures. Plan staffing 8 months in advance. It’s kinda natural
21. Nationalise the private maternity companies taking NHS contracts
22. Fund research into still births, and birth injuries
23. Improve procedures for induction of labour
24. Fully fund neo natal intensive care
25. Recruit more midwives, nurses and doctors,neo natal intensive care nurses and related staff.
26. Ditch the STPs and their cuts
27. Keep all our EU staff and make them very welcome
28. Fund improved ambulance services and train all staff including dispatchers around birth issues.
29. Fight maternal and child poverty

For our babies, for our mothers, for our sisters, for our lovers

Cumbria Infirmary, an attractive, quite new building, has massive debts to PFI and is unsafe from fire.The PFI will cost £1,018million for an £87m hospital

Liverpool Women’s Hospital was built in 1995. The Cumbrian Infirmary in 2001

What can we in Liverpool learn from this ?

Staff at Liverpool Women’s Hospital and the public have been told they will have a brand new building. What’s not to like? Why are campaigners so very wary?

Liverpool Women’s hospital was built 22 years ago and has no building debt. This is like being mortgage free.

Let us look at a hospital, a north of us, in Carlisle. Carlisle’s hospital, The Cumberland Infirmary looks beautiful, it really does. The entrance is impressive. It serves a huge area of the north of England. The staff are excellent NHS workers. You might have been there if you have hurt yourself on holiday in the Lake District. Care is not affected by PFI, except for the cost to the hospital budget and the separate problems in the build.

(Cumbria too has to fight for maternity services. We will cover in a different post )

So what happened with Carlisle Hospital?

The Cumbria Infirmary was built in 2001, a few years after the Liverpool Women’s Hospital. The hospital cost £87 million pounds to build. The PFI will cost £1,018million.In a PFI, the company builds the hospital and continues to own it for the period of the contract, 30 years normally. In that time, the first call on the budget of the hospital is the PFI payments.

How much has the NHS paid for the hospital so far on the PFI?

In year 14 of the contract, it had paid £260m, more than the cost of three hospitals. This money should have gone to staffing and to patient care.

The PFI contract though was sold on by the original contractors Interserve to Delamore for £90 million. To help give Delmore a better return the contract (like the mortgage term) was extended for 5 years. For more details see here

If at the end of 35 years, if inflation runs at 3% on average, the NHS will have paid £1018 million pounds

It costs a stupid amount, not to build, but to finance. The major expense was borrowing the money.

There is another major financial problem. “Developers will be handed huge swathes of land worth hundreds of millions of pounds, if the NHS fails to maintain a string of controversial Private Finance Initiative contracts, it can be revealed.”

Just one of our reasons to oppose the new build proposal is the way new hospitals are now usually funded. This is “PFI”. There are other reasons we oppose plans but this post concentrates on PFI

“The private finance initiative (PFI) is a way of creating “public–private partnerships” (PPPs) by funding public infrastructure projects with private capital.”

In this post we want to give just some of the background to PFI.For more detailed report read this https://www.theguardian.com/society/2017/aug/30/private-companies-huge-profits-building-nhs-hospitals

Why should people worry about how a hospital is paid for?

Before PFI, big projects were funded through the public works loan board. It was cheaper and the hospital owned the building and had more say in its construction. There was no profit to pay out to big private corporations

Many hospitals struggle to pay their PFI. In 2015 the Independent reported that “crippling PFI deals leave Britain in £222Billion in debt. Norfolk and Norwich hospital was reported as serious problems. The local paper said “How shareholders of PFI firm are making millions from cash-strapped Norfolk and Norwich University Hospital”

For an excellent summary of PFI issues in the NHS please read this

The massively expensive Cumberland Infirmary, Carlisle’s hospital, is Unsafe from Fire

Wikipedia says

“In 2015 a report commissioned by North Cumbria University Hospitals NHS Trust found that the fire proofing materials installed did not meet the required protection standard to allow for safe evacuation and prevent a fire from spreading across the building. It was described by the secretary of Cumbria’s Fire Brigades Union as “one of Carlisle’s biggest fire risks”. The Trust said that this was not the first time they had uncovered major flaws in the PFI scheme.[4]”

(We quote Wikipedia so we cannot be sued for saying this or dismissed as mad campaigners!)

Carlisle hospital’s fire safety sprinklers will not be fully installed until 2020. The faults were discovered in 2014. Meanwhile staff have rightly had to take extra precautions, taking time and money from patient care.

It was not just that the fire precautions ”were not as robust as those specified in the original plans” there was not enough staff from the fire service, nor from the NHS, to check on them

The Fire Brigades Union says

“Les Skarratts, a senior official with the Fire Brigades Union in the north west and Cumbria, said: “This demonstrates the consequences of cuts in the fire and rescue service in the area of fire safety inspectors. They’re skilled in inspecting places such as schools and hospitals. They bring enormous experience to the job and can resolve issues through taking enforcement action. Patients and staff in hospitals such as the infirmary deserve the best protection possible .In a public area, the effect of a sprinkler system is immediate .In this case, there should be some form of public inquiry.”

Despite this huge expenditure, the building has been found to be not safe from fire. Fire chiefs say safeguards “were not as robust as those specified in the original plans”.

Carlisle is not the only PFI built without fire precautions

“An independent report commissioned by the NHS trust that manages the hospital found that fire proofing materials installed by the private company did not meet the required protection standard to allow for save evacuation and prevent a fire from spreading across the building”

The Mirror reported other hospitals being unsafe from fire. Peterborough City Hospital, Coventry Hospital and Hereford County all have fire problems caused by PFI buildings. And chiefs at Hereford County Hospital fought to keep details of fire safety flaws secret after an enforcement notice was served on their PFI partner, Mercia Healthcare. (all from the Mirror)

The cost of making the hospital safe from fire will not go to the owners of the building but incredibly to the NHS.

“The private finance initiative (PFI) is a way of creating “public–private partnerships” (PPPs) by funding public infrastructure projects with private capital.”

Why should people worry about how a hospital is paid for?

Before PFI, big projects were funded through the public works loan board. It was cheaper and the hospital owned the building and had more say in its construction. There was no profit to pay out to big private corporations

The law of the land says buildings must be fire safe. These laws have not been observed.

Blessings be on the dead of Grenfell tower, and we give all respect their suffering, but that tragedy shows the scale of this further neglect of fire safety. And in hospitals too?

In Scotland when schools built with PFI began to fall down the Scottish government stopped paying the PFI. Carlisle is still paying, such is their contract

Carlisle hospital though is living lesson to those of to us in Liverpool, working in the NHS or fighting to save Liverpool Women’s Hospital and fighting to defend the NHS as a whole.

The new hospital in Liverpool, the Royal is being built with a PFI too, albeit one that is only slightly less expensive than Cumbria thanks to the detailed campaign waged against the original plans Alderhey Children’s hospital new building was built with PFI too. First bill to be paid each year is the PFI.

A PFI, however it is dressed up, means the first call on the money of a hospital budget is the PFI. Nationally and locally Money that should be spent on patient care and staff salaries, goes on the PFI

Doctors and nurses specialise in a field, such as Gynaecology, Heart issues, others in dermatology and many more. Not all doctors, nurses, and midwives know about PFI, or about STPs or about health economics, though many do. They should not need to know about this any more than they know about other specialisms. Their workload is heavy enough. In 2017, though, we all need to know in detail about this. PFI does though does affect everyone: doctors, nurses, patients, taxpayers, citizens are all affected. Of course, the very, very rich make money from it, far above the normal rate of interest or rate of profit. If you, friends, or family do work in the NHS, please do spread the word.

Why use this cumbersome and massively expensive system of financing hospitals? Two reasons It stays off the government balance sheet; the national debt looks a bit better, and it makes a pile of money for big business. These companies work for profit not for health care, and boy do they make profit.

Campaigners in Carlisle want the hospital nationalised so it becomes the property of us, the citizens.

If the Government spent the money on the hospital as ordinary capital spending it would cost the taxpayer millions less.

We want nothing to do with PFI

THE CCG in Liverpool has its self inflicted difficulties but the system of CCGs is flawed. Doctors were put in the front line of planning, something few doctors train for, then were given “expert” providers from the big corportaions whose business is to make profit.

The Carlisle debacle happenned before CCGs but it would be twice as foolish not to learn the lessons from Carlisle

We say Fire Safety check the new Royal repeatedly as it is being built.! Do it again and again

Liverpool Women’s Hospital should remain on site and be improved. The cost of providing extra staff, doctors and midwives and extra resources, to try to reduce the 15 transfers a year, to pay for for intensive care and improved blood services all pale into nothing compared to the cost of PF

Save Liverpool Women’s Hospital#onsite

Thanks to camapigner Peter Doyle from Carlisle for talking to us about it.

September 2017

Plans to “move” the Liverpool Women’s Hospital might be about to be announced; or they might not. This is a long limbo. Meanwhile fundamental changes are being planned for the whole maternity service in the UK, and Merseyside and Cheshire are “early adopters” of these changes. So in all this confusion think of two big issues; what’s happening to the Liverpool Women’s Hospital and what’s happening to maternity services? They are equally important.

(Of course behind it all, is the crisis in the NHS as plans to shift it to a privatised cut back model continue)

Normally we think of the main players being the Liverpool Women’s Hospital Trust, the CCGs and the Local Authorities but now we have two more players the NHS early adopters Maternity Review Vanguard (NHS Early Adopters in Maternity Services – Cheshire and Merseyside) and the Sustainability and Transformation Boards.

What’s Happening to The Liverpool Women’s Hospital?

The plans have been published (“The Review of Services Provided by Liverpool Women’s NHS Foundation Trust, Pre-Consultation Business Case”) in draft form for some eight months, but it looks like they may now be fully published for formal consultation. Elections, including the Mayoral and then the general election, were cited as reasons to postpone the consultation. These have now passed.

However, there is nothing in writing about the plans in the papers published for the September 1st Board meeting.

The Liverpool Clinical Commissioning Group is in some bother with a legal notice from NHS England and several senior resignations.

A Liverpool City Council meeting to discuss whether they should discuss the plans (yes, it is that convoluted) has been scheduled for early October.

“to receive further information on proposed changes to Future Women’s Services provided by the Liverpool Women’s Hospital. The same information will be received by Sefton and Knowsley Councils. In the event that two or more of the three local authorities determine that any proposed changes represent a substantial variation of service, a Joint Authority Scrutiny Committee will be established.”

A freedom of information request to the Liverpool CCG gave us this response, which boils down to “Well. we are getting ready”.

Question for Governing Body of Liverpool CCG Meeting of 8 August 2017

It has been seven months since Liverpool CCG published the Review of Services Provided by Liverpool Women’s NHS Foundation Trust, Pre-Consultation Business Case.

Thus, I would wish to ask the following:

1) Can you give some indication when the public consultation will begin?

We anticipate that the NHS England assurance process will resume in September as the additional information required regarding the financial case and an independent clinical review of the options should be completed by the end of August.

The assurance process could take up to two months which would mean the earliest start date for consultation would be November 2017, but a decision may be taken to commence after the Christmas period. However, consultation could only take place if NHS England is assured about the clinical and financial case and if support is given by a joint North Mersey Overview and Scrutiny Committee.

2) Is there any information in the public domain on the format for the public consultation?

Planning for a public consultation is at a very early stage and a draft consultation plan is currently in development.

We hope to update the three North Mersey OSCs on an outline approach to consultation in meetings to be scheduled for September.

3) The format for the consultation may indeed be determined by rules and guidelines laid down by various statutory bodies. However does the CCG have flexibility in the enforcement of these rules such as allowing public input into designing the format of the consultation?

There are statutory requirements for a formal public consultation which are set out in a number of documents, including:

https://www.engage.england.nhs.uk/survey/strengtheningppp/supporting_documents/ppppolicystatement.pdf-1

https://www.england.nhs.uk/wp-content/uploads/2015/10/plan-ass-deliv-serv-chge.pdf

In addition to OSCs, the CCG would engage with and seek input from organisations such as Healthwatch and existing patient engagement groups such as the Liverpool CCG Patient Engagement Group and the Sefton Consultation and Engagement Standards Panel in the design of the consultation process.

4) Does the format for the consultation have to be approved by the Joint Scrutiny Committee before it can begin?

Yes, commissioners would seek approval for the consultation plan from the joint OSC of North Mersey local authorities.

Money is a major part of the delay, as NHS England have to agree the capital money for the rebuild or the improvements on site (Our campaign’s preference is to improve on site). It is probably £140 million pounds for the CCG preferred option of a rebuild at the Royal published in the Review of Services Provided by Liverpool Women’s NHS Foundation Trust, Pre-Consultation Business Case. Such sums are not often forthcoming in this Government’s cuts scenario , unless there is a way as in PFI that big business can get a handsome profit.

What is happening to maternity services?

There are two other issues going on, less publicly:

One is the ‘Five Year Forward View’ and the linked implementation of the 44 Sustainability and Transformation plans nationally. Liverpool is part of the most complex STPs, Merseyside and Cheshire, which is attempting huge cuts, service rationing and preparation for the US style re structure into Accountable Care Organisations. The purpose of this is to make the NHS more accessible to US style ‘for profit’ healthcare companies.

The other is the Maternity Review, of which our area is a vanguard area, and the implementation of which is a real threat not to the existence of the Liverpool Women’s but to the structure of its services.

Maternity services are at risk across the country from STPS and the whole ethos of the Maternity Review

Our area is an Early Adopter of the misnamed “better births programme”. Catherine McClennan from this programme says “The majority of our women give birth in Hospital, we want to change that”. (at about one minute in on the video). They also speak of “popup” maternity units and greater ‘choice’.

We do need better births. We need fewer still births. Fewer maternal deaths. We need better ways to induce babies, we need more time with midwives, we need better ways to help breast feeding mothers and better mental health provision. We need happy, heathy mums and happy, heathy midwives, doctors and all the related professions. None of the stuff published under this heading is helping this at all.

Those implementing the Maternity Review seem to assume diversity of provision means greater choice, when it does not. ‘Diverse provision’, and ‘other providers’, are not the same thing as choice.

Across the country the loudly expressed choice of thousands of women to protect their local maternity services are being ignored, as services are closed willy-nilly. The choice of most of our local women is to give birth in hospital. Women giving birth can already use the midwife lead unit at the Liverpool Women’s Hospital, but that doesn’t count to the “reformers” because it is an ‘alongside’ unit, not a remote one. A remote unit obviously carries more risk, as one in four mothers giving birth in a midwife led unit has to be transferred to hospital. so the further away it is the greater the risk. Three out of four deliver happily and safely in such a midwife led unit.

A hospital or an alongside midwife led unit can be very homely and happy. Home births from the hospital midwives are also possible. Home births do not have to come from for profit companies outsie the NHS.

Where a remote midwife service exists in other parts of the country, and is safe, it should be protected. But that is not the issue here. This restructuring is not to do with saving babies or making labour any happier for mothers. Just look at some of the nonsense reported to the Women’s Hospital trust board;(Sept meeting minutes from ealier meeting)

The Director of Nursing and Midwifery explained that the Trust would be focused on specific areas:

1. Identification of hubs in suitable locations where services could be delivered from including
   1. ultrasound imaging,
   2. obstetric clinics,
   3. antenatal education
   4. and other support services such as smoking cessation and other public health message support;
2. Increasing the number of community births including homebirth and exploring freestanding birth centres;

(In other words, they are continuing to further the removal of services from the Women’s Hospital site, despite the consultation not having started…)

3. equitable access to an enhanced midwifery service providing support for vulnerable women experiencing complex health social factors such as perinatal mental health issues, substance misuse and child protection service input;
4. Consistency of breast-feeding support across the areas;
5. Offering contemporary antenatal education provision tailored to meet the needs of the women and families;
6. Examination of the New born provided in a timely manner in the most appropriate setting;
7. Provision of a model of continuity of carer within smaller teams promoting normality in pregnancy and birth whilst also coordinating care for women with additional risk factors;
8. Improvement in the Information Technology provision

We could critique this ‘till the cows come home, but should he really be doing this when we have babies to save? When mortality statistics still show concerns? When ninety-four of the sites where Hospital staff already work do not have risk assessments in place as the health and safety report in the same minutes shows?

Choice will be funnelled

However, the system that they are planning in this maternity vanguard programme will be able to funnel “choice” as the managers wish, through a single point of access – which will be a telephone service guiding women as to their options. Not your GP, or your local midwife, but a telephone system with the midwife giving advice (probably from a script and menu,) see one minute twenty three seconds into this video). This system will fit very well into the cost planning for a US style accountable care organisation,

Over worked staff

Then there is the huge problem of over worked midwifes and the pressures on them in the current climate of cuts. The Royal College of Midwives has made this very plain when commenting on the closure of the training bursaries scheme.

“We are dealing with a profession that is already overworked, understaffed and under paid. The Government should be doing all it can to make midwifery and working in the NHS as attractive as possible rather than deterring those by cutting public funding to train frontline staff”

The inadequate amount of money allocated to the maternity in the national maternity tariff means midwives will continue to be over worked and underpaid. This is unacceptable.

Our choices are

• Save Liverpool women’s hospital and keep all of its services on the much-loved site.
• Improve the Maternity Tariff – fund adequately for safe and happy births for all.
• Bring back the training bursaries.
• Give mothers more time with their midwives before, during, and after birth.
• Make both midwife led units and consultant led units fully funded and safe.
• Prioritise work to stop still births and maternal deaths.
• Stop cuts and privatisation.
• No to the US model of care.

There is a long-established technique for privatisation. The service is run down to the point where any suggested  change is welcome.The Conservatives are not fools They are not making a mistake by running down the NHS and starving it of funds. This is a part of the strategy to  remodel the NHS to fit the needs of the international health care insurance companies and  for profit health care  providers

The creation of Accountable Care Systems rearranges the structure of the NHS to mimic the structure in the USA. There a  city or region is organised as a heath care system then put out to the  private heath insurers who bid to run it.  If the UK signs a free trade deal with the US,  US companies will be able to bid to run chunks of our NHS. This is not bidding to run some services as Virgin does now, its bidding to run the whole shebang.

The Government may still pay the Accountable Care  System from taxation to keep it free at the point of need but it would be organised to make profit not to give care. Think of the rail privatisation. The government still pays for the railways, companies run the franchises ans take a profit but the  main cost is to the government. On the railways our taxes subsidise the profits for the companies and we have an inefficient expensive service. In the same way the Government could be paying for health care but a big chunk of the cost would go in profit.

The Accountable  Care System is one where the whole health system can be measures by an accountant. It is a money measure. To keep within that money limit, some services are rationed and not provided to patients. This is already happening here with limits on treatments say for IVF in some areas and some restrictions on IVF based on weight of mother or father. In the Chester area this is accompanied by an increase in the private provision of  IVF for those who can pay.

Some times the health insurance companies will put in a sweetener to make sure they get the bid, perhaps to pay for a new hospital.

The NHS is the largest integrated health care system in the western world. It spends a huge amount each year. In 2014 before this governments policies  really took hold it was the most efficient in the western world

Many companies would pay up front money  for even a slice of that cake. The long-term prospect of running the whole  NHS is Christmas  come early  to the big companies

But running a health care system is not the only prize. The NHS has an enormous bank of data on patients and treatments which is priceless to the big pharmaceutical companies

Liverpool and Merseyside are especially valuable to the private health sector because our people are more likely to suffer illness arising from poverty and so have multiple illness. This is potentially hugely valuable data for companies that want to produce drugs people will need to take for the rest of their lives. Cures have less financial benefit to the pharmaceutical companies.

So beware the big companies bearing gifts.  Our health is not their purpose.

Their purpose is profit.