What is happening with Liverpool Women’s Hospital in December 2024?
Liverpool Women’s Hospital is under a very serious and utterly ridiculous threat. Please see our suggestions here for how to support keeping the hospital open and better funded on Crown Street. This winter the Royal and Aintree are both overcrowded.
“Stables wanted for the birth of Liverpool babies when they close Liverpool Women’s Hospital”.
Imagine 7,000 babies and their mums and midwives crammed into the already overcrowded Royal? Will our babies be born on the corridors along with the very poorly people?
The fight goes on to Save Liverpool Women’s Hospital as a tertiary hospital on its own site run for women and babies. 76,000 people say so.
We are organising a public meeting with Kim Johnson MP in January and will continue with all the rest of our campaign work. Please help if you can. We especially want to talk to women’s organisations and union branches with big female membership
The future of Liverpool Women’s Hospital is in the balance. There is huge public support for keeping the hospital open and on the Crown Street site, our petition both on line and on paper is growing steadily and is already more than 76,000 signatures.
A Parliamentary report this week spoke of “Medical Misogyny”. The report said women were being left in pain and discomfort that “interferes with every aspect of their daily lives”, including their education, careers, relationships and fertility, while their conditions worsen.“
It also found there to be a “clear lack of awareness and understanding of women’s reproductive health conditions among primary healthcare practitioners” and concluded that gynaecological care is not being treated as a priority.
Pervasive stigma associated with gynaecological and urogynaecological health, a lack of education and “medical misogyny” has contributed to poor awareness of these conditions.
In this situation the closure of the hospital that provides all of Liverpool’s gynaecology care is crazy.
The maternity crisis nationally continues, yet they talk of closing our maternity hospital.
We also keep asking “Where will our babies be born?”
How can we keep a tertiary specialist hospital for women if they close the building, or scatter the services?
There are two big threats.
The trust has formed a committee with Liverpool University Foundation Trust( The Royal Aintree and Broadgreen. We fear that the needs of women and babies will disappear as women’s health and maternity have been neglected in the other big hospitals. So far all the services remain at Crown Street. The first joint meeting has been held. We are not aware of a maternity expert being on this committee. Certainly, men dominate the leading positions.
The ICB is a separate move that has finished an initial “public engagement “ over their plans to for the future of Liverpool Women’s Hospital. This is the first legal step towards closure or merger. We are preparing a detailed response to their plans. At all the public meetings the plans were robustly condemned.
At the ICB board in November we asked
Lobbying the ICB
“Re LWH & Women’s services, re the reporting process from the ‘engagements’ about the future of maternity and Gynaecology services in Liverpool Hospitals.
Why was the ‘independent firm’ not at any of the events? If they are writing the report including those meetings they will only have the ICB reporting on themselves.
How much is the firm getting paid & how much has it cost ICB staff time etc. for these events?
What is the timetable for receiving the results of the report & next steps
How will our petition be recognised by the engagement?
They answered.
As per best practice with an engagement exercise of this sort, NHS Cheshire and Merseyside commissioned an independent organisation – Hood & Woolf – to design and host the engagement questionnaire, collate and analyse responses to it, and to undertake an analysis and report on the feedback across all the different strands of our engagement activity. The report will include a description of the engagement activity undertaken, a summary of the findings, and the key themes, ideas, issues and concerns that have been heard over the six-week period. Analysing data – especially when there are large quantities of qualitative feedback – is a specialist skill, and it is standard practice for us to bring inexternal specialist support to carry this out. Hood & Woolf’s role did not include collecting feedback at engagement events. This is a task routinely carried out by our inhouse team when we are undertaking public engagement, even when the analysis is being supported externally. There was a dedicated note-taker (a member of NHS Cheshire and Merseyside staff) for each of the tables at all events (for the two online events, which had fewer participants, there was a single note-taker who took all the feedback). Their role was to literally take notes of the conversation, not to interpret it in any way. Each original, full set of notes will be provided to Hood & Woolf for them to analyse key themes and areas of discussion, so that this can be summarised in the report. It is important to be clear that the events were only one way in which we were collecting feedback during the engagement. Participants at the events were reminded that even though they had attended an event, it was still important that they completed the main engagement questionnaire. A QR code taking people straight to the questionnaire, and printed versions for those who were not able to complete the questionnaire online, were made available at the events to support this.
Our response to this will be detailed in a later post but we do not think the note-taking was independent or sufficiently detailed.
How much is the firm getting paid & how much has it cost ICB staff time etc. for these events?The core costs for Hood & Woolf’s work are in the region of £24,000.We have not broken down the cost of ICB staff time for this engagement exercise – the work was led by our in-house communications and engagement team, and no additional staffing costs were incurred. However, this has been a significant piece of work for the team, and for others in the organisation, both in terms of planning and delivery. ICBs have a legal duty to involve people, and we are committed to allocating the level of time and resource that this requires. In addition, the Women’s Hospital Services in Liverpool programme is a key organisational priority, and it is critical that we carry out comprehensive engagement with our communities to inform the next stage of work.
What is the timetable for receiving the results of the report & next steps?Work to begin analysing the feedback we’ve received is already underway and will continue over the coming weeks, however it’s important to note that we are still in the process of compiling feedback (for example, questionnaires provided in languages other than English will need to be translated before they can be included). Publishing the report and sharing findings with those who took part in the engagement is an important part of the process, and we plan to do this once the report is finalised and taken through our governance meetings and process. We are likely to be ready to publish the report and details of next steps during March 2025, but we will provide further confirmation on this nearer the time. ( our emphasis)
How will our petition be recognised by the engagement? ( At the last public meeting, the petition was spoken about with disrespect.) The petition was raised and discussed on a number of occasions during the engagement events. We are aware of and have heard the strength of feeling and different views people have shared, and we are grateful for the contributions people have given to our discussions. As stated, the information recorded during table discussions will beanalysed as part of the process of developing the engagement report. With regard to the petition itself, that too will be noted in the engagement report.
We fight for Liverpool Women’s Hospital and to Restore and Repair the NHS.
Day by day, the NHS provides services for patients often with great skill and good humour. Despite years of cuts, the NHS survives but it cannot provide all services we need because of austerity and the privatisation agenda.
We are in grim times, but the fightback is growing. Our petition has reached 76,000 signatures. We have had support to pay for our leaflets and meetings. People who spoke at the engagement meetings unanimously supported keeping Liverpool Women’s Hospital. Not a single member of the public spoke in favour of closing it, or dispersing its services. We have great support from the public, and two Liverpool MPs, Kim Johnson and Ian Byrne, have helped this week. The same day as the ICB meeting and the first joint board meeting of LUHFT and Liverpool Women’s Hospital, Kim Johnson raised the issue in Parliament. Ian Byrne sent a great letter to the Engagement Team, saying “NO!”.
However, the process decided by NHS bureaucrats rolls on. We can stop it if we organise.
The many people who have said “that will never happen” should join the fight back.
Two quotes show the seriousness of the threat we face
At the October 9th meeting of the ICB Fiona Lemens, leading the process said, introducing the engagement, “It’s too early in the process to speculate about how services might look, in the future at the Crown St. site and across the city, because we’ve not started that design work yet, but what we can say is that we need that hospital at Crown St. The things that we could consider that we currently need space for would be out patients, day case procedures. We’ve invested in a CDC, we need that diagnostic capacity for the patients in Liverpool, and this is an excellent building to provide that from and we are absolutely committed to NHS delivered services being delivered from that site, and there are no plans to discuss any other forms of services going in there.”
So, Fiona, where will our babies be born? Where will the women of Liverpool receive their gynaecology care? Where will fertility go? Where will genetics go?Where will the Bradford clinic go?
The website for Liverpool Women’s Hospital says about the second strand in this threat to the integrity of the Women’s Hospital, the largest maternity facility in the country :
“From 1 November 2024, Liverpool Women’s NHS Foundation Trust became part of NHS University Hospitals of Liverpool Group (UHLG). UHLG has been created through the coming together of Liverpool University Hospitals NHS Foundation Trust (LUHFT) and Liverpool Women’s NHS Foundation Trust (LWH).
Please note, Liverpool Women’s Hospital is now represented on the Group Board of Directors of NHS University Hospitals of Liverpool Group (UHLG). Details of past Liverpool Women’s NHS Foundation Trust public board meetings can still be accessed via the links below.“
On Thursday 28th November 2024, two crucial meetings happened. These meetings were:
1) The ICB meeting which received the first report of the Engagement process to decide the future of the Liverpool Women’s Hospital, discussed the winter crisis, and how to handle their lack of adequate funds. We, as members of the public, asked questions. We were told that the first response to the engagement would be reported in February or March. They are paying £24,000 to a company called Hood and Woolf to produce the report on the engagement.
We also learned of the grim financial position, and the situation regarding the terrible winter crisis, likely to be worse than last year. There will be a full report on this in a later post.
2) The inaugural meeting of a new joint committee, which has the delegated powers of the boards of Liverpool Women’s Hospital and the Liverpool University Hospital Foundation Trust (which covers the Royal, Aintree and Broadgreen). We fear that maternity will be treated as badly as maternity has been treated in so many other big acute hospitals, leading to major problems and major enquiries.
This joint committee of LUHT and LWH, also reported that the winter crisis is starting (staff tell us it started a while ago). They also discussed services that might be moved to, or from, the Crown Street site although such moves were already a fait acomplis, and the integrity of a Women’s Hospital seemed to be already lost.
We think it’s wrong that while the ICB follows a protocol to consult on service changes, the merging of the hospitals had no consultation whatsoever, and precious little discussion at the Liverpool Women’s Hospital Board. We were told at the engagement meetings, that merging hospitals does not need public consultation. This huge change was just ‘steamrollered’ through. Merging the Women’s is just the start. The intention is that the specialist hospitals in Liverpool, the Clatterbridge Centre, the Walton Centre and Broadgreen Heart and Chest, will be pulled into an even bigger merger. In contrast to LUHFT, the specialist hospitals have been funded nationally and do not share the financial crises facing LUHFT. It seems odd to us that such major reconfigurations are not considered to require public consultation, while (albeit cruel) changes to such things as celiac prescriptions do. At the ICB it was announced that they are going out to public consultation on whether prescriptions should still be available for gluten-free products for celiacs (A Gluten-free loaf can cost as much as £3.99.) We think this cut is terribly wrong for people already hard up, and struggling for enough food. Many celiacs don’t ask for prescriptions but the damage of this policy will hit the poorest hardest. The Celiac prescriptions cut is yet another cut amongst many – but surely, if this merits consultation, so must merging hospitals?).
Our campaign wants a well-staffed, well-funded Women’s Hospital on the Crown Street site. We want maternity to be funded and staffed well across the UK. We say enough of maternity scandals, enough of birth trauma, and enough of closures and cuts. We say this for all our mothers, daughters, sisters, friends, lovers, and babies. So many other countries do so much better than the UK in maternity and infant mortality. Once we were up with the best but austerity has damaged the service costing many of our babies’ and mothers’ lives, and women’s health.
We have 76,000 signatures on our petition to save Liverpool Women’s Hospital. People sent in many postcards opposing the idea of closure, or dispersal of services as set out in the engagement.
You can read more about the “engagement” process here from Greg Dropkin of Keep Our NHS Public.
We want to restore and repair the whole NHS, and to stop the relentless”Winter Crises”.
The NHS was founded to provide:
A national public service providing healthcare for all, free at the point of need, government-funded, publicly run, and publicly delivered, with well-qualified staff. For decades it worked very well, being declared the best health service in the world. Now it is seriously damaged and must be repaired.
The NHS came from decades of campaigning by working-class women, like the Cooperative Women’s Guild, and the Trade Unions, not from the rich and powerful. If we want to keep it we too fight for it.
The NHS has seen reorganisation after reorganisation in favour of the American model, most recently the Integrated Care Model. The ICB for our area is called Merseyside and Cheshire ICB. This body controls the allocation of money to the hospitals and policy over cuts. Cheshire and Merseyside ICB, and other ICBs simply do not have enough money to function properly. They were conceived as part of a hospital closure project, to reduce the costs of the service and make it more acceptable to US health corporations take-overs. There are other hospital closure plans still going on, as well as the threat to Liverpool Women’s Hospital.
The ICB conducted an “engagement” with the public about the future of Liverpool Women’s Hospital. It was not well publicised but did include four in-person meetings for which they asked people to register. In all four meetings, their proposals were roundly rejected, but the attendance was small, very little effort was put into getting real engagement. We will write more about this in another post. None of the meetings were at a time suitable for working mothers to attend.
What you can do to help
Help with the campaign distribute leaflets and help getting the petition signed.
Raise it with your trade union, or other organisation
Tell your MP and councillor Liverpool Women’s Hospital must stay at Crown Street as a full women’s service run by experts in women’s health, in maternity and related services. Tell your MP that hospitals must cooperate not compete or merge.
Tell them that the winter crisis is unacceptable. Tell them that problems including finance, staffing, buildings and equipment must be sorted and the drain into private companies must stop.
I am writing to you as my MP. I support keeping Liverpool Women’s Hospital at Crown Street. Please intervene to keep Liverpool Women’s Hospital fully functioning on Crown Street. I don’t care how much Spire wants the site.
As an MP, you will know about the many reports on the problems in Maternity nationally and the issues with women’s health in these years of austerity. You know about the increased risk babies face at birth in areas of poverty like Liverpool. Surely you do not support cuts to Maternity services?
The hospital needs much better funding, and all hospitals should work together cooperatively. We have a national Maternity crisis. Closing Crown Street will make things worse for all our mothers, daughters, sisters, friends, lovers, and babies.
The NHS faces an appalling winter crisis in winter 24-25. Make sure the NHS is funded and equipped to save lives, not cost lives.
Hospitals should be organised as Nye Bevan intended, a cheaper more effective system than any the Thatcherites designed.
I oppose racism. In the year we have seen the worst race riots this century, closing Liverpool Women’s Hospital at Crown Street is a slap in the face for all anti-racists. That hospital is seen as a safe space. It was built not so long ago as part of the reparations for the racism of the past.
I would like an appointment to discuss this with you.
I am writing to tell you, as my MP, just how worried I and many others, are about the situation in the NHS in Cheshire and Merseyside. We ask that you intervene.
Lord Darzi said, “The British people rely on it ( the NHS) for the moments of greatest joy – when a new life comes into beingand those of deepest sorrow.”
The current plans and lack of plans for operating with this lack of resources in Cheshire and Merseyside will damage the moments of joy and increase those of deepest sorrow.
I draw your attention to the threat to Liverpool Women’s Hospital.
I have followed the meetings of the ICB and of Liverpool Women’s Hospital. The financial situation for both organisations is unacceptable. It is wrong that the place where so many babies are born is so short of the money required to operate day to day.
The start of the process of closing Liverpool Women’s hospital, from the meeting on October 9th, is very worrying and cannot be isolated from the general crisis in the NHS. Please consider the following points
Liverpool Women’s Hospital is valued by the women of Liverpool and the public, with seventy-five thousand people signing the petition to save Liverpool Women’s Hospital. There have been three big rallies on this topic. The closure of this hospital will further damage the health of women and babies in Liverpool and the wider area. It is a regional maternal medicine centre. It is a tertiary referral centre for gynaecology, performing approximately 10,000 procedures per year. Liverpool Women’s Hospital is seen by the women of Liverpool and beyond as a safe place in an era of growing violence against women and in the context of declining health amongst women, as the parliamentary report showed
The CQC describes Liverpool Women’s Hospital as safe. Despite several recent visits, the CQC did not raise any of the issues raised by the ICB report of 9 October. Other issues related to staffing and safety in maternity were raised, but this is one of the safer maternity units in the country.
The document presented to the ICB on October 9th technically started the pre-consultation engagement about moving Liverpool Women’s Hospital services from Crown Street. Yet it gives no explanation of where our babies will be born, where gynaecology or all the other services will move to, or the indication of capital to provide alternative premises. There is no risk assessment or impact assessment.
Nationally and locally, the experience of women giving birth has deteriorated and this has done much damage. There is a maternity crisis in the UK following years of underfunding, understaffing and the disastrous outcomes of the 2012 Health and Care Act, as described in the Darzi report. It is widely anticipated that another heart-breaking report on Maternity services from Donna Ockendon will be published next month, this time about Nottingham. No one working in or around Maternity can deny the existence of this crisis. In this situation, women are angry. The CQC’s September 2024 report on the maternity service nationally said https://www.cqc.org.uk/press-release/action-needed-now-prevent-harm-maternity-services-becoming-normalised
The staffing system at Liverpool Women’s Hospital and other NHS maternity services rests on Birthrate Plus, which urgently needs review. We need better services for the babies, the mothers and the staff. Mothers and babies need more attention, and only increased staff can deliver this.
Liverpool Women’s Hospital has serious financial problems, with a deficit of 19% recently reported. The Maternity tariff on which much of their income rests is inadequate, nationally and locally. This tariff level is a core driver of the national Maternity crisis. Liverpool Women’s Hospital is currently fully staffed with midwives, at least according to Birthrate Plus, thanks to the recruitment of newly qualified staff. As with the national service, the loss of older staff who left in disgust at the safety of the whole Maternity service leaves intense pressure on these new midwives.
The health of Liverpool’s babies must have priority, especially as childhood health in Liverpool, already damaged by poverty and pollution, is not mentioned.
Liverpool Women’s Hospital is based in Crown Street Liverpool 8. It was built as part of Project Rosemary, a gesture of reparation for the terrible racism that the area has suffered. To remove the hospital in the same year as the worst race riots in Liverpool since Charles Wooton was killed is truly a slap in the face for all anti-racists.
Liverpool Women’s Hospital is one mile from Liverpool Royal Hospital; it is not “isolated.” Other branches of Liverpool Universities Hospital Foundation Trust are much further away from each other, and patients move between these buildings. The 2012 and related legislation introduced the business model, making each hospital a competing entity with other hospitals. This must change. Hospitals must work cooperatively.
One risk mentioned in the ICB document is that deteriorating women cannot be managed at Liverpool Women’s Hospital, yet the trust board has reported major improvements in this. No hospital can guarantee never having to move a patient to another hospital. About 10,000 such moves happen annually in the NHS. At present there is not a critical care unit (CCU) available at LWH. There is a high dependency unit (HDU) at Crown Street and staff working on the gynaecology HDU have undertaken training for critical care.
Another risk mentioned in the document is that other hospitals in Liverpool do not have staff to deal with pregnancy or other gynaecological conditions. This must be addressed, but not by closing Liverpool Women’s Hospital.
Another risk mentioned is that services might be moved out of Liverpool if certain specifications are not met. But this report does not say where Liverpool’s babies will be born. Will that, too, be sent out of Liverpool?
Risk 4 discusses recruitment and retention difficulties. Midwives at LWH face no recruitment problems. The problems with other specialities are national, not local.
In the weirdest contradiction, Risk 5 says, “Women receiving care from hospital services, their families and the staff delivering care may be more at risk of psychological harm due to the current configuration of services.” Closing Liverpool Women’s Hospital will definitely risk psychological harm, as the place we see as safe is taken from us against huge popular opposition.
The engagement events are inadequate. Only two of these events are not in working hours, none are in North Liverpool or locally in central Liverpool. It requires time and some computer skills to register for them.
I also have serious concerns about the NHS winter crisis 2023-24, which the ICB has been clear will not be better than last year. The ICB is underfunded ( but spends too much on financial consultants and contracts, driven to do so by NHSE.) It is also under pressure to get the Liverpool Specialist Hospitals, Liverpool Heart and Chest, Liverpool Walton Centre and Clatterbridge Cancer Centre firmly into the cash-strapped ICB control. Liverpool Women’s Hospital is also partially funded through the specialist hospitals programme and is affected by this move from national to local funding.
I recall the announcement nine years ago that one Liverpool Hospital must close, and then it was announced that Liverpool Women’s Hospital was the one they had chosen. The chaos over Liverpool Royal New build and PFI, plus the pandemic, gave some breathing space, but the coming of the ICB and NHSE’s determination to reduce the number of hospitals in Liverpool have brought this back to the table.
I would like to discuss this with you personally.
For all our mothers, daughters, sisters, friends, lovers and babies, Save Liverpool Women’s Hospital
Today, October 9th 2024, the ICB started the legal process that will allow them to close Liverpool Women’s Hospital. The papers for this meeting can be found here. Campaigners opposed the plans. We include videos of some of the contributions in this post.
Protestors outside the ICB meeting discussing the future of Liverpool Women’s Hospital.
The document did not discuss the financial situation or alternative provisions, nor did it include an assessment of the benefits of having a stand-alone Women’s Hospital.
After decades of cuts in healthcare and growing crises in women’s health and Maternity, there is naturally great concern about these plans. Similar plans have been put forward before. Seventy-five thousand people have signed our petitions to keep Liverpool Women’s Hospital open, and we have held three large demonstrations over its future.
Act now to avoid the winter crisis, with patients dying because of the long waits.
Keep Liverpool Women’s on the Crown Street Site and staff it well, with all the specialisms required to improve care and minimise transfers out of LWH. Give it long-term security.
Improve the intensive care at Liverpool Women’s Hospital.
Make all hospitals work cooperatively, not as competing organisations.
Protect the Emergency Departments at Liverpool Women’s Hospital.
Provide emergency Obstetric and Gynaecological care at the A and E at the Royal and Aintree.
Nationally, address the workforce training issues that have resulted in shortages of key roles, like anaesthetists.
Make the NHS a great place to work.
Act against the racism that damages the health of women and babies health.
Protestors holding a small sample of our petitions.
Liverpool Women’s Hospital opened in 1995. It is a modern low-rise hospital on a garden site in good condition. It provides maternity care and gynaecology for most of Liverpool’s women. About seven thousand babies are born there each year. It has a new large neo-natal unit and provides other linked services. It is just over a mile from the Liverpool Royal Hospital site.
Lesley Mahmood for Save Liverpool Women’s Hospital.Part one
The second half of Lesley’s speech
The ICB (Integrated Care Board) now runs finance and planning for the Cheshire and Merseyside area of the National Health Service, one of 42 such areas in the country, following the 2024 Health and Care Act. The aim is to bring all health spending for the area into this body and to restrict that spending. This mimics the Accountable Care boards that operate in some US States or cities. In the US, these organisations comprise one big or several small private healthcare corporations providing healthcare for profit. The Government provides funding, and the corporation profits by restricting the service. There has been a revolving door between the leaders of the NHS and the big US health corporations for some time, and there are close links between the governments and those big US health corporations. For details, see here.
This is an American definition of ACOs. “Accountable care organisations (ACOs) are defined as groups of clinicians, hospitals, and other healthcare providers who work together to provide high-quality, coordinated care to a defined population. If an ACO meets quality standards, achieves savings, and meets or exceeds a Minimum Savings Rate, the ACO will share in savings based on the ACO quality score.“
Felicity Dowling speaking for Save Liverpool Women’s Hospital Campaign.
The very grave financial difficulties of the NHS, this ICB, and Liverpool Women’s Hospital were not discussed. It was presented as a purely clinical case – as though such an idea is possible in such a funding crisis for the NHS. The Liverpool Women’s Hospital has been structurally underfunded for many years. The Maternity tariff and Birth rate + are inadequate. This funding problem affects all Maternity units nationally. Still, the impact is starker at Liverpool Women’s because it is such a large Maternity unit and does not share its budget with a general hospital. The Government made up some of the difference until the ICB was formed two years ago, but that has ceased. Many of the very real problems at Liverpool Women’s over the last few years stem from this chronic underfunding.
Greg Dropkin speaking at the ICB meeting. Greg is from Keep Our NHS Public.
Today’s meeting will be followed by a public engagement period, during which the public might be allowed to contribute to the discussion.
We believe Maternity is massively underfunded, and that is at the core of the national maternity and birth trauma crisis.
There were no alternative plans put forward as to where our babies will be born or where women’s health care will be delivered.
The core case made was that the most severely ill patients have to be transferred to the Royal, one mile away, and that women with obstetric and Gynaecological issues who present at the big A & E do not have on-site obstetric or gynaecological care available at those big sites.
Protestors reminded the board that the plans to close one hospital in Liverpool date back to 2015 when the then-head of the Clinical Commissioning Group announced them on a panorama programme.
Sheila Altes responded about some of the risks in the document.
Save Liverpool Women’s Hospital 2024 for all our mothers, sisters, daughters, friends, and lovers and for all the babies.
The ICB meets on Wednesday, October 9th, to discuss its latest attempt to close Liverpool Women’s Hospital.
Without the long and publicly promised consultation, the ICB has gone ahead, determined to close our much-needed hospital.
Our campaign rejects any attempts to close, merge, disperse or cut services for the women and babies of the whole area. None of the half-suggestions in the papers will improve anything for women or babies.
Papers such as those published for the meeting on October 9th are impossible to evaluate without a financial statement, research background, and impact assessment, all missing from the proposals.
The financial background for the whole NHS is grim. The last government’s financial plans and policies are still in place. The ICB in Liverpool is in serious financial trouble. There is a looming winter crisis. NHS England has said that the trusts must squeeze staff costs, and there is no chance to surge extra beds and social care resources as they did last year. We have consistently challenged the ICB on this.
Liverpool Women’s has structural financial problems. The largest maternity service in the country is most impacted by the inadequate Maternity tariff. Financial problems are not mentioned in the paperwork. No other hospital can improve on the Liverpool Women’s Hospital maternity service without improved funding.
Liverpool Women’s Hospital needs a level 3 high dependency unit added to its Intensive Care provisions, and it needs some more specialist staff, all of which would be more efficient and equitable than the current semi-proposals.
We will not stand by and see women’s services sacrificed again.
In 2015, plans were set out to close one Hospital in Liverpool, and they chose to damage services to women.
Liverpool Women’s Hospital’s financial problems are caused by the poor funding of maternity nationally, and the cost of the foundation trust system.
Maternity and women’s health need urgent changes, but these don’t include dispersing services and absorbing Liverpool Women’s Hospital into one giant conglomerate. Should we leave structural issues in our health care to “the professionals”? No way. The big managers of the NHS have caused havoc in the last ten years, implementing austerity, privatisation, the chaos of the building of the new Royal, and the move towards an American healthcare model. We have seen more than a decade of damage.
The priority must be the health and well-being of the women and babies of Liverpool. For too long, women and babies have paid the brutal price of austerity and poverty.
The ICB say they think it will help poor and black women to move a hospital from Crown Street, in one of the most hard-up areas of the city, and the traditional Black centre of the city! This within weeks of the most serious organised racist attacks in the city in decades.
We have always said hospitals should work cooperatively, rejecting the 2012 Health and Social Care Act competition model.
75,000 people have signed the petition to save Liverpool Women’s Hospital. There have been three large rallies, and countless meetings and street stalls on this issue.
Only the hard and skilled work of NHS workers and in this case especially, midwives, have kept a service afloat.
Restore and repair the NHS! Save Liverpool Women’s Hospital!
Liverpool Women’s Hospital is a much valued service for women and babies. The history of the building and the site are important, especially as racism has reared it head in Liverpool in a way unseen for decades. It is a modern low-rise building in good condition. No wonder the private sector lusts after it. The Crown Street site is, importantly, a green site, which helps sick women and babies heal, which is good for babies’ lungs, and is a good place to be born.
Nationally, Maternity is badly funded and badly organised. The Government spend more on payouts from the insurance than for the whole service. There has been a flight of older, more experienced midwives from the service, making the work of our much-valued younger midwives harder. Midwives nationally have been clear about the dangers, and a slew of reports have shown the damage done to women and babies. All these cases have been in co-located maternity systems.
NHS workforce planning has been appalling in the last decade. Blaming a standalone site for workforce shortage is ridiculous. The situation for anaesthetist training is a national scandal.
We call on the city of Liverpool, Merseyside, and beyond to defend what we have in the NHS, and to fight to improve the rest. No closures, no loss of services, no more mergers, no more outsourcing, no more overworked staff.
What has Liverpool’s “Place” NHS and Cheshire and Merseyside ICB done whilst maternity care nationally is in a well-publicised crisis and thousands of women are furious about the level of care they and their babies received? While the public enquiry into baby deaths at Countess of Chester has just opened? While Alderhey is at the centre of the Physician Associates scandal? While they can’t stop the next winter crisis, already upon our hospitals?
They announce the intention to fundamentally change Liverpool Women’s Hospital. This was without even a meeting with the organisations that have campaigned for a decade to keep the hospital and collected 75,000 signatures to keep the hospital on the Crown Street site as a women’s hospital for all our mothers, daughters, friends, lovers and for every precious baby.
The whole ICB is facing huge problems and does not have the resources to deliver safe A and E in the coming months. Yet, they think launching a discussion about merging Liverpool Women’s Hospital into one conglomerate of hospitals is sane and responsible.
This is the state of the Integrated Care Board, which is the controlling body for the NHS in Cheshire and Merseyside. It is from page 110 in the Board papers. A score of 20 in black means it is at the highest risk possible. They also said:
“There are currently no known plans for any additional funding to be allocated ahead of winter to support additional capacity and the expectation is that maintaining system flow through winter will need to be achieved through the delivery of these improvement plans.“
The document about Liverpool Women’s Hospital’s future can be found here. We will produce a detailed critique next week.
Maternity and women’s health need urgent changes, but they don’t include dispersing services and absorbing Liverpool Women’s Hospital into one giant conglomerate. We want to see the following changes nationally and locally.
Far better funding and staffing for maternity and an end to birth traumas.
More respect must be given to women giving birth and the women tending them in giving birth.
The funding currently given to insurance for maternity damages should be invested in the service to reduce those damages.
Women who need induction of labour should get that intervention in a safe and timely manner.
Fertility services must be fully available on the NHS, not the prerogative of the well-off.
Gynaecology services must be drastically improved, nationally and locally.
The NHS workforce must be given more respect, their workload improved, and the service must once more become a good place to work.
The whole NHS must be returned to being a national, fully publicly provided service, fully funded, repaired, and restored after all the damages of more than ten years of austerity and many forms of privatisation.
The public’s views must be respected – most women likely to use the hospital will be at work when this first meeting happens.
The research conducted at Liverpool Women’s Hospital must continue into key areas like endometriosis, menopause, and working to ensure our prem babies live and thrive despite being born very early.
Midwifery training must be made available to all without incurring huge debts.
Women’s health and healthcare must be given far more resources and respect.
Our petition, which is available on-line is at 44,656 signatures and more than 30,000 signatures on paper, says “Save the Liverpool Women’s Hospital. No closure. No privatisation. No cuts. No merger. Reorganise the funding structures not the hospital. Our babies and mothers, our sick women, deserve the very best”
It has over seventy-five thousand signatures. The people of Liverpool have attended three big demonstrations to save the hospital. Campaigners have attended every board meeting of Liverpool Women’s Hospital since the petition was launched and every ICB meeting since that was formed. Yet we have never been invited to present our views. Promises of consultation made in public clearly meant nothing.
Twenty thousand signatures were presented to the ICB in January 2023
Liverpool Women’s Hospital is a tertiary centre, which means patients are referred there from other hospitals from the rest of Merseyside and Cheshire, the Isle of Man and parts of Wales. Keeping that provision and the reputation that goes with it is important. The provision for the babies in the neonatal unit, near their mums, matters too.
We have said for years that the NHS must change the maternity tariff, the amount of money paid to hospitals for delivering maternity care. Liverpool Women’s Hospital is the largest provider of maternity care and is badly hit by how low the tariff is. Liverpool Women’s Hospital runs a deficit because of this, and over the years appears to have made some bad decisions on staffing because of the financial problems. Many midwives left. Yet somehow,the document from the ICB says:
“The case for change is focussed solely on the clinical risks, issues and outcomes for people using hospital-based gynaecology and maternity services. It does not consider productivity or value for money.”
The ICB is in serious financial trouble yet it claims not to be considering money in this situation.
We say that right from the beginning, it has been about money. It was about the decision made nearly a decade ago to close one of the Liverpool Hospitals to save money at the cost of our health. It is also about disrespecting women’s health and women’s opinions.
“We’ve known for some time that the poorest households and women have shouldered the greatest burden of austerity measures.” Women’s health has suffered particularly in this time. Liverpool has seen some of the worst overall loss of healthcare. Yet we still kept Liverpool Women’s as a treasured service, where most of Liverpool’s babies are born and where great steps have been made in research. We said before and say it again “In these hard times. what we have we hold.”
Should we leave structural issues in our health care to “the professionals”? No way. The big managers of the NHS have caused havoc in the last ten years, implementing austerity, privatisation, and the move towards an American model. We have seen more than a decade of damage.
Remember the chaos of the building of Liverpool Royal, with fewer beds than the old one and now needing more, with chaos in the financing, construction, and demolition?
We call on the city of Liverpool to defend what we have in the NHS and to fight to improve the rest. No closures, no loss of services, no more mergers, no more outsourcing, no more overworked staff.
“Do not appeal, do not beg, do not grovel. Take courage, join hands, stand beside us, fight with us”!
The Suffragettes knew how to campaign and so do we.
This post is being written just two weeks after the General Election which saw the Conservatives, who had so very severely damaged our healthcare, thrown out. (Hurray!)The new Labour Government has a massive majority but lacks a clear plan to restore and repair the NHS, and talks of more privatisation. They also have form in bringing in privatisation in earlier governments. So, we need to review the situation and renew our campaign.
We are far from alone. There are campaigns like ours dotted around the country. The NHS is immensely important to people in the UK.
Our online petition says Save the Liverpool Women’s Hospital. No closure. No privatisation. No cuts. No merger. Reorganise the funding structures, not the hospital. Our babies and mothers our sick women deserve the best.
We fight too for the whole NHS; the issues are inseparable. Maternity is one of many issues, including the overall reduction in healthcare capacity in this country as seen in the many hospital closures, shortage of doctors, multiple kinds of privatisation, the use of the business model, and the influence of big US “health” corporations. We, though, focus on maternity and our local issues (as well as the big national and international healthcare, women’s rights and children’s rights issues.)
From the start we said
For all our mothers, sisters, daughters, friends, lovers and every precious baby save Liverpool Women’s Hospital and the NHS.
In the years we have been campaigning we have seen severe damage to maternity care nationally, and to the whole NHS. Mothers and precious babies have paid a heavy price. Highly qualified people have conducted report after report into the situation and the last government gave lip service and let the situation deteriorate. These are heartbreaking and infuriating descriptions of some maternity in the UK.
The most useful definition of birth trauma we have found is this.
“A traumatic childbirth experience refers to a woman’s experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman’s health and wellbeing.”
There is support in issues around Birth if you contact the Birth Trauma Association, and sometimes through the maternity hospital. Liverpool Women’s Hospital has a service called the Rainbow Clinic for women having a baby after an earlier traumatic experience, normally involving the death of a baby but it is not advertised on their website.
Some mothers thankfully do have great experiences of birth but the numbers reporting far from good experiences is heartbreaking. The racial and class divides in Maternity outcomes are scandalous. Maternity is grossly underfunded and understaffed. The staff are overworked.
Continuity of Carer where pregnant women are cared for by a known small team of midwives from the pregnancy through birth and the post-natal period would help if it were fully staffed and funded would help. Without funding and staffing, the attempt to introduce continuity of care caused chaos. Donna Ockendon’s report called for it to be halted until full funding and resources.
We are concerned about women’s experience of delayed induction of labour and its link to emergency caesarean sections.
Staff in our hospitals and community teams work hard with inadequate resources and inadequate staffing. We will shout from the rooftops”We need more midwives.”
We have seen NHS managers looking for all kinds of magical thinking solutions to the problem but Liverpool Women’s Hospital does not need a new building, we do not need new fashions in childbirth, we need women’s choices to be heeded, we need more midwives, more obstetricians, more anaesthetists, more natal nurses, more health visitors, more infant feeding specialists. We need better blood services, well-maintained buildings, better food for staff at night, we need bursaries and we need to retain the staff we have. Above all, we need more midwives.
It would be nice if NHS managers were prepared to speak truth to power but we know that bullying is endemic in the NHS.
Many reports, especially in the right-wing press criticise “NHS Maternity Care”. However, the US model of maternity care is the worst in the developed world so no lectures from American Health Corporations or their UK offshoots or employees or political servants, please.
We must make the politicians listen. Our campaign must become deafening.
We took a big Restore and Repair the NHS campaign van around Cheshire and Merseyside in the week before the election. We went to Leighton Hospital near Crewe and up to Southport, to Ellesmere Port, to Chester, to Neston, to Warrington, to Kirkby, Whiston, Birkenhead, West Kirby and Liverpool. The van was met by campaigners in many places and had good support from the public. We heard stories of gratitude to the NHS and stories of long waits and being unable to access treatment.
We were not supporting a particular political party but we were opposing the last government and all the previous ones that had damaged our healthcare in the name of austerity or the discredited idea that private companies could run public services better than public services.
The NHS was one of the biggest issues in that election but too many people felt there was nothing they could do about it. We saw the lowest turnout in the election, the lowest since ordinary people had the vote.
One conversation comes to mind, one in Ellesmere Port Market(a great place!). A woman said there was nothing they could do about it however bad it was. We said that the suffragettes managed to change things, without even having the vote, that slaves got slavery abolished, that we do not send kids up the chimney anymore, and that the fight for the NHS was from the people not from political parties.
We also want to do a shout-out to the Lodge Lane food pantry, a great crowd of people who gave our van a real welcome.
It would be so much better if Repairing and Restoring the NHS was once again a serious commitment from one of the political parties but it still is not. We must make the issue of restoring and repairing the NHS such a big campaign that politicians must listen.
The NHS needs proper investment NOT “reform” and privatisation. This campaign joins with NHS workers Say No in saying #Wes change your plans #no to NHS privatisation.
Our campaign is part of a wider campaign in Cheshire and Merseyside to restore and repair the NHS. The local ICB we know is short of funds but now has been told to bring in a private company to look at how it can reduce costs. This is ridiculous. Liverpool Women’s Hospital requires additional funding to keep safe. Funding comes through the ICB. We are far from the only hospital or service in that situation. It is an intolerable situation and we call for public support to stop this dangerous nonsense. The lives and health of our precious babies and the health and at times lives of their mothers depend on improving the healthcare.
We warned the ICB that last winter would be dreadful in the NHS and dreadful it was. We need urgent action now to prevent another set of winter problems in this area.
Our hearts go out to the women and children of Gaza, especially to the pregnant and new mums. Cry justice for the dead and injured. We weep and rage with the patients whose doctors and health workers who have been willfully killed by Israel or tortured in Israeli prisons in this terrible onslaught. We mourn too the dead of Ukraine and those in all the other conflict zones.#CeasefireNow#StopGenocide#SavetheChildren.
With your help, in person or through donations, we will grow our NHS maternity campaign so it cannot be missed. Remember every campaign requires people to talk to their friends about the issue. These little conversations are the seeds of success.
What can you do?
1 Talk to your friends and workmates about the need for a fully funded publicly owned NHS.
2. Get involved with the campaign personally.
3. Tell us about your experiences and suggestions
4. Make formal complaints about poor service to the hospital and to your MPs and councillors. We can help.
4. Get your union branch or other organisation involved in the campaign. Ask us to send a speaker.
5 Give out leaflets in your street.
6 Put up posters.
7 Come to our events. Look out for events when the Labour Conference comes to Liverpool at the end of September.
Speak out for the NHS. The NHS matters in this election and after it.
Don’t leave it to the politicians.
The NHS came from the people and the people must organise to get it back!
Restore and Repair the NHS.
Cheshire and Merseyside NHS campaigners are taking a campaign van around the area to remind people of the need to Restore and Repair the NHS.Politicians should heed the needs of the people before the needs of the banks
This article gives information gives more information than the leaflet we are giving out
We say to any government, you must repair the damage of the last two decades, and rebuild the service after years of cuts. The capacity of the NHS to provide adequate timely treatment was cut as the population aged. But it made big money for the very rich. We want the NHS back for the people, not for profit.
Join our campaigns until the politicians restore and repair the NHS.
The Royal College of Nurses has declared a national emergency in the NHS.
Doctors are warning of large numbers of avoidable deaths from NHS shortages.
Life expectancy in Cheshire and Merseyside is lower than the national average for men and women. Access to health care is crucial in this. Will you willingly give up years of your life, and the lives of those dear to you, to fund privatisation and poor healthcare?
The NHS is underfunded. Our local Integrated Care Board said in May 2024 that “provider financial plans exceed the level of funding available” Providers are hospitals. The hospitals have huge waiting lists and dreadful A&E waiting times. They need the money. Maternity desperately needs funding.
The damage to the NHS has been deliberate. Privatisation, underfunding, deskilling staff, closure of hospitals and beds, organisational “reforms” using expensive financial consultants, PFI, and poor building maintenance; it all adds up to Government policy and it has been lethal.
Privatisation involves public money being paid to private companies to provide a service and allows the private company to make a profit and to deny care to some patients. That profit is money that could go to the public service. They are not more competent nor more efficient. £10 million pounds a week goes to private profit according to We Own It. The ICS structure is based around “commissioning services” pushing ever more of the NHS budget into the private sector.
Fund and staff maternity services to equal the best in Europe. We need more midwives. Can we say that again? We need more midwives. Did they hear that? Say it again WE NEED MORE MIDWIVES. There have been so many reports on the state of maternity services, we need action now. Women and their families are angry about what’s happening in maternity.
Children’s Health
The health of our children is worsening. Ensure every child has timely access to full healthcare, at birth, in the community, at the GP surgery, at Accident and Emergency, and in planned care in the hospital. Bring back health visitors.
GPs
The GP service must be restored and be staffed by qualified doctors. The government must allow spending on doctors as well as ancillary services. A good GP puts years on your life. GP services have been cut with overall funding cuts of 20% per patient per year since 2016.
Mental Health Care
Mental health services must be renationalised and brought back into the NHS and staff trained and paid to NHS standards. The damage is disgusting.
Dental Health Services
Everyone has (or did have) teeth. Our dental health services must be made available to everyone. The damage is immense. Change the contracts to ensure this. Bring back NHS dentistry.
Hearing Services
Audiology must be brought back in-house to make sure everyone has access and no one has to pay privatised prices. Hearing aids are free on the NHS if you insist on using the NHS. These hearing aids are just as good as the ones for which people pay hundreds
Ophthalmology
Eye health services must be brought back into the NHS to ensure quality of service, and access for all and to prevent unnecessary treatments that make profit. When so much of the service is farmed out to for-profit companies and the NHS just does the most complex the whole training system fails
A&E
Accident and Emergency Services. Waiting for hours in A&E is an awful experience as is being treated in a corridor. According to new estimates, long waits in A&E departments may have caused around 30,000 ‘excess deaths’ last year. The stress on staff is also unbearable. We say No more winter crisis. Employ the staff, provide the buildings, and open more hospital beds.
Healthcare for all, free at the point of need. End the policy of charging for some services, reduce prescription costs, and stop discrimination against migrants, who pay twice for the NHS and are charged at 150% of costs yet pay all the same taxes as everyone else.
Our data
The NHS as a national service for over 75 years is gold dust as far as big data companies, health insurance companies and the US health corporations are concerned, the information about our health care, our symptoms and treatment must return to being confidential. Palantir has been given a huge sum of money to manage our data. Kick out the big US data firms and the other private firms who are getting rich off of our data.
Staffing
All vacancies in the NHS must be funded and recruitment processes must be positive and wide-reaching, including winning back many nurses and midwives who have left. Say no to two-year trained staff, no to the use of Physician Associates except in situations where they are in real-time supervision. Workforce planning must be based on training and employing more qualified doctors and nurses to meet the needs of the people. Student debt in medical nursing midwifery and allied professions must be abolished, and bursaries re-introduced so ordinary people can afford to train.
Pay the NHS and social care staff well. This will help keep staff and reduce their stress.
Social care
Social care covers services to the frail elderly and to disabled people people of all ages both at home and in care homes. Councils are starved of funds and stupidly went along with the policy of privatising their own care homes. Now care homes are privately run, by for-profit companies and do not provide a universal service but a service where and when they can make big profits. Most are privately owned by big companies and hedge funds. This is more public money going to shareholders. Neither are care services free at the point of need but charge large fees to users who do not qualify for NHS funding or Local Authority funding. Children’s social care is in a shockingly bad state and adult social care needs radical reform. If you are interested in this area see the End Social Care Disgrace campaign
The private sector. This is no solution to the healthcare crisis. They don’t have the full range of treatments or facilities and are dependent on the NHS for backup. Most doctors who work in the private sector also work in the NHS. The NHS has103,277 general and acute beds while the private sector has about 11000
We all need healthcare. The need for the NHS is crystal clear. All the parties say sweet words about protecting the NHS, but we have to hold them to these promises. (bar one- Reform wants to bring in an Insurance/market-based system)
The NHS is the most cost-effective structure and the most equitable system for healthcare.
Give the NHS an immediate boost to its funding.
Renationalise the NHS. Make it once again a national service. Stop privatisation.
A healthy population is obviously more effective than one with millions of people waiting for treatment. Millions of people denied treatment or kept waiting for years is morally unacceptable and bad economics.
The incoming government must fund the NHS to prevent the next still worse winter crisis. It must address the issues around maternity, GPs, dentists and NHS pay, or the people will be very angry, just as the current government is blamed. It took many years to win the NHS and might take years to win it back but the campaign will go on if you give it your support
The campaign to restore and repair the NHS must go on !
When Save Liverpool Women’s Hospital campaign are out and about people often ask about GPs. Why can’t they get appointments? Why don’t we know our GPs like we used to do? Why are some practices closed? Which bits are privatised? Why are some doctors unable to get work? Why are so many people who are not doctors employed at GP practices? Why, when need is increasing, are there fewer GP practices in England than at any time since 2016? Why are GPs in dispute with NHS England? Why are GPs so overworked? Why when people are less healthy do we have less healthcare?Why is less spent on GP practice than in 2018? If we want to Restore and Repair the NHS we need to know what has already happened to this much loved and very valuable service, what is happening now, what the privatisers have in store for us next and knowing all this we need to talk about how we can win it back.
Sheila Altes answers some of these questions. We welcome contributions to this discussion. The condition of the NHS means that many more patients and their families and friends need to know more.
General Practices
General Practitioner (GP) practices are not private companies, they are independent contractor organisations set up to deliver NHS services for the NHS. Staff working in general practice are usually employed directly by the GP practice and not by the NHS.
Every partnership of GPs must hold an NHS GP contract to run an NHS commissioned general practice. These set out mandatory requirements and services for all general practices as well as making provisions for several types of other services that practices may also provide if they choose to.(The Kings Fund 2020).
There are 3 types of contracts in England:
General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS).
The majority of GP practices hold GMS or PMS contracts.
General Medical Services (GMS)
GMS contracts are negotiated nationally every year between NHS England and the British Medical Association’s (BMA) General Practitioners Committee (GPC England). The GMS contract is then used by the commissioner to contract GP services in a geographical area to deliver ‘core’ medical services.
Personal Medical Services ( PMS)
This is another form of contract. Similar to the GMS but negotiated and agreed locally by the commissioner with a practice. It is soon to be phased out.
The core general practice contract sets out the geographical area the practice will cover. They must have a register of patients and provide the essential medical services set out in the contract. There are other requirements such as standards of premises and workforce and key roles and responsibilities including complaint procedures, insurance, liability and governance. They must provide essential services for registered patients and temporary residents who are or believe themselves to be:
*ill with a condition from which a recovery is expected
*terminally ill
*suffering from chronic disease.
They must provide ongoing treatment and care.
Alternative Provider Medical Services (APMS)
This new type of contract for the provision of NHS services was introduced in 2004. This allowed the contract to be held by a private company or a not- for- profit organisation; the contract no longer had to be between a named GP or GP partners and the NHS.
This effectively opened up primary care to private companies owned by directors and shareholders. So instead of GPs who had worked in an area for years, who knew their patients, primary care could be delivered by a private company who employed salaried GPs.
APMS contracts were advertised with a fixed amount of payment over a long term usually 10 years. As long as mandatory services were met and any services covered in the contract, then any money not spent was profit for the company and its shareholders. If the company or organisation held several contracts then economies of scale come into play (Lowdown 20/3/21). Further profits were made by down- skilling and reducing the workforce. These efficiency savings (cuts) don’t go to the NHS but to the shareholders.
This gave rise to the entrepreneurial GPs who set themselves up as directors of these companies and made huge sums of money. SSP Health comes to mind. In 2013 they took over the management of 22 surgeries in Liverpool. One of these surgeries was Princes Park Health Centre. Under their management it went from being a flagship model of primary care to being ranked in the bottom 300 out of 8000 GP surgeries in the country. A campaign by Keep Our NHS Public Merseyside focused on the difficulties of the patients at Princes Park. This campaign forced SSP Health out of Liverpool and their contracts for all but 2 of the surgeries were awarded to other providers. However they are still active in the North West and manage over 40 surgeries. Details of the KONP campaign can be found on:
Even though the majority of GPs are independent contractors, the use of APMS contracts attracted many private companies who began to take over primary care.
Funding
GPs who hold a GMS or PMS contract are paid for services provided, both mandatory and additional services, where they have been agreed. Additional income is generated by the Quality Outcomes Framework (QOF). This is an incentive scheme that allows practices to earn points for performance of good practice, Achievement is measured for indicators in 4 areas known as ‘domains’: Clinical Domain, Organisational Domain, Patient Experience Domain and Additional Services Domain.
In the clinical domain, there are approximately 20 areas where points can be achieved. For example, registers of patients with long term conditions such as : asthma, chronic obstructive pulmonary disease, chronic renal disease, cardiovascular disease, hypertension, diabetes etc. If a certain percentage of these patients are reviewed annually and are found to be on the appropriate medication for their condition or if control of their condition is achieved within guidelines set out by NICE, then points are awarded and payments made.
The system is open to abuse and can become a box- ticking exercise. Unscrupulous practices can manipulate the registers remotely.
This system is operational in England, Northern Ireland and Wales. Changes to the framework for 2023/24 were imposed by NHS England but rejected by GPC England and NHS England has committed to a review of the system. More information can be found at:
Money is also paid based on the size of the practice population and “weighted” according to certain criteria. The average payment per” weighted patient” was £104.73 in 2023 (NHS England).
“Weighted” list size is a measure of workload on the basis that it represents a measure of time expected to be spent on consulting. Certain types of patients place a higher demand on practices than others, for example: elderly patients, patients with mental health issues, non-English speaking patients, or if the practice is in a deprived area where patients are more likely to have complex conditions.
The practice must pay all its salaried employees and the running costs of the practice. The partners do not get a salary but get paid out of the practice income. They are also liable for any losses made by the practice.
Further funding was made available to general practices if they became part of a Primary Care Network.
Primary Care Networks (PCN)
PCNs were introduced in England as part of the NHS Long Term Plan published in February 2019.
A PCN consists of several general practices working together, so instead of a general practice caring for a few thousand patients a PCN will have between 30,000 and 50,000 patients on its list. Each PCN will have its own Clinical Director, who doesn’t have to be a GP. Governance structures will be determined locally and recorded as part of a Network Agreement. Funding will be made available to GP practices in PCNs via the Network Contract Directed Enhanced Service (DES).The contract will be in addition to existing GMS,PMS and APMS The contract will be between the commissioners and the individual practices and the money will be channelled through a single bank account directed by the network.
Additional staffing will be required to deliver the seven National Service specifications of the DES. They are:
*structured medication reviews
*enhanced health in care homes
*anticipatory care (support that focuses on people with long term conditions with the aim of reducing the risk of their condition worsening that would result in a hospital admission)
*personalised care ( patients have more choice in the way their care is planned)
*supporting early cancer diagnosis
*cardiovascular disease case finding
*action to tackle inequalities.
The additional staff needed included physician associates, first contact physiotherapists, social prescribing link workers and clinical pharmacists. Funding is given for these via the Additional Roles Reimbursement Scheme (ARRS). Underfunded and understaffed general practices cannot use these funds to employ other GPs, with the result that many salaried GPs and locums cannot find employment.
Digital -first primary care became a new option for every patient, they would have the right to choose telephone or on- line consultations instead of face- to- face consultations. This could be with their own practice or a digital provider. A framework was created for digital suppliers to offer their services to networks on standard NHS terms. This represented a golden opportunity for software companies to jump on the bandwagon and also to access patient data, invaluable to health insurance companies.
The Long Term Plan was published in February 2019 and PCNs were to be formed by June 2019. Forcing successful and struggling practices into networks in such a short time did not give them the support needed to deliver priorities: all part of the plan. NHS England then published a list of approved suppliers of support and development available on the Health Services Support Framework. They included: Centene, Virgin Care, Optum, KPMG, Deloitte, Ernst & Young, PwC, McKinsey, Cerner, Atos and many more global corporations. This proves the intention is to stream NHS public funds into these corporations (Green,J.,2019)
The aim was to cut GP appointments and also the number of GPs needed to care for patients. Only patients with complex needs will see a GP, the rest will be sign posted by a “care navigator” to less skilled clinical staff.
Investment and Impact Funding (IIF) is another source of funding linked to networks rather than practices. The fund is an incentive scheme focusing on supporting PCNs to deliver high quality care; there are indicators that focus on where PCNs can achieve this. In 2023, the number of indicators was reduced from 32 to 5. Payments were made if the PCN achieved a certain percentage of people receiving flu jabs, learning disability health checks, fast track referrals for lower gastrointestinal cancer and patients being seen within 2 weeks of booking an appointment. This reduction in indicators freed up funds to be moved to the Capacity and Access Payments. to facilitate the Same Day Access scheme.
In this scheme, when a patient phones the GP practice, they will be put through to a centrally controlled system. If they want a same day appointment the call will be transferred to a Same Day hub where a ‘care coordinator’, not a doctor, will triage the patient on to someone else at the hub, also not a doctor, who will decide how to deal with the request. Each hub will be staffed by physician associates and only one senior supervising GP.
This caused serious concerns in North West London, where the scheme was being forced on the PCN from 1st April 2024. They were concerned that the plan could potentially cause serious threats to patient safety and could lead to the replacement of fully trained GPs by cheaper, less well trained staff (GP Direct. February, 2024). Patients could be sent anywhere within the group of networks, which would make continuity of care difficult. There is increasing evidence that a high level of continuity of care results in better health outcomes (NICE. February 2019)
The plan had been designed by KPMG, one of the 4 big accountancy multinationals, paid to design it and to train GPs how to use the service. No patients, residents and a minority of GPs were consulted. After a huge backlash the North West London ICB were forced to retreat but did not abandon the plan, only to introduce it more cautiously (Health Campaigns Together, Spring 2024).
PCN Incorporation.
PCNs are not legal entities. They cannot hold contracts, employ staff or own property. This means there is no corporate model, it is the practices themselves that have to enter these arrangements on behalf of the network. Rather than have a lead practice employing staff and managing funds on behalf of the other practices, a corporate vehicle can be used to manage PCN activity and funding between members.
Forming a corporate vehicle involves merging the PCN practices into a single practice. In this way they can become limited companies with shareholders. Once the corporation vehicle is formed, assets, staff and contracts can be transferred into the corporate vehicle.
The corporate vehicle may provide administrative activities or could sub-contract responsibility for clinical services delivered under the DES contract. It can enter contracts in its own right, own property and be responsible for employing staff.
If networks are forced to merge, as outlined in the North West London plan for Same Day Access hubs, then a company can be formed via a corporate vehicle. This is an attractive opportunity for private equity firms to invest in the company as income from the NHS is virtually guaranteed. In order to make a profit, private equity companies invest in companies for a limited period, they then restructure it and make efficiency savings, usually by reducing services, cutting corners and reducing staff. They fund the investment partly with their own investors’ money and by borrowing. Once the contract ends, they share the profits with their investors and pay off the debt. Depending on the contract they often leave the debt with the company invested in. Private equity companies don’t have shareholders so there is little transparency.
The responsibilities of GPs in the UK have increased, partly due to the austerity imposed by the Government in the last 10 years. Income inequality affects health, and poor health puts a greater demand on healthcare. The reduction of bed capacity in secondary care, causing ever increasing waiting lists adds more pressure on GPs as they care for patients awaiting hospital treatments (Pulse 4/10/2023).
The extra administrative work necessary to obtain funding adds to the pressure on GPs .The new GP contract proposal for 2024/25 will see an uplift of only 1.9%, while, according to local intelligence, overheads have increased by 15%.
Dr. Katie Bramall-Stainer, chair of GPC England, states in response to the new GP contract proposal:
“They know as well as we do, that can only mean practice closures, staff redundancies, loss of the GP workforce, fewer GP Nurses, reduced activity, reduced access and an unacceptable experience for patients” ( BMA 28/2/2024)
By understaffing, underfunding and overstretching primary care, it is little wonder that the numbers of GPs has fallen. There needs to be a recruitment and retention of GPs, adequate funding and an end to private providers in the NHS. We need to continue with our campaigning to restore our NHS to its original founding principles of a universal health service, funded by taxation and based on need and not the ability to pay.
Sheila Altes April 2024.
REFERENCES
British Medical Association (BMA) 28th February 2024
This banner in Liverpool Life museum is from one of the campaign groups for women’s health in the early twentieth century
Women and babies in Liverpool are entitled to the highest standard of healthcare. Our grandparents and great grandparents fought to found the NHS and left us this as their legacy. The NHS was a national service providing excellent healthcare, publicly provided and government funded. The new NHS did magnificent work for infant and maternal mortality.
We are campaigning to Save Liverpool Women’s Hospital and to restore and repair the NHS. We want to see improved funding and staffing and to see the whole NHS move back to its original model of a national public service, publicly provided, providing universal comprehensive and timely care for everyone free at the point of need and funded by Government. If you have not yet signed our petition please do so.
Healthcare staff have worked way beyond what should have been needed to keep some good services going. Every day people are grateful for their work, their kindness and humour but sheer human effort cannot compensate for inadequate funding and too few staff.
Liverpool Women’s Hospital provides some excellent services but it has some serious difficulties too.
The Liverpool Women’s Hospital board meeting on 9/05/2024 reported some excellent staff work, including improved methods of helping premature and very premature babies survive and thrive. It also reported the success of moving early pregnancy loss to its own area, a development much valued by the mothers involved. Previous meetings have seen patients reporting their experiences too. In April there was a very positive report from a patient about her experience of the care she received from the Rainbow Clinic as a previously bereaved mum. We have also seen excellent presentations about the pioneering work on endometriosis and menopause at different meetings. The Hospital website says Every day on average, 24 babies are born in Liverpool Women’s Maternity Unit and another three babies are born prematurely and cared for in our Neonatal Unit. Most of Liverpool’s babies are born at Liverpool Women’s Hospital and sick and tiny babies are cared for in the beautiful new NICU ( Neo Natal Intensive Care Unit)
Entrance to the NICU
The Liverpool Women’s Hospital is undertaking a major anti-racism drive to improve outcomes for patients and staff. We very much welcome this initiative. It is essential to save lives.
The core problem for Liverpool Women’s Hospital is under funding. This underfunding stems from the national underfunding of maternity as well as the general under funding of the NHS. This longterm underfunding has meant years of cuts. The NHS organisational changes from 2012 to create Trusts and Foundation Trusts also wasted many resources that should have gone to patient care.
Liverpool Women’s Hospital also has a long waiting list for cancer patients and waiting lists for gynaecology appointments. Some more staff have been appointed and hopefully the list will be dramatically reduced.These waits cost lives and health. The Chief executive reported that
“NHS England’s tiering process for cancer performance is designed to provide accountability and additional central support for trusts that are most at risk of missing national cancer targets. Trusts are categorised into tiers based on their performance, with Tier 1 being the most challenged and requiring the most support. Trusts may move between tiers based on their performance improvements or deteriorations. In a letter received on 26 April 2024 from NHS England, it was confirmed that following a review of cancer performance, and in agreement with the regional team, the Trust will be in Tier 1 for Cancer from the week commencing 29 April 2024. The move to Tier 1 will involve regular meetings to discuss delivery progress and any required support from the relevant parts of NHS England.
Last year the hospital had a poor Care Quality Commission report for maternity and it has taken work to improve on this.New management is in place and they have plans to ensure that improvements are happening.
Our babies, our mothers, deserve much more.Every mother every baby treated at Liverpool women’s deserves the very best. Poverty from low wages, low benefits and poor housing is costing lives, and causing long term ill health. Inadequate health services are part of this.The Care Quality Commision report last year showed how much harm has been done by this underfunding and under staffing. The management must also be responsible for some of the damage mentioned in the Care Quality Commission reports.
The funding issues at Liverpool Women’s means that to meet the current level of service it needs twenty five percent more funding. Money is spent very carefully but for basic safety to be met, that extra spending is essential. At present the required money is being spent and temporary support funding has been made available, by the ICB or national NHS. However this situation puts the hospital into whats called Level 3 of the National Oversight Framework which could bring in management decisions not based on the needs of staff and patients, as the government clamps down on public spending.
Many studies show that money spent on good healthcare repays for itself many times over. At birth this is especially so as bth injuries can last a lifetime.
Neither merging the hospital nor dispersing its services will change that fundamental financial situation. Only an improvement of maternity funding will make a real difference.
The underfunding of maternity leads to staff overwork and reduced services. Government safety figures for staffing are met but we say these safety figures are inadequate. The Government funding does not provide sufficient staff to deliver the kind of service patients and staff require. yet money is squandered on private companies and financial consultants.
There are national problems with maternity services described in many prestigious reports, as well as the Ockendon and Kirkup reports. No report has yet managed to shift the Government’s policies. We believe we need a huge campaign to win back the NHS.
A large part of Liverpool Women’s Hospital Maternity spend is on the maternity Incentive scheme, a government owned insurance system, run on a business model. Liverpool Women’s Hospital meets all the requirements of this scheme and so gets a refund from hospitals that do not meet all the safety requirements. This is an unbelievable situation..
Payouts from the fund are higher than the funding for maternity.If maternity were well funded fewer babies would be damaged and have to claim through the courts from this insurance fund.
In this crazy situation the hospital is still expected to make cuts (CIPs).
Our demonstration last October.
We have written before about how planned Cheshire and Merseyside ICB funding will not repair the situation patients experienced last winter. This poor experience was seen in many aspects, including A and E, care in corridors, access to GPs, access to NHS dentistry, and inadequate mental health provision. It will be worse next winter.
It was no surprise to hear there will be no new Hospital built in the next decade, nor does Liverpool Women’s require a new building. we believe that the new building idea was floated to make the idea of merging Liverpool Women’s Hospital into the big acute hospital more palatable. The existing building is less than thirty years old.However the drive to make fundamental changes remains, with merger or dispersal being the most likely recommendations. WE want to keep a distinct women’s hospital.
In the April Board meeting of Liverpool Women’s Hospital it was reported that work is in progress for major changes.
“the Women’s Hospital Services in Liverpool Programme. As part of the roadmap, the initial phase of the programme had been outlined, with an emphasis on the importance of openness, transparency, and continuous engagement with the public. The development of a clinical case for change was scheduled for the spring and summer of 2024, with publication expected later in the same year. Feedback from this engagement phase, gathered during the winter of 2024/25, would then inform the approach to designing future services, with further development of potential options anticipated to commence in early 2025.” So the threats to Liverpool Women’s Hospital are still very real.
A meeting has been held with other Liverpool hospitals about the future for Liverpool Women’s Hospital and women’s health in the other hospitals in Liverpool.We have not yet been able to see which issues the other hospitals raised. Public consultation is promised this year.
No hospital can exist in a vacuum. Every hospital should be working in a mutually supportive system. The NHS was founded to be a national service, not a collection of competing hospitals. System working was damaged by the 2012 Act and the drive to privatisation. Cooperation and system working is required for the future of the other specialist hospitals in Liverpool, like the Heart and Chest and the Walton Centre.
Our campaign to Save Liverpool Women’s Hospital and to restore and repair the NHS has huge public support and is growing steadily.
For all our sisters,mothers, daughters and babies.
Save Liverpool Women's Hospital 