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.
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
“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
Liverpool Women’s Hospital will not get a new building on the Royal Site. This announcement has been expected for some time. The BBC covered the story this week. On Radio Merseyside our campaign was asked to comment. We said that we were not surprised . The Hospital should stay on the Crown Street site and that what matters is proper funding, staffing, and resources because our babies deserve the best.
Reorganise the funding structures, not the hospital.
Our babies and mothers, our sick women, deserve the best.
What’s happening with the Liverpool Women’s Hospital?
There has been a press announcement that there will be no new women’s hospital built on the Royal site in the near future.
This announcement does not mean the future of Liverpool Women’s Hospital is safe, far from it. Public consultation about its future will be launched shortly.
The announcement is not a surprise to anyone who has followed the story of Liverpool Women’s Hospital or the story of broken promises from the Government about building new hospitals, even those in dire physical conditions.
For example in Leeds, the people were promised a new Children’s Hospital. In the meantime, services were dispersed to different hospitals to allow demolition. Now the new Hospital is not going to happen.
Nationally, maternity is underfunded and understaffed and has seen terrible scandals. We have written much about this in other posts. Just this week there was a report about delayed induction of labour across the country (and this also has been seen in Liverpool Women’s Hospital). The Care Quality Commission reported “The quality of maternity, mental health and ambulance services has seen a “notable decline” over the last year, which is contributing to “unfair care” and worsening health inequalities,”
“families whose babies died and whose mothers were harmed – in some cases dying – in the East Kent maternity scandal were still having to prove legal liability to get any compensation. This is despite Bill Kirkup’s report, published around 18 months ago, having already looked at their cases in detail and reached conclusions on whether better care could have led to different outcomes.
But NHS Resolution, which handles the NHS’s clinical negligence claims, says causation and a breach of duty of care will need to be proved in each case. This may mean families have to engage not just lawyers but also experts in midwifery, obstetrics, and neonatal care.”
In such a national maternity crisis we must protect the services we have in the area. We say women and babies will be harmed if the Liverpool Women’s Hospital is forced into a merger with the huge general hospital. The focus on women and babies will be lost. The great maternity scandals of our age have happened where there was no real focus on women and babies.
The government and the NHS bureaucracy have wanted to close one hospital in Liverpool since 2015. Liverpool Women’s Hospital was chosen. This is to do with saving money not patient care.
Liverpool Women’s Hospital sits on a great site on Crown Street. The official opening was on 7th November 1995 and the building is in good condition. A £20million pound neonatal unit was recently added to the hospital. It does not need a rebuild.
Liverpool Women’s Hospital does need more staff and additional resources like a proper blood service, an improved emergency medicine service, a 24/7 consultant obstetric presence. It needs to tackle the long waiting list for Gynaecology treatment, and improved intensive care. All of this requires funding and support from the national health service and government funding but without that funding our babies and mothers will suffer. The money must be provided.
Our Saturday stall n Bold Street
All hospitals should be run in a cooperative system with other hospitals but specialisms should be protected.
Liverpool Women’s Hospital, along with the whole of the UK, needs to improve infant mortality, maternal mortality and injuries to women and babies and to tackle gross inequalities.
Serious damage has been done to our health care. We see it in the terrible waiting times in Accident and Emergency, in the 14,000 preventable deaths caused by those A and E problems, we see it in dentistry, in the GP service, in mental health and in maternity. We see it in the eight million people on waiting lists. We see it in the exhausted staff.
The experience women have giving birth is getting worse because of these underlying, national problems and the day-to-day stress this brings into the hospital.
Liverpool Women’s Hospital is damaged too by the business model imposed on the hospitals. The drive to privatise and to move away from a service model in the NHS has caused problems all this century.
The new Chief Executive (James Sumner) and Chair of Liverpool Women’s Hospital (David Flory) are also the Chief Executive and Chair of the Royal, Aintree and Broadgreen Hospitals (Liverpool University Hospitals Foundation Trust). Neither man is a specialist in maternal or infant health. The Health Service Journal has said these joint appointments are likely to lead to a merger of Liverpool Women’s with the big hospital. We say no to a merger, and a big yes to cooperation between all the hospitals in the area. Such cooperation is anathema to the privatisers. We need continued support from the people of Liverpool to win this fight and we need to link up with other maternity campaigners.
Please help Save Liverpool Women’s Hospital. Sign the petition, talk to friends family and workplaces about this, join the discussion, and help with leafleting and social media.
Invite us to speak to your organisation.
Send us a donation.
For all our mothers, sisters, daughters, friends, and lovers and for every baby
The future of Liverpool Women’s Hospital has been under threat for nine years now. The petition which is at the heart of the Save Liverpool Women’s Hospital Campaign says “No closure. No privatisation. No cuts. No merger. Reorganise the funding structures not the hospital. Our babies and mothers our sick women deserve the very best.
In the Liverpool Women’s Hospital Board papers 11.04. 2024, it was announced that “An indicative programme plan had been developed and this reflected the unlikelihood that a new hospital building, co-located with an adult acute site, would be built within a five-to-ten-year timescale.
( In plain English this means they will not get a new Hospital)
And that
“… discussions were held on alternative solutions for citywide women’s healthcare.
Our opponents promised the public that a new smaller hospital on the Royal site would improve services. We always said that such a plan was magical thinking and that even if they got the money for a new building the existing problems would still be there. We said moving the Liverpool Women’s Hospital from the Crown Street site would be bad for women and babies.
Now we are in the horrible position that the bribe of a new hospital has evaporated but the core financial and organisational problems remain. We well remember the Panorama programme many years ago when it was announced that they wanted to close one hospital in Liverpool, and that clearly was Liverpool Women’s Hospital.
There are serious problems for Liverpool Women’s Hospital not to do with the Hospital site.
The Board of Liverpool Women’s Hospital has made it clear that safe services require extra funding. We demand that this money be provided.
Liverpool Women’s Hospital has a grave shortage of funds for crucial services. The fault for this lies with the last four governments but especially the current government who are very much aware of the damage they are doing to maternity care. There have been numerous high-profile reports on this, not least of these reports, being the work of Donna Ockendon. Donna Ockendon is now working on another maternity report, this time from Nottingham.
There are five reasons this national problem impacts on Liverpool Women’s Hospital
Healthcare in the UK is badly funded and badly organised, wasting money and resources on privatisation.
Eighty per cent of Liverpool Women’s Hospital’s budget comes through maternity funding, mainly the Maternity Tariff. The maternity tariff nationally is inadequate. No other hospital relies quite as much on maternity funding as the Liverpool Women’s Hospital does.
The hospital is a Foundation Trust, which is an expensive management model for a small hospital.
The model of healthcare from this, and some earlier governments, saw hospitals as competing businesses rather than a cooperating system. A small hospital could not thrive in such a scenario. This model is changing but the new ICB model also poses serious problems. We call for a return to the original Bevan model of the NHS, where a fully funded national, publicly owned and delivered health system based on cooperation not competition, sees ongoing improvement in maternity services.
Liverpool Women’s Hospital lacks crucial services because of these funding issues.
Our petition, now with more than 40,000 signatures online and more than 20,000 on paper, says “Save the Liverpool Women’s Hospital. No closure. No privatisation. No cuts. No merger. Reorganise the funding structures not the hospital. Our babies and mothers our sick women deserve the very best.”
Our campaign wants to improve the whole maternity journey for women and babies, every aspect of it, safety, respect and celebration of birth. We campaign for maternity everywhere in the UK. It is not possible to solve the fundamental problems of Liverpool Women’s Hospital without solving national funding and staffing issues but we can stop projects that make things worse. There are many and detailed reports about how the experience of maternity has worsened in recent years.
Our campaign wants midwives, nurses, obstetricians, CSWs and other staff to feel safe, and respected at work, free from undue stress, with access to ongoing education and training and with the opportunity to eat well, go to the toilet and have proper breaks at work, both day and night.
Our campaign wants to see maternity well-funded and protected from privatisation and protected from trendy, untried innovations.
We want those running maternity services to remember that as medics they have a duty of candour, to tell the truth about funding and staffing issues.
Since 2010 there has been damage done to all maternity and women’s health services nationally, and Liverpool Women’s Hospital has not escaped that damage. Underfunding, understaffing, and lack of key equipment and services have all had an effect.
We campaign for the whole of the NHS, not just maternity
Why do we want a women’s hospital?
We want excellent healthcare for women and babies. Our babies, our mothers, deserve the best. It is that simple.
However, that is not what this and previous governments have provided. We want to keep the focus on the needs of women and their babies. The scale and depth of the maternity scandals in other big multi-site, multi-specialism hospitals is a testament to how important this is. There have been many prestigious reports published about how bad the damage has been to Maternity and to women’s health. One in seven maternity units have closed during the period of cuts and this wave of closures has not stopped.
Cuts in NHS funding are part of the Austerity project. Austerity cuts have hit women and children and the working class very badly whilst the rich get ever richer. In this situation, we must protect what we have and not let it go. Maternity in England has suffered grievously under austerity. Maternal deaths are the highest in 20 years.
Ockendon’s reports have painted a grim picture of the failings of the system. Our campaign has fought hard for national as well as local funding and held two conferences on this matter. None of these hospitals involved in the big maternity scandals were standalone Women’s Hospitals like Liverpool Women’s Hospital and their failings were not blamed on being a standalone Women’s Hospital. Yet the standalone character of Liverpool Women’s Hospital was what all the case for change was based on.
When Donna Ockendon did her first report on the Shrewsbury baby deaths it was revealed that many hospitals providing maternity care did not even have a member of their board charged with Maternity care, so board papers could go with nary a mention of maternity. Bad Care Quality reports were not given due consideration by the Shrewsbury board.
“The Trust board did not have oversightor a full understanding of issues and concerns within the maternity service, resulting in neither strategic direction and effective change, nor the development of accountable implementation plans.“
Most of Liverpool’s babies are delivered at Liverpool Women’s Hospital. The hospital delivers roughly 8,000 births per year. The Hospital also provides maternity care from a wider region for complex pregnancies and very premature or very sick newborn babies. It is a Maternal Medicine Centre, one of three within the Northwest Maternal Medicine Network. The Hospital also provides Gynaecological treatments, Fertility services, Genetics services, Cancer care and termination of pregnancy, when that requires surgical intervention. The hospital also has a reputation as being a safe and caring place for women (though that has faltered a little in recent years). For all these reasons, Liverpool Women’s Hospital is considered to be especially important by the people of Liverpool and beyond, but not considered so important by the Government or NHS England. For the last nine years, the future of Liverpool Women’s Hospital has been under ongoing threat.
We ask the people of Liverpool to continue to support our campaign for a fully funded, fully staffed, fully equipped hospital on the Liverpool Women’s Hospital Crown Street Site and for a fully funded, fully staffed, publicly owned and delivered national health service.
I am sure you will all have seen the NHS described as not fit for purpose because it is ‘a 1948 structure trying to deal with 21st-century problems’. Politicians say it, health ‘think tanks’ like the King’s Fund say it, the IEA and health ministers say it. Even NHS campaign groups say it!!
I would say that we don’t HAVE a 1948-style NHS anymore and haven’t for a long while, so whether or not it is or would be ‘fit for purpose’ is a moot point.
The 1948 NHS had a clear set of principles. It had a basic organisational structure designed to put those principles into action. Hospitals were very haphazardly located pre-1948 according to local charity or local authority available funds and inclination. Rich areas had more hospitals than poor ones, although the distribution of illness meant poor areas should have had more. Many hospitals were completely unfit for purpose.
The public service NHS set about doing something that no other health service did or does. It started a 20+ year programme of redistributing and modernising hospitals to try to provide the same easy access to high-quality care for everyone, regardless of issues of rurality or urban deprivation. The private, voluntary and even local government sectors don’t have the power to do that kind of national planning.
It never reached its optimal distribution because after 24 years of gradual change and development to meet its ambition, it ran into major political opposition in the 1970s (up til then both Labour and Conservative governments carried on the programme, after the mid-70s neither did).
GPs were also badly distributed and although they originally all (well, 96% of them) signed up to the NHS immediately and continued in their own locales, a more equal (although again never quite equitable) distribution was achieved by the 1960s. This was partly as a result of Enoch Powell importing a lot of Indian and Pakistani doctors in the early 60s (all already GMC registered) to put into the under-doctored poorer areas where white middle class doctors couldn’t be persuaded to work.
Universities were linked with major teaching hospitals and the NHS and British Universities were at the forefront of cutting edge medical technology and healthcare innovation.
In the 1970s, for lots of reasons, the political climate changed and the very principle of a planned health service which was fully publicly funded was no longer flavour of the month.
And we have had nearly 5 decades of a slow assault on both the founding principles and the structures designed to provide them as a result.
In addition we have to a large extent dismantled the welfare state which was designed to support and promote good health in the population.
The NHS is now run along entirely different lines. In the ‘paradox of productivity’ although it is run on commercial imperatives with finance in the driving seat this produces worse outcomes for more money. We have closed down entirely, or downgraded, District General Hospitals particularly in poorer and more remote locations on the grounds of ‘financial sustainability’ leading to decreasing life expectancy. We have removed essential social support and exhort the poor to take better care of themselves instead. We pretend that the problem is too many over-qualified staff (our staffing ratio is poor in international comparisons) and use ‘different skills mixes’ which saves money but not lives. We have driven GPs out of the service by making their working lives untenable.
And we no longer have 1 NHS. We have 42 Integrated Care Systems built along US Medicare lines run by boards which are staffed by McKinsey clones and US health insurance ex-executives or private healthcare representatives. The intention of NHS England is to shift our NHS model of a whole population risk pool assumed by the government to a risk-and-reward sharing system where the ICS will be given a fixed, non-negotiable, capitated payment from which they will bear the profit or loss themselves.
Absolutely not the 1948 system. Nothing like it.
( Deborah has asked us to change the title as she does not want people to “make instant assumptions about starched sheets and matrons! (And they will….) So now this post is called Back to the Future,
Deborah is co-director of Public Matters, a policy partnership which has provided the secretariat for an APPG ( all Parliamentary Group)and produces articles, videos and briefings on public policy, particularly the NHS.
Next, listen to Maxine Peake on the damage to our NHS
Maxine Peake laments the damage to the NHS in her own special way.
The National Theatre is showing Nye, a play about the founder of the NHS, seventy-five years ago. The play is being live-streamed to many cinemas. So it’s appropriate for us to republish a local leaflet written advocating a return to the system of healthcare designed by Nye Bevan.
We face a Healthcare Disaster.
Take back the NHS. Go back to Bevan.
We cannot wait as the damage in healthcare escalates still further.
Nye Bevan, in the post-war Labour Government, set up a world-beating healthcare system that served us well for decades.
It was a national service – not a business. It was publicly provided by the nationally owned service – it responded to need not profit.
It provided all the treatments when we needed them – including GPs, mental health, elder care and dentistry. No to waiting lists! No to profits for private providers. It was a Health Service open to every human in the country – no migrant charges. The Health Secretary then was legally obliged to provide health care but no longer. It was free at the point of need – no charging.
Bevan’s system had capacity; it did not run at a panic level like today.
The Bevan Model of Universal Public Health care is cheaper, more cost-effective and more equitable than the vandalised service we now have. The for-profit business model costs more and delivers less.
We need immediate action on maternity, mental health, the GP service and dentistry. Action in hospitals, sort out budgets. More beds in the NHS not fewer. Invest, do not cut.
Restore the Public Health System. Plan effectively for epidemics and natural disasters
Address Women’s Healthcare needs. When the NHS started, women’s health improved; now under the semi-private system, it is declining. Even Maternity is unsafe.
Everyone working in health should be employed by the NHS on proper terms and conditions – no outsourcing, no commissioning. Demand good pay for all NHS staff – an immediate pay rise. Respect the staff. End bullying and lying to them. Win back staff who have left in disgust. Plan the workforce training.
We do not want and cannot afford the big corporations’ involvement in our NHS. Abolish the so-called Integrated Care System where all sectors are incentivised to cut and deny care. Bring back national, publicly owned and provided, comprehensive healthcare, free at the point of need.
Beware the corporate health lobby groups in all the political parties. Human needs should dictate our level of care, not Big Business and its failed ideology. The NHS privatisers are like vandals smashing and grabbing profit, albeit hidden behind a veil of lies and public relations gobbledegook.
End all privatisations: outsourcing, commissioning, reliance on private companies’ reports, staffing agencies, population health management, the rationing and denying of services, running down services, and using charities as substitutes for real NHS capacity.
Power concedes nothing without a demand. The NHS was a great social victory won by the generation that defeated Hitler. Let us make our demands as loud and long as those of our grandparents. No one else will save the NHS. It must be a mass campaign.
If the reader wants to read more about Bevan please read, a chapter from Nye Bevan’s book.
Organise in each ICS area to challenge the cuts, challenge the syphoning-off of our healthcare finances by private companies. Mobilise the unions and the communities. Demand world-class publicly owned and provided social care. Renationalise the NHS! Lobby all MPs and Councillors
This leaflet was produced by Cheshire and Merseyside Coordinated Healthcare Campaign, which involves local Trades Councils, Union branches, Health Campaign Groups, including Save Liverpool Women’s Hospital, Defend our NHS, Keep our NHS Public, (both Merseyside and Cheshire) and individuals. We work with many other campaigns nationally.
Campaigning works. The campaign to Save Liverpool Women’s Hospital has marked International Women’s Day for eight years now. We have fought hard to save the hospital in a time of great damage to the NHS and damage to the maternity services nationally.
Donna Ockendon with just one of her damning reports on maternity care.
These damages have been described in prestigious reports yet still the government closes its ears. The hospital has been damaged by cuts, poor staffing, and bad policy decisions, but the hospital is still there, still under threat, still underfunded and understaffed, but still there. Campaigning works. We have miles to go before we have the hospital we need but at least what we have has not (yet) been taken away
Grief in Gaza
On this International Women’s Day, our hearts break and our voices are raised for the plight of pregnant women and their babies in Gaza, giving birth now without any medical attention being available as every hospital is destroyed. Food and water are in very short supply. This damage to mothers and babies is sickening. We share the feeling of dread as the horrid Israeli threat of an attack at the start of the holy month of Ramadan approaches. We demand a ceasefire and a just peace where the children of Palestine and Israel can grow up in peace justice and harmony.
Retired midwife Rebecca speaking in Liverpool about the plight of women giving birth in Gaza
Our thoughts go to the women of Ukraine, and those from Ukraine now living in this city. Our thoughts to the women of Yemen, Sudan, and Haiti all caught in the maelstrom of crises and war. We send solidarity to the women of Russia organizing against the odds for peace, and to all the women of the peace movement across the world
We celebrate the victory of women in France who now see the right to abortion written into the constitution.
We send greetings to all the US women who are fighting a terrible reaction in politics generally, but especially in their rights to control their fertility. This is in a country that does not provide decent maternity leave, and with ten times the maternal death rate of Australia, Austria, Israel, Japan, and Spain. Eighty-four percent of reviewed maternal deaths were described as preventable.
We send greetings to the women of the Kurdish community here in Liverpool and to the Kurds fighting for respect and peace in their homelands.
Picture from the camp in Cox’s Bazaar in Bangladesh
Our hearts go out to the women and girls of the Rohingya community, driven from their homeland and living now in a million-strong refugee camp in Bangladesh.
We live in a time of genocide and war. We look to the generations of women who have worked for peace, including those from Greenham Common
Liverpool, once the second city of the British “Empire”( and all the racism that involved), and because of the trade links, is home to a black community dating back hundreds of years and one of the oldest Chinese communities outside of China.
From a mural outisde Liverpool Women’s Hospital entrance.
Sadly though we now mourn two black women who have died at Liverpool Women’s Hospital from complications in pregnancy or birth. In their honour, we rejoin our efforts to campaign for better safer maternity services, better staffing ratios, and well-paid staff with more time to think and plan, with more support top-down, to tackle blame culture & reduce tensions. This must be accompanied by more investment in staff. Managed decline has led to half the staff with double the workload. Paperwork is now all online so more admin and less time with patient contact. The culture needs to change. This will take a lot of work as there is still also a massive issue with hierarchy and bullying. More investment, and more support, will ultimately improve the work environment which will subsequently give women better experiences as tensions lessen.
Liverpool Women’s Hospital has a history of anti-racism but that, like many other great provisions, can be severely damaged by austerity cuts. This tradition of anti racism needs to be enthusiastically revived but overworked burnt out staff are hardly in a good position for this. A good indicator of a safe environment for Black and Ethnic Minority patients is ethnic minority staff reporting that they do not experience racism and discrimination. Sadly, a report to the board described the opposite. However, in a recent webinar about migrant women giving birth, Liverpool was highly praised for the support midwives gave to one of the speakers. The specialist teams supporting vulnerable women do great work.
Image from MBBRACE
We join with others in demanding action to make it safer for all mothers to give birth and demand action to reduce the particular risk to Black Asian and poor women of all races. In the UK, the rates of baby death and stillbirth among Black and Asian mothers are double those for white women. We have written about the higher number of deaths among black babies.
In one of these maternal deaths, investigators from the national body the Maternity and Newborn Safety Investigations (MSNI) were called in after the woman died. They reported that “Theinvestigation into her death found hospital staff had not taken some observations because the patient was “being difficult”,( our emphasis) according to comments in her medical notes.“…ethnicity and health inequalities impacted on the care provided to the patient, suggesting that an unconscious cultural bias delayed the timing of diagnosis and response to her clinical deterioration”. “This was evident in discussions with staff involved in the direct care of the patient“.
“She was being difficult”. These words have sparked fear and anger in many women. This sister would have been in a strange environment, far from home, with people speaking a language she did not speak. She would have been full of hormones from her miscarriage. She had had babies before and would have known what she was feeling was not right. And she was ill and in pain. Because she was being “difficult” she was not monitored as she should have been and this cost her the chance of life. Now two babies are motherless and a family bereft.
The wider impact of this death.
In the aftermath of this death, and the publicity it gained, Melissa Sigodo (@melissasigodo), a Zimbabwean and British community reporter from the Daily Mirror, held a Twitter (X)Space meeting with 90 mainly black women, from across the country, discussing the case. The experiences of these women were heartbreaking. This case had reawakened their fears.
There is no room for racism in maternity care.
The safety of women giving birth is the responsibility of the service, not the individual. Every woman matters. Liverpool Women’s has had a good reputation for anti-racism. This reputation must be regained. Most midwives, health care assistants, and obstetricians would agree. Developing a safe place for every woman to be treated and to work takes time and effort. We echo the words and determination of the suffragettes, in saying “There must be deeds, not words” on this matter.
The hospital is changing its systems to support patients who are rapidly deteriorating and we welcome this.
Liverpool Women’s Hospital was built on Crown Street site as part of Project Rosemary, to help heal the injustices which had led to the uprising in Toxteth in 1981. Black building workers were employed in the construction of the hospital. The hospital now serves a great ethnic mix of people, for example in Princes Park Ward non-White English/ British resident population range is 59%, and in nearby Picton is 52%. Racism at this Hospital would be particularly offensive.
Mary Seacole Pioneering nurse and heroine of British soldiers inthe Crimean war
We can do it!
Let us remember the work of the great nurse Mary Seacole and all the women of the Windrush generation who so wonderfully staffed the early NHS. Liverpool Women’s Hospital must be a pioneer in antiracist women’s healthcare so no black woman fears using the service nor working in this or any other hospital.
We need to campaign – and the history of International Women’s Day reminds us that campaigns can win.
On March the 8th and the few weeks that follow it we celebrate International Women’s Day. Women’s lives have been improved and much has been achieved since the founding of International Working Women’s Day. The gains made for women over the last 150 years are significant. The Fawcett Society published a list of these gains a few years ago. The women who won these gains did so despite the difficulties they faced.
Women today are potentially much more powerful than previous generations. We too can organize to improve our lives. So many of us are in employment that we have real power there, that could be organized much more effectively through trade unions. We can more easily campaign across the world. Remember the Women’s Strike in Iceland.
Fans supporting food banks provides practical help and campaigns against food poverty
Today we face real problems and worsening conditions so there is a greater need than ever for women to organise. We can take courage from the past for the very serious obstacles women face today. Those obstacles are serious and becoming ever more so.
Clinical support workers at Arrowe Park Hospital ion strike in the snow.
We salute all the NHS staff who have taken industrial action. We salute them also for working on in the terrible conditions imposed by this government. This shows the strength we have. War, austerity, climate, and economic crises make this era extremely dangerous but never have women been more equipped to demand and force change for the better.
“Whether they are older women suffering loneliness and isolation, single parents with additional caring responsibilities, or simply working mums trying to stretch household budgets to feed their families, the survey shows that women are significantly more likely to need food support from charities and community groups.”
There is much to do to improve women’s lives and many of the gains made are being eroded. The Cost-of-Living crisis hits women hardest. 75% of people accessing food support from Fare Shares a food charity are women.
It is great that women are in work but not good that male and female pay is far from equal. It’s great that sex discrimination is illegal but it still happens, less openly perhaps. It’s great that equal pay law exists but women still earn less than men and the gap widens over a working life.
Women are described as “the shock absorbers of poverty”, managing family bills and compensating for the government’s neglect and austerity policies.
Image credit to CADTM
What is happening in the UK is mirrored in other countries. Oxfam International’s report shows that while the richest 1 percent captured 54 percent of new global wealth over the past decade, this has accelerated to 63 percent in the past two years. $42 trillion of new wealth was created between December 2019 and December 2021.
Not one thing that women have gained has been won without organisation, agitation, campaigning and struggle. So, it is today. Let our inspiration be in how women have struggled for a better life in the past and in the great campaigns today.
“Inspire Inclusion” is 2024s International women’s Day slogan. We want to inspire women’s inclusion in the drive to improve the lives of working-class women and children.
It wasn’t wealthy women who led the earlier struggles of the women working in mills, tobacco factories, or as domestic servants. Our inspiration is with the women who fought for all women, and founded International Women’s Day
Bread
and Roses
In the words the women’s anthem Bread and Roses ( credit to Unison) we say
“As we go marching ,marching we battle too for men for they are women’s children and we mother them again”
In the tradition of the suffragettes,Let’s Inspire or incite women to rebellion, or even incite women to organise for a better life for locally nationally and internationally.
For all our sisters,mothers, daughters and babies.
Save Liverpool Women's Hospital 