Privatisation of maternity services

[Dappy]

http://www.wirralnews.co.uk/wirral-news/local-wirral-news/2011/05/02/private-company-to-care-for-pregnant-women-in-wirral-instead-of-nhs-80491-28620320/


PREGNANT women in Wirral are to be cared for by a private company.
The borough’s primary care trust (PCT) has approved an application from a company called One to One to provide a "community midwifery service".
But the move has been criticised by Labour as "sinister" and privatision "by the back door".
Wirral’s Labour group leader Steve Foulkes said he was shocked by the move and added: "There has been little or no consultation about moving from the pilot to a full blown service. It looks like the forerunner to many other services going out to private partners. The NHS is a public service and should be publicly accountable to public scrutiny.

"No elected member, as far as I am aware, has been consulted about this.
"The Coalition Government has put massive financial pressure on the NHS and they are having to look for solutions they would never have looked at before, and@ this is leading them by the back door to privatisation. It’s pretty sinister."
The company would look after pregnant women throughout their pregnancy within the community, and would also be responsible for delivering home births.
Community midwifery services are currently provided by NHS hospitals including Arrowe Park and Liverpool Women’s.
Health chiefs said the developments would improve and expand care, building on what was already provided.

Last night unions said they were watching developments closely, and had some concerns about the effect on NHS staff already working within the community.
Frances Day-Stirk, director of Learning Research and Practice development at the Royal College of Midwives, said: "We are watching developments around this with interest.
"If the service enhances choice for women then this is perhaps something that should be considered seriously.

"The RCM has no objections to relatively small-scale provision of services by non-NHS providers.
"However, we would be deeply concerned if a tendering of services out to a private organisation led to job losses among NHS staff.
"We would see this as an add-on service, not a replacement for what the NHS should be providing.
"It does however, raise questions as to why this service cannot be provided in the NHS."

The company has already completed a pilot scheme in Wirral, treating 150 women.
It focuses on deprived areas and teenage mothers, and is made up of experienced, trained midwives.
The service has been secured under the Government’s new "any willing provider" contracts.

Board papers seen by the News read: "One to One midwives will provide complete care from the beginning of a woman’s pregnancy, antenatally, throughout the birth, and then to provide postnatal care and support for six weeks. The service will be provided in community settings, including GP surgeries and the women’s homes.
"One to One midwives will provide a 24 hour on call system for when a woman goes into labour.

"A One to One midwife will attend at home and provide birth support and assessment.
"If the woman chooses a homebirth a second One to One midwife will attend."
One to One’s formal proposal reads: "This service model will transform maternity services, improving choice, promoting improvement and innovation and prioritising investment to reduce health inequalities."

An NHS Wirral spokesman added: "GP Consortia, Wirral University Hospital Trust (which runs Arrowe Park) and One to One midwives are signed up to developing joint working.
"Arrowe Park is working with One to One to ensure that patients who book with them receive appropriate services when access to hospital based maternity services are required."



Is this good or bad? Will this offer a better service to women than the NHS can? Or is this the start of the end for NHs maternity services?

Thoughts?

[ContraryMary]

Isn't this effectively what independent midwives do but now being provided via the NHS in this region? Or have I read that wrong?

I agree with the RCM that if this is an add on service as opposed to forcing NHS midwives out of jobs then its a good thing. It will be able to offer support to women who have more specific needs such as women with previous birth trauma and help take pressure of NHS midwives.

I am sure something similar was suggested by IM's here in Scotland as a way around the insurance issues IM's are faced with.

[crossfire]

This is the IMA community midwifery model isn't it? Didn't the midwives doing this pilot come to the ARM conference in Stone last year? I think this is what is needed and if this gives midwives who want to work this way a loophole out of the insurance nightmare its all good. After all in many trusts community midwifery is being chipped away at, with reduced pn visits and no homebirths due to staffing issues. Admittedly it is probably caseholding and not everyone wants to work in that way (Although the continuity you get with women is fantastic). I don't think for one minute that the nhs will let go of hospital care anytime soon. And if this is providing a good solution for all parties concerned then its a good thing. Didn't the albany work this way?

[Dappy]

I think a couple of the issues are the thoughts of community midwives being pushed out of community and being replaced by private contracted midwives.

I think another issue is the NHS contracting in private services. Although I'm not sure why but it always seems to come under attack when public services contract in private companies etc, there was a public school recently where the council contracted in a private company to run it and transform it, this also came under scrutiny.

Crossfire I don't know much about the IMa community midwifery model so if you have any links that would be fab so I can read.

I think personally if the service benefits mothers I'm all for it, if women get more one to one and individualised care then surly that can't be wrong as at the moment we are so far away from that.

I think the only difference from a private IM to this group/company is that this group/company will be covered for insurance under the NHS and be accountable to the NHS, is that right? As in the NHS will be their boss? Similar to how the Albany where accountable to KIngs trust wasn't it?

I just hope that if they implement a service like this that they don't just snatch it away like with what happened to the Albany, that left far to many mothers devasted.

[Delilah]

This service is vital. Women are getting the gold standard of care on the NHS. It should be rolled out everywhere.

The community midwifery model is here http://www.aims.org.uk/Journal/Vol16No2/21CenturyMidwifery.htm

These midwives are not accountable to the NHS but, are covered under their insurance.

They did come to the ARM conf, I know these midwives. They are amazing and passionate - the best kind of midwife.

RE: caseloading - yep it is caseloading. I think every midwife should work that way. The only 'midwives' in hospitals should be obstetric nurses. Don't even get me started on midwifery led units...

[ContraryMary]

The only 'midwives' in hospitals should be obstetric nurses.

Amen!

[cscmadwife]

The only 'midwives' in hospitals should be obstetric nurses. Don't even get me started on midwifery led units...

I disagree. Some mothers and babies need hospitals, whether for birth, or before or after having the baby. A MTB with fulminating pre-eclampsia needs an obstetrician to help time the birth, and prescribe any medication to help to protect her and her baby's health. But she is still a mother to be. A midwife can help explain things, be an advocate, and help put the normality back into the abnormal. I don't feel an obstetric nurse would be the best person to do that. A mother who has given birth by CS needs post surgical care, but she is also a mother, adapting to motherhood and with a baby to care for. A midwife can provide the postnatal care, whilst also explaining how her body may change postnatally, how to care for and feed her baby, how she may feel emotionally. Specialist midwives provide women focused, specilalist services, whereas obstetric staff may only see the woman as a high risk obstetric patient. I feel we all have a role to play in supporting families.

[Kipling]

I am struct by the sentence in Maternity Matters. All women need a Midwife, some need a doctor too(or words to that effect. )

I would love to do caseloading, but it doesn't fit in with my family at the moment. So I am glad of the option to do shift work. Ideally in the future I would like to work in the Midwifery Led unit away from the prying eyes and then move into caseloading after that. However, it worries me that I would be expected to take on too many mothers in an NHS scenario, and that there wouldn't be enough support or work in an IM one.

[MrsBanks]

I agree with CSCMadwife. Hospitals need midwives, because in the absence of them (ie in private hospitals here where doctors rule the roost and midwives have very little control) you have higher rates of interventions and complications. Working caseload is unlikely to suit my family for a long time so I fully intent to work shifts in a hospital once I aqm qualified and although it's not the ideal I do think it is a worthy career.

[Dappy]

A take from the mirror.. http://www.mirror.co.uk/news/top-stories/2011/05/15/maternity-care-up-for-sale-in-government-nhs-shake-up-115875-23130846/


PREGNANT women will be cared for by midwives from private-sector companies in another blow to the NHS.

Healthcare firm One to One has landed a lucrative three-year contract to provide “community midwifery services” for more than 1,500 mums-to-be a year.

They will run antenatal classes and handle home births as well as other vital post-natal treatment.

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It has been introduced at NHS Wirral after a trial involving 150 women last year. Similar schemes are expected to be rolled out across the country because of a shortage of 3,000 NHS midwives.

Katherine Murphy, of the Patients’ Association, said: “The Government should be investing in maternity services rather than paying outside firms to do the job.” And Dr John Lister, of patients’ group Healthcare Emergency, said: “Instead of lining the pockets of private companies we should be driving up NHS standards.

“This is yet another sinister example of how NHS services are being privatised by the back door.” Jo Parkington, from One to One, said: “Our staff put women at the forefront of their care and decision making. The service also relieves the pressure on the NHS.”

[Flopsy]

Midwives are experts in normal. Women who need hospital care are more than likely not having a 'normal' pregnancy or require extra obstetric input so why can we not call them "obstetric nurses". Some Midwives thrive on the beeps and buzzers that go with HDU and theatre.

I can not think of one reason why this private company is putting CMWs out of work!! how can it be privatisation through the back door when the company is providing a service that is badly needed and cheaper???? Sinister - what a crock....
Flopsy
xx

[ContraryMary]

how can it be privatisation through the back door when the company is providing a service that is badly needed and cheaper???? Sinister - what a crock....
Flopsy
xx

I think the concern maybe coming from the proposed shake up of the NHS. According the information I have been seeing at 38 degrees, the government proposals will remove a councils legal obligation to provide free health care.
This move could be seen as a pre-empt to that?

[Delilah]

To play devils advocate here...

1. if women had to pay for midwifery care/obstetric care, i'm sure we'd see more 'research' from future parents going in to it.
2. I think our birth rate would drop, our 'abortion' rate may rise (which i assume may be chargeable?)
3. People would have 'safer' sex? Perhaps STI's etc decrease?

[ContraryMary]

To play devils advocate here...

1. if women had to pay for midwifery care/obstetric care, i'm sure we'd see more 'research' from future parents going in to it.
2. I think our birth rate would drop, our 'abortion' rate may rise (which i assume may be chargeable?)
3. People would have 'safer' sex? Perhaps STI's etc decrease?

I think if you want an idea of what the UK's maternity services would look like if you were to privatise them you only have to look across the pond...
When my mum was working within the NHS back in the 70's she said it took about 10 years for what was happened there medically to happen here. The crossover now is much less.
Add money into that equation and the UK would be consumed by pharmaceutical companies eager to put profit before care.

[crossfire]

Ummmm, it's not the councils that provide free health care is it? i thought NHS was separate.

Star not so sure the abortion rate would increase, I think the unbooked (for want of a better word) pregnancy will increase so no antenatal care and unassisted birth will occur with more still births and nn deaths and then more emergency admissions postnatally from pregnancy/birth problems. Or people will go to A&E for initial care and decline anything that has to be paid for.
BUT since there seems to be very little structure for actually collecting the money from those that are required to pay for care atm, this will need to put in place properly with a means of chasing it up before the system can work properly.

However more and more people do have some health insurance through their employment or privately so perhaps this is one of the first areas that will need to be covered. Mind you in the USA there are many that don't have obstetric cover. I think the pharmaceutical companies are already dictating care over here by the cost of the drugs. Trusts have lists of drugs they will allow the doctors to prescribe. I didn't know this until we had some regs that came from outside the trust and the drug choice and regime where they came from differered widely to my unit. And differed slightly to the other unit within the trust.

Star it would be a lovely thought that more safe sex would be practised but I think its a long way off tbh.

[ContraryMary]

Do you have any statistics to back up that UC and UP will cause more NN death and still birth? As I believe that there is more NN death and still birth caused in US hospital than is caused by 'lack of care'

I do suspect however that yes initially, there will be a large number of women dropping into the gap of not really being ideal for UC or UP which can and will only cause problems.

Interesting to know what strangle hold the pharmaceuticals have over here already. I thought it was bad anyway, but seeing it confirmed...yikes.

[crossfire]

No stats to hand but the cmach and cmace reports over the last few years have cited lack of antenatal care as a causative factor in maternal deaths and neonatal deaths. Not an absolute but undiagnosed pet for example can cause the death of a mum and baby and this and clots were the no 1 killers. If you look at countries where there is a lot of pregnancy with no maternity care there is a much higher incidence of maternal and neonatal death and sb.

[crossfire]

there are 2 main drug companies in the uk.. glaxosmithkleinewellcome or whatever they call themselves and the ici conglomerate that contains pfizer and 3m... zeneca Most of the drugs used in hospitals across the board are the trendy new ones that cost a fortune have had less testing (it used to take about 15 years from drug creation to available on presecription in hospital, then another 10 or more if it was ever going to be otc.. I did this in my pharmcology medical science degree), than the older ones. However the older ones are now all out of license , cost pennies to produce and so are not now marketed. The only area where they are used is in obstetrics as they have been used for so long there is enough evidence so far to show they are not teratogenic. You cannot test drugs on the unborn or pregnant as it is not ethical. (There is a trial going on using metformin but this drug has been used in pregnancy for many many years and it is the use they are changing not the drug).
Drug companies are total capitalist like all big corporations and the mighty dollar speaks loudest. Therefore the new drugs which have had most spent on their development are required to make a profit so will be pushed within the medical communities as the new "in drug". Sometimes this backfires and the drug needs to be withdrawn due to unforseen effects or lack of effect or efficacy, or due to massive compensation cases, or due to spurious research that the media blows up out of all proportion.. (remember the contraceptive pill issues in mid 1990s? or seroxat in early 2000-2005 because of its addictive nature). The biggest markets are in hospitals and the drugs are often introduced as part of trial, funding research posts, providing jobs..... for example the baby milk companies do this with much uproar, but still they carry on. How can someone who is paid by a baby milk company be unbiased when researching infant feeding we ask ourselves? Other drugs are introduced this way and it becomes habit until something "better" or cheaper comes along.

There are many cancer drugs that are very effective but cost too much to provide for the population they serve. If the drug companies were savvy then there would be a win win situation but they are greedy and want a return on their investments asap. I think the monopolisation of health care by the drug companies is alive and well in the uk, just a little obscured by politics.

[ContraryMary]

If you look at countries where there is a lot of pregnancy with no maternity care there is a much higher incidence of maternal and neonatal death and sb.
and likely low living standards, poor nutrition and environmental conditions which support the growth of diseases?

Mind you having said that - if a one midwife in a Nazi concentration camp can keep 3000 mothers and babies alive for birth in Aushwitz I have to question modern maternity care in general.

Did you see the article circulating about how a university in Canada has found a cure for 3 types of cancer, but because the pharmaceuticals cannot patent it, it is being ignored? I have only seen one source for it and haven't looked through the research. I am waiting to hear back from my cousin who is a pharmacist on what she thinks.