Your new National Health Service starts on the 5th July. What is it? How do you get it?
It will provide you with all medical, dental, and nursing care. Everyone – rich or poor, man, woman or child – can use it or any part of it. There are no charges, except a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in times of illness (National Health Service Leaflet 1948).
There's a revolution in the NHS. No longer shall the NHS be shaped and driven by the health outcomes of everyone - rich or poor, man, woman or child. The NHS of the 21st century is financially driven; it's a market place and there's profit in numbers. So out with the old and in with the new – and that means a new approach to services. Specialist care centres, emergency centres serving wider geographic areas, phlebotomy centres, vasectomy clinics: more specialist, less general medicine is the way of the future. This model is possibly financially superior but is hopeless for the hapless users of the service. Previously, one could nip to one's local surgery to have a blood test, a veruca removed, or the coil fitted; now one has to trek across town to be serviced by a plethora of healthcare professionals in a disparate web of healthcare outlets. We're told that our care has improved and that we should be grateful for what we get because healthcare is draining the economy.
Now here's the nub: we all know that healthcare and the NHS has been re-shaped to operate as a business, and the bottom-line of business is profit. All NHS facilities – that's hospitals, GPs, sexual health clinics etc - have to meet the health needs of their clients while meeting their bottom-line and making a credible profit. At the same time as the move to a private sector model for our public services, we have been sold a myth: specialist services, hubs of care and improved 'customer services' in the NHS improves health outcomes. This is a fabrication sold to the public by the handsomely paid management consultants who populate health think-tanks and NHS England. And these consultants are being increasingly used – and paid for – by the Department of Health and individual Trusts to advise on changes to health services. It's no wonder that we have moved away from health as the focus for care when we no longer use public health professionals and doctors to improve service provision.
So, let's get down and dirty and talk mums and babies. Maternity is unlike any other health service. The users are not patients, they do not need treatment: they need care – sometimes complex care – and they need respect. We know that small maternity units, midwife or obstetric-led give a better and more valued service. So why are so many of these units being downgraded or closed?
Margaret Hodge stated in a recent report: "There is evidence that many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care." A worrying statement when childbirth is always the end result of pregnancy, and the childbirth rate is rising.
Every day news stories report cases of women giving birth without a midwife and hospitals groaning with over-stretched capacity on labour wards. And yet the government writes and rewrites papers and policy that demands more “choice” for women in maternity and higher ratios of midwives to women. Ministers drone on about woman-centred care, about midwife-led birth centres, case-load midwifery. But the reality is that the service lacks thousands of midwives, and midwives are leaving the profession in their droves: within 10 years of qualifying a third of midwives leave the profession.
In 2013 Jeremy Hunt, Secretary of State for Health, attempted to downgrade Lewisham Hospital's maternity service to leave a stand-alone birth centre with no obstetric-led care – despite the fact that Lewisham sees over 4,000 births per year and houses some of our country's most deprived women, with all the complex healthcare and challenges of that population. Only 12% of women in Lewisham would have been able to use the midwife-led unit. The vast majority would have been forced to use the already burdened units at neighbouring hospitals, stretching their capacity to over 7,000 births per annum. Lewisham Hospital battled Hunt in the courts twice and won both times. Lewisham was a test case for many maternity centres up and down the country. And Hunt was so outraged that he had lost in Lewisham that he is using clause 119 of the Health and Social Care Bill to push through closures and downgrades to service provision more easily and without the hassle of having to go to court. And where are the headlines? Where is the debate? If the Coalition succeed in passing the bill no hospital or maternity service in the country will be safe and that means fewer and fewer women will have access to good, comprehensive local care.
Childbirth is intimate, it requires the mother to feel safe in her environment, confident about the support from her midwives. Women ask for a more personal service. No one wants to be herded into cavernous hospital wards with anonymous carers and a conveyor belt service to give birth in fear or by the surgeon's knife.