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.
