In July, Chair of AIMS, Beverley Beech visited Professor Wendy Savage to seek her views on the changes that are happening within the NHS.
Beverley: Can we talk about the current state of the NHS?
Wendy: It’s a terrible mess. One of the aims of the Health and Social Care Act was, supposedly, to remove the tinkering with the NHS by the Secretary of State. So although he no longer has a legal responsibility to secure and provide a comprehensive health service, it hasn’t stopped him interfering with it all the time. It’s not at all clear how the responsibilities of the Department of Health, NHS England, the CQC, Monitor and the Foundation Trust Development Authority all link in.
Originally, NHS England (it wasn't called that then) was going to commission maternity services and then they said it would go to the GPs in clinical commissioning groups. This was a pity because if you had to have this system, it seemed to me that a body that was commissioning specialist services is more likely to have the expertise than two hundred clinical commissioning groups.
Beverley: What do you think of these charades of ‘consultation’?
Wendy: The government’s rules for consultation say that it must be able to make a difference. So the consultation about ‘Equity and Excellence’ (www.gov.uk/government/uploads/system/uploads/attachment_data/file/213823/dh_117794.pdf) failed that test because they didn’t say that this was about whether they should do it, it was about what you thought about it when they were going to do it! The fact is that nothing else changed after this huge consultation with six thousand responses.
Beverley: Why is this government so determined to privatise health care? Apart from the obvious - they have shares in these companies and can make a fat profit for themselves.
Wendy: The government ideologically opposes the National Health Service. The Conservatives see it as Labour’s greatest achievement, which it was.
Beverley: So what do you think the impact of this Health and Social Care Act is going to be, on maternity services and women and babies?
Wendy: Well, we haven’t seen a lot of social enterprises springing up to provide care for women have we? One of the aims of the Health and Social Care Act is to privatise the health service and try to encourage alternative providers. But apart from the group in Liverpool, I haven’t read about groups of midwives setting up alternative services to compete with the NHS.
Beverley. Our worry about the few groups we do have is that midwifery standards will be set by insurance companies and as they are private ‘companies’ the big boys are going to take it over and reduce everything to the lowest common denominator.
Wendy: On the whole, I think that the private companies are probably not going to be very interested in midwifery because it's very labour intensive and if something goes wrong you’ve got huge costs. So I think that it’s unlikely that predatory companies like Serco and G4S and all those people who know nothing about medicine are going to venture in. How does Serco get contracts for out-of-hours care and Virgin get it for children’s care, when they’ve never done it? It’s shocking. Care UK provides community services in Suffolk. They immediately cut down the number of staff, who now have to drive miles farther to get to the patients. Because managers are short of money, they fall for these smooth-talking companies
Beverley: How do you think this will affect maternity care?
Wendy: I think maternity care is not going to be very attractive to private companies. Because the costs are high and unpredictable, and the risk of something going wrong is not high but when it happens it’s enormously expensive. So I feel the predatory capitalists are not going to be interested in maternity care ... but I may be wrong.
Beverley: The midwives in Holland are fighting a rearguard action. Midwifery over there has always been held as a gold standard – but it is being whittled away and it’s run much more like a business.
Wendy: They’ve had privatisation in Holland and people aren’t happy about it. No doubt the midwives got caught in that aswell.
When you think of the Albany Midwifery Practice in south east London, how they negotiated all those things with making contracts with the NHS and all the rest of it, and then got absorbed by the NHS, it did have a great impact because women were really given choices and over 40% opted for homebirth, which was safely achieved, and then this attack on them.
Beverley: Do you think that a system that would be sustainable could possibly work? It is clear that the midwives within the NHS are so bound by tick boxes, and protocols and everything else, that they are not giving individual care, and when they go outside the protocols there is trouble.
Wendy: We’ve got problems with the NHS structures and all the rest, but we’ve also got the problems of the midwifery profession and how confident they are about being proper midwives and how they don’t support midwives who get caught up in the system very well.
One of the hopeful things is that the academic midwives seem to be very much on the side of giving women what they want and evidence-based midwifery which favours normality.
Beverley: How do we get the NHS to listen to what women want?
Wendy: I think one of the problems is that people who are making the decisions are older so their ideas about maternity care were formed twenty, thirty, maybe even forty years ago. And they tend to defer to the medical people and of course that was the whole era where home birth was considered anathema.
Beverley: Are we going to have a dual system of care in which those who can pay get siphoned off and everybody else gets substandard care?
Wendy: Certainly if we don't manage to stop this Health and Social Care Act, the end result is going to be just that. Andrew Neil [TV news] asked Louise Irvine (who stood for National Health Action Party) about what services had been privatised. Two thirds of contracts have gone to the private sector since the Act came in – the NHS Support Federation did an analysis of it.
I'm just thinking join Keep Our NHS public, lobby your MP, lobby the Labour Party so that they actually come up with some proposals. See www.keepournhspublic.com. The Labour Party has said it is going to repeal the Health and Social Care Act but you’ve also got to restore the Secretary of State’s legal responsibility for providing the service. At the moment hedoesn’t have a legal responsibility, he only has political responsibility so he just blathers on about things and reports to Parliament and if something goes wrong he’s not legally responsible.
Beverley A Lawrence Beech
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