Speaking Truth to Power

On October 14th 2022 the Editor of the Health Services Journal, Alastair McLellan, wrote an editorial titled “Seventeen days to save the NHS”, adding “An exaggeration of course. But only a little one”. 

His concern was that inflationary pressures would add an extra £7bn to NHS costs which the government would not be able to meet.  The NHS has been tasked to recover from the pandemic by finding “efficiencies” worth £12bn over three years. It also needs £2bn extra to fund the 2022 pay settlement.  This may mean that parts of the NHS will become unviable, and performance and service standards will plummet further.

 A further decline in performance is going to lead many “to conclude, wrongly, that there is something fundamentally wrong with the NHS model”. The task therefore is simple, according to McLellan: convince the government it must meet some or all of these costs. 

Source: Alastair McLellan, Seventeen days to save the NHS, Health Services Journal, October 14th 2022)

Labour’s travails part 2

NfN readers may remember reading our short report on the Labour conference in issue 114 (October 2022). The supporters of a motion on the NHS were so pleased that Conference supported it unanimously that they rashly claimed the motion represented Party policy. Not so, as we pointed out. Labour policy is made by the National Policy Forum, which would of course consider the unanimously passed motion. 

The Socialist Health Association has modified its judgement of the motion and now says: “The unanimous support for the [motion] means these commitments are much more likely to end up in Labour’s manifesto”. This is a truism. Of course, commitments are more likely to be included in the manifesto if they are promoted at Conference. If we don’t speak we can’t be heard. On the other hand shouting (by voting unanimously) is not persuasive in itself and might just reduce the likelihood of influencing policy.

Source: Socialist Health Association Labour Party Conference Report 2022

Knights & Knaves

Junior doctors seem likely to ballot for industrial action in January 2023. Their primary grievance is that their earnings are 26 per cent less in real terms than they were in 2008. To which NfN can add its own grievance about the all too often shabby treatment of ‘juniors’ by the NHS, who deserve better. But this is also a minefield. Newly selected President of the Royal College of Physicians Sarah Clarke was told off very firmly by the BMA for speaking against industrial action. How did she not know that the Knights of the RCP must cede influence over money to the Knaves of the BMA? And where was her comms team?

Source: Health service Journal Daily Insight, October 10th 2022

Baby talk

As we reported in News from Nowhere 114 (October 2022) NHS England has abandoned the midwifery continuity of carer (MCoC) model for maternity services, due to concerns around staff shortages. 

As always, the short version of the rise and fall of an innovation hides its complexities. The back story for MCoC starts with enterprising midwives in The Wirral who pioneered continuity of care, giving women a named midwife through pregnancy and birth, as well as encouraging home births.

Collapse; Their company One to One Midwives negotiated multiple NHS contracts in the North West before suddenly collapsing in 2019, disrupting the care of almost 2,000 women. NHS England commissioned a review from consultancy firm Niche, which reported last September after two years of investigation. The Health Service Journal’s star analyst Lawrence Dunhill snapped up the report.

One to One Midwives had secured a full contract in The Wirral in 2011. This contract made arrangements for One to One Midwives to obtain specialist obstetric advice from and to transfer women with complex births to the local acute trust, Wirral University Teaching Hospital Foundation Trust (WUTHFT). Commissioners in Liverpool, West Cheshire and Warrington agreed similar contracts from 2014.

Follow the money; Tensions emerged in WUTHFT around loosing maternity income and Trust maternity teams raised concerns about One to One Midwives’ safety record.  Arguments developed about finances, clinical coding, level of interventions and interpretations of the complex maternity tariff.

One to One Midwives sought to agree local charging arrangements and joint working arrangements with Trusts, as recommended by national NHS guidance, but encountered “unwillingness to engage”. 

Complex care; From 2014 onwards, quality and safety problems did begin to emerge, such as concerns over record keeping, risk assessments, joint working with NHS trusts, and the experience/skill levels of some midwives. Despite these problems One to One Midwives won new contracts in 2016, and clinical commissioning groups in Vale Royal, South Cheshire, South Sefton, and Southport and Formby also signed deals.

Tensions then escalated quickly, with Mid Cheshire Hospitals FT and other trusts triggering debt recovery procedures and winding-up petitions against the One to One Midwives, while some of the CCGs issued contract notices and service suspensions. 

Rivalry; NHSE came to the conclusion that the maternity payment tariff would not work for the One to One model.  Relationships worsened. One to One Midwives complained to the NHSE of “unprofessional behaviour” by NHS maternity teams and their “unwillingness to engage”. The company filed for insolvency in August 2019, with estimated debts of £2.4m.

The Niche report is clear that One to One Midwives was pioneering but had multiple problems, especially with financial planning and governance processes. There were also failings on the part of the NHS. The Niche review was critical of the NHS’s “them and us” culture, a lack of understanding about the innovative service, and concerns that were often “unfounded” being raised about One to One Midwives. Due diligence on the services and the company was inadequate, with contracts allowed to run on despite the precarious financial position. 

The NHS’s response to the competition that One to One Midwives represented was, in some places, openly hostile and resistant to change. Is there a clearer example of how the NHS thwarts market mechanisms?

Sources: Lawrence Dunhill  North by North West: The downfall of a ‘pioneering’ private provider  Health Services Journal 26 September 2022;  Kate Jury, Elizabeth Donovan, Michelle Carberry An independent review into the cessation of maternity services provided by One to One Midwives  Niche Health & Social Care Consulting, August 2022

Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/