Saturday, 24 May 2014

High Risk Births at a NICE price

OFFERED: Fabulous boutique room, freshly painted, king size bed, 24-hour staff, pool. REQUIRED: vaginal delivery of a perfect baby.

Of course, you'll be lucky to make it through the doors of this little piece of heaven within the NHS. If you have any hint of a complication you'll be sent packing to your standard local obstetric-led maternity suite. Oh, but hold on – there's no room at the inn: all of the obstetric-led units have been shut!

Don't get me wrong, I am all for natural childbirth, women should be supported to give birth at home or in a midwife-led unit; let's make sure every baby's first moments are skin-to-skin, suckling at the breast. But the harsh reality is that the sweet, sweet words from NICE are nothing more than a whispered lullaby to lull women into thinking that they have a heart and that they've listened to mums and midwives. With a shortage of nearly 5,000 midwives nationally and a maternity service in tatters thanks to countless hospitals being downgraded there is no way that a move to a midwife-led model of maternity care is a serious proposition.

So, let's get serious. Women need an individual service tailored to their needs. Home birth requires two midwives to be present but is otherwise cheap as chips and has very good outcomes for mums and babies (within reason). Birth Centre delivery requires one midwife, with very little intervention, is slightly more expensive and also has good, reliable outcomes for mums and babies (within reason). Acute Obstetric care is on a graded scale of expense with increasing intervention and has good outcomes for mums and babies (within reason). Reason, skill and medical training decide where it is most appropriate for a woman to give birth. In a service where the mother is at the centre of care, this should be a fairly straightforward decision – but in a service where profit and a confusing web of tariffs, CQUINS (and I'm not talking disco here) and penalties take centre stage, then the woman and her ever-expanding waistline are left to the mercy of a lottery of the market.

NICE can say what they like but the Department of Health are no longer accountable for our care and with the advent of the CCG they have no control of a national maternity strategy. When asked in a recent government report the Department of Health was not able to name a national policy for maternity. It's still Maternity Matters, by the way, Jeremy.

The Health and Social Care Act untethered the Department of Health from the NHS. It claimed to hand over power to the Clinical Commissioning Groups, but in reality they are at best confused and at worst rife with corruption. All of this while introducing an open market that is spiralling out of control. The result for women is that maternity services are floundering. In that government report it was found that the Department of Health is no longer responsible even for such basic and fundamental aspects of care such as how many midwives are employed by the NHS. So, who is? No one.

With Public Health banished to the savaged hinterland of the Local Authority there is no longer a powerful body integrated into either the NHS or the CCGs to ensure that local commissioning of maternity services is in line with Department of Health Policy. Even if they knew what that is. By breaking up the NHS, the Department of Health has made it perfectly clear that it is not remotely interested in having a public health policy at all. They prefer to focus on forcing hospitals into becoming Foundation Trusts as quickly as possible.

Jeremy Hunt and his cronies may not care about boring epidemiological studies and evidence-based care, but for us mums the fragmentation of services is a catastrophic blow to choice, continuity of care and equal access to healthcare. With the desperate shortfall of 4,800 midwives and almost half (47%) of UK hospitals lacking enough consultant obstetricians, along with a steady baby boom in England over the past decade, there is increasing strain on maternity services. Midwives and obstetricians look after women with much more complex needs. The Coalition, UKIP and other misguided souls push an identity parade of people to blame: Immigrants (the Polish get a hard time despite working legally, paying taxes and so therefore no different from Mr and Mrs Smith born and bred in Tunbridge Wells); The Poor (to listen to George Osborne and Iain Duncan Smith one could be forgiven for thinking that eugenics may well be on the cards for the next election manifesto); The Needy (we might as well kick the disabled while they're reeling from ATOS); and finally, The Labour Party (they gave those pesky women far too much with their tax credits, Child Benefit, Children's Centres and Maternity Matters).

Amid the frenzied dismemberment of the NHS we are hurtling towards an insurance-based system for our maternity care, which embraces intervention rather than holistic, aromatherapy and massage amongst caring midwives handy with a birth stool. We need to ask ourselves, do we seriously want to live in a society in which only the super-rich can afford to have babies while the rest of us lucky enough to have health insurance count the pennies to calculate whether we can afford for the stork to pay us a call?

Never forget that pre-NHS women died in their droves in cavernous lying-in wards or for want of an experienced midwife. The idea that all women are going to have the opportunity to lie-in in a luxurious birth centre would be a joke if it weren't so utterly terrifying that the back-up intensive obstetric care is being closed down. We mothers need to fight and fight hard for our hard-won maternity services. We need to join together and fight those seeking dismantle the NHS and fight them we shall: we shall fight them on the labour wards, we shall fight in the midwife-led units and we shall fight in the birthing pools; we shall never surrender. We shall go on to the end.