18 comments By Joanne Parkington
It feels like the main issue here is that everyone expects the services to be delivered as they currently are and as such the contract is undervalued with a reduced cost base. The challenge with any service is to now think differently and deliver a service that meets the needs of their patients within a sustainable financial envelope. Buurtzorg has done this on a large scale and maintained quality and safety and I think there is a lot to learn from providers that have the innovative culture but also the commissioning/procurement landscape to support large scale change. The NHS is flawed at every level and until innovation is not just supported but embraced these conversations will continue to go round in circles with no end.
The RCM has not abandoned the Normal Birth Campaign at all, it has changed the word 'normal' to 'physiological'. I have been a midwife for 25 years and I am appalled by the behaviour of some people, particularly those people who have supposed power. The evidence and research supports the role of the midwife for all women, regardless of risk, and the role of the midwife is to above all, support safe and APPROPRIATE care for women and their babies. Sometimes this involves timely referral and escalation. A midwife's role is complex because pregnancy and birth is complex due to the individualised nature of the PHYSIOLOGY of pregnancy and birth for each woman. Midwives have to adapt their care quickly and rapidly and this is difficult and challenging to do when a midwife is caring for a number of women in labour at any one time or if the midwife is not familiar with the women she is caring for. The implementation of continuity of carer models and sufficient staffing levels will go along way to support midwives to fulfil their roles safely and effectively.
This is still the argument around NHS =good and private = bad. When is this going to move on? This should be about any provider being able to deliver services that are clinically effective as well as efficient. We are a small private provider - I set up our organisation after working for the NHS for 20 years. We now produce the best outcomes for women and babies, including mortality and morbidity rates and we get excellent experience feedback - all for the same money. As long as private providers can deliver this should be the focus. My concern as a small provider working in an area with one of the largest NHS providers in our field, is that we will once again move to a monopoly landscape because of these type of conversations making generalised assumptions without any real evidence to support their own beliefs. Even with our outcomes we have struggled for years to be a real choice option for women because GPs/the system still directs them to the local NHS provider - this would indicate that even when legislation removed the purchaser-provider split the culture still maintains the status quo.
There is an assumption here that they are 'Good' because they are non profit. This is misleading - of course they are a profit making business - we all have to make a profit to be a sustainable and viable business - they just do not pay out dividends to shareholders and reinvest any surplus into the organisation. I would argue that is what all organisations do in the NHS whether they are NHS, private or third sector. The NHS does not enable large profits to be made within the tariff system - most organisations are struggling to survive.
In response to 3:36pm - not all independent providers have the resource to put together glossy tender documents and I feel it is offensive to make that assumption. As an AQP ourselves, we have no guaranteed activity and have to respond to the needs of the patient as they will 'choose' to go elsewhere if we get it wrong. This debate is detracting from the real issues of providing patients with the care and service delivery to get the best outcomes - not whether you are handed the work on a plate or whether you have to work hard to evidence that you do provide a service that the patients want. To me the whole privatisation issue is just engendering fear - the NHS cannot survive doing what it does - we have to think differently and do things differently and fighting these battles is just not helpful to get the real work done.
Making a profit ensures that the business is sustainable. PROFIT should not be such dirty word in the NHS - if you do not make ends meet you cannot continue to function. If you cannot afford your mortgage you have to give up your house, if you do not have any money you cannot walk into a supermarket and just take food without paying. The NHS is in a mess because management do not run it as a business they run it as if money grows on trees and it is never ending. Even charities have to make a 'profit'. We run a community based midwifery service and can produce excellent outcomes to tariff - this does not mean we make a large profit but we have to evidence sustainability to ensure that the service will be recommissioned, we do not have the privilege of a rolling contract!
It still remains unclear as to why pregnant women are excluded from the NHS Constitution and do not have a right to choice of provider.
I am a midwife of 20 years and I started One to One because i wanted to give women and their families access to the best possible care that evidence says will achieve the best outcomes - and our model did. One to One was set up by clinicians and is run by clinicians - we are doing EXACTLY what government policy has asked for. We are a clinician led service, providing safe quality care that is achieving the BEST outcomes in the UK within tariff. One to One have been commissioned for 4 years and we have been regulated and performance managed like any other NHS commissioned service. I can assure you all that there is not a 'level playing field' out there. As a private provider we are vilified just because we are 'private'. People cannot look past the politics and are just out to protect their own jobs. One to One have demonstrated that there is a different way to provide maternity services and it does work - if the CCGs were not so keen to protect their existing providers then they would be able to look up around them and see what else is available. We do not aggressively market (although we could if we wanted to) most of our women know about us through word of mouth. We are not working in Yorkshire because we stuck a pin in a map - we went there because the women asked us to. To date we have had nearly 300 women across the region request our service. Surely the commissioners should be listening to the voice of their population and not the voice of their providers??
One to One Midwives commissioned in the North West are achieving the best outcomes in the Uk, One to One provide a community case loading midwifery model and provide the same named midwife for the woman and her family throughout the whole of her pregnancy, birth and postnatal period. One to One epitomise everything the Government has released in Policy since 1993 - continuity, choice and control. We deliver on the NHS Mandate TODAY. Women want to access our service from all over the country yet we are being prevented from providing our model of care due to bureaucracy and apathy. We can work to tariff and still ensure women receive the individualised care that large organisations are struggling to deliver. How many more woman have to be subjected to interventions that do not work and they do not want, how many women have to walk away from their birth experience just feeling grateful that they have a live healthy baby? In the Uk we have had midwifery led care for generations and we should be the world leader in delivering the safest highest quality care in the World yet we lag behind our European neighbours for nearly all indicators, including perinatal mortality. There is a solution and we are evidence of that - when will someone actually do something???
Surely this does not comply with the co operation and competition framework? If these innovative approaches are prevented at every turn by the incumbent providers what chance have we got in turning the NHS around? Out come based commissioning should be the way forward for all services - not target driven. The decision to abandon this approach for maternity services is very disappointing. It just goes to show that there is no real desire to place women at the centre of the service and that maternity will continue with the service being all abut the provider and what they can do - not what the women want or indeed should have or expect. Sad news!
Here we go again - this is not privatisation!! Tendering contracts to qualified and accredited providers is competition not privatisation. The NHS is not being 'sold off' it still remains a state run service - why does everyone insist on skewing the language to create public hysteria? It does not benefit anyone. There are many small private companies doing fantastic work for the NHS and it is insulting to them to keep accusing them that they are only doing it to make a profit. They are doing it to make a difference and that is exactly what the NHS needs.
I am puzzled by the consistent use of demonising private providers and the assumption that the use of private providers is removal from NHS care. Private providers are the NHS! The definition of the NHS is a National Health Service which is free at the point of delivery. If this can de delivered at cost and achieve quality and excellent outcomes surely this should be the main driver. We are not SELLING OFF the NHS - private providers, and indeed any provider, is permitted to perform a service on behalf of the NHS for a designated period as defined in their contract. We do not buy slices of the NHS- we all work as part of the NHS family and I do not feel that this demonising any provider is helpful in the debate.
The focus should be on the performance of providers not on who the provider is. We are an independent provider of NHS services and we are performance managed on a monthly basis by the CCG to ensure that we abide by the contract and service specification and achieve the KPIs. Our organisation is producing the best maternity outcomes in the UK, within tariff,which no other NHS provider has been able to demonstrate. There are good and bad providers and it is down to the commissioning and monitoring of the contract to ensure safe and effective care.
I can vouch that community case loading midwifery can be achieved at tariff and does produce better outcomes. It is interesting that the reference costs are derived from the data submitted by these trusts that are now saying they cant afford it! Maternity services have been supporting other services for years, including gynae services. It was estimated by some of our local trusts that only 60% of funding was ever received by the maternity department, is it any wonder nobody knows the real cost of anything when this is how trust have to operate financially. The simple matter is that there are alternative ways of delivering safe quality care and achieve it in existing tariff - at the same time it will eventually reduce the cost of litigation.
Unfortunately spending money on ensuite facilities is not making our maternity services 'safer'. We need more midwives with the skills and expertise to care for women, wherever they choose to have their babies. There appears to be a complete lack of understanding on what women need to ensure a safe, positive birth experience; numerous studies have identified that women want to have their care from a known and trusted midwife, and this one single aspect of care provision improves outcomes of care more than anything else.
It is also important to say that as a private provider of maternity services we have to work hard to promote our service to the public because women are just not being given the choice. The hospital has the monopoly and some women have been told that if they wish to use our service then they will have to find a new GP! It has to be a level playing field for the process to be fair and competitive and I can assure you that it is far from this.
I think we should also remember that FTs need to make a profit!! No business is sustainable without managing money wisely and NHS organisations are no exception, no more bailouts!! Surely it is about outcomes and quality, if any provider can deliver excellent safe care then good luck to them if they can also balance the books at the same time.
I am a private provider of NHS services. I have been an NHS midwife for over 14 years and watched maternity services become more medicalised and fragmented with money being spent on obstetric led care when all the evidence suggests that the majority of women would have better outcomes with continuity of midwifery care. This was said with the Winterton Report in 1992 and repeated with Maternity Matters in 2007. 15 years and no change!
I now have a company that employs midwives and provides evidence based SAFE high quality care as an Any Qualified Provider. Without Labour bringing in the AQP I would never have had the opportunity to ensure that midwifery care becomes a primary care service and not subsumed into a secondary caremedical model.
Not all private care is for profit, I started my company because I am passionate about midwifery. We work within NHS tariff and are able to provide an enhanced service model compared to current NHS services. Our outcomes are better than the national average. We have to be regulated and demonstrate compliance to all processes and procedures, including CQC registration just like any NHS provider.
I want this Health Bill to go through, I want the opportunity to provide our service to the NHS. This is not about money this is about saving babies lives, literally!!