The must-read stories and debate in health policy and leadership.

Don’t call the midwife

The abrupt closure of Neighbourhood Midwives, a small independent midwifery provider, came as a shock to the women using its service in January.

The company was running a pilot continuity of carer service in Waltham Forest, where each woman was looked after by a small team of midwives from pre-natal, through birth and into post-natal care.

The pilot should have ended in November 2019. But the women in its care received an email on 24 January saying the service would stop one week later.

The service produced positive results – the women who used it praised it, NHS England called it “trailblazing” in a case study put out with the long-term plan, and it had an experienced team of midwives, plus a chief executive who was part of the review panel for Better Births, the 2016 national maternity review.

So, it was understandable many women in its care took to social media when it emerged the service was closing. They lambasted Waltham Forest Clinical Commissioning Group, the commissioner, and started a petition calling on the CCG to reinstate the service.

But Neighbourhood Midwives was not a victim of NHS cuts. The company had to close after building up nearly £1m in net liabilities.

A leading investor and creditor described the company’s goals as “ambitious”. There may just be too many systemic barriers in the way of small providers like this one to allow them to thrive.

But there are unanswered questions, including how a company with significant losses already on its balance sheet won such a contract in the first place – the service had made a financial loss every single year since 2013-14. 

The CCG, NHS England, the company’s directors, and other stakeholders have started investigating what happened. It will be interesting to see what they conclude.

Calling it a day

The half-hour debate on the effect of the tapered annual allowance on NHS pension scheme members may have been frustrating for many.

While health minister Jackie Doyle-Price said there was “clearly an impact on the behaviour of practitioners”, she also said a general review of the annual allowance taper and broader systems of relief are matters for the chancellor.

This is a huge and urgent issue for those running health services. 

Some of the statistics given by the minister were alarming. Of the retirements taking place in 2016, 2017 and 2018, a third of all hospital doctors and more than half of GPs had opted to hang up their coat early.

Examples given by politicians attending the debate only fuelled these concerns. Conservative MP Paul Masterton, who called the debate, said one surgeon who contacted him was hit with a tax bill of £62,000. Another had received a bill of £29,000, despite doing no work outside of the NHS.

Ms Doyle-Price clearly recognised that pensions tax would contribute to decisions of senior clinicians to retire early. But, other than saying the government would look at potential further measures, she made clear clinicians would not be treated differently to other taxpayers and gave no suggestion of what action the government might consider.