'Trailblazing' community service shuts under financial strain

Neighbourhood Midwives, a social enterprise, had built up liabilities that exceeded its assets by over £900,000, according to its most recent annual accounts.

The company said in a statement online that it could not keep running “in these times of national economic uncertainty and change in NHS maternity services”.

Its commissioner, Waltham Forest Clinical Commissioning Group, also published a statement online saying “the pioneering midwifery service” had to close because of “significant challenges around coordinating business planning and the commissioning timetable”.

The employee-owned company gave a week’s notice that it would stop trading, distressing pregnant women in its care.

NHS England said Neighbourhood Midwives produced a “trailblazing” service model that influenced the development of national maternity services.

Its chief executive, Annie Francis, was a member of NHS England’s national maternity review team, which reported in February 2016. A year earlier, the company was praised in the House of Lords as pioneering by Conservative peer Baroness Cumberlege, a month before she was appointed as the independent chair of the National Maternity Review.

Expectant mothers were told on 24 January via email that their midwifery service would end on 31 January.

Leila Reyburn was 33 weeks pregnant when she found out the service was closing. She told HSJ it “was a massive, massive shock” that brought her to tears.

She said the lack of clear communication from both the company and CCG had left her “particularly angry”.

While the company ran “a brilliant scheme that women love[d]” and was staffed with “brilliant” midwives, she questioned whether it had sufficient business expertise among its management. She also asked how the CCG had not picked up on the company’s financial situation sooner.

Neighbourhood Midwives began operating as a private provider of independent midwifery services in London in 2013. It won its first NHS contract in November 2016 for a pilot scheme with Waltham Forest CCG.

It provided women with “continuity of carer”, ensuring they would have a small team of dedicated midwives who would work with them through their pregnancy, labour and into postnatal care. The service was praised by its users in a July 2018 survey and was due to run until November 2019.

The NHS contract was “one of the key elements of its overall purpose; to provide a continuity midwifery model through the NHS, free at the point of care,” according to its 2016-17 annual accounts.

The company reported in June 2017 that two directors had personally loaned the company over £177,000. Current and former directors had also put up £130,000 as guarantees for other loans.

The company also said in its 2017 accounts that its financial challenges would continue, despite winning the NHS contract, because the service needed “to establish itself as a new provider and the payment system based on tariff was not designed for small independent providers”.

Neighbourhood Midwives directors told HSJ in a statement: “We are sorry that we have had to take the decision to close. This is a very difficult time for everyone, and our priority has been, and continues to be, to support the women in the care of our midwives to choose and transfer to alternative midwifery care.”

The company added: “Where we have been made aware of issues in choosing alternative care, we are working with midwifery providers and commissioners to address them.”

Waltham Forest CCG’s chair Anwar Khan said: “We are disappointed that Neighbourhood Midwives have decided to close for financial reasons.”

Dr Khan continued: “As local GPs we have had lots of positive feedback about the work of the service. I am hopeful that the midwives currently working for Neighbourhood Midwives will continue to work in our community with local NHS organisations.

“Our top priority is making sure mums expecting their baby in the next few weeks still have a range of choices open to them, including home births where this is their wish.”

A spokesperson for NHS England’s London region told HSJ: “The local NHS has worked together so that all women affected by this closure are provided with the same level of personal and safe maternity care, ensuring each woman is able to have the birth of their choice.”