This is a question I’ve been meaning to ask the Clinical Commissioning Groups at the hospital cuts consultation drop ins:

• Where are the community midwives coming from to provide the increased home births proposed in the Right Care Right Time Right Place Have Your Say Consultation Doc (p30)?
• And are the CCGs relying on the recommendations of the National Maternity Review, that women employ private midwives through the £3k voucher scheme? And what happens to such women if things go wrong in labour and they need specialist obstetric help which will cost far more than £3k?

Jessica Ormerod, former Lay Chair of Lewisham’s Maternity Services Liaison Committee (which represents the interests of Lewisham women and their infants), says the National Maternity Review cannot deliver its rose-tinted view of the future, given the NHS’ currently understaffed and fractured services. It is selling choice as the panacea for poor care.

Who could disagree, at face value, with the aspirations of the recently published National Maternity Review? Women do need more personal care, they need to give birth safely, their choices should be respected and they need to be listened to at every stage of their pregnancy, birth and postnatal care. They need, in short, a full, local maternity service. Many aspects of the report such as women having one midwife throughout her pregnancy, birth and postnatal care and safer care through improved ‘cross boundary’ working seem to be the answers to many women’s dreams.

For all its apparent common sense, the review looks like pie in the sky. The National Maternity Review cannot deliver its rose-tinted view of the future on the NHS’ currently understaffed and fractured services and is selling choice as the panacea for poor care.

The report itself admits that there have been improvements to women and babies’ safety. A sensible plan is to continue developing best practice where this has improved outcomes, not start from scratch with a new system. It hints at the chronic underfunding of the maternity system we have now with further cuts to maternity planned. We have learned to the cost of the nation’s health just how expensive constant reform is, why add this extra burden now?

However, the most important aspect of this report is the call for ‘personal care budgets’: a radical move away from the way the NHS has always been funded by population rather than individuals. The report recommends that all pregnant women are given a personal care budget of £3000. There should be real concern about the potential lack of access to obstetric care when women have serious complications of pregnancy. How will they be paid for? Women do not ‘choose’ pre-eclampsia, gestational diabetes or emergency c-section at the end of a normal pregnancy.

I would argue that this is the real point of this review – the roll out of Simon Stevens’ 5 Year Forward View. Midwives are to be encouraged to leave NHS provision and set up as local community providers. Women can then use their personal fund to pay the provider of their choice for their care. With the current staffing crisis where are these additional midwives coming from? And where is the evidence that personal health budgets do anything other than further fragment care or that a multiplicity of providers are capable of co-ordinating care.

Behind the rosy language is an offer that cannot be matched by real resources. We will have fewer services, privately provided. Technology replacing clinical care. Obstetrics unavailable locally. These decisions have already been taken in the 5 Year Forward View’s non evidence based experimentation with the NHS. Pretending this offers women what they want is shocking.