NHS staff and patients should not stay silent. It is time to demand an end to the willful destruction of our national maternity care before we see further tragedy, writes Jessica Ormerod, former Lay Chair of of Lewisham’s Maternity Services Liaison Committee which represents the interests of Lewisham women and their infants.

A coroner’s finding that baby Kristian Jaworski  died because his mother was denied a caesarean section due to cost is shocking. There can be no recompense for such a tragedy for this family; the least that can be offered them is the certainty that this will never happen again. But the senior coroner Andrew Walker has warned the Department of Health:

“there is a risk that future deaths will occur unless action is taken”.

Money being spent in the wrong places is driving the NHS to make changes which will worsen patient care. I was the chair of Lewisham Maternity Liaison Committee during the period of consultation on the maternity section of NHS England’s 5 Year Forward View, the blueprint for these changes. The plans in both the 5 Year Forward View and the Maternity Review are the result of expert testimony being neither considered nor permitted. We should not stay silent about this.

The difficult nature of healthcare means that there will always be deaths. But we should not allow the pushing through of plans in which financial considerations are raised above health concerns and structures are put into place which are simply not designed to give the right care. That is the way to design more tragedy into the system.

The Maternity Review was written in line with the Five Year Forward View which claims to personalise maternity care and empower women. In reality it will do the opposite and deny more women the vital acute services they need. Maternity services have been savagely downgraded, worsening access to obstetric care and there is a national shortage of midwives.

As maternity wards are closed and downgraded, Simon Stevens’ answer to this crisis is to encourage midwives to set up practices as Independent Community Providers and allow women to use personal care budgets to choose how and where to give birth. Consultant led services will be centralised, making rapid access to those services from a community provider difficult, should complications arise. This is part of the ‘choice’ agenda we are told the future offers.

But there is no choice if there is no money and no service. Reducing access to obstetric care by a relentless push for homebirth and care in the community regardless of circumstances is not choice.

With a huge amount of evidence proving to the contrary, we can only assume that what may seem a worrying lack of understanding of both resource and of the unexpected nature of childbirth is in fact a deliberate ideological drive to radically change the delivery of maternity care. It is being ‘transformed’ from a national service in terms of funding and co-ordinated care to one that is fragmented and privately provided.

Women need a full local maternity service. Women should be supported to have the safest birth they require. This is not a simple demand for more money. The NHS has always been a low cost system in comparison with other developed nations. But now it is not only being expected to operate on the cheap but large sections of its budgets are diverted into the costs of running a competitive market and management consultants led ‘transformation exercises’ which pay them well and do nothing to improve service delivery.

I think it more than reasonable to demand that no birth should be determined by cost. We rightly prize our health service and its fundamental principles; the human cost of making the wrong call is too high. And to avoid that wrong call we have to end the wilful destruction of our maternity services.