Thursday, 30 September 2010
Wednesday, 29 September 2010
Walk in Centres Consultation
Let your feelings be known. Oppose the closures.
Engagement on Urgent Care Services in Salford
NHS Salford is responsible for funding health services in Salford (often referred to as commissioning). We are asking the public and patients for their views on urgent care services on behalf of all the organisations who contribute to urgent care services in Salford.
What are urgent care services?
Urgent care services are used when there is an unplanned or emergency health need, for example, urgent treatment or advice from a GP, Accident and Emergency (A&E) or Walk-in Centre.
Why do urgent care services need to change?
Urgent care services need to change because the economic recession means that there is less money available to spend on public services across England, including the NHS. We believe that £6.4 million can be saved from urgent care services without impacting on the safety of patient care
We have worked with staff and the public to develop a proposal to provide safe, cost-effective and joined-up urgent care services to the people of Salford that safely reduce unnecessary costs.
So, what is the proposal for urgent care services in Salford?
The proposal includes plans to:-
1.Develop a new Urgent Care Centre on the hospital site at Accident and Emergency and relocate the existing Pendleton and Little Hulton Walk-in services into the new centre. We believe that this will help to reduce the current pressure and costs from unnecessary Accident & Emergency attendances and provide a wide range of experts and treatment facilities in one place.
2.Promote alternative choices to Accident & Emergency amongst the general public.
3.Improve care for specific groups through alternatives to hospital admission, e.g. people with long-term conditions or the elderly.
Tell us your views
We have developed an engagement document to give you more information about our proposal for urgent care services. You can read this by clicking on the link below.
•Full engagement document (1.00 MB)
You can send us your views on the proposal by filling in the online response form, which is available at the link below.
•Full online response form
Summaries of the engagement document will be available in public venues across Salford, such as GP surgeries, libraries and leisure centres.
The engagement finishes on 13 December 2010, so you have until then to send us your views.
http://www.salford-pct.nhs.uk/EngagementOnUrgentCareServices.aspx?section=4
Engagement on Urgent Care Services in Salford
NHS Salford is responsible for funding health services in Salford (often referred to as commissioning). We are asking the public and patients for their views on urgent care services on behalf of all the organisations who contribute to urgent care services in Salford.
What are urgent care services?
Urgent care services are used when there is an unplanned or emergency health need, for example, urgent treatment or advice from a GP, Accident and Emergency (A&E) or Walk-in Centre.
Why do urgent care services need to change?
Urgent care services need to change because the economic recession means that there is less money available to spend on public services across England, including the NHS. We believe that £6.4 million can be saved from urgent care services without impacting on the safety of patient care
We have worked with staff and the public to develop a proposal to provide safe, cost-effective and joined-up urgent care services to the people of Salford that safely reduce unnecessary costs.
So, what is the proposal for urgent care services in Salford?
The proposal includes plans to:-
1.Develop a new Urgent Care Centre on the hospital site at Accident and Emergency and relocate the existing Pendleton and Little Hulton Walk-in services into the new centre. We believe that this will help to reduce the current pressure and costs from unnecessary Accident & Emergency attendances and provide a wide range of experts and treatment facilities in one place.
2.Promote alternative choices to Accident & Emergency amongst the general public.
3.Improve care for specific groups through alternatives to hospital admission, e.g. people with long-term conditions or the elderly.
Tell us your views
We have developed an engagement document to give you more information about our proposal for urgent care services. You can read this by clicking on the link below.
•Full engagement document (1.00 MB)
You can send us your views on the proposal by filling in the online response form, which is available at the link below.
•Full online response form
Summaries of the engagement document will be available in public venues across Salford, such as GP surgeries, libraries and leisure centres.
The engagement finishes on 13 December 2010, so you have until then to send us your views.
http://www.salford-pct.nhs.uk/EngagementOnUrgentCareServices.aspx?section=4
Tuesday, 28 September 2010
Our journey back to power
John,
It is a tremendous honour to have been elected to be the Leader of the Labour Party.
I am proud that so many people have joined Labour under my leadership to make a real change. Just this afternoon, a new member has joined every minute.
I want to draw upon the strengths of all the thousands of Labour members to change this Party and, in doing so, change this country.
Please watch my speech and take a look at the stories of those who have joined us
As the Leadership passes to a new generation, we’re presented with an opportunity to change. Our last government had huge achievements to its name – and we should all be proud.
Now, a new generation leads Labour, humble about our past and idealistic about our future. It is a generation which thirsts for change. This week, we embark on the journey back to power.
Facing a new world with new challenges, we need to think again about how we can best serve the people we seek to represent. Labour's new generation must be different – with different attitudes, different ideas, different ways of doing politics as we shape the centre-ground.
Please take a look at my speech and ask your friends to join our latest recruits
We must have the courage to admit the mistakes we made and to embrace fresh thinking if we are to win back people's trust. Whether people are angry about the economy, lack opportunities or feel like they can’t get on in life – our party must be there for them.
With more new members joining every hour, we can make that case
Working together and joined by our latest recruits, I am optimistic that we can once again become an unstoppable force in British politics – and return Labour to power.
Ed
It is a tremendous honour to have been elected to be the Leader of the Labour Party.
I am proud that so many people have joined Labour under my leadership to make a real change. Just this afternoon, a new member has joined every minute.
I want to draw upon the strengths of all the thousands of Labour members to change this Party and, in doing so, change this country.
Please watch my speech and take a look at the stories of those who have joined us
As the Leadership passes to a new generation, we’re presented with an opportunity to change. Our last government had huge achievements to its name – and we should all be proud.
Now, a new generation leads Labour, humble about our past and idealistic about our future. It is a generation which thirsts for change. This week, we embark on the journey back to power.
Facing a new world with new challenges, we need to think again about how we can best serve the people we seek to represent. Labour's new generation must be different – with different attitudes, different ideas, different ways of doing politics as we shape the centre-ground.
Please take a look at my speech and ask your friends to join our latest recruits
We must have the courage to admit the mistakes we made and to embrace fresh thinking if we are to win back people's trust. Whether people are angry about the economy, lack opportunities or feel like they can’t get on in life – our party must be there for them.
With more new members joining every hour, we can make that case
Working together and joined by our latest recruits, I am optimistic that we can once again become an unstoppable force in British politics – and return Labour to power.
Ed
Wednesday, 22 September 2010
The case for retaining full maternity services in Salford
The case for retaining full maternity services in Salford Sept 2010 Page 1
Keep Hope Maternity Open Campaign Group
http://www.keephopematernityopen.com
The case for retaining full maternity services in Salford
The case for retaining full maternity services in Salford Sept 2010 Page 2
Foreword, Lisa Kean, Chair of the Salford Maternity Forum
In July this year, Andrew Lansley ordered that the decision to close Salford maternity and neonatal services be reviewed, stating that decisions on service change must now meet four strengthened criteria. These criteria are that proposed changes must: focus on improving patient outcomes, consider patient choice, and be based on sound clinical evidence, as well as having support from General Practitioners (GPs). The Salford Maternity Forum has therefore commissioned this report which examines the case for retaining services at Salford, based on the first three criteria.
We are now sending this report to all GPs in Salford, as we believe it sets out a compelling case for retaining Salford‟s excellent maternity and neonatal services. We believe that it is not too late to reverse this wrong decision and ask for your support in achieving this, for the sake of Salford people now and in the future.
The case for retaining full maternity services in Salford Sept 2010 Page 3
Summary
1. The „Making it Better‟ (MIB) consultation was biased from the outset, as the Children, Young People and Families‟ Network team ignored a report they themselves had commissioned from TMS consultancy just prior to the consultation. This report in February 2005 stated unequivocally that Hope Neonatal Unit should be retained.
2. The proposals were based on the assumption that the birth rate was declining, whereas in Manchester and Salford the birth rate is projected to increase. Staff in local maternity units are currently struggling to cope; St Mary‟s, for example, was forced to close on 39 occasions last year. In its most recent report the North West LSA (the midwifery statutory supervisory body) has expressed concerns regarding future capacity if the reconfiguration goes ahead. Reduced capacity, with pressure on staffing and beds, will result in a less safe service for the majority of mothers and babies.
3. In 2008 Salford was designated the eighth best performing Trust for maternity care in England by the Health Care Commission. It has also achieved Level 3 in the Clinical Negligence Scheme for Trusts (the highest safety level, which means reduced insurance premiums). Maternity and neonatal care at Salford is therefore currently recognised as safe and effective, with lower intervention rates than in the surrounding hospitals. These enviably low intervention rates, achieved through sustained effort and teamwork, will be jeopardised by the closure. If intervention rates were to rise, care for Salford women would be not only less safe, with long term public health implications, but also more expensive.
4. The closure of Salford maternity would mean less choice for women in Salford. Even if a stand- alone midwifery led unit were to be retained, this would only cater for the healthiest women (around 500-600 per year).
5. The closure of Salford maternity and neonatal services would mean that women and their families would have to travel further, incurring greater expense and inconvenience than currently, and running an increased risk of giving birth before arriving at hospital. Salford has a high level of non car owners. The closure of an excellent unit serving a deprived population will result in perpetuation of the „inverse care law‟– those who need it most have the poorest care.
6. Bigger is not necessarily better when it comes to maternity care; evidence from this country and Europe suggests that smaller maternity units (supported by excellent networks for transfers to neonatal intensive care units for very low birth weight babies) have higher staff retention and better outcomes.
The case for retaining full maternity services in Salford Sept 2010 Page 4
The ‘Making it Better’ review
The „Making it Better‟ reconfiguration programme (MIB) was set up in 2004 by the Children, Young People and Families Network, to carry out a public consultation on reconfiguring children‟s, maternity and neonatal healthcare services across Greater Manchester. This then expanded to take in East Cheshire and High Peak and Rossendale, a review area with a population of around 3.1 million people. In July 2005, the Network published a discussion document, Making It Better (MIB). More than 120,000 copies of the document and 400,000 copies of an information leaflet were distributed. According to the MIB team, around 242,000 people had their say on the proposed changes during a 4-month public consultation and more than 55,000 formal written responses were received.
The discussion document suggested the creation of eight „Centres of Excellence‟ for maternity and children's services, with neonatal intensive care provided at three large specialist units. Option A, which had been identified by the team from the start as the „preferred option‟ was finally chosen at a meeting of 13 PCTs on 8th December 2006. Option A proposed Centres of Excellence at 8 sites: Royal Albert Edward Infirmary in Wigan, Royal Bolton, Royal Oldham, St Mary's, Stepping Hill, Wythenshawe, North Manchester General and Tameside General; with Neonatal Intensive Care Units at St Mary's, Royal Oldham and Royal Bolton Hospitals.
Background to the decision to withdraw services from Hope
Consultation had been going on in Greater Manchester for some years regarding neonatal and paediatric care. By early 2004 the Greater Manchester Neonatal Network Board (GMNNB) had reached broad agreement on the future location of neonatal intensive care services. Their recommendation to the Children, Young People‟s and Families Network, who were to be tasked with consulting about the reconfiguration, was to retain St Mary‟s and have 2 other designated neonatal intensive care sites: ROH, Bolton and either Stockport or Wythenshawe.
It is not clear to us why Hope, the only other NNU accredited by the Royal College of Paediatrics and Child Health, was omitted as a designated neonatal intensive care site at this point. In response to the GMNNB‟s position and prior to their MIB consultation, in June 2004 the Children, Young People and Families‟ Network commissioned a report by Teamwork Management Services (TMS) ‘to make recommendations on how neonatal intensive and high dependency care should be configured in future, to improve the outcomes of care for babies, as well as explore the potential impact for parents, families and staff’. TMS was a leading clinical management and business strategy consultancy which specialised in redesigning health services. Their detailed report was published on 14 February 2005. It stated that the preferred option (1) would be to reconfigure these neonatal services onto 3 sites, adding ‘in terms of which sites should provide specialist neonatal care it is sensible to build on the existing, well-established and accredited units at St Mary’s and Hope hospital. There is no evidence from the service user, clinical or commissioning perspectives, or published audits available to this review, that either of these established services should be moved from the two existing hospital sites’ (p17). The Report therefore unequivocally recommended that Hope should be one of the designated sites.
The case for retaining full maternity services in Salford Sept 2010 Page 5
What happened to this report? It is not mentioned in any of the MIB statements in the public domain. This suggests that prior to the public consultation the Children‟s Network Board, following the GMNNB, had decided that Hope would not feature as an option for intensive and high dependency neonatal care - despite the fact that it was the only other RCPCH accredited unit apart from St Marys. One of the requirements for lawful consultation is that at the formative stage the team must have an open mind on the outcome. This background clearly demonstrates bias. Further, employing a consultancy is costly; this ignored report must surely constitute a waste of public money and put into question the motives of the Network Board in purposely excluding Hope from their proposals. Membership of the Network Board itself may have affected its ability to make objective decisions on these matters. It is interesting that the team then did not return to TMS for analysis of the responses to the MIB discussion paper but instead chose a different company, Tribal Consulting. This consultancy analysed the responses and came up with new options but none of these included Salford Royal, and therefore there was very little chance of maternity and neonatal services being retained at Hope. Hope was only included in the initial options as Option C after lobbying by local MPs.
The MIB consultation had a neonatal bias, focussing largely on the care of very low birth weight babies (1% of the total) at the expense of the wider issues for all mothers and babies. Anthony Emmerson, neonatologist and lead clinician for the GM Neonatal Network has been quoted in MIB press releases as saying: ‘It's about moving forward and improving outcomes for these tiny infants (Bury Times Thursday 30th August 2007) … we believe (the changes) will help to save the lives of up to 30 more babies every year’ (MIB press release 24 August 2007). The public consultation questions focused on the care for sick babies and children. This created bias as parent‟s responses to questions about how far they were prepared to travel for care of their sick baby (a rare occurrence) were interpreted to also mean they would be happy to travel the same distance for maternity care.
Although the MIB team has been self-congratulatory about the size and scope of the consultation, calling it the largest ever response to a health consultation in the UK, the community of Salford was in the main highly critical of the proposals. In Salford there was a large protest rally supported by local MPs and Salford Council. A petition against closure was signed by over 26,000 residents of Salford. Salford Council Health Scrutiny Committee referred the decision to the DH Independent Review Panel (IRP). Midwifery educationalists, supervisors of midwives and many clinicians expressed concerns about the proposals and about the consultation process itself to the Network Board and to the IRP, which unfortunately upheld it in June 2007.
In July this year, Andrew Lansley outlined new, strengthened criteria that he expects decisions on NHS service changes to meet. They must focus on improving patient outcomes; consider patient choice; have support from GP commissioners; and be based on sound clinical evidence (DH 2010).
He ordered that the decision to close Salford maternity be reviewed according to these criteria; this review is currently ongoing.
The case for retaining full maternity services in Salford Sept 2010 Page 6
The case for retaining full maternity and neonatal services in Salford
Health and well-being at birth have far reaching implications for health throughout life. Optimal maternity care should be that which aims to be effective, do the least harm and which takes account of women's experiences (NCT 2010). If maternity services were audited with this in mind then priority would be given to those units with low intervention rates, low caesarean rates and a high normal birth rate because these would the ones associated with reduced physical and psychological morbidity. These would also prove to be the units that were most cost-effective due to the PbR tariffs.
Reconfigurations leading to centralisation of services are often cited as justified as being cost effective and as a means of improving patient safety. The MIB reconfiguration can be challenged on this basis as it appears to have been predicated on consultant rotas meeting the Working Time Initiatives rather than being quality and safety driven (see MIB end of project report 2010). In August 2007 Andrew Lansley said of the Manchester MIB consultation: "It was clearly driven by pressures from the European Working Time Directive [to limit doctors' working hours] and it failed to adequately reflect how access to services impacts the overall quality of care. Our contention is that with suitable support, good risk assessment and a neonatal critical care transport service, more of the existing locally based obstetric units can be maintained."(BBC News 24 August 2007) We agree with this view.
If the hospitals affected by the review are analysed for the latest statistics (Drazek 2009) then it is obvious that Salford is both safe and cost-effective and in fact performs better on all indices than its neighbouring units (Fig 1):
Salford (3100 births)
Bolton (4400 births)
St Mary’s (4700 births)
North Manchester (2900 births)
Caesarean section
18%
23%
21%
23.3%
Instrumental
11%
8%
14%
10%
Inductions
11%
24%
25%
21.4%
Stillbirths
16
33
42
16
Closures
1
3
39
N/A
These figures show that maternity care offered at the proposed sites of St Mary‟s, North Manchester and Bolton will not be better than that at Salford Royal – indeed it is likely to be less effective. A focus on safety is necessary as litigation costs are very high, so care provided should be appropriate to the risks of the population. Salford Royal maternity unit holds a Level 3 certificate for CNST, the highest level, which means the Trust pays reduced insurance premiums. The unit is held in high esteem by local women and is often chosen by women who live out of the area which is also an indicator of its reputation as a safe and supportive place to give birth.
The case for retaining full maternity services in Salford Sept 2010 Page 7
The MIB document was based on the premise that the birth rate was falling: “The birth rate
nationally is falling so there will be fewer children and young people in the future” (p18) and
this meant that there was not a need for all the current maternity units to be retained. The
latest available statistics from ONS (2008) show that this assumption was mistaken. ONS
predicts that the population of fertile females is set to reduce in all areas in Greater
Manchester apart from Manchester, Salford and Trafford (Fig 2). With the establishment of
Media City at Salford Quays the Salford childbearing population is likely to increase beyond
that currently projected.
ONS 2008 based population Projections - GM Districts - Change in the
Number of Fertile Females (Aged 15-44) 2008-33
-5
0
5
10
15
20
Bolton
Bury
Manchester
Oldham
Rochdale
Salford
Stockport
Tameside
Trafford
Wigan
District
Change - Fertile Females (000s)
Fig 2
The reconfiguration of maternity services across Greater Manchester will reduce bed
capacity. This will impact on safety as women will be more likely to be diverted away from
their hospital of choice. We judge that the new unit at St Mary’s will be barely able to
meet the needs of its own population let alone that of Salford. Indeed the Local
Supervising Authority Annual Report to the Nursing and Midwives Council ( Drazek 2009)
has expressed concern about future capacity in Greater Manchester, stating: The temporary
closures… are of particular concern in view of the reconfiguration of maternity services
across Greater Manchester and the fact that this will significantly reduce capacity and bed
numbers further’(p63).
The network board has said that "flexibility" has been built in but has not given details of
what this means for women. Does it mean being discharged after 2 hours to „free up‟ beds, as
some units are doing, to reduce bed occupancy? Or women not being cared for on a labour
ward until they reach 6cm dilatation? Both these scenarios are currently occurring in other
The case for retaining full maternity services in Salford Sept 2010 Page 8
units due to pressure on beds. These are not safe practices and are not contributing to positive experiences for women and their families.
MIB placed a strong emphasis on reducing health inequalities and yet perversely has voted to close down the very unit in the area most in need of locally based services. Moving maternity and neonatal care out of the City will cause already disadvantaged families more hardship. Salford scores highly in all deprivation indices such as unemployment, reliance on social housing, reduced life expectancy, low birth weight and low car ownership. Specifically, 39.2% of Salford residents do not have access to a car as opposed to 26.8% of England‟s households. 12.5% of Salford residents are lone parent families against 9.5% of England‟s households (LINK 2009).
The proposal to retain only a stand-alone Midwifery Unit will result in only the healthiest, low risk women able to give birth in Salford, while women with complications will have to travel further. Ill health is higher in more deprived populations such as Salford therefore the reconfiguration will result in perpetuation of the „inverse care law‟ (Tudor Hart 1971) – those who need it most have the poorest care. Increased mortality and morbidity are recognised to be a consequence of poverty. Salford has a level 3 accredited unit for a very good reason - the residents of Salford need one!
In 2008 Local Involvement Networks (LINKs), were set up to give communities a stronger voice in how their health and social care services are planned and delivered. Local residents of Salford have identified and voted three top priorities for their first work plan: Access to local health and social care services. Promotion of healthy lifestyles Healthcare service provision (LINK 2010)
For 2010 – 2011 one of the top priorities identified by Salford residents was the need for access to LOCAL hospital services (LINK 2010). It is clear that Salford is a city that wishes its services, which include maternity and neonatal services, to remain located locally and to be of a high standard.
Public transport links to the proposed „super centres‟ from Salford are poor and not family friendly. The plans will unquestionably increase travelling times, put pressure on the ambulance service and possibly deter women from attending. Low car use amongst its population means that women will be less likely to easily access services or afford to travel to Manchester or Bolton. The MIB team did examine distances from Salford to other units but distance analysis is a crude measure and does not take into account aspects such as rush hour traffic, city congestion and public transport links. The MIB plans do not include plans for increased emergency support such as airlift for urgent maternity/neonatal cases at times of severe congestion/gridlock. In Liverpool, currently the largest maternity unit in the UK with around 8,000 births per year, 553 women gave birth unattended in 2008-9 (Drazek 2009). The reasons for this have yet to be examined but can be supposed to be down to geography and difficulty in accessing the service.
Large centres equal increased levels of management where the focus of care (i.e. care of women) may become lost. It is well recognised that midwives do not work well within these units and that care becomes fragmented (Ball et al 2002). Safety becomes an issue then as
The case for retaining full maternity services in Salford Sept 2010 Page 9
highlighted by the Healthcare Commission Report (2006). Bigger units mean that women are more likely to be left alone in labour and less likely to have the same midwife caring for them during labour (Statistics from Birthchoice UK). Large units also tend to stifle dissenting voices. For example, Liverpool Women‟s Hospital was found by the Health Care Commission in 2007 to have had 20% of staff suffer bullying, harassment or abuse from managers or colleagues and it failed to investigate serious claims of abuse. Such working environments are not conducive to woman centred care. Recruitment and retention of staff becomes difficult which adversely effects care (Ball et al 2002). It is not yet evident whether all Salford staff will transfer to the other units. Some have already left and others have cited a preference to taking early retirement rather than transfer site. This equals a loss of experience and skill sets, which has worrying implications, as the riskiest times for services are post merger. This is demonstrated by the Healthcare Commissions enquiries into maternity services at Ashford and St Peter‟s Hospitals and Northwick Park as well as the independent inquiry into maternity services at Wyre Forest Birth Centre. These reports illustrate problems of management and staff morale arising as direct or indirect consequences of mergers. Furthermore the loss of midwifery skills and experience which will follow as a consequence of the closure of Hope will impact upon the sound training of future midwives, consolidation of skills, and retention, with the risk of further increasing intervention rates.
Although the question of whether there is any association between the size of maternity units and the quality of their clinical care has never been systematically evaluated, the Healthcare Commission report (2006) into Northwick Park Hospital challenges any assumptions which may have been made about the safety and quality of care in very large units (Macfarlane 2008). The sustainability of very large units needs to be addressed. Large units are known to have frequent closures due to staffing pressures. St Mary‟s closed on 39 occasions last year and this is before Salford is scheduled to close. If this level were to continue women would be turned away more frequently with all the increased risk and anxiety that this entails. Closures put women at greater risk of complications.
Other European countries use improved neonatal transport networks to achieve excellent outcomes and their mortality rates are lower than ours (Bosanquet et al 2005). Their largest units care for no more than 4,000 births per year, supported by excellent networks for transfers to neonatal intensive care units for very low birth weight babies.
Salford has a long standing history of excellence in maternity care and has been a thriving referral centre for women with complications of pregnancy (including neurological and renal problems) due to the excellent regional specialist services provided by Salford Royal Foundation Trust. It is not clear where pregnant women requiring this specialist input would be cared for in the future. The acute trust has a team of highly skilled and committed staff which in turn has meant it has an enviable recruitment and retention rate. The team strives to be innovative and has been the forerunner in many aspects of care, which have been disseminated and recognised both nationally and internationally. The people of Salford need and deserve to retain this service.
The case for retaining full maternity services in Salford Sept 2010 Page 10
Report compiled by:
Sarah Davies, Senior Lecturer Midwifery University of Salford, Salford resident
Heather Rawlinson, Midwife, Salford resident
on behalf of the Keep Hope Maternity Open Campaign Group, 8th Sept 2010
REFERENCES
Ball, L., Curtis, P., Kirkham, M. (2002) Why do Midwives Leave? Women's Informed Childbearing and Health Research Group, University of Sheffield
BBC News (2007) Johnson backs maternity closures http://news.bbc.co.uk/1/hi/england/manchester/6961877.stm Accessed 6th Sept 2010
Bosanquet N, Ferry J, Lees C and Thornton J (2005) Maternity services in the NHS. Reform. http://www.reform.co.uk/Research/Health/HealthArticles/tabid/80/smid/378/ArticleID/596/reftab/69/t/Maternity%20services%20in%20the%20NHS/Default.aspx Accessed 5th Sept 2010
Commission for Health Improvement (2003) Maternity services – Ashford and St Peter’s Hospitals NHS Trust. London: Commission for Health Improvement,.
Department of Health (2010) Health Secretary outlines vision for locally led NHS service changes. Statement, 21 May 2010 http://www.dh.gov.uk/en/MediaCentre/Statements/DH_116290 Accessed 6 Sept 2010
Drazek, M (2009) North West Local Supervising Authority. Annual report to the
Nursing and Midwifery Council on the statutory supervision of midwives &
midwifery practice 2008-2009. NHS Northwest
http://www.northwest.nhs.uk/document_uploads/lsa/LSA%20Annual%20Report%2008-09%20%20final.pdf Accessed 6th Sept 2010
Greater Manchester Children, Young People and Families‟ NHS Network (2010)
A Network Approach to Achieving EWTD Compliance. End of Project Report
Health Care Commission (2006) Investigation into 10 maternal deaths at, or following delivery at, Northwick Park Hospital, North West London NHS Trust, between April 2002 and April 2005. London: DoH
Health Care Commission (2007) National NHS staff survey. Brief summary of results from Liverpool Women’s NHS Trust http://www.cqc.org.uk/_db/_documents/AH_NHS_staff_survey_2007_REP_sum.pdf. Accessed 6 Sept 2010
LINK (2009) Salford Annual Report. 2008 – 2009. Unlimited Potential, Salford
LINK (2010) Salford Annual Report. 2009 – 2010 Unlimited Potential, Salford
National Childbirth Trust (2010) Normal birth as a measure of the quality of care. London, NCT
South West Midlands Strategic Health Authority (2004) Maternity Services at Wyre Forest Birth Centre. Report of an independent inquiry under Section 2 of the NHS Act of 1977.
Tudor Hart J (1971) The inverse care law. The Lancet 27 February 1971
Keep Hope Maternity Open Campaign Group
http://www.keephopematernityopen.com
The case for retaining full maternity services in Salford
The case for retaining full maternity services in Salford Sept 2010 Page 2
Foreword, Lisa Kean, Chair of the Salford Maternity Forum
In July this year, Andrew Lansley ordered that the decision to close Salford maternity and neonatal services be reviewed, stating that decisions on service change must now meet four strengthened criteria. These criteria are that proposed changes must: focus on improving patient outcomes, consider patient choice, and be based on sound clinical evidence, as well as having support from General Practitioners (GPs). The Salford Maternity Forum has therefore commissioned this report which examines the case for retaining services at Salford, based on the first three criteria.
We are now sending this report to all GPs in Salford, as we believe it sets out a compelling case for retaining Salford‟s excellent maternity and neonatal services. We believe that it is not too late to reverse this wrong decision and ask for your support in achieving this, for the sake of Salford people now and in the future.
The case for retaining full maternity services in Salford Sept 2010 Page 3
Summary
1. The „Making it Better‟ (MIB) consultation was biased from the outset, as the Children, Young People and Families‟ Network team ignored a report they themselves had commissioned from TMS consultancy just prior to the consultation. This report in February 2005 stated unequivocally that Hope Neonatal Unit should be retained.
2. The proposals were based on the assumption that the birth rate was declining, whereas in Manchester and Salford the birth rate is projected to increase. Staff in local maternity units are currently struggling to cope; St Mary‟s, for example, was forced to close on 39 occasions last year. In its most recent report the North West LSA (the midwifery statutory supervisory body) has expressed concerns regarding future capacity if the reconfiguration goes ahead. Reduced capacity, with pressure on staffing and beds, will result in a less safe service for the majority of mothers and babies.
3. In 2008 Salford was designated the eighth best performing Trust for maternity care in England by the Health Care Commission. It has also achieved Level 3 in the Clinical Negligence Scheme for Trusts (the highest safety level, which means reduced insurance premiums). Maternity and neonatal care at Salford is therefore currently recognised as safe and effective, with lower intervention rates than in the surrounding hospitals. These enviably low intervention rates, achieved through sustained effort and teamwork, will be jeopardised by the closure. If intervention rates were to rise, care for Salford women would be not only less safe, with long term public health implications, but also more expensive.
4. The closure of Salford maternity would mean less choice for women in Salford. Even if a stand- alone midwifery led unit were to be retained, this would only cater for the healthiest women (around 500-600 per year).
5. The closure of Salford maternity and neonatal services would mean that women and their families would have to travel further, incurring greater expense and inconvenience than currently, and running an increased risk of giving birth before arriving at hospital. Salford has a high level of non car owners. The closure of an excellent unit serving a deprived population will result in perpetuation of the „inverse care law‟– those who need it most have the poorest care.
6. Bigger is not necessarily better when it comes to maternity care; evidence from this country and Europe suggests that smaller maternity units (supported by excellent networks for transfers to neonatal intensive care units for very low birth weight babies) have higher staff retention and better outcomes.
The case for retaining full maternity services in Salford Sept 2010 Page 4
The ‘Making it Better’ review
The „Making it Better‟ reconfiguration programme (MIB) was set up in 2004 by the Children, Young People and Families Network, to carry out a public consultation on reconfiguring children‟s, maternity and neonatal healthcare services across Greater Manchester. This then expanded to take in East Cheshire and High Peak and Rossendale, a review area with a population of around 3.1 million people. In July 2005, the Network published a discussion document, Making It Better (MIB). More than 120,000 copies of the document and 400,000 copies of an information leaflet were distributed. According to the MIB team, around 242,000 people had their say on the proposed changes during a 4-month public consultation and more than 55,000 formal written responses were received.
The discussion document suggested the creation of eight „Centres of Excellence‟ for maternity and children's services, with neonatal intensive care provided at three large specialist units. Option A, which had been identified by the team from the start as the „preferred option‟ was finally chosen at a meeting of 13 PCTs on 8th December 2006. Option A proposed Centres of Excellence at 8 sites: Royal Albert Edward Infirmary in Wigan, Royal Bolton, Royal Oldham, St Mary's, Stepping Hill, Wythenshawe, North Manchester General and Tameside General; with Neonatal Intensive Care Units at St Mary's, Royal Oldham and Royal Bolton Hospitals.
Background to the decision to withdraw services from Hope
Consultation had been going on in Greater Manchester for some years regarding neonatal and paediatric care. By early 2004 the Greater Manchester Neonatal Network Board (GMNNB) had reached broad agreement on the future location of neonatal intensive care services. Their recommendation to the Children, Young People‟s and Families Network, who were to be tasked with consulting about the reconfiguration, was to retain St Mary‟s and have 2 other designated neonatal intensive care sites: ROH, Bolton and either Stockport or Wythenshawe.
It is not clear to us why Hope, the only other NNU accredited by the Royal College of Paediatrics and Child Health, was omitted as a designated neonatal intensive care site at this point. In response to the GMNNB‟s position and prior to their MIB consultation, in June 2004 the Children, Young People and Families‟ Network commissioned a report by Teamwork Management Services (TMS) ‘to make recommendations on how neonatal intensive and high dependency care should be configured in future, to improve the outcomes of care for babies, as well as explore the potential impact for parents, families and staff’. TMS was a leading clinical management and business strategy consultancy which specialised in redesigning health services. Their detailed report was published on 14 February 2005. It stated that the preferred option (1) would be to reconfigure these neonatal services onto 3 sites, adding ‘in terms of which sites should provide specialist neonatal care it is sensible to build on the existing, well-established and accredited units at St Mary’s and Hope hospital. There is no evidence from the service user, clinical or commissioning perspectives, or published audits available to this review, that either of these established services should be moved from the two existing hospital sites’ (p17). The Report therefore unequivocally recommended that Hope should be one of the designated sites.
The case for retaining full maternity services in Salford Sept 2010 Page 5
What happened to this report? It is not mentioned in any of the MIB statements in the public domain. This suggests that prior to the public consultation the Children‟s Network Board, following the GMNNB, had decided that Hope would not feature as an option for intensive and high dependency neonatal care - despite the fact that it was the only other RCPCH accredited unit apart from St Marys. One of the requirements for lawful consultation is that at the formative stage the team must have an open mind on the outcome. This background clearly demonstrates bias. Further, employing a consultancy is costly; this ignored report must surely constitute a waste of public money and put into question the motives of the Network Board in purposely excluding Hope from their proposals. Membership of the Network Board itself may have affected its ability to make objective decisions on these matters. It is interesting that the team then did not return to TMS for analysis of the responses to the MIB discussion paper but instead chose a different company, Tribal Consulting. This consultancy analysed the responses and came up with new options but none of these included Salford Royal, and therefore there was very little chance of maternity and neonatal services being retained at Hope. Hope was only included in the initial options as Option C after lobbying by local MPs.
The MIB consultation had a neonatal bias, focussing largely on the care of very low birth weight babies (1% of the total) at the expense of the wider issues for all mothers and babies. Anthony Emmerson, neonatologist and lead clinician for the GM Neonatal Network has been quoted in MIB press releases as saying: ‘It's about moving forward and improving outcomes for these tiny infants (Bury Times Thursday 30th August 2007) … we believe (the changes) will help to save the lives of up to 30 more babies every year’ (MIB press release 24 August 2007). The public consultation questions focused on the care for sick babies and children. This created bias as parent‟s responses to questions about how far they were prepared to travel for care of their sick baby (a rare occurrence) were interpreted to also mean they would be happy to travel the same distance for maternity care.
Although the MIB team has been self-congratulatory about the size and scope of the consultation, calling it the largest ever response to a health consultation in the UK, the community of Salford was in the main highly critical of the proposals. In Salford there was a large protest rally supported by local MPs and Salford Council. A petition against closure was signed by over 26,000 residents of Salford. Salford Council Health Scrutiny Committee referred the decision to the DH Independent Review Panel (IRP). Midwifery educationalists, supervisors of midwives and many clinicians expressed concerns about the proposals and about the consultation process itself to the Network Board and to the IRP, which unfortunately upheld it in June 2007.
In July this year, Andrew Lansley outlined new, strengthened criteria that he expects decisions on NHS service changes to meet. They must focus on improving patient outcomes; consider patient choice; have support from GP commissioners; and be based on sound clinical evidence (DH 2010).
He ordered that the decision to close Salford maternity be reviewed according to these criteria; this review is currently ongoing.
The case for retaining full maternity services in Salford Sept 2010 Page 6
The case for retaining full maternity and neonatal services in Salford
Health and well-being at birth have far reaching implications for health throughout life. Optimal maternity care should be that which aims to be effective, do the least harm and which takes account of women's experiences (NCT 2010). If maternity services were audited with this in mind then priority would be given to those units with low intervention rates, low caesarean rates and a high normal birth rate because these would the ones associated with reduced physical and psychological morbidity. These would also prove to be the units that were most cost-effective due to the PbR tariffs.
Reconfigurations leading to centralisation of services are often cited as justified as being cost effective and as a means of improving patient safety. The MIB reconfiguration can be challenged on this basis as it appears to have been predicated on consultant rotas meeting the Working Time Initiatives rather than being quality and safety driven (see MIB end of project report 2010). In August 2007 Andrew Lansley said of the Manchester MIB consultation: "It was clearly driven by pressures from the European Working Time Directive [to limit doctors' working hours] and it failed to adequately reflect how access to services impacts the overall quality of care. Our contention is that with suitable support, good risk assessment and a neonatal critical care transport service, more of the existing locally based obstetric units can be maintained."(BBC News 24 August 2007) We agree with this view.
If the hospitals affected by the review are analysed for the latest statistics (Drazek 2009) then it is obvious that Salford is both safe and cost-effective and in fact performs better on all indices than its neighbouring units (Fig 1):
Salford (3100 births)
Bolton (4400 births)
St Mary’s (4700 births)
North Manchester (2900 births)
Caesarean section
18%
23%
21%
23.3%
Instrumental
11%
8%
14%
10%
Inductions
11%
24%
25%
21.4%
Stillbirths
16
33
42
16
Closures
1
3
39
N/A
These figures show that maternity care offered at the proposed sites of St Mary‟s, North Manchester and Bolton will not be better than that at Salford Royal – indeed it is likely to be less effective. A focus on safety is necessary as litigation costs are very high, so care provided should be appropriate to the risks of the population. Salford Royal maternity unit holds a Level 3 certificate for CNST, the highest level, which means the Trust pays reduced insurance premiums. The unit is held in high esteem by local women and is often chosen by women who live out of the area which is also an indicator of its reputation as a safe and supportive place to give birth.
The case for retaining full maternity services in Salford Sept 2010 Page 7
The MIB document was based on the premise that the birth rate was falling: “The birth rate
nationally is falling so there will be fewer children and young people in the future” (p18) and
this meant that there was not a need for all the current maternity units to be retained. The
latest available statistics from ONS (2008) show that this assumption was mistaken. ONS
predicts that the population of fertile females is set to reduce in all areas in Greater
Manchester apart from Manchester, Salford and Trafford (Fig 2). With the establishment of
Media City at Salford Quays the Salford childbearing population is likely to increase beyond
that currently projected.
ONS 2008 based population Projections - GM Districts - Change in the
Number of Fertile Females (Aged 15-44) 2008-33
-5
0
5
10
15
20
Bolton
Bury
Manchester
Oldham
Rochdale
Salford
Stockport
Tameside
Trafford
Wigan
District
Change - Fertile Females (000s)
Fig 2
The reconfiguration of maternity services across Greater Manchester will reduce bed
capacity. This will impact on safety as women will be more likely to be diverted away from
their hospital of choice. We judge that the new unit at St Mary’s will be barely able to
meet the needs of its own population let alone that of Salford. Indeed the Local
Supervising Authority Annual Report to the Nursing and Midwives Council ( Drazek 2009)
has expressed concern about future capacity in Greater Manchester, stating: The temporary
closures… are of particular concern in view of the reconfiguration of maternity services
across Greater Manchester and the fact that this will significantly reduce capacity and bed
numbers further’(p63).
The network board has said that "flexibility" has been built in but has not given details of
what this means for women. Does it mean being discharged after 2 hours to „free up‟ beds, as
some units are doing, to reduce bed occupancy? Or women not being cared for on a labour
ward until they reach 6cm dilatation? Both these scenarios are currently occurring in other
The case for retaining full maternity services in Salford Sept 2010 Page 8
units due to pressure on beds. These are not safe practices and are not contributing to positive experiences for women and their families.
MIB placed a strong emphasis on reducing health inequalities and yet perversely has voted to close down the very unit in the area most in need of locally based services. Moving maternity and neonatal care out of the City will cause already disadvantaged families more hardship. Salford scores highly in all deprivation indices such as unemployment, reliance on social housing, reduced life expectancy, low birth weight and low car ownership. Specifically, 39.2% of Salford residents do not have access to a car as opposed to 26.8% of England‟s households. 12.5% of Salford residents are lone parent families against 9.5% of England‟s households (LINK 2009).
The proposal to retain only a stand-alone Midwifery Unit will result in only the healthiest, low risk women able to give birth in Salford, while women with complications will have to travel further. Ill health is higher in more deprived populations such as Salford therefore the reconfiguration will result in perpetuation of the „inverse care law‟ (Tudor Hart 1971) – those who need it most have the poorest care. Increased mortality and morbidity are recognised to be a consequence of poverty. Salford has a level 3 accredited unit for a very good reason - the residents of Salford need one!
In 2008 Local Involvement Networks (LINKs), were set up to give communities a stronger voice in how their health and social care services are planned and delivered. Local residents of Salford have identified and voted three top priorities for their first work plan: Access to local health and social care services. Promotion of healthy lifestyles Healthcare service provision (LINK 2010)
For 2010 – 2011 one of the top priorities identified by Salford residents was the need for access to LOCAL hospital services (LINK 2010). It is clear that Salford is a city that wishes its services, which include maternity and neonatal services, to remain located locally and to be of a high standard.
Public transport links to the proposed „super centres‟ from Salford are poor and not family friendly. The plans will unquestionably increase travelling times, put pressure on the ambulance service and possibly deter women from attending. Low car use amongst its population means that women will be less likely to easily access services or afford to travel to Manchester or Bolton. The MIB team did examine distances from Salford to other units but distance analysis is a crude measure and does not take into account aspects such as rush hour traffic, city congestion and public transport links. The MIB plans do not include plans for increased emergency support such as airlift for urgent maternity/neonatal cases at times of severe congestion/gridlock. In Liverpool, currently the largest maternity unit in the UK with around 8,000 births per year, 553 women gave birth unattended in 2008-9 (Drazek 2009). The reasons for this have yet to be examined but can be supposed to be down to geography and difficulty in accessing the service.
Large centres equal increased levels of management where the focus of care (i.e. care of women) may become lost. It is well recognised that midwives do not work well within these units and that care becomes fragmented (Ball et al 2002). Safety becomes an issue then as
The case for retaining full maternity services in Salford Sept 2010 Page 9
highlighted by the Healthcare Commission Report (2006). Bigger units mean that women are more likely to be left alone in labour and less likely to have the same midwife caring for them during labour (Statistics from Birthchoice UK). Large units also tend to stifle dissenting voices. For example, Liverpool Women‟s Hospital was found by the Health Care Commission in 2007 to have had 20% of staff suffer bullying, harassment or abuse from managers or colleagues and it failed to investigate serious claims of abuse. Such working environments are not conducive to woman centred care. Recruitment and retention of staff becomes difficult which adversely effects care (Ball et al 2002). It is not yet evident whether all Salford staff will transfer to the other units. Some have already left and others have cited a preference to taking early retirement rather than transfer site. This equals a loss of experience and skill sets, which has worrying implications, as the riskiest times for services are post merger. This is demonstrated by the Healthcare Commissions enquiries into maternity services at Ashford and St Peter‟s Hospitals and Northwick Park as well as the independent inquiry into maternity services at Wyre Forest Birth Centre. These reports illustrate problems of management and staff morale arising as direct or indirect consequences of mergers. Furthermore the loss of midwifery skills and experience which will follow as a consequence of the closure of Hope will impact upon the sound training of future midwives, consolidation of skills, and retention, with the risk of further increasing intervention rates.
Although the question of whether there is any association between the size of maternity units and the quality of their clinical care has never been systematically evaluated, the Healthcare Commission report (2006) into Northwick Park Hospital challenges any assumptions which may have been made about the safety and quality of care in very large units (Macfarlane 2008). The sustainability of very large units needs to be addressed. Large units are known to have frequent closures due to staffing pressures. St Mary‟s closed on 39 occasions last year and this is before Salford is scheduled to close. If this level were to continue women would be turned away more frequently with all the increased risk and anxiety that this entails. Closures put women at greater risk of complications.
Other European countries use improved neonatal transport networks to achieve excellent outcomes and their mortality rates are lower than ours (Bosanquet et al 2005). Their largest units care for no more than 4,000 births per year, supported by excellent networks for transfers to neonatal intensive care units for very low birth weight babies.
Salford has a long standing history of excellence in maternity care and has been a thriving referral centre for women with complications of pregnancy (including neurological and renal problems) due to the excellent regional specialist services provided by Salford Royal Foundation Trust. It is not clear where pregnant women requiring this specialist input would be cared for in the future. The acute trust has a team of highly skilled and committed staff which in turn has meant it has an enviable recruitment and retention rate. The team strives to be innovative and has been the forerunner in many aspects of care, which have been disseminated and recognised both nationally and internationally. The people of Salford need and deserve to retain this service.
The case for retaining full maternity services in Salford Sept 2010 Page 10
Report compiled by:
Sarah Davies, Senior Lecturer Midwifery University of Salford, Salford resident
Heather Rawlinson, Midwife, Salford resident
on behalf of the Keep Hope Maternity Open Campaign Group, 8th Sept 2010
REFERENCES
Ball, L., Curtis, P., Kirkham, M. (2002) Why do Midwives Leave? Women's Informed Childbearing and Health Research Group, University of Sheffield
BBC News (2007) Johnson backs maternity closures http://news.bbc.co.uk/1/hi/england/manchester/6961877.stm Accessed 6th Sept 2010
Bosanquet N, Ferry J, Lees C and Thornton J (2005) Maternity services in the NHS. Reform. http://www.reform.co.uk/Research/Health/HealthArticles/tabid/80/smid/378/ArticleID/596/reftab/69/t/Maternity%20services%20in%20the%20NHS/Default.aspx Accessed 5th Sept 2010
Commission for Health Improvement (2003) Maternity services – Ashford and St Peter’s Hospitals NHS Trust. London: Commission for Health Improvement,.
Department of Health (2010) Health Secretary outlines vision for locally led NHS service changes. Statement, 21 May 2010 http://www.dh.gov.uk/en/MediaCentre/Statements/DH_116290 Accessed 6 Sept 2010
Drazek, M (2009) North West Local Supervising Authority. Annual report to the
Nursing and Midwifery Council on the statutory supervision of midwives &
midwifery practice 2008-2009. NHS Northwest
http://www.northwest.nhs.uk/document_uploads/lsa/LSA%20Annual%20Report%2008-09%20%20final.pdf Accessed 6th Sept 2010
Greater Manchester Children, Young People and Families‟ NHS Network (2010)
A Network Approach to Achieving EWTD Compliance. End of Project Report
Health Care Commission (2006) Investigation into 10 maternal deaths at, or following delivery at, Northwick Park Hospital, North West London NHS Trust, between April 2002 and April 2005. London: DoH
Health Care Commission (2007) National NHS staff survey. Brief summary of results from Liverpool Women’s NHS Trust http://www.cqc.org.uk/_db/_documents/AH_NHS_staff_survey_2007_REP_sum.pdf. Accessed 6 Sept 2010
LINK (2009) Salford Annual Report. 2008 – 2009. Unlimited Potential, Salford
LINK (2010) Salford Annual Report. 2009 – 2010 Unlimited Potential, Salford
National Childbirth Trust (2010) Normal birth as a measure of the quality of care. London, NCT
South West Midlands Strategic Health Authority (2004) Maternity Services at Wyre Forest Birth Centre. Report of an independent inquiry under Section 2 of the NHS Act of 1977.
Tudor Hart J (1971) The inverse care law. The Lancet 27 February 1971
Monday, 20 September 2010
Cllr Lindley to resign?
Cllr Iain Lindley will be deciding whether or not to resign as Tory planning spokesman after most of his group either abstained or voted with Labour when he urged them to oppose the waste plan.
There are more compelling reasons for him to resign other than lacking the confidence of his group.
The waste plan recognises our duty in Greater Manchester to deal locally with the waste we produce and, as far as is technically possible, to stop burying it underground.
The plan encourages a shift to new technologies which allow us to use waste as a resource through recycling and turning it into renewable energy.
These new ways of dealing with waste require developments that are virtually indistinguishable from the typical manufacturing industry found on industrial estates.
Furthermore they bring with them new ‘green collar’ jobs which is a growing sector.
The plan also beefed up the controls on waste management facilities.
Cllr Lindley’s opposition to the green shift in waste management policy is a betrayal of future generations and would weaken the power of the Council to stop inappropriate development. For that alone he should resign.
More seriously, he vowed to carry out a campaign to scare people about the possibility of the high tech. modern facilities going on to industrial estates.
This cynical attempt to manipulate people and create unnecessary fear for electoral reasons is the reason he should resign.
He did not fool his own party who rejected his views. The public should not be fooled by his immature and irresponsible campaigning.
Councillor Derek Antrobus
Lead Member for Planning
There are more compelling reasons for him to resign other than lacking the confidence of his group.
The waste plan recognises our duty in Greater Manchester to deal locally with the waste we produce and, as far as is technically possible, to stop burying it underground.
The plan encourages a shift to new technologies which allow us to use waste as a resource through recycling and turning it into renewable energy.
These new ways of dealing with waste require developments that are virtually indistinguishable from the typical manufacturing industry found on industrial estates.
Furthermore they bring with them new ‘green collar’ jobs which is a growing sector.
The plan also beefed up the controls on waste management facilities.
Cllr Lindley’s opposition to the green shift in waste management policy is a betrayal of future generations and would weaken the power of the Council to stop inappropriate development. For that alone he should resign.
More seriously, he vowed to carry out a campaign to scare people about the possibility of the high tech. modern facilities going on to industrial estates.
This cynical attempt to manipulate people and create unnecessary fear for electoral reasons is the reason he should resign.
He did not fool his own party who rejected his views. The public should not be fooled by his immature and irresponsible campaigning.
Councillor Derek Antrobus
Lead Member for Planning
Thursday, 16 September 2010
Monday, 13 September 2010
Disabled people protest against cuts that will KILL
The Conservative party's summer conference will be host to some of the most important protests of recent times.
Birmingham on Sunday October 3 will see disabled people from across the UK unite to rally against the drastic welfare cuts proposed by the Coalition, which are set to hit disabled people hardest.
The cost of the cuts will push disabled people, of whom three-quarters already live in poverty, towards levels of destitution that should be a distant memory in a first world society.
Campaigners say this group are being unfairly picked on by direct and indirect cuts because they are seen as an easy target.
Like many on the lowest incomes disabled people bear the brunt of the austerity drive. The cost of the cuts will mean some essential care and support is lost, meaning some cuts are quite likely to be life threatening.
Disability benefits designed to pay the extra costs of disability and originally awarded for a lifetime term are being reassessed. Many who were certified by medically qualified and independent doctors are losing their meagre incomes to politically appointed and performance incentivised ATOS assessors.
Data from the National Equalities Panel shows that over three quarters of all disabled people live in poverty with a tenth of disabled women attempting to live on less than 31 pounds a week. Yet ATOS makes millions in profits. This is part of the new economy of Britain.
Cuts in housing benefits, cuts in services, the closure of the Independent Living Fund, job losses in the public sector and VAT increases will impact severely on the poorest in society - however it is disabled people who might just pay the ultimate cost - their lives.
Linda Burnip said: Disabled people will be descending on Birmingham on October 3rd to tell all politicians that enough is enough. We are fed up with being vilified as scroungers by successive governments, we are sick of hearing about disabled people who have died from neglect and lack of services or who have committed suicide because services and benefits were withdrawn from them. We are fed up with being unfairly picked on because we are seen as vulnerable and we want to make sure politicians know we will not accept these attacks on our lives any longer. As disabled people we can and will fight back, and we plan to start in Birmingham on October 3rd.
Thanks to Salfordonline for this story
Birmingham on Sunday October 3 will see disabled people from across the UK unite to rally against the drastic welfare cuts proposed by the Coalition, which are set to hit disabled people hardest.
The cost of the cuts will push disabled people, of whom three-quarters already live in poverty, towards levels of destitution that should be a distant memory in a first world society.
Campaigners say this group are being unfairly picked on by direct and indirect cuts because they are seen as an easy target.
Like many on the lowest incomes disabled people bear the brunt of the austerity drive. The cost of the cuts will mean some essential care and support is lost, meaning some cuts are quite likely to be life threatening.
Disability benefits designed to pay the extra costs of disability and originally awarded for a lifetime term are being reassessed. Many who were certified by medically qualified and independent doctors are losing their meagre incomes to politically appointed and performance incentivised ATOS assessors.
Data from the National Equalities Panel shows that over three quarters of all disabled people live in poverty with a tenth of disabled women attempting to live on less than 31 pounds a week. Yet ATOS makes millions in profits. This is part of the new economy of Britain.
Cuts in housing benefits, cuts in services, the closure of the Independent Living Fund, job losses in the public sector and VAT increases will impact severely on the poorest in society - however it is disabled people who might just pay the ultimate cost - their lives.
Linda Burnip said: Disabled people will be descending on Birmingham on October 3rd to tell all politicians that enough is enough. We are fed up with being vilified as scroungers by successive governments, we are sick of hearing about disabled people who have died from neglect and lack of services or who have committed suicide because services and benefits were withdrawn from them. We are fed up with being unfairly picked on because we are seen as vulnerable and we want to make sure politicians know we will not accept these attacks on our lives any longer. As disabled people we can and will fight back, and we plan to start in Birmingham on October 3rd.
Thanks to Salfordonline for this story
Monday, 6 September 2010
SAVE HOPE MATERNITY UNIT.
Well done to all who turned up at The Born In Salford Rally on Saturday. A Fantastic turnout and very well organised. Special mentions for Lisa Kean & Heather Rawlinson for pulling it all together.
We will now continue to work to put pressure on Andrew Lansley and the relevant bodies to ensure we keep our maternity unit in Salford so that future generations of Salfordians are born in Salford.
Keep signing the petitions and and lobby your GP's.
Thursday, 2 September 2010
Sarkozy's Roma Purge.
Having done work for the Council of Europe around the Roma population and their continuing persecution across Europe, I couldn't agree more with the sentiments of this editorial from today's Independent.
By the letter of the European law, Nicolas Sarkozy has the right to expel immigrant Roma from France and break up their settlements. Although the two countries where the majority of Roma have long been settled, Romania and Bulgaria, are now members of the EU, until 2014 their citizens are only allowed to stay in other EU states for a maximum of three months, unless they have jobs there.
So M. Sarkozy – whose ministers met European Union officials this week to defend their actions – can claim that he is merely upholding the law. And, technically, there are other justifications he can summon for his initiative, which has seen more than 600 Roma put on flights to Eastern Europe since July, and more than 8,000 expelled so far in the course of the year. It is an "offensive sécuritaire", because the Roma pose a security threat; it is an "action humanitaire", a "voluntary repatriation" of individuals whom the French government is generously presenting with gifts of a few hundred euros to start afresh. And it is a blow against human trafficking.
Nobody should be fooled by this rhetoric. In hard times, when politicians feel the lash of people's anger, there is nothing more satisfactory than a good scapegoat. And the Roma have always been the ideal scapegoat, being not only visually distinctive but also poor and atomised. To an increasingly intolerant element within France, and many others in Western Europe, gypsies are an insult to the settled way of life, and certain ideas about property, education and work.
They are, in other words, the perfect victims, and M. Sarkozy would not be the crafty politician he is if he did not see in them an excellent opportunity to steal a march on Jean-Marie Le Pen's National Front. There is evidence that his campaign is already paying dividends in the opinion polls.
The risk now, after objections were raised when the expulsions started at the end of July, is that the matter is forgotten about. But that must not be allowed to happen. Hitler did not target gypsies because they were a security threat but because in the Nazi scheme they were labelled as genetically inferior. The rationale was different, but the impulse was the same, and so were the victims. Wrapped into our belief in progress is the idea that we learn from history, and that collectively we have the wisdom to avoid repeating the more terrible mistakes of the recent past. M. Sarkozy's Roma purge is a reminder that we ignore that lesson at our peril.
By the letter of the European law, Nicolas Sarkozy has the right to expel immigrant Roma from France and break up their settlements. Although the two countries where the majority of Roma have long been settled, Romania and Bulgaria, are now members of the EU, until 2014 their citizens are only allowed to stay in other EU states for a maximum of three months, unless they have jobs there.
So M. Sarkozy – whose ministers met European Union officials this week to defend their actions – can claim that he is merely upholding the law. And, technically, there are other justifications he can summon for his initiative, which has seen more than 600 Roma put on flights to Eastern Europe since July, and more than 8,000 expelled so far in the course of the year. It is an "offensive sécuritaire", because the Roma pose a security threat; it is an "action humanitaire", a "voluntary repatriation" of individuals whom the French government is generously presenting with gifts of a few hundred euros to start afresh. And it is a blow against human trafficking.
Nobody should be fooled by this rhetoric. In hard times, when politicians feel the lash of people's anger, there is nothing more satisfactory than a good scapegoat. And the Roma have always been the ideal scapegoat, being not only visually distinctive but also poor and atomised. To an increasingly intolerant element within France, and many others in Western Europe, gypsies are an insult to the settled way of life, and certain ideas about property, education and work.
They are, in other words, the perfect victims, and M. Sarkozy would not be the crafty politician he is if he did not see in them an excellent opportunity to steal a march on Jean-Marie Le Pen's National Front. There is evidence that his campaign is already paying dividends in the opinion polls.
The risk now, after objections were raised when the expulsions started at the end of July, is that the matter is forgotten about. But that must not be allowed to happen. Hitler did not target gypsies because they were a security threat but because in the Nazi scheme they were labelled as genetically inferior. The rationale was different, but the impulse was the same, and so were the victims. Wrapped into our belief in progress is the idea that we learn from history, and that collectively we have the wisdom to avoid repeating the more terrible mistakes of the recent past. M. Sarkozy's Roma purge is a reminder that we ignore that lesson at our peril.
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