The problem with NHS outsourcing


Waltham Forest CCG announcing the launch of Neighbourhood Midwives in November 2016 (credit neighbourhoodmidwives.org.uk)

Local service collapse shows NHS outsourcing doesn’t work, argues Norma Dudley from Waltham Forest Save Our NHS (WFSONHS)

Jeremy Hunt, in 2016 when he was the health secretary, promised that maternity services in England would enable women to choose personalised continuity of care, from a small team of named midwives, throughout their pregnancy, labour, and post-natal experience.

Although this sounds wonderful, health professionals found it difficult to see how it could be achieved when we were experiencing the biggest sustained fall in NHS spending for any period since 1951.

That same year Waltham Forest Clinical Commissioning Group (CCG) agreed a two-year contract with Neighbourhood Midwives; a social enterprise and private provider whose chief executive, Anne Francis, was a member of NHS England’s maternity review team at the time.

This was Neighbourhood Midwives’ first NHS contract, and they started caring for pregnant women in Waltham Forest in November 2016. The service was popular and clinically effective. A report to Waltham Forest Council’s health scrutiny committee in March 2018 found that the number of home births and use of the midwife-led Lilac Unit at Whipps Cross Hospital had increased among women using Neighbourhood Midwives.

The contract was therefore extended until November 2019. So imagine the shock when expectant mothers were given one week’s notice that the service would close on 31st January. During the remainder of their pregnancy the women would have to rely on mainstream NHS services, mostly from Whipps Cross.

The sudden demise of Neighbourhood Midwives demonstrates why outsourcing NHS services ultimately does not work, either for patients or taxpayers, if we want a safe reliable and comprehensive public healthcare system.

Despite what’s often said, the NHS has been rated one of the most cost effective healthcare systems in the developed world. Private providers are required to make a profit, which they can only do either by charging more to the taxpayer or by reducing the quality of healthcare provided. Neighbourhood Midwives, while providing excellent care, ran into serious financial difficulty reporting that “the payment system based on tariffs was not designed for small independent providers”.

This exemplifies the risk of independent providers going bust; the NHS then picks up the pieces. It cares for sick patients with complex needs that the private sector will not touch, and however much it is overstretched and faces funding cuts, it never closes for business.

Importantly, outsourcing also undermines the NHS, by diverting funding from local services. The only realistic way that any health minister could ensure all women have a personalised maternity service would have been to significantly increase the funding of all NHS maternity services across the country; a strategy which WFSONHS would wholeheartedly recommend.