Category Archives: Women

I can’t recommend this film – which focuses mainly on older political activists campaigning for the NHS – too highly.
(Statement of competing interests: I feature briefly in the film)

Pensioners United

Directors: Phil Maxwell, Hazuan Hashim

Country: UK

Running Time: 75′

Year: 2018

A potent account of a passionate group of pensioners who unite together to fight for a better life for themselves and those who will follow them. Starring Jeremy Corbyn, Harry Leslie Smith, the late Tony Benn, and thousands of inspirational pensioners from across the UK.
~ Allyson Pollock

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For everyone who couldn’t make the Conference, here is Alison Scouller’s ( Vice Chair ) speech. An audio file is also posted.

Jean Hardiman Smith

Hello Alison Scouller here, sorry I can’t be with you. These are my thoughts to accompany the SHA discussion document before you. We decided to write this policy as part of our wider policy work, as we had no statement of the SHA’s perspective on maternity care.
I’m a retired midwife who worked in hospital, community and latterly as a midwifery lecturer in South Wales. To devise a policy I took inspiration from the Save Liverpool Women’s Hospital campaign’s manifesto for maternity and worked initially with two Welsh members, Billie Hunter, Professor of Midwifery and Gill Boden who is a campaigner for AIMS, and another Midwifery Professor Mavis Kirkham from Sheffield as well as liaising with our secretary Jean Hardiman Smith. Since then we have revised the policy considerably, following suggestions and contributions from Central Council members.
We have taken on board the particular concerns of the Liverpool campaigners in the context of the creeping privatization of the English NHS, but in writing this policy we had to have a policy which is applicable across the UK. Therefore the first paragraph sets this out. .
We decided that the right to access contraception and abortion that should form part of another document about reproductive rights, including fertility treatment, and that here we should focus on care for pregnancy.
As you can see in point 1) we put the importance of addressing poverty centre stage, and the overarching importance of good nutrition from pre to post pregnancy, in fact throughout everyone’s life! We decided not to be too specific on particular public health measures, as our policy has to be applicable in different versions of the NHS and the wider context. We also included the issue of other forms of stress and their detrimental effect on pregnancy outcomes, both in terms of women and babies.
The next 2 points emphasize the importance of those at the centre of maternity care needing to be listened to, whether it’s about their own individual situation or in terms of general observations about how care should be. Planning for care should of course reflect diversity in all communities. In order to address inequalities in society, whilst all should receive the same level of care, extra provision should be there for some, as was recognized by previous Labour Governments in projects such as Sure Start.
We went on to identify issues related to specific stages in pregnancy itself, having covered the pre pregnancy period. In point 6) Antenatal care is clearly crucial to ensure that women are aware of as many aspects of their health as possible, such as family history, normal physiological changes of pregnancy, Body Mass Index , any pathological conditions already present or precipitated by pregnancy, and how these may impact on their pregnancy outcomes. It needs to be accessible as early in pregnancy as needed. It should be as local to women as possible and include at least one home visit, unless the woman does not wish for this, with her named midwife.
When we talk about antenatal education this does not mean in a formal, school type environment but can range from physically meeting in a group setting with a midwife to having education available on CDs, online and via social media. It’s not just about being given information for example about how labour may progress but also learning practical skills to cope with it, such as exercise and relaxation. It’s also about what happens after the birth and coping strategies for parents. The social and support aspects of women and family members meeting with others going through a similar experience are usually the most valued by those enjoying group education. Of course specific needs have to be catered for, so that some women may prefer to attend women only groups and prefer less formal settings.
The evidence for the effects of adverse childhood experiences on people’s ability to be good parents is now quite compelling, hence point 7)
In relation to point 8) We know from research and experience that women’s wishes in relation to place of birth are determined by many factors, and these are very varied. Health care professionals must strive to provide as much evidence based information to enable women and their families to make the right choices for them. All places of birth carry some risks, with home birth and stand alone birth centres there are always concerns about access to ‘back up’ in emergencies. On the other hand there are risks associated with unnecessary intervention (mistimed, inappropriate and even dangerous) in childbirth, both in terms of mortality but also morbidity of mothers and babies I think Lesley page coined the phrase ‘too much too soon, too little too late’ to summarise the problems unfortunately still occurring. The other thing to bear in mind is the importance of antenatal care and education in ensuring safe outcomes. If that care is as it should be, then women at risk of complications are less likely to have poor outcomes because care will have been tailored to mitigate those complications.
Moving on to point 9) we identify the importance of continuity of care. This can be difficult to achieve in cash strapped services but has been consistently shown in research and other feedback to be a key concern for women and promotes positive outcomes.
Finally we put in relation to after birth, points 10) and 11). Physical, emotional and mental health are equally important here. Increasing breastfeeding rates would make a huge difference to children’s health, yet initiation and continuation of breastfeeding rates in the UK remain low. Once again peer support has been shown to be critical to breastfeeding success, as well as support from midwives and health visitors.
In the past, care of women’s mental health has lacked coordination between midwives, health visitors, GPs and community mental health nurses. Equally where babies have been compromised by maternal complications before or during birth and/or being born preterm then neonatal special and intensive care cots should to be available as needed.

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For everyone who couldn’t make the Conference, here is Jessica’s speech to our Fringe meeting on the future of Women’s health that I referred to earlier in a members email.

Jean Hardiman Smith

 

Thank you for inviting me to speak to you today. My name is Jessica Ormerod. I run a research and information organisation called Public Matters with my lovely friend and colleague Deborah Harrington.
Although we write about all aspects of the NHS and other public services, I have a particular interest in maternity. I have been writing about maternity issues for seven years since I was the chair of the maternity services liaison committee for Lewisham Hospital which coincided with our fight to save our maternity services. We won that fight but we have by no means won the war because as you know maternity services up and down the country are being closed and downgraded.
But before anything else I want to paint the picture of what is happening to the NHS as a whole. Because every closed maternity ward, service or reduction in staff is the direct result of changes to the NHS that have been happening since the 2012 Health and Social Care Act. These changes are having a devastating impact on access to care. It is no exaggeration to say that we are witnessing the reversal of 70 years of universal, comprehensive and equitable care.
The 2012 Health and Social Care Act put into place all the major elements for a step change in the privatisation of the NHS.

A QUANGO called NHS England was formed as the Commissioner-in-Chief of the service, with over 200 subordinate local commissioning units. These commissioning units broke with the tradition of planning services, replacing it with buying in from public, private and voluntary sector providers. Areas of work are subdivided into contractable units and NHS public providers are obliged to compete. The loss of a contract means loss of income, which has a knock-on effect on the viability of the public sector, which is left with high cost acute care and a reduced income.

In 2014 a new CEO was appointed to run the NHS in England. He created a new plan for the NHS, the Five Year Forward View and this was greeted by the establishment as a welcome antidote to what was seen as the fragmented mess left by the 2012 Act (this was only a mere 18 months on from it being enacted). But it’s important to recognize that far from being an accident, the Act achieved the fragmentation necessary for privatisation to be embedded at an organisational level, including many major health industry players taking key roles in the commissioning and policy-making process.

At the heart of NHS England’s Five Year Forward View is the idea that the NHS in England will never again be funded to a level that maintains its services in the way they are run now. It puts together a series of proposals for change which are not just cuts but are about a fundamental reshaping of how services are provided. Expensive specialist and emergency care are relocated to centralised hubs and more care is to be delivered in the community via partnerships with local authorities. There is an aspiration for fewer emergency admissions with an improvement to overall health which it argues will lead to less dependency on NHS services.

We could say the scope of this aspiration is far reaching or we could say it is pie in the sky. It not only assumes the NHS can cope with a growing population without corresponding growth in services but that it will do so with a reduced service with much of the change becoming the responsibility of local authorities.

The process of transforming the NHS in England, is based on close co-operation between successive politicians and Department of Health managers over many years with the US Health Maintenance Organisation or Accountable Care Organization principles of managed care. This process is continuing without any checks and balances of substance within the formal organisational structures of government. Politicians go to great lengths to deny both privatisation and US influence on the current changes.

There is, however, a groundswell of resistance to the damage being done to the NHS and there is a lot of knowledge surrounding individual service contractions and closures, but little in the public domain about the overall programme of change. And that is what I am here to talk about today.

The National Maternity Review, aka Better Births – A Five Year Forward View for Maternity Care, is one of the Five Year Forward View’s New Models of Care. It emphasises community care delivered through local hubs with a theoretical reduced demand on hospital services. It recommends an increase in independent sector providers and introduces Personal Care Maternity Budgets. Personal Care Budgets commoditise and monetise the system. They add layers of unnecessary complication, increase expense, fragment accountability and lead to an accounting nightmare.
44 Local Maternity Systems have been established. The systems have been introduced without consultation, peer review, pilot studies or effective oversight from public health or parliamentary scrutiny. They are small-scale Integrated Care Systems. Unlike the Integrated Care Organisations which are now under consultation, they have been put into place with very little fanfare or institutional opposition.
As with all the changes to the NHS currently taking place, there is a real problem that rhetoric about better care closer to home is not matched by real resources or access to physical structures like hospitals. NHS England consistently refers to services being more important than organisations but fail to fill in the blanks about how this works. They also insist that travelling in order to receive excellent care is not a concern to patients. There is no acknowledgment that time, expense and severity of health condition all very much effect the distance people are able to travel regardless of the excellence of the service at the end of the journey.
In the case of maternity, these questions of distance and the emphasis on community care run two different risks. The first being the potential for increase of emergencies outside hospital setting. The second is that mothers might be taken in to hospital for assisted birth or caesarean in order to pre-empt risk arising.
But what makes maternity different from other services?
Most people use health services most at the beginning and end of their lives. Pregnant women are the exception to this. During pregnancy women come into more contact with the NHS than they probably have ever done in their lives. This is particularly the case if they have a complicated pregnancy or birth. Healthy women can become profoundly unwell during pregnancy and they can be vulnerable to life-threatening complications during birth. That’s why it is so important that women have all levels of care within easy access.
Until now maternity services have been provided in the most part by the NHS. Women have always been free to employ a private midwife. But the NHS has a duty to provide a midwife at every birth even if a private midwife is also in attendance.
Maternity services are woven through the traditional structure of the NHS. Women see their midwife at home or at their local GP. They receive a minimum of two scans to check the baby’s progress and health at the local hospital. If they have a pre-existing condition or they develop a pregnancy-related illness then their specialist will work alongside the maternity team to ensure that the woman and baby are safe and as healthy as possible throughout the pregnancy.
Currently women can give birth at home, in a ‘stand-alone’ facility run by midwives, ‘co-located midwifery unit’ – that’s a midwife-run facility on hospital grounds, or in an obstetric unit which includes doctors and surgical theatre. Obstetric units can only be sited in hospitals with A&E because they require acute services which is blood, air and surgeons. A woman can become dangerously ill very quickly during birth so timely access to acute care is essential.
Put this into the context that since 2010 maternity services have been starved of funds and there has been a staff recruitment and retention crisis. Many maternity units have already been downgraded or closed, hundreds of GP practices have also closed so women already travel further to receive care. This means it costs more and takes more time to see a midwife, GP or hospital doctor. It also means longer emergency transfer times. The risk is this will only get worse once the STPs restructuring of the NHS is complete.
Who is driving the changes to maternity?
Surprise, surprise, Better Births panel includes private health providers and those private companies are working with government to re-write policy.
Although most current providers are NHS hospitals, private providers are now being strongly encouraged. Local Maternity Systems set their own payment systems. This means that they can choose whether they pay via their geographical population or they can pay per activity or service. However, they do not follow established budget areas; they do not share boundaries with CCGs or Local Authorities even though they rely on budgets from both. Across the country there is now a mish-mash of payment systems. The risk is that women will fall through the gaps.
NHS Trusts have been ‘incentivised’ to adopt Better Births by offering a chance to win ‘pioneer funding’ to speed up the transition to the New Models of Care. In November 2016, Seven ‘early adopter’ sites started to implement the recommendations – I don’t need tell you about this because you’re part of it! The sites were told to be bold and radical. Another incentive is ‘the maternity challenge fund’ which instructs successful trusts ‘to explore innovative ways to use women’s and their partners’ feedback to improve maternity services’. A pioneer site is not the same as a pilot test site.
LMSs are encouraged to work alongside private providers in order to offer women a wider choice. As most women have previously been cared for by the NHS this simply means opening the door to the private sector. In a climate of serious staff shortages, it is possible that some midwives may see the benefit of setting up an independent midwifery practice rather than staying in the NHS. Despite protestations to the contrary, this does actually reduce the ‘NHS offer’ and opens an income stream for public money to be handed over to the private sector.
Better Births tells us it is working on a new accreditation scheme for maternity providers. But in a publicly provided NHS service, this is unnecessary because the NHS trains staff to a professional standard.
Private providers are required to have a contract with the NHS in order to receive payment via a Personal Care Budget. It is claimed that the budgets (which are described as ‘notional’) will demonstrate to CCGs the kinds of choices women make during pregnancy, birth and postnatally. This will apparently encourage CCGs to respond to women by increasing their offer. The claim is that this will also empower women. But it is decidedly unclear about how this can be achieved. The guidance talks about using Personal Care Budgets for birth pools, place of birth settings or breastfeeding support but all of this should be available to every woman regardless of a personal care budget. In fact, all of these used to be available to women as part of the normal care given by the NHS.
Moreover, it precludes the notion that women become ill in pregnancy. No one chooses to get gestational diabetes, pre-eclampsia, HELLP or any other life-threatening condition. What happens when your health needs change but you’ve used up your £3000 on hypno-birthing? There should be real concern about the potential lack of access to obstetric care when women have serious complications of pregnancy. Or to return to the issue of financial balance, if £3000 is a notional budget for a normal birth which can be used up in a number of ways then the acute hospital will potentially have to pick up the cost of the emergency care without a matching budget.
What does this all mean?
Scale and pace have taken precedence over caution and evidence. Academic research will take years to catch up to establish the public health consequences of this new policy.
This is a top-down reorganisation of a national service with little to no consultation, pilot schemes, peer review, oversight or risk assessment. A Health Select Committee inquiry into the maternity transformation plan was not completed because of the 2017 election. It has not been re-opened.
The Vice-Chair of the maternity transformation programme finishes his report with the following advice to LMSs: Be Bold! Don’t wait for instruction!
Clearly long gone are the years of epidemiological study, of public health planning, of consultation with experts.
Better Births is based on consumer choice issues around personalised maternity care. There is a serious lack of evidence that this restructuring will give women the vital services they need. There are fewer services, obstetric departments are being stretched even further and technology is replacing face-to-face clinical care.

On the other hand, it embeds private care and fee-for-service. And, most importantly of all this is not how a national public service works.

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For those who were unable to attend Conference, here is Dr Coral Jones speaking at the conference.

https://www.youtube.com/watch?v=q7oiIeuQfqk&feature=share

Jean Hardiman Smith

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Stella Creasy’s proposal and its significance for the entire UK

The decisive victory of the campaign to repeal the Eighth Amendment of the Constitution of Ireland – which banned abortion unless necessary to save the life of the pregnant woman – has had a seismic impact in the UK. The 1967 Abortion Act, which made abortion up to 28 (later 24) weeks’ gestation legal in Britain was never extended to Northern Ireland, meaning that in order to access abortion, women must make long and arduous journeys to Britain. The Irish referendum result provoked immediate calls for reform north of the border, with campaigners’ rallying cry now being ‘the North is next.’

Should there be an abortion referendum in Northern Ireland?

While some commentators have suggested that there could be an equivalent referendum on abortion in Northern Ireland, this is not necessary. In the Republic of Ireland, a referendum is required in order to alter the Constitution. There is no such requirement in order to legalise abortion in Northern Ireland, which is still governed by abortion laws created at Westminster in the 19th century. And not only isn’t a referendum needed, it is also not wanted by many abortion rights campaigners – they argue that human rights should not be subject to public mood.

Calls for action at Westminster are therefore growing louder. These were hashed out in an emergency debate on 5 June, secured by Labour MP Stella Creasy and a cross-party group of mostly female MPs. In the debate, Creasy presented abortion access as a human rights issue, noting the UN Committee on the Elimination of Discrimination Against Women’s condemnation of the UK for criminalising abortion in Northern Ireland.

Stella Creasy’s proposal

Creasy and her allies will now push to amend the UK government’s forthcoming domestic abuse bill to allow reform in Northern Ireland. Specifically, they call for the repeal of sections 58 and 59 of the 1861 Offences Against the Person Act, which criminalise the procurement of ‘any poison or other noxious thing’ or the use of ‘any instrument’ with the intent of inducing abortion. These reforms would not impose specific legislation on Northern Ireland, but rather would prompt Stormont to create its own legislative framework for regulating abortion.

The incredible thing about Creasy’s proposal is that it would not simply extend the 1967 Abortion Act to Northern Ireland, but bring about the wider decriminalisation of abortion across Britain. The contested sections of the Offences Against the Person Act in fact also apply to England and Wales (abortion has been a devolved issue in Scotland since 2016). The 1967 Abortion Act did not undo this criminalisation, but rather provided exemptions in certain circumstances, usually requiring the agreement of two doctors that the pregnancy poses a risk of injury to the physical or mental health of the pregnant woman. If the relevant sections of the Offences Against the Person Act are repealed, abortion in later stages of pregnancy would still be illegal, due to the Infant Life (Preservation) Act of 1929 which criminalises abortion of ‘a child capable of being born alive’.

In her opening speech, Creasy contended that extending the Abortion Act to Northern Ireland would not be adequate. The Act, Creasy argued, represents ‘paternalism that says women are not to be trusted to make choices about their bodies’. The fact that the Act does not grant a legal right to access abortion, but places restrictions on how and why an abortion can be carried out, causes problems. The need to obtain two doctors’ permission places unnecessary delays on the process of accessing abortion, and also restricts the ability of clinics to provide nurse- or midwife-led care. The requirement for medical oversight in the provision of early medical abortions can result in women miscarrying on their way home from the clinic instead of having the option to delay the process until they are in the privacy and comfort of their own home.

Reformists therefore want to see change not only in Northern Ireland, but also around the UK. The current campaign builds on a bill introduced by Diana Johnson MP in 2017, which also aimed to decriminalise abortion in England and Wales. This bill would also have repealed sections 58 and 59 of  the Offences Against the Person Act. It passed its first reading by 172 votes to 142. As an item of backbench legislation, the bill was unlikely to progress further, but it was a significant gauge of parliamentary opinion.

Just how much do these developments mean?

And yet, these demands would have been unthinkable until recently. Outside of Parliament, campaigners have been calling for decriminalisation for some time. But within Parliament, the mood has been different. When I was researching for my PhD thesis between 2010 and 2014, MPs – however pro-choice they might be in private – were reticent to call for such a significant reform. Those I interviewed suggested that the parliamentary ‘climate’ was wrong for reform and spoke of the need to defend the Abortion Act. Inadequate as it may be, they argued, it is at least reasonably workable. They emphasised the potential dangers of opening the Act up for debate.

What Creasy’s emergency debate represents, then, is not just a step forward for reproductive rights in Northern Ireland. It is broader than that: it means that MPs now feel able to push for liberalisation rather than defend the status quo. It also means that the campaign for abortion rights in Northern Ireland is becoming more fundamentally linked with reproductive rights campaigns in Britain as the roots of criminalisation in Westminster law-making are more fully recognised.

Achieving reform will not be easy, of course. The current UK government is reticent to upset the staunchly anti-abortion DUP, with some commentators predicting that this issue could even ‘topple’ Theresa May. Despite the reformists’ argument that to repeal the Offences Against the Person Act would not impose legislation on Stormont, the Secretary of State for Northern Ireland, Karen Bradley, cautioned in the debate against ‘disenfranchising’ Northern Irish citizens. Theresa May has privately told MPs that she believes that change is impossible. But there are signs of divisions within the Conservative Party, with the Minister for Women and Equalities, Penny Mordaunt, tweeting that if Northern Ireland doesn’t act, ‘we will’.

First published on the British Politics and Policy blog

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Almost a million adults have currently given up paid work to care for friends and relatives. Most of these unpaid carers are women and in large part they are exiting the labour market because social care provision is inadequate. Meanwhile, life for the women who are paid to provide social care has become much harder. As social care provision has been eroded, they have faced a regressive, sexist, and systematic subordination of their interests as women, and because they are women.

The inadequacy of equal pay law

In 1997, most care workers were employed by local authorities and received an employer-funded pension, pay when sick, and the security of 37 hours a week of regular work. However, female care workers were underpaid in relation to men in comparable work. State employers promised that within a decade they would eliminate sexist wages and provide the care workforce with equal pay. This simply didn’t happen. Instead, sexism in wage-setting was effectively put on steroids through privatisation: the care workforce of today is employed in jobs which carry less than half the financial value of the jobs that care workers occupied 20 years ago. A systematic degradation has also been made possible by the utter inadequacy of equal pay law. Evidently, the Equal Pay Act 1970, and provisions in the Equality Act 2010 which replaced it, are not fit for purpose.

Equal pay law was supposed to ensure that the blight of sexism in pay-setting was eradicated. Not so for care workers. Where women do not work in close proximity to men, equal pay law offers very little and prevents women from comparing their wages to those of men who do not work for the same employer. It is a widespread misunderstanding that equal pay law protects the wages of women: it does not. Rather, the right to equal pay prevents male wages from being undercut. Inadequacies in equal pay law perpetuate the historic subordination of women in low-waged work, prevent care workers from achieving economic independence, and exemplify the economic invisibility of skills and abilities which are thought to arise ‘naturally’ in women.

The inadequacy of minimum wage law

The financial crisis of 2007/2008 heralded UK labour market changes in which care work became the largest source of low-waged work for women. The real value of the national minimum wage fell each year until 2014. For more than a decade, politicians and policy-makers were aware of minimum wage law being flouted in the social care industry. Nothing was done despite voluminous evidence that huge numbers of care workers were paid unlawfully low wages.

In various forms, non-compliance with national minimum wage law has continued even though the state is the main customer as well as the regulatory overseer of the social care industry. When the social care minimum wage scandal of 2017 highlighted that thousands of care workers were paid nothing more than pocket-money to ensure the overnight well-being of vulnerable adults, employers were outraged that they should have to pay care workers what was legally owed. The government’s initial response was to suspend the full enforcement of minimum wage law in the social care sector; months later, it implemented an industry-specific exception scheme in which care workers will not receive all the wages to which they are entitled until March 2019 and employers will avoid penalty fines.

The inadequacy of statutory pay protection

Yet a lack of political interest in enforcement has not been the only minimum wage issue to blight care workers’ earnings. Care workers are failed by the current right to a minimum wage where their work is not recognised as ‘work’ for the purposes of statutory pay protection. Regulations exempt the work of co-habiting family members paid as care workers via direct payments from minimum wage protection. Regulations also exempt the work of care workers who live-in and are treated ‘like family’ by their employers from minimum wage protection. In case law, the work of carers who are contractually required to remain on-site during lengthy shifts is not automatically recognised as ‘work’. Judges have devised special tests to apply when care workers bring minimum wage claims. Unlike the situation facing other workgroups, it is not enough for care workers to simply be present because their contract requires it: they must additionally show they are busy, needed, working alone or carrying special responsibility for others.

The engrained culture of non-payment

The National Minimum Wage Act 1998 and its accompanying regulations were supposed to communicate the universal value of paid work but do not require employers to pay for all the hours they require a worker to work. The scheme merely calculates a minimum wage total to be met or exceeded when pay is averaged across all hours worked. Although the right to a minimum wage was supposed to prevent exploitation, it has become standard industry practice for care workers to work for free during increasingly large parts of each working day. For example, in 2014, homecare employers calculated that workers were unpaid for an average of 19% of their working time due to non-payment of travel time between clients. On top of this, they were routinely unpaid for time spent training, waiting for ambulances or other healthcare professionals, time spent waiting for co-workers to help them lift heavy clients, time spent in supervision meetings with management – and the list goes on. An engrained culture of non-payment in the care industry has been made possible by the inadequacy of UK minimum wage law.

Why all this matters

Hands-on care work is the UK’s most highly female-segregated occupation. Traditionally, women are expected to provide care for free within families and they continue to provide the vast majority of unpaid work at home. A sex-based ideology about women’s subservience to the needs of others still circulates in the contemporary labour market, and minimum wage law does not do enough to assert the value of care work.

There are two million workers in adult social care, the vast majority of them women. If we continue to tolerate care workers being employed to work without pay, the future of care work will be based on sexist expectations that care work should be done for free. Unless we stand up and demand that carers’ skills attract decent economic reward, the future of social care will be based on the idea that caring skills are ‘natural’ for women and don’t have to be paid for. Until the wages of care workers are free from sexist devaluation, and until the work of care workers is fully recognised, the labour of all women is devalued.

First published on the British Politics and Policy blog

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A group of individuals in Northern Irish politics obstructs change

In a matter of months, the Republic of Ireland will hold a referendum on repealing the eighth amendment of the constitution and paving the way for legal abortion for the first time in the country. With both the Taoiseach, Leo Varadkar, and the leader of the opposition, Micheál Martin, declaring that they will campaign for repeal, and with the electorate broadly supportive of the move, change looks likely. Following only three years on from the country’s historic same sex marriage referendum, Ireland appears to be moving from one of the more socially conservative countries in western Europe to one which is signalling a new, liberal dawn.

By contrast, Northern Ireland has not seen similar sea changes. Same sex marriage remains illegal and the 1967 Abortion Act, which legislates for the procedure in England, Scotland, and Wales does not apply. Abortion is only allowed in a very small number of cases in Northern Ireland, and is not automatically legal in instances of rape, incest, or fatal foetal abnormality. Although Northern Irish women can now access abortions on the NHS in England, thanks to Stella Creasy’s amendment to the Queen’s speech, this does nothing to change the strict legal situation in Northern Ireland, nor does it help with the financial costs of travelling for the procedure.

The absence of policy movement in either of these areas is often chalked up to Northern Ireland’s difference, especially the strength of Christianity (both Protestant and Catholic) within its population. Indeed, in the wake of the DUP confidence and supply arrangement with Theresa May’s government, much was made of the DUP’s social conservatism in the British press and Northern Ireland’s variance from the rest of the UK.

Yet the restrictive situation in Northern Ireland can equally be explained through the politics and institutions of the region. Abortion in particular has long been a political football in Northern Irish politics following devolution. As early as 2000, the Assembly debated the motion that it was ‘opposed to the extension of the 1967 Abortion Act to Northern Ireland’, despite the fact that there was no attempt from Stormont or Westminster to do so. Following a 2004 ruling, the Department of Health at Stormont was ordered to produce guidance for medical professionals outlining the specific circumstances in which termination of pregnancy was legal. It took until 2016 for this guidance to be officially released, the intervening years seeing a period of legal and political blockades thrown at them. In 2012, a Marie Stopes clinic opened in central Belfast, operating under the strict legal parameters that Northern Ireland allows for, and has excited much political debate and energy at Stormont in the years since.

For much of Northern Ireland’s devolved period therefore, abortion has been a political stumbling block. In particular, a handful of key individuals have driven this pattern of obfuscation and resistance. Jim Wells, who stepped down as Stormont Health Minister in 2015 following comments he made about homosexual parenting, has been a key critic of any attempts to change abortion law, and instigated a debate on the issue in Stormont in 2000. In the mid-2000s, Iris Robinson lead the way in trying to ensure that proposed guidelines around abortion were obstructed via the Assembly. In 2013, Paul Girvan DUP MLA and Alban Maginness SDLP MLA attempted to outlaw any private abortion providers in Northern Ireland which would have closed down the newly opened Marie Stopes clinic in central Belfast.  These individuals have come from very different political parties and from across the ethno-national divide. Although mostly men, this largely reflects the male-dominated make-up of the Northern Irish Assembly.

Feminist political scientists have long employed the concept of ‘critical actors’ to refer to key individuals who instigate positive change within political institutions. Stella Creasy’s amendment, discussed above, is one such example of an individual politician working to enact huge change. Using the example of Northern Irish abortion politics following devolution, I argue for an understanding of conservative critical actors as well as progressive critical actors.

Over a period of years, movement on abortion has been stalled, not just by the male-dominated nature of the political institution, nor by party policy on the issue, but also, as detailed above, by a key group of individuals in Northern Irish politics. When considering why some policies are difficult to change, or even to implement at all, consideration must be given to the actions of individual members of political institutions. The role that they can play in encouraging or obstructing policy change can be as important as the role of parties, formal rules or the nature of political institutions themselves. This has been the case in Northern Ireland, where a small number of critical actors have obstructed change on abortion for many years.

Attempts to change abortion policy at the moment are also not helped by the fact that Northern Ireland is facing one of its most challenging political periods in decades. With the Assembly suspended now for over a year, and talks to reinstate it failing in February, the hope for reform any time soon appears bleak. Should direct rule occur, Westminster will have the power to enact change on abortion in the region. With reform so long stymied in Belfast, the transfer of powers to London may open the door for abortion change in Northern Ireland.

First published on the British Politics and Policy blog

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The CCG have decided to restrict discussion on the future of the hospital to just one option, not the four explicitly
promised.

The North of England Clinical senate has advised on this single option. The North of England Clinical senate is not a neutral body but one that works within the Government plans for the NHS, which includes privatisation and shrinking services. It is not a neutral body.

  • The move will be massively costly, over £10 million. This at a time the Royal College of Nursing says nursing staff shortages are compromising patient care, staffing is so tight that patients can be left to die alone. The removal of bursaries is hitting recruitment.
  • Services across the country are being restricted.
  • The actual problems at the Liverpool Women’s Hospital cannot wait the 5 years or so a new building might take, The neonatal unit needs to expand and update, the blood services (not just at LWH) and imaging need to be improved, now.
  • Maternity care facilities are being cut across the country and the pernicious Maternity Review is being
    implemented. This area is a maternity vanguard area. They are on record as saying they want women to give
    birth at home, not in a hospital. See our facebook for the video
  • The US model of care to which the NHS moving, does not cater well for maternity. Texas has the highest
    maternal mortality rates in the developed world
  • The NHS in the north of England (covered by the NHS Senate,that penned,the report) also said,
    Women in labour can safely travel four hours without risk to their baby.
  • Many hospitals are on more than one site, including both the Liverpool Royal and Arrowe Park, yet it is said to be too dangerous for the Liverpool Women’s to be a mile away from an acute hospital? One mile away is dangerous, we are told, yet women giving birth at home could be many miles away.
  • At Free Standing midwife units, (unlike the alongside midwife led unit at our hospital) one in four women need to be transferred to hospital. On that basis, this must also be dangerous. Yet four hours travel in labour is safe?
  • Most of the cost problems in Liverpool Women’s hospital come from the internal structures and systems of
    the internal market in the NHS.
  • The Maternity Vanguard are intent on setting up a “pop up” maternity unit to “explore women’s choices”. No mention of the choices tens of thousands of women have indicated in our petition. Choosing our choices
    for us it seems.
  • The NHS needs to be fully funded with more beds doctors and nurses and midwives and related professions.
  • The STPs and accountable care organisations are a risk to the whole NHS, free at the point of need,  publicly provided and a universal service. Merseyside and Cheshire STP is one of the largest.
  • PFI hospital building has wasted billions of pounds of taxpayer money and not one is fire safe. The private companies get the fees and profits and guess who pays to make these brand new hospitals fire safe?
  • Staff still work under the pay cap and many cannot make ends meet. What does Hunt the health secretary offer? An app to let you do more shifts.
  • Not one mention of the major problems of traffic pollution at the proposed site which especially damages babies in the womb and new borns. The site proposed will include the Cancer centre and a life sciences commercial building, bringing in still more traffic. Can we have some joined up thinking please?

How you can be involved?

Invite our campaign to meet a group of your friends or your organisation. Ask us to your union meeting. Come to a campaign meeting. Leaflet your street.

Contact us on facebook

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The historic 1967 Abortion Act is 50 years old this month, yet this fundamental part of women’s health care continues to be a fiercely contested issue. There are still politicians who want to turn back the clock and win support for complete opposition to all abortions in any circumstances. Tory MP Jacob Rees Mogg declared this as his view only last month, although his position was swiftly undermined by revelations that he profits from shares in a pharmaceutical company that produces abortion pills.

Rees Mogg’s desire to deny women any rights to legal abortion is a minority one in Britain. Here a clear majority, 70 percent in the most recent British Attitudes Survey, support a woman’s right to choose. But there is no room for complacency when women in one part of the UK, Northern Ireland, have no right to abortion unless they travel to Britain. The 1967 Act was never extended to Northern Ireland and thousands of women needing an abortion have had to cross the Irish Sea to access a legal termination. As an added injustice, until recently they also had to pay for it. This was only overturned in June after the snap general election when the Tories courted the anti abortion Democratic Unionist Party for support to win the Queens Speech. The ensuing outcry forced Theresa May to ditch the requirement for women from Northern Ireland to pay for terminations.

Today the increasing vocal pro-choice side is highlighting the plight of women living in countries where abortion is banned, including on both sides of the Irish border. In the Republic of Ireland more than 40,000 people poured through the streets of Dublin on Saturday for the sixth annual March for Choice to demand a repeal of the eighth amendment to Ireland’s constitution. This amendment deems the rights of an embryo equal to those of the woman carrying it, at any stage of the pregnancy. This law against abortion doesn’t stop abortions happening, it simply exports them. Thousands of women are forced to travel to England to enable them to take control their own fertility. Over 200,000 women have travelled to Britain from Ireland to have an abortion since the 8th amendment was enacted in 1983.

After last year’s March for Choice, the Irish government handed the issue to a Citizens’ Assembly to examine and debate. The Assembly came out with a clear call for a change in the law, showing just how much attitudes are changing in Ireland. Last week the government finally announced it would hold a referendum on the question in 2018. This provides opportunity to overturn more than a century of anti-abortion legislation in the country, which up to 2013 included the 1861 Offences Against the Person act. This archaic law is still in place in Britain and it makes having or carrying out an abortion a criminal act punishable by life imprisonment. The 1967 Abortion Act did not replace this act, instead it created exceptions to allow legal abortions when certain conditions are fulfilled.

Even 50 years ago these conditions were restrictive, now when the majority of abortions are carried out by taking pills they are an oppressive anachronism. The website Women on Web reported that they receive requests from women living in Britain for abortion pills because access to abortion services is limited by the requirements of the law. The reasons women gave for contacting the website included the distance from a clinic providing abortion care, long waiting times, childcare responsibilities and the difficulty of getting time off work. But any woman in Britain who uses pills bought online potentially risks a prison sentence because of the strict controls over how abortion services are provided.

This is a situation that cannot hold. The Royal College of Obstetricians and Gynaecologists joined the British Medical Association and the Royal College of Midwives last week in calling for abortion in Britain to finally be removed from criminal law and be treated as simply a medical issue.

Repressive laws and attitudes to women’s rights to control their own bodies are being challenged across the globe. While online access to sites such as Women on Web saves lives, millions have no access even to this service. The World Health Organisation estimates that 25 million abortions globally are unsafe, that’s almost a half of all terminations.

In Britain the fight is on to defend the rights won by past generations but to also extend those rights to allow genuine reproductive choices. Whatever the utterances of anti abortion campaigners such as Rees Mogg, pro-choice activists are on the march and determined to win the long-running abortion wars.

First published on the Policy Press blog

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We call for protection of women’s rights:

  • Guaranteeing family friendly employment terms and conditions affecting morale, recruitment retention of women including Lesbian, Gay, Bisexual and Transgender people.
  • Fertility control In Vitro Fertilisation, contraception and abortion access: thus protecting women’s mental health, finances and family stability
  • Safe childbirth for every woman. Risk assessment for home births (evidence of deaths increasing)
  • Reverse the outsourcing of maternity services.
  • Increased support for carers, to improve health and protect people from poverty.
  • Integrate the care system with the National Health Service to be free at the point of use, paid for by taxation.
  • Employ nurses in care homes and improve training and terms for care workers.

Equality:

We call for protection of women’s rights with respect to equality which addresses:

  • the long-term impact of domestic abuse, in the widest context, on health
  • the impact of gynaecological intervention that harms women internally e.g. mesh implants and externally e.g. Female Genital Mutilation.
  • the impact of caring on mothers of children who have specific and higher needs over their lifetime
  • the effect on women refugees and European Union migrants of the new United Kingdom Comprehensive Sickness Insurance regulations involving healthcare charging
  • the quality of and accessibility to women’s mental health services, including primary post-partum treatments.

This is to be presented to the Labour Party Women’s Conference 2017

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