A meeting of the Merseyside and Cheshire Integrated Care Board may sound like bit of a dull affair but on Thursday January 26 it was anything but.
The meeting was taking place at Wirral's Floral Pavilion building bringing together NHS, health and social care partners from across the region. Things were well underway until the meeting was suddenly suspended about an hour-and-a-half in.
This is because a group of protestors had began to loudly vocalise their feelings towards an item being discussed by the board. After a few minutes of increasingly heated back and forth the board's chair Raj Jaine announced that the meeting would be adjourned.
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The item the protestors were exercised about concerned the future of Liverpool Women's Hospital and the results of a 'Liverpool Clinical Services Review' which they believe will be the beginning of the end for the women's hospital as it currently stands.
Services review
The services review being discussed at the board meeting was carried out by London-based consultancy Carnall Farrar and conducted over a 16-week period between August and December last year. Its objective was to "identify ways in which to improve outcomes and ensure clinical and financial sustainability of acute and specialist services delivered by NHS providers in Liverpool".
Liverpool is said to be "exceptional" in the number of specialists trusts it has - including the Women's, the Heart and Chest Hospital and the Walton Centre for neurology - and there are concerns amongst some there is a growing desire to reduce the number of these trusts. The findings of the review - ordered by NHS England - and some of the language used is unlikely to have tempered these concerns.
While looking at all trusts in the city, the first 'critical priority' mentioned by the board regards "solving the clinical sustainability challenges affecting women’s health in Liverpool".
So what are the concerns about Liverpool Women's Hospital?
The Clinical Services Review states that 'overwhelmingly' the challenge that needs addressing is the "clinical sustainability of services for women in Liverpool and the associated clinical risk".
It states: "The Liverpool Women’s Hospital NHS FT main hospital site at Crown Street is isolated from other adult services in Liverpool meaning it is less able to manage acutely-ill or rapidly deteriorating patients, women with complex surgical needs and significant medical co-morbidities.
It adds: "The consequence of this is that women and babies are transferred by ambulance between sites to receive the care they need. Liverpool Women's Hospital has the one of highest rate of transfers in the country for mothers and their babies with 11 transfers for every 1,000 discharges. While many risks have been mitigated or worked around, stakeholders spoke extensively about their concerns for the safety of women and babies whose condition deteriorates while within the hospital and the subsequent risk of being transferred across the city."
Previous proposals for change
The Liverpool Women's Hospital only opened in its current Toxteth home in 1995 but has been the subject of a number of proposals for its closure or relocation - as well as the subject of plenty of campaigns against any such moves.
Since 2015, Liverpool Women's Hospital NHS Foundation Trust has argued that patient safety would be improved by re-locating the service close to a major acute hospital where patients can be quickly transferred in emergencies.
In 2016 plans were announced to move Liverpool Women's Hospital out of its home under a major NHS shake-up. The preferred proposal was for maternity and women's services to be relocated to a new £100m facility next to the new Royal Liverpool Hospital - which had been intended to open the following year but would go on to be delayed by five years.
Other proposals included a £100m facility that would built next door to Alder Hey Children's Hospital.
These proposals sparked large campaigns, protests and rallies by those desperate to keep the Women's Hospital on its current site and as an individual facility for the women of the city. As those at the Floral Pavilion last week witnessed, that campaign continues passionately today.
The trust has been unsuccessful in previous attempts to secure capital funding from the Department of Health and Social Care in recent years, but in July 2021 the Government invited bids for eight new hospitals across the UK.
A £150m proposal submitted aimed to see a new building connected to either the soon-to-open new Royal Liverpool Hospital or to Aintree Hospital by a footbridge - with the Royal a considerably more likely option. This bid was also unsuccessful.
So what is being proposed now?
Well at the meeting of the Integrated Care Board last week, leaders were very clear to state that there are no current proposals to change or move the Women's Hospital on the table currently. But that doesn't mean they aren't coming down the line.
The board's chief executive Graham Unwin told those protesting that what was being voted on was not a future decision about the hospital but the next process to look at improving healthcare. He said there would be “no change to these services without a proper consultation” and denied it would just be a paper exercise.
He said the board of the Women’s Hospital NHS Trust believed there were elements of the service which were not safe and would struggle to maintain patient safety in the long term - even struggling to recruit staff in some areas. Mr Unwin added: "“We are concerned about the safety and sustainability of these services but we have made no decision about what the answers should be.”
While this may well be the case, looking through the clinical services review that board members were instructed to approve last week, the idea of 'co-locating' services for women on a larger acute site like the Royal Liverpool Hospital clearly remains the favoured one.
The review says that in terms of the Women's, work should "begin by 'reconfirming and strengthening the current case for change". It moves onto explicitly spell out the benefits of 'co-locating' women's services on one larger hospital site, adding: "Optimal clinical co-location of services would result in improved patient safety, outcomes, and experience, through enhanced provision of clinical necessary services.
"Furthermore, co-location would expand the development of world-leading services for women and babies in Liverpool building on the existing research portfolio and strengthening the resilience of the workforce."
In its raft of recommendations concerning women's health and the future of Liverpool Women's Hospital, the review calls for a large programme of work to begin, led by the Integrated Care Board and a new operating model to be developed between Liverpool Women's Hospital and the city's main university hospital trust."
What the protestors say
For those who felt the need to interrupt the meeting last week, this is only heading one way - and they are dead against it.
One of the group was Dr Rebecca Smyth, a 59-year-old former midwife who previously worked at Liverpool Women's before going on to become a senior lecturer in midwifery.
She said: "They are basically saying its not safe at the Women's so it has to move. My understanding of that is that they want to close Liverpool Women's Hospital and put it on the site of the Royal Liverpool Hospital.
"I'm a midwife. I'm a woman. I'm a member of the community and I wasn't asked what my priorities are. Neither was anyone else. No one has been consulted. Where is the voice for women?"
"There is no proper evidence for what they are suggesting. They are not making the same claims about hospital transfers about other sites like Liverpool Heart and Chest Hospital. It just doesn't stack up."
Dr Smyth said she and the other protestors were told by health leaders at the board meeting that there is currently no money to build a new women's facility on the site of the Royal. She added: "If that is true then our concern is that they may move some services from the Women's to the Royal - we don't want any of it moved. It is a safe space for women and women's health.
"If we hadn't forced them to adjourn the meeting then we think this would have been passed. Had we not been there it would have been signed off with no voice for women and no voice for the community. There has been no public or patient input up until this point - including a six-month review. How can that be right? It's appalling."
She added: "If we thought Liverpool Women's Hospital was not safe as a standalone hospital then we would be up for moving it. But why move a hospital when it is working fine for the community, for patients, for staff and most importantly for women. If there were problems with it then people would be shouting about it."
What the Women's Hospital says
Following that eventful board meeting and the publication of the Liverpool Clinical Services review, we spoke with Dr Lynn Greenhalgh, the medical director at Liverpool Women's Hospital.
Outlining what she believes the key risks are at the current Crown Street site now and in the future, she said: "The Liverpool Women's has been raising concerns about the clinical risk on site since about 2015. We were really clear at that point that this was a risk that was going to become higher as the future moved on and it was about the fact that we have more women coming into our services than there ever were. We knew this was only going to increase. We knew all of that from data that was around.
"So we have this increasing complexity in our patients. We then have the NHS organising itself with pathways and guidance about what is optimum treatment and the standards we need to meet. Quite rightly this is driving up standards in patient care. Being on an isolated site means we can't meet some of those service specifications because we don't have those services on site."
She added: "The third thing we need to look at is staffing. We know that if you qualified as a consultant you would have had a really general background. Our surgeons would have had a general training in surgery and then specialised in obstetrics and gynaecology and the same with maternity and anaesthetists. But today the newer consultants coming through have much more specific skills in those areas. They come with a slightly different set of skills. Put that on an isolated site and what they don't have is the skills to look after an acutely deteriorating patient."
If it sounds from Dr Greenhalgh's words above that she favours a move to a new acute hospital site for her hospital, that's because she does.
Asked explicitly by the ECHO what her position on the future of the Women's is, she answered: "Life in Liverpool starts at Liverpool Women's and I am really glad that people are really proud of what we do here and they should be, because we do amazing things here and we really look after our patients and keep them safe. But there are so many spinning plates in doing that. The risk is here and the risk is real - and what we are saying is we need to move before all those risks really land.
"If you ask me, my opinion as medical director of Liverpool Women's, we need to be co-located with an adult acute site. But there is a process that this has to go through and we will absolutely support our ICB colleagues and the recommendations and we will go through that process, if the process finds something different then fine. But in my opinion, that's what I believe."
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