The sudden closure of a midwife service reveals deep flaws in the NHS’s private sector contracts

One to One midwife holding a newborn baby
Glen Black

The sudden closure of a midwife service has left hundreds of pregnant women unable to have home births. One to One Midwives said the NHS’s “unsustainable” contracting process forced its closure. And the news is an example of how deeply flawed the NHS privatisation process really is.

Thousands affected

One to One announced on 29 July that it had made the “difficult decision” to put the company into administration from 5pm on 31 July. The company provided home birth services across the north-west of England as well as in Essex. It started operating in 2010 and claims to have helped nearly 14,000 families since it began. But One to One said that a “challenging NHS landscape” and unwillingness by clinical commissioning groups (CCGs) to change their “financial basis” had resulted in its closure.

The BBC reported that about 1,150 women are directly affected by One to One’s closure. HuffPost said that “around 2000” women will no longer have access to their personal midwives. And the Essex paper Daily Gazette said the closure will affect 280 women in the county.

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“Snatched away at the last minute”

Women who have used and are using the service shared their thoughts about the news on Facebook and Twitter. Most were very upset at One to One’s closure. The BBC shared the story of Gemma Davies, who said she was “heartbroken” by the news:

I got no notice. My midwife rang on Monday to tell me what was happening. … I have really got to know my midwife over the past few months – and now she has been snatched away at the last minute.

Davies said the changes will force her to give birth in hospital. However, due to previous traumatic experiences with a hospital birth, Davies said “the last thing” she wanted was a hospital birth. HuffPost also shared the story of ‘Sarah’, who said that the “prospect of a medicalised hospital birth is extremely [emotionally] stressful”. Both talked of the support and confidence that One to One had given them.

An NHS spokesperson said the NHS would provide a dedicated team to support affected women. However, it could not guarantee any of them a home birth.

Continuity of carer

One to One is a private company that offered “continuity of care”, which means mothers-to-be would meet the same midwife throughout and after pregnancy. In 2016, NHS England published Better Births. It emphasised this model, saying [pdf, p78]:

Improving continuity of carer is not an optional luxury. If we are to improve quality, we must improve this.

And in March 2019, the Royal College of Midwives (RCM) repeated the report’s call for improving continuity of care. Chief executive Gill Walton stated that “there will absolutely need to be continued investment and support for this work”. NHS England’s first chief midwifery officer Jacqueline Dunkley-Bent highlighted the benefits including, crucially, significantly lower chances of women losing babies during pregnancy.

However, the most recent estimate by RCM said NHS England has a shortage of 3,500 midwives.

Vulnerability of the private sector

As a result, some have voiced frustration about the government underfunding the NHS. Labour councillor for Sefton, Nina Killen, said more government investment is “needed” to ensure services continue. And HuffPost executive editor Jess Brammar pointed out that this is an example of “when NHS outsourcing goes wrong”. Dunkley-Bent also commented on One to One’s closure, repeating the importance of ensuring such services continue.

However, Twitter user That Midwife wondered whether the outcome is the result of the company’s own “financially unsustainable model”. And Amy Prodgers pointed out that CCG funding is limited by the government’s own investment. One to One’s closure shows, she said, “how vulnerable we become once healthcare moves into private hands”.

One to One’s case echoes the end of a similar company, Neighbourhood Midwives, in January. The London-based company was employee-owned and its founder had been part of the Better Births report team. But Waltham Forest CCG, which paid Neighbourhood Midwives for its services, said the partnership had ended due to “financial reasons”. And its closure affected 129 women who were in its care.

Human cost

A woman’s choice of where to give birth is of the utmost importance, and for many a home birth is essential. The sudden closures of both One to One and Neighbourhood Midwives show how hazardous privately contracting NHS services can be. And they’ve denied thousands of women choice over one of life’s most important and powerful experiences.

It’s clear that many women and their families welcomed the permanent midwife One to One provided. But as long as this type of service is delivered through the private sector, profit-and-loss will be an underlying factor. Those calling the shots will balance real lives against market pressures and, ultimately, it’s people that will suffer.

Featured image via YouTube – One to One Midwives

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