‘Inadequate due diligence’ before One to One Midwives collapse

The collapse of One to One Midwives in July 2019 came as a shock to many – including hundreds of pregnant women using the service.

With a shop on Sankey Street in the town centre, the service proved popular with Warrington women preferring a home-birth experience rather than a hospital-led pregnancy.

But financial insecurity saw the firm collapse – leaving Warrington Hospital with a bill of more than £1million.

An independent review into the cessation of maternity services provided by One to One Midwives has finally been published, more than three years on.

The report was commissioned by NHS England following the sudden loss of service continuity for more than 1,800 women receiving care from One to One Midwives.

This has slammed a lack of due diligence in ‘taking stock’ of the firm’s ‘precarious financial position’ before the awarding of a further contract in Cheshire.

What was One to One Midwives?

One to One Midwives was a community midwifery service contracted to provide care on the NHS and was set up in 2010.

The service was for women who did not want a hospital-led pregnancy.

A woman could get her scans and tests done at the Sankey Street shop and be assigned the same private midwife for the entirety of their pregnancy, birth and postnatal period.

Mums would give birth at home under the care of a One to One midwife.

One to One received its first NHS contracted payment from Wirral Clinical Commissioning Group (CCG) in 2013.

It then won a contract to provide community midwifery services on behalf of NHS Warrington CCG in 2016, and this was due to run until March 2020 before it went out of business.

One to One Midwives offered a difference service for women who did not want a hospital-led pregnancy

At the time of the company’s collapse in July 2019, thousands of women in the north west were then receiving pregnancy advice from One to One’s midwives, some more than 40 weeks’ pregnant.

Warrington Hospital was subsequently left with a bill of more than £1million after One to One failed to pay its bills for years.

When a woman in One to One’s care experienced a complication or illness, they were sent to A&Es across the north west, often without their medical forms or information.

Maternity units in Warrington, St Helens, Liverpool, Chester, Mid Cheshire and Wirral then took over the woman’s care and sent invoices to One to One Midwives for the cost of treatment.

These bills were often not paid, and hospitals were left with outstanding debts of more than £2.6million.

Women would often be sent to be scanned at hospital trusts if the Sankey Street centre was unavailable, with bills again routinely unpaid.

A series of freedom of information requests in 2020 revealed the scale of these debts.

A statement of affairs outlined the estimated claims from NHS trusts as £2,691,289, while employees with outstanding wage claims in relation to holiday pay are owed an estimated £92,600.

The cost of transferring and delivering ongoing services to women who transferred from One to One to Warrington and Halton hospitals from the period stood at £321,241.

The trust was also owed £877,691.37 for the failure of One to One to pay the bill for services carried out at the hospital, such as scans or treatment a mother or child needed with a home birth.

What does the independent review say?

Published on Thursday, the review commissioned following One to One Midwives’ collapse offers a scathing view of ‘due diligence’.

It says that in the case of One to One Midwives, challenges to the enhanced way of delivering maternity care it offered proved to be ‘numerous and ultimately insurmountable’.

An executive summary within the report reads: “Problematic relationships between One to One and NHS stakeholders were evident from the outset, and conduct which sometimes lacked professionalism was apparent on all sides throughout the lifespan of One to One.

Warrington Hospital was left with a bill of more than £1million

“The service was perceived as unsafe by the NHS, with quality concerns frequently raised often shown to be unfounded.”

It adds: “Due diligence on the safety and effectiveness of One to One’s services and its financial position were inadequate.

“The contract was allowed to run on, despite the serious risks emerging and implications of the company’s precarious financial position.

“There were several early opportunities to take stock and potentially pause the further expansion of the service which were not taken, and within this context, the decision to award the com-commissioned contract in 2016 appears imprudent.”

Reviewers stated that minimum activity levels required by One to One to achieve financial viability in Cheshire and Merseyside ‘did not appear realistic’ within the short timescale required for financial recovery.

They said: “It would have been prudent to have taken stock before the award of the larger co-commissioned contract across Cheshire and Merseyside in 2016, and to have planned for a controlled exit of the existing contract, given the serious financial viability concerns and clear destabilisation of local systems.”

Among the core recommendations following the review, the report states that proposals for new maternity service models should be ‘comprehensively tested before commitment’.

A comprehensive audit, from both a financial and quality perspective, should also be undertaken before all key contracting decisions and on a regular basis.

What is the reaction to the review?

The trust which runs Warrington and Halton hospitals said it would not be commenting further than statements issued by NHS bodies in the region.

A spokesman for NHS Cheshire and Merseyside said: “Integrated care brings with it the opportunity for system partners to work more closely to prevent something similar from happening again.

“The report provides an important reminder of the disruption caused to women, families and midwives, and the learning that we must work together to apply.”

In addition, a spokesman for NHS England North West added: “We welcome the publication of this report and will be working with partners across the NHS to ensure the learning is embedded.”