Mention the word politics in ordinary conversation and many people begin to glaze over. Such disengagement seems increasingly common, and is often attributed to a disillusioned electorate. Maybe the media's contemporary tone of negativity towards the subject of politics is an additional factor. Yet the practice of politics is fraught with inherent challenge, as it attempts to balance multiple and competing interests in order to derive solutions concerning important aspects of people's lives. The issue of politics may inevitably provoke a degree of disillusion because it exists predominantly as a mechanism to resolve disagreements and inevitably cannot obtain resolution for all interested parties in a debate. Nevertheless, democratic political structures prevail and dominate internationally. They are not a perfect model of governance, but rather require endless refinement and contribution. The fact remains that democratic politics concerns everyone, not just politicians and powerful lobby groups. Midwives are both members of society and important professional actors in the health care arena. We therefore owe it to ourselves and our profession to find a way to effectively participate within this process (Stocker, 2006).
I believe the engagement of midwives' in politics is additionally desirable in the UK because of the NHS. This ‘health care system’ provides the vast majority of maternity services in a manner that is internationally unique on the global stage. As a result, both perceptions of public health and ‘health care system’ policy, dominate party political agendas. Virtually all UK midwives are employees of the NHS, which over the past 15 years has undergone major and somewhat ‘bewildering’ reform. The historical influence on health care services by the medical profession has been replaced by the alternative dominance of government policy, which in turn derives from political will. Exploring the political context of such health policy will hopefully encourage participation by midwives within this debate. This will be useful as we face increasing complexity on a daily basis in our professional roles. Critical awareness of the political aspects of health policy engenders an appreciation of certain key influences on midwives and maternity services. What's more, we as midwives should contribute to proposed health policy and attempt to influence future policy-making decisions that may impact on our profession.
Whenever I contemplate the role of midwives and current maternity services in England, inevitably the question arises, ‘how did they develop into their current form?’ This evolution has been a political process, influenced by successive governments deriving their policy from a neoliberal economic perspective that culminated in an emphasis on ‘consumerism’ and ‘choice’ (Klein, 2010). It is important to appreciate that this capitalist, neoliberal economic paradigm dominates all governance administrations, regardless of their political orientation, as a homogenous ideological position. Ultimately this doctrine endorses the notion of private sector management as a superior model for health care system provision. This legitimises the application of narrow neoliberal criteria to what is consequently defined as the ‘under-performing’ public sector and apparently constitutes a compelling argument for reform to policy makers of all political persuasions.
Neoliberal economic ideology is also important to consider because it confers legitimacy on powerful institutions that influence the UK government. These include organisations within the private sector that influence the development of health policy and exist with the principle goal of obtaining profit. Even NGOs and charities, who were traditionally viewed as supportively lobbying government on health issues, may be established to support commercial interests or trade federations. This is a concern that also applies to a broad range of industry funded ‘think tanks’ or establishments that produce reports on health matters whom I describe as the ‘evidence authorities’. Policy reform founded on neoliberal economic ideology can have unforeseen and potentially negative consequences for midwives. For example, Louise Silverton recently expressed concern about the proposed reform of the Nursing and Midwifery Council (NMC) via the Law Commission Bill, which seeks to abolish the Statutory Midwifery Committee in the modernising agendas for Fitness to Practice hearings. Such reform essentially diminishes the influence of midwives at the NMC. Yet this is not a new phenomenon in policy direction, in a similar vein an extensive ‘midwifery influence vacuum’ was created by New Labour when the Department of Health was reformed and the Standing Nursing and Midwifery Advisory Committee was abolished in 2005.
It is indisputable that the present Coalition Government has fundamentally and irreversibly advanced the ‘hyperactive’ neoliberal NHS reforms implemented under New Labour with the Health and Social Care Act 2012. This highly complex legislation directs the political landscape of NHS policy firmly away from its founding philosophy. It has an entire chapter dedicated to ‘competition’ in relation to the provision of NHS services. Such radical NHS reforms were not a component of either the Conservative or Liberal Democrats election manifestos. The overall lack of debate surrounding the Act in the national media, or professional Royal Colleges, is lamentable. The question I still ask myself 2 years later is ‘How did that happen?’ and more importantly, ‘What, if anything, do midwives want to do about it?’
It is valuable for any health practitioner, including midwives, to appreciate the negative aspects and politically disregarded impact of market style reforms on health care services. These include issues worthy of consideration such as: loss of integration\fragmentation of services and facilities due to increased competition, the diminishing accountability that is inevitable with private governance of health care systems and the higher costs associated with the regulation of fragmented services (Hunter, 2008). Understanding such issues requires midwives to become enrolled in political debate and establish a forum to scrutinise health policy that could ultimately solidify into an effective presence within the politics of governance.