Picture: Flickr/Joshua Rappeneker. Some rights reserved.

Public-sector outsourcing is damaging not only the intrinsic value of our public services, but also the voluntary sector which in the past commanded respect for its ethical purposefulness and diversity.

The neoliberal imperatives of commercialisation and marketisation are cutting away ever more deeply at our social fabric. They are killing off the belief that to be of service to others in our community is in and of itself an immutable good. That a contribution directly to some indirectly contributes to the wellbeing of everyone’s lives.

Instead, the profit-driven language of the neoliberal project has converted the work of supporting the social good into the current poisonous scramble in the voluntary sector for contracts and bids to provide ‘goods and services’. Individual charities ‘rebrand’ themselves with costly packages bought in from PR and design agencies. They outline their ‘strategies’, eyeing up the chance for mergers and acquisitions to strengthen their ‘market position’ in a time of ‘scarce resources’ - scarcity that is itself an effect of neoliberal policies.

Just at the point when we need a plurality of democratic voices and engagement to respond to and contest the terrible impact of these policies on health, education, social services, and community solidarity [1], the voluntary sector has succumbed to the ideology of turning the whole of our society into one giant marketplace.

Under such conditions, the notion of a non-profit charity is rendered meaningless.

There is mounting evidence over the last decade from the United States, where these trends have been most advanced, that marketisation of the non-profit sector has negated the commitment and good will the sector once had from ordinary people who wished to deal with serious, pressing issues. Charities are left in confusion as to which direction to take, For all their abundant use of buzz words like ‘vision’, ‘partnership’, and ‘leadership’, other terms like ‘growth’, ‘corporate opportunities’ and ‘efficiency’ point to the heavy emphasis of the non-profits on their ‘products’ and the idea of ‘consumers’. This orientation drags them towards the private and the fee-paying and away from any ethical contribution to public and community values.

A recent cautionary tale exposing this facile logic in the UK comes from the dual need for excellent social support for pregnant and new mothers and for best quality, reflective evidence for midwifery.

It is no secret that our maternity services are under increasing pressure: rising birth rates, a brutal centralisation of services within the beleaguered NHS, and staff cutbacks make the entry into new motherhood for women an increasingly unsupported and fearful experience.

Midwives themselves are unsupported. Spaces where local groups of women and midwives have worked hard to build viable, supportive alternatives have been closed down at the bean counters’ behest. Comprehensive care for pregnant and new mothers, well-resourced and trained midwives up to date with the latest evidence - these are apparently a luxury we can no longer afford.

In 2011, the once distinguished National Childbirth Trust (NCT), whose initial work in the 1960s and 1970s was based on volunteers in the community supporting new mothers, sought to rebrand itself and add to its ‘stable’. It reached a ‘pre-merger’ agreement with MIDIRS, an equally distinguished educational charity which since 1985 has provided midwives with outstanding publications and literature search facilities to support best midwifery care.

MIDIRS wanted to offer their work directly to women and families, as well as birth professionals. A win-win marketing development, in the language of the day. In business, such a decision should warrant no more than a shrug of the shoulders: mergers are standard fare.

However, these are not businesses but organisations with a wider social remit. Mothers and midwives are desperate for radical change to reflect latest best evidence, and see the important role that MIDIRS can play.

The ‘Hands Off MIDIRs’ campaign, set up earlier this year on Facebook, gives a fascinating - and worrying - insight into the charitable sector in general, and the needs of new mothers and midwives in particular.

An agreeement to merge between MIDIRS and the NCT turned into an unwelcome takeover in April of this year. Acting like a corporate stalking horse, NCT became the sole ‘member’ of MIDIRS, which appeared to open up the outcome, not for reviewing the agreement to merge as to its relevance, but for carrying through what the corporates term a ‘hostile takeover’.

According to campaigners, by 2013 the Trustees of MIDIRS made it clear to the NCT that they had concerns following the agreement to merge agreement. MIDIRS’ Trustees argued that far from the two organisations sharing some collaborative projects, MIDIRS would lose its independence, including its priceless editorial independence, and become part of the growing NCT ‘stable’ with a turnover of £23 million over 18 months and an intended reach of 20 million parents.

Campaigners allege that the MIDIRS Trustees were threatened with removal. The five original Trustees subsequently resigned en masse. They were followed in turn by the editors of MIDIRS and its companion journal Essentially MIDIRS, the board of Essentially MIDIRS and the long-standing business manager. The editorial function had been undertaken mainly by midwives, ably supported by an academic childbirth activist. As their letter of resignation observes, MIDIRS and the NCT are ‘very different’ and the threat to MIDIRS’ independence is a huge concern.  

In their place have been parachuted NCT-appointed Trustees with close NCT links. Midwifery experience is seriously deficient among the new incumbents - only one of the current MIDIRS Trustees has a midwifery background.

This arrangement leaves MIDIRS vulnerable and under the control of Trustees who are likely to experience conflicts of interest.

What is at stake here is the independence of a publication which is unique in midwifery. MIDIRS was not obliged to adhere to the party line or to consider the concerns of potential or actual advertisers. Whilst the NCT does have an ethical advertising policy - for example it does not accept advertisements from manufacturers of breast milk substitutes - there remain concerns. Many journals in the field of childbearing depend heavily on advertising from, and partnerships with, manufacturers of both baby products and technological interventions and equipment, sometimes with little or no evidence base for usage. There is a desperate need for a journal such as MIDIRS Digest, which was known by all to be free of such influences. 

The independent survival of MIDIRS is crucial if midwives are to be able to respond effectively to the needs of women. The merger will result in a charity that has lost sight of the needs of its members and its raison d’être. MIDIRS takes account of all of the women who midwives attend, and not just the vocal middle class women who are well able to articulate their needs. The Royal College of Midwives’ latest figures suggest that it will be a decade before we have a full complement of midwives to guarantee safety in birth.

The international literature on hostile corporate takeovers suggests that these tend to occur where opportunistic behaviour on the part of a larger entity in relation to pre-existing or even implicit contracts leads to a breach of trust, the common state of play in which the takeover is effected.

The reasons given for takeovers always come from the bigger and better school of business management: creating greater net worth, greater efficiency, greater productivity.

Scholars of hostile corporate takeovers are critical of these objectives, pointing out that they are often paper gains only, while there are considerable social losses [2].

There are certainly losses for both these charitable organisations. The rebranded NCT comes away diminished. MIDIRS is gutted of its value to a struggling midwifery profession.

The dismal story of NCT and MIDIRS should make us think very hard about the wholesale adoption of a market-oriented ideology and market-driven language for the voluntary sector. These events run counter to our pressing need for collective approaches and a recovery of ‘deep democracy’ in which individual and grass roots voices genuinely shape the direction of vital public efforts.

Finally, it forces us to conclude that for the crucial work of supporting new mothers and making the most cutting edge evidence available to midwives, we will need to begin anew.  

Editors note - this article has been edited to amend some factual inaccuracies that appeared in the original version.

 The Politics of Maternity by Rosemary Mander and Jo Murphy-Lawless was published by Routledge earlier this year. 

[1] Eikenberry, Angela (2009)  Refusing the Market: A Democratic Discourse for Voluntary and Nonprofit Organizations. Nonprofit and Voluntary Quarterly 38 (4) 582-596. 

[2] Thomas, Lee (1992) Hostile Takeovers: When the Vultures Call. Business and Society Review  Summer 92, Issue 82 60-63

Like this piece? Please donate to OurNHS here to help keep us producing the NHS stories that matter. Thank you.