Retired nurses dressed as suffragettes chained themselves to the railings of the Margaret Pyke Centre in central London yesterday. The centre, which provides contraceptive services and sexual health outreach and training, has been described by the Care Quality Commission as “outstanding”, but is threatened with closure – despite assurances that government cuts to public health budgets wouldn’t hit frontline services.
For a hundred years suffragettes have been a potent symbol of the fight for women’s rights, and the retired nurses and service users who brandished “Women need coils” placards in the demonstration were referencing the connection between the provision of contraception and the ongoing struggle for women’s equality.
Many members of the women’s suffrage movement were pioneering campaigners for birth control because they recognised that women’s lives, wellbeing and ability to participate fully in society were limited by the relentless and gruelling cycle of pregnancy and childbirth. Yet, as a society, we seem to take for granted the enormous life-saving, public health and social benefits that contraception has brought us. It is considered a low priority, and access and choice of method are at the mercy of incomprehensible and often inequitable funding mechanisms.
It means, in practice, that despite decades of development in contraception since the introduction of the pill in 1961 – there are theoretically 15 different methods now available on the NHS – many women are still not offered the full range of options, and may be being deprived of the contraception best suited to their needs.
The Margaret Pyke Centre provides a vital service not just because it is staffed by specialists with up-to-date technical knowledge of all these methods, but because of its expertise in supporting women, and helping them to understand their options and choose the method that best suits them. Glowing reports from service users testify to the compassionate care on offer. One young woman, who walked out of the clinic and into the demonstration, said she had travelled across London to use the service because the staff are so well-informed and conscientious, and the centre so friendly, clean and bright.
Local GP Mel Gardner is just one of thousands of doctors and nurses who have trained at the centre over its 46-year history. GPs, she said, “are on our knees in terms of workload” and women just wouldn’t get the care they need if they were solely reliant on their doctors. But doctors know that Margaret Pyke staff are on the end of the phone to offer advice in complex cases.
This kind of ad hoc, unfunded support doesn’t show up on balance sheets. Nevertheless, the economics are clear. Every £1 spent on contraception saves the NHS £11. By any reckoning the Margaret Pyke Centre, offering 20,000 consultations a year, is good value for money. Unfortunately, while women and taxpayers pay the price for cuts in contraceptive services, the consequences are not felt directly by the trusts making funding decisions. Thus the labyrinthine funding and commissioning regime put in place by the Health and Social Care Act encourages commissioners to know the price of everything and the value of nothing.
The Central and North West London NHS Foundation Trust, which will make the decision about the Margaret Pyke Centre’s future in the context of a big budget shortfall, may be taken aback by the spirited campaign launched by its doctors, nurses, service users and medical students. It has been suggested that the trust is now committed to trying to find ways to save the service, even if it has to move out of its recently refurbished home.
Hopefully the centre will be saved without compromising on staff or shoving it into a dusty backroom of a crumbling building – where so many of our sexual health services languish. If the centre loses its battle for survival we should consider this to be the canary in the coal mine for contraceptive services around the county.
If it is saved, it should motivate others to fight to save theirs. As Sarah Pyke, great-granddaughter of the centre’s founder, said: “If you can’t have control over your own body, there are so many aspects of your life you can’t control. Contraception is not just a public health issue. It’s a human rights issue too.”