Unfortunately I think you are mistaken there. Evidence shows that one to one care from a known midwife is safer, so why isn't that available to everyone? The majority of women are attended by people they have never met before many of them having to share a midwife between two or three others. Where is the evidence to say that's a good model of care?
Yes, but that's confusing the best evidence available with evidence that something is acceptable in terms of risk. The NHS basically calculates risk levels in line with resources/budget available and gives the least possible care that is most likely to secure an okay outcome. That's the harsh reality. What happens in research, on the contrary, and on committees looking at best practices etc is that the evidence is looked at objectively and on its own merit and guidelines are drawn up with limited reference to cost. CFM is more efficient because it uses up less manpower. That's why. I know people see this as EVIL because no one seems to want to realise that actually budgets ARE important.
In my area of clinical practice, I can say right now that even the highest risk clients who are most in danger of long term negative outcomes without proper care get the least amount possible. They get a lot more than low risk clients, but they get the least amount possible. This is not because any of us working with our clients want to work against guidelines or deny best available evidence, it is very much a case of the loaves and fishes.
However, there is always some evidence to suggest that what's being done (as opposed to the overall quality of the care model) is "okay". Generally speaking clinicians and their managers spend a great deal of time reflecting and analysing how things could improve, what could be changed, thinking of ways in which to multiply the loaves and the fishes, suggesting x hasn't worked as well as hoped so maybe y should be tried to improve it. However, the gap between theory and practice can be gapingly wide at times... and the answer, though the media and the government's PR machine dress it up beautifully as "inefficiency" is that high-quality healthcare in the 21st century costs a LOT. As for "yes, but, if they invested here x would happen.." thinking, that's sort of naive. The court cases will still still happen, there will still be negligent care from idiot practitioners or well-meaning ones who make a mistake at a crucial moment. Women and babies will die, whether or not care is absolutely top notch. People with mental health difficulties will still commit suicide. Adults with Learning Difficulties with still find it hard to get work.
What the NHS doesn't do is create protocols that are completely and utterly devoid of reason. Yes, there will be an element of making things run smoothly and providing efficient service but this really IS because there's not a lot of option. If you are going to provide a cut-price service to the masses (and that is what the NHS is, make no mistake) there have to be "efficiencies" and sometimes these seriously compromise patient care. However, it is NOT a conspiracy or (generally) wilful.
So just because the service isn't good elsewhere that means we shouldn't try to improve our own services? Some NHS care is extremely good - we should be doing more to find out which these services are and to see that they are emulated throughout - so much of our healthcare is a postcode lottery at present.
No, of course we should be trying to improve. But the sooner people realise that the NHS is not an easily fixable problem and that often, though not always, the reason some care is better than other is that certain areas will prioritise some services over others (robbing Peter to pay Paul) the better placed they will be to make suggestions about improvements. Even within departments, this happens. Sometimes these decisions are really tough. What do you do if you are faced with closing a cardiac care unit for children or the MLU? Who "deserves" it more? Why does anyone think there are simple answers to these questions? What I often see is lot of hysterics about how the mean money makers are out to get us all, that protocols are just there for the sake of it as if the money were a non-issue etc.
The average member of the public believes they should have better and better services - and more of them - for the same money, more or less. That every gap in service is because of some fault in the system that could easily be ironed out if... if.. if... In reality, it IS about the money. No one wants a system like the US, no one wants it to be about profiteering or for rich people only BUT by the end of next year, my small service of 55 will be reduced to 35-40, with a lot of specialist staff going who will not be replaced. Anyone who genuinely believes that the NHS is not in a serious situation right now and that quality of care is about to be HEAVILY compromised is really, really deluding themselves. We need to start asking what can WE do as well as what are WE owed if we want to save a service for all.