Maternity services. Volume II, Minutes of evidence.
- Great Britain. Parliament. House of Commons. Health Committee
- Date:
- 1992
Licence: Open Government Licence
Credit: Maternity services. Volume II, Minutes of evidence. Source: Wellcome Collection.
18/320 (page 350)
![[Continued [Audrey Wise Cont] the country. Correct me if I am wrong, I think I read the evidence which suggested that you, on a previous occasion, thought there was no domino scheme in Preston? 806. I know there is not. I know there is something called a domino scheme which is not in fact a domino scheme. (Mrs Bottomley) | think we begin to identify why it is sO important that the Institute of Manpower Studies at Brighton helps us clarify the range of schemes throughout the country. In preparation for coming to give evidence to you, like the Select Committee, I have been on a number of visits to different maternity units. Like most women I have had some experience of maternity units and my feeling is there is a great range of interpretation as to what precisely a domino scheme is. What all are agreed about I believe is that midwives have very important skills, training and qualifications. Indeed I think many of us would argue our midwifery system is a model many other countries around the world could follow. We have to make sure we have a clearer mapping of what the different models are before seeing how we can then carry them forward. 807. Minister, domino is domiciliary, in and out. The patient has a named midwife, or midwives, who visits or sees the patient during pregnancy, takes that patient into hospital, delivers the baby, brings the patient out. It has in some areas been in operation for a long, long time. It is popular, it is cost-effective, I would suggest, cheap in a genuine sense. Have you not ever collected any costings and used those costings as an additional inducement to spreading this system? (Mrs Bottomley) | am going to ask the midwifery officer, Joan Greenwood, if she wants to come in. (Miss Greenwood) The answer is we have not collected costings at present but as Mrs Bottomley was Saying, it might be something we can do when we have the results of this research study. 808. Why wait? Why not do it now and then we could have the results in time for our Report? (Mrs Bottomley) Mrs Wise, I have to come back on this. I really do not think we are sufficiently clear as to what you would be comparing with what. It is very clear what the blue print is but if you go to different districts or talk with different maternity services many claim—and I am sure you have found this—to have a domino scheme. Yet, as in your own case, you do not have the agreement that it is a domino scheme in the way you envisage it. In other parts of the country it has been said that it is a domino scheme but of course the midwife is part of a team of Community Midwives and she might be able to go herself or maybe her partner would attend instead. Actually the point where the definition in your terms ceases to be a domino scheme would, I think, be difficult to establish. If 1 may say, Chairman, I think Mrs Wise makes an excellent point because what we want to do is to continue to build on the success we have seen over the last ten years. I would argue maternity services have really led other parts of the Health Service in encouraging patient awareness and consumer awareness through the participation of mothers in the way in which they want the service delivered, the whole movement towards birth plans, and the whole dialogue increasingly in which mothers become engaged. Mrs Wise made reference to the named nurse or midwife. That is one of the commitments made in the Patient’s Charter. The issue Mrs Wise is raising is very much going with the grain of the progress we are already making. If wecan try and develop that further so we have more precise costings I think that would help. Chairman 809. Supporting what Mrs Wise has said to you, and being very happy you agree with so much of what Mrs Wise has said to you, is it not surprising, Minister, you have not got some better basic understanding of the costings bearing in mind everybody to do with the Health Service currently is based on costings and operating within budgets, and the maternity services are a very large part of the activity of the Health Service? With Mr Edwards here from the Severn Trent area, would he not be able to help the Committee a little more about just what costings they have in that particular region of the country? Because Mrs Wise has come on to the issue of the domino system which has been about for five, six, ten or even more years, why have we not got costings bearing in mind you, Minister, and the Secretary of State and other Ministers are favourably indicating we need the costings of the Health Service? (Mrs Bottomley) | am going to ask Mr Edwards to speak but it is an essential principle of the Health Service that professionals should make their maximum contributions, and that we should seek cost-effective ways of providing treatment. Certainly I would hope that, in deciding on the best form of maternity care, these matters would be very evident to the purchasers and to the providers. The question you are raising with me is whether we can establish some centrally determined or evaluated system of costing. We would clearly want those actually providing the care in the district and in the unit to make those assessments. But I think there is great merit myself if the form of maternity care that is established addresses the concerns of the mother, of the professionals, and is safe and cost-effective. Is there more we can do from the centre? You will know | for this year, and indeed for the last three years, the Management Executive have been particularly looking at the maternity services. For example, in our Memoranda of evidence we talked about the role of paediatricians and pathologists, and the whole question of the review of the maternity services and the setting up of targets. We are also establishing a task force to carry forward that work and to help the Management Executive set targets and in monitoring services and the dissemination of good practice. It seems to me that is another area where Mrs Wise’s suggestion could very well have validity if it is about disseminating good practice. That is an aspect of information which would be of great use to them. 810. Mr Edwards, can you shed any light? (Mr Edwards) The first range of the contracts this year for the maternity services has tended to be block contracts with a fixed sum. They have restrictions on the current services within them, they do not break that down by individual cost elements. As we move forward I think you will find district health authorities will be wanting to break the elements](https://iiif.wellcomecollection.org/image/b32222907_0018.jp2/full/800%2C/0/default.jpg)
