Maternity services. Volume II, Minutes of evidence.

Great Britain. Parliament. House of Commons. Health Committee

Date:: 1992

Catalogue details

Licence: Open Government Licence

Credit: Maternity services. Volume II, Minutes of evidence. Source: Wellcome Collection.

22/320 (page 354)

[Continued [Mr Rowe Cont] It is of concern for midwives as much as for obstetricians. There is a whole discussion about litigation. I do not think that is what is impinging on these matters. I think there is a longstanding tradition of concentrating maternity services in hospital. That seems to me to be linked with what women perceive to be the safest and most appropriate route. I detect from the Committee a certain strength of feeling that one per cent is a very small percentage figure and they would feel that there was more genuine choice if that figure was rather larger. That is a matter of judgment as to what women really want: whether they want to go into hospital for shorter and shorter times to deliver the baby or whether they really want to have the child delivered in their own home. It seems to me we have to continue to take all possible steps to ensure women are well-informed, and, to take opportunities to enable women to put their views, whether through Maternity Service Liaison Committees, through the consumer surveys increasingly being undertaken by health authorities, or by ensuring that different professional groups are giving clear and balanced information. That, it seems to me, is a point that comes back to Mr Hinchliffe. What is wrong is for the woman to feel she is at the centre of a demarcation dispute. We do not want duplication nor do we want women to be confused because they are getting different information from different groups. I think the most effective way of ensuring that it is the woman’s choice, which is enshrined in the Patient’s Charter and in the birth plan as a whole, is for the policy to be reinforced by clearer statements by the professions about what their respective roles are. Mr Hinchliffe 835. In response to the Minister, I do not want to give the impression from a personal point of view that I am necessarily pushing one form of birth as opposed to another. My own personal experience of my own two children is | was damn glad my wife had them in hospital, for reasons I will go into with the Minister in private. My understanding is the Department’s policy enshrined in “Maternity Care in Action” states women should be encouraged to have their babies delivered in hospital. Am I right or wrong, that is official policy according to our advisors? Can I take this a little further, Chairman: we want to look at the issue of choice vis a vis the new Patient’s Charter and the Minister having been a mother on three occasions, am I right? (Mrs Bottomley) | still am! 836. I will try and rephrase that! (Mrs Bottomley) Unless you know something I do not know and I ought to leave now. 837. You have had personal experience of delivering three children. You are obviously aware that—- (Mrs Bottomley) 1 am not briefed on this subject. 838. It is an extremely personal issue whereby the mother is the best person to make the choice as to the process she goes through in terms of individual midwives having different approaches, individual hospitals having different approaches. The one worry some of us have is the increasing evidence of the way that reforms have constrained that choice by virtue in some areas, and an example was quoted in the Chamber yesterday, women who have had a child in hospital and choose to return there for the second child no longer can do so. That is worrying and this is a point that needs clarifying. I have women saying to me in my area that their choice is now constrained through the placing of contracts. There was a choice of three hospitals in my area, that constraint is on the one where the contract is. I would be grateful if this point could be clarified because if the understanding I have is incorrect people need to be told at a local level that understanding is incorrect because it appears that choice is no longer the case. (Mrs Bottomley) Chairman, if I may, just to start off with Mr Hinchliffe’s first point that it is Departmental policy to encourage women to have their babies in hospital. The Department’s view is based on the advice of the Maternity Services Advisory Committee and is very clearly spelt out in the Pregnancy Book. I would refer Mr Hinchliffe to them. It sets out the choices and their merits as clear and simple as possible. I would resist the statement that choice is constrained by contracts. I do not accept there is any evidence that there has been any difficulty over choice due to the implementation of the reforms. What I would accept is that in the first year of implementation there has really been an unprecedented level of discussion between the districts and the GPs about the traditional referral patterns, what are their aims, what are their objectives. Of course as they then discuss the contracts for next year they have, for the first time, the opportunity to specify the quality improvements they want to see. The district has never had that before: the position of really championing the interests of their local GPs and their local women in the establishment and in the detail of the contract. All districts have set aside money for extra contractual referrals but the aim and the objective would be to achieve year on _ year incremental quality improvements. We know the sort of quality improvements we are talking about are often not resource related. They are to do with thoughtfulness and information, the way you are treated, all sorts of details concerned with maternity services. It is not only a question of money. As I say we do not have the impression that even in the first year there have been difficulties about choice. Certainly if it is extra contractual referral then the processes have to be gone through but there is no suggestion that there is difficulty there. Mr Edwards may wish to speak particularly, as a Regional General Manager about to how it is working in his region. (Mr Edwards) We all were concerned that there was a theoretical possibility that that might happen. I can confirm it has not happened in my region and I see no possibility it will. We seem to be able to cope with the traditional flows, they have not been changing very much and the reserves we have have been coping with the occasional difficulties. We have not had any problems at all. Chairman: There will be problems and Mr Hinchliffe referred to the one raised in the House yesterday. We would like to receive that note you promised in respect of the Netherlands and other matters your experts can help us on.