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.
24/320 (page 356)
![[Continued (Sir David Price Cont] improvements, and that really relates to the second part of this question. It is excellent that one of the healthiest places in the country to be born is Huntingdon. Huntingdon has now, I think, been beaten by East Dorset. Obviously we wish to see the same achievements in other parts of the country. That is the significance of the targets being set by the Management Executive for the regions and by the regions for their districts, and that is very much the work of the task force. We will not be allocating money specifically for maternity services. We will be demanding improvements from the Health Service to make sure we build on the remarkable successes we have seen over the past ten years. 846. Do I understand implicit in what you are saying, although you are not explicit about it, that as we improve all of these other factors, particularly the things we were dealing with in the first part of our inquiry, the health of parents and the preconception stage, that in fact we should accept for a given number of births there should be an actual reduction in the amount of care you have to deliver and, therefore, a reduction in the expenditure? (Mrs Bottomley) 1 do not think you can assume that. Certainly there is an extension of perhaps Mrs Wise’s point on community midwives. Although we have not been able to provide you with the figures, an increasing amount of work is done in the community, whether antenatal, at the delivery or post-natal is cost-effective and there would be cost savings. (Mr Shaw) | think what the Minister has been saying can be summed up in two words: “increased productivity’. 847. I tried to avoid using that word, it did not seem appropriate in connection with maternity services! (Mr Shaw) Would “efficiency”’ be better? 848. Cost-efficiency? (Mr Shaw) I think it is slightly dangerous to take one year and look at it in that way rather than looking at the trend as a whole. In taking the particular year in question, as all are agreed, the expenditure in total went down but as the Minister has suggested actually, certainly, in hospital activities the in-patient activity increased by 1.8% over 1988/89 and 2.2% over 1989/90 in 1990/91 so there is considerable efficiency in that example. But turning from the individual years to the trend of the thing, we know that the overall trend in improvements in perinatal infant mortality are impressive and that there was real term growth in expenditure of 11.9% between 1980/81 and 1989/90. The Minister said there was a fall in the average length of stay from 7.5 days per birth in 1980 to 5.7 in 1988/89 and 5.5 in 1989/90. Thirdly and finally, there was a dramatic increase in community midwifery and expenditure there doubled in real terms over the period from 1979/80. (Mrs Bottomley) The other element of the question is whether we would anticipate those figures being part of a trend. We do not feel able to comment or predict on that front. I would be surprised, partly because the birth rate has gone up again. What happened was there was this significant fall in the birth rate in that particular year. But we do not anticipate that to be part of a change in direction. 849. Obviously if the birth rate goes up you expect the expenditure to go up but I am asking about the quality element in the general improvement we hope there is in the health of the nation, particularly of pregnant women. In fact one would hope, because it is natural health and not illness, having babies, one would expect there would be a gradual downward trend if all the other factors are improving as you have suggested they are. This is not a sickness service this is a health service. (Mr Edwards) What I think we are missing out of this equation, Sir David, is that it is certainly true of the maternity side itself that in my region in 1990/91 we had a 4% increase in activity and a 2% reduction in overall cash input and we are investing quite separately in areas like intensive neonatal care and we are not adding those into the equation but maybe we should. Chairman 850. Is Huntingdon in East Anglia? (Mrs Bottomley) Yes. 851. You might be interested to know that East Anglia has the highest percentage of home births. You referred to it in glowing terms! (Mrs Bottomley) If 1 may, I will see if there is a significantly higher proportion of home births in Huntingdon itself. (Dr Walford) The Committee were very impressed with Hinchingbrooke Hospital. (Mrs Bottomley) Mr Edwards was giving a list of items not covered in the figures we were looking at. The other aspect is GP payments. They are not part of the overall picture so if there was a change in the pattern and role of GPs that is another element to be considered. Overall, we are that we do not have the comprehensive data on costings to make predictions. What we have is the absolute determination to see those figures continue to improve. Sir David Price 852. In a way we should not take those figures you gave us on the maternity services too seriously? (Mrs Bottomley) You can take seriously indeed there are 24% more midwives and 20% more obstetricians and paediatricians, more members of the team providing maternity services. 853. With respect, those are the output figures but not the input. Select Committees have to look at the input because we are using public money. (Mrs Bottomley) We are not in a position at present to comment on the significance of that particular figure in that particular year. But we had to see it in the context of a number of other factors which are extremely positive, and certainly in terms of the only outcome we are really talking about which is improving the perinatal infant mortality figures. Sir David Price: We would agree with you on that. Mr Rowe 854. It is a very complex issue and of course everybody wants to see increasing improvements as the Minister has just said. On the other hand there must come a point at which the question is how much incremental improvement youcan achieve for a given](https://iiif.wellcomecollection.org/image/b32222907_0024.jp2/full/800%2C/0/default.jpg)
