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.

25/320 (page 357)

[Continued [Mr Rowe Cont] input of money? I just wondered whether the Department has in this field or any other any ratio of input for a desired improvement in the service? (Mrs Bottomley) Mr Shaw? (Mr Shaw) The best I can offer is not in the context of maternity services, but whether in the Civil Service or public service at large or in the NHS we do look for a 1% per annum efficiency improvement across the board. That would be the best I could offer. Chairman 855. While we are on basic financial matters could, Minister, you or one of your officials tell the Committee why general practitioners receive a separate fee for providing maternity care and has your Department any plans to review such fees? (Dr Walford) In fact GPs can receive a number of fees for providing different aspects of maternity care. They may provide the full maternity care, and as you have pointed out that is reasonably uncommon, most GPs provide antenatal care usually on a shared basis with the hospital and with the midwives. Many GPs provide post natal care, they certainly provide the post natal examination but not necessarily post natal visits. There is a separate fee for a visit and the examination. There is a fee schedule, if you like, for general practitioners and they make claims according to the services they have actually delivered. GPs fees are paid in relation to the services provided. 856. Fine, but can you indicate or can the Minister indicate, because this may perhaps be a policy matter, has the Department considered instead extending the system of capitation payments to give GPs a payment in respect of the number of their patients who are women of reproductive age? (Mrs Bottomley) We have not considered that option but certainly if this Committee makes recommendations in any of those areas we would look at them very carefully. GP remuneration and terms of service is the subject of discussions with general practitioners. I am quite sure were recommendations to be made in that area we would look at them very seriously. 857. It looks as if Dr Walford has been handed a useful piece of paper? (Dr Walford) | endorse what the Minister has said wholeheartedly. 858. Can we move on to contracts because although this is important it has come up not least in relation to a matter raised earlier by David Hinchliffe. Can you tell us, Minister, what problems, if any, have arisen in the operation of contracts for maternity services between purchasers and providers? How are cross-boundary referrals for specialist services (antenatally or for neonatal care) being organised? Are admissions to neonatal centres “extra contractual referrals” and if so, is there a guarantee that the parent health authority, will always agree to pay the bills? (Mrs Bottomley) This is an area that has not caused difficulties. It is an area which clearly, with the satisfied would work effectively. I think the most sensible and helpful approach for the Committee is to ask Mr Edwards to comment on the way in practice it is working in his particular region. (Mr Edwards) J have with me, and I am happy to make available—because they are public documents—the contracts available between the district health authorities and provider units in my region. They specify the range of services, they specify the range of choices they would like to offer to women in the district. They give an indication of the range of volumes and fix a price. They also have a lot of quality standards which you might be interested in which they negotiate. I think for the first time we can see much more clearly a clear relationship between what the DHA think the community needs and what the hospitals are commissioned to and willing to provide. As far as neonatal intensive care is concerned we have not had any financial problems. We do have problems occasionally as the units hit peaks in activity this year and we do occasionally have to arrange for transfers. That is an occurrence which happens from time to time. We have not, however, had any financial barriers put in the way thus far, I do not expect we would. These are very ill babies and we would normally expect the professionals to get on with it and we will sweep up after them. 859. On that matter, Mr Edwards, I believe I am reliably advised neonatal intensive care services are being charged for at a flat rate. Why is that? Because obviously some babies are very much more ill than others and therefore why are these babies being charged for at a flat rate which I understand is the position? Am I correct, first of all, in stating that the neonatal services are being charged for at a flat rate and if I am why is that? (Mr Edwards) There is not, I do not think, a uniform national position on this currently. In some regions the services are contracted for regionally on the basis of an agreed sum which is top sliced and allocated. This is the pattern across most of the country. In some parts of the country these specialist services are handled at the level of the district, in most parts they are handled at the level of the region and in that respect they are a free good. (Dr Walford) In the note we provided for the Committee about the contracting position in regions, you will probably see in many regions although these cases are being handled under a block contract this year the intention is to move to cost per case. 860. At the moment you are confirming they are being charged at a flat rate? (Dr Walford) Ina block contract, yes; not the same rate for each contract necessarily. 861. Does this not encourage units to admit the maximum number of babies who need a short stay to the inevitable disadvantage of the most ill babies who might need to stay in intensive care for several months? (Dr Walford) | consider that is a most unlikely scenario, Mr Chairman. These units exist to serve acutely ill, seriously ill babies and to suppose any financial consideration, where the contract exists and the baby can be taken in, determines which baby can be taken in I think to be a highly unlikely proposition. 862. lam reassured. Obviously commenting on Mr Edwards I understand his is the only region which has a block contract for this area of activity?