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.

26/320 (page 358)

[Continued [Chairman Cont] (Dr Walford) No, I think a vast majority of regions actually have block contracts between the districts and the regional units so there is a contract actually established between a purchasing district and the unit, only a few regions now themselves have a block contract with the unit. The contract has been established on the basis of previous referral patterns and previous expenditure. There has been no cutting back whatsoever on the funding of these centres. 863. I understand, coming back to Mr Edwards, no other region in fact. Is this to do with top slicing? (Mr Edwards) 1 doubt if your information is correct. We need to check it. (Mrs Bottomley) We could check this. 864. I think there could be some misunderstanding and we may not have the information that actually would be most helpful and most accurate for us. This clearly is very, very important to us, I hope you will understand, not least because this Committee or its predecessor carried out an in depth inquiry and a subsequent follow up inquiry into perinatal and neonatal mortality and we are waiting for the Government to accept some of the recommendations we made many years ago. Can I continue on the matter of neonatal intensive care? Is it the Government’s policy that smaller maternity units may provide neonatal intensive care or is the regional structure of such specialist services to be retained? (Dr Walford) Chairman, the levels of service for neonatal intensive care are basically either three in certain regions or two. The three tier service is a regional highly specialised service, a number of sub- regional services and basic specialised care but not highly intensive care delivered in each district. Each district has to have the capability for a minimum period of 24 hour emergency care for babies, if you need a more specialised service this may be in the regional level or at the sub-regional specialist unit. We have no plans to change that arrangement, we believe certain babies must go to specialised units and it would be quite wrong for that district to try and duplicate those services at that level. 865. Following up my question and your answer, do you think a scheme of accreditation of neonatal intensive care units should be introduced basically to prevent small units taking a hand on the grounds they may be able to do it more cheaply? (Dr Walford) Purchasers have a responsibility not to purchase care that is not of the standard required. If purchasers refuse to purchase the service from their district because the service is not appropriate, and the service is not there, hospitals are not going to go it alone. The money will not follow the patients and hospitals, as providers, cannot set up in this field. It will be for Health Authorities to purchase for their recipients the best possible care. It is quite possible this will not be in the local maternity unit for intensive care, it will be in another district or at regional level. 866. Are you accreditation or not? (Dr Walford) Accreditation per se is not necessarily the answer. We, of course, support the concept of medical audit and we know in order to have the best possible outcomes you have to have a certain throughput of patients in any given area and supporting this scheme of in a unit which is likely to treat only a small number of patients you can anticipate in advance the outcome will not be as good. A system of accreditation is not in contemplation and is quite likely to be unnecessary in this area. (Mrs Bottomley) This is one of the standards the Clinical Advisory Group are interested in considering but their thoughts on how to carry this forward are not yet finalised. I want to reinforce what Dr Walford said about the significance of audit, but also the forthcoming Confidential Enquiry into Stillbirths and Deaths in Infancy. There will be a number of measures to make quite sure we are achieving the quality of service for these fragile early infants all of us would want to see. It is not our experience at this stage that it is causing difficulties. But this is an area we would want to watch very carefully indeed. 867. If there is, therefore, no accreditation, and Dr Walford has said she thinks there will not be, and it is unnecessary, how can the purchasers of these vital technical services know what they are getting? (Mrs Bottomley) The development of effective purchasing, and of quality purchasing guidelines is part of the work of the Management Executive. We have talked about the task force for maternity services generally. It is important that purchasers become increasingly aware of the criteria they would to address in carrying forward their purchasing strategy. It is no different in that respect whether it is neonatal intensive care or maternity services generally. I do not know whether Mr Edwards wants to add anything more on that. (Mr Edwards) These decisions are not made in that manner. When you get a doctor in a peripheral hospital with a distressed child they do not worry about where the contract is, they make the decision whether their skills are enough or whether they ought to go to a different clinical territory, that is where the difficult decision making goes on. You have differential decision making, some units are building up their skills to a point where they feel comfortable, others are not. This is where professionals work together with the dedicated centres and they clearly know when to refer and they are working together. 868. That is the way the world actually works. We accept that, but obviously costs always feature in anything that is done with the Health Service purely on the grounds we have to get better value for the Service. Clearly in dealing with neonatal intensive care and these specialised units you are actually dealing with a great deal of money and I am wanting to hear, as Chairman of this Committee, and I suspect my colleagues too, that at no time will the cost of dealing with one of these distressed, vulnerable babies ever be taken into account, it will be the distress of the baby? (Mrs Bottomley) Chairman, it may be the case that the perception you have of the reforms is of an emphasis on cost, but that is only so we can improve care. The true revolution, surely, is the new emphasis on outcome figures. The development of audit is about making sure we have those figures readily available and are committed to continuing to increase the number of babies who survive infancy. Any question of costs is secondary.