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.

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    6 November 199] ] [Continued Department’s response: The majority of referrals to neonatal intensive care units will be covered in advance by contracts and so the question of where financial responsibility rests will rarely arise. In emergencies, the baby will be treated promptly and the funding arrangements made at a later date. An emergency extra contractual referral is clearly defined in legislation (section 3(5)(b) of the NHS and Community Care Act); that is, where “the condition of the patient is such that he needs those goods and services and, having regard to his condition, it is not practicable before providing them to enter into an NHS contract for their provision.” What is practicable in terms of arranging a contract will depend on the individual circumstances of the case. It is a matter for the individual purchasers to decide the level of detail. However, where the referral is an emergency and does not fall within an existing contract (ECR), the charge made will be in accordance with a published tariff. (j) In Q866, Dr Walford rejected the idea of accreditation of regional units. Does the Department expect to review this policy? Department’s response: The NHS Management Executive believe that purchasers should continue to secure improvements in the quality of service delivered through the negotiation and specification of quality terms in contracts. DHAs are able to negotiate and agree with providers quality terms which reflect their particular local needs and circumstances. It also enables clinicians to become actively involved in discussions about the standard of service they deliver leading to greater “ownership” of the quality terms agreed in contracts. Accreditation of national minimum standards runs the risk of ensuring that the minimum standards are the only standards people bother with. The Committee also wishes to obtain the Department's response to the following supplementary questions: 3. What has been the impact to date of the findings and recommendations of the Maternity Services Advisory Committee? Department's response: The Maternity Services Advisory Committee’s three reports, ““Maternity Care in Action’’, provide detailed guides to good practice and checklists for action in the areas of antenatal care, interpartum care and postnatal and neonatal care. The Committee’s advice forms the basis of Government policy for maternity and neonatal services. It is a matter for health authorities to determine how best to implement the advice contained in the MSAC reports using their detailed knowledge of local needs and circumstances but, as stated already in the Memoranda submitted to the Committee, the reports have been commended by Ministers to the NHS and their impact on service delivery has been monitored by special surveys conducted in 1986 and 1988 into selected aspects of care. The results of these surveys have shown that health authorities have taken steps to improve their maternity and neonatal services in the light of the MSAC reports and they have enabled the Department to identify areas where there was room for improvement. This in turn, has led to maternity services being accorded a high priority in the annual planning guidelines issued to the NHS since 1990-91. For instance, for 1992-93 all regions have been required to agree targets with their districts and FHSAs to reduce stillbirths and infant deaths and to play a full part in the national confidential enquiry. The NHS Management Executive has asked regions to pay particular attention to reducing smoking among pregnant women; issues of access to services for certain groups of women—eg those from ethnic minorities; and arrangements for consultant cover of labour wards. 4. Have Maternity Services Liaison Committees been successful in achieving the aim of greater user involvement in the planning of local maternity services? Can you give us examples of where significant advances have been made as a direct result of the work of a Maternity Services Liaison Committee? Department's response: Most Maternity Services Liaison Committees (MSLCs) have succeeded in involving user representation with, for example, members from Community Health Councils and the National Childbirth Trust. Most of the success of user involvement seems to be connected with the operation of services rather than in planning; with discussions of issues, such as the ‘‘Maternity Care in Action” reports and “The Breast Feeding Initiative” and conducting consumer surveys being the most prominent activities. In general terms the balance that users