Examination of Witnesses (Questions 359-379)
TUESDAY 25 MARCH 2003
PROFESSOR JAMES
WALKER, MRS
ANN GEDDES,
MS CAROL
BURNS, MS
KAREN FOX,
MS GILL
SMETHURST AND
MS PHILIPPA
MCENROE
Chairman: Welcome to you all. Thank you very
much for joining us. This is the third of four sessions that we
are having with different units from across the country as part
of our Inquiry into the different services that women are experiencing
across the country, what that means for women's services and what
lessons that can be learned from that for maternity services—obviously
picking up some of the work the Health Service Committee did with
the Winterton report, following on from some of the work we did
there. We do appreciate you coming, and coming from some distance
to help us with our Inquiry. We are going to be covering data
collection, caesarean rates, induction rates and so on, staff
structures and the provision of training. So we will go at it
in that order, starting off with Richard Taylor on the data collection
issue.
Dr Taylor
359. Thank you very much. I am sorry to hit
you straight away with the nasty subject of data collection. The
people we have talked to already have given us the impression
that data collection varies across the whole country tremendously;
that computers crash, that computers do not talk to each other
and that there is a vast amount left to be desired about data
collection. Really, from both units, one at a time, what is your
impression of the way you collect data? What do you need? What
are you short of? Are you still using paper, as some places are?
Do you have computers? Do they talk to other computers? Perhaps
to Professor Walker to start. What is it like in the centre of
Leeds?
(Professor Walker) Leeds has two hospitals,
which comprise the Trust, and both hospitals are slightly different
in the computer facility they have. Both are out-of-date and need
to be replaced. The main problem with all computer systems I have
experience of in maternity services is that they are put into
place by administrators who want administrative data, they have
not been put in place by people wanting clinical data. So from
our point of view it can give us information about the number
of people that deliver and certain basic information, but does
not give us any clinical information that we can use for audits
or care comparisons. We are looking at replacing the computer
equipment but the usual resource problems that come into improving
computers and buying computers come into play. So there is a system
in place, it gives us basic information but it is not nearly as
good as we would like it to be and there is a resource implication
on trying to get what we want.
360. Presumably your two different computer
systems do not talk to each other?
(Professor Walker) The two systems do not particularly
need to talk to each other because they are in separate hospitals.
The problem is that there are problems in our delivery computer
systems talking to hospital computer systems like pathology results
or things like that. That is true in many hospitals.
361. How old is your existing system?
(Professor Walker) About ten years old in St James's.
362. Very old. So you have obviously got to
change that.
(Professor Walker) Yes.
363. For audit at the moment, are you reduced
to getting out piles of notes and going through notes, or can
you do any of that on computer?
(Professor Walker) We can do some on the computer—basic
information; if you want to look at caesarian sections you can
get information about who they are. You then need to retrieve
case records to get any further information about the individual
or we use things like the delivery suite book, but it is going
to case records for the final audit.
364. With a new system do you think the day
will ever come, which the Government wants, whereby systems are
standardised across the country? Do you think we can wait for
that?
(Professor Walker) What we need is to try and aim
for a common data set that we collect around the country. Whether
we use exactly the same computer systems is probably less important,
as long as they can communicate and can be adapted accordingly.
I think each individual unit has different needs, so the one-size-fits-all
may not be the best way forward, as long as there is a degree
of uniformity across the board.
365. Are you aware of work being done at the
moment to try and make this common data set?
(Professor Walker) We have been working on a common
data set for the last 30 years. This is not a new concept, it
is a revisited concept.
366. Is it getting anywhere?
(Professor Walker) It goes in certain directions and
then it falls back again depending on the enthusiasm of the people
doing it.
367. What could we do to push it? Should it
be one of our main recommendations?
(Professor Walker) Yes. If it is recommended that
it has to be done, then it has to be done. If it is recommended
as a good idea then it will be put down the pecking order of things
implemented.
368. So this should possibly be one of our strongest
recommendations?
(Professor Walker) I believe so. Earlier in my career
I worked in Scotland where we do have a common data set and it
is actually hugely beneficial.
369. We have heard from everybody that that
is the case; that it is simple and it works.
(Professor Walker) It is simple and works, but Scotland
is a smaller place. Therefore, it is an easier concept to manage
a country which is the size of an area. Yes, it is possible and
it can be done.
370. Over to the other side. Obviously you are
a smaller unit. Are you computerised or are you on paper records?
(Ms Smethurst) We have been computerised but we are
now unable to retrieve any of the data from the computer[1]
371. You are unable to?
(Ms Smethurst) Yes.
372. Why?
(Ms Smethurst) We had a maternity information system
set up for us and the chap who set it up left and nobody else
knows how to get anything from it. The very sad thing is that
we are still inputting on to it.
373. So you are still putting stuff in knowing
that you cannot get anything out?
(Ms Smethurst) Yes. We have a new maternity information
service, hopefully, later on this year across the Trust, which
is in three sites, which we will be using. In Goole specifically,
we still decided to keep paper records of everything when the
maternity information system came in about five years ago, so,
thankfully, we still do have good statistics, but they are on
paper. It is a register that we keep.
374. All this stuff you are putting into the
computer that you cannot get out, will you be able to transfer
that on to your new computer system?
(Ms Smethurst) We do not think so, no.
Chairman: Why are you still using the computer?
Do we need to move swiftly on?
Mr Hinchliffe
375. Can I ask the witnesses from Goole: the
information we received is that your unit in Goole is 25 miles
away from the nearest consultant-led unit. Would that be at Scunthorpe
or Pontefract?
(Ms Smethurst) They are all more or less the same—Hull,
Doncaster, York, Scunthorpe, Pontefract.
376. What would be the choice of the majority
in relation to where women would go from Goole, assuming they
lived in Goole centre?
(Ms Smethurst) They would probably choose—if
it was a consultant unit—Scunthorpe because then they can
have their scans in Goole and there are some pathology services
as well.
377. Thank you. I wanted to look at caesarean
section rates. I am the sole remaining member of the Committee
that initiated what has now become the Winterton Report because
Nick was the Chairman at the time. At the time we took evidence,
which was 1990-91, I think we were very aware of the stark differences
in caesarean section rates across the country and were determined
to establish why that was. I find it very worrying that all these
years later we still have these huge differences. I wondered what
your thoughts were, as witnesses with very different perspectives,
on the reasons why across the country we have got very, very big
differences in the number of times caesareans are used.
(Mrs Geddes) It is a very good question. Women have
the right to choose and some women will require caesarean sections
for some very good reasons—others perhaps not so good. I
feel our role is to give the information that is required in a
non-judgmental way and help them to make that decision. In a unit
such as ours, where we have tertiary pre-natal referrals and tertiary
referrals for foetal medicine issues, some of these women will
go on to have caesarean sections both for their own safety and
for the safety of the baby.
378. So your argument would be that it is very
much women's choice. Do you think that explains the significant
differences geographically? Often in similar areas, with a similar
nature and with similar backgrounds, inner cities, the rates are
markedly different.
(Mrs Geddes) I think you have to look in context at
the mother—the condition of the mother and the condition
of the baby. Not every woman will require a caesarean section
but there are some who, for very good reasons, will. Yes, break
down the geography of that, but the women's individual needs and
her health needs are important as well.
Chairman
379. Your rates are just so much lower than
virtually every other unit we have spoken to. Are you really saying
that the women who come to your unit are somehow significantly
different from those going to other units in the country?
(Mrs Geddes) Probably not.
1 The retrieval problems are due to an inability to
validate data rather than retrieval itself. To be clear we are
unable to retrieve validated data. Back
| 
