Examination of Witnesses (Questions 400-419)
TUESDAY 25 MARCH 2003
PROFESSOR JAMES
WALKER, MRS
ANN GEDDES,
MS CAROL
BURNS, MS
KAREN FOX,
MS GILL
SMETHURST AND
MS PHILIPPA
MCENROE
400. If you ask for it?
(Ms McEnroe) Yes.
401. It is not automatically covered?
(Ms McEnroe) If you are having a normal pregnancy
and it did not arise, then I do not think you would need to know.
402. All I recall, 15 years ago, for the first
child we had, was a video which was pretty basic stuff. You do
not feel it is appropriate in parent craft to be addressing these
issues?
(Ms McEnroe) I went to parent craft classes for my
first child and I think it was covered, but until the time of
your actual birth then you do not know how things are going to
go.
403. Basically, what you are saying is in your
parent craft classes you received sufficient information?
(Ms McEnroe) Everything was covered in relation to
caesarean. It was all covered, yes.
(Ms Burns) My personal experience is a lot longer
than 15 years, so I am talking about users that I am in contact
with. On the basic issue of information, it is one of the commonest
criticisms that comes back in feedback—and we have had a
full-time worker on our project doing involvement work, particularly
with hard-to-reach groups—that they did not get enough information
when they wanted it and when they needed it. They felt that this
issue of being fully informed was sometimes hard to achieve, really.
Although I agree with some, I think it is a very fine balance.
I think some users would say "Well, I do not want to know
about caesarean section because that is if something goes wrong
and I do not want that when I am three months' pregnant".
I think it is very complicated and there is a balance between
the individual women's needs and providing the information. In
Leeds we have explored a variety of things, including a video
which people can access in bits when they need it. There are information
packs that people get. Even so, we still get a lot of feedback.
I think that interaction, particularly because most of our bookings
are done in the community with community midwives, and relationship
between the midwife is crucial, really. I am not sure that people
do get the information that they need, overall, when they need
it. If English is not your first language then I think we have
got huge issues of communication and resources to support that,
and I think we are struggling. Although we do have a very good
project in Leeds which tries to address that, I think there are
still huge issues.
Dr Naysmith
404. I want to ask a few questions about staffing
matters and how easy it may be to get particular professionals
and, also, go on to say a word or two about how professionals
interact with women who are having babies, both before and after
delivery. Can I start off by asking Mrs Geddes and Professor Walker
first: do you have any difficulties in staffing the units that
you are responsible for?
(Mrs Geddes) We do not have any difficulty in Leeds
in recruiting staff. We are very lucky that we have a feed-in
institution from Leeds University who train 40 midwives a year.
We do have a retention problem because people tend to come and
stay and not move on; therefore, the opportunities for promotion
are few and far between. What we have been trying to do is look
at retention issues, about how we can encourage people to stay
by developing new skills and extending the midwife's role.
405. So what you are saying is you do not really
have any problem with recruiting at all?
(Mrs Geddes) No.
406. But keeping them as just ordinary midwives
(midwives are not ordinary) or not promoted midwives is difficult?
(Mrs Geddes) It is difficult. Obviously, when people
have had a few years in the profession they are looking for promotion—because
we all do that, do we not—to further their career.
407. In a way, is it not a good thing to have
a reasonable turnover?
(Mrs Geddes) That is right.
408. It sounds to me as if you are all right,
really.
(Mrs Geddes) We are okay, in terms of the staff that
we have. The difficulty is getting sufficient numbers and sufficient
funding.
409. The interesting thing about what you have
just said, and we constantly find that in this Committee, is that
things that people have as an idea—that everyone is short
of nurses and midwives—is not true. What you are saying
is there is not for you.
(Mrs Geddes) That is right. I am aware of that, and
I am very lucky compared with other places in the country.
Andy Burnham
410. Something that I found very strongly from
my own surgery was a shortage of midwife training places in Manchester,
and great difficulties in getting on to a training course. From
what you are saying, is that something that is the same in Leeds—there
is great demand for places, and that might lead to a difficulty
in getting on to a training course?
(Mrs Geddes) There is more demand than there are places
available at Leeds University. We work very closely with Leeds
University in terms of our recruitment and there are always more
recruits for the programme than there are places.
411. Are they providing enough training places,
or could they be providing more?
(Mrs Geddes) They could be providing more but that
comes with the funding stream, of course.
Dr Naysmith
412. One of the things we have heard is that
the new European Working Time Directive causes problems. Has it
caused problems for you?
(Mrs Geddes) No, because we are very flexible in how
we allow our shifts to work. We obviously have to comply with
the Working Time Directive but I have midwives who work one night
a week, two nights a week, three days a week, etc. We very carefully
plan it because we understand the parameters of the Working Time
Directive. We have done a lot of work to make sure we comply.
It is very difficult to expect a midwife to be looking after a
woman 12 or 14 hours later, because she is not going to be sharp,
she is not going to be of any benefit to that woman. So we have
done a lot of work to make sure our shifts are flexible.
413. I want to ask a question about continuing
care and carers later, but I will come back to that. That is all
very interesting. How about you, Ms Smethurst?
(Ms Smethurst) I would say the same. We do not have
a recruitment problem in our area. We have students from Hull
University and those courses are over-subscribed as well.
Dr Naysmith: Why do you think it is that in
the South they have so many problems in recruiting people?
Mr Hinchliffe: Yorkshire is a much nicer place
to live!
Dr Naysmith
414. Scotland is even better than North Yorkshire.
You do not have any of those sorts of problems?
(Ms Smethurst) No.
415. Can I go on to a slightly different area?
How well do community and general practice services link up with
hospital services? Do you work together? Perhaps I could start
with you, Ms Smethurst?
(Ms Smethurst) In Goole we work very well with the
GPs in that they have very little input into the maternity services.
They were quite happy to reduce their input some years ago, and
we have good communications with them. They let us know if we
need to know and we let them know, but they do not actually see
the women any more.
416. Are you happy with that?
(Ms McEnroe) Yes, I am. When you are dealing with
the midwives there is no real need to see your GP.
417. A question I was going to ask was: to what
extent do local GPs and local community services support women's
choice of place of birth and the kind of care that is given? What
you are saying is they have very little to do with it. As soon
as there is a pregnancy they just hand over to you?
(Ms Smethurst) I think the GPs support the midwifery
services by their absence, if you like. That gives the women confidence.
(Ms Fox) GPs are not always aware of the choices available
to the women, either. Things change. We keep up with the changes,
the GPs have enough on without keeping up with changes in maternity
services. So it is much easier for us to keep up with the maternity
service because it is a very small part of a GP's case load. They
will refer the woman to us or the woman is self-referred to us
and then we will give them the information on what their choices
are.
418. Is it the same in Leeds?
(Mrs Geddes) Very similar. We work very closely with
the Primary Care Trusts and the Primary Care Teams locally at
the surgery to involve the midwife in the decision. Obviously,
the patient is going to be a pregnant women but she is going to
need other primary care services. So the communication, particularly
in some of the more difficult areas, is very, very important.
Chairman
419. Are you both supporters of home births
as well? Are GPs supportive of that as well?
(Mrs Geddes) We provide a home birth service in Leeds.
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