Examination of Witnesses (Questions 643-659)
TUESDAY 1 APRIL 2003
MR RICK
PORTER, MS
HELEN JONES
AND MS
JULIANNA BEARDSMORE
Chairman
Can I welcome you to the Committee. You are
a rather smaller group because we were also hoping to have Taunton
here today but they have not been able to join. We might throw
the odd question about Taunton in your direction but we do not
expect you to have any particular expertise on that. The Committee
are aware that you are going through some particularly interesting
times at the moment which we realise you may want to comment on
which may be very useful to us as we look at these very important
questions. We are picking up on issues, as some of you will have
heard from the previous session, on data on differing caesarean
rates and differing normal birth rates etc across the country,
staff issues and training in that order and Richard is our resident
expert on questioning regarding data.
Dr Taylor
643. Could I just ask a couple of geographical
questions first in order that we know the scenario because Bath
and West Wiltshire do not somehow seem to mix to me. What sort
of distances are you coping with? There is the one central consultant
unit in Bath but how many peripheral units do you look after,
where are they and how many miles are involved?
(Mr Porter) The first problem is that
the consultant unit is not central. In essence, like most other
health provisions in the country, it is based on historical quirk.
Historically, we have had an area of provision which is effectively
a semi-circle with, of all the absurd things, a consultant unit
at the centre of the original circle. So, we actually fan out.
The furthest point of our provision from Bath is about 30 miles.
So, the radius of the semi-circle is about 30 miles. We have a
consultant unit and we have seven community units.
(Ms Jones) May I just add that we are unique in that
the primary care trust which manages us manages acute and community
and I think that makes a difference and is probably why you are
confused.
644. So, a primary care trust manages you?
(Mr Porter) Yes, the whole caboodle.
Dr Naysmith
645. What is the relationship with the Royal
United Hospital Bath and the acute trust?
(Mr Porter) We rent the space. The medical staff are
primarily employed by the Royal United but the primary care trust
purchases 43 or 44% of their time, but all midwives and all the
other staff within the service are employed directly by the PCT.
Dr Taylor
646. Coming on to data collection, what are
your problems with it? Are you computerised? Do your computers
talk to other systems? How are you with data collection?
(Ms Jones) We have an in-house computer system that
does not connect with anything; it is completely stand-alone.
So, it is a major, major problem for us because any data that
we need to collect is always retrospective. We have to provide
RCOG stats, RCM stats, stats birth case for CEMD and we have the
Dr Foster stats and they all require something different. It is
a nightmare and we would really support the idea of having a national
computer system.
647. Do you have any communication with your
seven peripheral units?
(Ms Jones) The stand-alone system does.
648. So that does?
(Ms Jones) Yes.
649. Can you get data off the system easily?
(Ms Jones) Yes, for deliveries only. So it only captures
intrapartum care.
650. Is this why we have the gaps on the information
from you about induction rates, instrumental delivery rates and
normal birth rates?
(Ms Jones) I did not realise you had any gaps on there.
No, there should not be.
Chairman
651. That is because when we tried to extract
it from national information we do not get it, though you have
supplied it separately.
(Ms Jones) Dr Foster could not cope with seven community
units and an acute unit because he wanted to keep separating it
out and unless you actually collect the data whole, it really
skews the figures.
652. From that data, I have your seven units
there and the Princess Anne Wing which has most of the births
and we have Bath teams.
(Ms Jones) That is correct. Rick mentioned that we
have seven community units but we also have Bath City teams. They
do not have a stand-alone unit but they have a room, a midwife-led
room, within the acute, so that is what they are.
Chairman: That is the one I have visited and
seen. I am told that the data is not from Dr Foster, what we have
been trying to get hold of is from the Department of Health but
it would be the same.
Dr Taylor
653. I think that is it. You have told us that
it is a major problem and presumably the system does not talk
to anything else at the Royal United Hospital in Bath, not to
the PAA system or . . .
(Ms Jones) Not at the moment, no. We are looking at
different systems at the moment and we are hoping that the new
system, which is supposed to arrive this year or next year, will
be able to talk.
(Mr Porter) Just to go over that ground again, part
of the problem that we have had and the reason why we came quite
late to computerisation is that because of the very strange nature
of what we do in terms of 34% of our deliveries taking place outside
the community unit, it was absolutely crucial to us that our system
captured everything in a way that was unique or more or less unique
to us which is why we were not able to buy an off-the-peg information
system and even with our bespoke and designed in-house system,
we still have problems but it is the best that we can achieve
at the moment in the market as it is.
654. How long have you had it? How old is it?
(Mr Porter) A couple of years old.
655. Not older than that?
(Mr Porter) No.
656. Are you confident that a new system will
be able to cover your specific requirements?
(Mr Porter) Do you mean a national system?
657. If we come to a national system.
(Mr Porter) No.
658. Presumably the new system that you think
you are going to get at the moment will not be part of a national
system.
(Mr Porter) No. I do not think so. It would be a little
perverse, I suppose, for anybody to design a national system that
takes in people as strange as us, really!
Mr Hinchliffe
659. With regard to caesarean sections, on your
stats that we have in front of us for last year, the sections
are primarily concentrated at the Princess Anne Wing and at Bath.
What was the other? There is one other.
(Ms Jones) It was a mistake made by midwife inputting
data; it occurred at Poulton. So, although the system is probably
new—
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