Examination of Witnesses (Questions 700-719)
TUESDAY 1 APRIL 2003
MR RICK
PORTER, MS
HELEN JONES
AND MS
JULIANNA BEARDSMORE
Chairman
700. Twenty is the overall rate.
(Mr Porter) Twenty is the overall rate and 21% is
the rate if you only take the deliveries in the Princess Anne
Wing. I personally never quote that rate but, if somebody wanted
a measure of what an ultra-filtrate, what a selected group was
coming through the Princess Anne Wing, then that is a good measure
of it.
Dr Naysmith
701. It is my fault. I admit it and put my hands
up. I just was not reading the column.
(Mr Porter) It is very difficult because we are different.
(Ms Jones) And that demonstrates statistical collection
because sometimes we are asked for it.
Dr Naysmith: It just demonstrates idiocy!
Chairman
702. Can we pick up on the homebirth rate because
your Bath team has a very high homebirth rate of about 10%, overall
it is about 3% for your area. With the last group, I was picking
up this possible tension between wanting to get a reasonable number
of births in your community units against wanting to give women
a choice on homebirth. Do you pick up any of that stress between
the two?
(Ms Jones) We have a real difficulty with staffing
and homebirthing in the community units because we have tried
to make them as cost effective as possible. So, when you have
homebirths as well as community births, it means that you have
extra on-call commitments and so, quite naturally, there is a
tendency to want people to come into the community unit. However,
I believe that they are still given the choice. What happens in
the Bath team is that they do not have a community unit and I
think that has to play some factor. A few years ago, the women
in Bath demonstrated what they wanted. They wanted team midwifery.
This was just after Changing Childbirth. I could not introduce
it quick enough for them. They said, "If I cannot have team
midwifery, I will go for a homebirth because I know that my midwife
has to visit me at home" and they pushed the whole birthrate
up beyond 15%. Once they experienced that, I believe that they
quite like it and then it settled down into a pattern and I think
that is what we are seeing now. It has dropped a little this year—I
have just been looking at the figures again—and I think
that is because I have had a turnover of staff in teams. A few
junior members have gone out and they are just beginning to get
their confidence now and then we are beginning to see it creep
up again.
703. Why have other parts of the country not
taken that up from Changing Childbirth? Most of the witnesses
we have had here have not had a homebirth rate in any part of
their service at anything like 10%?
(Ms Jones) I believe that our midwives are really
motivated into promoting normality and active birth and they have
gone out of their way. Also, I believe that the women in Bath
are very well motivated, they know what they want and the demands
come from them.
704. If we as a committee wanted to get the
choice that obviously women in Bath have more available across
the country, are there any particular recommendations you could
suggest to us to try and achieve that?
(Ms Jones) I would increase the confidence of midwives
to try and undertake homebirths.
705. How would you do that?
(Ms Beardsmore) I think that comes from the midwives
and from the women. In this area, there is a culture of, "It
is okay to have a baby, you do not need a consultant unit behind
you" and they talk to their friends. So, the women feel better
about it and then the midwives provide this sort of service. So,
it is not seen as something odd people do, to have babies away
from hospital, it is just seen as a thing that lots of women do
and I think that helps both sides.
(Ms Jones) They have become well known and we do get
Bristol mums saying, "We have heard about the homebirths
and we want some of that", so it does spread.
706. But hard to create it from a national level.
I think you were picking up on training.
(Ms Jones) What is happening this year is that there
is a big emphasis on normality and active birth and I think that
promoting it through those means is . . .
707. Is that through training and issues like
that?
(Ms Jones) Yes.
(Mr Porter) It has to start somewhere. I think that
we need to start to get somebody saying, "Look, it is not
just crazy places like Portsmouth and Shrewsbury and Bath that
can get away with this. If it works there, surely it could work
elsewhere." We know it can because look at the experience
of King's in London which has very high homebirth rates with very
good results in a very socially deprived area. So, we know that
it is not just a quirk of several well-to-do burghers around Bath,
it actually can be transferred to what would previously have been
thought to be impossibly challenging areas. I think that is a
very, very important message and it seems to me that there is
still an incredible reluctance that is borne out of slightly irrational
fear in many parts of the country and I do not see why we still
have this fear in 2003. There are plenty enough areas of experience
around the country which have demonstrated that this can work
and I think people should stop smothering themselves in a false
cloak of anxiety.
708. We must get on to staffing, but the final
issue is a matter I asked of the last group about whether there
is, for you, a minimum number of births that should take place
in the community unit.
(Ms Jones) No.
(Mr Porter) Personally, I do not think there is because,
if you put a number on a piece of paper, then you might disenfranchise
very distant and remote areas, which would be a tragedy really.
Some areas just cannot rustle up 100-plus deliveries and to say
that therefore they cannot possibly run a service seems to me
to be inappropriate. Also, I think a great deal depends on the
maintenance of skills and experience among the midwives concerned
and I think a lot of it is about having close relationship with
their consultant unit.
(Ms Jones) Absolutely. I would reiterate everything
Rick has said. We have a system whereby all the midwives have
the opportunity to rotate out from the acute unit and rotate in
from the community units and as long as you have some sort of
systems like that . . .
Sandra Gidley
709. Moving on to staffing, I suppose the basic
question is, how is it for you? We hear of shortages; is that
the situation in Bath?
(Ms Jones) We have not really experienced major problems
this year. We have a turnover rate of 1.1% and a sickness rate
of 3.8% and I think that is excellent.
710. Can I just clarify: is that over the whole
of Bath?
(Ms Jones) The whole of the maternity services.
711. And there is no difference between the
Princess Anne Wing and the more distant units?
(Ms Jones) We have not pulled out that sort of information,
but I would say that probably the turnover is slightly higher
in the acute unit because we serve the community in this. So,
we take on all the students when they first qualify, they build
up their confidence and then they go to the community units. So,
that is the turnover rate. Within the Princess Anne Wing, you
do have a lot of junior staff. You do also have a lot of the core
staff as well.
712. Can I ask about the European Working Time
Directive because it has come up before now in this inquiry. Does
that have an impact, particularly probably on doctors more than
midwives?
(Ms Jones) I think it is going to have an impact on
midwives in terms of on calls and breaks and defining what a break
is. So, those are the problems that we will have, but everybody
will have those
713. And for doctors?
(Mr Porter) Every unit in the country will be affected
by European Working Time Directives, there is no doubt about that.
Indeed, as you in this Committee will know only too well, in some
areas, to the extent that it actually endangers the continuation
or threatens the continuation of that unit and, in some cases,
has caused the closure of units. We have the slightly difficult
position where we did actually look at the top 15, in numbers
and deliveries, maternity units in the country, of which we are
one and we were so far behind in junior staff numbers that we
were just off the map effectively. So it comes back—and
I said we would come back to this earlier when we were talking
about our failings in our audit systems—to the fact that
we are very aware that our junior staff are working so close to
the limit in the current hours that they are allowed to that we
do not want to put pressure on them to be running these audits
because only one person has to be off long-term sick and the unit
is nigh unto closing, it is that close, and that is a little local
issue that we have which we still do not appear to have resolved
and we do not seem to get the recognition for the numbers of jobs.
I was fascinated to hear, for example, the Portsmouth figures.
I think I am right in saying that the numbers added up to 13 consultants.
I think they have around 400 or 500 more deliveries than we do
and we have seven consultants. I know that their junior staff
levels are approximately twice our levels for 400-odd deliveries.
There is something slightly cookie about this, but we do not seem
to be able to get the message through.
714. Is this an argument you are having with
your Trust?
(Mr Porter) No. It is about recognition of middle-grade
jobs.
Dr Naysmith
715. What you are saying is that you are under-staffed
and under-established.
(Mr Porter) No, we are under-staffed.
716. Are you meant to be having more staff but
you cannot recruit them?
(Mr Porter) No. It is about having recognition for
jobs.
Chairman
717. From . . .?
(Mr Porter) From the recognising authority.
718. From colleges?
(Mr Porter) Exactly.
Dr Naysmith
719. Why should that be?
(Mr Porter) I do not know. It is historical. We have
struggled with this problem for years and years and years and
we cannot seem to get through it. The only reason we keep going
is with, shall we say, a slightly creative solution.
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