Examination of Witnesses (Questions 740-757)
TUESDAY 1 APRIL 2003
MR RICK
PORTER, MS
HELEN JONES
AND MS
JULIANNA BEARDSMORE
740. One-to-one midwifery care is something
I have not been able to get the Government definition of. I think
they think that, as long as you have a midwife at the end, you
have one-to-one care. What do you think it is and does it occur
in your units?
(Ms Jones) One-to-one care in established labour—I
am not quite sure what it is. I think it is that every lady who
is in established labour should be supported by a midwife and
I would say that, in most cases, that is the case.
741. Is that in the community and in—?
(Ms Jones) In the community and in the Princess Anne
Wing, but with peaks and troughs. Sometimes that is not possible
but we have mechanisms in place like on-call systems where midwives
come in and are there as soon as possible.
Chairman
742. What do you say to those units who will
not support homebirths at all and say, "We do not have the
staffing to support them"?
(Ms Jones) We work through it.
743. Do you think it is acceptable for parts
of the country not to be able to offer homebirths ?
(Ms Beardsmore) No, every woman should have that option
and it can be worked within the staff, but it does require a certain
amount of goodwill because often you have somebody who would not
be scheduled to be on call and you have one in the unit, one on
call, a second midwife for the unit, and then you have to have
another on call for the homebirth. Generally, there is that flexibility
because those midwives actually feel strongly and enjoy their
job. It does require a big commitment from the midwives.
(Ms Jones) It is all about working times and not every
midwife is happy to . . .
(Mr Porter) I have often felt that there is an economy
of scale sometimes. Just providing the odd homebirth is pretty
expensive on staff time but I think that once you get up beyond
a certain critical number, it becomes easy to staff or much easier.
I think we found that.
(Ms Jones) We have had three or four homebirths going
on in Bath at the same time.
Dr Naysmith
744. I want to finish off by talking a little
about training and how it is organised. Do you have training for
all the various professionals involved in maternity work in your
unit because you have lots of units and it is something you have
to think about quite carefully. So, how is the training of staff
organised?
(Ms Jones) It tends to be organised in two different
halves and one person in each half takes the lead and we have
mandatory days where we cover a number of different topics including
skill drills and anything that has been recommended by CESDI or
CEMD or the NICE recommendations get put in on those dates and
we have multi-disciplinary joint sessions.
745. I was going to ask whether midwives, consultants
and other members of staff all train together where it is appropriate.
(Ms Jones) They do in one half. It is quite difficult
in the other half. We include the GPs in some of the training
but the midwives all go to the ALLSO course—we support all
our community midwives in attending the ALLSO course—and
there it is multi-discipline training.
746. I did not quite catch why it was difficult.
(Ms Jones) Because of the travelling and the commitment
to release people from the workplace.
747. Does that make it difficult?
(Ms Jones) It makes it very difficult.
748. And the need to replace people while other
people train?
(Ms Jones) There is always insufficient backfill numbers
when there is training.
749. You mentioned one or two of the courses
that you have done, but what were the last two or three courses
that have been run for your staff?
(Ms Jones) We have monthly mandatory days. One is
just called a mandatory day and one is a supervisors' day and
what is on there is mentors' and assessors' updates to help students
with their paperwork and what is going on in the university. Then
they have obstetric skill drills and then they have CTG training,
lone working and bereavement and I think they finish with fire
on that particular day. On the supervisors' day, they start with
supervision, what it means to them, how to use it and how it can
support you, and they have the CESDI updates or the CESDI recommendations
are discussed. Then breastfeeding, then antenatal screening and
smoking cessation.
750. I was going to ask particularly about giving
advice to women. We have heard a little about it earlier on. We
heard about the difficulties. Can you try to get people to talk
about the care and advice they are going to give, doctors, midwives
and other professionals, so you are giving the same kind of advice
to women?
(Ms Jones) Yes.
751. Do you do that on training courses?
(Ms Jones) We have started doing it, yes, particularly
with antenatal screening and we had a two-hour session on that.
Chairman
752. Finally, you raised an interesting point
which we have not come across before of being run by a PCT. Are
there advantages to that? Do you get left alone? Do you get interfered
with more because you are run by the PCT? Does it make relationships
with health visitors and other community services easier or is
there not too much difference?
(Ms Jones) I think it is hugely different. The focus
is definitely in the primary care setting. That is the biggest
thing. Yes, you are in constant contact with health visitors and
school nurses and GPs.
753. So more areas of the country should be
thinking about that?
(Ms Jones) I would say so and maternity is big in
the primary care trust.
(Mr Porter) I think that is a reasonable conclusion
to reach. I am not quite sure why nobody else is even thinking
about it. I think it is a shame. It does not matter that the hi-tech
obstetrics is not in an acute trust, frankly. It is not the same
as taking gallbladders out and dealing with diabetic comas. It
really is not. It is far closer to delivering people in the community
units and I think people might care to think about that.
Dr Naysmith
754. I just have one matter that has been triggered
off by what has just been said. Obstetrics and gynaecology, you
do not have any specialisation? We have heard two or three times
in this inquiry that some consultants are specialising very much
in one rather than the other, the obstetrics rather than the gynaecology.
(Mr Porter) And it may well grow, I think.
755. What happens with your unit?
(Mr Porter) With one exception, we are all duallists.
The one exception is our oncologist and even he does on call for
obstetrics because he chooses to do so, he wishes to do so. He
could take a different line and say, "I am an oncologist
and I will not touch pregnant women", but he prefers not
to do so. That is his choice and he is jolly good at it.
Chairman
756. So, you have a contract with the acute
trust for the gynaecology bit and . . .?
(Mr Porter) No, we are solely employed by the acute
trust. People sometimes ask us about this, "Do you feel split
loyalties? Do you suddenly think, oh my goodness, I am working
for the PCT now and, in ten milliseconds, I am going to be thinking
of a gynaecology problem and then I am working for the acute trust"?
The answer is really, "No, of course not." I think we
are able to rise above that. The fact is that it does not make
any odds to us but it does make a huge difference to the maternity
service because it helps us to fulfil what we consider to be our
major role, which is to place the maternity services in the community
because that is where we think it lies best.
757. Just to make sure we understand that, they
manage you but the contract for your work there is actually done
by the acute trust?
(Mr Porter) Yes.
Chairman: Last but definitely not least, you
described yourselves as "strange" but actually it was
very, very useful for us to get the picture from your part of
the world too, so thanks for coming and helping us with our inquiry
and, as you heard, we hope we are going to be able to help you
with recommendations that we produce as a result of this inquiry.
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