Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 406 - 419)



  Q406  Chairman: Good morning. Could I welcome you to the Committee and thank you for coming along to help us with our third evidence session in looking at the issue of NHS charges. I wonder if I could just ask you to introduce yourselves and what organisations you represent.

  Ms Elliot: I am Maggie Elliot. I am representing the Hammersmith Hospitals NHS Trust.

  Dame Gill Morgan: I am Gill Morgan and I represent the NHS Confederation.

  Mr Lewis: Derek Lewis and I am the Chairman of Patientline.

  Q407  Anne Milton: My first question really is addressed to Maggie. Perhaps you could tell us a bit more about the scheme in place at Queen Charlotte's Hospital where expectant mothers can pay for NHS care. Maybe you can expand on that and tell us a little bit about why it was developed in the first place.

  Ms Elliot: First of all, the mothers do not pay for NHS care and we are quite clear about that. The mothers actually book in to the hospital normally first, so they actually are entitled to, and absolutely would receive, NHS care if they themselves did not choose to go private. The scheme started about two years ago or the concept was two years ago, but the actual commencement of the scheme was about 18 months ago. One particular midwife came to me very, very keen to provide 24-hour on-call service to reassure women that everything is all right and that sort of thing, so it was started as a result of that conversation. She had also been aware of a very similar, but not the same, scheme in another trust. There was a demand from women, so we looked into it fully and started.

  Q408  Anne Milton: So, just for the record, mothers pay for that?

  Ms Elliot: Mothers pay for the 24-hour on-call service that this midwife and now, since then, one and a half others actually provide which is not available to other women basically.

  Q409  Anne Milton: So what you are suggesting is that, if you cannot afford to pay for it, you do not get the reassurance in the middle of the night?

  Ms Elliot: Yes, you do, but you do not get the same person to do that. Of course the relationship builds up with that one midwife, so, as soon as the woman calls her, she knows immediately who it is, what her issues are and provides very reassuring advice or tells her to come into the hospital or whatever. Yes, other women are able to call the hospital, but they speak to either a midwife on the delivery suite or they speak to a community midwife basically.

  Q410  Anne Milton: There has been evidence around for years and years and years about the outcomes for women in pregnancy if they have a named midwife and certainly organisations like the NCT have been calling for that for years, so in fact your access to somebody you know is quite important when you are pregnant?

  Ms Elliot: It absolutely is and we would move towards that for everybody, particularly if it is part of the NSF, so it is planned for the future, but currently we do not provide the absolute midwife for that woman. The other thing of course is that the scheme has allowed us to provide this service for women with a clinical need, so, as well as this midwife and now another one and a half actually providing that service for the women who pay for it, we actually now can provide it for women with severe clinical need, and she takes on women free of charge which we would not have been able to have done if we had not actually started this scheme.

  Q411  Anne Milton: What would be the clinical need?

  Ms Elliot: It is people who may have had a very traumatic experience with their first birth, so they would come to me and I would have a conversation with them on the telephone and then I would refer them on to the Jentle Midwifery Scheme because they basically need the reassurance of one, single midwife.

  Q412  Anne Milton: You talk about difficult socio-economic circumstances as well. What do you mean by that?

  Ms Elliot: Well, that could be somebody who had a history of domestic violence. Basically anybody who needs the reassurance of a midwife who absolutely knows their history from start to finish are the people who are referred to this scheme.

  Q413  Anne Milton: So clinical or socio-economic, people whose pregnancy is flagged up as maybe being complicated for a number of reasons?

  Ms Elliot: Yes. To put this into context, because it is a pregnancy from start to finish, this is called a "caseload", so the Jentle Midwifery Scheme have actually taken 51 women who have actually delivered with them who have actually paid. Additional to that, they have taken on an extra 25 who have not paid, and they were able to expand that number as well, but they also provide reassurance and care to other women as well.

  Q414  Anne Milton: Are you comfortable with it?

  Ms Elliot: Absolutely, yes.

  Q415  Anne Milton: I need to ask you that because it could be seen very much as a two-tier system.

  Ms Elliot: It is not a two-tier system because all women at Queen Charlotte's, I hope, have a high quality of care. These women do not actually receive a better quality of care, but they simply pay for the reassurance of one midwife and nobody else will get that.

  Q416  Anne Milton: You are subsidising, richer people are subsidising the needs of a group of people you have flagged up as having exceptional needs during their pregnancy? Yes?

  Ms Elliot: We are able to reinvest the money back into the NHS, yes.

  Q417  Anne Milton: Quite. Just moving on to Gill, do you think this kind of scheme will be introduced elsewhere?

  Dame Gill Morgan: I think the challenge for schemes like this is that they are right on the cusp between the private sector and the NHS which makes it, I think as you have been exploring, really quite difficult to know how far people will take them. We are not aware of a large number of schemes of people trying these sorts of things, but we are aware of individual organisations trying them. This is really quite different, I think, from the other one which has had a lot of publicity recently which is the dermatology clinic which is quite clearly a private service run in NHS hospitals. We have always been able to run private services in NHS hospitals and we have always been able to offer extra amenity in terms of beds and hotels right back to 1948. This is really exploring a new territory and I think we are not going to know, and this is one of the problems for organisations, quite how acceptable it is until at some point it gets tested in law because it is right at the boundary, I think, in terms of position. You will have tested it before you actually set it up, but it will be the test of whether anybody challenges it in court which will finally encourage organisations to do it. I think people will be looking at this, but not necessarily intending to go down the route at the moment.

  Q418  Anne Milton: Just to come back to you, Maggie, do you have any figures of the people who pay for this, how many of them have the sort of need that you would have identified?

  Ms Elliot: Well, first of all, anyone who had a need would have had our one-to-one midwifery service anyway, so it is actually a want absolutely rather than a need. They pay for something they want.

  Q419  Anne Milton: So they are paying for something they want, not something that they need?

  Ms Elliot: That is right.

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