Examination of Witnesses (Questions 406
THURSDAY 9 FEBRUARY 2006
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
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
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
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
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
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?
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
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
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.