Examination of Witnesses (Questions 440
- 459)
THURSDAY 9 FEBRUARY 2006
MR DEREK
LEWIS, DAME
GILL MORGAN
AND MS
MAGGIE ELLIOT
Q440 Dr Taylor: Do not try and defend
it!
Ms Elliot: It is not a better
level of care than the women on the NHS receive.
Dr Taylor: Of course it is. What they
want is the same midwife—
Q441 Chairman: Let her answer the
question.
Ms Elliot: We do have a one-to-one
midwifery scheme and that does provide a named midwife, but that
midwife cannot be guaranteed, because of annual leave and because
of other reasons, to provide that level of care. This midwife
and now the two whole-time midwives give that guarantee to them
that it will be them that actually will deliver that baby because
they arrange their annual leave around those women, so they will
not go on annual leave when they have got women booked, so it
is a guaranteed service. The women actually want that. They want
the reassurance of a midwife and it truly is not a better level
than women with clinical need actually get.
Dr Taylor: I think you have dug the hole
deep enough. Thank you.
Q442 Chairman: Obviously the individual
concerned can arrange holidays in terms of days of the week, but
the actual day, as I understand it, can be quite a long process
in terms of hours and everything else.
Ms Elliot: Yes.
Q443 Chairman: Indeed on a couple
of occasions I have sat through those long hours, waiting! Obviously
it will disrupt that day, particularly the day of birth, for these
individuals in terms of going back perhaps to their families and
everything else at the times they would normally have been able
to, so is there any personal gain in those individuals' income,
as it were?
Ms Elliot: For the midwives?
Q444 Chairman: Yes.
Ms Elliot: No, they receive the
NHS salary.
Q445 Chairman: And that is it?
Ms Elliot: Yes, and of course
including all of the on-call allowances that the NHS provides
as well.
Q446 Chairman: So they will get that
whether it was somebody who had £4,000 sitting alongside
them or not? That would be the same?
Ms Elliot: Yes, so, whether the
women are either paying for the extra services or not, the midwifes
would receive exactly the same salary.
Q447 Anne Milton: I would just make
a comment really about when you were talking about prescribing,
Gill. I think one of the issues, and where it gets very complicated,
is that compliance is a big issue, so, even if there is no difference
in the tablet, but I would like Lasix and I do not like that ghastly
furosemide, that comes into it, and also there is the placebo
effect of drugs where, if somebody perceives that Lasix will be
better for them, then they are more likely to get better if they
take the Lasix actually?
Dame Gill Morgan: Sure.
Q448 Anne Milton: But just to come
back to Maggie, and I think you were given a particularly hard
time by Dr Taylor actually, what these women are paying for is
a guaranteed person?
Ms Elliot: That is right.
Q449 Anne Milton: If you believe,
therefore, that they are not getting anything that they need,
but it is something that they want, and I am sorry to be controversial,
it is going to be said, therefore, that you are exploiting women
at a very vulnerable time in their lives.
Ms Elliot: There is a huge demand
for this and we are turning people away all the time.
Q450 Anne Milton: But I can say that
it is exploiting them and encouraging them to believe, because
they will believe, I would guess, that they need this.
Ms Elliot: We absolutely do not
advertise it in any shape, form or description. It is the women
that ask for it and for a long time they have always said that
they cannot provide it, but this midwife had actually had experience
of a very similar scheme and knew that it worked very well, so
we were asked for it. She came to me with the proposal and, I
have to say, the women that actually go on to the scheme actually
have to be booked with us first, so, because we are in London
and there are capacity issues, we cannot take women from Timbuktu,
but they actually have to be booked with us and live within our
local area in order for us to accept them on to the scheme. We
are currently turning a lot of women away from it because we just
cannot provide the demand.
Q451 Chairman: Gill, can I just ask
you about this issue of purchasing beyond a generic prescription.
It is a form of choice, is it not?
Dame Gill Morgan: Yes.
Q452 Chairman: "Choice"
is the sort of buzzword now certainly in terms of patients, though
I am not sure about the people who are providers who work in the
Health Service. I know this is not a confederation view, but just
your personal view—
Dame Gill Morgan: This is just
a discussion, yes.
Q453 Chairman: Do you see choice,
which has effectively a co-payment in that respect, as being something
that is consistent with the NHS as it has been in the past or
indeed is now or could be in the future?
Dame Gill Morgan: My personal
view is that, where co-payment is necessary for something which
is essential, we should not be charging co-payments. That does
not fit with the NHS and the ethos of the NHS, but, where this
is something which is about preference, I think you could begin
to explore different ways of thinking about co-payments. For example,
we have always made amenity beds available where people have been
able to pay an additional sum to have a private room. It seems
to me that there are opportunities in that sort of zone to think
differently because there is some choice and that is why some
of my response to this is that it is right at the edge of things
that we have always done. You could argue that having a private
room, for which we charge an amenity charge, is some sort of way
where you could only do it if you have got the money, it is unfair,
but at the same time you know that, if the private room is needed
for an individual patient for a clinical need, there will not
be an amenity bed available. I just think we need to be thinking
differently about some of these charges and whether there are
ways that we can do it where we are not co-paying for fundamental
treatment because I personally feel very strongly that that is
not the ethos of the NHS or the way we should be going.
Q454 Chairman: I have got in mind
the situation where, if you look at the Calman-Hine report of
quite a long time ago now about surgery, and cancer surgery in
particular it was looking at, we had hospitals and clinicians
who were identified as being better skilled at saving somebody
who had to have surgery for cancer than other establishments.
It would be very tempting for somebody to say, "I'd like
to co-pay on the NHS to go to that hospital with that surgeon",
which Calman-Hine identified where the chance of surviving that
cancer is quite a few percentage points higher than not going
there. What would you say to that?
Dame Gill Morgan: I would find
that completely unacceptable, on personal grounds. As far as our
members are concerned, it would be very hard and we have never
surveyed our members collectively on that, so I cannot speak on
behalf of the NHS.
Chairman: I understand that and it is
not in our script either, but it is just something I thought I
would like to test out with you. We will move on to David Lewis
now.
Mr Amess: Before that, poor Maggie! She
has had a terrible time in this Committee and even Richard has
been sticking the boot in. I am so sorry the opticians have gone
because I just wanted to say to you, Maggie, that I think your
glasses are splendid! I bet they were not taken off the shelf!
Mr Campbell: More importantly though,
how much did they cost!
Q455 Mr Amess: We have with us now
this morning Mr Lewis and I am sure that what the Committee would
really like to know is what really went on between him, Michael
Howard and Miss Widdecombe, but we are not going to pursue those
matters and we are going to talk about Patientline. Now, there
has been some very, very tough stuff in terms of the criticism
of Patientline, huge criticism about the costs of installation
when you think that, with the technology developing, they are
practically giving TVs and phones away, et cetera, so I think
the first thing the Committee would like you to address is how
you can defend the very, very high costs of installation.
Mr Lewis: Well, of course these
systems are very sophisticated systems. These are not simply
televisions and telephones at the bedside. When the so-called
Patient Power programme, under which they are installed, was specified
back in 2005 as part of the NHS Plan, what the NHS was then looking
for was a device that would not only provide telephone, television,
radio and so on, but would have the capability of doing a lot
of other things, providing interactive services for patients at
the bedside, being capable of providing access to electronic patient
clinical records at the bedside for use by nurses and doctors,
and being able to provide the mechanism for patients to order
their food at the bedside for dietary management and so on. Therefore,
the systems that have been installed are essentially a PC at every
bedside and it is a specially designed PC for the hospital environment,
as a result of which the cost of installation is high. It is typically
about £1,750 per bed, all of which is funded by the providers
who install them who additionally fund the operating costs and
that involves having staff in each hospital, typically about five
people in each hospital, who keep them clean, who maintain them
and who look after patient needs in relation to them. That inevitably
results in a substantial amount of cost being incurred. The UK
is unique in that this particular type of sophisticated system
is funded in this country in a way that it is not anywhere else
and that is that at this point it is funded entirely through payments
by patients and by their friends and relatives who make calls
to patients. As you may be aware, Ofcom, which was still investigating
the costs of incoming calls at the time we submitted our evidence
to the Committee, has subsequently reported and has concluded
that the charges for incoming calls were essentially an unavoidable
consequence of the way the funding structure has been set up in
the UK where the providers, as was recognised by the NHS at the
time, had little choice but to recover the bulk of their costs
from charges for incoming calls. The great opportunity, we believe,
and we welcome the Ofcom report, is to extend the use of these
systems for the purposes for which they were originally designed
and selected so that the benefits extend well beyond those of
patient entertainment and communication. We hope that the review
group that is now being established by the Department of Health
will indeed explore those further uses so that we can achieve
a much more equitable spread of the cost of the systems between
different users.
Q456 Mr Amess: You have really sort
of guessed many of my questions really, including talking about
Ofcom. In terms of the volume of complaints, have you had a lot
of complaints about the cost of charges not only from patients,
but from Member of Parliament?
Mr Lewis: I think it is important
to say, first of all, that, by and large, there is a remarkably
high level of satisfaction with these services on the part of
patients, and the NHS itself conducted research about a year ago
which indicated that 90% or thereabouts of patients were satisfied
with the services that they received. There are obviously concerns
about having to pay at all in the hospital environment within
the NHS, but again, by and large, the majority of patients feel
that the charges for television and for outgoing calls, which
were deliberately capped as part of the original programme, are
reasonable and they are happy to pay those. There have been complaints,
and there has been quite a significant volume of complaints, about
the costs of incoming calls which are set at a much higher level
and which are now higher than the norm for telephone calls generally,
and those complaints come from callers, friends and relatives
who call patients and indeed from Member of Parliament who are
reflecting the views of their constituents.
Q457 Mr Amess: In terms of the technology
that you have available, would you share with the Committee what
other services you feel you could provide and can you try and
seduce us by saying that, if you did provide these extra services,
in actual fact you would be saving money for the National Health
Service?
Mr Lewis: A number of these services
not only, in our view, would save money, but produce some significant
improvements in patient care, patient satisfaction and indeed
patient choice, but, with a PC at the bedside, the scope is very
considerable. For example, and these are all things which are
now being done, but not to the extent that we would like to see
them done, there are two hospitals in the UK where patients now
order their food on the system.
Q458 Mr Amess: Which are those hospitals?
Mr Lewis: They are in the north-east,
North Tees and Hartlepool, the first two hospitals to do so. That
brings a number of benefits: the information about the menu and
its dietary parameters is easily available to the patient; they
can order their food a very short time before the meal is actually
delivered; it arrives at the right bed because they have not moved
bed in the interim and that brings significant reductions in food
wastage; it completely eliminates the need to print menu cards;
changes to the menu can be done instantly; and it is a means of
providing information about what food patients have ordered for
the monitoring of their diet. In those two hospitals and the other
hospitals that are now looking at it, there are some very tangible
savings and clinical benefits.
Q459 Mr Amess: Will you answer the
direct charge though that one of the reasons your expenses are
so high is that you are not getting that which you thought you
would from the National Health Service and it is the poor old
patient who is lumbered with these costs?
Mr Lewis: I think there is an
element of truth in that. When this programme was conceived, it
was anticipated that things like food-ordering and access to clinical
records at the bedside would be widely used and would generate
a significant source of income for the providers. The development
of that income has been much slower than was originally expected.
Had that income developed at the pace that everyone expected at
the time, we would have expected to have been able to reduce the
level of incoming call charges by now.
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