Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 440 - 459)



  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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