Examination of Witnesses (Questions 100-105)
NATIONAL HEALTH SERVICES
27 FEBRUARY 2008
Q100 Nigel Griffiths: I have your explanation for that. I am just interested to know whether in Whitehall alarm bells ring when that is seen and a dialogue takes place as to whether or not it needs to be addressed.
Mr Nicholson: Our expectation is that the alarm bells ring at local level because it is at that level that people can take action. If it is sustainable and is a pattern then, through the work of the task force, I would expect us to be much clearer about what we should do.
Q101 Nigel Griffiths: How do you calculate the proportions of levels 1, 2 and 3? Do you have a model that affects urban and rural areas?
Dr Shribman: When the networks were established there was a clear look at which units should be designated to deliver which levels of care, but we have heard this afternoon that though we developed a modelling tool for capacity at that stage times have now moved on and there is a need to review capacity, and a number of networks need to look again at their particular patterns. Certainly, those that we have visited recently have seen an increase in birth rates and need to look again at designation.
Q102 Nigel Griffiths: To return to my previous point, I am concerned to know that the inability identified by the National Audit Office to give an average or definite cost per cot—in your case, per baby—hampers forward planning and, I imagine, the adoption of best practice where networks exist. Do you have an active strategy to address that?
Mr Nicholson: Yes. I described the development of a national tariff which is exactly the point you try to make. That will be based on an absolute analysis of cost across the system and the way in which patient activity relates to it. I have already said that we shall give the Committee detail about how we are taking it forward. [6]
Q103 Nigel Griffiths: You referred to the importance of encouraging mothers to book early. What steps are you taking to reach that group of mothers who are least responsive to that message?
Dr Shribman: First, we have set the challenge to the system that this should be by 12 weeks, so we expect everyone within the health system to work towards that. Clearly, as we roll out our Maternity Matters strategy locally people have been looking at how to reach the very communities to which you refer. One has to design this individually for the particular population. One might be looking at travelling families and take a particular approach perhaps with liaison staff; one might be looking at a particular community with language challenges. To work closely with those individual communities is the way forward to ensure that the services are designed around their particular needs and they can access them in a way they find easy and successful. That is the challenge to which we are working.
Q104 Nigel Griffiths: Has that started? Are there any shining examples about which you can talk?
Dr Shribman: Our Maternity Matters policy has in particular emphasised the importance of access and choice in reaching the more disadvantaged communities. There has been a series of regional workshops to look at how to implement that. In the process of Lord Darzi's review of next steps for the NHS, Our NHS Our Future, there is a specific work stream on maternity and the new born. I am aware from discussions with people leading those groups that they are particularly prioritising the delivery of Maternity Matters but also health inequalities and the new born. Therefore, people are actively looking in their SHA groups at how they might do this in new and innovative ways, because in the past we have not reached these groups as effectively as we need to. Lots of initiatives are being looked at. One might make mention of particular towns. For example, Bradford has particular challenges and it is tackling them in innovative ways.
Q105 Nigel Griffiths: We look forward to hearing the outcome.
Mr Nicholson: One of the things we said in terms of our own planning was that 2007-08 was a year in which people were to plan this and 2008-09 was the year in which they delivered it, so we expect action in 2008-09.
Chairman: Mr Nicholson, we thank you and your colleagues. That concludes our hearing. This is a multi-faceted Committee because of the sheer range of its work. On Monday we talked about nuclear decommissioning and today we are talking about helping premature babies. I for one find it very interesting and once again I pay tribute to what your staff achieve. We hope that by our report we can put the spotlight on the shortage of nurses and ensure that mothers when most in need get the services they require and expect.
6 Ev 16-17 Back
| 
