Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 240-249)



  240. Is not part of the reason for the size of the workload you undertake the failings in the NHS provision?
  (Mr Jones) Sorry, it is doing what?

  241. Because of the failings in the other parts of the NHS to provide those services.
  (Mr Jones) Absolutely, yes.

  242. If we were starting to do that that must impact back to your activity or are you saying you will do it under contract to commissioners?
  (Mr Jones) I have lost track of what you are trying to say, Mr Dowd. We originally undertook work which was not able to be provided within the NHS but I think what is happening more and more now is that work could be undertaken within the NHS but engaging in partnership with the independent sector releases space within the NHS to do other work and other priorities. I think in that sense it is not just a filling gap situation any more, it is a true partnership to assist in delivery in both sectors.

  243. Fine.
  (Ms Davies) Also it is meeting quality standards and meeting what the client actually wants and needs from an abortion service which I think in the independent sector we are uniquely able to provide. As we said earlier, we have got our own quality standards in place and one of those is an entry time of far less than three weeks. Certainly at Marie Stopes we aim to provide the service to the woman within a week of enquiry. That is one of the main issues that women demand from us. Over the years we have collected this data from our clients, we do talk to them, and there are a number of quality standards they require from an abortion service but the main one that overrides everything is how quickly they can access that service as soon as they ring in and say "I have decided I want to seek an abortion now. This is the decision I have made, can I come in tomorrow? When can I have this done?" I think that is very important, that we have to meet the needs of the women, not just the needs of the Strategy. That has to be evolved around the needs of the woman.

Dr Naysmith

  244. Have you ever come across any medical complications in the service you provide?
  (Ms Davies) Yes, of course.

  245. How do you deal with those?
  (Ms Davies) It really depends what the complication is. Actually early surgical termination carries a very low complication rate. The most widely recognised is incomplete abortion. It happens in less than one per cent of our total client load. We can sort that out in-house, the client will come back to us if she has a problem with being in pain.

  246. What if she comes from another part of the country, which I understand happens quite often?
  (Ms Davies) We always advise them on what to do post-operatively. We advise them on what to look for, on what symptoms they should be worried about, what the pattern of bleeding may be. There is an advice line so that they can ring us at any time day or night. We do have nine centres throughout the country that they can go back to. If it is impossible for them to get to any of our centres then obviously we would advise them to either see their GP or—

  247. Do you have any contractual relations with other hospitals if there was a really serious emergency?
  (Ms Davies) Yes, we do. At all our centres we have contractual arrangements with hospitals and the local ambulance services to transfer if necessary.
  (Dr Guthrie) I think you are picking up on a very real issue. I am all for services going to the most appropriate place but what is happening is particularly our junior staff are becoming de- skilled because abortion services are going more to the private sector. If a complication does arise, or if it is not a complication but there is anxiety on the woman's behalf, it may be her local unit that has got very little experience of dealing with the complications of abortion, so there is definitely a training issue.
  (Mr Jones) There is a two-way issue there, in fact, because the history of so much of this work being conducted with the independent sector has, as Kate said, resulted in some de-skilling within the NHS but, equally, within the independent sector, where so much of our expertise has been directed toward the single procedure that we are conducting, occasionally when complications do arise, particularly with the serious ones (and there will be with this volume of work even though it is a recognised and safe procedure) some surgeons within the independent sector are not significantly skilled in gynaecological interventions and it is perfectly appropriate that they be referred back into the NHS for that. In the management of all our services we have an obligation to ensure that there is that liaison and partnership with the NHS to take that care on.

Dr Taylor

  248. I have a general point picking up some of the points relating to resources that several of you have made. I think we are all in favour of decentralising and devolution of power to PCTs, but there is a tremendous conflict because services that have got NFSs and NICE guidelines seem to get priority. You are without that priority largely. How are you going to protect yourselves? What can we do to help to make sure that subjects that have not got NFSs or NICE guidelines do not get penalised?
  (Dr Guthrie) I wish I had the answer to that. I really do not know the answer to that.

  Mr Burns: On that note—

  Dr Taylor: On that happy note—

Dr Naysmith

  249. It has got to be commissioning pressure on PCTs.
  (Dr Guthrie) It has but, unfortunately, if it has not got a financial service structure around it—I would think the PCT at the end of the financial year probably has a list of things they have to pay for and they cannot pay for them all, so who says they pay for us? Unless we have a structure to protect or ring-fence money or do something, what says they will put money into sexual health?

  Dr Naysmith: Our report will help you to achieve that!

  Mr Burns: We will see. Ladies and gentlemen, can I thank all of you very much indeed for coming and for answering our questions and educating and increasing our knowledge which, as Dr Naysmith said, will help us to hopefully produce a viable and relevant report. Thank you very much indeed.

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