Examination of Witnesses (Questions 240-249)|
WEDNESDAY 10 JULY 2002
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.
(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.
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
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
249. It has got to be commissioning pressure
(Dr Guthrie) It has but, unfortunately, if it has
not got a financial service structure around itI 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
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.