Wednesday, November 29, 2006

Chapter 11 - The Future of the NHS

This is a summary of chapter 11, the Organisation of NHS maternity care, by Professor Jim Thornton. He is a Professor at the Academic Division of Obstetrics & Gynaecology and Child Health, City Hospital, Nottingham.

He descibes three organisational features which distinguish NHS maternity care from that of most other West European countries.
1. Britain has the most centralised system. Not only do we have a low rate of home births, typical of most other countries, but we also have the lowest proportion of small delivery units <1000,>5,000 deliveries.
2. Doctors, and in particular senior doctors, are relatively uninvolved in labour and delivery. It is difficult to overemphasise the importance of close consultant involvement in labour. Although maternal and perinatal deaths are now both uncommon, the day of delivery remains the most dangerous in most individuals’ entire lifespan. Yet normal deliveries are left largely to midwives and senior doctors leave complicated deliveries, forceps and caesareans, to doctors in training.
3. Probably as a consequence, Britain is unique in having the majority of normal births conducted by midwives. However, midwives are expanding their role outside labour and the required number of midwifes has not kept pace with these new developments leading to a possible overall shortage of midwifes.
4. The potential medico-legal claims arising from alleged negligent care in labour causing brain damage, now dwarf all other medical claims from any other NHS specialty. The chapter reviews evidence of the NHS having the highest rate of sub-optimal care in Europe and suggests ways to improve the service.
To dicuss further about some of his more chilling insights, then please e mail me direct or post a comment.


Unknown said...

Hi Michelle,
I discovered your blog using "Google Alerts". They tell you whenever a new website mentions your name. I get a lot of false alarms about a radio host called Jim Thornton somewhere in the US.

You need more comments to liven up your blog. I'll mention it on my discussion group

Jim Thornton

Unknown said...

Whoops! Pressed send b4 i was ready.

May I comment on your final sentences about my chapter above? They could be read as implying that I advocate more funding of obstetricians. I do not. I think we already have sufficient consultants and that they are well paid. I would pay them differently to encourage them to spend more time on obstetrics. My proposals should be cost neutral.

Dr Michelle Tempest said...

Thanks for this Jim - glad to hear that 'google alerts' work. I deleted that final sentence.

NHS jobs are once again top of the news, but it seems they are still struggling to plan in any longer term fashion.

I wish you every happiness for 2007.