The President of the Royal College of Obstetricians and Gynaecologists (RCOG) will today call upon the new Coalition Government to listen and to work with its doctors to change the NHS for the better. This comes on the day the College releases the results of its pre-election member poll at the 32nd British International Congress of Obstetrics and Gynaecology (BICOG) in Belfast.
Prior to the elections, RCOG members were asked for their views on a range of issues concerning the provision of healthcare services within the specialty1. The main findings are as follows:
Generally, RCOG members agreed that a patient-centred NHS should be the main driver for all those involved in the care of women. There was unanimous agreement that an over-managed NHS resulted in an obsession with meeting targets and the bureaucratic culture present in the majority of hospitals. These developments have taken doctors away from what they are there to do (ie. focusing on their patients) and impacted on the quality of care given to women.
According to respondents, the main challenges facing the next Government post-elections are:
- Staffing - the NHS needs more midwives and consultants to run its busy maternity services. There are emerging challenges posed by the need to comply with the European Working Time Directive (EWTD) alongside safety issues from the reduced number of hours that junior doctors are allowed to work.
- Service pressures - financial cutbacks from the recession, a target-driven ethos in the NHS and too many NHS managers were identified as problems.
- Social pressures - the rising birth rate, rising numbers of complex pregnancies and the increase in patient expectations have had an impact on O&G services.
When asked about what RCOG members would like to see change in present NHS O&G services, the common themes that emerged were:
- The focus must be on patients rather than targets.
- There is the need to reduce bureaucracy so that clinicians can get on with their work.
- There were too many NHS managers interfering in clinical matters and not involving clinicians in management decisions.
- The reorganisation of services - there is an acceptance that some centralisation is needed to provide better care. However, there seems to be a split in views about reorganisation. The main view was that reorganisation needs to be done in a case-by-case basis according to local needs.
When asked about how the quality of O&G services can be improved, respondents mentioned that the EWTD had impacted negatively on safety and training. The solutions offered by members included the provision of a consultant-led service, opting out of the EWTD or extending the length of postgraduate medical training so that doctors have the requisite knowledge, skills and competencies by the time they complete their medical training. Respondents also felt that the reduced number of working hours has resulted in service gaps that need to be addressed urgently.
The RCOG was also keen to hear from its membership what they would personally like politicians and policy-makers to do to improve O&G services. Respondents mentioned that politicians need to better understand the pressures which doctors go through and the service needs/demands by engaging with healthcare professionals and professional bodies. Some respondents felt that politicians should cease their meddling in clinical matters and to stop developing policy which is either unrealistic and/or difficult to fulfil without further investment in services (eg. the home birth pledge).
Members were asked to vote what they thought are the most important actions which will result in better care in NHS O&G services over the next year. The top three are:
1. Providing the training that the service requires based on clinical needs
2. Increasing consultant presence in labour wards to enhance supervision
3. Reducing NHS litigation in the specialty by greater investment in staffing
Members were asked to vote on what they thought are the most important public health issues affecting women's healthcare at the moment. The top three are:
1. The increasing incidence of maternal obesity in the population
2. The rising birth rate leading to a redistribution of NHS resources
3. Smoking in the female population
RCOG President Professor Sir Sabaratnam Arulkumaran said, "Over the course of the last year, with the build-up to the elections, there was a lot of talk about which political party had the best policies on various aspects of healthcare.
"There was the feeling amongst healthcare professionals (especially those at the coal-face of service delivery) that some existing policy ideas, though laudable, were impractical at best, misguided at worst. We decided to ask our members what they thought were the pressure points facing obstetric and gynaecological care in the NHS. More importantly, we wanted to know what they thought were the changes needed so that the quality of services improves.
"Safety and patient satisfaction were identified as paramount issues. Most notably, an overwhelming majority of our members stated that the European Working Time Directive (EWTD) is having a negative impact on junior doctor training and there may be a serious knock-on effect on the provision of safe services in years to come. We call upon politicians, policy makers and civil servants to pay heed to these concerns. Develop solutions on your own at your own peril. Instead, work with the Royal Colleges and those involved in service delivery so that you are aware of the appropriate levels of care needed and what can be achieved given our limited resources.
"The Coalition Government has a unique opportunity here. Many of the health announcements made over the last weeks shows it is determined to start with a clean slate and to make some bold changes. The previous government did much to put maternity back on the agenda. We would urge the new Government to work with us as we make our maternity services one of the best in the world."
For more information about BICOG and to view the programme, please click here.
1 To complement its Election Manifesto, the RCOG undertook an online survey of its UK membership in March and April this year. Members were asked a series of questions on the state of maternity and gynaecological services on the NHS, the external factors impacting on the provision of these services and the areas where improvements can be made.
254 responses were received.
Source:
Royal College of Obstetricians and Gynaecologists
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