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A letter from Sussex Place, July 2011

Tony Falconer, President, writes....

The current Officers have been in post for nine months and it is appropriate to reflect on the political scene and our responses. It is said that the current proposals in the Health and Social Care Bill (2010) are the most fundamental changes the NHS has seen since its inception. As an organisation one can oppose or try and use the opportunity to advance changes that we believe will improve quality of care. We have been active participants during the ‘listening’ exercise and I have had the opportunity to reflect some aspirations at the highest level. All clinicians are aware of the challenges to save money as part of the ‘Nicholson’ financial savings package. At the same time maternity services, in particular within the large conurbations are being stretched to the limit by a combination of numbers and complexity of case mix. Finally, the current workforce issues are creating unacceptable pressure on some senior doctors.

David Richmond and I have received several letters expressing grave concerns about the tariff arrangements for maternity services and indeed in some areas financial disincentives are being introduced to raise the normal delivery rates. In some trusts gynaecological workload will compensate for financial problems in maternity. We plan to hold a ‘brains trust ‘at the RCOG shortly involving interested parties to tease out some solutions.

We hope that the new commissioning arrangements, provided under the umbrella of the NHS Commissioning Board will incorporate standards, including the RCOG maternity and gynaecological standards, which really will improve care. It appears that clinicians working in secondary and tertiary care will have a ‘real’ voice either through clinical commissioning groups or through clinical senates.

The configuration of clinical services and where they should be placed creates understandable political and professional tensions. However, the reality is that women’s services are changing at a speed few of us would have predicted ten years ago. Maternity, due to capacity and complexity issues has become centre stage. In contrast, the more conservative therapies for the gynaecological end of our discipline has created a trend to more outpatient and community based services. Complex and complicated care involving cancer, reproductive medicine, urogynaecology and pelvic surgery, either open or laparoscopic, are likely to be more focused and concentrated in fewer units. Similarly consultant based labour ward cover will be located in fewer units delivering care to high risk patients, possibly in person around the clock. This anticipates an expansion of collocated midwifery run units to provide care for low risk patients who do not require the high risk strategies. The needs for acute gynaecological services needs local solutions.

We believe that women’s services, including maternity, require configuration on a network managed basis, similar to current services in neonatal and cancer care. A ‘life course’ approach to women’s healthcare should incorporate elements of the public health agenda which would fit neatly into a HQIP framework. A change of emphasis incorporating prevention as a core theme can only be advantageous.

The implications to consultant working practices and the training agenda have not been forgotten. Indeed, there will be symmetry with the next working group analysing consultant practice and logically training will follow on.

On 14 July we released a major part of our strategy - ‘High-quality Women’s Health Care’. We have already shared some aspects with Ministers and senior personnel at the DH. Your council have been very constructive throughout the process in guiding us.

All members in the UK will receive their own copy and I would encourage you to read the document as we believe that this encapsulates the direction of travel for our services.

So, our style has been to try and deliver a creative analysis of our service but to be mindful of the current political climate. Having visited several trusts over the last few months and engaged with consultants, trainees and managers, I hope and believe that we are not completely out of tune with our membership.

We believe that the RCOG has a central role in national leadership for women’s health but these aspirations would be reinforced by the appointment of a national clinical director for women’s health.

With best wishes

Tony Falconer
RCOG President

If you have any comments, please write to letterfromsussexplace@rcog.org.uk