The NHS could make huge savings on doctors and midwives wages’ by enlisting patients to input their own health records and conduct their own antenatal care, a partner from the consultancy firm McKinsey suggested last week.
The influential consultancy firm has kept a low public profile for much of this year, following a Mail on Sunday in report February linking it to the government’s NHS reforms.
But speaking at a conference organised by think tank Reform last Wednesday, McKinsey partner Penny Dash called for the NHS to “loosen the stranglehold of some of the professional bodies on the way we deliver care”.
People, she said, had begun to look at examples overseas that were “really challenging the notion” that “we need a nurse who’s been trained for three years to do tasks which require training of two weeks”.
“The most visible example of that is that you need to have one midwife for 28 births,” she added. “Why? There is no data whatsoever to substantiate that other than current working practice.”
In New Zealand, Dr Dash said, midwives delivered “more like 60 babies a year”.
The majority of antenatal care, she added, could be delivered by women themselves. “Most women are perfectly capable of measuring their own blood pressure and dipsticking their own urine,” she said. “If we can [introduce] this for a chunk of people then that frees up significant amounts of time, which essentially means less staff, which essentially means less money.”
She also pointed to a Cardiff project which allows patients to input their own health details into an electronic record before visiting their doctor. “At least 50% of every doctor’s time, not to mention every nurse’s time… is spent collecting [their] patients’ medical history, that the patient could have put themselves into their own health record”.
She added that the NHS needed to introduce large-scale “efficient delivery models” in community as well as hospital care. “You can’t just set up an urgent care centre and say, ‘tick, we’ve done it’.
“They’ve got to be done in a way which ensures high volumes of patients so you utilise your staff and your assets efficiently, and that does mean taking out capacity of both staff and of buildings.”
But the Royal College of Midwives challenged Dr Dash’s comments and said they suggested a “lack of understanding about the role of the midwife”.
RCM deputy general secretary Louise Silverton said: “I fear that she is treating maternity care like a production line.
“We would agree that midwives need to be able to concentrate on the care that delivers the greatest benefit to women, and that health professionals shouldn’t have their time taken up with unnecessary form filling.
“In many places women already weigh themselves, test their own urine and measure their blood pressure. However it is the midwife who interprets the results along with the findings from the physical examination and discussions,” she said.
The RCM also refuted the suggestion that recommended midwife to birth ratios were too high, noting the ratio of 1 midwife to 28 births covered not just the birth but all of the care a midwife provided to the “woman, her family and the newborn throughout and beyond pregnancy”.
Ms Silverton added, “We are happy to engage with anybody who has suggestion for reducing bureaucracy and costs whilst ensuring safe and high quality care. However, we cannot treat women and the work of helping them to bring babies into the world like a unit of car production.”