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'Women could do most antenatal care themselves', claim management consultants


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.”



Readers' comments (7)

  • All well said but how much does the NHS spent on consultancy firms??????

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  • Does this work for women who have high risk lives - multiple partners/drug useage/alcohol usage/abusive relationships/those from care/those with complex medical history/obstetric history/ undiagnosed medical conditions/social deprivation/those with children on the at risk register/UK not their palce of birth - this is the majority in most communities.

    Proper well supported antenatal care is the only time in some peoples lives where they feel supported and this is an opportunity to turn their lives around and prevent costly litigation/disease/social dependancy/health of their child/ support netwrok/ contribution to society.

    Absolutely priceless - no value!

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  • a lot of mums to be are unable to recognise
    changes in BP some are normal some are not, urine changes need scrutinizing not just testing and recording, swelling of fingers, toes, itchy skin? and what about those little niggly things like pain in hips. Do you honestly think that all of them would seek help and support rather than going off on a shopping spree or out for the night.Many struggle to look after themselves let alone a new forming individual. How many more emergency admissions, sections, foetal deaths will we see?

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  • would there be any correlation between 'DIY care' and a rise in cases off post-natal depression?

    Maybe this is an area McKinsey should investigate.

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  • Would there be a significant reduction in litigation as there would be no one left to interpret the results. They really do not need to worry as self care will be essential soon as many midwives are due to retire in the next ten years and they are not recruiting any where near enough midwives, or it will be like it is in nursing where midwives are recruited from abroad. The patients will not be able to understand them anyway so self care will become essential.

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  • “More than 100 mothers have died in childbirth in London in the last five years,” according to The Independent.

    The newspaper says the rate is twice as high as the rest of the country, and that a shortage of midwives may be to blame.

    Oh, so the women are not so good at caring for themselves then!

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  • Is this for real? I am a student nurse and a mother. During childbirth I had an inexperienced midwife, who kept leaving me on my own, no anti-natal care so was unable to breast feed my first child and quite an awful experience, with my second, I had an experienced midwife, who didn't leave me for a second, was supportive and kind and made the experience much more pleasant. This idea is madness, women are vulnerable, in pain and often frightened and need the support of experienced midwifes and HCA's. Plus would this proposal not prevent the formation of a therapeutic relationship, detection of abuse, postnatal depression etc. Plus who trains the patients to do these tasks? I often wonder why I am going into nursing!!!

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