PERTINENCIA DEL PROGRAMA

There was concern expressed by several

representatives about whether midwives would be willing to take on an additional role and whether some existing elements of their work and training would need to be delegated or omitted. The RCPCH group were concerned that midwives would not want to carry out the newborn examination, as there were already too few midwives to deliver babies. Similarly, the NCT representative recognised a concern that “with a limited number of midwives practising at the moment” and “the difficulties of providing one-to- one care during labour”, extending their role in this area might not be a priority. The AIMS representative was also concerned about the impact of additional midwife commitments. There were several suggestions about the way in which the midwives’ role could be restructured to enable them to carry out newborn examinations. The RCM representative had similar suggestions in relation to government thinking about extending midwifery responsibilities to around 6 weeks and focusing care more on public health and women’s health.

Other comments were made about the timing and organisation of the newborn examination. The NCT representative said that ideally the baby should not be examined before 24 hours to allow the mother and baby opportunities to be together and have loving physical contact. She saw

midwives examining as enabling mothers to go home earlier and to have their baby examined at home. The RCGP representative said that if midwives were examining this would still be carried out mainly in hospital and would have little impact on GPs’ workloads, but he could see

easier. The NMC representative saw no problem with accountability if midwives were to refer any babies with problems. Similarly, the RMC representative had no major concerns about accountability, although she was aware that some midwives do have these worries. She said that cover from employers would solve any such difficulties.

Conclusion

It was clear throughout these diverse interviews with representatives of the Royal Colleges and professional, teaching and consumer bodies that there was unanimous and strong support for midwives to carry out the examinations and serious concern about inadequately trained SHOs doing so. The only topic of disagreement was

about training, where the general view was that all midwives should be trained to carry out the examination as part of their core preregistration training, but the paediatricians thought that the need was for a small number of midwives with specialist training associated with each ward. There was general agreement across all the representatives that appropriately trained

midwives could examine all babies on the normal wards where mothers were caring for their babies and that some of the current exclusion criteria were unnecessary. This would suggest, as the RCPCH representatives said, that midwives could examine all but 7–12% of babies. There was widespread recognition of the benefits that midwives would bring in terms of experience, training, rapport, health education and continuity of care, and their potential for training SHOs, but that some extra resources may be necessary. Interviews with representatives of Royal Colleges, training bodies, professional bodies and consumer groups

Summary

Costs were considered in terms of three different scenarios suggested in the interviews with the representatives of the professional organisations. If midwives examined all babies where there were no complications of birth or antenatal history, there would be savings of about £2 per baby born, equivalent to savings of £1.2 million nationally.

Were midwives to examine all babies on normal wards, with other babies examined by registrars, there would be savings of about £4.30 per baby born or £2.5 million nationally. Were there no extension of midwife examination, but registrars were to examine instead of SHOs, there would be an extra cost of about £1 per baby or £0.4 million nationally.

There were differences of opinion between the paediatric representatives and the midwives about whether all or only selected midwives should examine. This would have implications,

particularly for costs of training, and these issues would need to be agreed by the professional bodies concerned. There would be likely costs of training of £0.1 million nationally for 4 years. Overall, the economic implications of any of the scenarios were not major but would imply some net costs to midwifery departments.

Introduction

This economic analysis sets out to address the question of what would be the cost implications of possible policy changes suggested by

representatives of the professional bodies as a response to the results of this trial, the National Survey and interviews. Various scenarios are considered. The cost implications are presented on the basis of implications for the costs

nationally, for an average unit and per baby; training cost implications are presented on a national basis.

Methods

The results from each of the substudies indicated that midwives carry out the examination at least as well as do SHOs. It is clear that they receive more formal training, have more continuing experience and are observed to carry out examinations to a higher level of technical competence and communication. The present arrangement of examination by inadequately trained SHOs was considered to be less than satisfactory by all the professional groups and the representatives of the professional bodies interviewed. There was no direct evidence of difference in safety as indicated by referrals between the two examining groups, but there was increased maternal satisfaction with midwives, related to discussion of healthcare issues and continuity of care. This evaluation is therefore a cost analysis or cost-minimisation analysis, rather than a cost-effectiveness study. Data are used from each of the studies and the implications are costed using the unit costs published by the Personal Social Services Research Unit for 2001.62Three different scenarios of change are considered and costed on the basis of the cost comparison with the current examination system as identified by the National Survey.

Scenario A: midwives examine 50% of