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Wake up to Mother's Choice

Tuesday, July 29, 2008
Category: Sunday Times

The option exists in England, so why is there no private maternity hospital in Scotland asks Deany Judd?

Living in Britain before and for the duration of her pregnancy, when it came to deliver her baby Madonna beat a hasty retreat to Los Angeles decrying facilities in maternity hospitals in Britain as “old and Victorian.” Presumably she had checked out the private maternity facilities in England, such as The Portland Hospital, the biggest private maternity hospital in England, before reaching her decision. Just as well she didn’t check out the private facilities in Scotland - there aren’t any.

Looking through The Portland Hospital brochure it’s no wonder so many women choose to have their baby there: it has 106 beds, all in luxuriously appointed private rooms with en-suite facilities, television, radio, a comfort cooling air conditioning system, a nurse call system and a telephone with direct dial facility. In other words, what in an ideal world, every woman who has just delivered a baby should have.

However we don’t live in such a world and it’s only the seriously wealthy who can afford this. To stay at The Portland for three days costs in the region of £3000 for a normal delivery; £4000 for a caesarian birth. Add to this the consultant’s fees for ante-natal care and the whole business is beginning to look as if it’s only within the reaches of a select few.

Yet The Portland is not unique; there are private maternity hospitals in Birmingham, Manchester, Newcastle and most big cities in Britain. In Ireland it’s the norm for professional people to pay for maternity care. In this area Scotland is lagging behind. It is not possible to have a baby in Scotland and stay in private facilities thereafter.

Certainly ante-natal care is available privately, that is you can see a consultant obstetrician in a private hospital before the baby is born. But once the baby is born, delivered by the NHS, you cannot opt out of the NHS system and pay for the luxury of a private room with en-suite facilities, decent food and more intensive nursing care.

Private medicine is a thorny issue. Something you either believe in or don’t; the argument of a two tier system being the one most often raised against it. Whatever your opinion the fact remains that choice is limited in this area in Scotland when it’s not elsewhere in the country. And whilst most decent people would argue that everyone should have the same options, well, life’s not like that; ability to pay enters every aspect of life: schooling, travel, healthcare, and housing to name but a few. So why no private maternity facilities in Scotland? It was not always so.

In Glasgow alone there used to be three such private maternity hospitals: the Park Nursing Home, The Kelvin Nursing Home and St Francis Nursing Home, where many a woman enjoyed the rest and cosseting for at least five days before returning home. It was all very nice for the mother, but the medics involved viewed it rather differently.

One senior consultant obstetrician and gynaecologist in Glasgow remembers those days with horror. “You were on call almost permanently. It was very difficult to make any kind of social arrangement because you obviously didn’t know when a woman was going to go into labour. The difficulty too was that most women who saw you privately for ante-natal care believed that you would be at the birth, no matter what. You couldn’t possibly have been at every birth, but many women had difficulty understanding this.”

In Glasgow it was the opening of the Queen Mother’s Hospital in 1964 coupled with advances in medical techniques that effectively heralded the end of private maternity hospitals. The facilities in the Queen Mother’s were next to none: anaesthetists and paediatricians on call night and day, lots of single rooms as well as wards, and of course the excellent paediatric facilities on site. The introduction of the epidural, a spinal injection which freezes the body below the waist making childbirth less painful, requires an anaesthetist to administer and private maternity hospitals would therefore need to have an anaesthetist and a paediatrician on call 24 hours a day; not a cheap option. All things considered, there was no longer the need to go private.

That was thirty years ago. Advances in people’s expectations and standard of living would suggest that there would have been a rejuvenation in the private option; that many women could afford and would desire private facilities if they were on offer.

Opinion amongst those who know remains divided. A senior consultant obstetrician in Glasgow says the main reason in his opinion there are no such facilities in Scotland is because the NHS in Scotland works far more efficiently than the NHS in England. He even goes as far as to say “When Nye Bevan envisaged the NHS, the way it works in Scotland comes pretty close to that. We’ve shorter waiting lists, more beds, better funding and more consultants per head of population than England. There simply isn’t the same need to go private in Scotland.” Perhaps borne out by the fact that only 6% of the population in Scotland has private medical insurance compared with 27% in England.

Yet another consultant obstetrician in Edinburgh who sees patients privately for antenatal care says that there is no doubt in his mind that if private post-natal facilities were on offer in different parts of Scotland there would be a high take up. He adds that the subject has been raised on several occasions in the recent past but is so politically sensitive that it never gets past the discussion stage. He sees around ten women a year for private antenatal care and if that figure is multiplied by the number of consultants involved in private obstetrics, it would suggest that there could be a demand for private maternity facilities.

Dr Peter Copp of GP– Plus in Edinburgh, the only private GP practise in Scotland agrees “I do not doubt for a moment that there is increased demand for private healthcare in Scotland, in particular a demand in pay-as-you-go healthcare.” He adds “I provide private ante-natal care for a number of women who prefer to see a GP consistently throughout this period of time and where there is an opportunity to discuss all their concerns without feeling rushed or ‘bothering’ a busy doctor.”

Tracy Grabiner, who lives in the south side of Glasgow has three children “It seems very odd that there are no private maternity hospitals in Scotland. Whilst the NHS provided an excellent service when I had my children and it was very reassuring to know that if anything went wrong expert help was at hand, it would have been nice to have had the choice to stay in more luxurious surroundings. Especially if the money to pay for it was put back into the NHS and everyone would benefit.”

Laura Macfarlane from Milngavie adds, “ I saw a consultant privately before my children were born but what I really wanted was the use of private facilities once the baby was here. This is a time, above all others, when if you can afford it, you would want the use of private facilities. I don’t understand why, if it can be offered in London, it can’t be offered here”

Gordon Masterton, Chairman of the Independent Hospitals Association, says it’s more complicated than this. “The two cannot possibly be compared. London has a much bigger population as well as people travelling from all over the world to use its facilities. Scotland simply doesn’t have the demand.” He explains “There is no private insurance available for having a baby, it is not the same as private medicine. It must all be paid for out of the individual’s pocket, making it a very expensive business. He continues “The service provided by the NHS for women in labour is next to none. If anything goes wrong, either with the mother or the baby the personnel and expertise are on site to deal with it. That would not be the case if a private maternity hospital was set up without this back up.”

Surely then a middle way is the answer; a private wing or floor within an NHS Hospital, whereby there are private facilities on site with the expertise of the NHS as back up if needed. Importantly the money spent on such facilities would go straight back into the NHS, thereby benefiting everyone. Such is the practise in many hospitals in London. One such is St Mary’s Hospital in Paddington which has a private wing, the Lindo Wing, where Prince William and Prince Harry were born. A typical stay lasts for three days and costs in the region of £3000. There is no conflict between private patients and NHS patients because they are in separate buildings and there are no queues in obstetrics anyway, so nobody feels hard done by.

So what of the immediate future? Does the NHS have any such plans for maternity hospitals in Scotland? Well, it would appear not. The new Princess Royal Maternity Hospital being built on the Royal Infirmary site in Glasgow is due to open in May 20001 with 122 beds, all in 4 bedded wards. What would Madonna think?

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