Thursday, January 3, 2013

NEWS: Northern Ireland endorses NICE guidance


On December 31, I received this reply from the DHSSPS, in answer to my question about whether its new Maternity Strategy would include the evidence-based NICE recommendations on maternal request cesareans, as published in November 2011:

"Following a Departmental process, the guidance was endorsed for the HSC in November 2012. As set out in Circular HSC (SQSD) 04/11, the Health and Social Care Board are currently considering how best to commission services in line with this NICE guideline.

The Strategy for Maternity Care in Northern Ireland 2012-2018 was launched by the Minister in 2012. The strategy recognised that interventions, such as caesarean sections, can and do save lives. As such, it does not set targets for the rate of caesarean sections in Northern Ireland. However, as the variation in practice between units within Northern Ireland is not adequately explained, the Strategy does recommend that inappropriate varation should be reduced by examining all intervention rates and benchmarking against comparable units across Northern Ireland, the rest of the UK and Ireland."

On the face of it, this is very good news, not least for women like the severely tokophobic woman who contacted me in November 2012 (and prompted my December 3 DHSSPS email) after her cesarean request was repeatedly denied - even by an obstetrician who personally believed it would be the best birth option for her.

But while this endorsement is undoubtedly a very welcome step in the right direction, I remain concerned about how it will be commissioned in practice...

As I've written about many times, even in England and Wales women have contacted me to say that the NICE guidance is being ignored, and in previous correspondence I've received from the DHSSPS (October 24, 2011) it said its Strategy "promotes normalising birth through midwives taking the lead" and that "health care uses its limited resources wisely".

Therefore, given some of the language contained in the second paragraph above (i.e. cesareans may need to be "adequately explained", and "inappropriate varation" "reduced", and the "examining" and "benchmarking" of "all intervention rates" carried out), and in the context of my original (September 29, 2011) blog on Northern Ireland's maternity care proposals (Pay (Not) To Push, says Northern Ireland's health minister Edwin Poots), I can only hope that the NICE guidance will be implemented there in full - and assure readers that I will continue to correspond with the DHSSPS to find out what specifically is being done to ensure that the November 2012 endorsement prevents this November 2012 antenatal conersation from being repeated throughout hospitals in Northern Ireland in 2013 and beyond:

"I spoke to my consulant about NHS/NICE guidelines but he just said this doesn't cover Northern Ireland and sent me on my way."

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