Holland seems to be developing a less unequal society than the UK and Great Britain. It’s unified and (Rationing and models) overtly rationed health care system may be part of the reason. With 4 different health systems, all independent, and based on different ideologies and therefore priorities we cannot expect much change. The power of a universal and unified mutual is evident in the Dutch Medical system. One of the biggest problems in the UK is that political boundaries are not coincident with Health trust / CCG boundaries. In rural areas especially, this tempts MPs (and WAMs in Wales) to side with the protesters against change(s), which they interpret as threatening. In my case they speak for “little Pembrokeshire” rather than the “big Hywel Dda trust“. The utilitarian approach needed, and endorsed by Trust Boards, is therefore undermined. Planning for longer term and with less conflict should be possible with fewer political representatives who represent CCG areas, and a Proportional Representation system of government.
Holland has achieved a dramatic reduction in its stillbirth rate by putting women at the centre of 24-hour-a-day maternity care.
According to a report published by The Lancet last month, there has been an average annual fall in stillbirths of 6.8% in Holland since 2000, compared with 1.4% in Britain.
With a stillbirth rate of 1.8 per 1,000 births in 2015, Holland is ranked third best in the world. The UK is 21st with a rate of 2.9.
Yet in 2000 the stillbirth rate in Holland was 5.3. It was only after a steering group was set up to look at the problem in 2008 that the tide was turned.
The subsequent report, A Good Beginning, demanded seven changes: putting mother and baby “in the starring role”, noting that “healthy old age begins in the womb”, ensuring a well informed pregnancy, joint responsibility across healthcare bodies, extra help for vulnerable women, avoiding women giving birth alone and 24-hour availability for urgent care within 15 minutes.
Jan Jaap Erwich, professor of obstetrics at the University Medical Centre in Groningen, set up a national audit programme in 2010 where every stillbirth was analysed so lessons could be learnt.
“We ensured better working together, with lower thresholds for midwives discussing patients with hospitals and making better paths of care for individuals,” said Erwich, who suggested Britain could benefit from more ultrasound machines.
Karlijn van Driel, of the KNOV Dutch midwives’ association, said: “In the past 15 years a lot has happened. There’s lots of attention given to women in vulnerable situations, attention to lifestyle factors such as stopping smoking, good measurement to see whether babies are growing enough and midwives and obstetricians now work intensively together.”
The success of Croatia, ranked fifth in The Lancet study, is attributed to a well integrated four-tier healthcare system combining local and regional care.
Dr Milan Stanojevic, a neonatology specialist in Zagreb, said: “We have relatively cheap but well organised perinatal healthcare. More than 95% of women in Croatia make more than eight visits to their gynaecologists during pregnancy . . . Every year we also analyse and evaluate trends in perinatal mortality so that we can respond more effectively.”