(14 years ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Mr David Amess (Southend West) (Con)
When I applied for this Adjournment debate, I did not anticipate quite the level of interest that there appears to be from colleagues, because I did not want to talk about specific constituency matters; I wanted just to draw to the House’s attention to one or two general midwifery matters. So all I would say, Mr Speaker, is that I hope that colleagues will be fortunate enough to catch your eye.
There can be no more personal, emotional or exhilarating experience than watching a baby being successfully delivered. I had the privilege of watching each of my five children being brought into this world, and the sense of wonder and excitement is very personal and unique to everyone, but I am much more comfortable observing babies being born than having to deliver one. It is extraordinary how some members of the animal world seem to have babies so much more easily than human beings do.
However, the point that I really want to make is that from a woman’s perspective, there can be nothing more personal than the relationship that a lady having a baby has with the midwife. Indeed, when our five children were born, I represented Basildon, and so strong was our relationship with the midwife, a wonderful lady called Ladze, that she ended up being godmother to all our children.
Despite some improvements in the national health service’s maternity provision in recent years, much more must be done to ensure that women throughout the United Kingdom receive the best care possible. For those and many other reasons, I want the House tonight to consider how best we can value and support the work of our wonderful midwives.
Let me say immediately that Southend’s maternity services are absolutely splendid. Indeed, their quality was recognised in the Healthcare Commission’s report into maternity services in the UK, in which Southend University hospital was rated one of the very best in the country. Indeed, I have just heard that I have become a member of the Royal College of Midwives parliamentary panel. It is unpaid and voluntary, but I declare it as an interest. As I am sure that all colleagues will agree, midwives throughout the country provide an absolutely invaluable service.
Recently, when I was privileged enough to undertake voluntary service overseas in the Philippines in order to support Filipino nurses, I went to a village in Ifugao, and there at first hand I witnessed just how difficult it is for some ladies to deliver babies. Our services in the UK are somewhat better than those in the Philippines, bearing in mind the challenges that are faced there, but we could still do much better.
Relations between midwives and consultants must be strengthened, and I say to my hon. Friend the Minister that more training should be available to midwives. Although the previous Government claimed some success in introducing consultant midwives in 1999, by 2009 there were only 59 throughout the United Kingdom—just not enough.
Midwives throughout the country are anxious about the outcome of the review of their pensions. The NHS pension scheme hands billions of pounds over to the taxpayer. Indeed, more is paid into the fund than is paid out to pensioners. In the past five financial years, the scheme has handed over £11.3 billion in surplus to the taxpayer, thereby helping, not hurting, public funds.
I congratulate my hon. Friend Baroness Cumberlege on the work that she did when she was a Health Minister in 1993. The report that she produced, “Changing Childbirth”, is as relevant today as it was back then. Furthermore, the work of the Royal College of Midwives, under its very capable general secretary, Cathy Warwick, must be acknowledged. This organisation, which represents 95% of all practising midwives in the UK, does wonderful work that helps women and newborns across the country. The NCT has also given me an excellent briefing on this subject and I know that it supports the points that I wish to raise this evening.
There has been a decade-long baby boom, with 100,000 more babies born last year than in 2001. Rises in the number of midwives have gone some of the way towards catching up with this extra demand. Indeed, there has been an increase of 2,000 in the number of midwives in the last three years and more than 600 more places for student midwives than there were four years ago. However, those extra midwives have largely been swallowed up by the need to provide valuable one-to-one care in labour. This means post-natal care remains woefully inadequate. Extra demand has also come from growing complexity. Mothers are increasingly younger or older than before, and some mothers have serious weight problems. The conception rate for women aged 40 to 44 has doubled since 1991, while the teenage pregnancy rate in the UK remains the highest in western Europe. There have also been significant increases in multiple pregnancies and pregnancies to women with medical conditions that would previously have precluded childbirth. The caesarean section rate is also at a historically high level—just shy of one in every four births. More midwives would help to provide women with the level of antenatal care that would prepare them properly for labour and birth.
Currently we are almost 4,800 full-time equivalent midwives short, based on calculations using established midwifery work force planning tools. For too long, maternity services were not a priority within the NHS: spending on maternity care as a proportion of the NHS budget fell from more than 3% in 1997 to below 2% in 2006, and the share of the NHS work force made up of midwives fell throughout the Labour years. Indeed, while in 1997 there were more midwives in the NHS than there were managers, after 12 years of a Labour Government, by 2009 there were 18,000 more managers than there were midwives—a ridiculous situation. The contrast in what has happened to the two work force groups illustrates how focus may have slipped away from clinical care on to performance monitoring and the dreaded targets. It is the task of the new Government to ensure that midwives do not continue to be sidelined, that their work is valued and that focus returns to good quality patient care.
Aside from resources, however, is the question of policy. The recent White Paper promises that the Government will extend maternity choice but there are questions about how it will be achieved. Although the Labour Government often said the right things and made many promises in relation to choice, they failed to deliver. Progress in implementing choice for women throughout pregnancy, childbirth and the post-natal period was impeded by a lack of sustained investment in maternity services; insufficient recruitment of midwives; and a lack of prioritisation on the part of many commissioners and providers of maternity services. It is easy to assume that it saves money to consolidate, but I do not believe that in the medium to long term that is true.
The main issue with choice is location—the options being birth in a consultant-led unit in a hospital; birth in a midwife-led unit, which may or may not be on a hospital site; and birth at home. A midwife can handle more births in a year in a midwife-led unit or at home than in a hospital, so it is an issue of efficiency as well as choice. Capital investment to provide more midwife-led units is vital, but sadly the total number of such units has dropped significantly in the last two years.
The price of getting maternity care wrong is extremely high, as the cost of litigation shows, and in a time of austerity these are costs that the country simply cannot afford. Of the 100 biggest damages payouts made under the clinical negligence scheme for trusts, 79 derived from obstetric care, and of the total £3 billion paid out in damages under the CNST, almost £1.4 billion was down to claims deriving from obstetrics. Cutting corners in maternity care carries a heavy human and financial cost.
In conclusion, the Prime Minister has admitted that the profession is “stretched to breaking point”, “overworked” and “demoralised”. During the election, all three parties agreed that more midwives were needed to cope with the continuing shortfall. Rightly, the NHS was shielded from cuts in the comprehensive spending review, and this protection should mean that the Government can provide enough midwives to deliver the level of maternity care that women and newborns expect and thoroughly deserve.
Mr Speaker
Order. I understand that the Members seeking to catch my eye have the agreement of both the hon. Member for Southend West (Mr Amess) and the Minister.
Caroline Dinenage (Gosport) (Con)
I will be brief, Mr Speaker. I just wanted to reiterate what my hon. Friend the Member for Southend West (Mr Amess) said. My constituency has a midwife-led maternity unit, Blake ward, at Gosport war memorial hospital, but it has been shut down temporarily on the basis that there are not enough midwives to cover the area. They have all been put into the Queen Alexandra hospital in Portsmouth. I am concerned about that because Gosport is a peninsula serviced by the A32, which is an unbelievably difficult road at the best of times, and I am worried that babies will be born somewhere along the road or on a roundabout.
I desperately wanted to bring that to everyone’s attention, particularly the Minister’s. The ward has only been shut until January, but this follows an incident earlier in the year when the birthing pool was shut down. Now the ward has been shut down temporarily because of a baby boom caused by the snow earlier in the year. I sometimes feel that these are closures by stealth and that eventually the ward will be shut permanently. It is important that everyone understands the huge importance of these wards, particular the midwife-led maternity units, and especially in areas such as Gosport, which has high levels of social deprivation.
Jason McCartney (Colne Valley) (Con)
I congratulate my hon. Friend the Member for Southend West (Mr Amess) on securing this Adjournment debate. Maternity services are an emotional and controversial topic in my constituency, because Huddersfield royal infirmary consultant-led maternity services closed in August 2008. Mums now have to be transferred to Calderdale hospital if there are complications during birth. Many mums are opting for Halifax just to be safe. There is a new midwife-led unit at Huddersfield royal infirmary, but mums want specialist and emergency care available there too. In an emergency, the time it takes to travel to Halifax can be the difference between life and death for mother and baby. Many Departments of the coalition Government are championing localism, and rightly so. I therefore plead with the Minister to reconsider restoring full maternity care close to where mums need it most.
Mrs Helen Grant (Maidstone and The Weald) (Con)
In a few months, if the current plans proceed, there will be no consultancy-led maternity service at Maidstone hospital in my constituency, which means that every year, 2,000 mothers will be put at greater risk, and lethal consequences could follow. Maidstone is the county town of Kent, and is a growth point area. There are many areas of multiple deprivation, and we have high rates of teenage pregnancy, so we need a full maternity service. Our community has spoken out loud and clear against the reconfiguration plan. Thousands have signed petitions saying no. Our borough and county councillors have said no. The business community has said no. As a local resident and mother of two, I have said no, and in a survey with a 77% response rate, 97% of our GPs also said no.
We are not people who are resistant to change. We are not asking for anything new; we do not want anything extra. We simply want to retain our existing services, and make safe and genuine choices for our people. Choice, we are told by the trust, will be available to Maidstone mothers for the first time, but the choice is between a midwifery-led birthing unit with six beds for the county town of Kent, serving 250,000 people, or travelling to Pembury, Medway, Ashford or Dartford. However, mums with complications will have no local choice, and neither will mums needing an epidural, mums needing a caesarean section or mums who just want to know that they will have the best expertise and equipment available to them when their baby decides to come. The trust says that patients will vote with their feet, but it does not tell people that, if they want to remain in Maidstone, they cannot do so.
I have with me a bundle of letters to the Secretary of State for Health signed by more than 100 GPs in the Maidstone area. They say that the new journey times, over bad rural roads, are unacceptable. They say that the extra risk and stress to mothers in labour is unacceptable. Those GPs also say—this is really worrying—that it is a near certainty that some babies born in Maidstone may die or suffer brain damage while en route to Pembury or elsewhere. They are our GPs: they know exactly what they are talking about. They have voted. They have put their names down and they are saying no. They are talking about our mothers, our children and our babies. The campaign has been going for about two and a half to three years while I have been involved. It is about community, choice and safety. The evidence against downgrading is powerful and profound. The reconfiguration plan is very wrong and dangerous, and it will lead to fatalities. I urge the Secretary of State to reject the reconfiguration plan when he considers the matter imminently.
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I will come to the speeches by other hon. Members when I have dealt with—that sounds awful, —my hon. Friend the Member for Southend West (Mr Amess).
I am aware that my hon. Friend has maintained an active interest in this issue for many years, and I congratulate him on securing the debate. I should like to start by agreeing with him that there is nothing in the world more wonderful than a baby being born. I have given birth to four children, at four different hospitals. As is the case for many parents, having a baby was the most amazing thing that has ever happened to me. Getting elected to this House was a close second, but nothing compares to giving birth.
Maternity care is so much more than a new arrival in the family. Pregnancy is a vital time for health promotion, and a time when parents are receptive to information and advice, and motivated to do the best for their children. For some of the more hard-to-reach people in our communities, pregnancy is one of the first opportunities that health service professionals have to talk to them about bringing up children, as well as about their own health and well-being. The impact that midwives can have is significant. Midwives and our maternity services can help us to tackle issues such as nutrition, physical activity and health inequalities, which are some of the biggest public health issues that we face. Later this year, the Government will publish a public health White Paper setting out more detail, but there is no doubt that pregnancy and childbirth are golden opportunities.
The Government set out their long-term vision for the future of the NHS in the “Equity and excellence: Liberating the NHS” White Paper. We are committed to extending choice in maternity, to enable women and their families to make safe, informed choices throughout pregnancy and about childbirth. Maternity networks will help to make this a reality. They will extend choice by encouraging providers to work together to offer expectant mothers and their families a broader choice of maternity services and to facilitate a woman’s movement between the different maternity services that she might want or need. Networks will also need to work closely with health visitors to ensure the very best support for families at this vital early stage in their child’s life. The extra 4,200 new health visitors that we plan over the lifetime of this Parliament will complement the work of maternity services to improve support for all new families and help to ensure extra support for those who need it most. The White Paper consultation period closed earlier this month and we are now considering the responses from the various royal colleges, stakeholders and the public.
I should like to join my hon. Friend the Member for Southend West in commending the work of the Royal College of Midwives, of Cathy Warwick and of all those who have gone before us. He mentioned the noble Baroness Cumberlege’s work on the “Changing Childbirth” report. That document has stood the test of time, with its insight into what is needed during this special time for families. I should also like to join the praise for the National Childbirth Trust. I am proud to say that I was chairman of its Hackney and Islington branch many years ago, when my first child was born. I certainly know only too well the contribution that it makes to many families.
Women and families who are well informed about the maternity care options available to them are more likely to receive the care that meets their particular needs, to feel more satisfied with their care and to feel confident about the transition to parenthood. In recent years, maternity services have faced increased challenges, including a rising birth rate and an increase in complexity in pregnancies. Demographic changes in childbearing, such as more women giving birth at a later age, increased rates of heart disease and obesity, and more births to mothers born outside the UK have resulted in a greater number of higher-risk births. We welcomed the recent guidelines produced by the National Institute for Health and Clinical Excellence on pregnancy and complex social factors.
Stephen Lloyd (Eastbourne) (LD)
Will the Minister confirm that the organisations that she has mentioned, including the National Childbirth Trust, all emphasise, as my hon. Friends have done this evening, that a key part of pregnancy and maternity services is that they should be close to the mothers-to-be? I believe that that is a clear objective of the White Paper, as well as of many of the organisations and groups that have been mentioned. Will she confirm that that will be a thread running through the findings of the White Paper when they finally come before the House in the form of a Bill?
Anne Milton
Absolutely. Proximity to the people for whom we are trying to design services to meet their needs is vital.
I should like to mention the Marmott review, “Fair Society, Healthy Lives”, which highlighted the strong associations between the health of mothers and the health of their babies. It also pointed to equally strong associations between the health of mothers and their socio-economic circumstances. This means that pre-conception care and early intervention before birth are as important as support during and after the birth. We need women to access maternity care early and for that to continue, exactly along the lines that the hon. Member for Eastbourne (Stephen Lloyd) suggests.
Family nurse partnerships will be extended so that we can provide the highly targeted, highly specialised support through pregnancy and the first years of life that the most vulnerable young families need. Our vision is for all women to have choice and equity of service standards and quality of care, wherever in England they are receiving care. However, we know that, in practice, not all women are offered a choice. “No decision about me without me” is what this is all about. It is about giving people the opportunity and support to make the choices that will make a difference to them, their babies and their families. It is also about giving them the information they need to exercise control, and of course the confidence to use it. Not all families find that easy.
The new outcomes framework proposes five national outcome domains covering all treatment activity across effectiveness, patient experience and safety. A number of indicators for maternity and children were proposed, including maternal death, infant mortality and the unexpected or unplanned admission of term babies to neonatal care. The consultation period has now closed and we are considering the responses. I hope that that will deal with many of the issues that have been raised this evening.
Midwives and the maternity team use their skill and compassion to help parents-to-be along their journey—a vital journey—to parenthood. We will make sure that any changes in services are led by local clinicians, patients and service users. The NHS White Paper is all about giving control of health services to the clinical staff who deliver them. My hon. Friend the Member for Maidstone and The Weald (Mrs Grant) spoke passionately about that this evening.
Effective skill mix in the maternity work force will be important. The NHS is focusing increasingly on utilising the whole maternity team and helping to use innovation and new technology to drive up the quality of care and deliver value for money.
In the next few months, we will receive information about women’s experience of maternity services from surveys conducted by the National Perinatal Epidemiology Unit and the Care Quality Commission. These survey results will give us a clear and up-to-date picture of what women think about the maternity services they receive and what more needs to be done.
My hon. Friend the Member for Gosport (Caroline Dinenage) raised local concerns about the closure of the Blake. Although I am assured that it is due to open again in January next year, I know how very unsettling it is to have local services closed. It causes a loss of confidence among local people.
My hon. Friend the Member for Colne Valley (Jason McCartney) raised the closure of services in his area. I am sorry, but sadly we cannot always turn back the clock. I am delighted to hear that a new midwife-led unit has opened and I hope it will be possible to provide people with the services they need.
As I have already said, my hon. Friend the Member for Maidstone and The Weald also raised some constituency issues. Nobody but nobody could have done more or have campaigned harder on those issues. I know that the Secretary of State asked the strategic health authority to report to him at the end of September, and he now has that report. I am sure that my hon. Friend will agree that the Secretary of State must be allowed some time to consider the report’s content.
I thank my hon. Friend the Member for Southend West for calling this debate. He has raised a number of important points about maternity care and the provision of maternity services. Our White Paper gives us the chance to refocus the NHS on what is important to its users and staff, providing those services so that we achieve the results that are important to them—ensuring that all women and their families have access to the best possible care at this crucial time in their and their family’s lives.
Question put and agreed to.