Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a great pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on securing this important debate on neonatal services. He strongly advocates the needs of his constituents, but also raises an important issue that we are already focusing on and improving, to give every child the very best start in life.
It is also a pleasure to hear from my hon. Friend the Member for Hexham (Guy Opperman), and I am looking forward to visiting his constituency in the near future. An April visit is in the diary at the moment, and I look forward to visiting and seeing for myself some of the excellent care delivered locally. He is right to highlight that midwifery-led units play an absolutely vital part in delivering high-quality care for women and their families. The Birthplace study absolutely supports his points and suggests that midwifery-led units may well play an even more vital role in the future provision of maternity services. I am sure that we will discuss such matters in future debates.
Before we get on to the specifics of neonatal care, I want to discuss some of the more general points made by my hon. Friend the Member for Daventry. He mentioned air ambulance services, and he is quite right to say that if we want a co-ordinated and integrated emergency response, particularly in more rural and sparsely populated areas, air ambulances must play an important part. The land and air-based responses need to be co-ordinated effectively, particularly for road traffic accidents. He makes a good point and I am sure that the local commissioners in Daventry and elsewhere will take note of our discussions today.
My hon. Friend was quite right to say that the payment- by-results system has been problematic in many areas of medicine. My right hon. Friend the Leader of the House, when he was Secretary of State for Health, made strides towards changing the tariff system in many areas of care, particularly the year-of-care tariff for people with longer-term and more chronic conditions. We also have changes being implemented to the maternity tariff to encourage a normalisation of birth. We want to view birth as a normal, everyday, natural process and to move away from births that need hospitalisation, by supporting people better in the round through antenatal care and more holistically throughout pregnancy, childbirth and the post-natal period.
My hon. Friend mentioned the unacceptable variations in care that exist across the country, which was highlighted poignantly today in the debate on the NHS in mid-Staffordshire. He has also previously advocated the reduction of stillbirths and supports the excellent work that Bliss does to raise the importance of high-quality neonatal care. More work is necessary, but I want to describe some of our achievements and the progress that the Government have made over the past couple of years, which shows that we are taking such issues seriously. As my hon. Friend quite rightly outlines, there is more that we can do and we intend to do more over the months and years ahead.
As has been said throughout the debate, we cannot divorce childbirth and midwifery care from neonatal care; the two are linked in terms of service provision and the care that is provided for premature babies. We want to provide more care and support for women during pregnancy, and the latest work force figures show that midwife numbers increased by 1,117 between May 2010 and October 2012. Training places in midwifery are at a record high, and we are ensuring that commissions for future training places will remain at a record high, so that we can continue to provide personalised, one-to-one midwifery care for women. The birth rate is increasing, and that is why we are employing more midwives and keeping training commissions high.
On neonatal care, 1,376 neonatal intensive care cots were available in December 2012, of which 951 were occupied. In December 2011, only 1,295 such cots were available. So in a period of 12 months—between 2011 and 2012—we have seen an increase in the number of neonatal intensive care cots available nationally, and I am sure that my hon. Friend will agree that that is a good thing.
The number of paediatric consultants has also increased, from 1,507 in 2001 to 2,646 in 2011, and the number of paediatric registrars—or middle-grade junior doctors—has also increased by almost fourfold in the same period, with some of those registrars specialising in neonatal medicine. Consequently, I believe that we must give some credit to the previous Government for some of the work that they did in this area, but this Government have taken their work forward with renewed vigour to make this a priority.
The number of full-time paediatric nurses has also risen, from 13,300 at the beginning of the century to 15,629 in 2011. So, in general, we are seeing good progress being made in putting more resources into children’s health care, giving every child the very best start in life.
Specifically on neonatal services, my hon. Friend is right to highlight the fact that we need to do more to ensure that there is no variability in the system. We made a commitment very clearly as a Government to high-quality, safe neonatal services, founded on evidence-based good practice and good outcomes for women and their babies. Improving outcomes, rather than focusing on process measures, is what we are all interested in. We want to ensure that babies who need neonatal care are given the very best care and have the very best outcomes in terms of their future life and, indeed, the care that they receive on neonatal wards.
In our mandate to the new NHS Commissioning Board, we will be holding it accountable for all health outcomes. We want to see the NHS in England leading the way in Europe on health care outcomes. The Secretary of State for Health has made it clear that mid-table mediocrity must be a thing of the past in all areas of medicine, and I will make sure that I work closely with Bliss and other organisations and, indeed, with my hon. Friend to make sure that we hold the NHS Commissioning Board to account for delivering high-quality health outcomes everywhere, particularly in this important area of neonatal care.
It is worth highlighting, and I think that I have time to do so, the different types of neonatal facilities that are available; the different types of special care baby units, or the level 1, level 2 and level 3 units. Special care units, traditionally known as level 1 units, provide care effectively just for the local population in the local area. They provide neonatal services, in general, for singleton babies born after 31 weeks and six days gestation, provided the birth weight is above 1,000 grams. For slightly more complicated births or slightly more premature births, there are level 2 units, which provide neonatal care for their own local population and for some sicker, or more premature, babies from elsewhere. They provide neonatal services, in general, for singleton babies born after 26 weeks and six days gestation, and for multiple-birth babies born after 27 weeks and six days gestation, provided the birth weight is above 800 grams. Then we have level 3 units as they are traditionally known, which are neonatal intensive care units, and they are sited alongside highly specialist obstetric and fetomaternal medical services. For example, there is a level 3 unit across the river from here, at St Thomas’ hospital. Such units take very premature babies.
That description highlights the fact that neonatal care must be considered alongside the provision of high-quality maternal care; the two go very much hand in hand. The point that my hon. Friend made—my hon. Friend the Member for Hexham made it as well—is that when services are being redesigned or reconfigured the most important thing is to provide high-quality patient care. Reconfiguration is about delivering those high-quality patient outcomes and that high-quality care.
The best example of where service reconfiguration has really benefited patients that I can think of was in Manchester, which I visited towards the end of last year. A redesign of the maternity and neonatal provision in Manchester in a very planned, systemic way resulted in about 30 babies’ lives being saved every year. When the case for reconfiguration is made in terms of patient care and not in terms of cost, as my hon. Friend the Member for Daventry outlined, that is the right reason to reconfigure and redesign services. What we cannot have, and what has been expressly ruled out under the criteria for reconfiguration, is redesigning services purely on the basis of cost. If we are going to redesign the way that we deliver care, it must be done in the way that it was done in Manchester, where—as Mike Farrar, who is now the chief executive of the NHS Confederation, said—it is about saving babies’ lives. That service reconfiguration in Manchester was right, because it is saving 30 babies’ lives every year. That is the right reason for reconfiguration.
My hon. Friend was absolutely right to highlight that in some cases, when we look at these issues in areas where there are long distances to travel and considerable rurality, all these factors need to be taken into account when redesigning services. However, the end result must always be for the benefit of patients. It may be the case that sometimes people have to travel a little bit further to get that high-quality care, but these decisions must be considered in the round and on the basis of achieving high-quality outcomes and doing the best things for mothers and their babies.
In conclusion, it might be worth highlighting a few other specific things about neonatal care that the Government are committed to doing. We now have a toolkit for neonatal care, and we are looking to ensure that it is properly implemented across the NHS. Some parts of the country are doing very well in ensuring that the majority of their staff working as nurses in neonatal units have specialist training, but that is not the case everywhere. We have established that toolkit; that was a direct challenge that the Government have picked up and taken forward, to ensure that we drive up the standard of neonatal care everywhere.
Guy Opperman
Does the Minister accept that, as the health care reforms kick in, it is incumbent upon GPs to make the point when they first advise expectant mothers that they can give birth at various places and that midwife-led units provide the full spectrum of care from well before the birth to well after it?
Dr Poulter
My hon. Friend is absolutely right. It is vital that whenever there is a discussion with any patient—in this case, it is a discussion with an expectant woman about where she should give birth—that an informed choice is made. That should not just happen initially, but that choice should be reviewed consistently, according to what the risk factors might be throughout the pregnancy, and women should be helped and supported into choosing the most appropriate birth setting for them. And all factors, such as the woman’s safety or what care might be required immediately after the birth, are vital ingredients in that decision-making process.
What we want to promote, and what we all believe in, is patient choice in the NHS. One thing that is facilitating patient choice in maternity care is having a national set of maternity notes now, so that all women effectively have a transferrable set of notes that they can take from one unit to another. That is something that is being driven across maternity care, and I think that it will make a real difference if the location of care needs to change in the future.
I will also say something specifically about how we will ensure that we better implement the toolkit, which we agree is a good thing in driving up the quality of training available to neonatal nurses. Very shortly, I will be devising and helping to set up the Health Education England mandate, which will be responsible for training health care professionals in England; not just doctors but all health care professionals. A mandate will be established for how that body will operate and what it will prioritise as areas of training. I am very happy to give a commitment, just as we did on the mandate for the NHS Commissioning Board, to ensure that giving every mum the right support in pregnancy and every baby the very best start in life is something that we will look to incorporate in that mandate, to make sure that high-quality training is available for health care professionals involved in all aspects of pregnancy, birth and beyond, and of course neonatal care is an important part of that.
That is something that I will take away from this debate, to ensure that it is clearly an important part of the Health Education England mandate that we look very seriously at neonatal services, to help to iron out the unacceptable variability in training that we have identified. I hope that that is reassuring to my hon. Friend the Member for Daventry. I thank him for securing this debate, and I thank you, Mr Streeter, for chairing it.
Question put and agreed to.