Maternity Services

Baroness Bennett of Manor Castle Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the important speech of the noble Baroness, Lady Gohir. Her words reflect what I heard last night at a meeting with Justice for Windrush Generations, where there was a reflection that minoritised communities share the experience of inequality and discrimination but the individual experience of different communities is different and needs to be acknowledged.

I thank the noble Baroness, Lady Taylor of Bolton, for securing this debate and reminding me of a meeting that I attended in Huddersfield in 2016. It had 480 people stretched across two meeting rooms with hundreds of people outside, unable to get into the room. It was the “Hands Off Huddersfield Royal Infirmary” campaign. I note in looking around today that a book recounting that campaign, Fighting from the Heart by Cormac Kelly, has just come out. It will pick up one of the themes of my speech: we have rightly been focusing on listening to individual patients but we also need to listen to communities and the demands that they make of their maternity services. The case of what has happened with Huddersfield Royal Infirmary is an example of that.

I am perhaps quite unusual in this debate in that I bring neither personal nor professional experience, so I put the topic out around the Green Party to collect people’s views and experiences. One that came back shocked me a little, and I will anonymise it because I am referring to a member of staff. This member of staff reflected on her personal experience. She was a professional woman in London, so you would have expected her to be well equipped to navigate the system, but her experience was that she did not have the NICE-recommended number of antenatal appointments and, as a result, a serious issue was missed. That reflects on an individual level what we are hearing from all the royal colleges et cetera about the inadequacy of services in all the statistics.

Coming back to the community point, a Green Party Birkenhead and Tranmere councillor, Amanda Onwuemene, who is herself a former midwife, drew my attention to the current perilous situation of the Liverpool Women’s Hospital, which is threatened with closure. The alternative accommodation and services being proposed do not match those being lost in maternity and other services, and the NHS and the women of Merseyside are being shortchanged again.

I want to look at what is happening there because it is a reflection of something we have not talked about very much: the issue of private finance initiatives, the privatisation of the NHS and how it has cut away at resources. That is reflected in what is happening in Liverpool and other places. The concern is that a particular quality of service is at risk of being lost.

That is also reflected in what is happening in London, where NHS North Central London is consulting on the potential of closing one of two maternity services in London hospitals due to fewer births. These are the Whittington and the Royal Free. If someone from outside London looks at a map, they might look at those two and think that they are not too far apart, but anyone who knows this area—and I do well from previous political campaigning—will know that the public transport provision heading east-west across London is extremely poor. People frequently have to take three buses to get from the east of what is the Whittington’s catchment area to the Royal Free, and people need local services and that is something that really must not be lost. I quote Mayani Muthuveloe from Whittington Maternity and Neonatal Voices, who told BBC London that there was a real “sense of reassurance” from giving birth in hospital near to where family and friends live, and that travelling to a facility further away would “add pressure” on patients.

We are seeing not just overall quality of service issues, but an issue of loss of local services. It is worth contrasting this with the Government’s own words in commenting this month on the women’s health strategy for England. That is focused on expanding women’s health hubs and, rightly, on maternity care,

“continuing to deliver on NHS England’s 3-year delivery plan for maternity and neonatal services”.

So the Government have plans for this, but, as we have heard from so many noble Lords, we are not seeing the outcomes that we desperately need.

I will pick up some points made by the noble Baroness, Lady Gohir, because the figures are deeply shocking. These are grouped figures, because those are what the NHS provides, but I am relying in part on the briefing from the Royal College of Obstetricians and Gynaecologists. Women from black ethnic backgrounds were three times more likely to die during or up to six weeks after pregnancy, and Asian women twice as likely. Deaths from mental health-related causes, as many noble Lords have highlighted, account for nearly 40% of the deaths occurring within the year of an end of pregnancy. I have a direct question here. Will the Government, as the royal college is calling for, commit to a time-limited target to reduce maternal inequalities to drive the innovation, improvement and, crucially, investment that is needed in these areas?

I will briefly pick up a point made by the noble Baroness, Lady Watkins, because I think it is terribly important. There is no doubt that the serious, major issues we are seeing in the outcomes of maternity services reflect more broadly the poor level of public health across our entire population. This is where I run into the Green Party problem, which is that everything is related to everything else. When you bring systems thinking in, you need to think and talk about everything. When we are talking about maternal health, we have to talk about people’s working hours and commuting time. Are people able to work from home? Do people get the breaks and the kinds of working conditions they need to have a healthy pregnancy and birth and to provide healthy care for their baby?

I was looking at a really interesting study from the University of Swansea about how, counterintuitively, during the biggest period of lockdown during the pandemic, when there were real shortages in the provision of services—probably unavoidably—in Wales, they found that rates of breastfeeding, successful breastfeeding and length of breastfeeding actually went up. This is where we need to look at that social setting. If people are able to work from home, if they are at home and if they have less commuting time and are able to spend more time with a newborn, you end up with healthier outcomes. While we have to acknowledge that breastfeeding cannot and will not work for everybody, we all know that it is crucial for the health outcomes of both mothers and babies to encourage that as much as we can.

I am sure that pretty well all noble Lords have received the perhaps predictable but important flood of briefings before this debate from Mumsnet, the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, to which I have already referred, Baby Lifeline, Sands and the Care Quality Commission itself. They all stress the huge problems with the workforce, particularly people not being trained or having to be trained under conditions of extreme debt and, of course, the number leaving the professions, particularly midwives.

I am reminded of a trainee midwife who I spoke to just as the change was being made that midwives would be loaded down with debt through having to pay for their own training. She was, as is often the case, doing a second degree. She had done one degree, had worked, had a couple of children and decided to retrain as a midwife. She was speaking of her experience of being a trainee midwife in a birth suite where, tragically, there had been an unexpected stillbirth. It happened that all the fully qualified professionals in that room were occupied with medical things and she found herself comforting the mother who had just had an unexpected stillbirth. I find it obscene that people are now having to pay fees to be doing something like that as they are completing their training. I do not think that is acceptable.

I have some more on the debt point. These figures are from the Royal College of Midwives. Three-quarters of the student midwives in England surveyed expect to graduate with debts of more than £40,000. Just 1% expect to graduate with less than £5,000 of debt. About half—47% of all student midwives in England—have a job outside their training in order to earn money, and that job is unsurprisingly having a negative impact on their training. That cannot be acceptable. It cannot set people up for a long-term, secure, stable career in midwifery. I am referring here to the Sands briefing, which states that the lack of staff puts more pressure on the existing staff, so more people leave, and then the lack of staff puts more pressure on. It cites a midwife, who says:

“Staff are frightened to work in an understaffed under-resourced unit, for fear of mistakes or incidents occurring due to the high activity and understaffing. Fear of investigations as a consequence and fear for their mental health and wellbeing as a result”.


This is what we are doing to our midwives.

I have one financial point to make, drawing on the Mumsnet briefing. The Government paid out £2.6 billion in the past year as a result of failures in maternity and neonatal care in the NHS. This is costing us enormously, including financially. Circling back to my initial point about the importance of local facilities, women’s facilities and listening to communities, I looked up Historic England, thinking about the situation in Liverpool. The first women’s hospitals appeared in the 1840s. There were 12 by 1871. Many people may know of the site, no longer there, where Elizabeth Garrett Anderson founded the New Hospital for Women, London, on the Euston Road. We have been through several cycles. In early modern times we had female midwives who, by the standards of the time, provided good-quality care. We then saw the arrival of male midwives, which actually saw more deaths. Then in Victorian times we saw the upswelling of women’s services. We are now at risk of losing them again. This is a cycle we need to break.