Maternity Services

Debate between Baroness Stuart of Edgbaston and Baroness Burt of Solihull

Tuesday 1st February 2011 Westminster Hall

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

I wanted to have today’s debate on maternity services for three reasons. One is the confidential inquiry into intrapartum-related death, conducted by the Perinatal Institute in Birmingham in October 2010. Incidentally, its director is one of my constituents, which, of course, adds to the quality of the report.

Secondly, I vividly remember an article in The Sun during the election campaign in 2010, in which the right hon. Member for Witney (Mr Cameron) clearly promised 3,000 extra midwives. The third reason is last night’s debate on the Government’s health reforms. The three are unfortunately related.

I will begin with the report. An enormous amount of good work is being done in maternity services and provision, and the Birmingham women’s hospital in my constituency provides excellent care. The west midlands should not feel that it is being singled out. It was simply the first area that took a good, honest look at what is happening and, therefore, has produced figures from which the rest of the country can learn. The west midlands is an area of huge diversity, both in income and ethnic background. Roughly speaking, it has 70,000 deliveries a year, which account for 10% of live births in England and Wales. It also has about 10% of babies who die from intrapartum-related causes—that is, events surrounding labour and child birth.

In 2006, the chief medical officer highlighted the fact that one of his areas of particular concern was intrapartum-related death. In a national report in the 1990s, that was continually highlighted as requiring more attention, but the figures did not show any particular improvement. For that reason, the Perinatal Institute decided to look at that area. We know that in politics to be described as “brave” sometimes means “foolhardy”. However, in this case the institute was brave to look at the figures honestly. It looked at 25 cases that caused concern. The full report is available on the institute’s website. It found that of those 25 cases, in four there was substandard care and different management would have made no difference to the outcome.

[Lorely Burt (Solihull) (LD)]

As another west midlands MP—the Heart of England trust covers my constituency—I wonder whether the hon. Lady has noticed any problems with care of parents after neonatal death. I have the charity Stillbirth and Neonatal Death Society, SANDS, in my constituency—as I expect she has—and it is most concerned about the quality of care for parents following the death of a baby.

[Ms Stuart]

I have come across SANDS. The Heart of England trust did some work, which I will consider later, whereby it looked at midwives’ case load and found it to be far higher than required. Incidents are spread across an area and each of us probably sees only one or two cases occasionally. The real problem comes when we look across the city and the west midlands. We should pay tribute to SANDS and its work and to the bereavement nurses it has now put in hospitals. They are in east Birmingham and in my patch. However, that is not good enough.

Coming back to the 25 cases, in four cases of substandard care, different management would not have made a difference. In five cases, it might have made a difference to the outcome, but in 16 cases, different management would reasonably have been expected to make a difference to the outcome. In other words, 84% of the deaths were considered potentially avoidable. The overall conclusion that the report reached looking at the west midlands was that many deaths were avoidable and need to be avoided. That is why we need to discuss this report and decide what to do about that.

This is not a particular west midlands problem; it is just that the west midlands has been the first to take an honest look.

--- Later in debate ---

[Ms Stuart]

I am sure the Minister will be grateful for that helpful intervention. However, have we not been told that the NHS is ring-fenced? That is how I understand it. Therefore, the financial argument really does not hold.

I would like to analyse what the Prime Minister said a little more. He went on:

“It doesn’t have to be like this…First, we’re going to create new maternity networks…Second, we are going to make our midwives’ lives a lot easier. They are crucial to making a mum’s experience of birth as good as it can possibly be, but today they are overworked and demoralised. So we will increase the number of midwives by 3,000. This is the maternity care parents want: more local and more personal. And under a Conservative Government, it is what they’ll get.”

[Lorely Burt]

As the Prime Minister said, the aspiration should be for more local and more personalised services. However, in my local hospital at Solihull, the full maternity service has unfortunately been downgraded as a fait accompli, and instead of 2,700 births a year, we are led to expect only 300. Does the hon. Lady agree that that hardly offers the choice, localism and personal service that we should seek to achieve anywhere in the country?

[Ms Stuart]

I will respond to that point before returning to my favourite subject of the Prime Minister’s promises. The hon. Lady is right: there is always a huge tension between local and more centralised delivery. My first Adjournment debate in this Chamber as a junior Minister was about the closure of the William Courtauld maternity unit in Braintree in Essex. It had about 300 deliveries, and there was always a tension about whether services should be offered there or in Colchester. We need both. However, when campaigning to keep local maternity units, we should note that the Royal College of Nursing looked at changes in maternity care. It stated that, apart from the rise in numbers, there are more older mothers with higher rates of complications, and there is a higher rate of multiple births and more obese women who are less fit for pregnancy. More women survive serious childhood illness and go on to have children, and they need extra care during pregnancy and childbirth. There are also increasing rates of intervention.

Therefore, apart from social and ethnic diversity, some births are becoming increasingly complicated. If the hon. Lady were to go to the Birmingham women’s hospital, where women who have had heart transplants give birth, she would see that a safe delivery might require not only the expertise of the women’s hospital, but that of the Queen Elizabeth hospital next door. There is always a natural tension between localism and the best care. The real answer is that we need both.