Maternity Services

Baroness Taylor of Bolton Excerpts

Thursday 25th January 2024 Lords Chamber

Moved by

[Baroness Taylor of Bolton]

That this House takes note of the delivery of maternity services in England.

[Baroness Taylor of Bolton (Lab)]

My Lords, I am pleased to have this debate today. I thank those who have put their names down to speak. It is really interesting to see the level of expertise on this subject here, which proves the value of this House in contributing to wider debates.

One of the reasons that I wanted to discuss this issue was the pressure on maternity services that I have been hearing about in my local area. In Kirklees, we have no NHS birthing facilities whatever; it is one of the largest metropolitan areas in the country. The unit at Huddersfield Royal Infirmary was suspended more than 12 months ago and the Brontë Birth Centre in my former constituency of Dewsbury, whose opening I remember with a fanfare as something to be celebrated, has been closed since August 2022. The basic reasons for these closures have been the crisis in staffing and the level of staffing shortages. The local trust is trying to reopen the Brontë centre, working with a neighbourhood trust, but the problems of staffing are having a real input and will be a deciding factor.

No one can doubt the critical importance of maternity services. Those of us who have given birth will recall many details, good and less good, of that experience. The experience of maternity care can affect the future of both mother and baby. A difficult birth experience can affect bonding and early relationships—a point emphasised to us by the Royal College of Psychiatrists. Everybody who is involved in maternity services will know the significant responsibility that they have. Thankfully, most pregnancies end in the birth of a healthy baby, although that in itself does not mean that the mother’s experience has been optimal. On the other hand, some expectant mothers have their own views of what their experience should be; sometimes, those views are not realistic and can create extra pressure on midwives and others. Locally, I know that the trust has reported more high-risk women wanting births in settings designed for low-risk women, creating extra pressure and highlighting the complex problems that many midwives have to face.

I want to start with the recent important reports on the overall state of our maternity services. The report from the Care Quality Commission is absolutely critical here but I believe we have all received many briefings from mothers of babies, the Maternity & Midwifery Forum, the Nuffield Trust, Mumsnet, SANDS, the Royal College of Obstetricians and Gynaecologists and, of course, the Royal College of Midwives. They have all consistently reported a very alarming situation.

The Care Quality Commission tells us that maternity services were under pressure prior to Covid and that that has worsened. Covid did not help but we cannot continue to use it as an excuse for all the failings in all our services across the board. The pressures on maternity services have been building for more than a decade. The commission also tells us that almost half of all the maternity services inspected in 2023 were rated as either in need of improvement or inadequate—an increase on last year, with things moving in the wrong direction.

Many factors have been highlighted by the CQC. Staffing shortages—especially retention issues, which I will come back to in a minute—are top of the list but it has also reported systematic racism, leadership issues, and workplace and environment issues. All of these are significant and each needs attention but we should not lose sight of the overall situation and the fact that nearly half of these units are causing concern. In those circumstances, we need to stop and think about what needs doing—and doing urgently. I know that there has been considerable ministerial churn and that current occupants may try to distance themselves from previous decisions. Although new Ministers must say that there should be greater emphasis on women’s health, et cetera, the same party has been in government for 13 years and decisions taken during those 13 years have made the situation worse. I think that Ministers in that Government are culpable.

To my mind, the most significant problem is clearly the shortfall in staffing, in particular the imbalance in the workforce because of retention problems. The fact is that many senior midwives, gynaecologists and obstetricians are leaving their professions. There are concerns about the number of students going into midwifery and their experience but the problems of retention make the situation critical.

Earlier this month, the BBC reported on midwives being concerned that staff shortages were causing safety issues. One midwife reported that she kept patients safe only by the skin of her teeth; another said that she had quit because she could not face the possibility of the consequences of poor care. I know of one experienced midwife who left her chosen profession after being in sole charge of six women in labour and being afraid for her own mental health because of all the pressures that that responsibility brought.

The Royal College of Midwives says that staffing is the most important issue. We hear that some trusts have one in five jobs unfilled. In Kirklees, the figure is 18%, but it is not a matter of just getting more students into midwifery. Retention is a serious problem and burnout is a real issue. If we cannot retain experienced midwives, we cannot give student midwives the support and the mentoring that they need during placements.

There have been some suggestions that existing midwives feel threatened by some of the training changes that were introduced a few years ago, and there is always a question about the balance between theory and practice. Certainly, the profile of students in midwifery and nursing generally has changed. I know from my time as chair of the University of Bradford, which has a fantastic department in this respect—maybe the Minister would like to visit—that the profile of students coming into nursing has changed significantly, especially when bursaries were cut by this Government. The intake of mature students declined sharply and immediately, and it has not fully recovered. It has been pointed out to me that having mature students among the student group helps everyone to develop and understand what all the pressures can be. Of course, many students are feeling the cost of living crisis and want to work to survive financially, which is obviously not easy if you are on a midwifery course. I worry about the figures for those dropping out of their courses in the early years.

One factor that particularly worries me is that I am told that there is less continuity of supervision of students on the ward during placement. Each student used to have one named mentor, but I am told that this is no longer the case and that students therefore report that they no longer feel part of a team or that they belong, and that this was also affecting the drop-out rate. Overall, this is a worrying picture. Unless the Government address the retention issue, we will not make the substantial improvements that we need.

I must also talk about maternal mortality. The latest report shows that it has risen to its highest rate in 20 years. A key finding is that the maternal death rate for black women is three times higher than that for white women; for women from Asian ethnic backgrounds, it is two times higher; unsurprisingly, women living in the most deprived areas have a maternal mortality rate twice as high as that for the least deprived. This is not a revelation; other reports have talked about it for a long time. There is no excuse for a lack of action here. I note that the Select Committee in the Commons pointed out that, at the time it was writing its report, the Maternity Disparities Taskforce had not met for nine months. That cannot be acceptable and shows a worrying level of complacency.

I have outlined a very depressing situation, and urgent action is needed. Midwives and others deserve credit and recognition for the work that they do—my noble friend Lady Thornton will tell us about the remarkable achievements in her area of dealing with the consequences of female genital mutilation, and I know from a colleague in the other House, Jess Phillips, that midwives are often critical in helping women escape from abuse—but, overall, we have a crisis. For such a significant service as maternity, in 2024 this is unacceptable. It is up to the Government to provide a proper lead to solve this. I emphasise again that the No.1 priority must be the retention of experienced nurses and midwives. We need a raft of measures to reduce the pressure on midwives and allow them to feel that they can do the job that they are trained to do and want to do to the level that they want to achieve. If the retention issue is not tackled urgently, there will be no space to deal with all the other issues such as updating training. This is all against a general backdrop of serious health inequalities which exist in this country anyway.

We are now in 2024. It is just wrong that maternity services are causing such concern. Every woman deserves the best while pregnant and during childbirth, and every midwife deserves the right conditions in which to work. The Minister said at Question Time earlier that he believed in evidence and common sense. I urge him to attach that common sense to the some of these problems that we are facing this year.

--- Later in debate ---

[Baroness Taylor of Bolton (Lab)]

My Lords, I thank everybody who has taken part in this debate. I think we have all learned from each other, and it has been really interesting to see the different levels of experience and how they have come together, but I hope the Minister is acknowledging that, despite people coming at this from different levels of experience, the actual message is extremely clear: we have a crisis in maternity services and unless the Government take action quickly, we are going to see more of the scandals that have alarmed us so much in recent years. We all recognise the dedication of the staff and acknowledge that they do their best, but we are facing a very depressing situation and, indeed, a crisis. I know there have been calls for new inquiries and new plans, but, as my noble friend Lady Warwick said, we have many of those but we do not have the building blocks and the progress to underpin what actually needs to be done.

I am struck by the fact that we have this cycle of problems. Current midwives are overworked, so they do not have time for extra training, or to mentor students, or to listen to mothers, as several Members have said is vital. Therefore, they get burned out; therefore, we have fewer midwives and all these pressures intensify. I think that that is really the crux of where we are now. Unless we can break that cycle and find some way of giving experienced midwives the support they need, this problem is going to continue. Of course, there are problems in terms of students and drop-out rates. The noble Baroness, Lady Watkins, mentioned the cost of second qualifications, and I do not think we should ignore that as one of the reasons why so many experienced nurses are deterred from moving into midwifery. Similarly, my noble friend Lady Donaghy raised issues about pay structures. These are points that Ministers could take on board and move quickly on, and I hope that the Minister, having listened to so many voices, will feel he can have some confidence that things need to be done in certain ways.

Similarly, I welcome the evidence that the noble Baroness, Lady Gohir, gave us, which everybody took note of and understood and was a bit surprised about, in terms of the lack of data on some of the crucial issues of systemic racism that she uncovered. Maybe the answers lie, as the noble Lord, Lord Allan, suggests, in different ways of working with the IT systems, but it is something I think the Minister could make real progress on very quickly and I hope the debate has helped in this respect.

I hope that what the Minister said about the Brontë Birth Centre in Dewsbury is correct: we want to see it open in April, but it is dependent on the staff being available. Incidentally, when we lose a place such as the birth centre in Dewsbury or the facility in Huddersfield, we do not just lose the maternity and labour provisions for women, we lose the student placement positions that allow us to train more people, so it really is a very serious situation.

We can all agree that women deserve good, local facilities when they are in maternity services. All women need proper care. All midwives, I would say, deserve the joy and the pleasure of seeing women cared for properly and the healthy births that the noble Lord, Lord Patel, talked about. I think that to achieve that, we need a step change, and I hope that this debate has been one significant step forward in urging Ministers to look at this problem with a new eye and new determination. I beg to move.

Motion agreed.