NHS Long Term Plan

Baroness Cumberlege Excerpts

Thursday 31st January 2019 Lords Chamber

[Baroness Cumberlege (Con)]

My Lords, my interests are in the Lords register. This debate is opportune because today we heard an announcement from Simon Stevens on the first steps to implementing the plan.

The NHS is frequently likened to a sea-going tanker. I do not agree with that; I think it is more like a flotilla. Numerous boats sail in the same direction but when the storm rages, the flotilla disintegrates, with each ship seeking its own safe harbour. The 2012 Act enabled disintegration, which is why this plan is so crucial. It seeks to cement new systems to integrate health, on a population base, through integrated care systems. Along with other noble Lords, I welcome that.

The wise and wonderful Sir Cyril Chantler published in the Lancet:

“Medicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous”.


That emphasis on being potentially dangerous has driven us to consider how we can make medicine safer while recognising its complexity and the need to involve patients, consumers and citizens. The plan assures us that having a baby is now safer than it was 10 years ago, which we welcome. Nevertheless, giving birth in this country is not as safe as in Sweden. Why? Its teamwork is awesome: it learns from mistakes and avoidable harm, then spreads the learning. We do not. The maternity review fashioned a system based on the Swedish system, called “rapid resolution and redress”. We have no confidence that the department will introduce it, so I would welcome some support from the Minister to enable that to happen.

We know that we can improve safety by ensuring that women have continuity of care from the health professional, usually the midwife, to care for her through her pregnancy, the birth and the early days of parenthood. Research shows that with continuity, 19% of women are less likely to have a miscarriage, 24% are less likely to experience a pre-term birth and 16% are less likely to lose their baby overall. Should we be surprised by that? Of course not; it is common sense and it is what women seek. Technology has its place and can aid continuity through the use of iPhones, emails and so on, but when it comes to maternity care, robots are not the answer. Women want the skills, the personal knowledge and the relationship they have with their professional friend. Being handed from one midwife to another does not make for a good experience or aid safety. Continuity does, which is well understood in the long-term plan.