Maternity Services

Baroness Donaghy Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I thank my noble friend Lady Taylor for initiating this debate with her usual thoroughness and elegance. If the recommendations made by the noble Baroness, Lady Cumberlege, were all implemented, we could go home now. The noble Lord, Lord Patel, nearly made me cry. This is a very important subject, and I am glad that it is being debated. I hope that, even with all the other difficulties that the health service is faced with, the Minister will take on board the vast experience in this Chamber on this subject.

When I was a non-executive director at King’s College Hospital NHS Foundation Trust, we were fortunate to have Cathy Warwick as the lead for maternity services. Directors were kept well informed about what was happening, but I understand from various CQC reports that that good practice does not exist.

I will cover items about the pay structure and about those who experience birth trauma of a severe kind—as well as a little about the deterioration in maternity care; but that has been well covered, so I will reduce that section of my speech.

I believe that the NHS pay dispute was avoidable. The origins go back to the clumsy and arrogant stance taken by previous Health Secretaries. One Health Secretary took the junior doctors on some years ago and beat them. Ministerial memories may be short, but junior doctors have longer memories. Whether they are badly led or well led does not matter; the strength of feeling is still there.

I will refer to the Government’s consultation on creating a new pay scale for nurses and midwives. Having had experience of this, I would caution the Government against any separation for a number of reasons. The Agenda for Change pay structure, carefully negotiated over a long period of time, is underpinned by the NHS job evaluation scheme, which determines the levels at which all healthcare professionals are paid. A separation of the nurses’ pay structure would divide and rule, which is irresponsible in the long term. It would not lead to more money or more midwives, it would not help with the chronic retention problem and, most importantly, it will lead to equal pay claims and a serious risk of unplanned extra costs.

That is not a theoretical view. When I first arrived at ACAS, I was faced with over 500 equal pay claims from ACAS staff. It caused a great deal of amusement from my previous TUC General Council colleagues when they heard I got the job of chair. This was in the days of a Labour Government, so I am not making a party-political point on the subject of pay structures. The problem arose because of the break-up of the Civil Service negotiating structure and the separation of grading by government departments and non-departmental public bodies. ACAS, as an organisation, given the problem of 500 equal pay claims, was faced with sclerosis and low staff morale and risked being a laughing stock, because it was supposed to solve employment relations problems, not be the centre of them.

It was clearly a priority for the ACAS council and the new chief executive to solve. I will not go into the details of how it was done—why give away trade secrets?—but it cost us £10 million. We were given the money by government, but exactly the same amount was taken off us the following year. Subsequent redundancies cost us hundreds of staff and thousands of years of experience. Compared with the number of nurses and midwives, that cost is small beer. I urge the Government to think very carefully before they leave such chaos behind.

The Minister will no doubt be aware of the All-Party Parliamentary Group on Birth Trauma and its recent launch of a parliamentary inquiry on birth trauma. It is co-chaired by Rosie Duffield MP and Theo Clarke MP, and will be assisted by the charity Birth Trauma Association. Its stated aim is to collect evidence so that government can take practical and achievable steps to improve care and support for new mothers and their partners, and incorporate birth trauma into the women’s health strategy. The stories told by some women of their experience are horrifying, and the physical and mental trauma suffered by some are often unrecognised by the very professionals who should know better.

A relative of mine gave birth to two children and the effect on her was shattering. Her mental health did not recover for two decades. She spent months in a mental health institution after each birth. This might have happened under any circumstances, but recognition of the dangers, and the right information and preparation, might have led to a different outcome.

Recent CQC inspections reveal that maternity units are failing women; the figures have already been stated. According to the Birth Trauma Association, some women who have had a dreadful experience find that they are not listened to. They say that complaints are met with attempts to minimise the women’s trauma and deny responsibility. Frequently, the BTA was the first organisation to listen to women’s accounts and acknowledge their trauma.

A common feature is the failure to acknowledge pain levels. In a recent television drama series, two of the regular male doctor characters were challenged to take a test to experience similar levels of pain to those experienced by women in childbirth. The test went from “mild” to “severe”, and they were only half way up the painometer before they pleaded for it to stop. I know that it was a drama—although we have learned how powerful dramas can be, in different circumstances—but it clearly illustrated a point that women have been making for centuries. I should add: please do not try this at home. Will the Minister ensure that his department studies the results of the APPG inquiry when it is published and take steps to improve things?

Finally, the CQC’s 2022 maternity survey, designed to assess the quality and safety of maternity services in England, received over 20,000 responses. They showed that experiences of maternity care have, as has been said, deteriorated, particularly over the last five years. The issues of availability of staff, confidence and trust, and communications and interactions with staff have already been outlined.

I should emphasise, as did the noble Baroness, Lady Cumberlege, that the majority of respondents were satisfied, but sometimes it is now a very narrow majority. For instance, in-hospital care after birth showed that a worrying 57% of respondents said they were always able to get help, while, as my noble friend Lady Warwick said—she has already mentioned the shortage of 2,500 midwives—the Royal College of Midwives has described the impact of staff shortages on women as “stark and sobering”.

Up to now, the Government have said that they have no plans to commission a public inquiry into the future of maternity services, despite the fact that it has been suggested by the Maternity Safety Alliance and Mumsnet. Can the Minister say in what circumstances the Government would change their mind about a public inquiry?