NHS: Maternity Care

Baroness Manzoor Excerpts

Thursday 5th February 2015 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, I also congratulate the noble Lord, Lord Harrison, on securing the debate. Today is Time to Talk Day, a national day where everyone across the country is encouraged to take five minutes to talk about mental health. That is what I intend to do today.

Women in around half of the UK have no access to specialist prenatal mental health services. Up to 20% of women develop a mental health problem during pregnancy or within a year of giving birth. Suicide is also a leading cause of death for women during pregnancy and within the first year of giving birth. More than one in four women have c-sections. Evidence suggests this rate is well in excess of the number of c-sections necessary to create health benefits for women and babies, as has already been alluded to by the noble Lord, Lord Harrison. Perhaps the Minister can see whether this financial tariff is to be re-evaluated and reviewed again.

The Centre for Mental Health and the LSE examined the economic and social costs of perinatal mental health programmes and problems, and the cost of effective interventions to manage them. They looked at three of the most common mental health problems—depression, anxiety and psychosis—which affect women during both pregnancy and the first year after they have given birth. Those organisations found that these perinatal mental health problems carry a total cost to society of about £8.1 billion across the UK each year. This is equivalent to a cost of just under £10,000 for every single birth in the country. Some £1.7 billion of this cost is borne by the public sector, of which the greatest costs of around £1.2 billion accrue to health and social care services. They also found that nearly three-quarters of the costs of perinatal mental ill health relate to the poorer health and prospects of the mother’s child. This is based on growing evidence that mental health problems during and after pregnancy have a significant impact on children’s health, many of which can last a lifetime.

There is clear guidance from NICE about what services need to be in place for women. This includes: training midwives and GPs to spot the early signs of distress; speedy access to talking therapies; specialist community services for women needing more intensive support; and mother and baby hospital beds for women who need in-patient care once their baby is born. However, the NHS offers just a fraction of the treatment and support required to meet this level of need. It is estimated that only 40% of women with perinatal depression have their needs identified. Of those recognised, just 60% receive any treatment, of whom only 40% get effective care—that is, care according to national guidelines. This means that just one woman in 10 is getting good quality care for prenatal or postnatal depression.

The Centre for Mental Health and the LSE calculated that the cost of improving perinatal mental health support to include all the interventions recommended by NICE would be about £300 million nationally. This would imply an additional spend of £1.3 million for an average CCG—about a third of the cost to the same CCG of not providing the right care. In other words, investing in better care could actually save the NHS money, as well as bringing about both immediate and longer-term benefits in communities.

The Government have recognised a major deficit in support for women with postnatal depression. The most significant area of progress so far is investment in greater numbers of midwives and health visitors. It is crucial that these are trained adequately in recognising and responding well to distress in women they see. However, there has been no “big push” relating to maternal mental health; little reliable data about outcomes and coverage; and no one is accountable for achieving improvements. Hence, NICE guidance on perinatal mental health is not being adhered to in most areas seven years after its publication.

What needs to be done? First and foremost, we need government to make it clear to the NHS that improving mental health in maternity services is a top priority for reinvestment, and that progress will be monitored actively to improve identification of needs and speed of access to psychological support. Identification of mental illness is key. This could be improved by better training of GPs, midwives and health visitors in perinatal mental health. It is not the quickest of wins, but could be achieved within a reasonable timescale if given priority. The other major change would be to prioritise women in the perinatal period for access to psychological therapy, so that there is a clear process for getting women in to these services quickly. It is estimated that it would be possible to develop a fully functioning service at all levels—including specialist mother and baby units—within five years. It would be helpful to hear the Minister’s views on this.

To conclude, the cost to the public sector of perinatal mental health problems is five times the cost of improving these services. That is why we, as Liberal Democrats, have committed to invest at least £500 million extra in mental health each year in the next Parliament, building on the waiting time standards that we have already introduced and improving support for new mothers, children and adolescents.