NHS: Maternity Care

Baroness Wall of New Barnet Excerpts

Thursday 5th February 2015 Lords Chamber

[Baroness Wall of New Barnet (Lab)]

My Lords, I, too, congratulate my noble friend Lord Harrison on securing this important debate about maternity services. Noble Lords have a range of interests to bring to debates and this is no exception. That is terrific. I wish to concentrate on the training and development of maternity staff to meet future needs.

We all know that, with advances in clinical techniques and technology, it is very possible that premature babies, even those who are 22 weeks old, can now, with careful, 24/7 care provided by skilled staff, live to be healthy babies to the joy of their parents. However, that outcome requires a skilled maternity team.

Our midwives and support staff require knowledge and experience to deliver babies who have gone to full term. However, something may still happen that should not, and their preparation for such events, and the skills they deploy, are hugely important in delivering babies safely, which brings a lot of love and joy for the mum, the midwife and the family.

I want to share with noble Lords some of the training and support mechanisms that Milton Keynes Foundation Trust, of which I am chairman, has developed, and continues to develop, to ensure that the skills of our maternity staff are constantly updated and refreshed. If you were to ask our head of midwifery at Milton Keynes—as I did—what the key issues are for her, she would say, “The key areas around the provision of great care are attracting the right people into the profession, standards of training and the ongoing development of staff to provide that care”. At Milton Keynes we train student midwives in partnership with Northampton University. Our clinical practitioners are involved at the very beginning with the recruitment of prospective students and use a value-based recruitment strategy which tries to ensure a caring and compassionate approach to the midwifery profession. Applicants need to have demonstrated that they have undertaken some care work prior to applying. This is hugely important as it illustrates their interest.

During training, the students work in all areas of the profession and we carefully monitor the time they spend with an appropriately trained midwifery mentor. Through discussion with our head of midwifery at Milton Keynes, I learnt that our consultant midwifes and senior lecturers run reflection sessions throughout the training to enable discussion and learning from experience to guide the students in providing safe, quality care. I was fortunate and honoured to take part in such a discussion last week in preparation for this debate. After students qualify at Milton Keynes, there is a very robust preceptorship competency programme. That programme is hugely important and is valued highly by students.

I would like to say a little more about what happens at Milton Keynes in terms of assessment and competency. However, in the short time that I have left, I will focus on the provision of quality evidence-based guidance, which is vital. However, it is useless if staff do not follow it. It is hugely important to encourage them to follow it, and that midwives monitor that. Good care is achieved only through good clinical practice and leadership, enabling staff to be involved in decision-making and supporting individual development and training. We do all this at Milton Keynes but many other trusts do not necessarily have such a robust programme for staff. We have heard accounts from my noble friend about what happens in some instances of community midwifery as well as in some hospitals.

Following the tragic and unacceptable situation at Morecambe Bay and then at Guernsey Hospital, a review was carried out by the King’s Fund. Sadly, this review, which was contributed to by the Nursing and Midwifery Council, took place in a closed meeting. There was no discussion with any of its members or with experienced midwives. The NMC accepted all the recommendations, including on the loss of statutory supervision of midwives in the near future. That is concerning as this has been a gatekeeper for safe midwifery practice since the Midwives Act 1902. Removing it from local maternity units to a centralised system removes this important responsibility, which is key to safe local practices. Everyone understands the horror of those two hospitals and the necessity for the report to look at them. I ask the noble Earl to look at this carefully before it reaches the stage of legislation. Many midwives, including my head of midwifery, believe that—excuse the pun—this is throwing the baby out with the bathwater.