Maternity Services

Daniel Kawczynski Excerpts

Tuesday 1st February 2011 Westminster Hall

[Ms Stuart]

That leads me to my next point. We have clearly not come up with systems in the NHS that allow us to learn properly from mistakes when things go wrong. I fully accept that we have the NHS Litigation Authority, and that the NHS insures itself. We try to deal with negligence effectively and efficiently. However, there is still a mentality of institutions, when something goes wrong, closing in on themselves. I wonder whether we should look at the way the aviation industry deals with accidents. Fault is not allocated; the facts are looked at, and the real outcome is what to do as a result of the problem. Rather than understanding the errors that have gone further and further, we should consider what is to be done as a result.

Going through newspaper cuttings, I found one over Christmas about Good Hope hospital. There was a very unfortunate incident when a lady who had miscarried was left for four hours in sight of other patients. She complained to the hospital, which simply apologised and said it hoped to do better. Hoping to do better simply has not done us any good, if that experience is anything to go by.

It is not clear to me who has responsibility for this matter. In the current structure we have PCTs and strategic health authorities, where at least theoretically we could allocate responsibility. In the new NHS, who will do that? I will return to that point.

We need national maternity data sets that are much more standardised and allow us to make us comparisons across the country. That is not a question of money. Given that we are told that the NHS is one area that is ring-fenced, there is much we can do within existing provision.

I now come to the promise that the right hon. Member for Witney made during the election campaign. We all know what happens during elections; not keeping election promises is not particularly new. However, let us look at what he said in January 2010. Maternity and childbirth is an immensely emotive subject. It is not an illness; it is one of the most joyful events in life. In the majority of cases, a healthy baby is born and we try to keep the medics out of the process as much as possible. When politicians go into election campaigns and talk about maternity services—particularly when they do so in The Sun—it is a pretty toxic mix. The right hon. Member for Witney went to a maternity unit and said:

“Having a baby might be the most natural thing in the world.”

Fine, I agree with him. He continued:

“Every parent wants…to give birth in a relaxed local setting, where they get the personal attention they need. So, why isn’t that happening? It’s because after a decade of constant reorganisation, Labour are giving us bigger and bigger baby factories where mums can feel neglected and midwives are stretched to breaking point.”

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

Will the hon. Lady give way?

[Ms Stuart]

I assume that the hon. Gentleman comes in on the bigger and better baby factories.

[Daniel Kawczynski]

The hon. Lady surely understands that after 13 years, the previous Administration had still not managed to achieve some of its long-term goals and aspirations. She almost indicates that the promises made by the Prime Minister should have been met seven or eight months into a new Administration. Given the state of the public finances, she must acknowledge that it will not be as easy to deliver on those promises as quickly as she—or I—would like.

[Ms Stuart]

I am sure the Minister will be grateful for that helpful intervention. However, have we not been told that the NHS is ring-fenced? That is how I understand it. Therefore, the financial argument really does not hold.

I would like to analyse what the Prime Minister said a little more. He went on:

“It doesn’t have to be like this…First, we’re going to create new maternity networks…Second, we are going to make our midwives’ lives a lot easier. They are crucial to making a mum’s experience of birth as good as it can possibly be, but today they are overworked and demoralised. So we will increase the number of midwives by 3,000. This is the maternity care parents want: more local and more personal. And under a Conservative Government, it is what they’ll get.”

--- Later in debate ---

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

I congratulate the hon. Member for Birmingham, Edgbaston (Ms Stuart) on securing the debate. Maternity services are an extremely emotive issue. When my daughter, Alexis, was born at the Royal Shrewsbury hospital, it was the most emotional day of my life. As a non-smoker, I smoked two packets of cigarettes that day.

I pay tribute to the hospital’s staff, whom I found extraordinarily professional, hard-working and dedicated. However, there has been a lack of funding for maternity services in Shropshire hospitals over the past 13 years. The hon. Lady talked about broken promises, and I want to highlight my concerns about the huge inequality in funding for maternity services around the United Kingdom. I sometimes go to Birmingham and I see the hospitals there, and there are huge differences between the quality of the buildings, equipment and resources in Birmingham and the quality of those in Shrewsbury and rural shire counties.

The Royal Shrewsbury hospital covers not only Shrewsbury and the whole of Shropshire, but the whole of mid-Wales, and I hope that my hon. Friend the Member for Montgomeryshire (Glyn Davies) will have the chance to explain the benefits of the maternity services for his constituents. The population of Shropshire and mid-Wales is not that much smaller than the population of Birmingham. Yes, the populations of those areas, even when combined, are smaller than that of Birmingham, but not by much. However, we have only two hospitals to cover our whole area. I am not sure how many hospitals there are in Birmingham. The hon. Lady said that there was a hospital for women’s services in Birmingham. My goodness, I wish we could have a hospital dedicated to women’s services covering my county and the whole of mid-Wales. I will find out how many hospitals there are in Birmingham, but I want to stress that my county lacks facilities.

As a result of the debate, I am also going to research the outcomes in Shropshire and mid-Wales versus those in Birmingham and to look at the resources that both receive. From all the league tables I have seen, many of the outcomes in maternity services are better in Shropshire than they are in Birmingham. Why is Shropshire so far ahead of Birmingham in the league table when it gets a fraction of the resources? The hon. Lady seemed to imply that greater resources needed to be provided, but I would say that we need to learn from Shropshire how it manages to provide such excellent maternity services when it receives such limited funding compared with Birmingham. When I have done that research, I will send it to the Minister.

During the 13 years of the previous Labour Administration—I briefed the Minister on this last night—there was a chronic lack of funding. I am not embarrassed to say that I think the previous Government deliberately targeted inner-city Labour areas with investment and deliberately stripped it from rural counties, which are predominantly Tory. That was done in a political way to put investment into Labour heartlands, and although the hon. Lady won her seat because she is an assiduous and hard-working MP, many other Labour MPs were re-elected because of that direct channelling of resources into Labour inner-city areas at the expense of rural shire counties.

As a result of that chronic lack of funding for Shropshire, a consultation is under way on proposals for a mass reconfiguration of maternity services. That will see in-patient children’s services and consultant maternity services move from Shrewsbury to Telford. My constituents expressed extreme concern about that at a public meeting on Sunday, as they have over the past few weeks. In the six years that I have been an MP, I have never received as many e-mails, telephone calls and letters from concerned parents, clinicians and GPs as I have over these reconfiguration proposals—there is a lot of concern.

I should stress that I expect any proposals put forward by local hospitals and primary care trusts robustly to meet the stringent tests set out by the Secretary of State for Health in relation to support from GP commissioners, public and patient engagement, clinical evidence and patient choice. If those stringent criteria are not met, I very much hope and expect my local council’s overview and scrutiny committee to refer the proposals to the Secretary of State, in anticipation of their being reviewed by an independent reconfiguration panel.

Today, I will write personally to all the GPs in Shropshire to find out their views about the reconfiguration proposals for maternity services, rather than being told by the PCT or the chief executive that GPs are in favour of them. If they are against the plans, I will share that information with the Minister, and I hope she will support me in challenging them.

Yesterday, I had a meeting with the deputy general secretary of the Royal College of Midwives, Louise Silverton, who has promised to help me get the Royal College of Midwives involved. I will also write to the Royal College of Obstetricians and Gynaecologists to find out its views. I have spoken to the Minister, who has kindly agreed to meet me and a delegation of concerned constituents so that we can raise these issues with her.

I do not want to speak for too long, because I hope that my hon. Friend the Member for Montgomeryshire will get a chance to speak. I would not wish a reconfiguration of maternity services on my worst enemy. It is turning my hair grey and I am extremely upset about it. I am cognisant of the views of my constituents and I want to stress that they are very concerned at the prospect of Shrewsbury losing maternity services. People expect maternity services to be ever closer to them, not further away. Our services cover the largest landlocked county in the United Kingdom, with a vast rural expanse, as well as the whole population of mid-Wales, and we hope and expect that maternity services will stay in Shrewsbury and not be moved to the extreme east of the county, to Telford.

[Andrew George]

I do not want to intrude on concerns about reconfiguration in Shropshire. However, on the basis of yesterday’s debate, the Government’s intentions and the principle of “No decision about me, without me”—as well as the intention, at least, under the proposed Government health reforms, that many decisions will in future be made by communities working through their health and well-being boards with the GP commissioning consortia, and with the political support of the Government—presumably the community and GPs in Shropshire have a greater say in the present culture than they might have in the past. I should have thought that my hon. Friend might be reassured by that and would not necessarily need to get Ministers involved in the dispute.

[Daniel Kawczynski]

Yes, I concur with a lot of what my hon. Friend has said. However, I listen to members of the public, because I am directly accountable to them as their Member of Parliament, and often my voting and other decisions are affected by them. There is a bond of accountability between each one of us and our constituents. Unfortunately, chief executives and managers of trusts and PCTs do not necessarily have that bond of accountability. They are here one minute and gone the next. That is the problem. Many of my constituents are trying to engage in the consultation process and put questions directly to the PCT and chief executive, but they are not getting answers. I should like the Minister to be aware of that. If the Government are putting forward public and patient engagement as a stringent criterion of whether a reconfiguration of service should go ahead, it is important that the Secretary of State should have confidence that that aspect of the process has been fully and robustly carried out. My understanding is that the only method of referral is by the council’s local overview and scrutiny committee, but if the council is not minded to do it, what can local people who still have concerns do?

I have been approached about extraordinarily emotive cases, involving women who have major issues to do with maternity and paediatric services. They are very emotional about the prospect of those services being moved away from their community. I want them to be heard.

[Ms Gisela Stuart]

An important thing we have learned in the past 15 to 20 years is that when it comes to extremely complex and difficult clinical cases, a hospital must perform a particular function a minimum number of times if it is to be at its clinical best. Some of the hon. Gentleman’s constituents will end up in Birmingham. He questions why Birmingham has received investment, but it is because we provide national centres of excellence. Some of the mothers from his area will come to the women’s hospital because their case is so complex that only the women’s hospital can deal with it. There can be only two or three centres in the country able to provide that clinical excellence. There is always that tension between the local and the centralised.

The hon. Gentleman is unhappy about the reconfiguration, but does he have an objective assessment of how good, clinically, his area’s maternity services are? He may feel good about them, but does he have a professional assessment of whether they could be better?

[Daniel Kawczynski]

That is a very good question. The chief executive of the trust and the PCT and many others believe that there must be a reconfiguration and specialisation at both hospitals. The argument is that without it, we shall lose services, which will go out of the county. We shall not get our NHS trust foundation status and services will be moved out even further away. That is the gun being pointed at my head—not to rock the boat too much on this issue, because there is the possibility of services moving away. I understand that. I feel that the maternity services at the Royal Shrewsbury hospital are good. When my daughter was born there I found the services tremendous. Speaking emotionally, obviously I want them to stay in Shrewsbury. I understand that we must have the reconfiguration debate and that the professionals and clinicians must make the decision, and that is why I shall write to local GPs and consultants to gauge their views. I shall keep the Minister informed.

I congratulate the hon. Member for Birmingham, Edgbaston on raising an important issue, and look forward to hearing what the Minister has to say.

[Jim Dobbin (in the Chair)]

I call the shadow Minister.

--- Later in debate ---

[Emily Thornberry]

I respectfully agree with my hon. Friend. In a moment, I shall be speaking about another part of the work force, health visitors. They suffer exactly the same problem. The majority of the work force is over 55. It is important to retain such valuable and experienced people—they are mostly women—but we cannot increase their number if we continue to lose existing staff at the current rate.

According to the Library, the number of births in the UK was projected to fall in 2009-10, in 2010-11 and in 2011-12. If the Prime Minister’s pledge was based on the latest birth projections, perhaps he expects to cut the number of midwives. That is clearly nonsense. We need to consider what is needed and ensure that it is fulfilled.

My hon. Friend the Member for Birmingham, Edgbaston made a devastating analysis of the difficulties that will be caused by the changes the Government propose. How can we make forward projections and how are we to manage the national health service if we give NHS commissioning to doctors? They will simply consider the needs of the local area and not our national needs.

In passing, may I briefly touch on the important issue of Sure Start? During the election, the Prime Minister claimed that Labour was scaremongering when we said that there would be difficulties in relation to Sure Start. He said:

“Yes, we back Sure Start. It’s a disgrace that Gordon Brown has been trying to frighten people about this.”

The Under-Secretary of State for Work and Pensions, the hon. Member for Basingstoke (Maria Miller), then the shadow Minister for the family, said:

“It’s unforgiveable that Labour has used the tactics of creating fear and anxiety amongst families and Sure Start staff”.

[Mr Roger Gale in the Chair]

The Minister of State, Department for Education, the hon. Member for Brent Central (Sarah Teather), has said:

“Sure Start is at the heart of our vision for early intervention”

If that is true, why did the charities 4Children and the Daycare Trust find out that 250 centres, which serve 60,000 families, are certain either to close or be earmarked for closure? There are 3,578 children’s centres in England, 3,100 of which have been told that their budgets will be cut this year. About 2,000 services will be cutting their services as a result. The findings are based on responses from almost 1,000 Sure Start managers to a questionnaire sent out by 4Children and the Daycare Trust.

It is hugely important for a new mother to be able to find a friend, get guidance and go to a children’s centre. Nevertheless, centres offering such services are being cut. The other friend that mothers need is the health visitor. Again, when the Prime Minister was in opposition, he made a big thing about increasing the number of health visitors:

“The substantial increase in the number of health visitors will mean that families get more support—from properly trained professionals. Health visitors will be able to spend time with families, have the opportunity to spot parenting issues, and build the trusted relationships needed to help with them. For instance, if they feel a mother is not bonding with her baby, and recognise the cause as post-natal depression, they might gently recommend that she visit her GP, or steer her towards a local counsellor.”

He was absolutely right; no one can disagree with that. However, when I met London health visitors from the Community Practitioners and Health Visitors Association earlier this year, they told me that there was a huge problem in recruiting new health visitors. They were losing a lot of older, experienced staff through early retirement. Nearly a third of health visitors in London are over 55 and they have dangerous work loads. In some cases, there are more than 1,000 children per five health visitors. That is four times higher than Lord Laming—the writer of the Baby P and the Victoria Climbié reports—recommended. His recommendation is for health visitors to have a quarter of their current work load.

In an area such as London, which is very demanding, current work loads are dangerous. We need more health visitors. The Government recognise that a health visitor should have no more than 250 children under five and no more than 100 in highly vulnerable areas, as was recommended by Lord Laming and the Community Practitioners and Health Visitors Association. Will the Government consider that recommendation when they look again at how many health visitors are needed?

When I asked the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), whether the Government would take responsibility for recruiting and training the extra 4,200 health visitors promised, the answer I received was odd. She said that she will learn from the decisions on the case loads and they will be “locally determined”. In the same answer, she says that the Department is shortly to publish plans to

“conduct a demographic and geographical analysis to establish location and population need and match with trainees and training places; and ensure positive correlation between work force growth and population need.”—[Official Report, 27 January 2011; Vol. 522, c. 460W.]

On the one hand, the Government say they will look nationally and decide what the need is, and on the other they say that it will be left to localities to decide. We really cannot have it both ways. What we have is a lack of health visitors.

[Daniel Kawczynski]

The hon. Lady talks about the need for more health visitors and staff and maternity services. If there were a Labour Government, the NHS would not be ring-fenced and there would be cuts in the NHS budget. Only our party has promised to ring-fence the NHS budget. How can she promise additional services when there would have been cuts in the NHS budget under Labour?

[Emily Thornberry]

Although the Government have said that, in principle, there is a ring fence to the NHS budget, a closer analysis will show that that is not true. The real position is that there is double-counting of over £2 billion—