Maternity Services: Gloucestershire

Danny Chambers Excerpts

Wednesday 9th October 2024 Westminster Hall

[Max Wilkinson]

I would. The hon. Member makes a strong case, and I will come on to some of the evidence from the Royal College of Midwives later. It has done some important studies into the stress that midwives are put under in the system.

I will move on to Stroud—the hon. Member for Stroud (Dr Opher) is in his place. In Stroud, six post-natal beds were closed around the same time as the closure to new births at the Cheltenham Aveta centre. The reason given by the trust was that the temporary closure would consolidate staffing across the county and provide a safer level of care for births across the whole of Gloucestershire. I am certain the hon. Member will have more to say on this if he is called to speak later, and I am pleased to see him here.

In our county, the 6,000 families who rely on our maternity services each year view this as a significant downgrade in service, and it is a cause of worry for a large number of families. It is clear that these services can only reopen when staffing levels improve. At the moment, the trust says it is around 13% below the staffing level required to return to the previous level of service, with Cheltenham open and the beds reopened in Stroud. However, the nature of midwifery means that quite a lot of the midwives will be off on maternity leave themselves at any one time. Indeed, I will come on to talk about the stress that midwives are under and some of its causes, which have led to a larger proportion of midwives being off for a significant period of time each year than staff in the rest of the NHS.

Research into what is driving the recruitment and retention crisis exposes the scale of the challenge we face in Gloucestershire and across the rest of the country. We are told that recruiting to a trust under a section 31 safety notice is even more challenging than it is elsewhere. Midwives who are already under significant pressure are subjected to additional strains in the form of monitoring and bureaucracy, and that can have an impact on staff morale. Of course, monitoring and bureaucracy are important when we are trying to get trusts out of safety notices; however, we cannot look past the fact that that makes it more difficult to overcome those recruitment challenges.

If that were the only barrier, it would be somewhat simpler. The Royal College of Midwives conducted a randomised survey of weekly hours worked by midwives and maternity support workers. The findings were absolutely shocking. It found that the staff surveyed reported a collective total of nearly 120,000 unpaid hours that week. That is a stark illustration of the demands placed on frontline NHS staff, who go above and beyond in a system that appears to be falling apart at the seams.

It is no wonder that the Darzi review reports that there is a high rate of sickness absence among midwives at 21.5 days a year per midwife. The most common reasons cited for absence were anxiety, stress or depression, or other psychiatric illnesses. Midwives go into the profession because of a commitment to the health of women and babies and to giving care at a critical moment, and to be part of a joyful moment in so many families’ lives. The fact that they are collectively suffering such high levels of stress tells us just how badly wrong the system has gone.

[Dr Danny Chambers (Winchester) (LD)]

As the Liberal Democrat spokesperson on mental health, I believe we should acknowledge and pay tribute to NHS staff in general and specifically midwives because we know that one factor that causes stress is overwork. We are also aware that the NHS very much runs on good will—people working extra hours and unpaid hours. That has been the norm for many years, but it is not sustainable. We need to acknowledge the support they need from a mental health point of view.

[Max Wilkinson]

My hon. Friend makes a strong point. Employee assistance schemes have a strong role to play here. I understand that in the NHS there is quite good support in general. However, it is a massive struggle when people are working so many extra hours to ensure that they get the support they need. In the case of midwifery, it is a stressful job—a life-and-death matter in many circumstances.

There is a clear and obvious link between the extreme overwork identified in the RCN survey and the findings of the Care Quality Commission. Obviously, if staff are working so many extra hours, they will suffer. Gloucestershire Hospitals NHS Foundation Trust has identified staff turnover levels and low morale due to the workload as significant factors. The Darzi report also calls for a shift away from care in centralised hospital settings towards communities, and states that that is a likely route towards the recovery of our health services. That being the case, and with a Minister in the room, I say that there is a clear argument for restoring Cheltenham families’ access to a fully functioning birth unit in our town as soon as it is safe to do so.

I have three questions for the Minister, if she would be so kind as to answer them. First, what is the Government’s position on seeking to reinstate maternity services in places such as Cheltenham and Stroud, which have been recently downgraded? Secondly, what will the Government do to address the ongoing recruitment and retention crisis in midwifery? Thirdly, in cases such as Gloucestershire’s, where a section 31 notice is exacerbating recruitment and retention issues, what can the Government do to help local trusts improve their staffing position? I understand that there are examples of trusts around the country being supported to pay high wages and salaries to ensure that midwives can be properly recruited and to overcome shortages.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

One of the biggest problems that has come up time and again in every maternity inquiry is that women are not being listened to, and too many times their concerns about their care are dismissed. That really needs to change, so we need to start prioritising the voices and experiences of women if we are serious about fixing this crisis.

I said earlier that I am the Liberal Democrat spokesperson on mental health, and I need to mention the shocking statistic that suicide is now the leading cause of death for women between six weeks and 12 months after they have given birth. World Mental Health Day 2024 is tomorrow and it is heartbreaking to think how many new mothers must be really suffering without the support they need.

We need to recognise the financial impact of this crisis. The NHS faces a £21 billion maternity negligence care bill—money that should be going into providing maternity care. When the negligence payout is three times the actual funding for the care, the system absolutely needs resources to be poured into it to ensure that we get that bill down and instead use the money to deliver safe and effective care.

In Winchester, people are particularly concerned about proposals to downgrade our consultant-led maternity services to a service that does not have consultants and surgeons on site. Unlike the hon. Member for Stroud (Dr Opher), who is a doctor, I am a vet, so I do not have his experience. However, I have done countless emergency caesareans, so I know that when something starts going wrong in childbirth, especially halfway through a birth, timing is everything. The thought of starting to give birth in Winchester but then having complications and having to be transferred up to Basingstoke is understandably concerning and terrifying for many constituents. We are therefore fighting to keep consultant-led maternity services in Winchester, because the problem in Gloucestershire arose partly because of the downgrading of services and the move to other hospitals.

The safety of maternity services is a concern nationwide, including in the Hampshire hospitals NHS foundation trust area. In 2023, the Care Quality Commission downgraded the trust’s maternity services from good to requires improvement after it found serious safety concerns. The trust’s amazing staff have been working really hard to improve things, and I am pleased to report that the trust exited the maternity safety support programme in July this year. However, there is still a long road ahead to restore public trust in these vital services.

I want to acknowledge the brilliant work of a Winchester resident who is here today. Jo Cruse launched the Delivering Better campaign, and I urge everyone here today, who will obviously have a particular interest in maternity services, to engage with and learn more from it. Jo has shared her story with me, and with her permission I will read it out:

“My daughter’s birth in October 2021 was the most terrifying experience of my life. I entered motherhood injured by a series of poor clinical decisions, and deeply traumatised by a three-day labour during which my calls for help and pain relief were repeatedly ignored or dismissed.

The experience eroded my trust in a healthcare system I have always revered, pushed my marriage to the brink, stripped me of my dignity, led me to develop suspected PTSD and many months of painful recovery. It has had a significant impact on how I feel about whether I will have more children. I cannot overstate how far the shockwaves of that experience have extended in my life.

I live with the knowledge that what happened to me was not only avoidable, but is happening every day in maternity wards across the country. This is not an issue localised to a few ailing trusts. This is a public health crisis being allowed to unfold in plain sight.”