Maternity Services

David Amess Excerpts

Tuesday 26th October 2010 Commons Chamber

[Mr David Amess (Southend West) (Con)]

When I applied for this Adjournment debate, I did not anticipate quite the level of interest that there appears to be from colleagues, because I did not want to talk about specific constituency matters; I wanted just to draw to the House’s attention to one or two general midwifery matters. So all I would say, Mr Speaker, is that I hope that colleagues will be fortunate enough to catch your eye.

There can be no more personal, emotional or exhilarating experience than watching a baby being successfully delivered. I had the privilege of watching each of my five children being brought into this world, and the sense of wonder and excitement is very personal and unique to everyone, but I am much more comfortable observing babies being born than having to deliver one. It is extraordinary how some members of the animal world seem to have babies so much more easily than human beings do.

However, the point that I really want to make is that from a woman’s perspective, there can be nothing more personal than the relationship that a lady having a baby has with the midwife. Indeed, when our five children were born, I represented Basildon, and so strong was our relationship with the midwife, a wonderful lady called Ladze, that she ended up being godmother to all our children.

Despite some improvements in the national health service’s maternity provision in recent years, much more must be done to ensure that women throughout the United Kingdom receive the best care possible. For those and many other reasons, I want the House tonight to consider how best we can value and support the work of our wonderful midwives.

Let me say immediately that Southend’s maternity services are absolutely splendid. Indeed, their quality was recognised in the Healthcare Commission’s report into maternity services in the UK, in which Southend University hospital was rated one of the very best in the country. Indeed, I have just heard that I have become a member of the Royal College of Midwives parliamentary panel. It is unpaid and voluntary, but I declare it as an interest. As I am sure that all colleagues will agree, midwives throughout the country provide an absolutely invaluable service.

Recently, when I was privileged enough to undertake voluntary service overseas in the Philippines in order to support Filipino nurses, I went to a village in Ifugao, and there at first hand I witnessed just how difficult it is for some ladies to deliver babies. Our services in the UK are somewhat better than those in the Philippines, bearing in mind the challenges that are faced there, but we could still do much better.

Relations between midwives and consultants must be strengthened, and I say to my hon. Friend the Minister that more training should be available to midwives. Although the previous Government claimed some success in introducing consultant midwives in 1999, by 2009 there were only 59 throughout the United Kingdom—just not enough.

Midwives throughout the country are anxious about the outcome of the review of their pensions. The NHS pension scheme hands billions of pounds over to the taxpayer. Indeed, more is paid into the fund than is paid out to pensioners. In the past five financial years, the scheme has handed over £11.3 billion in surplus to the taxpayer, thereby helping, not hurting, public funds.

I congratulate my hon. Friend Baroness Cumberlege on the work that she did when she was a Health Minister in 1993. The report that she produced, “Changing Childbirth”, is as relevant today as it was back then. Furthermore, the work of the Royal College of Midwives, under its very capable general secretary, Cathy Warwick, must be acknowledged. This organisation, which represents 95% of all practising midwives in the UK, does wonderful work that helps women and newborns across the country. The NCT has also given me an excellent briefing on this subject and I know that it supports the points that I wish to raise this evening.

There has been a decade-long baby boom, with 100,000 more babies born last year than in 2001. Rises in the number of midwives have gone some of the way towards catching up with this extra demand. Indeed, there has been an increase of 2,000 in the number of midwives in the last three years and more than 600 more places for student midwives than there were four years ago. However, those extra midwives have largely been swallowed up by the need to provide valuable one-to-one care in labour. This means post-natal care remains woefully inadequate. Extra demand has also come from growing complexity. Mothers are increasingly younger or older than before, and some mothers have serious weight problems. The conception rate for women aged 40 to 44 has doubled since 1991, while the teenage pregnancy rate in the UK remains the highest in western Europe. There have also been significant increases in multiple pregnancies and pregnancies to women with medical conditions that would previously have precluded childbirth. The caesarean section rate is also at a historically high level—just shy of one in every four births. More midwives would help to provide women with the level of antenatal care that would prepare them properly for labour and birth.

Currently we are almost 4,800 full-time equivalent midwives short, based on calculations using established midwifery work force planning tools. For too long, maternity services were not a priority within the NHS: spending on maternity care as a proportion of the NHS budget fell from more than 3% in 1997 to below 2% in 2006, and the share of the NHS work force made up of midwives fell throughout the Labour years. Indeed, while in 1997 there were more midwives in the NHS than there were managers, after 12 years of a Labour Government, by 2009 there were 18,000 more managers than there were midwives—a ridiculous situation. The contrast in what has happened to the two work force groups illustrates how focus may have slipped away from clinical care on to performance monitoring and the dreaded targets. It is the task of the new Government to ensure that midwives do not continue to be sidelined, that their work is valued and that focus returns to good quality patient care.

Aside from resources, however, is the question of policy. The recent White Paper promises that the Government will extend maternity choice but there are questions about how it will be achieved. Although the Labour Government often said the right things and made many promises in relation to choice, they failed to deliver. Progress in implementing choice for women throughout pregnancy, childbirth and the post-natal period was impeded by a lack of sustained investment in maternity services; insufficient recruitment of midwives; and a lack of prioritisation on the part of many commissioners and providers of maternity services. It is easy to assume that it saves money to consolidate, but I do not believe that in the medium to long term that is true.

The main issue with choice is location—the options being birth in a consultant-led unit in a hospital; birth in a midwife-led unit, which may or may not be on a hospital site; and birth at home. A midwife can handle more births in a year in a midwife-led unit or at home than in a hospital, so it is an issue of efficiency as well as choice. Capital investment to provide more midwife-led units is vital, but sadly the total number of such units has dropped significantly in the last two years.

The price of getting maternity care wrong is extremely high, as the cost of litigation shows, and in a time of austerity these are costs that the country simply cannot afford. Of the 100 biggest damages payouts made under the clinical negligence scheme for trusts, 79 derived from obstetric care, and of the total £3 billion paid out in damages under the CNST, almost £1.4 billion was down to claims deriving from obstetrics. Cutting corners in maternity care carries a heavy human and financial cost.

In conclusion, the Prime Minister has admitted that the profession is “stretched to breaking point”, “overworked” and “demoralised”. During the election, all three parties agreed that more midwives were needed to cope with the continuing shortfall. Rightly, the NHS was shielded from cuts in the comprehensive spending review, and this protection should mean that the Government can provide enough midwives to deliver the level of maternity care that women and newborns expect and thoroughly deserve.

[Several hon. Members]

rose—