Maternity Services

Diane Abbott Excerpts

Tuesday 1st February 2011 Westminster Hall

[Anne Milton]

The hon. Lady is already falling into difficulties. She wants central Government to prescribe what works on the ground. If one looks at the proposals for GP pathfinder consortia, one sees that the proposed consortia vary in size enormously. That is because local people on the ground know what size of consortium will work for them. We will see more details emerging as the health Bill goes through Parliament and as the consortia get going. What matters is to be locally responsive. The hon. Lady mentioned accountability; having the right accountabilities in the system is important. What also matters is using the commissioners in particular to drive up quality.

Our focus on public health is also critical to maternal outcomes. Healthier women have healthier babies and for the first time we will ring-fence public health money. The hon. Lady was right to mention inequalities. Increased rates of stillbirth are associated with deprivation. I must say that, despite the previous Government having what was doubtless the best will in the world, during the 13 years that they were in power, health inequalities widened. I do not think that that was because they were utterly incompetent; it was partly because it is extremely difficult to do something about inequalities. However, I believe that our focus on public health and our ring-fencing of public health money will have a significant impact.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does the Minister agree that, although choice is very important, in a constituency such as mine, which is in the east end of London, public health issues, such as nutrition, access to advice and quite low-tech care during pregnancy are just as important to good maternal health outcomes? Underweight babies are one of the big problems in my constituency. They often have poor educational outcomes later, and cost the taxpayer tens of thousands of pounds, because they have to be put in incubators and so on. That problem is to do with the sort of advice that those young mothers receive and it is a public health issue.

[Anne Milton]

I thank the hon. Lady for her intervention; I think that we broadly agree on this issue. That is why we are focusing on public health. Preparation for pregnancy and having a healthy baby starts long before a woman gets pregnant. The education and support that women receive, the social networks that they are part of and improving the public’s health all matter. Nothing could be more important than improving the outcomes for women and, indeed, their babies.

Choice is important and it is also important that women can make informed choices; choices must be well informed to improve the outcomes for women and their babies. Furthermore, it is important that women have access to maternity services at an early stage in their pregnancy. In fact, ensuring such access is probably one of the most fundamental characteristics of high quality maternity care, which is why we have included the 12-week early access indicator as one of the measures for quality in the NHS operating framework for 2011-12.

Of course, it is also important that there are appropriate numbers of trained maternity professionals to provide the maternity service. The number of clinicians needed by mothers depends on several factors, ranging from the mother’s medical circumstances, to the complexity of the pregnancy, to wider societal factors, which can have a considerable impact.

Looking at the bigger picture, the birth rate must be considered when we are planning maternity services. Although the number of births in England has been rising since 2001, as I mentioned earlier, the birth rate peaked in 2008 and fell, by just less than 1%, in 2009 to about 671,000 live births. We are determined that staffing rates should be calculated purely on how many staff are needed to provide safe, quality care. We are considering ways to improve midwife retention and recruitment, and the planned number of midwives in training in 2010-11 is at a record level of about 2,500. Therefore we expect a sustained increase in the number of new midwives who will be available for maternity services during the next few years.

Complete and absolute focus on staffing numbers is totally ridiculous. If the birth rate shot up, 3,000 extra midwives would not be enough. Ensuring that the maternity work force has an effective skills mix is also an important consideration. I was recently in an extremely busy maternity unit, and the midwife there made it clear that what they needed was not more midwives but more support staff. Doubtless in other units there will be support workers in place, but not enough midwives. We want to focus on using the whole maternity team, including obstetricians, anaesthetists and support workers. It is not just the number of qualified midwives that is important, but their experience, and one issue that we need to address is attrition. A newly qualified midwife does not have the experience, nor perhaps the skills, to lead the team in a way that a midwife who has been in practice for 10 years or so can.