Health: Midwives

Earl Howe Excerpts

Wednesday 5th March 2014 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Department of Health has been working closely with Independent Midwives UK, which represents self-employed sole-practitioner midwives, to explore possible options to secure insurance for its members. Independent Midwives UK has presented a business plan to the department seeking government funding, which has been carefully assessed. As any solution must be applicable across the UK, discussions have also taken place with the UK devolved Administrations. A decision regarding Independent Midwives UK’s proposal is imminent.

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend for that Answer and declare my interests as listed in the register. It has occurred to me that the first person to see your Lordships in the nude is a midwife. Midwives are very special people, and independent midwives are equally so. It is a travesty that independent midwives will not be able to practise if they cannot get clinical indemnity. As my noble friend said, Independent Midwives UK has worked very closely with the department but, unfortunately, there is still a gap of £1 million, the initial pot required to get midwives clinical indemnity. Will my noble friend work very hard to ensure that he and his colleagues fund that £1 million? I have to say that, in the context of the NHS budget, which is £110 billion, it is simply short change.

[Earl Howe]

My Lords, I hesitate to correct my noble friend but Independent Midwives UK submitted a business proposal to the department which would require the Government to provide a £10 million grant to support the inception of an insurance scheme for its members to provide full maternity care. We have considered two options, either of which would deliver that result. The creation of any government scheme specifically for Independent Midwives UK would effectively position the Government as the underwriter of the independent sector. That is something that we have hitherto found difficult to consider.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I refer noble Lords to my health interests. It sounds to me as though the Government are perhaps going to come up with a positive outcome. Why have independent midwives been excluded from the NHS Litigation Authority’s clinical negligence scheme for trusts? Would that not be a very straightforward way of allowing independent midwives to continue and to be regulated? Clearly, one of the big issues at stake is that, without cover, it is likely that they will not receive proper registration in the future.

[Earl Howe]

Yes, my Lords, that would be a very simple solution but it was rejected by Independent Midwives UK when it was put to it.

[Baroness Manzoor (LD)]

My Lords, the Royal College of Midwives says that there is a shortage of 4,800 midwives —a welcome drop from the 6,000 in recent times. However, this shortage and the shortage of obstetricians are resulting in variations in maternity services and in standards of care among trusts. What is the Government’s strategy to address these concerns?

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[Earl Howe]

My Lords, the Government are committed to improving the choice of place of birth for women, continuity of care for mothers and the experience of care that they have. There are now 1,800 more full-time equivalent midwives than in May 2010 and there is a record number—in excess of 5,000—in training at the moment. The most recent data from November last year show that the number of midwives has increased at twice the rate of the number of births—by more than 6% since May 2010. We know that we need more midwives in the service but they are coming down the pipeline.

[The Earl of Listowel (CB)]

My Lords, is the Minister aware of the Australian research which suggests that the NHS could save £300 per birth if it adopted the one-to-one midwifery model? Might he consider how to encourage clinical commissioning groups and health and well-being boards to commission caseload midwifery? This has proved very effective in reducing the number of episiotomies and in encouraging, for instance, breastfeeding.

[Earl Howe]

My Lords, I am very interested to hear what the noble Earl says about the Australian experience. The mandate that the Government issued to NHS England, published in November 2012, states that women should receive better care during pregnancy and have a named midwife responsible for ensuring personalised, one-to-one care throughout pregnancy and childbirth, as well as postnatally. As part of that, we want NHS England to work with partner organisations to ensure that women are able to make informed and safe choices about where to have their baby. However, it is probably too soon to commit to a ratio of one midwife to one expectant mother.

[Baroness Gardner of Parkes (Con)]

My Lords, I am sure we all support the position of the midwives, but I would like to bring up the financial aspect again. Last week, we had a debate on how people would manage to finance their care in care homes and I mentioned that there are many difficulties, including the fact that no one will now give bridging finance for anything. I understand that all the midwives are asking for is contingency support to enable them eventually to run this as an independent scheme. They simply need the finance to get it off the ground. If that is the case, I remind the Minister of all the difficulties involved in raising funding for anything.

[Earl Howe]

My Lords, any bridging loan requires to be repaid, and that is one of the issues that we are looking at.

[Baroness Wall of New Barnet (Lab)]

My Lords, following on from the question from the noble Earl on the Cross Benches, I am sure that the Minister is aware that most trusts—this is certainly the case in the maternity unit at Barnet hospital—now have a community midwife at the birth, and that midwife follows the mother home and stays there for as long as the mother needs support. Therefore, there is one-to-one care from a midwife, not necessarily during the delivery but certainly in the care that the mother receives when she goes home.

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[Earl Howe]

I am very glad to hear about that. It is certainly the aspiration that every trust should have. It is important for me to point out that we are talking here about a very small number of independent self-employed sole practitioners representing less than 0.5% of the 32,000 registered midwives in England. That is the context of this debate.