Maternity Services

Emily Thornberry Excerpts

Tuesday 1st February 2011 Westminster Hall

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I want to make three points about the provision of maternity services. The first is about the provision of extra midwives, the second is on the question of Sure Start and the third is about health visitors.

It seems to me that maternity and antenatal services are provided not only at birth; they are also post-natal services, and new mothers rely upon them strongly. I had two babies under a Conservative Government and one under a Labour Government. At none of those births did I believe that there was sufficient investment in maternity services. That situation continues.

During the last three years of the previous Labour Government there was a massive increase in investment in maternity services, and a new strategy was put in place. Unfortunately—perhaps fortunately—that coincided with a great increase in the birth rate. There was increased investment in maternity services; for example, the number of midwives rose in 2007 by 624, in 2008 by 571 and in 2009 by 787. However, that coincided with one of the largest rises in the birth rate. Being able to keep up with the increase was a problem.

We passed the baton on to this Government. They must build on our achievements and not let us down. We need to continue working on maternity services. Through an article in The Sun, the public heard loud and clear that the Prime Minister was promising 3,000 extra midwives. The fact of the matter is that 3,000 extra midwives would in any event not make up for the shortfall in their number. Even if the Government were to provide 3,000 extra midwives, we would still need at least another 1,700. The problem is that, having made that pledge and promise, the Government seem to be going back on it.

A spokesman gave this pledge on behalf of the Government:

“There must of course be enough midwives to meet the demands arising from the number of births.”

The Royal College of Midwives agrees; it calculated the national England-wide shortage of midwives in 2009 to be 4,756. If, as the nameless Conservative spokesman says, we should have enough midwives to meet demand, we need more than 3,000. The spokesman then said:

“The commitment to 3,000 midwives made in Opposition was dependent on the birth rate increasing as it has done in the recent past.”

My hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart) asked—she put it so beautifully—what was his starting point? What did he mean? The whole piece was written in the present tense. Midwives are stretched to breaking point. They are overworked and demoralised, but the increase in the number of midwives was contingent on a continuing rise in the number of births.

The spokesman’s next excuse was this:

“It was not in the coalition agreement because predictions now suggest the birth rate will be stable over the next few years.”

The veracity of that statement does not stand up to proper analysis. There has not been a prediction since the Prime Minister made his pledge, so we do not know what the difference would be. If improvements are made, we need to continue to build on them. I suggest that the Government are letting everyone down.

[Ms Gisela Stuart]

I have some figures on the future of the midwifery work force. The Department of Health document “Midwifery 2020: Delivering expectations” states:

“The midwifery workforce across the UK is ageing with 40%-45% of the midwifery workforce reaching the current retirement age in the next ten years.”

In other words, even if we stand still, we will undermine midwifery as a result of the fall in the work force.

[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—

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

indicated dissent.

[Emily Thornberry]

The hon. Lady is welcome to intervene if she wants to get into an analysis. The Government’s promise of a ring fence and a year-on-year increase in the NHS budget is one that does not stand up to scrutiny. There is double-counting going on. Currently, given the increased demand, we must have 4% efficiency savings each year in the NHS. In fact, we will see cuts. It is simply not right for the Government to continue to say that the NHS budget is ring-fenced, that the NHS is safe with them and that services will not be cut. The reality is that the NHS is going through a very difficult time, and, on top of that, this Government are putting it through an absolutely needless reorganisation, which means that we will not get a national steer on things such as maternity services.

Simply giving commissioning to GPs will not help. It has been a matter of policy for years that we keep pregnant women away from doctors if we can, because they are not ill. We pass their care into the hands of the midwives, and hopefully everything will be fine. If a doctor is needed, bring the doctor in. Essentially, women go to a GP to find out that they are pregnant. They then go to a midwife and the midwife looks after them. That has always been the case. GPs do not have an understanding of midwifery or services for pregnant women. The difficulty is that such services will be sidelined and that is not fair on women. That argument was made to the Government when the point was being made that midwifery and post-natal services should be commissioned nationally. I do not know why the Government have changed their mind about that, and it is one of the questions I want to ask the Minister.

The NHS is going through great economic trauma. It is used to having a year-on-year increase in budget. Now, its budget will be cut year on year at the same time as the service is being reorganised. Will we have proper tactical decisions on midwives, community nurses and all those things on which mothers rely, or will we simply allow such services to be given to GPs—at a time when a cold wind is blowing through the national health service?

I think I have got through most of my questions to the Minister. I have just a few more. How will she drive improvements in maternity services? Before the election, the Prime Minister talked about maternity networks. What levers does he have that will make them a reality? Why did the Government ignore the representations of professional bodies such as the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists in relation to commissioning? Furthermore, why has the Prime Minister handed over commissioning to GPs and maternity services? Will the Minister give us an assessment of the involvement of midwives in GP pathfinder consortia?

--- Later in debate ---

[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.

[Emily Thornberry]

Although I agree with what the Minister says, surely the difficulty she has is that the Prime Minister promised us 3,000 more midwives. Although I accept that we need experienced staff to ensure that midwives are trained up properly—the same applies to a number of different skills—the Prime Minister promised us the 3,000, so is it right that the Government are rowing back on that promise?

[Anne Milton]

There is no rowing back. We have always made it clear that the number of midwives will be in proportion to the birth rate. In fairness to the previous Government, they made concerted attempts, although much too late, to increase the number of midwives in training, and, as I have said, we have 2,500-odd in training now. We will continue to ensure that we have the right staff mix and the right number of midwives to ensure that women have safe births.