Maternity Services

Lord Allan of Hallam Excerpts

Thursday 25th January 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am also grateful to the noble Baroness, Lady Taylor of Bolton, for the debate, and to all speakers, whose points will inform my contribution. Like the noble Baroness, Lady Donaghy, I was moved by the description of a new mother’s experience from the noble Lord, Lord Patel, which brought back memories of the birth of my twins across the river at St Thomas’, where the labour room has a splendid view of this building. I offer a tip to partners who are present during labour: pointing out interesting features of the Palace of Westminster and taking photos may not endear yourself to the mother, who is doing all the work. On a more serious note, it is good to be able to offer a belated and public thank you to the staff at St Thomas’, who were superb—particularly at dealing with multiple births, which I know is a much more specialist and complex procedure.

I am grateful to all noble Lords for the expertise they have shared. I will largely focus on the digital aspects, which is something that I have more hands-on experience of than medicine or giving birth. I also want to pick up the point about the workforce and the student experience. Although my children are not at the taxpayer stage, unlike those of the noble Baroness, Lady Watkins, I observe them and their peers going through the process of making their higher education choices and the kinds of calculations they make. The debt figures presented by the Royal College of Midwives that we have heard about from the noble Baroness, Lady Bennett, and others in the debate are alarming. It seems blindingly obvious that they are putting people off going into the profession, causing enormous stress for students during the process of learning and contributing to drop-out rates that are higher than any of us would like.

I hope that the Minister has something to offer in this area around how we can make sure that training to be a midwife, as well as training in other medical professions, is something that an 18 year-old, when they make those calculations, thinks is worth their while. However well-motivated they are inside, you cannot ignore the economics of being saddled with huge amounts of debt.

My first digital point is also a workforce point to a certain extent. It is about people’s changing expectations as they come into the workforce. Having survived the training and debt, as they move into work, that has to be workable for the individual based on how they live their lives today. The noble Baroness, Lady Watkins, touched earlier on scheduling and rostering, and flexibility at work. It is an issue across the wider health and care workforce, but is especially acute for roles dependent on a safety-critical presence in the workforce. These are not roles that can be moved around; people have to be present at a certain time, on a certain date and in certain numbers for safety to be maintained.

To build on the points made by the noble Baroness, Lady Watkins, this is really difficult for employers. They have to know that the right staff will be on-site to cover each shift. There is no way around that, but where this leads to inflexible rostering, that can clash with other staff needs. These may be other caring responsibilities—caring either for younger or older family members—or personal goals, such as travel, which people do have now as they enter the workforce. They may look for extended breaks—sabbaticals were mentioned—or they may want a month to go travelling. That may be a reasonable expectation people have today that they might not have had 15 or 20 years ago. Where rostering systems do not allow sufficient flexibility, staff may either leave the profession altogether, as it just does not add up, or may not accept a trust contract but move into agency work. The NHS then ends up paying more for the same person to do the job. Simply because they did not have the flexibility to take a month off, they have now moved to agency work from a full-time NHS contract. That seems to me to be an absurd outcome.

We talk a lot these days about whizzy technology, such as artificial intelligence, but what we need here are much more straightforward, efficient scheduling systems that enable staff levels to be met while giving individuals more control over the way rostering occurs. That is the expectation they have today. We need a willingness from trust management to change with the times and allow that flexibility to happen. I hope the Minister can look into the question of how we could improve staff retention through improved rostering systems—for all NHS staff, but particularly midwives in the context of today’s debate. This is basic and cheap technology that, used well, could prove to be enormously beneficial in the cost-benefit equation.

The second area I will touch on is information to mothers. This comes out as a key area of concern for respondents to the CQC maternity survey, which was referenced by the noble Baroness, Lady Cumberlege. It seems to be getting worse. In this wonderful information age, we find mothers saying that the information provision they get from maternity services is getting worse, and that seems extraordinary to me.

A key tool in improving that is offering self-help systems, where people can access information themselves. This is better for those who prefer direct access to information, but it should also lead to improvements for those who want to talk to somebody directly, because it frees up staff time to be available for those who need that direct access. Self-help access to information about your own care is critical; it can also be a benefit with language issues, as providing translation and interpretation at scale can often be done more effectively when enabled by technology than if you are reliant on getting somebody with a particular language to a particular location at a certain time.

I would also be very interested in the Minister’s thoughts on accessibility, a point rightly raised by the noble Baroness, Lady Bull. Again, if we want to make information available, it needs to be truly accessible to people, whether they have learning disabilities or any other particular requirement that means that a standard provision of language may not be as useful as something tailored to their needs.

The Government recognise this need, and they gave us a commitment. In the debate today, people have said that we need more than commitments; we need action. The commitment was very clear. The NHS Long Term Plan said: “By 2023/24”—which I think is now—

“all women will be able to access their maternity notes and information through their smart phones or other devices”.

I hope that the Minister can update us on where we are with this target, whether we are likely to reach it and what issues are surfacing. It is normal that things surface during the rollout process, but I would be interested to hear what issues are surfacing and what action the Government are taking to address those.

The third area I will address is maternity electronic health records. I have been looking at this because of an alert issued by NHS England at the end of last year about one of the systems used for managing patient records across several NHS maternity units. It was found that the system could overwrite records, which produces significant safety risks. Here is an area where I praise NHS England—as a board member, the noble Baroness, Lady Watkins, can take this back to it—as the issue was picked up, due processes were followed and an alert was issued to every trust using the system, warning them about it and making sure they put remedial measures in place. I also thank the Minister and his staff for producing a very comprehensive response to queries I made around this.

This prompted questions about the information flow in maternity care generally between GPs, hospital trusts’ general systems and these specialist maternity systems. It seems that we have ended up with a complex jigsaw of different systems handling patient records, which makes life more difficult. I would be interested in whether the Minister thinks information is flowing effectively in the context of maternity services, given that we often seem to have created dedicated systems for maternity services that may not be connected to the other systems. From the patient’s point of view, you want one integrated view of your care—before you became pregnant, during your pregnancy and postnatally—yet because we have different systems, that integration may not be taking place. That is a special challenge because the data is held by different entities. It is the classic NHS challenge that different entities have bought their own bits of this jigsaw puzzle and nobody is responsible, as far as I can understand it, for putting the pieces together.

I was also interested in this in the context of the question raised by the noble Baroness, Lady Gohir, about data collection. I suspect that some bits of this jigsaw will be collecting the data that we are looking for, but other bits may not be, yet because of the way the systems are structured, that may not be joined up, which would be a real shame. It is one thing if we have not collected the data, but it is quite something else if we have collected it but we cannot use it because it is in the wrong bit and has not been connected to the right bit.

I appreciated hearing all the experiences that noble Lords have brought to this debate and I hope my somewhat geeky contribution has flagged some issues that could contribute positively to keeping up the standards of our maternity services. If noble Lords in future find me on the Terrace staring wistfully across the river at St Thomas’, they will know that I am just having a moment.