NHS: Maternity Care

Lord Harrison Excerpts

Thursday 5th February 2015 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what steps they are taking to improve maternity care and to ensure that maternity staff are trained and developed to meet future needs.

[Lord Harrison (Lab)]

My Lords, today, we call the midwife. We do so in England and Wales, and I am particularly indebted to the National Federation of Women’s Institutes for bringing to my attention its excellent report, Support Overdue: Women’s Experiences of Maternity Services.

My adult children’s contemporaries are now growing families. In chatting to one new mother and friend of the family I learnt that her experience of childbirth was unsettling, to say the least, and her anxieties find all too ready an echo in the WI report. The report highlights that 700,000 women give birth each year in England and Wales. Indeed, that is the single biggest reason for admission to hospital. Midwives play the crucial role of setting families on the right path, from pregnancy through to birth itself, and then shape the first few weeks of family life. The report highlights shortcomings, which I will examine, while it readily acknowledges that mothers in England and Wales enjoy some of the highest quality maternity care in the world.

Choice of location of birth still remains an aspiration, not a reality, for many women. For too many women the choice of the four standard location options is a chimera. Thus the Government’s pledge to deliver choice in NHS maternity is defaulted on.

Secondly, maternity care is still fragmented; it is still a long and bumpy road that a woman treads from preconception through to pregnancy, birth and postnatal care. Thirdly, despite the best efforts of NICE, a postcode lottery for postnatal care remains, with wide variations in quality and standard of care across the country. Too often when we call the midwife, she is not there. Despite an increase in the birth rate of some 15% over the past decade, we still fail to provide the promised 1:28 midwife to birth ratio keenly advocated by the four royal colleges involved in midwifery. Despite the recent baby boom, some 50 trusts and boards even now employ fewer midwives than they did previously, which is astonishing. Call the midwife. Unfortunately, some 34% of women complained that they were not given the name or number of a dedicated midwife they could phone if worried or wanting advice. Surprisingly, some nine out of 10 women had not met any of the midwives who cared for them at the time of labour and birth before going into labour. Some 30% of mothers urgently wanted the designated midwife to,

“remain responsible for my care (not pass me on to someone else)”.

Call the midwife—but only one in 10 mothers had the full four choices of where to give birth, a promise unfulfilled in part because we have trained too few midwives. Matters are beginning to look up as more trusts and boards are promoting and expanding location options by building new, freestanding or colocated maternity units, or funding home birth services. Can the Minister update us on offering the full four locations, and give us figures on the provision of complementary services, such as birthing pools and partner accommodation? Can he give us up-to-date figures on the worrying incidence of temporarily closed units or suspended maternity services attributable to staff shortages and capacity problems due to unavailable bed space? Why do only one out of two women obtain the desired home birth?

Finally, three out of five mothers want more not less postnatal care, but a quarter of mothers were unable to call the midwife to fix up appointments convenient to themselves, as new mothers deal with the baby. Will the Minister ensure that CCGs develop transparent frameworks for postnatal care? We all know how crucial the transition to parenthood is for new mums and dads—and, please, do not forget the dads. Can the Minister respond to the Support Overdue report by the WI, and say which recommendations the Government might take up?

Furthermore, are maternity health planners taking into account the wider health needs of women during pregnancy? How is the midwife’s crucial role of influencing new mothers’ lifestyles being supported and expanded? Is the pivotal role of the supervisors of midwives being protected? Too often these valuable personnel are used to cover up midwife shortages, instead of supervising their charges. When will we fund and ensure one-to-one maternity care, surely the crucial relationship in any happy birth? Has the troubling and outmoded use of handheld notes and paper records to give vital information on risk status during birth been eliminated? I would be grateful if the Minister could update us and respond to the 2013 State of Maternity Services report published by the Royal College of Midwives.

The Government have funded the increase in midwives begun by the previous Labour Government, but it is worrying that the midwifery workforce has not kept pace with the rising number of births in the last decade, and worrying that the marked ageing profile of the current cohort of midwives threatens real instability to future maternity services as experienced midwives leave in droves. Student midwives’ recruitment stalled in 2014, and even though the baby boom has now paused, the RCW calculates that births still need to fall by some 130,000 before we can satisfactorily match midwife numbers to the current birth rate.

I turn to the findings of the National Audit Office report of these services, and ask whether there is a reply from the Government to the concerns of the Commons’ Public Accounts Committee. Should the department not more rigorously assess whether it can afford to achieve its declared policy objectives? Indeed, are the current tariffs for maternity care set at the right level? What is the Government’s view on the finding that many efficiencies and savings in the service could be found and implemented if more midwife-led birth centres were established, as set out in the Birthplace in England study by NICE?

The PAC also points out that still too few women secure the birth location of their choice. Local maternity networks are an important route to share and spread best practice between and within networks, thereby improving quality and helping to eradicate unacceptable variations across the country. Does the Minister accept that current maternity networks are less well developed than other NHS networks? What can he do about it?

I am pleased that the noble Baroness, Lady Manzoor, will speak on mental health services for pregnant mothers. Indeed, I hope that other colleagues and maybe the Minister will pursue other aspects of maternity services that I do not have time to turn to, including maternal mortality rates and their breakdown into socioeconomic groups, perinatal deaths and the comforting of mothers suffering still births, the availability of hospital beds, the screening of babies for debilitating diseases, and data collection in maternity services, which is crucial in developing policies.

Will the Minister say more about pay, which has been frozen for midwives since 2011 and 2012, with just a 1% rise in 2013 and frozen again in 2014? This is an important recruiting angle that needs to be prized. Will the Minister confirm that in future the Government will listen to and implement the recommendations of the independent pay review body?

In my final minute, I turn to the European Union and ask the Minister whether there is sharing of practice across the EU. If it stands for anything, the European Union is the swap shop of ideas, which the National Health Service should be involved in—and nowhere more than in maternity services.

Finally, are we doing anything to recognise the wonderful nurses who go out to deal with the Ebola problems that have been experienced, and are we doing more to share the best practice with other parts of the globe, where improving maternity services is so crucial to getting a better world?

I look forward to the debate and hope that the Minister will be able to reply to some of those points and to write to me on those that he does not have time to cover.