NHS: Maternity Care

Lord Hunt of Kings Heath Excerpts

Thursday 5th February 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, very much welcome the initiative of my noble friend Lord Harrison in allowing us to debate these very interesting issues. I agree with many of the points that he made about the risk of fragmentation of services and the need for more prenatal and postnatal care. The noble Baroness, Lady Manzoor, made a very good point about mental health, and indeed it was raised at Oral Questions this morning by my noble friend Lady Royall in relation to postnatal depression. The role of fathers was given a great deal of emphasis by my noble friend and the noble Lord, Lord Farmer. Also recognised was the excellence of many maternity services. I agree with my noble friend that one of the roles of maternity services in this country is to share good practice globally.

On the question of choice, it is very clear that we have a problem at the moment. The Public Accounts Committee made some very important recommendations about choice in its report of January 2014. In particular, the National Federation of Women’s Institutes suggested that although many women wish to take advantage of midwifery-led units, not enough are given the choice. It is not always my experience that these units are used sufficiently once they are set up, and certainly, looking at the numbers in a lot of them, it is clear that they are bordering on viability. Despite the view that has come across from opinion polling, confidence in using those units needs to be built up among parents and mothers. That is something that the NHS may need to think about in the future. Often, the units are set up because the service has been downgraded. Services are now centralised and I am sure that that is appropriate, but it can lead to a loss of confidence among many members of the public about what is left of those midwifery-led units.

I want to ask the noble Earl, Lord Howe, something else that was raised by the PAC. It says that the NHS has persistently failed to deal with inequalities in maternity care. It adds that the latest data on women’s experiences show that black and minority ethic mothers are less positive than white mothers about the care they receive during labour and birth. What is the NHS doing about that? I also refer the noble Earl to Oxford University’s National Perinatal Epidemiology Unit, which found that the most deprived women in England were 38% less likely to be seen by a professional prior to 12 weeks’ gestation and 40% less likely to report being able to see one as early as they would have desired. Presumably they are the people who most ought to take advantage of those services. What can we do about that?

Can the noble Earl respond to the point raised by the PAC concerning confusion around the department’s policy on maternity services, what it wants to achieve and who is accountable for its delivery? Of course, this is partly a product of the arrangements resulting from the 2012 Act, but clearly it is very unsatisfactory in terms of having a cohesive policy at local level and then ensuring that it delivers. I point out to the Minister that, prior to the PAC report, the NAO inquiry found that the department did not fully consider the implications of delivering the ambitions that it had set out in its strategy for maternity services. It went on to say that it was unclear how local commissioners were monitoring the performance of the providers of maternity services and holding them to account. The noble Baroness, Lady Cumberlege, pointed to the ability of mothers to take advantage of home births. How can we make sure that the enunciated policy is implemented unless there is proper monitoring? I very much agree with what she had to say about that.

My noble friends Lady Wall and Lord Harrison referred to training commissions and training in general. There is a concern that with a huge increase in the number of births in recent years, the number of training commissions is not keeping pace with need and demand. That is one reason why so many midwives have left the profession and why it is such a challenge to bring them back into the service. I should just like the noble Earl to say a little more about how convinced he is that we have got the number of training commissions correct.

Is the noble Earl prepared to say something about the relationship between midwives and consultant obstetricians? My noble friend referred to Morecambe Bay, where I think one of the issues was a very poor relationship. We know that there are tensions up and down the country. I wonder whether there is a leadership role within the department to try to bring the professions together at a national level and to resolve some of those tensions. They cannot be good for the safety and quality of care within midwifery units. Yet this issue is being raised in a number of areas.

Finally, on midwifery leadership, it is essential that we have visible, strong leaders locally and nationally. Is the noble Earl satisfied that at his department’s level and at NHS England there are sufficient midwifery-led professionals and a visible head of profession, perhaps a chief midwifery officer? Often, midwives are subsumed within the nursing profession. They are a separate profession but they often come under the management and leadership of a chief nurse. Sometimes midwifery does not get a fair shot when it comes to issues about arguing for resources and priorities. I wonder whether the noble Earl is able to comment on how we can enhance leadership nationally and locally.