Maternity Services

Lord Markham Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Patel]

To ask His Majesty’s Government what steps they intend to take in response to the Care Quality Commission’s Maternity Survey 2022, published on 11 January.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, we are committed to continuing our work to ensure that all maternity services provide safe and compassionate care. We will continue to closely monitor progress in improving the standard of maternity care across the country. We have made significant investment into maternity and neonatal services, with £127 million announced in 2022 to go into the maternity system to help to increase the NHS maternity workforce and improve neonatal care.

[Lord Patel (CB)]

My Lords, I thank the Minister for his Answer. The Ockenden report on Shrewsbury and Telford, the Kirkup reports on East Kent and Morecambe Bay, the current report of the CQC, the fact that the CQC fined a Nottingham hospital the maximum amount—£800,000—for a baby death, and the fact that we are now paying out in maternity litigation costs over £1 billion per year all point to one thing: a question of safety in our maternity units. Mothers and babies should not die in our maternity units without care and compassion, but that is what is happening. I am glad that the Minister, the honourable Maria Caulfield, met Dr Kirkup last week, which is a great improvement and progress. I hope the Government will now take seriously the need for zero tolerance of mothers dying in our maternity units and zero tolerance of normally formed babies dying or being damaged in childbirth. I shall keep pursuing this until we get that.

[Lord Markham (Con)]

I welcome the noble Lord’s pursuit because that is absolutely the right thing to do. I think we all agree with that, and we would all say that what happened in East Kent and the other examples from the Ockenden report are clearly not something that we are happy with or that we should put up with. The Kirkup and Ockenden reports gave us a north star, a way forward. I am pleased to see that we are making progress on that, but I expect the noble Lord to hold us fully to account because I am holding the department to account on this.

[Baroness Manzoor (Con)]

My Lords, building on what the noble Lord, Lord Patel, has said, my noble friend will know that continuity of care is really important and has been recommended by the Better Births maternity review. That builds up with better medical understanding of the woman, the pregnancy and the issues related to it. However, only 37% of women are afforded this, and that drops down to 27% in antenatal care. What are the Government doing to take steps to address this so that the terrible examples that we have seen recently are averted?

[Lord Markham (Con)]

I agree with the work by my noble friends, including the noble Baroness, Lady Cumberlege, to put the importance of midwifery continuity of care at the centre of everything. The survey to which my noble friend’s question refers shows that that is coming through in terms of a consistent message that having that confidence in the person in treating them is vital to all of this. That remains important. Key to this is the workforce, so this is one of the things that is being built into the workforce plan. That is starting with ensuring that we have new people coming in. The 1,200 graduates that we now have going into training each year are a vital part of making sure that we can deliver.

[Baroness Barker (LD)]

My Lords, report after report shows that the current system of treating maternity and reproductive health services on an episodic basis is costly and inefficient. Will the Government undertake to review that so that we can begin to go back to the system where staff were trained in both maternity and general nursing? We could therefore treat women on the basis of the whole of their lifestyle and get back to doing the most important jobs, such as making postpartum contraception available, which in the end would not only enable women to be treated more safely but save the NHS money.

[Lord Markham (Con)]

That question probably deserves a more detailed reply then I can give here in 30 seconds. In terms of the direction of travel, continuity of care, not just in the maternity service but in understanding that person and their needs, has to be the right thing to do to make sure that we have cradle-to-grave treatment with people who know your case. So I agree with that direction of travel and I will follow up with a more detailed response.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend update the House on the number of midwives available? I understand that there is concern among expectant mothers about the availability of midwives.

[Lord Markham (Con)]

The figure for the number of midwives has been roughly constant over the last few years at about 23,000. We want to increase that, which is why we have made a commitment to increase the number of graduate places to more than 1,000 each year. This year, as I say, we have 1,200 places, so we are making good progress.

[Baroness Merron (Lab)]

My Lords, there is an almost twofold difference in maternity mortality rates between women from Asian ethnic groups and white women, while black women are now 40% more likely to experience a miscarriage than white women. When will there be a report from the Maternity Disparities Taskforce? Could the Minister confirm that Parliament will have a full opportunity to examine its findings and review the progress that has been made?

[Lord Markham (Con)]

The noble Baroness is quite right to point out those figures, and they are something that none of us is happy with. That is exactly what the Maternity Disparities Taskforce was set up to deal with, so I am happy to make a commitment to talk through with the noble Baroness the progress of that.

[Baroness Finlay of Llandaff (CB)]

My Lords, running through the reports that my noble friend Lord Patel referred to are two strands: one is workforce, which relates to numbers and qualifications, but the other is dysfunctional teams and a failure of teamwork across the different disciplines, both within maternity services and relating to general medical services, for providing support to women, particularly those with multiple comorbidities who are then going through pregnancy and delivery. I wonder whether the Government are commissioning a specific piece of work to look at ways in which these teams can alter their behaviours internally and be supported to improve on this dysfunctional behaviour within them, which is having an adverse knock-on effect on the experience of mothers and on the clinical outcomes which, as has been said, are sometimes fatal.

[Lord Markham (Con)]

Yes, one of the Kirkup recommendations—recommendation 3, I believe—was about an improvement in teamwork, and that is what will be done under the guidance of national and regional maternity safety champions. I should say that while there is much improvement that we want to do, the overall context is a 19% decrease in stillbirth since 2010 and a 36% decrease in neonatal mortality over 24 weeks since 2010. So it is an improving picture, but it is something that we want to improve further.

[Lord Allan of Hallam (LD)]

My Lords, another day, another area of the NHS that is suffering from serious staff shortages, and these shortages are having a real impact on the willingness of midwives to stay in the profession, more than half of whom are considering leaving the NHS, according to surveys by the Royal College of Midwives. What is the Minister’s view on the proposals that have come from various groups that there should be nationally agreed minimum staffing levels for maternity and neonatal staff?

[Lord Markham (Con)]

Again, I think there are certain things that we are saying we want to see in place. Continuity of care is part of that, and the workforce plan is how we put teams around to do that. It will always be a feature that we then expect the local health trusts and ICBs to work out how best to do that in their own situations. I also say in this context that we are increasing our numbers but this is not like other demographics where we have an ageing population. The birth rate, as we all know, is actually constant/declining, so it is not like those other areas where we are talking about that. Notwithstanding that, as I mentioned before, we are increasing the number of graduate places.