Midwife and Maternity Services

Lord Walney Excerpts

Tuesday 17th January 2012 Commons Chamber

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

Let me begin by not only congratulating my hon. Friend the Member for Crawley (Henry Smith) on securing the debate, but thanking him for raising the high-profile issue of midwife and maternity services. Those services, and the midwives who work in them, are extremely important to women, and the provision of high-quality maternity care is non-negotiable for a Government and a health service. I want to outline some of the measures that we are taking to improve the quality of that care, but let me first pay my own tribute to the midwives throughout the country who do such a fantastic job.

I hope that you will allow me a brief personal comment, Mr Speaker. My four children were delivered in four different hospitals, but in each of those instances the midwife had a profound impact on the experience, and a profound impact on the start that we made with a new little family member. I know that it will have been the same for many other families. The importance of midwives and maternity services cannot be overestimated.

We want to ensure that all pregnant women and new mothers receive the best care that it is possible to give. As my hon. Friend has said, and as other Members will know only too well, maternity services face increasing challenges, and they will have to evolve to meet those challenges. Over the last few years the birth rate has been rising, and the number of complex pregnancies is rising as well. There are also more high-risk births. Women are having babies when they are older, heart disease and obesity are increasing, and more mothers born outside the United Kingdom are giving birth here.

Impressive improvements have been made in many services. The Care Quality Commission’s 2010 survey of women’s experiences of maternity services found that 92% of the women surveyed rated their care during pregnancy as excellent, very good or good, 94% rated their care during labour and birth as excellent, very good or good, and 89% rated their care after birth as excellent, very good or good. I hate statistics as they can seem meaningless and dry. It is important to congratulate the midwives who achieved those satisfaction figures, but we should never forget that if 94% of women rated their care during birth as good or better, then 6% thought they did not get care that was good enough. That might not seem like a large proportion, but for the women concerned it is all that matters.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

I have written to the Minister about the high-profile problems at the Furness General maternity unit, triggered by personal tragedies. What reassurances can she give on the future of that unit? More generally, what can she do to ensure that trusts with poor performing services in need of investment get the resources they need to deliver the first-class care people in my constituency and the whole country rightly expect?

[Anne Milton]

I acknowledge that the hon. Gentleman has written to me about those issues, and I will come on to discuss the measures we want to put in place to ensure such past tragedies do not happen again. CQC reviews have corroborated that there are problems. It raises concerns about the safety and quality of maternity care in some areas. They are small but significant areas of concern, and they must be of note to all involved in this area of care, especially as sometimes they involve personal and family tragedies.

Media and public attention on maternity services has picked up pace over the last year. In particular, there is anxiety about safety, capacity and changes to services. In many respects, there is a “perfect storm” of circumstances, which makes things difficult. The issue is how well we react, and how well services evolve and the work force are equipped to react positively.

We have put extending maternity choice as a key priority in the NHS operating framework. To help communities achieve the desired outcomes in the most individually suitable ways, when services change, that change will be led by clinicians, midwives, and women—the very people who run and use those services.

To make sure the maternity infrastructure is being put to best use, I want there to be maternity provider networks across the country, bringing together all the different elements of maternity services, so there are no gaps or hidden corners where mothers might get substandard care. The incident that the hon. Member for Barrow and Furness (John Woodcock) raised involves precisely such hidden corners and gaps, and such incidents often result in a personal tragedy. Hospitals, GP surgeries, charities and community groups can all be linked up to share information, expertise and services.

We also want more efficient use of skills in maternity wards themselves. Obstetricians and gynaecologists, maternity support workers and, of course, midwives can come together and use their complementary skills and expertise to get the best results for mothers, with appropriately trained support workers providing valuable assistance, for example with breastfeeding, leaving midwives to concentrate on the more specialist areas. This is not just a numbers game; it is about getting the skills, expertise and team mix exactly right. That will mean the talents of all 27,000 midwives can be put to the best, most efficient, use. That number shows that more midwives are working in the NHS now than ever before. The picture looks good for the future, too, because it is backed up by a record number of midwives entering training. Subject to the number of forecast births, that will be maintained.

In July, we published “Supporting Families in the Foundation Years”. That report does not have the catchiest of titles, but it is important because it sets out how everyone who commissions, delivers or leads on something can work to support parents and families. We cannot overstate the importance of the health and well-being of women before, during and after pregnancy; it is a critical factor in giving children a good start and in continuing that good health and well-being as they get older. The latest data show that more than 90% of women who gave birth in the third quarter of 2010-11 saw a maternity health professional within 12 and a half weeks. That is another dry statistic, but it is crucial. Early intervention and early contact with a maternity health professional is crucial to the well-being of not only the mother, but the child. Those meetings are about more than just basic maternity care. Work will have been done on, and discussions will have been had about, things such as diet, exercise, smoking and drinking. This is about improving the health of the baby, the mother and the whole family, and decreasing the kind of health inequalities that remain and are so persistent in our society. All those things affect the outcome for those women and their babies, and the lasting impact of those things cannot be underestimated.

To back all that work up, from April a maternity experience indicator will be introduced as part of the NHS outcomes framework. That will be an important part of identifying those gaps, as it will allow us to chart a woman’s experience of care throughout antenatal care, labour, delivery and post-natal care. It will also allow women and their partners to compare people’s experience of care and make choices about what they want to do. It will be a valuable tool for midwives as well, as they will be able to see how they are doing in relation to peer organisations. If they are doing well, this will drive them on to maintain their level and if there are weaknesses, the experience indicator will show specific areas to improve. As I say, this is not about the numbers; it is about getting the team mix right. In one busy maternity unit that I visited, it was simply about moving women around the labour facilities effectively and efficiently.

The Department of Health funded the “Birthplace in England” study, which was published in November last year. It provided evidence about the expected outcomes for women and their babies at “low risk” of complications. It was the first study of its type in this country, and the findings will be a very important part in shaping maternity services, as well as other, linked parts of the NHS, such as ambulance services, so that every part of the system is working together. It is an extremely important body of evidence. In addition, we have asked the Centre for Workforce Intelligence to carry out an in-depth study of the nursing and maternity work force to determine whether we have the right skill mix and professional teams, and whether they are able to deliver what is needed. That will start this year and will inform the future commissioning of training places.

I hope that what I have said reassures my hon. Friend the Member for Crawley and other hon. Members in the Chamber that we are continuing to improve maternity services to women, whoever they are, wherever they live and whatever their circumstance; it is not good enough to give excellent care in one place and for services to be patchy elsewhere. We want consistently high-quality care and we will carry on with that process, making sure maternity services and midwives are fully prepared for the demands of the modern maternity landscape.

I know that my hon. Friend has had specific issues to deal with in his local area and that they have been ongoing for many years. I am also aware that the picture is complex in terms of the circumstances of the women who end up using the local services. I hope that I have reassured him, to some extent, that we have taken note of what is going on. There is no doubt that the birth of a baby is a very special moment and we want it to be a positive experience that shapes the future of not only the child and their mother, but the whole family.

Question put and agreed to.