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Midwife-led Maternity Units
3. Michael Fabricant (Lichfield): If he will make a statement on the future of midwife-led maternity units. [43717]
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): The NHS provides various types of care for women during pregnancy and childbirth, including care in midwife-led units for low-risk births. The Government expect that variety to continue to support choice for women, although it is for health authorities and trusts to decide the pattern of service provision in each area.
Michael Fabricant: Before the last election, the Government said that they would undertake a review of the future of midwifery-led units. The Minister may know that I led a delegation of people from Lichfield and Burntwood, local charities and Conservative and Labour councillors to discuss the future of in-patient care in
Lichfield and Burntwood. The visit took place in November, when I also wrote a letter to the Department; the answer came in January, but there was nothing at all about what would happen to midwifery and maternity care in Lichfield, nor was there anything about the future of health care in Burntwood. Can the hon. Lady finally put people in Lichfield and Burntwood out of their misery and say what is the future for in-patient health care?
Yvette Cooper: The hon. Gentleman will be aware that it is for the health authority and, in future, primary care trusts to propose local services and their configuration in his area. However, I can tell him that the Government support properly established midwife-led maternity units, which are extremely popular with women. The maternity and neonatal work force group is looking at all kinds of models of care in maternity services and the different work force requirements and procedures needed to support them.
Mr. Barry Gardiner (Brent, North): My hon. Friend will be aware that the Secretary of State visited the maternity unit at Northwick Park hospital last year and saw for himself the care provided by midwives there. There is an undertaking to modernise that maternity unit. What will be the role of midwife-led care in that modernisation, how much money will be made available and when we can expect an announcement?
Yvette Cooper: I know that hon. Members are keen to secure improvements to their local services. We have already announced £100 million of investment in maternity services this year and next to improve the physical infrastructure and facilities for women, their babies and professional staff. I will write to my hon. Friend about progress on the situation at Northwick Park. He is right to say that midwives are crucial in providing high quality maternity services, wherever they are delivered and whatever the care model and play a critical role.
Mr. Peter Lilley (Hitchin and Harpenden): Last month, I welcomed the decision of the Minister's predecessor to override the plan of local management to close the special care baby unit and maternity and women's units at Hemel Hempstead hospital. Can the Minister confirm that last week local management decided to reverse that plan and close the special care baby unit, but not to announce that until Parliament was in recess? Can she confirm that no fewer than two thirds of the nursing posts in that unit are vacant—I accept that that means that it must close—but that one third of the posts in the unit at Watford, with which it is to merge, are also vacant, so she must draft in extra nurses? She must set out a plan for the full restoration of services at Hemel Hempstead, and must appoint permanently two consultants to replace those who have gone, subject to an inquiry which reported unsatisfactorily this week.
Yvette Cooper: I understand that the relevant trust has made and announced a decision today to close temporarily the special care baby unit at Hemel Hempstead on safety grounds and that a further meeting is taking place this afternoon to discuss maternity services. We have always said that patient safety is paramount; trusts have a duty not to put women and babies at risk. A series of local
factors has been involved in the situation at Hemel and Watford, but there are no clinical reasons why a maternity unit of that size should not be viable.The right hon. Gentleman is right to raise the issue of staffing; the local trust must address concerns about staffing, not just at Hemel, but at Watford. My noble Friend Lord Hunt of Kings Heath has already asked the NHS Modernisation Agency to work closely with the trust to try to improve the staffing situation. If the trust decides this afternoon to close the maternity unit temporarily, my noble Friend will ask the chair of the Bedfordshire and Hertfordshire strategic health authority to convene a taskforce to restore appropriate services at Hemel as rapidly as possible.
Ms Julia Drown (South Swindon): Midwife-led units have been very successful in reducing caesarean rates and increasing breastfeeding rates. Does my hon. Friend agree that a major part of every local maternity service, whether it is provided by an acute hospital or by a community hospital, should be midwife-led? Could we not obtain major public health benefits from reduced medicalisation of births—allowing interventions only when midwives and parents agree that they are appropriate?
Yvette Cooper: My hon. Friend is right: many midwife-led units have proved extremely popular and successful. It is important for women to have a wide range of choices, and not to feel that a birth is being over-medicalised when that is not appropriate. Those choices should include the availability of a variety of pain-relieving drugs in maternity units throughout the country.
Delayed Hospital Discharges
4. Miss Anne McIntosh (Vale of York): How many delayed discharges there were in (a) May 1997, (b) May 1999 and (c) January 2002; and if he will make a statement. [43720]
14. Miss Julie Kirkbride (Bromsgrove): If he will make a statement on delayed discharge. [43730]
The Secretary of State for Health (Mr. Alan Milburn): The figures we have show that the number of delayed discharges fell by 21 per cent. between June 1997 and the start of this year. The number of people aged over 75 whose discharge from hospital was delayed in June 1997 was 5,973; in June 1999 the figure was 5,276, and in December 2001 it was 5,117. The numbers have fallen further since then.
Miss McIntosh: Is the Secretary of State saying that the Northern and Yorkshire region is bucking the trend? The figures there have risen by 20 per cent.
Is the Secretary of State aware of the particularly acute problem affecting elderly and mentally infirm patients who have nowhere to go? What is he going to do about
the lack of funds, especially for personal social services, and the lack of co-ordination between primary and acute health care providers and social services departments?
Mr. Milburn: It is true that there are capacity problems in nursing and residential care homes in some parts of the country, including the hon. Lady's area. Three things need to be done.
First, we need to invest more in social services, and that is precisely what we are doing. It is worth remembering that whereas investment in social services rose by a miserly 0.1 per cent. during the last Government's final Parliament, it has risen by an average of 3.1 per cent. in real terms under this Government.
Secondly, in dealing with capacity problems we must not just focus on providing more residential and nursing home places, but respect what most elderly people and people with mental health problems want—which is not to be banged up in a care home, but to be cared for in their own homes. That is why we are making extra resources available.
As the hon. Lady says, one issue is the relationship between primary care trusts and acute hospitals. As she knows—this is the third point—we have provided the necessary legislative powers to enable them to work together rather than separately.
All those measures—measures to provide extra cash, extra capacity and reforms of the structures between health and social care—we support, and the hon. Lady and her party oppose.
Miss Kirkbride: Like my hon. Friend the Member for Vale of York (Miss McIntosh), we in Worcestershire have a significant problem with delayed discharges. Along with many of my hon. Friends, I receive a steady stream of letters from distraught people who are watching their elderly parents spending the final moments of their lives in hospital, rather than being cared for in their own homes or in nursing homes where they can be surrounded by their possessions and photographs.
As in much of the rest of the country, the problem in Worcestershire is not a lack of capacity, but finding the money to fund places in nursing homes. What is the Secretary of State going to do about that in places such as Worcestershire?
Mr. Milburn: What we are doing, in Worcestershire and in other parts of the country, is providing extra resources. The hon. Lady should know that Worcestershire county council has received an extra £700,000 for this financial year and the next. That is already having an impact, and it is part of a £300 million package intended to deal with the problems that the hon. Lady has cited.
It is pretty self-evident that when we put resources in they produce results. Since September last year, when we provided that £300 million, the number of so-called bed blockers—delayed discharges from hospitals—has fallen by 1,400. We need to go on investing, and to make changes as well.
The hon. Lady cannot have her cake and eat it. She cannot say that her constituents are experiencing troubles—and I acknowledge that there are difficulties—while at the same time not committing her party, as her
Front Bench refuses to do, to extra investment in health and social services. There is a straightforward choice. If she is worried about these problems, the answer is self-evident—to get more investment into public services, particularly the NHS and social services.
Mr. David Hinchliffe (Wakefield): I warmly welcome the improvements secured by the Government in addressing delayed discharges. I think that my right hon. Friend will accept that within the improved figures, there are still marked differences from area to area. I wonder whether he and his colleagues are evaluating the reasons for these marked differences, particularly the fault line between social care and health, and whether the joint budgeting arrangements, taken up in certain areas, have had any impact on delayed discharges.
Mr. Milburn: My hon. Friend makes an extremely good point. He is well versed in these issues and in dealing with the interface between health and social services. An extra £1 million or thereabouts has been made available to Wakefield to deal with some of the problems.
My hon. Friend is right to say that the picture is pretty patchy. Overall across the country, the number of delayed discharges from hospital is falling. However, particular parts of the country have particular problems. Frankly, the situation gets worse the further south we get. That is not to say that there are not problems in some parts of the north, but as my hon. Friend knows, labour market problems and property prices down here make the situation much worse. We will be evaluating the take-up of the pooled budget, lead commissioner arrangements, and so on. We also need to ensure that we move towards a system under which there is a much closer working relationship between the national health service and social services than there has been in the past.
Mr. Bob Blizzard (Waveney): The Government's cash for change money is reducing the amount of delayed discharge in my constituency. Does the Minister agree that it is important that social services departments make the best use of their core money? Will he crack down on departments that continue to exercise their inspection role under the guise of contract monitoring, even though we are about to move to national care standard inspections? Is that not a wasteful duplication?
Will my right hon. Friend also look at the delayed discharge of elderly mentally infirm patients—
Mr. Speaker: Order. The hon. Gentleman must ask one question only.
Mr. Milburn: On the first issue, my hon. Friend is absolutely right. As for elderly mentally infirm patients, to whom he was about to refer, in many parts of the country, sadly, local provision is not available in the way that it should be. That means that sometimes relatives and carers have to travel further to visit their elderly relatives in accommodation that is some distance from their home. Again, the answer is precisely the same—we must keep putting money into public services. [Interruption.] I know that Opposition Members do not like that because their commitment is not to increase investment in public services but to go for tax cuts. We cannot have one and the same agenda, with tax cuts on one side—
[Interruption.] Frankly, Harrogate was one of the more unbelievable weekends in anyone's experience. Conservative Members know all about vulnerability—they created it.
Mr. Paul Burstow (Sutton and Cheam): Does the Secretary of State accept that delayed discharges and emergency readmissions are the symptoms of a wider crisis in the funding and staffing of social care, and that the investment that he has told us about today has resulted in 100,000 fewer people receiving care in their own home over the past five years and the loss of 50,000 long-term care beds, not the 19,000 that is claimed by his Department? This has been an unplanned and unforeseen loss of capacity in the care sector. When will the right hon. Gentleman recognise that health and social care are two sides of the same coin and that because of his actions, he has undermined those services and not invested in them enough?
Mr. Milburn: I am delighted to hear that the hon. Gentleman has been reading my speeches. With regard to extra investment and the number of extra beds, it is true that there has been a loss of residential and nursing home beds, but not on the scale that he suggests—not 50,000; probably closer to 11,000. On extra spending, may I say to the hon. Gentleman in all candour that he should look at the performance of individual local authorities? I had the pleasure of being in Liverpool last week to visit Alder Hey hospital. I was horrified to learn that the extra investment that is going into the national health service there is being compromised by decisions being taken by Liverpool city council—a council, as hon. Members are aware, that is controlled by the Liberal Democrats.
The Liberal Democrats are cutting from social services in Liverpool £9 million in the current financial year and £7.5 million from 1 April for the next financial year. Why? In order to pay for a measly council tax cut. So when the Liberal Democrats say in the House that they want to see more investment in social services, they should look to their own. They should look to themselves. They are always talking about a postcode lottery in care. What we have with the Liberal Democrats is a postcode lottery in policy, where different fare is served up—
Dr. Liam Fox (Woodspring): I hope that the Secretary of State will reflect on the phrase that he used at the beginning of his answer to the question, when he referred to elderly patients being banged up in nursing homes, which will have caused huge offence to many dedicated staff who look after elderly patients.
The right hon. Gentleman will be well aware that the proportion of patients with delayed discharge who are kept in hospital more than a month has rocketed to 40 per cent., and that that is having a major impact on cancelled operations. What does he say to a trust which advises that
- "if there is doubt as to whether admissions can be accommodated the following day, the cancellation should occur the day before"
- "this will enable the Trust to deliver our target of NIL same day cancellations"?
-
Does the right hon. Gentleman approve of such a policy?
Mr. Oliver Heald (North-East Hertfordshire): Fiddled figures.
Mr. Milburn: The hon. Gentleman is muttering from the Front Bench that those are fiddled figures. They come not just from the national health service, but from local authorities. I would guess that among those are many Conservative local authorities.
Dr. Fox: The Secretary of State should read a little more carefully the answers given by his own Ministers. They show that the number of patients with delayed discharge who are in hospital for more than a month has risen. In the latest quarter the figure is up from 36 per cent. to 40 per cent. Waiting lists are going up again. Cancelled operations are at a record level. There is a bed-blocking crisis and a collapse in the care home sector, and all that despite the Government, admittedly, putting in more money. Can the Secretary of State tell us how, despite a 30 per cent. rise in expenditure, the NHS managed to treat fewer elective patients last year than the year before?
Mr. Milburn: The hon. Gentleman is well aware of the waiting list figures, but for his convenience I shall remind him of them. Under this Government waiting lists have fallen by 100,000. Under his Government, they rose by 400,000. He asks where the money has gone. Under his Government the number of nurses in training fell; the number of GP training places fell; and the number of acute beds in hospital fell. Under this Government, all those indicators are moving in the right direction—they are increasing. The number of beds is up, the number of nurses is up, the number of GPs is up, the number of patients treated is up, and the number of accident and emergency departments being modernised is up. We have the biggest new hospital building programme that the country has ever seen. What people will see is the greatest contrast between the Labour party, which believes in building up the NHS, and the Conservative party, both in government and in opposition, that believes in running it down and talking it down.
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