| Previous Section | Index | Home Page |
Dr. Ladyman: The hon. Lady cannot get away with the suggestion that somehow parents and carers have been downplayed. Standard 2 supports parents or carers, and includes chapters on information and education for parenting, on supporting the parenting of pre-school children, on parents of school age children, on parents of teenage children, on helping parents to promote resilience, on supporting parents who have specific needs, on supporting adoptive parents, on supporting adults caring for looked-after children and on listening to parents. It goes on and on. She must have missed that bit of the document.
Sandra Gidley: I will not let the Minister go on and on. I take his point. I was making a point that has been made by others, and that I had picked up on. If he assures me that standard 2 will be as highly focused on as the other standards, I shall withdraw that comment.
I want to focus particularly on the standard for maternity, as there are some issues surrounding it. The support for normal childbirth is very welcome, and the National Institute for Clinical Excellence has done a lot of good work in debunking some of the myths that some of the interventions that happened years ago were negative rather than positive. The emphasis on women from disadvantaged communities is particularly welcome, as that was picked up on in the Health Committee report. I do not know whether that emphasis is a result of the report—if so, I would like to thank the Minister as I worked on that Committee—but it is good to see.
20 Oct 2004 : Column 972
The mention of domestic violence, which often starts for the first time during pregnancy, was also useful. What I did not see—I only had the chance for a quick read, and I could get only half the document from the Department of Health, and could not print it off, so it may be there—was a mention of the fact that often children are aware of domestic violence and are a route to finding out when it may be a problem.
One thing that the NSF is less clear about is the problem of pregnant women with mental health problems, or pregnant women who develop mental health problems. We are told that
"all NHS maternity care providers are expected to put in place policies and protocols for identifying and supporting women who are at risk of developing a serious post partum mental illness."
That is all very well, but in many parts of the country women develop mental illnesses so serious that they have to be hospitalised, and often there are not enough places for them to go to with their babies. As I am sure the Minister realises, if a woman is separated from her baby at that stage it may prove detrimental later. It is all very well to have policies and protocols, but what is being done to ensure that treatment is available in such cases?
Moreover, all the policies and protocols in the world cannot identify every woman. There is no way of predicting which women will experience, for the first time, an illness that may be prompted by a hormonal factor. Women get together after having babies, and the talk is all about how wonderful it is: "My baby is doing such and such." A woman who is, in fact, having a hell of a time is in no position to say that, for her, things are not so good. We women want to project a superwoman image, and we feel that we are failing if we do not love our babies. I have encountered many women who have struggled to admit that there is a problem.
The proposal for choice in regard to the place of birth is extremely welcome and I was pleased by the emphasis on midwife-led units and home births. However, as was pointed out by the hon. Member for South Cambridgeshire (Mr. Lansley), there is a shortage of midwives. Between 1997 and 2003—the latest period for which figures are available—the number of midwives increased, but the whole-time equivalent was up by only 391. A 50 per cent. increase in NHS spending has increased the whole-time midwifery work force by a mere 2 per cent., and despite the national increase midwife numbers have fallen in the north-east, the north-west and Yorkshire and Humberside. The most recent annual staffing survey by the Royal College of Midwives revealed that 83 per cent. of midwifery units had vacancies, 56 per cent. of which had been unfilled for more than three months.
I think it was in the national plan that the Government identified a need for 10,000 extra midwives, and there is clearly a great potential for them to be used. Given that only 391 have been provided in six years, however, I estimate that that target will not be met until 2150. If the Minister disagrees with my estimate, will he please tell us what he will do to ensure that the necessary number of midwives are provided?
As the hon. Member for Braintree (Mr. Hurst) demonstrated, choice of the place of birth will not be achieved unless that important issue is tackled. The shortage of midwives has led to closure of some
20 Oct 2004 : Column 973
midwifery-led units. In other cases, women have been told almost at the eleventh hour that they cannot have the home births that they were promised. Although much in the NSF is good, if the Government cannot crack the problem of midwife numbers an opportunity will have been missed.
I welcome the support for breastfeeding, but I do not think that the NSF goes far enough in that regard either. The benefits of breastfeeding are clear. Formula-fed babies are five times more likely to be hospitalised with stomach infections in the first year of their lives, twice as likely to develop eczema and ear infections, and five times more likely to develop urinary-tract infections. They have higher blood pressure and are at greater risk of obesity and childhood diabetes. The list goes on, and that is before we even consider the various benefits of breastfeeding to the mother. So there are some positive recommendations, but a comprehensive breastfeeding strategy is missing. Is the Minister content with the fact that the breastfeeding rate in England—28 per cent. of babies have some access to breast milk at the age of four months—is among the lowest in Europe?
Social inclusion is supposedly high on the Government's agenda, but breastfeeding is a perfect example of the stark way in which the statistics break down according to social class. At the age of four months, 56 per cent. of babies in social class I are breast fed, compared with just 13 per cent. in class V. If the Government are serious about tackling health inequalities, what better place to start than at the very beginning of life, and by making a particular effort to tackle women in disadvantaged groups? We often do what our peers do, and such women might not have had much social contact with women who breastfeed; as a result, they do not regard it as the norm. Much work could be done in that regard.
I cannot argue with most of the national service framework. It is very well meaning and if it works, it will dramatically influence the way that we deliver services to children, but there are various points that one can pick up on. Although no one would argue with the promotion of good oral health, is the Minister happy that in many parts of the country children have access to an NHS dentist only if their parents agree to sign up privately with that dentist? That is morally wrong, yet it seems to go unchallenged.
As a former pharmacist, I particularly welcome the introduction of standards on medicines. I have seen some of the problems that the use of unlicensed and off-label medicines can cause, and some influence needs to be brought to bear on the pharmaceutical industry to ensure that it develops formulations for children. Most of the accidents that occur result from doctors and other health professionals using diluted adult formulations for children. Occasionally, the calculations go wrong because the adult formulations are completely unsuitable. If the Minister has any power to persuade the pharmaceutical industry to develop more children's formulations—[Interruption.] He looks doubtful, but I wish him all power to his elbow.
The initiatives on mental health problems are also very welcome. On talking to teenagers, I was surprised to discover how high up their agenda such problems are, and they do often develop during teenage years. But there is another issue that needs to be picked up on, and I hope that the Minister can reassure me that it will be.
20 Oct 2004 : Column 974
A local teacher pointed out to me that teachers often have to deal with the problems associated with children whose parents have mental health problems. Such children often cope for some time, albeit with difficulty. They are probably more at risk of developing such problems themselves, and they encounter specific difficulties as a result of living in such an environment. This issue could in part be tackled through the greater use of school nurses and health visitors. Such visits often stop at the age of five, and there is very little formal contact after that age; one does not see a health visitor or a district nurse in the same way. I hope that the Minister can reassure me that the needs of children who fall into this category will be dealt with.
I am not sure whether specific money is available for children's mental health services. The Minister will be aware that, traditionally, such services are underfunded in many parts of the country and they struggle to meet the demands placed on them. If there is a way of redressing the balance somewhat, that would be welcome news.
There is much that is good in the framework, but it would help if we had a clearer timetable for implementation, even where such initiatives are implemented at local level. We cannot afford to put this issue on the back burner for a few years; we need primary care trusts and other authorities to get on with it now.
5.49 pm
| Next Section | Index | Home Page |