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9 May 2006 : Column 13WH—continued
I put the example of my son, Sami, who was born within minutes of getting through the door of St. Paul’s maternity unit, to the chief executive of the foundation trust and asked what would have happened if we had had to add another 20 minutes to our journey. Would he have been born on the Golden Valley bypass between Cheltenham and Gloucester? The chief executive’s reassuring reply was, “Nature would have taken its
course.” That will not be of much reassurance to my constituents. Inevitably, they will suffer the injustice of losing a service that is much valued and supported, despite the fact that there has been no financial crisis in our primary care trust area.
We are promised a consultation period, but we had a consultation period on children’s services last year, which revealed overwhelming public opposition to the closure of overnight care at Battledown children’s ward in Cheltenham, and 27,000 people signed a petition against that closure. All three primary care trustsand the local NHS foundation trust categorically agreed that a nurse-led unit, at least, would survive and that 350 children a year would not be transferred to Gloucester from Cheltenham under a pilot scheme. Despite all of that however, those proposals were discarded at a few weeks’ notice due to the pressure of the current financial crisis. Little wonder, then, that13 local NHS trust governors described the process of public consultation on significant change as having been reduced to “absolute farce”. As my hon. Friend mentioned, the fact that there is only one local service left reduces to nonsense the concept of patient choice between different local services. Sadly, I fear that maternity services will go down the same path.
10.27 am
Mr. David Drew (Stroud) (Lab/Co-op): Thank you for your forbearance, Mr. Caton. I was sorry to miss the remarks of, in this case, my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton).
I would like to make two points, one of which follows on from my intervention on my near neighbour, the hon. Member for Cheltenham (Martin Horwood), dealing with the continual review of these services. No one can quite understand the psychological damage that that does to members of staff who are for ever looking over their shoulder, wondering whether they will have a job or a service to deliver. The sad thing is that Stroud maternity hospital was set a whole series of measures that it had to meet to survive. It has more than met those. In fact, it does not want too many more births because that will put it under significant pressure.
The danger in the current review is that the hospital faces the centralisation of services and staff feel somewhat forlorn and thrown aside because of the threat to the work that they did to meet those requirements. The threat comes from the acute trust, in its various forms in Gloucestershire, which is a matter that I have already taken up with the chief executive because I think that it is wrong.
The second issue is that Stroud hospital, while not being unique, is somewhat unusual in that it provides cradle-to-grave care. If we take the cradle away from an important community hospital, we shall immediately create a chink in the armour that is the health service in Stroud. Our area does not have an acute hospital—we lost that in its previous incarnation, which I could saya lot about—but we have maintained very effective community services.
If women choose to have their babies in a community setting, but the community facility is then taken away, many will then choose to have home births. We know that there would be no saving: the figures
have already been done. In fact, it is likely that the cost will increase as the number of home births goes up. That may be a good thing, and it may be the choice of those mothers, but it is not very satisfactory when the arguments on financial grounds are driven by the idea that centralising can save money. I know that there are medical considerations, but we seem to have overcome those. We are now faced with the brutal reality that it is a question of cost, not choice. I hope that the Minister listens, and that she already understands the view in my area. I hope that we can kill stone dead the idea of closing Stroud maternity hospital.
10.30 am
Sandra Gidley (Romsey) (LD): I start by congratulating the hon. Member for Macclesfield (Sir Nicholas Winterton) on initiating this debate. It is an important subject, and I pay tribute to the Select Committee report of years ago, which was followed by the Cumberlege report “Changing Childbirth”. The hon. Gentleman did not mention that in 2002 the Health Committee decided to set up a sub-committee to review what progress had been made since those days. The work goes on, and he got us off to a good start.
I was interested to hear what my hon. Friend the Member for Cheltenham (Martin Horwood) said. I got quite nostalgic, because my two babies were born inSt. Paul’s, which was an excellent and popular unit. I did not live in Cheltenham, I lived in Tewkesbury, but Tewkesbury mothers chose to go there, and it would be a real loss to the local community were it to close. I do not understand the reasons for it, and I wish him success in keeping it open.
The hon. Gentleman raised many points that I would have raised myself had I had full rein. I agree wholeheartedly with everything that he said, and he provided a comprehensive analysis of the subject. The underlying factor in maternity services is the shortage of midwives and the inability to increase their numbers. The Select Committee report in 2002 raised concerns about retention rates, high drop-out rates, and thehigh drop-out rates on some midwifery courses. The Government’s response was to commission Professor Mavis Kirkham and team at a cost of £70,000 to carry out a study called “Why do Midwives Stay and Why do Midwives Return?”, stating that the results would inform future midwifery recruitment and retention policy.
It will be helpful if the Minister tells us whether the report has been produced, what assessment has been made of it, and what future plans there are to increase the number of midwives. As the hon. Gentleman pointed out, there has been an abject failure in the Department. One can in no way saythat there has been success, when in 2005 the head count fell by 36. We all know that the head count is the Government’s preferred way of accounting, and the Minister please should not insult us by returning to whole-time equivalents just because it happens to suit the occasion.
It is easy to bandy figures about, but the availability of midwives underpins so much more. Some services have suffered, and poorly staffed units are leading in some cases to closures. The 2002 report received considerable
evidence to show that poorly staffed units often have an increased rate of caesarean sections. That procedure is more expensive and places a greater demand on national health service resources. It has not been mentioned much today, but we should try to tackle it. The rate of caesarean sections in this country is about 24 per cent, and the World Health Organisation says that it should be about 14 per cent., so there seems to be a problem with the way in which we are managing things.
Hon. Members have illustrated today that if units close, choice decreases. Often, the midwife-led units suffer. Other impacts include a lack of time to devote to the detection of domestic violence, which often starts during pregnancy. Our report highlighted that midwives are ideally placed to identify domestic violence and link up with other health workers. However, many midwives simply do not have time for that, nor do they have any extra time to give to ethnic minority women and to public health matters such as encouraging pregnant women to give up smoking, which I am sure the Minister is keen to encourage. A recent local development that has worried me greatly is that antenatal classes have been axed. I shall cover some of those matters inmore detail.
The cuts in antenatal classes are particularly worrying because that is where many women obtain information about where to give birth and what will happen when they do, and about post-natal support such as for breast feeding. That service has been cut ostensibly because of lack of numbers, but it is clear that no attempt has been made to commission services from elsewhere and organisations such as the National Childbirth Trust and even independent midwives would be keen to step into the breach.
What is even more worrying is that many women decide at antenatal classes where to give birth. Until that point, they may not have been aware of a local birthing or midwifery unit and it is insidious to reduce demand for a birthing unit so that in future years, or even months, NHS managers will be able to turn round and say that there is no demand for such services.
It is extremely worrying that women will not receive information about giving birth because if they know what is going on they are more likely to have a pleasant experience. Some people would say that childbirth is never a pleasant experience, but there are differences in how people feel about giving birth and how they cope with it. Antenatal education can help with that. Women are left to obtain information from a variety of sources, which is okay if they are educated and can afford to buy books and magazines, but more difficult for those who are struggling on a budget and do not know where to go for help.
It is more common for a woman to arrive at hospital feeling frightened and vulnerable, which can lead to her not having a good birth experience. That brings me to one-to-one midwifery care. Much is made of that and most midwives would say that one-to-one midwifery care enables a midwife to stay with a woman and to provide support from the onset of labour and probably even before that, during pregnancy, and to be present during the birth, but one-to-one care is shown in the figures if the midwife is simply present at the end to
deliver the baby. The reality is that in busy obstetrics units many midwives look after more than one woman during labour. That is a disaster waiting to happen.
I tabled some parliamentary questions to try to obtain a definition of one-to-one midwifery care and had a spectacular lack of success. A certain Mrs. Blair opened the new Royal College of Nursing building and happened to mention that she had had two midwives. She was lucky, but she did not seem to think that it was unusual. It might help if someone made it clear that Members of Parliament and their wives should have the same treatment as other people.
One-to-one care is more likely to be achieved in a birthing centre. Other advantages of midwife-led units are that care is provided by midwives who can specialise in supporting women through normal births with a minimum of intervention and an explicit philosophy to provide a friendly, individualised, women-centred and family-focused service which can deliver high-quality care. The problem seems to be that on paper the costs are a bit higher. What often happens is that the wider picture is not taken into account and there is evidence to show that women delivering in birthing units have a lower rate of intervention and less need for aftercare. That is not factored into the equation, but it should be.
I have talked a little about the rates for caesarean births. The Government have decided to publish success rates for certain cardiac surgeons, but when the Health Committee suggested that they should publish obstetricians’ success rates for caesarean sections, we were told that there were no plans to do so. Now that we have more openness in other areas, it would be useful to develop that idea.
I am rapidly running out of time. I end by saying that the lack of midwives means that there is little time to devote to breastfeeding. Next week is national breastfeeding awareness week. It would be useful if the Minister could tell us when the breastfeeding co-ordinator will be replaced—the post has been unfilled since February. Perhaps we shall hear some good news next week.
10.40 am
Mr. John Baron (Billericay) (Con): I congratulate my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton) on securing this debate and on the eloquent way in which he raised the issues. I wish him well in his campaign to keep mother and child in Macclesfield hospital, and also in promoting option D.
I welcome the Minister to her new responsibility for maternity services. May I say how sad we were to hear that the right hon. Member for Liverpool, Wavertree (Jane Kennedy) had resigned? Despite her obvious defence of Government policy, one felt that one could hold a constructive debate with her. I hope that that will continue.
To say that midwives and those who work with them make an invaluable contribution to the NHS and to our national life is to state the obvious. We have all been touched by a midwife. However, contrary to what has been said by the Health Secretary, it has not been a good year for maternity services. Unfortunately, as we have heard, they are rapidly becoming the latest victims of NHS deficits.
According to a survey by the Royal College of Midwives carried out last September, 78 per cent. of maternity units in England have been experiencing staffing shortages. Vacancy rates in England stood at almost 5 per cent. of establishment, the figure rising to more than 10 per cent. in London. Of those vacancies, almost two thirds represent long-term vacancies of more than three months. My hon. Friend went into some detail about why the Government may be understating the extent of those midwifery shortages, so I shall not go over that ground again.
Meanwhile, according to last month’s work force census, the number of full-time equivalent midwives—the best way of measuring their availability—has risen by only 5 per cent. since 1997, during which time spending on the NHS has almost doubled. That suggests that midwifery is one of the poor relations within the NHS.
The big question on many people’s lips is, “Where has all the money gone?” Even on the Government’s head-count measure, the number of midwives working in the NHS fell between 2004 and 2005. It is generally accepted that the Government have bombarded the health service with targets. That has spawned a massive growth in bureaucracy, because the targets have to be monitored and measured; and that bureaucracy has soaked up a lot of the new NHS money and prevented it from reaching front-line services. Maternity services certainly seem to be suffering as a result.
The challenges facing maternity services are growing, not diminishing. The number of births in England in 2003-04 was 5 per cent. higher than in the previous year. Women are experiencing childbirth both earlier and later in their lives, and younger and older women tend to be at greater medical and social risk. That is one of the factors that has contributed to the need for more medical intervention in childbirth, which has resulted in longer post-natal stays and greater pressure on hard-working midwives.
Now is the time to have more midwives—that is generally accepted—yet we believe that staffing shortages under this Government are now compromising patient care. In July 2005, the Healthcare Commission report on maternity services highlighted the problems of overcrowding, the shortage of midwives and the fact that staff are too busy to give advice on the feeding and bathing of new babies. The RCM and others pointed out this week that the current financial crisis in the NHS is adding to the woes of the profession. Indeed, in a snapshot survey of heads of midwifery carried out by the college, one in three managers reported that maternity service budgets had been cut and one in four respondents reported that midwifery staffing numbers had been reduced; and almost half of all trusts have a freeze on recruitment. If the Minister believes for one moment that NHS deficits are not affecting front-line services, I strongly recommend that she examine the RCM data.
The shortages have a knock-on effect for the midwives who remain in the NHS, as their work load increases so that the system can cope, they become more stressed and morale suffers. Such dedicated professionals deserve better support. The impact of deficits on front-line services can be seen in the scaling back of antenatal classes and neonatal home visits in some areas,
as my hon. Friend the Member for Hornchurch(James Brokenshire) has highlighted in the House on a number of occasions.
Elsewhere, specialist neonatal care units are suffering; there is no shortage of evidence of that. We have heard about a case in which a Coventry woman who went into premature labour was driven more than 100 miles in an ambulance because there were no available facilities anywhere in the midlands. The woman, who was expecting twins, ended up in Manchester, in pain and feeling very isolated. That story made the local press.
The Government recognise, to a certain extent, that there are problems. In their last manifesto, they made a clear commitment—referred to by one or two speakers today:
“By 2009 all women will have choice over where and how they have their baby and what pain relief to use.”
“We want every woman to be supported by the same midwife throughout her pregnancy.”
However, I ask the Minister how the Government can hope to implement their manifesto promises, or meet the standards already drawn up, when there is a shortage of midwives. As the right hon. Member for Liverpool, Wavertree admitted recently in evidence to the Health Committee, although one-to-one midwifery support
“is a commitment we made in our manifesto...The brake on us delivering that is the lack of midwives...we do not have enough midwives to be able to provide it”.
Perhaps the Minister can tell us how many women are currently being offered one-to-one maternity services. Or perhaps she would care to comment on the Jentle midwifery programme run at the Queen Charlotte’s and Chelsea hospital, which invites couples to part with £4,000 in return for 24-hour one-to-one care. I do not for one moment criticise women for seeking the best possible maternity care in the NHS, and I understand that the aim of the scheme is to reinvest profits in front-line services, but it would be absolutely outrageous if some mothers were being charged for a service that Labour says ought to be theirs by right, while those who cannot afford to pay are being left behind by the Government. Having offered a policy at the last election, Ministers should be implementing that policy for all mothers, irrespective of their ability to pay, but staff shortages stand in the way.
How can the Government offer women greaterchoice in where they give birth when the National Childbirth Trust has drawn our attention to closuresof community-based birth centres? At least 10 of approximately 100 centres across the UK are either closed or facing closure. As we all know, those centres allow maternity services to be delivered in a less medicalised, more home-like setting and therefore promote choice, but choice is now being curtailed as cash-strapped primary care trusts withdraw midwives to cover shortages in acute hospitals. An alternative to giving birth in hospital is home birth, but one in four respondents to the RCM’s survey of maternity managers reported a reduction in the number of home visits by midwives.
There can be little doubt that we need to tackle the current financial crisis and develop longer-term strategies for recruiting more midwives into the profession and for
retaining the ones that we have. I would like to ask the Minister a few questions, and if she cannot answer them in the time available to her, I hope that she will do so in writing. First, what plans does she have to raise the status of the profession, for example by enabling more midwives to prescribe from the nurse practitioners’ extended formulary? Giving midwives greater responsibility and status would promote the profession and give encouragement to those working in midwife-led units, which are already very popular with women.
I refer the Minister to the reports produced by the Nursing and Midwifery Council and the RCM that point to the ageing profile of the work force, and the problems that that will create in a few years’ time.
We also need to tackle the high attrition rates in midwifery training courses, which can be 20 per cent. or higher. At the last election, the Conservatives were pledged to enhance access to bursaries, which would have more closely reflected the cost of living. Will the Minister comment on the need for greater financial support to be given to trainee midwives? I also ask her to make a short statement on her policy in respect of the NHS community midwifery model proposed by the Independent Midwives Association and supported by other childbirth charities.
In conclusion, I simply say that maternity services are vital for our future and deserve our support, and I ask the Minister to clarify what action the Government will take to address urgently the shortage of midwives in the NHS.
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