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The Minister of State, Department of Health (Caroline Flint): I congratulate the hon. Member for Macclesfield (Sir Nicholas Winterton) on securing the debate, and on his role as an honorary vice-president of the Royal College of Midwives. My namesake Caroline Flint was once president of the RCM, and during my political activities since I was a student we have sometimes been mixed up with each other. Being approached as an expert in this area is something that I have experienced on a couple of occasions, and I have had to correct people by pointing out that I am not that Caroline Flint. However, I have met her, and she has done a fantastic job in representing midwives, as well as in her professional work.
I should also say that I am covering this Adjournment debate for the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who will take on his new ministerial responsibilities for maternity services and childrens services from the former Health Minister who is now the Minister for Policing, Security and Community Safety. However, obviously I am interested in this area, and I am happy to listen to the discussion.
I am pleased to be able to say that, although there is room for improvementthat is why the national service framework was initiated80 per cent. of women in a survey last summer said that they were happy with maternity services. We have invested £1.4 billion per year in maternity services, and in 2001 we made a capital investment of £100 million to modernise facilities and improve the environment in which maternity care is delivered. I understand that East Cheshire NHS trusts
share of that investment was approximately £1.3 million, which was used to build a state-of-the-art antenatal centre.
We are committed to trying to improve choice for womenand for fathers and familiesand to meet the needs of future generations. Several hon. Membershave raised the fact that more women are having babieslater in their lives, but there is also the fact that younger women are having babies. I have a particularconcern about that, because as public health Minister I am responsible for health inequalities, and about60 per cent. of infant mortalities are linked to young womenI would describe some of them as young girlswho have babies perhaps too early in their lives.
However, there are also issues to do with other women who, because of technology and other changes, are able to have babies when they might not have been able to have had them in the past; in vitro fertilisation treatment is one example. Also, because of new technologies and better services some women with different types of disabilities are now able to give birth to their own children, which 10 or 20 years ago might not have been possible. We are dealing with a changing landscape. Ten or 20 years ago, some services in relation to children required longer stays in hospital. My youngest child was 18 yesterday; 18 years ago new mothers might have been expected to stay in hospital for three or four days. These days, mothers can be out of hospital within hours of having had their child, if everything has gone well. The diseases and conditions that children faced 30 years or more ago are also, thank goodness, no longer as prevalent. We have to address this changing landscape.
The number of midwives has increased over the past few years. The number of training students is up 44 per cent. since 1997, and there is good news in other areas such as obstetrics and gynaecology. However, the Department is aware that there are concerns in this area, and I will take back to it some of the points made about shortages and other worries. That is one reason for our considering what better support we can give midwives. Through the 57 trusts, we have piloted midwife support workers as possible members of the team, to carry out some of the activities for which a qualified midwife is not needed but which are important aspects of the experience for women, thus freeing midwives for the aspects of supporting women in childbirth for which only they are qualified.
I take on board the concerns raised by the hon. Gentleman about changes concerning payment by results; such concerns are one reason why we are proceeding with it only for some of the key acute services and why we are still considering, and discussing with many organisations, how payment by results would link to maternity services. I am pleased to tell him that the working group on developing models of payment by results is attending to issues of social complexity, and I assume that some of the issues that he raised will be taken into account.
We have established the maternity standard implementation advisory group, which represents stakeholders that include the royal colleges, service providers and the voluntary sector. The hon. Member for Romsey (Sandra Gidley) mentioned a role for the voluntary sector in antenatal classes. I am somewhat surprised to hear about the cutting of antenatal classes
and will be happy to pursue that and write to her further, because they are important in the process of ensuring that all women have as healthy a delivery as is practicable. Importantly, as she said, the opportunity to explore issues such as smoking and weight and how to look after the baby once it is born has a huge public health impact. Those services are very important to some women. That is a reason for my being keen that health, and questions of how such services are provided, should be a part of the development of childrens centres.
We have also been working on developing a minimum maternity data set, which will provide more accurate and reliable information on which to plan services. That is why it is important to hear from colleagues during Adjournment debates. Sometimes our overview does not pick up on particular local circumstances. As I have said, we are working to improve our overview of what is happening on the ground, as opposed to what we may sometimes think is happening.
The handbook deals, I think, with a helpful process in which midwives and other health professionals can find out if a woman, and possibly her unborn child, are being abused during the pregnancy. Rates of domestic violence during pregnancy are too high. Not long ago in Lambeth I met people from a domestic violence support group who were already receiving referrals of women who had had conversations with their midwives about such matters in a sympathetic way.
As I said before, and keeping in mind the points raised by the hon. Member for Macclesfield, we are looking at how to develop services, and wide-ranging consultation is going on. Services in Macclesfield are part of the relevant options.
Sir Nicholas Winterton: Will the Minister give an assurance that the consultation is meaningful? The pram push organised by the Macclesfield branch of the Royal College of Midwives attracted more than 2,000 mums and other people pushing prams, which was clearly a sign of huge interest. Is the consultation serious, and will it be heeded?
Caroline Flint: All public consultations are serious and should be meaningful. As the hon. Gentleman knows, they provide opportunities not just for people in the health service but for the community and local government to offer a view. If oversight and scrutiny committees are concerned about an issue, there is an opportunity for referral back to the Secretary of State.
The process is about considering how best to provide services, in what environmentwith regard to safetyand, importantly, what more community-based services should be available throughout the country to support people who are expecting children, and to provide services for those children. I assure the hon. Gentleman that the exercise is not just a question of saving money here or there: it is about trying to look, for the whole of his area, for the best way forward in providing such services.
Mark Lazarowicz (Edinburgh, North and Leith) (Lab/Co-op): I am delighted to have secured this debate. Debates on cycling policy are certainly not regular occurrences in the House, although I hope that will change, and the main purpose of my introducing the debate is to ask why cycle use has not in general increased in this country, despite the steps that have been taken to encourage it, and to make some suggestions of what we need to do to change that position and to bring UK cycling levels up to those enjoyed in some other European countries, for example.
Before I discuss the general policy, I want to spend a couple of minutes on an issue that is causing great concern to cyclists and cycling organisations, which is the proposal for changes to the highway code. Consultation on the proposals closes tomorrow, so the debate is timely. The Minister is, I am sure, aware of those concerns, as I imagine many other hon. Members will be, as about 11,000 e-mails and letters on the issue have been sent out by cyclists.
I will not set out the concerns at any great length, but will describe them briefly for the benefit of those watching or listening to the debate, or who read it in the future. It is proposed to change the wording of the recommendations on cycle facilities under the highway code. The Cyclists Touring Club, or CTC, which has provided a briefing note to many Members, for which I am grateful, believes that the new wording means that
the use of cycle facilities will no longer be discretionary for any cyclist who wants to protect him/herself from the threat of adverse legal action.
If a cyclist was injured and there was a cycle facility nearby...the drivers insurer would have all the pretext they needed to argue that any compensation due to the cyclist should be reduced on the basis of contributory negligence.
That threat is not just an academic nicety. Existing highway code rules have been used against cyclists in such a way, and cyclists have lost thousands of pounds as a result of not wanting to challenge such claims of contributory negligence when they are made against them in legal action following an accident.
David Taylor (North-West Leicestershire) (Lab/Co-op): I know that my hon. Friend is a frequent cyclist, as am I, although I do not think that we have to declare interests in such debates. Does he encounter, particularly in urban areasperhaps when he cycles in his constituencybadly designed or poorly maintained cycle routes or paths? It can often be safer for cyclists to use the main road. To have any damages to which they are entitled reduced because of that choice is a perverse interpretation, is it not?
Mark Lazarowicz: That is a good point. I do not want to start sounding like the Jeremy Clarkson of the cycling fraternity, but we could all think of examples where a badly designed cycle path, one that is badly maintained or one that is blocked by traffic is more dangerous to use than not. All cyclists are aware of the position described by my hon. Friend. It is important not effectively to encourage the idea that cyclists
should be corralled into a small, often badly-maintained section at the edge of the road, and that they should not be entitled to use the rest of the road, like other road users, if they consider it appropriate to do so.
Mr. David Drew (Stroud) (Lab/Co-op): As we are talking about the highway code, one cannot, as a keen cyclist, avoid the issue of cycle helmets. I happen to disagree with the CTC and think that people should wear helmetsI would never cycle without a cycling helmet, and I cycle all the timebut I worry about how, having been put into the highway code, that subject has become a cause célèbre. People are almost going out of their way to advise others not to wear a helmet. Surely, the Department needs to pull people in and get some resolution on the issue. I find it difficult to encourage my children to wear a helmet, because it is not the done thing. Does my hon. Friend agree that the issue needs to be resolved one way or another?
Mark Lazarowicz: My hon. Friend raises a good point. There have been lengthy debates on the wearing of cycle helmets, although I do not want to go into them now. Like him, I cycle regularly. I not only try to use cycle facilities and cycle paths, but wear a helmet and encourage my children to do so.
It is important that our approach should not only be rational, but encourage and facilitate cycling, the appropriate use of facilities and the wearing of appropriate protection in the right circumstances. We should not end upto coin a phrasedriving people away from cycling because of ultimately self-defeating restrictions. The general thrust of what my hon. Friend says has a lot of merit.
I call on the Minister to ensure that, after the consultation period, any wording in the new highway code that could give rise to unwarranted contributory negligence claims against cyclists is removed. Moreover, he should take the opportunity to include clearer advice to drivers on how to interact safely with cyclistsfor example, on how much space to leave when overtaking them, and on the importance of leaving cycle lanes unobstructed and not blocking up facilities such as advanced stop lines, which have been provided in many urban locations but are frequently ignored by a number of motorists.
Emily Thornberry (Islington, South and Finsbury) (Lab): Would it not be to the advantage of us all if advanced stop lines were made compulsory rather than simply advisory, so that if a motorist stopped within one, they would be committing an offence? At the moment, they would not be.
Mark Lazarowicz: That is a very good suggestion, and I hope that the Minister will consider it. There is also, perhaps, a role for those who employ drivers, including large public sector bodies. They could do a lot to train their drivers to recognise the importance of observing not only road traffic regulations in general, but cycle stop lines in particular. As my hon. Friend rightly points out, those are frequently ignored.
I turn to the wider issue of the steps that we need to take to achieve a real and significant increase in cycling in the UK. As the excellent background note from the
CTC points out, cycle use has not increased in spite of ambitious targets. Although 68 per cent. of all trips and 58 per cent. of all car trips cover less than 5 miles, cycling accounts for less than 2 per cent. of trips made in Britain. That compares with a modal share of between 10 and 20 per cent. in many other European countries, and of up to 50 per cent. in some cities in the Netherlands.
I am aware that the figure for Britain may be a little misleading, as it does not take into account some of the increase in cycling on off-road routes. That is not included in the overall statistics. In some towns and cities, there has been notable success in increasing cyclings share of overall transport use. However,that must mean that it has gone down in other cities, towns and communities. The overall picture is still pretty clear.
David Taylor: I am grateful to my hon. Friend for yet again being so generous in giving way. He referred to off-road cycling. He may refer to the organisation later in his speech, but will he pay tribute to Sustrans for all the work it has done to encourage and develop the national cycling network? I and others have used large sections of itthe coast to coast route, the Pennine way and so on. My observation, although anecdotal, is that usage of that network, particularly in my constituency, is rising steadily. That has to be good.
Mark Lazarowicz: Indeed it is, and I pay tribute to what Sustrans has done. Part of one of its routes runs through my constituency, near my home, and I regularly use it. It is also well used by other cyclists. Unfortunately, however, the overall picture is that we are nowhere near reaching the cycling levels of our European neighbours.
Martin Horwood (Cheltenham) (LD): Is not one of the problemsand perhaps one of the reasons for that trendthe fact that not everyone has the joined-up thinking of organisations such as Sustrans? At the same time that Sustrans is planning its safe routes to schools and safe routes to work campaigns, thereare proposals for out-of-town railway stations, for example, which would encourage everybody to travel to the station by car, unlike in Cheltenham Spa, where I have regularly cycled to the railway station. Such counter-trends might be responsible for the figures to which the hon. Gentleman referred.
Mark Lazarowicz: I do not feel able to comment on the position in Cheltenham, as I am sure the hon. Gentleman will understand, but the general point about ensuring joined-up thinking on the issue atall levels of Government is essential. Those local authorities that exhibit joined-up thinking are the ones that have achieved increases in cycle use, while others have not.
How do we increase cycle use in the UK? I agree with those who say that above all we must tackle the perceptionin some cases, the realitythat cycling can be dangerous. The danger is often exaggerated but nevertheless is, I am sure, the most significant factor in deterring, in particular, new cyclists, younger cyclists and children from cycling, and parents from encouraging
their children to cycle. Part of the solution to tackling that perception must be a much more extensive network of cycle paths, routes and facilities in urban and rural areas.
A lot has been done, but we all know from personal experience of existing cycle networks with major gaps in them that, having travelled along a route that one wants to take, one has to join the normal street network at a particularly busy and apparently dangerous point. Experienced cyclists can perhaps cope, but those who are not experienced are deterred by those gaps in the network. They are also deterred by the localised gaps to which my hon. Friend the Member for North-West Leicestershire (David Taylor) referred, which require cyclists to dismount or stop every few yards. To be blunt, that can make the cycle path quite useless and can occasionally increase the danger to cyclists as well.
We need to change that, and we need a significant extension of cycle facilities, crossing paths and cycle lanes. Depending on what is appropriate to a location, that is the approach we need to encourage a change in perception and to make cycling much more widely taken up in this country. If we do not provide cycle facilities that are of use to cyclists, they might not use them and motorists might get uptight because they think money is being wasted on those facilities. Unnecessary hostility could arise between cyclists and motoristsand sometimes pedestriansbecause of facilities not being properly planned and thought through.
We need a comprehensive process that ensures the right approach for each road and location, and there are opportunities to achieve that. The Department for Transport is finalising guidance notes on pedestrian and cycle planning and shared-use facilities, and a promising first draft has been produced. However, the issue is not just about routes, lanes and cycle facilities. Cyclists, like pedestrians and the wider population, also benefit from traffic reduction measures, speed reduction measures, 20 mph zones and home zones. By reducing speed, those measures make the roads safer for cyclists and pedestriansand indeed motoristsand could also help to improve the vibrancy of local streets and shopping centres, strengthening community life in our towns and cities.
Mr. Drew: I thank my hon. Friend for being so kind in giving way again. One thing that would instantly make cyclists feel safer is getting motorists to stop using mobile phones. When I cycle, I feel that the people who pose the most danger to me are those who continue to use mobile phones. I know that that is being dealt with in the Road Safety Bill and that additional penalties are being considered, but until we get people to stop using mobile phones, they will often be oblivious to cyclists and cyclists lives will be in danger.
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