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“welcomes the extra investment in NHS maternity services under this Government; further welcomes the endorsement by the Royal College of Midwives of the ambitious vision for maternity services; notes that this investment has funded 2,400 more midwives than in 1997 and supported a 44 per cent. increase in students entering the midwifery profession, and that the latest surveys show that 8 out of 10 women say they are satisfied with their maternity care; recognises the preparatory work underway to deliver the Government’s manifesto commitment that by 2009 all women will have the choice over where and how they have their baby and what pain relief to use, and that every woman will be supported by the same midwife throughout her pregnancy, with this support linked to other services provided in children’s centres; supports the focus of services to tackle inequalities; and recognises that maternity services will need to continue to change in order to deliver this commitment and to ensure that the NHS provides the safest and most effective maternity care for babies, parents and families and the best possible value for money for taxpayers.”.
I recently had the opportunity to attend the annual awards ceremony of the Royal College of Midwives, where I was able to meet many of the midwives who provide such outstanding care to women, their partners and babies all around the country: professionals such as Jackie Christer and George Brook at Northumbria Healthcare NHS Trust, who have led the creation of midwife and nurse-led neonatal care. Their team is providing round-the-clock cover to the special care baby unit, the delivery suite and post-natal wards.
As I like, when possible, to find a point of agreement with the hon. Member for South Cambridgeshire (Mr. Lansley), I note that at the Alnwick midwife-led centre in the Northumbria Healthcare NHS Trust, a small midwife and nurse-led unit is providing superb quality care to mothers and their babies, with fewer than 200 births a year. I want to return to that point a little later, but it serves to illustrate the fact that depending on the way in which the local NHS chooses to organise care, and the investment it makes in the training and support of its staff, it is quite possible for a small midwife-led unit to provide high quality, safe care to mothers—in that case, in an isolated, rural area.
Gregory Barker: Research from southern California, to which my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) referred in his speech, has been cited by the PCT and the hospital trust as a reason for closing one of the maternity units at Eastbourne or Hastings. Does the Secretary of State accept that that research from the early 1990s is valid for regular, UK maternity closures of, for example, of units handling 2,000 deliveries?
Ms Hewitt: I prefer to take my advice about consultant cover for hospital births from the—British—Royal College of Obstetricians and Gynaecologists. I shall have a little more to say about that in a moment when I turn in more detail to the issue of clinical standards.
Like most Members on both sides of the House, I still remember the midwives and the consultant obstetrician who helped my husband and me with our two children. That was about 20 years ago, but millions of families around the country have every reason to be grateful to NHS staff for the superb quality of care they give at a critical point in people’s lives.
All of us should be proud of NHS maternity services. Women are generally happy with them; according to my Department’s latest maternity survey, eight in 10 women tell us that they are happy with the care they received during birth. That is down to the superb hard work and dedication of thousands of NHS midwives and other clinicians and professionals. It is down to the increased investment—more than £1.5 billion a year—that we are making in NHS maternity services. It is down to the fact that the number of midwives has increased by about 2,500 over the past 10 years, which is of course reflected in the fact that childbirth is probably safer now, for both mothers and their babies, than at any time in the past.
As many of us know, in some parts of the country services are not only good, not only safe, but outstanding: they match the best in the world.
Mr. Eric Martlew (Carlisle) (Lab):
Unlike Opposition Members, I have a long memory. I was a member of a health authority for many years. During that time, an independent report about my constituency of Carlisle stated that babies were dying because there was a split site; the consultants were on one site and the maternity unit was 2 miles away across a crowded city. In 18 years, the Conservative Government did nothing to assist us, yet within three years of a Labour Government it was put right. We have a brand new hospital. The maternity
unit was moved to the same site as the consultants and we now have an excellent service. Those people across the road should remember what it was like when they were in charge of the NHS.
Ms Hewitt: My hon. Friend speaks with great experience in the matter. He is absolutely right and has given us a vivid illustration of how in many parts of the country maternity services need to change to provide even better and even safer care for mothers and their babies.
Mr. David Gauke (South-West Hertfordshire) (Con): The Secretary of State says that maternity services need to change, and that in many places there is satisfaction with the quality of maternity services. What would she say to expectant mothers in my constituency whose antenatal classes, provided by West Hertfordshire Hospitals NHS Trust, have been withdrawn with little notice? First-time mothers in particular feel nervous about giving birth, for understandable reasons, and they were relying on those classes to provide them with the education and preparation that is so useful, yet it has been withdrawn. The reason? Financial deficits.
Ms Hewitt: I should be happy to write to the hon. Gentleman about the details of that point but, as he knows, there are real financial difficulties in some parts of the country, including his. In a minority of places, there has been overspending at the expense of NHS patients and staff in other parts of the country. That is simply not fair. It is particularly unacceptable at a time when more money is going into the NHS than ever before and, in case the hon. Gentleman has forgotten, his party voted against that extra investment. The local NHS in his area needs to make sure that it gets the best value for the increased money we are putting in, and that it delivers, within that budget, the best possible services.
Ms Hewitt: I want to make some more progress.
The hon. Member for South-West Hertfordshire (Mr. Gauke) and I agree that we need to do more. In parts of the country, there are more births, more births to older women, more complex births, more assisted conceptions and more babies born prematurely—thanks to the advances in medical technology more premature babies and babies with profound disabilities survive. That is a great advance for human progress, but all those changes in society and in medicine mean that maternity services need to change, too.
As we stressed in our national service framework, we know well that giving birth does not need medical intervention for a high proportion of women. Many of those women would much rather give birth at home or in a community setting, supported by a midwife.
Dr. Brian Iddon (Bolton, South-East) (Lab):
The shadow Health Secretary tried to depict the Manchester reconfiguration as the basis for cuts in provision. Is my right hon. Friend aware that when Manchester reconfigures its services significantly more money will be spent on maternity and children’s services and there will be a
significant emphasis on services to mothers and babies and young children in their homes rather than in a hospital setting?
Ms Hewitt: My hon. Friend is absolutely right. I shall talk about Manchester in a little more detail in a moment.
First, I want to make the point that only about 3 per cent. of women have their babies at home and only about 4 per cent. in community facilities such as a midwife-led birthing centre, although in some parts of the country, such as Torbay, where I had the opportunity to meet the midwifery team last year, maternity services have been organised differently. More women are being supported so that they have a real choice about where to have their babies, and more than 10 per cent. already give birth at home.
Mr. Simon Burns (West Chelmsford) (Con): On the Secretary of State’s response to her hon. Friend the Member for Bolton, South-East (Dr. Iddon), if everything is so fine why is the Minister without Portfolio, her right hon. Friend the Member for Salford (Hazel Blears), campaigning and demonstrating against the plans?
Ms Hewitt: Let me turn to the issue of—
Mr. Burns: Answer the question.
Ms Hewitt: Let me turn to the reorganisation of services in Greater Manchester, which has been under consideration for many, many years and has been subject to more than two and a half years of formal consultation. As my hon. Friend the Member for Bolton, South-East (Dr. Iddon) indicated, it will involve increased investment in maternity services in Greater Manchester.
Paul Rowen (Rochdale) (LD): Will the Secretary of State give way?
Ms Hewitt: No, I will not give way at the moment. The reorganisation has nothing whatever to do with the financial difficulties that recently emerged, or with the overspending in a minority of NHS organisations over the past year. The reorganisation of services has been proposed and led by clinicians. It is disgraceful that the hon. Member for South Cambridgeshire spent so much of his speech attacking and denigrating outstanding NHS clinicians in Greater Manchester—clinicians such as Dr. Anthony Emmerson, consultant neonatologist, who says that across the review area, which is Greater Manchester,
“There are too many hospitals each seeing too few patients”—
so the issue is not the working time directive—
“to maintain the skills and expertise of those who provide obstetric or paediatric care.”
Ms Hewitt: I will make progress before I give way again. Let me continue to quote a professional on the issue of the Manchester reconfiguration:
“Doctors treating babies so small that they fit into the palm of the hand can do so with far more confidence and skill if they see those cases every week”
than if they see such babies on only a handful of occasions a year. Changes to intensive care will save the lives of approximately 20 babies every year. It is the assessment of the clinicians and the NHS professionals who are leading that reconfiguration that if services are changed in the way that they propose, between 20 and 30 babies a year will live, who previously would have died.
Andrew Gwynne: I was a premature baby—I was born at St. Mary’s hospital in Manchester some 32 years ago—so I support what the Secretary of State says. Is not the good news story of the reconfiguration the fact that central Manchester will have a state-of-the-art facility for the whole county of Greater Manchester, which we do not have at present?
Ms Hewitt: My hon. Friend is absolutely right, but let me stress that a final decision on the reorganisation of services has not yet been made.
Ms Hewitt: I will not give way, because I want to respond to the points already made, particularly about the Minister without Portfolio, my right hon. Friend the Member for Salford (Hazel Blears). It is absurd for Opposition Members to attack my right hon. Friend for making representations about NHS changes in her constituency, and yet to spend months, as they did last year, accusing us of gerrymandering NHS changes to protect Labour constituencies. They simply cannot have it both ways. Opposition Members seem to be saying that a Member of the House should not make representations to his or her local primary care trust and strategic health authority, or put forward the case for nine, rather than eight, specialist maternity centres. Are they really claiming—this is what the hon. Member for South Cambridgeshire says—that the people of one constituency should have less representation in the House of Commons simply because their Member of Parliament sits on the Front Bench? That would be completely unacceptable. I do not know— [Interruption.]
Madam Deputy Speaker: Order. I call the Secretary of State.
Ms Hewitt: I do not know whether that is the policy that the Opposition propose to adopt, should they ever form a Government again, but it would be entirely wrong to do so.
Rob Marris (Wolverhampton, South-West) (Lab): I want to take the Secretary of State back slightly. The hon. Member for South Cambridgeshire (Mr. Lansley), who opened the debate for the Opposition, said that the working time directive was driving matters. Clearly that is not the case—the issue is improving the quality of service—but does my right hon. Friend, particularly as a former Secretary of State for Trade and Industry, share my dismay that the Conservatives, who broke European Union law by not implementing the working time directive are, 10 years later, apparently still against it? It is a safety measure for staff.
Ms Hewitt:
My hon. Friend is absolutely right. The Opposition negotiated the working time directive when they were in government—and a pretty poor job they made of it, too. As my right hon. Friend the Leader of
the House has explained on many occasions, they ignored the advice that they were given at the time and failed to negotiate the directive effectively, and thus opened the way to judgments in the European Court that have made life genuinely difficult for parts of the national health service.
Mr. Lansley: That is precisely the point: we had a new deal for junior doctors, which would have reduced their hours, and it would have been consistent with the working time directive, but the SiMAP and Jaeger judgments completely changed all that. They made it impossible for doctors to be asleep when on call in hospital, and for that time not to be treated as working time. Back in 2004, the Secretary of State’s predecessor said that that would all be changed, but that has not happened. That is what is driving the proposals.
Ms Hewitt: The hon. Gentleman is simply wrong to say that the proposals are driven by the SiMAP and Jaeger judgment, although it is causing additional problems and we disagree with it, as do most other European Union countries. We have spent several years reaching an agreement within the European Union to change the SiMAP and Jaeger judgments, but unfortunately we have not been able to reach agreement with some of our European colleagues about the individual opt-out.
Mr. John Baron (Billericay) (Con): Just do it!
Ms Hewitt: Opposition Members keep saying, “Just do it”, but they may not have noticed, given their extraordinary hostility to the European Union, that an individual country cannot simply overturn the judgment of the European Court on such matters. We will therefore continue to make services safer, and to bring down doctors’ working hours. As my hon. Friend the Member for Wolverhampton, South-West (Rob Marris) said, that is better for doctors and safer for the patients for whom they care. As we bring working hours down, initially to 56 hours from 2009 onwards, and then to 48 hours, there will be an impact on maternity services. Of course, the NHS has to take that issue into account, but working hours are not the only factor, as the Manchester clinician whom I quoted made crystal clear.
I want to make it crystal clear that when the final decision is made in Greater Manchester on the reconfiguration of services, it will be made on clinical grounds, and on the basis of what is best for patients—for women and their babies. It will not be made on political grounds, either there or elsewhere.
Daniel Kawczynski (Shrewsbury and Atcham) (Con): There has been a lot of discussion about Manchester and other cities, but does the Secretary of State agree that some of the reconfigurations will have a far more significant impact on rural areas, such as Shropshire? The hospital trust in my area covers more than 1,300 square miles, and it deals with mothers from mid-Wales, too. There is a significant impact on the Royal Shrewsbury hospital, because 16 beds are being cut in maternity.
Ms Hewitt: I entirely agree with the hon. Gentleman that such decisions need to be made locally, in light of local circumstances, because what is right in a large city will not be right in a rural area; different issues will need to be taken into account. That is why, wherever possible, such decisions should be made locally.
Ms Hewitt: I will not give way; I will make some more progress. Earlier, the hon. Member for South Cambridgeshire referred to the reorganisation in Calderdale and Huddersfield. In that case, there was consensus across the local NHS that two consultant-led units should be replaced by one consultant-led unit and one midwife-led unit. There was considerable consternation among local people, particularly in Huddersfield, about whether the midwife-led unit proposed for the area would provide good quality, safe care. That issue was referred to me by the overview and scrutiny committee, which plays a critical part in the statutory consultation that we have insisted should take place locally when there is to be any substantial change in services.
The panel made it absolutely clear that the standards to which local clinicians worked were set by the royal colleges themselves, including the Royal College of Obstetricians and Gynaecologists, which says that dedicated consultant cover should be available for a minimum of 40 hours during the working week. It wants that to be increased—rightly, in my view—to 60 hours by the end of 2008.
Paul Rowen: Much has been made of the situation in Manchester, but the Pennine Acute Hospitals NHS Trust provides alternative arrangements, as consultants work across four hospitals to provide the necessary cover. The Government’s decision to concentrate everything in one or two large facilities need not always apply, and alternative arrangements would prevent Bury and Rochdale from losing maternity and obstetric services.
Ms Hewitt: That is a matter for local decision making; local clinicians should take the lead on it.
Kali Mountford: Although the perception was that it was a done deal, it is important to acknowledge that there are opportunities to make even more improvements in assessments, and to provide new transport arrangements, community services and maternity services, as well as initiatives to tackle teenage pregnancies and help young mothers. Now that the decision has been made, more can be done with the local hospital to provide better services for local people. It is not a done deal.
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