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2 May 2007 : Column 483WH—continued

Of course, pay is an issue. It is interesting that, when speaking to midwives, one is aware that they are continually and clearly demonstrating their commitment to and support for the service and their professionalism. Hardly any of them mention, as their first concern, their quite justifiable gripe about the way in which the pay review body’s recommendation of a 2.5 per cent. pay rise for this year will be phased in. The Government have been tackled on that issue a number of times already, but midwives are caught in that conundrum. In effect, this year, they will receive a pay cut, which is poor reward when they are being asked to have ambitions for the
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future with regard to the rolling out of a policy proposal that is, of course, very welcome—although if it is to be rolled out, we have to get midwives on board.

The professionalism of the service is excellent. The Minister will acknowledge that. However, in this respect we need to consider, for example, the National Institute for Health and Clinical Excellence guidelines with regard to post-natal visits to mothers. The advice is to visit on day one, day five and day 10. If it is part of the Government’s assessment that that is when the community midwife will visit, it may be the professional judgment of many midwives that they should visit on more occasions than that, and that is important. Leaving a newborn baby without a midwife’s visit for the number of days that is proposed in the guidance concerns many professionals.

The Government have claimed that the UK is among the safest places to have a baby, yet following another written question that I tabled, answered on 16 April by the Financial Secretary to the Treasury, I received an answer from the Office for National Statistics that shows that it is almost impossible to make any international comparisons when assessing perinatal statistics, because perinatal information is recorded in different ways in different countries. Even then, however, if we look at the number of maternal deaths per 100,000 live births, we see that the UK does not perform terribly well at all. Yes, the figure is roundabout the European average, but the expanded European Union has many poor countries, as the Minister knows, and certainly the UK is behind Ireland and Italy in respect of maternal deaths.

Martin Horwood (Cheltenham) (LD): My hon. Friend may not be aware that, in 2003, the EuroNatal working group reviewed, as an alternative to those difficult perinatal mortality and maternal mortality statistics, the statistics on sub-optimal care that may have led to deaths in maternity units. In a survey of 10 countries, it found that England had the highest risk.

Andrew George: The numbers are so small that a statistical blip can greatly change the statistics. The unfortunate and tragic circumstances at Northwick Park might well be one cause of the difficulties with the UK statistics on maternity deaths. Even so, we in this country should not necessarily be content with the overall figure. I hope that the Minister takes that point on board.

“Maternity Matters” is a welcome statement as far as ambitions for the future are concerned, but I urge the Minister to ensure that the Government can at least crawl before they try to run. Before anything else, they must get front-line and core services in place and ensure that they know how to assess and monitor those services so that they are properly assessed. They must also put safety first and ensure that health inequalities are addressed before they move on to the luxury of choice, which is what the document is primarily about.

Maternity services should be clinically audited to establish how mothers are being treated and where the inequalities are and to monitor how effective interventions are. At the moment, we monitor only mishaps, and stillbirths are recorded as being unexplained. I have spoken to Professor Jason Gardosi of the Perinatal Institute in Birmingham about this matter a few times—I believe that the Minister knows of his work. The professor
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proposes five basic performance indicators, which I urge the Minister to consider, particularly in relation to early booking and groups such as less well-off, young teenage mothers and other women who do not refer to a midwife early on.

I urge the Minister to address also continuity of care and, perhaps most importantly, the detection of foetal growth restriction, which is a clear indicator of later problems both at the point of childbirth and later in life. Will he consider carefully those proposals and the need for the Government to address issues of safety and the inequalities of health? Will he also consider whether there could be better central monitoring of the way in which the service is managed? We need to get the number of midwives right, to ensure that safety is put first and to get health inequalities right before we have the luxury of choice.

Mrs. Janet Dean (in the Chair): Order. I advise hon. Members that I intend to call the Front-Bench spokesmen at 3.30 pm. There should be ample time for Members who wish to take part to do so if they moderate their speeches.

3.3 pm

Mr. David Burrowes (Enfield, Southgate) (Con): It is a pleasure to have you in the Chair, Mrs. Dean. I hope that this debate is more constructive than the last one to which I contributed when you were in the Chair.

The debate is particularly timely for two reasons, one of which is close to home. Our sixth child was born two weeks ago at Chase Farm hospital, so I have a particular interest in, and some experience of, maternity services in Enfield. I shall focus my comments on those services, particularly the ones with which we had contact during the birth, and the challenges that they face. I shall not go through all six of our children’s births, given the time constraints. I expect also that my wife would prefer not to read blow-by-blow accounts of them in Hansard. I shall therefore focus on just two of them, which provide an example of the challenges that maternity services face.

The debate is also timely because Sir George Alberti’s report on the reconfiguration plans for health services in Enfield and Barnet was published today. The plans include the downgrading and effective removal of the Chase Farm accident and emergency services, and the transfer of consultant-led maternity services from Chase Farm to Barnet hospital. I commend the hard work of my colleague Nick de Bois in Enfield, North, who is campaigning hard on those services.

A little closer to home, our son Toby was born two weeks ago. We ticked all the boxes to qualify for a midwifery-led service—it was a low-risk pregnancy, and we chose to go ahead with that service at Ridgeway birth centre. Similarly, with our third child Dougal, we ticked the boxes and had a midwifery-led service. Those two births, indeed all six, had unique challenges. That is the first point that I want to make: each birth is unique and cannot be fully planned, strategised and targeted. Unexpected complications may arise midway through births or at any time during labour, and it is important when we look at such issues with the mantra
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of choice in mind that we realise that choice may be taken away unexpectedly during labour.

For Dougal’s birth, we took advantage of the midwifery-led service at Chase Farm and everything was going smoothly until the later stages, when worrying complications meant that we had to be transferred down to the labour ward. Happily, we currently have a labour ward and consultant-led service at Chase Farm, so they were literally just down the stairs. We went down in the lift, but the lift took some time and those seconds were absolutely crucial to me, as a father, and to my wife, who was in the throes of labour. Every second mattered during that transfer.

Toby’s birth, a few weeks ago, was similar. Everything was progressing normally and we were motivated. There was an interview of our leader on television with Andrew Marr, but that did not motivate Toby enough. Neither did the “Match of the Day” highlights. Eventually, he came, but only in his own time and, as he was on his way, there were again complications. If the birth had not happened within the hour, we would again have had to be transferred to the consultant-led service. Happily we had a safety net. We appreciated the fantastic care that the midwives provided, but we were happy to have the safety net of the labour ward just downstairs.

If the reconfiguration plans go through as advised by Sir George Alberti and others, that labour ward will be transferred to Barnet and we will not have that safety net. That is of great concern and might jeopardise children’s lives. We would have been profoundly concerned if we had had to be transferred by ambulance during those births when there were potential complications. We would have had to go to Barnet, but Enfield routinely calls Barnet at night and finds that it is full, and people then have to be transferred to Whittington or to another hospital that has space. Those practical realities must be borne in mind when we talk about choice.

The Ridgeway birth centre, which is a fine centre and which was opened not long ago in 2003, is at risk of being relocated to another area. It has the space and environment to encourage safe and healthy births, and it has one midwife at night—there should be more, but we have already heard about the lack of midwives nationally. The location of that centre is key, because the labour ward is there on hand, and there is no need for transfers further afield. That is important, and we and other parents in Enfield are concerned that the birth centre will be undermined by the loss of the safety net of the consultant-led labour ward that is planned as part of the reconfiguration.

We and other residents feel that the reconfiguration will break up Chase Farm’s maternity services, which have paediatrics and children’s services all under one roof. It will also fragment the midwifery training at Chase Farm. Midwives there tell me that they are very concerned about the plans to move the consultant-led service away from them. That change will also affect people’s confidence in the care that they will receive. Currently, they can be confident of the fine care that they will get at Ridgeway birth centre and confident in the security that if there is an emergency or unexpected circumstance, they will have the benefit of the service downstairs.

The case made by the hospital and, indeed, by Sir George Alberti, who seeks to garner the royal
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college’s support, is based on numbers. They say that 4,000 births are needed to cover the presence of consultants and that we can have only two consultant-led services in the wider area rather than three. That is one of my concerns, and perhaps the Minister can draw out some of the arguments. Why is the figure specifically 4,000? Is it a fixed figure? Is there flexibility? Should we take proper account of local circumstances? Should proper account be taken not only of the historical figures in Barnet and Enfield, which, it must be conceded, show that there were just about 3,000 births at Chase Farm last year, with just over 3,000 at Barnet and 3,500 at the North Middlesex, but of present demand? Perhaps my family is doing its bit to encourage the demographic trend, but one hears that there is an increase in demand for services. Should we really be hidebound by the 4,000 figure, when that might lead us to do a disservice to many parents who want an all-round choice? Should we look properly at local choice?

The Government have a national strategy of putting mothers and babies first and they talk about giving mothers choice over where to give birth, but the Minister must concede that the reality in Enfield is that choice will be limited once we lose the safety net of the labour ward downstairs. Indeed, the project director for the reconfiguration plans said that

However, the problem goes further, because life is not that straightforward, and birth certainly is not. As the cases of two of my children illustrate, complications can occur mid-birth, and one needs to be able to choose to have a consultant-led service on hand. Choice should not be limited at such a crucial time. My wife and I relied, happily, on Chase Farm hospital to help care for our new baby and cover for such unexpected emergencies. I am therefore resolved to continue the fight, despite Sir George Alberti and, indeed, the Government’s national strategy, because the same choice should be available to future parents and children at Chase Farm.

3.12 pm

Mr. David Drew (Stroud) (Lab/Co-op): I rise to take part, albeit briefly, in this important debate. I congratulate the hon. Member for St. Ives (Andrew George) on bringing the issue before us once more—several of us have debated it regularly. If nothing else, the Government will hear our opinions and, I hope, act on them.

I have a vested interest in this issue, because the Stroud maternity unit has been reviewed more times than virtually anywhere in the western world. Reviews are a daunting prospect, and I feel for the staff every time they are reviewed. Sometimes reviews have a purpose, but sometimes they seem to take place without a purpose, almost as a way of escaping taking inevitable decisions that may not be palatable.

We have had another review, and the hon. Member for Cheltenham (Martin Horwood) will no doubt speak in due course about the implications of the proposals because they take in Cheltenham general hospital as well as Stroud maternity hospital and the Gloucestershire Royal hospital. All those institutions
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maintained some semblance of their maternity services, but it was a difficult process, and I thank the Minister for talking to me about it personally. It is fair to say the decision was a local one, although the Government did look at it because it sets precedents. Stroud maternity was and, I believe, still is the third biggest independent unit left in the country, so if it were to close, that would set important precedents for independent units elsewhere in the country. I therefore pay tribute to Michelle Poole and all the team at Stroud maternity.

I want to concentrate now on a couple of national issues. The first, to which the hon. Member for St. Ives alluded, is the relationship between the “Maternity Matters” Green Paper and the reviews that are being carried out by the King’s Fund and the National Perinatal Epidemiology Unit. Having been somewhat involved with those giving evidence to the various reviews, I am confused about the relationship between the different elements in the evolution of the Government’s policy. The Government have made their views clear in the Green Paper, and one hopes that it will be a good staging post.

There is also, however, the issue of the two independent reviews, which I totally support. One would think that safety was paramount in this area, but it is interesting that there is a lack of information nationally and internationally about what we mean by safety and what we would accept as the parameters of safety and about other elements involved in childbirth, such as the early take-up of breastfeeding and post-natal depression. There may be a lot of statistics about, but there is not much interpretation of them and there are not many comparisons of different units and different sizes of unit. I therefore welcome the two reviews. I just want the Minister to clarify what we expect the outcome to be. What is the timetable for the two reviews? How will they impact on Government policy, notwithstanding the fact that we cannot prejudge their recommendations?

Having taken part in the review in Stroud, I know that any reconfiguration, to use that dreadful term, is subject to the national picture, and local people certainly feel somewhat hamstrung because they know that things might happen locally as a result of the national driver. The Minister is looking a bit quizzical, but if he could say something about what we expect the two reviews to say, that would help me.

Suzanne Tyler did some good work on Stroud, which I hope will feed into the process. She made a quite devastating analysis of the arguments against shutting the unit and in favour of keeping it open. I hope that that work by an independent consultant and reputed expert in the field will be listened to.

My second national point relates to insurance, and it is the one about which I am really worried; indeed, I am a bit surprised that it has not come up yet. In the debate on Stroud, we got into the nitty-gritty of which unit should be the preferred one and what we meant by choice, but the backcloth to that debate was the issue of insurance. That issue has come up in relation to independent midwives, and I am unclear about what the Government are saying. What help might they offer independent midwives, who play an important role, not least because they can bolster the numbers in some of our units?


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If I understand the picture clearly, it is a sad fact that more than half of litigation cases involve maternity incidents. That, of course, is a strong reason for people to have some form of indemnification against being sued. However, we cannot have it both ways. I very much support the choice agenda, and people want low intervention, starting with home births all the way through to midwife-led units, with consultant-led provision at the other end of the continuum. If people are offered choice, however, we must know that it is real choice. If deaths result because units cannot be kept open and midwives cannot keep operating because they cannot get insurance, that is not choice, and we need some clarity on the issue.

I have talked to midwives, I worry that they are beginning to practise very defensive medicine. That may be what any sensible practitioner should do, but if that is the only way in which people operate in their chosen profession, we will not have future generations of midwives, because they will be driven out of the profession. We need to know where we stand and we need to give a clear purpose to people who are doing a difficult job and offering choice. The choice should not entail their being held personally liable if things go wrong. As the hon. Member for Enfield, Southgate (Mr. Burrowes), whom I congratulate, made clear, we need to understand that these things happen and we cannot rule them out.

Recruitment is a key factor in the pressure that midwives are under. There is a dearth of people coming into the profession. I know—I hope that the Minister will say something about this—that more training places are being made available and that we are bringing people into the profession through training, but that is for the future. I am concerned about immediate problems.

We need some transparency. When people are offered a choice, it should be a real one and they should understand the risks. That can happen only through greater transparency. I hope that the Minister will attend carefully to my questions, and, even if we cannot have the answers now, I hope that we shall get some later, because midwives in general want such reassurance. If they do not get it, I fear for the profession.

3.21 pm

Tony Baldry (Banbury) (Con): I congratulate the hon. Member for St. Ives (Andrew George) on introducing the debate, and my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) on the birth of his child—although I hope that someone has explained to him that babies grow into teenagers. That has been my experience.

As the hon. Member for Stroud (Mr. Drew) said, what is important in the debate is choice. The Secretary of State says that as a consequence of “Maternity Matters”, every mother will have the choice of a home delivery or delivery in a midwife-led unit or a consultant-led unit. Although that sounds very good, behind it there will be the potential for considerable downgrading of services in various parts of the country.

The Horton general hospital in Banbury has served for more than a century a significant area of the United
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Kingdom—north Oxfordshire, south Northamptonshire and south Warwickshire. We have for a long time—decades, centuries, generations—had a consultant-led unit at the Horton, but that is now threatened with being downgraded to a midwife-led unit. We already have an excellent midwife-led unit at Chipping Norton hospital. Any mother who wants a midwife-led birth can go there.

When the proposals were made, local GPs responded as part of the consultation to the Oxford Radcliffe Hospitals NHS Trust. I think that what they said is worth repeating:

They continued by discussing maternity services specifically:

That is a strong word. Their submission continues:


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