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Mr. Eric Martlew (Carlisle) (Lab): I congratulate my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) on initiating the debate and on the quality of his speech. We sometimes forgetwe should say this because there will be women watching the debate who are anxiousthat the United Kingdom is one of the safest countries in the world in which to give birth.
The point that I want to make is that things can change. Hon. Members have been going on about the problems in their constituencies and I can understand that. I made a similar speech about 15 years ago. In Carlisle, the maternity hospital was on the site of the old workhouse. The consultants worked at the district general hospital 2 miles away and they had to travel through congested streets if there was an emergency. An independent inquiry at that time concluded that, because of the facilities and the split site, babies were dying. I brought that point to the attention of the House. I shall not go into the politics of it and which
Government were responsible; in fact, probably both GovernmentsHarold Wilsons Government and the previous Conservative Governmenttake some of the responsibility.
However, the situation is transformed. We had the first private finance initiative hospital in Carlisle. I can tell the Minister that that was not without its problemsone never wants to be at the cutting edge on such matters. One of the advantages of the new hospital was that we got rid of the split site and provided an excellent maternity facility with birthing rooms for mothers. The Healthcare Commission now says that the quality of maternity care in the North Cumbria Acute Hospitals NHS Trust area is excellent; in fact, it is the third best in the north of England. Dr. Gwyneth Lewis, the medical lead in maternity services, has been to the area recently, and she said that the service is exemplary.
There are problems with the service, but I cannot understand why Members say that we should have a uniform NHS. It will never be that way because provision depends partly on the quality of staff and buildings, for example. We need to bring standards up everywhere. Obviously, Cumbria is a rural county. We have community midwifery services from the north at Brampton down to Millom in the south, and another excellent maternity unit at West Cumberland hospital. Those things have been achieved because of the commitment of the staff in Cumbria, and not only the maternity unit staff. I should like to place on the record my appreciation to the work force in Cumbria, and to the Government, who provided the investment so that we could move forward.
Andrew George (St. Ives) (LD): I congratulate the hon. Member for Leyton and Wanstead (Harry Cohen). Although I endorse much of what the hon. Member for Carlisle (Mr. Martlew) said, I urge him to examine the perinatal mortality figures. The hon. Member for Stroud (Mr. Drew) referred to a debate that I was fortunate enough to secure on 2 May last year. I refer the Minister to my comments in it. Many of the issues raised then are pertinent today.
When I intervened on the speech of the hon. Member for Leyton and Wanstead, I referred to the fact that the Princess Alexandra unit at the Royal Cornwall Hospitals NHS Trust has excellent and professional staff who provide a very good service, despite the tremendous structural problems within the building. Despite the problems, the unit was given the status of one of the best-performing maternity units in the country. People who have experienced the service will say, If this is the best, God knows what services are like in the rest of the country.
The issue of community midwives has not been properly addressed in the debate, which is a pity because there is pressure on those services. Community midwives are increasingly being asked to work in maternity suites, and the stress caused to them is significant, particularly for those whose skills and experience are not up to date.
Many Members drew attention to the problems of insufficient recruitment into the service. In the debate to which I referred, the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis) acknowledged
that only 3,000 midwives are needed.[Official Report, Westminster Hall, 2 May 2007; Vol. 459, c. 481WH.]
funding for maternity services will increase over the next three years to reach an additional £122 million
nationally. The press release seems to say that the increase will come between 2008 and 2011. Do I understand that correctly? It also says that the money will be used to implement the Governments Maternity Matters strategy, which needs to be in place by the end of 2009, so how come it will not be fully in place until the 2010-11 financial year? The increase is welcome, but can increases in spending be set centrally in the era of payment by results? Perhaps the extra money will filter into the system through increases in the tariffs for maternity care. If that is the case, will trusts not simply siphon off the money generated through payment by results from maternity care and spend it on other services?
In the financial year 2006-07, spending on maternity services fell by £55 million, as was mentioned earlier. We do not yet have the spending figures for 2007-08, but there may have been a further drop. Will the Government commit to a further injection of money into maternity services if NHS spending on maternity services falls again in 2007-08? If not, the extra £122 million will simply make up for money that has been siphoned off out of the service. I hope that the Minister will address those finance questions.
Mr. David Kidney (Stafford) (Lab): I congratulate my hon. Friend the Member for Leyton and Wanstead (Harry Cohen), and I thank hon. Friends and hon. Members for their brevity, which has allowed me to be the last Back-Bench speaker in the debate.
I should like to deal briefly with three challenges, and then to say something constructive about the future. First, I urge caution on those who describe us as being in the middle of a baby boom, as my hon. Friend the Member for Leyton and Wanstead did. The fact is that in the years up to 2006, there was a gradual decline in our birth rate, such that there are now debates up and down the country about closing schools because of falling rolls. It is true that the Office for National Statistics figures for 2006 show an increase of 30,000 births in England on a total of about 600,000, but it is early days to be calling that a baby boom. There are distributional effects, and issues concerning the diverse ethnicity of mothers create specific problems, which is why, I suspect, the debate has focused on London.
Secondly, there has been an increase in premature births and hence the challenges they create for maternity
servicesother hon. Members have not mentioned that. For whatever reason, there has been an increase in premature births and, thanks to advances in medical science and in the skills in our health care services, more babies are surviving. Of course, the child and parents must be given support for much longer, and that support is resource-intense, which puts additional pressure on services. The issue was brought to our attention by a BLISS report last autumn, Too little, too late?, and was repeated in an article in The Observer last Sunday.
Thirdly, the Healthcare Commission review of maternity services, which was the first of its kind, and which the commission described as comprehensive, draws attention to both best practice and poor services. The challenge is to make the best practice common practice everywhere, whichto be constructiveis where I begin, with one minute of my time remaining.
First, we should praise the staff who work in the service. Often in debates about NHS services, we say how dedicated and committed the staff are, but we can give particularly great thanks to the people who work in maternity services. I have enormous admiration for midwives and health visitors for the work they do. We have put support in place for them and provided a framework. We have the national service framework and the National Institute for Health and Clinical Excellence guidance, but next we need to get training right.
My hon. Friend the Member for Leyton and Wanstead mentioned the baby friendly initiative, which NICE recommended should be part of the level of care that maternity units ought to provide. The initiative is a worldwide programme, created by the World Health Organisation and UNICEF, and accredits units for their level of service; it promotes breastfeedinga subject that I am very keen onand it suggests that there are health gains for parents, increases in the rate of breastfeeding and reductions in costs for services if the initiative is followed. I suggest to my hon. Friend the Minister that one important way to spread best practice to all maternity units is to improve take-up of the baby friendly initiative in accordance with the NICE guidelines.
Sandra Gidley (Romsey) (LD): I congratulate the hon. Member for Leyton and Wanstead (Harry Cohen) on securing this debate and on his timing; in the wake of the Healthcare Commission report, the issue has understandably become rather high profile. The commissions report highlighted patchy performance. We see a service under considerable strain.
I am not sure whether there is a baby boom; all I know is that Southampton has seen a large increase in the number of births over the last few years. That is causing considerable strain locally and is forcing the decision to close small midwife-led units in order to centralise services. That has proved somewhat controversial.
All that is unfortunately set against only the tiniest of increases in midwife numbers. In 1997, we had the equivalent of 18,053 full-time midwives in the NHS. By
2006, the number had risen to 18,862a rise of only 809, or 4.5 per cent. over nine years. Even worse, last year the number had fallen by 87 from the previous year. Put simply, we need the equivalent of about 22,000 full-time midwives, and we need them quickly.
The hon. Member for Leyton and Wanstead highlighted the drop in the number of student midwives, which is serious. The headcount number of midwives also fell by 375 between 2004 and 2006, so despite the Governments claims over the seven years since I became a Member that they are planning to address recruitment and retention rates, they have seriously failed to address the problem of retention. Many midwives leave the profession after only a few years. We have a demographic time bomb on our hands, because the age profile of the midwife community is skewed towards the upper age limit, with a large number due for retirement within the next 10 years. That will have a real impact on services.
The regional picture is patchy. Areas such as Yorkshire and Humber have seen a decrease of 141 in the number of midwives. It would be interesting to hear from the Minister what exactly is being done to increase the number of student midwives. Will the Government reverse the trend that has been evident over the past couple of years? How will they improve the retention rate?
How do the problems and pressures manifest themselves? The Healthcare Commission report showed that only 64 per cent. of trusts provided a named midwife for antenatal and post-natal care in 2008. That is not good enough. Most women have the realistic expectation that they should know who is to provide their care, but 34 per cent. of trusts meet that expectation only sometimes and, rather worryingly, 2 per cent. do not meet it at all. London trusts experience delays in booking, with consequent effects on the number of antenatal appointments that a woman can have.
The closure of small maternity units has been alluded to briefly. It decreases the choice available to women. Although a lot of women choose to have their first baby in a unit with a consultant unit attached, many women assess the risk and decide that they would prefer to give birth in a midwife-led unitsomething they are happy withso it is a pity that some of those units are closing.
When a woman goes into labour, she should be guaranteed one-to-one care by a midwife. Having heard the previous Prime Ministers wife exclaim proudly that she had two midwives attending the birth of her last baby, I tabled a parliamentary question to ask for a definition of one-to-one care.
The Department seems unwilling to provide a definition of one-to-one care during labour. Many people contend that it should mean that a woman has the undivided support of a midwife to give encouragement and to help her through the birth process. That is clearly not happening.
In October, the Royal College of Anaesthetists, the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and the Royal College of Paediatrics and Child Health issued a joint report entitled, Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour. To achieve the standards highlighted in the report, we need to double the number of consultant obstetricians and provide an extra 5,000 midwives. The colleges said that unless dramatic changes were made, the shortfalls would become a problem that would have
disastrous effects for mother and baby.
It was also disclosed that, of more than 100 obstetric and midwifery units in England and Wales, only 27 per cent. have the equivalent of a midwife for every woman in labour. That is far from the Governments stated aim.
Other manifestations of the problem can be found in a womans opportunity to have her choice of pain relief. Although the Healthcare Commission report highlighted a relatively high satisfaction rate of 78 per cent., it still leaves nearly a quarter of women dissatisfied with the pain relief they receive. That situation can only get worse. If more women are giving birth, it will put more pressure on the system. If an anaesthetist is not available, an increasing number of women will be deprived of their choice of pain relief.
The hon. Member for Stroud (Mr. Drew) touched on some of the mental health issues connected with pregnancy. That is important, because the Birth Trauma Association has established a strong link between a negative birth experience, which is often related to pain control, and post-natal problems. It is not overdramatic to suggest that some women see the problem as akin to post-traumatic stress disorder.
None of us wants to see another Northwick Park, but reports from my local hospitals include some frightening experiences. There are regular reports of one midwife looking after two or three women in labour; of staff being pulled off post-natal wards to help cope with risk periods in antenatal wards, which means that some post-natal checks are not done; and, echoing the comments of the hon. Member for Cities of London and Westminster (Mr. Field), of things such as filthy toilets with dried blood not being cleaned up within 24 hours. If those problems were a one-off, I would not have mentioned them, but there is a consistent theme that unfortunately keeps returning to me and to other hon. Members.
The drive to reduce the length of stay has led to an increase in readmissions. When that happens care must be taken to ensure that women have regular post-natal contact with a midwife, and that those visits are made. Problems can develop post-natally and it is important that we look after those women.
The lack of midwife cover can lead to an increase in caesarean sections. It does not reflect well on our country that the rate of caesarean sections is well over 20 per cent., when the World Health Organisation says that 13 or 14 per cent. is probably the optimum.
The hon. Member for Stafford (Mr. Kidney) highlighted problems with breastfeeding. In some maternity units, only 58 per cent. of women initiate breastfeeding. I fully endorse the hon. Gentlemans comments about the UNICEF initiative on breastfeeding.
Sadly, I am out of time. However, I must say that what is really depressing is that although there have been numerous Select Committee reports about maternity services over the years, we are still discussing the same old problems. Will the Minister tell us when those problems will be tackled?
Anne Milton (Guildford) (Con): The hon. Member for Romsey (Sandra Gidley) has given me my cue to start. She mentioned the number of reports on this issue. I would refer all Members here, including the Minister, back to Changing Childbirth, which I believe was published in 1993; it still holds good today. We are still facing very clear gaps in the delivery of service on maternity care.
I congratulate the hon. Member for Leyton and Wanstead (Harry Cohen) on securing this debate. He gave us a very good basis on which to launch this discussion and highlighted many of the issues that the Healthcare Commission has referred to in its report on maternity services. For me, the biggest issue that he raised was choicewhere and how a woman has her babyand the fact that childbirth is meant to be a happy experience for women, not a traumatic one. Although there is scant research at the moment, anecdotally we know that the experience that women go through during labour has a profound effect not only on their own healthincluding their mental healthin the years ahead, but on their babys.
My hon. Friend the Member for Cities of London and Westminster (Mr. Field) highlighted the issue of mothers feeling as if they were being passed from pillar to post. That is a common theme and a number of other Members have highlighted it. My hon. Friend also mentioned the particular problems facing London, including problems with mobility and diversity, which create particular challenges for the capitals work force. Ensuring that we reach the groups that are hardest to reach, who are often the most mobile and often do not have English as a first language, is vital.
I noticed that while my hon. Friend was speaking, the Minister shook her head. I ask her not to deny the problems, and to accept that he was speaking in good faith and relating the experiences of his constituents, particularly one who had a very sorry tale to tell of poor care that led to infection.
My hon. Friend the Member for Banbury (Tony Baldry) spoke with considerable passion, as he always does, about the Horton hospital, which it has been my privilege to visit. He also raised the issue of travelling times, which, although no other Members here today have raised it, is of concern in places across the country where smaller maternity units are closing. He rightly said that the Horton is a place of safety. Again, we come back to the issue of choice. If the Minister and the Government want to deliver choice, the message from my hon. Friend is loud and clear: his constituents would like to have the choice of their babies being delivered at the Horton hospital.
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