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30 Jan 2008 : Column 84WH—continued
Although my hon. Friend the Member for Welwyn Hatfield (Grant Shapps) is not present, I should point out that he introduced me to a constituent of his whose wife’s pregnancy sadly ended in tragedy when the doors of the local maternity unit were closed due to staff
shortages. Smaller maternity units offer a place of safety. They are often what women and their families want. I ask the Minister specifically to address the issue of the closures of any such units.
We also heard from a number of other Members. The hon. Member for Stafford (Mr. Kidney) raised the issue of premature births. In fact, the figures on premature births are dreadful and I will refer to them again a little later. The hon. Member for Carlisle (Mr. Martlew) praised his local maternity services; it is always good for us to do so. The hon. Member for Leyton and Wanstead began by paying tribute to midwives, and I am sure that all of us would pay our tribute to them and to the administrators, health visitors and members of the other allied professions, all of whom support women in childbirth. I certainly pay tribute to them.
I could go on quoting from similar figures. For example, Mind has produced several sets of figures on this issue. The hon. Member for Stroud (Mr. Drew) talked about mental health problems. In fact, Mind estimates that 13 per cent. of women will face mental health problems in the first 13 weeks after childbirth, and that figure rises to 20 per cent. in the first year after childbirth. That is a significant proportion of women. If we do not have the midwives, if there are staff shortages, and if we lose the smaller, local maternity units, those figures will undoubtedly get even worse, because there will not be the support staff—in particular, the midwives—to identify any problems at an early stage.
The story is one of a rising childbirth rate. The hon. Member for Stafford said that he was not sure whether we were experiencing a “baby boom”; whatever we are experiencing, the childbirth rate is rising by 13 per cent. across the country. I make particular reference to London, where the rate has risen by 16 per cent. The story is also one of closures of smaller maternity units. Indeed, Lord Darzi’s plans open the door for the closure of up to 10 obstetric or maternity units in London. That would have a profound effect on an area whose problems have already been highlighted.
We also have a shortage of midwives. There has been a 4.5 per cent. increase in the number of midwives over the last 10 years, but recently the number of midwives has reduced by 87. I have heard Ministers quote the number of midwives. The trouble is that we hear about the number of midwives and not the number of full-time equivalents. The latter number is what matters when it comes to providing care for women in labour.
We also have a retirement bulge coming up. The Royal College of Midwives estimates that half our midwives will retire in the next 10 years. Furthermore, there are reductions in the money available for maternity services. They used to take 3.1 per cent. of the total NHS budget, but now, that figure is down to 2 per cent. The ratio of midwives to women is also going in the wrong direction—it is getting worse, not better. Moreover, we have problems with staffing levels. The Healthcare Commission’s report on maternity services associated poor staffing levels with poor performance. In addition, there has been a 16 per cent. drop in training places in the last two years.
Other issues have been raised. I have mentioned that of premature babies, particularly premature twins, which the BLISS report, “Too little, too late?”, has highlighted. Some 35 per cent.—more than a third—of sets of twins are looked after in separate units. One can only imagine the trauma for a mother who, having just given birth, has to visit her two children in two separate hospitals. There is also a problem regarding the number of consultants coming through to train as obstetricians. The Royal College of Obstetricians and Gynaecologists estimates that the number of students putting themselves forward for training has gone down from 4.8 per cent. to 2.8 per cent. The issue frequently raised is fear of litigation.
The hon. Member for Romsey mentioned caesarean sections. A quarter of women now have caesarean sections; in 1980, only 9 per cent. did. The current figure is well above what we should expect. We must also consider the issues associated with mental health and breastfeeding; in particular, we must consider those women in society who are vulnerable and hard to reach, and who often have a number of other related problems in raising their children.
I finish by referring to what Dame Karlene Davis, General Secretary of the Royal College of Midwives, has said on this issue. The RCM has welcomed the “Maternity Matters” report, but Dame Karlene, summing up the problems identified in the report so well, says:
“It also shows that everything is far from rosy in the garden, and it should be a wake-up-call that jolts the Government from its slumbers. They need to rub the sleep from their eyes and reverse the lack of action on maternity services and galvanise the NHS. They are sleeping while mothers and babies are not getting the high quality care they deserve, while maternity services are crumbling and while midwives are working themselves into the ground.”
This is a wake-up call for the Government. All that I ask of the Minister is that she tell me what she and, indeed, the Government have been doing for the past 10 years. The problems that we are discussing are not news—they have been around for the past 10 years. Will the Minister therefore tell me what she is going to do about increasing the number of midwives and the percentage of the NHS budget that goes into maternity care? What is she going to do about giving women the choice that she has promised?
10.50 am
The Parliamentary Under-Secretary of State for Health (Ann Keen): I congratulate my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) on securing a debate on the important subject of maternity services in the NHS, and on his fortuitous timing. As always, he has put his finger right on the button. I appreciate all the comments that have been made and I congratulate all Members who have spoken. I particularly congratulate my male colleagues on showing such a remarkable interest in childbirth, as we knew they would, and on being so supportive of mums and families. Members have always held this issue in the highest regard because of its personal nature.
I congratulate the hon. Member for Cities of London and Westminster (Mr. Field) and I wish him and his family well. I should add, however, that the comments that he mentioned should not have been
made about the NHS. There is great joy and happiness every day, hour and minute in the NHS and in the independent sector, although there are also tragedies in both sectors. It would be unfair of me not to acknowledge that the NHS is the safest place in this country to give birth, and that is well acknowledged and well recognised. In whichever sector someone chooses to have their children and the marvellous experience of childbirth, they should always expect safety. I hope that the hon. Gentleman will take the case that he raised to the trust and that there will be a satisfactory outcome, given that the care received by those involved appears, from his description, to have been totally unsatisfactory.
Last Friday, the Government announced the funding for maternity services for each of the next three years, which totals more than £330 million. That funding will ensure that mothers get the best possible care and are guaranteed a full range of choices. Trusts will have access to that additional money from April.
Anne Milton: Will the Minister give way?
Ann Keen: Just for one second, because I have very little time to cover all Members’ comments.
Anne Milton: What percentage of the NHS budget will that money represent?
Ann Keen: I shall deal with that if time allows.
Ensuring that all women and their babies and families receive high-quality, safe and accessible maternity care is a top Government priority. Of course, we have a rising birth rate, which always seems to be the case under a Labour Government—perhaps people feel safer and more secure in their employment and that their families will be cared for financially, so they continue to increase the size of their families.
The recent Healthcare Commission survey of mothers’ experiences showed that 89 per cent. of women are pleased with the care that they receive when they have a baby. That shows that there has been improvement since the survey of maternity services undertaken by the Department in 2005, when 80 per cent. of women said that they were satisfied with the maternity services they had received.
It is worth putting on record that, on publishing the findings of the maternity services review, the chief executive of the Healthcare Commission said:
“Being put in the least well performing category does not mean that a service is unsafe. If we believed any unit to be unsafe, we would take immediate action to ensure patients were protected. We would not hesitate.”
It is important that that be put on the record, because women and families will be watching this debate, and it is essential that Members on both sides of the House unite in saying that the United Kingdom is one of the safest places to give birth. That will have an impact on the recruitment of midwives, which is so important to us all. If a negative view is promoted that does not show the true picture of maternity services in the health service, that could have a knock-on effect on recruitment.
I therefore encourage all those Members who have participated in the debate and all those who have shown an interest at other times to help us work on
work force planning with the Royal College of Midwives. The RCM is often quoted, and Dame Karlene Davis deserves to be quoted. As she has said:
“This review provides a good base to measure Trusts’ delivery of maternity services, and it is encouraging that over half of the Trusts are performing well.”
We must remember that this country remains among the safest in the world in which to give birth, and it is Dame Karlene’s members, as well as doctors, who provide the services.
My hon. Friend the Member for Carlisle (Mr. Martlew) congratulated Cumberland infirmary this morning, and I look forward to visiting there to acknowledge its work myself. My hon. Friend the Member for Stafford (Mr. Kidney) certainly supports his local service, and he has raised concerns about premature births. I am of course aware that the hon. Member for Banbury (Tony Baldry) will be giving evidence to the independent panel tomorrow, and it is fortunate to have him there. The hon. Member for St. Ives (Andrew George) mentioned a number of issues, but I shall need to write to him about them, given the time restrictions.
My hon. Friend the Member for Stroud (Mr. Drew) raised some important mental health issues. Following the publication of “Maternity Matters”, which also covered mental health issues, we should never underestimate the fact that although births go well for many mums and families, they can be a traumatic time. Some aspects of the mum’s mental health have been ignored in the past, and we encourage all commissioners to be very much involved in providing integrated maternity services, as part of the maternity mental health networks.
In the time that remains, it is important that I look at some of the other issues that have been raised. In my area, West Middlesex University hospital is part of the UNICEF baby-friendly scheme. My hon. Friend the Member for Stafford, among others, has worked hard on the issues of breastfeeding and a breastfeeding manifesto, and he should be congratulated on that.
There has been much change since I worked in the health service, and there was much change in the ’80s and ’90s, when closures were a significant aspect of meeting financial need. Today’s reconfiguration of many services, however, is clinically and locally led. Maternity units are special to their local communities. “Maternity Matters”, “Changing Childbirth”, which has been mentioned, and past Health Committee reports have all shown the great significance of change to the way in which we manage maternity care for mothers and babies.
The work of paediatricians and health visitors, which Members have mentioned, is very important, because there are still inequalities between families. We have heard reports today about how migrant mums have made a difference to some aspects of our maternity services. However, we should remember that we have a migrant work force in the national health service and that the NHS has provided excellent services throughout the years since its inception in 1948. As we go into the 60th year of the health service, we can be proud that we are the safest country in the world in which to give birth—much safer than America and France. We should be proud of those figures.
When things go wrong, it is important that clinical areas are monitored differently, because such experiences are totally unnecessary in today’s health service, and I look to local management and local leadership to put such things right. I also look to all Members to work with us in the next few months, when we will be ready to launch a bigger recruitment campaign. There is difficulty recruiting, but we must acknowledge that, look at the reasons why and put in every effort to change things. NHS London is certainly doing that, and I shall be happy to let Members know of the work that is taking place.
It is for all of us to raise concerns, but we should not be negative, because there have been improvements. We need to work together to ensure that we recruit and maintain midwives, and that we acknowledge and thank them for their continuing work. I thank my hon. Friend the Member for Leyton and Wanstead for raising such an important debate today.
Gaza
11 am
Jeremy Corbyn (Islington, North) (Lab): I am very pleased that we are having this debate today, but sad about the situation facing the people of Gaza at the moment, which is nothing short of a humanitarian crisis. A very large number of people are living—or surviving—with shortages of medicines, food and water and with regular cuts in electricity supplies. Much of this was debated last week during the Westminster Hall debate on the Foreign Affairs Committee report “Global Security: The Middle East”. I am pleased that we can return to this subject today, because I want to put a number of specific points to the Minister.
As one who has had the good fortune to visit Gaza, on three occasions, as I told the Chamber last week, every time I go, I leave feeling that the situation is appalling, and each time we return, it appears markedly worse. I suspect that the situation now is as bad as it has ever been. Some very sad news was reported on all the media this morning. I quote from the al-Jazeera website:
“The United Nations Security Council has abandoned efforts to adopt a statement on the crisis in the Gaza Strip caused by an Israel's blockade after the US refused to support it.”
I would be grateful if the Minister could give us some hope of a possibility of returning to that matter and of the UN Security Council coming to an agreed position. It is more than sad that on an occasion as serious as this the UN is apparently unable to come to a decision.
For the record, Gaza is a 225 km² rectangle originally occupied in 1948 when large numbers of Palestinians were removed from what is now Israel and sent there. It has been a part of Palestine ever since. It is one of the most densely populated places in the world and requires a large amount of aid in order to survive. Its economy is dependent on the ability of Palestinians in Gaza to cross into Israel, where in the past they could work, and of those who produce manufactured goods or grow food on its small farms to export their goods. Traditionally, it has relied on fishing, which is now limited to a very small inshore area, where stocks have more or less disappeared as a result of over-fishing. They cannot fish anywhere else because they are surrounded by the Israelis.
Two weeks ago, the state of Gaza, which effectively is a prison under siege from the state of Israel, changed dramatically when a number of people broke down the wall at the Rafah crossing in the south and crossed into Egypt. The exact figure is unclear, but it is possible that more than 500,000 people—one third of Gaza’s population—have already crossed into Egypt. Furthermore, a large number of people have crossed from Egypt into Gaza, via Sinai and the Rafah crossing. There are many family connections on both sides of the border owing to the original connection between Gaza and Egypt. There are reports that Egypt will attempt to reclose the border between Gaza and Egypt, and if it succeeds, Gaza will once more become a complete prison, and it will be impossible for anyone to pass in or out.
It is very hard for us in this country to understand what it is like to live in what is effectively a prison. People cannot travel in or out; our only life would be television and computers, if we had electricity to turn them on, and watching the world through the internet.
There is something deeply poignant about that. Having visited Gaza on a number of occasions, two of my most enduring memories are of talking to an elderly lady who described her life since 1948—all her children had either gone abroad or were in prison in Israel—and of talking to a group of young teenage girls, to whom I said, “What are your ambitions in life?”, to which they replied, “To visit Gaza city”. That was in Rafah. It is no distance at all, but they could not face the roadblocks. Their whole life was this very small dusty town in the southern end of the Gaza strip.
Israel claims that it is necessary to close off the Gaza strip because of rocket attacks made from the northern part of the strip into Israel. Every one of us in this Chamber will absolutely and unreservedly condemn those rocket attacks. We are not here to endorse such activity; it is completely wrong and I am not attempting to defend it in any way. However, I would point out that the casualty rate—deplorable as it is—of Israeli civilians killed by those rocket attacks is matched many times over by the number of people in Gaza killed by aerial bombardments, targeted assassinations and drones in the sky aiming to take out what are believed to be people preparing rocket attacks. The death rate in Gaza is very high, which obviously is terrible for the people of Gaza. The solution is neither the continued imprisonment of its people, nor the continued firing of rockets or bombardment of buildings in Gaza, but a political agreement that brings about some kind of justice for the people of Gaza and indeed all Palestinians.
When the Palestinian elections were held, first for the presidency and then for the Parliament, many international observers were present, including myself, my hon. Friend the Member for Birmingham, Northfield (Richard Burden) and other MPs. We observed the elections and could not honestly say that there was anything wrong with them. They were incredibly well run with unbelievable attention paid to the minutiae. The people of Gaza voted largely for Hamas, as was their right—in fact, Hamas won more than half the seats in the west bank and Gaza.
Last December, I received a letter from the Foreign Secretary, after he had promised to write to me following a question that I asked about members of the Hamas-led Palestinian Legislative Council. He pointed out:
“Since 28 June 2006, the Israeli Defence Forces have arrested 39 Hamas Palestinian Legislative Council members. Wasfi Kabaha, Nasser Al Shaer and Samir Abu Eisheh, all former Ministers of the then Hamas-led Palestinian Authority have since been released.”
The letter goes on to state that a number of them have not yet been charged and are still held in custody.
We cannot stand by and allow elected members of a fellow Parliament to be arrested and held without charge or trial in Israeli prisons. I am a member of the Inter-Parliamentary Union Executive, and every time we meet we discuss human rights issues facing fellow parliamentarians around the world. More Palestinian legislators are in prison than legislators from all the other Parliaments in the rest of the world put together. Surely that is cause for very deep concern. I hope that the Minister will tell us that serious pressure has been put on Israel to release those parliamentarians.
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