 House of Commons |
Session 2007 - 08 Publications on the internet General Committee Debates Health and Social Care |
Health and Social Care Bill |
The Committee consisted of the following Members:John Benger, Celia Blacklock,
Committee Clerks
† attended
the
Committee
WitnessesRosemary
Dodds, National Childbirth Trust
Ben
Bradshaw MP, Minister of State, Department of
Health
Giles Wilmore, Head of System
Management and Regulation, Department of
Health
Nick Clarke, Head of Health and
Social Care Regulation, Department of
Health
Jonathan Stopes-Roe, Head of
Health Protection (Strategy and Legislation), Department of
Health
Jonathan Athow, Head of Work
Incentives and Poverty Agency Team, HM
Treasury
Public Bill CommitteeThursday 10 January 2008(Morning)[Derek Conway in the Chair]Health and Social Care BillFurther written evidence to be reported to the HouseH&SC 18 National
Childbirth Trust
H&SC 19
Terence Higgins Trust
H&SC
20 Twins and Multiple Births
Association
9.2
am
The
Chairman:
This morning, we will hear Rosemary Dodds. The
Committee will have questions to put to her. We will then have a short
private break to sort out questions to the Department. In that way, we
shall not eat into the time of the National Childbirth Trust.
I thank you,
Rosemary, on behalf of the Committee for coming before us this morning.
If you are comfortable and ready to go, it will be helpful for the
record if you tell us your name and
position.
Rosemary
Dodds:
My name is Rosemary Dodds. I am the policy
officer at the National Childbirth
Trust.
The
Chairman:
Do you wish to say anything to the Committee
before my colleagues ask you questions, or do you want to go straight
into a few
questions?
Rosemary
Dodds:
I assume that you have seen the written
evidence that we submitted earlier in the
week—
Rosemary
Dodds:
And that you have also seen the Twins and
Multiple Births Association
submission.
Q
197197
Anne
Milton (Guildford) (Con): Good morning,
Ms Dodds. You welcomed the proposal for a health in pregnancy grant,
but also pointed to the need for continuing advice. Will you expand on
your belief that the one-off payment will make a difference? What other
measures do you consider necessary to improve on
that?
Rosemary
Dodds:
The important thing is the intention of the
payment. Originally, there was a lot of discussion about impact on
birth weight and prematurity, but the intention of the payment has not
been made clear. In order to answer the question about what the impact
would be, we need to know the intention of the grant. If the impact is
desired on birth weight and on prematurity, my understanding is that
even 25 weeks is too late, from the evidence base, to have much impact.
If the intention is to support pregnant women and to support new
families—their health in general but also in a wider
sense—that needs to be measured differently.
A contribution
of £190 I am sure would be welcome because it is a time, as I
have pointed out in the evidence, when families are particularly under
stress and low-income families obviously are harder hit. The stress of
being in debt or having a very low income is an additional factor in
pregnancy-related
disorders.
Q
198
Greg
Mulholland (Leeds, North-West) (LD): Are
you effectively saying that you think the reasons that have been given
for this grant are the wrong ones and, therefore, perhaps we are having
the wrong
debate?
Rosemary
Dodds:
I am not clear what the reasons are because my
understanding originally was that the emphasis was to improve health
and to improve diet in particular, with a view to reducing the risk of
prematurity and improving birth weight in this country and, therefore,
to give children a better start in the long term.
There is good
reason to think that improving women’s diet at the
pre-conception stage may have that impact but improving diet later in
pregnancy is likely to have much less impact. Therefore, I would like
to be clear, and I would like the Government to be clear, what the
intention of the payment is because then it will be possible to assess
the impact. Does that answer what you were
asking?
Q
199
Greg
Mulholland:
Yes, I think it does and I think it is quite
revealing. There has been a lot of criticism. You generally support the
measure, although, as I think is clear, you support it perhaps not for
some of the reasons that have been given for bringing it in. You are
also aware that there is a lot of criticism about it. A lot of
organisations and experts have said that they do not think that it is a
good idea. In fact, the King’s Fund has dismissed it as, I
quote,
“silly”.
Because
you think it is a good idea, albeit for different reasons from the ones
that have been given for bringing it in, how do you think it could be
changed? What other provisions do you think could be introduced or
alternatives brought in to make it actually deliver and succeed in the
way you that you would clearly wish it to
be?
Rosemary
Dodds:
One of the things that would help would be to
pay it earlier in pregnancy, from as early as possible, from 10 or 12
weeks, when women first attend for antenatal care. It should be
possible to do that even if women attend later. They can start later
and receive the same amount of money. I think the logistical problems
could be overcome. It would then have the advantage of particularly
supporting the women whose babies are born at 25 weeks. They are not
going to benefit at all if the grant does not start until after 25
weeks.
The other
thing that could have a potential impact on women’s health in
pregnancy and their children’s future health would be to
increase the healthy start payments which have been stuck at
£2.80 since they were introduced. That is the same sort of level
as they were previously under the milk tokens scheme.
Healthy start
can commence at 10 weeks and continue throughout the pregnancy up to
the age of four. That may also have an impact on the future pregnancies
of a woman who is in a poor nutritional state when she starts her first
pregnancy. It is a way of reaching the pre-conception stage for
subsequent pregnancies and it also goes to all women under 18 who are
pregnant, who are at a particular nutritional
disadvantage.
Q
200
Greg
Mulholland:
Clearly healthy start is conditional and
therefore is spent on exactly what it is devised to achieve. Do you
think therefore that this new payment to women, whenever it
is—you have clearly stated that, ideally, it would be
earlier—should also have some conditionality to ensure that it
is spent on something relevant to assisting diet, baby clothes or
whatever? Do you think that there should be some
conditionality?
Rosemary
Dodds:
No, I do not think so. As I pointed out on the
first page of the briefing, there are a lot of advantages to universal
benefits.
Q
201
Greg
Mulholland:
So when you say conditionality, you mean in
terms of what can be spent and not in terms of who it goes
to?
Rosemary
Dodds:
In the same way that child benefit is not
conditional on spending even that money on the child itself, there are
advantages in enabling women to make their own decisions about how to
spend the pregnancy grant. It may be that if they are in debt, the
greatest advantage to them would be to pay off their debts and then
reduce their ongoing interest payments, and then they will have more
money available to spend on food. So I do not think that conditionality
would overcome all the
problems.
Q
202
Greg
Mulholland:
But again, presumably you then have to be
clear what this payment is actually for, in the light of why it is
being given. If it is supposed to be about diet, which has been one of
the suggestions, and is going to be spent on debt repayments, that is
not going to achieve anything in terms of diet. We must be clear on
that.
Rosemary
Dodds:
As I say, it could have an impact on
diet—if it means that women are spending less on exorbitant
interest payments, they will have more of their household income to
spend on diet. I think it is important to be clear about the intent in
order to evaluate the impact, because I think that the Government want
to be evidence-based and you cannot be evidence-based unless you have a
reason for doing
things.
Q
203
Mr.
Stephen Crabb (Preseli Pembrokeshire) (Con): Is the
National Childbirth Trust aware of any international examples where
such a one-off grant to pregnant women has been
used?
Rosemary
Dodds:
I have not looked into that, but I understand
that there are similar grants in other European countries, in Australia
and possibly in
Canada.
Q
204
Mr.
Crabb:
One-off payments at some point during early
pregnancy? Does the evidence from those examples support what Ministers
have said, in terms of the way they expect the money to be used by
pregnant woman, and what they anticipate the benefits will
be?
Rosemary
Dodds:
I am afraid I cannot comment on
that.
Q
205
Mr.
Crabb:
It seems to me that a lot of the benefits we are
talking about of this payment are theoretical, and I am not sure I have
seen a lot of evidence to demonstrate that the grant will do what
Ministers claim it will do.
Rosemary
Dodds:
No, but there is a lot of support for the
redistribution towards families. Obviously there are many, many reasons
for that, and the health of children in the very early
stages—prior to conception and in the first few
months—does have a long-term impact on their future health, in
terms of their complete lifespan health. So there are some logical
reasons to think that improving health, particularly among the poorest
people, will have a future benefit. What you are saying is one reason
why we think it is important to evaluate the impact of this and to
commission research studies—we said the same at the launch of
healthy start—to look at what happens to the grant and what
impact it
has.
Q
206
Mr.
Crabb:
It seems that you are looking at this in terms of
poverty alleviation. If that is what you think this is about, then
surely there should be a discussion about the right ways of helping
poor, pregnant women. What we have here is actually a one-off payment
to all pregnant women. Do you think it is fair to criticise it on the
basis that it is not
targeted?
Rosemary
Dodds:
I think that in order to reach all pregnant
women who are in need, a universal benefit has a lot of advantages in
itself, but there are advantages in supporting all women who are
pregnant, whatever their income, because of the redistribution impact
that I mentioned earlier and because this method of payment reaches
many more of the poorest women. Universal benefits are well known to be
administratively easier, both for those who are giving the money out
and also for claimants, so that they are always clear that they are
entitled and almost always apply. There is a very high take-up rate and
therefore it is a very effective way of reaching people. As I mentioned
in my submission, the End Child Poverty Coalition is very supportive of
this move to increase universal
benefits.
9.15
pm
Q
207
The
Minister of State, Department of Health (Mr. Ben
Bradshaw):
I wonder, Rosemary, if you are aware that the
three European countries we are aware of that pay similar one-off
grants like this all pay them at about the same time that we are
proposing to pay this one? France, Finland and
Belgium?
Rosemary
Dodds:
Do you know what the logic is for
that?
Rosemary
Dodds:
Because, if at all possible, in order to have
an impact on health, speaking as a nutritionist, I would say that if it
is going to have an impact, the earlier the
better.
Q
209
Angela
Browning (Tiverton and Honiton) (Con): Can I ask if women
will be informed enough to use this money in such a way that their own
nutrition helps the foetal development? There are certain aspects of
foetal nutrition, particularly, for example, in the laying down of the
initial calcium for bones and teeth, where certain foods are very
relevant. Are we satisfied that there is enough information out there
so that when women get this money they really do have the knowledge and
perhaps even the motivation to spend it on the right things that are
actually going to help foetal health and the long-term health of the
child?
Rosemary
Dodds:
No, I think you raise a very important point
and as I have pointed out, health professional bodies have in general
said that they do not have sufficient training on nutrition to provide
individualised dietary advice to women. It is no good suggesting that
women eat a lot more high-value foods if their income is not going to
cover it, for instance. It is not only calcium and vitamin D, for
instance, that are important, but also oily fish. There is a lot of
confusion about oily fish yet there is good evidence that it can have
an impact on the future health of the child. That is one reason why we
mentioned improved training, particularly for midwives and GPs who have
said they really do not have enough nutrition
knowledge.
Q
210
Angela
Browning:
I am pleased to hear that, but I have to say,
Chairman—I did study nutrition to an advanced level
myself—I do wonder. If we take, for example, the battle Jamie
Oliver had with the Turkey Twizzlers, just getting mums, particularly
mums who were probably in areas where they most needed information and
expertise on why to eat a balanced diet, to understand why fruit and
vegetables are an important component of diet. I worry that socially,
there is still lack of acceptance of the need to eat a proper, balanced
diet; even if Marks and Spencer cut out all their salt and all these
sorts of things happen, I worry that the people who would benefit most
will not do so, because they either do not know, or equally are not
going to use it because of lack of motivation to do so
anyway.
Rosemary
Dodds:
Therefore it behoves us to discover ways of
reaching people with the right information and enabling them to make
healthy choices, because that stage of their lives, and their
children’s lives, is so important that we cannot just sit back
and do
nothing.
Q
211
Angela
Browning:
No, I agree, but in terms of this particular
grant, are you satisfied that the information exercise for the mothers
will go hand in hand with the handing over of the money? Because if it
does not—let us put to one side extreme cases such as women who,
when pregnant, actually decide not to give up cigarettes or alcohol
consumption; there will also be a small group of women who are drug
dependent—one has to look at these groups and say, how are you
going to ensure foetal health through additional
resources?
Rosemary
Dodds:
That is why it needs to go hand in hand with
advice from their health professional, which we are hoping will be
improved through better training, and there are people who are willing
and able to do that. Also, the NICE maternal and child nutrition
programme development group is about to come out with its
recommendations for reaching the most disadvantaged women with
information on improvements in diet. We need to find the mechanisms to
make that work.
Q
212
Mr.
Stephen O'Brien (Eddisbury) (Con): I am grateful to
Rosemary Dodds for making such a clear exposition of the challenges
that we face in trying to make something intended to be a good,
actually work. As best as we can understand, the genesis for this was
when the Prime Minister was Chancellor and first
announced the then extension of child benefit into the last months of
pregnancy. He said that it was on the basis that nutrition is most
important
“in the last
months of pregnancy”.—[Official Report, 6 December
2006; Vol. 454, c. 308.]
Has
the National Childbirth Trust, as one of the greatest practitioners and
organisations in the field in the country, been consulted on that? Have
you seen the evidence that supported it? Is it something with which you
find yourself in total
accord?
Rosemary
Dodds:
No, I cannot say that we were consulted. My
reading of the evidence is that it is pre-conception and very early
pregnancy nutrition that is most important. That is not to say that
women who are sick and do not manage to eat very much at all will not
have babies that are often just as healthy, so it depends on the
functioning of the placenta, and that is influenced by many other
factors. Diet is one factor, but definitely the time around conception
is most
important.
Q
213
Mr.
O'Brien:
I am grateful for that. It will no doubt lead us
to some interesting discussions during our deliberations in the coming
weeks. At the outset of your remarks, you made clear that it is
difficult to make judgments on the area until one is absolutely clear
what the intention is. I think we are all agreed that it would be
helpful when the Minister appears after you to try to gain some
clarification from him. If the intention is to tackle birth weight and
prematurity, that is one set of circumstances whereas if it is just for
the general support of the mother and the family that is another set of
circumstances.
On Tuesday we
had the Which? representatives in front of us, and they indicated that
they are willing to supply written evidence, as a result of our
questioning, which might impact on what behaviour, influences and
evidence can be found to make sure that the proposal will work. In your
experience, what tends to influence the behaviour and choices of
pregnant women? Particularly, as you say, at the conception stage and
the early days of pregnancy, in the first three months when often they
have not told many people—which is normal practice. What
influences them to make the right choices? At the extreme level,
cigarettes and alcohol are given up, but also, more positively, if this
is to deliver, what influences their choice on nutritional
improvement?
Rosemary
Dodds:
I have to say that the most important thing is
education. Education in schools is one of the best ways of reaching
people. We are aware, from research on encouraging women to take folic
acid prior to conception and for the first 12 weeks, that it is the
women who are most well educated, most likely to look at websites and
read magazines who are most aware of that information. We need to put
more emphasis on providing girls in particular, but girls and boys in
general, with nutrition education in schools and encouragement to
implement those nutrition messages by explaining the impact on the
future health of themselves and their
children.
Q
214
Mr.
O'Brien:
I am grateful. I was interested in
the Minister’s question about the three
European countries. The other evidence we have is from Australia, where
some people have, rather brutally, called their one-off payment the
“plasma payment” because of the tendency—which is,
I expect, anecdotal—of a number of pregnant
mothers to go off and buy plasma screens rather than the necessary
improved food. I am therefore anxious for us to understand, from your
point of view, and with your experience and the great contact you have
with pregnant mothers, with what evidence you would hope to show that
this initiative would bring about the intended behavioural changes, to
encourage women to make the right choices? Let us say that the cost is
£80 million at the moment. If you were given a cheque for that
amount, is this the way you would use it to improve maternal and foetal
health?
Rosemary
Dodds:
The latter question I will come back to. In
terms of improving awareness of the importance, I am likely to get into
philosophy if I am not careful, because the importance of children in
society and of the parenting role needs to be bolstered in order to
encourage women to take their health and the health of their children
seriously. At the moment, parenting is seen as an optional add-on for
many people, and not something that is an important part of their
lives. Work is the most important thing; parenting is sometimes
denigrated and not sufficiently valued as an important part of the
future society. That involves not only health, but how much time you
spend with your children and how you bring them up. In order to
encourage women in particular to improve their diet to maintain their
health and the health of their children, I would like to see parenting
and child rearing more valued in society.
Q
215
Mr.
Bradshaw:
There is quite clear evidence, however, that
less well-off people—and less well-off women in
particular—spend a higher proportion of any extra resources they
have on their
children.
Rosemary
Dodds:
Yes.
Q
216
Kelvin
Hopkins (Luton, North) (Lab): I wonder what you think the
Government might do more positively about the biggest single problem
with foetal damage in pregnancy, which is from
alcohol—particularly that consumed just prior to conception and
during the early stages of pregnancy. As I understand it, foetal
alcohol damage is far and away the most significant factor affecting
babies before birth, causing greater damage than all the other factors
put together. Have you got a message for Government, as to what they
might do to improve the health of babies before they are
born?
Rosemary
Dodds:
I do not see that that is the immediate topic
in relation to the health and pregnancy grant. Smoking, alcohol and
illegal drugs all have an impact on the health of babies before they
are born and prior to conception. Obviously, some of those babies will
not survive because of the substances that their mother is
ingesting.
Q
217
Kelvin
Hopkins:
If I can interrupt, I understand that alcohol is
overwhelmingly more significant than the other factors. It causes
serious physical damage and mental incapacity later on.
Rosemary
Dodds:
I am aware of that concern, but I am not sure
that the evidence is sufficiently robust. Many more women are smoking
and we do not know the impact of very poor diets. Alcohol consumption
is
one of the factors, but I do not think that the correlations are as
strong as you suggest. Yes, there is more that could be done to inform
young women, in particular, of the dangers of drinking excessive
amounts of alcohol, but so many of those women are also
smoking—they are not considering that their health, or their
baby’s health, is damaged by those behaviours.
I want to
pick up on what Mr. Bradshaw said about the income being
spent on the children, which is obviously important. There is evidence
that women themselves go without food in order to give their
children—and even their partners—the best, which adds to
what I said about women not feeling that their own health is
sufficiently important.
The
Chairman:
Miss Dodds, we have sadly come to the end of our
fixed session with you, but on behalf of the Committee I thank you very
much for coming before us this morning and for answering our questions
so frankly and with such interest.
I am afraid
that we have to clear the public gallery, as the Committee has to go
into private session to prepare for the next questions for the
Department, so I must require the public to
leave.
9.30 am
The
Committee deliberated in
private.
9.37
am
On
resuming—
The
Chairman:
We now move into the second question session
with the Minister and his team. I am not going to allow the Minister to
question himself as a member of the Committee, but he can certainly
answer the Committee’s questions. Would you like to introduce
your team, Mr.
Bradshaw?
Ben
Bradshaw:
On my far left is Giles Wilmore, head of
system management and regulation in the Department of Health; on my
immediate left is Jonathan Athow, head of work incentives and the
poverty agenda with the Treasury; on my far right is Nick Clarke, head
of health and social care regulation in the Department of Health; and
on my immediate right is Jonathan Stopes-Roe, head of strategy and
legislation for health protection in the Department of
Health.
Ben
Bradshaw:
No.
Q
218
Mr.
O'Brien:
We are all delighted to be
involved in this new process and to have the chance to take evidence
before we debate the Bill on a line-by-line basis. To open, it will, I
hope, be helpful all round to establish what intent and motive lies
behind amalgamation of the three bodies—the Healthcare
Commission, the Commission for Social Care Inspection and the Mental
Health Act Commission—to form the new Care Quality Commission,
given that some of those bodies were recently formed and have not had
the chance to bed down. We are just getting to the point at which they
were demonstrating their experience and added value, and we have the
opportunity to give them new powers,
so what has persuaded you to establish a new commission at this stage?
Has the measure come too late or too
early?
Ben
Bradshaw:
There are two basic reasons. The first was
articulated well by the Local Government Association when it gave
evidence on Tuesday. Increasingly, on the ground, service users and
members of the public do not interpret the bodies as unseamless, but
services are increasingly delivered in an integrated way. Other
political parties and stakeholders have for some time called for
integration. We accept that change such as this is never easy; it will
always cause an element of disruption. However, the reasons for the
intent and the timing of the measure are that we have a legislative
opportunity, there is increased integration on the ground and the
Government are committed to reducing the number of public regulators to
streamline and save costs, which I imagine most people here would
support.
Q
219
Mr.
O'Brien:
Are you satisfied that the
provisions as they are currently laid out are in what we all accept is
a framework or something of a portmanteau Bill? A lot of the devil will
be in the detail. We now have some regulations to work with, which is
welcome. Are you satisfied that there is not, through this disruption,
a danger that things will fall through the cracks and that we might
lose some things—a situation that might otherwise have been
avoided?
Ben
Bradshaw:
I accept the fact that we have to manage
this process very carefully. I also accept the evidence that was given
by the LGA witness who said that whenever there is a transition like
this, there are problems. However, he went on to say that those
problems are easily outweighed by the benefits. We have to manage the
process very carefully. We have been working at the highest level with
the three organisations involved to try to address their concerns and
to ensure that the transition is managed well, and that they continue
to fulfil their responsibilities while we get a shadow Care Quality
Commission up and
running.
Q
220
Mr.
O'Brien:
We hope that some favour may shine upon the
transitional arrangements that we shall propose in amendments during
the course of our deliberations. That would also include giving the
same emphasis to social care as to health
care.
Ben
Bradshaw:
I do not think that we need to worry too
much about that given the fact that the social care section will be the
bigger part of the new regulatory body. As we made clear on Second
Reading, we are very sensitive to the concerns of the CSCI. We have
addressed the concerns and we will continue to do so as we scrutinise
the Bill.
Q
221
Kelvin
Hopkins:
Were you surprised by the evidence given by the
Healthcare Commission on Tuesday? It seemed that it said one thing when
the Bill was first published and then something else in Committee. An
innocent such as myself was very puzzled. Can you explain it
all?
Ben
Bradshaw:
I was as surprised as you were. In none of
the meetings that I or the Secretary of State have had with Sir Ian
Kennedy, going back more than
six months, did he ever expressed those concerns either in the content
or the tone in which they were articulated. I was also slightly
concerned to read them in the press before evidence was given to this
Committee. However, during the Sitting, we usefully teased out the
position of the three regulators, including the Healthcare Commission.
You may recall that when I asked Sir Ian, he said that since he wrote
the Bristol report some years ago, it was his position that bringing
together health care and social care is desirable. He said that the
citizenry do not know and care less under what system they are being
looked after. They want it to be seamless and well organised, so the
principle is right. His concern seemed to be about the timing, and we
have already had a brief discussion about that. In some senses, the
timing is never attractive to someone who is already in charge of a
regulatory body that is doing a very good job. It is not natural to
welcome that level of disruption and also the abolition of your very
good
organisation.
Q
222
Angela
Browning:
You mentioned that your Department has been in
discussion at the very highest level with the three existing
inspectors. We heard from Lord Patel, Chair of the Mental Health Act
Commission, about the importance of regular inspections and the
expertise of the team of people who carry out the inspections. In his
evidence to us, he seemed to be
content,
“as long as
those are retained and strengthened, we would support the
Bill.”——[Official Report, Health and Social
Care Public Bill Committee, 8 January 2008; c.
6.]
Given the fact that he said
that to the Committee, can we accept that he has not had that
reassurance from your Department’s in its discussions with
him?
Ben
Bradshaw:
We have certainly given him that
reassurance. I cannot quote verbatim the assurances that were given on
Second Reading. The powers that his organisation have at the moment
will be strengthened under the new Care Quality Commission. We do not
think that it is for us to dictate to the new commission at this stage,
saying that it should regularly visit particular organisations or
institutions. There will always be a need to strike a balance between
how much we prescribe here during the passage of this Bill to the work
that they do and how they do it and how independent they are. Those
issues will be addressed during our deliberations. Given the fact that
the new organisation will have to fulfil the duties of the existing
organisation, including Lord Patel’s, I would envisage that that
would include the regularity of visits in the cases that he was
concerned
about.
9.45
am
Q
223
Richard
Burden (Birmingham, Northfield) (Lab): The new commission
will have the power to issue penalty notices and suspend registration
for organisations or individuals that do not comply with its
requirements. As you will remember, that was an area that we questioned
the three existing commissions about on Tuesday, and they gave slightly
different replies to those questions. Let us concentrate for a moment
on what members of the Healthcare Commission said. If I understood them
correctly, they were saying that they were not asking for new powers,
but that they did not want them removed from the Bill, if they were in
there. They were concerned that those
powers should not be used at the drop of a hat. They wanted it to be
established that those powers would be used on an escalating basis and
that things would not come down too heavy-handedly. Under what
circumstances would you expect the commission to use the new powers
available to it?
Ben
Bradshaw:
I would expect the new commission to use
its judgment and to take advantage of the new sliding scale of powers,
which I think were probably more warmly welcomed by the other two
organisations than by the Healthcare Commission, which feels that it
already has adequate powers. You are right, Mr. Burden, to
say that, when questioned, Anna Walker said that she did not want those
powers to be taken out—I suspect because there is a belief that
the new range of powers is not only about how the commission will use
them, but the galvanising and deterrent effect that the existence of
those powers will have on provider organisations. I do not think that
we should lose sight of that issue, which was not really raised on
Tuesday. We should leave that to the judgment of the new commission. I
do not think that we should lay down in the legislation under what
circumstances the commission should issue a penalty notice or suspend a
licence. That will be for the commission itself to decide, in a
proportionate but robust
way.
Q
224
Richard
Burden:
On the specific issue of health care-associated
infections, which came up on Tuesday, how would you expect the
existence of those new powers to allow the commission to intervene more
effectively on that
area?
Ben
Bradshaw:
This is where I slightly disagreed with
what Anna Walker said on Tuesday, because I think that the new powers
will enable the new commission to be more flexible in its interventions
in relation to health care-acquired infections and to intervene more
quickly. The increase of the maximum fine to £50,000,
potentially—that is for just one breach of a regulation and
there could be multiple £50,000s in a very serious
case—is an extra tool in its armoury. One should not lose sight
of the damage to an organisation’s reputation that could be
caused if it was fined in that way. The Healthcare Commission might say
that it has enough powers at the moment, but the flipside of giving it
these new powers is the motivational and deterrent effects on health
care organisations to ensure that they improve their
performance.
Q
225
Richard
Burden:
Another point that was made, particularly by the
Healthcare Commission, was that it felt that it needed to have more
powers to intervene in relation to commissioners, not simply providers.
How do you respond to
that?
Ben
Bradshaw:
I entirely agree with that. In fact, that
is one of the areas that we have been working on closely with the
Healthcare Commission over recent months. One of the reasons why I was
so disappointed with the tone and content of Sir Ian’s written
evidence was that we have moved on that issue. The Healthcare
Commission was very much concerned that its powers should not be
limited to providers, given that 80 per cent. of the taxpayers’
money that is now spent on the health service is being spent through
primary care trusts, which are the main commissioners. I entirely agree
with that. We are confident that the Bill makes clear that the
commission’s role extends to commissioning as well as
provision.
Q
226
Anne
Milton:
Why do you think it has changed its mind? You are
obviously surprised that it is coming up with different things now from
what you have heard privately. What do you think has changed its
mind?
Ben
Bradshaw:
I do not really think that that is for me
to answer. We could speculate. It might be to do with the fact that
this was the chance for its last hurrah—it has membership
organisations and structures, it wants to be seen to be defending its
existing regulatory organisations and nobody likes to be abolished.
What is interesting is that by the end of the sitting on Tuesday, two
out of the three organisations had acknowledged that they supported the
principle of integration. They did not start in that position. I do not
know; it would be more fruitful to ask it. I am not sure that it has
changed its mind. I think that it is a difference in tone and a
difference between when you are in public and when you are discussing
how to make the best system in the
future.
Q
227
Anne
Milton:
My understanding was that it thinks the direction
of travel is right, but that it is concerned about the detail, in
particular the transitional
arrangements.
Going
back to health care-acquired infections, I think that the transitional
period is crucial in relation to those that stop for no man. An
18-month loss of focus would not be unlikely, and I understand that
some organisations are already leaking staff because of this proposed
change. I would appreciate your comments on that.
Ben
Bradshaw:
That goes back to the answer that I gave to
a previous question. It is important for us to manage the transition
and support the work that the three organisations—in this case
the Healthcare Commission—are doing, particularly on health
care-acquired infections. The Government have recently invested a large
extra sum of money in the area of health care-acquired infections, and
that work will continue while we get the shadow organisation up and
running. The shadow organisation will have to manage the transition
carefully and take on the expertise that is already there. We will help
and encourage it to do
so.
Q
228
Anne
Milton:
Will the powers extend to all care settings:
private, independent, voluntary and charitable?
Giles
Wilmore:
Yes.
Q
229
Anne
Milton:
So these powers will apply to institutions,
irrespective of the sector from which they originate.
Giles
Wilmore:
That is right, and later this year we will
consult on the exact scope of the new system of regulation in terms of
which services need to be covered. However, the intention is to have a
fair coverage of all sectors in the
provision.
Q
230
Sandra
Gidley (Romsey) (LD): On a slight change of tack, clause
23 gives organisations 28 days to respond when the commission gives
written notice of its intention to suspend or cancel registration. If
there is an urgent problem, is that not too long a period of
time?
Ben
Bradshaw:
It could be, but there is provision to take
more urgent action if necessary. In clauses 26 and 27, we give the
commission the power to take urgent action when it considers that
necessary, but in general we think that it is right and fair for a
provider or manager to have the right to challenge a proposed action. I
think that we have got the balance right, and there is a safeguard that
more urgent action can be taken, if it is considered
necessary.
Q
231
Sandra
Gidley:
Decisions on urgent cancellation
will be referred to a justice of the peace. Are you confident that the
judges are qualified to assess such situations—for example,
whether lives are at risk as a specific result of failure to control
infection?
Giles
Wilmore:
The role of a justice of the peace in that
situation will be to assess the evidence in front of them and to check
that the process has been robust and fair to all
parties.
Giles
Wilmore:
Primarily, yes. Obviously the Healthcare
Commission will be responsible for bringing forward sufficient evidence
to justify enforcing the powers that it wishes to use. The legal
process will be to check that that evidence is robust and that the
process of gathering it has been fair and above
board.
Ben
Bradshaw:
No, it is providing an important balance to
the powers of the commission to close down a
service.
Q
234
Mr.
Crabb:
Clause 42 talks about the reviews that the
commission will carry out with respect to health and social care
organisations as “periodic”. Clause 45, I understand,
gives the commission the powers to set the frequency of those reviews.
Does that mean an end to the annual statutory
review?
Giles
Wilmore:
No, it means that the annual statutory
review does not necessarily have to be annual for every type of
provider and that the commission will determine the most appropriate
frequency. For main NHS providers such as hospitals, when we have the
annual health check, it is likely that we will want the annual review
of performance to continue. That is what clause 42 allows.
Q
235
Mr.
Crabb:
But the new commission will have the freedom to
determine whether that is the
case?
Giles
Wilmore:
Yes, but it will need to agree that with the
Secretary of
State.
Giles
Wilmore:
Yes, that is
right.
Q
237
Sandra
Gidley:
The new commission has the power to conduct
special reviews. It is not clear how it will determine and prioritise
those areas, and concern has been raised that there might not be the
funding to do it. Will the net effect be that it will end up reviewing
only those subjects specified by the Secretary of State in clause
45?
Ben
Bradshaw:
No. There is no restriction from the status
quo in terms of the freedom of the new commission to conduct reviews.
Clearly its remit will focus on safety and quality and we have made
that quite clear throughout this process. The commission will be free
to conduct the reviews that it needs to with the proviso of a one-year
time lapse while the registration system is got up and
running.
Q
238
Mr.
O'Brien:
The Bill, of course, creates a new body, the
Office of the Health Professions Adjudicator, which will take over the
conduct of the practice panels of the General Medical
Council. In addition to the more general question of why you think that
a new and separate body is necessary, I wish to point out that the GMC
will still be able to publish guidance telling the OHPA what sanctions
to impose on professionals found unfit to practise, thus giving rise to
the potential for confusion about who has the ultimate responsibility.
Given the extensive evidence that we have already had on the subject,
during which, of course, you have been present, I would be grateful if
you would comment on the need for total
independence—particularly considering Lady Justice
Smith’s evidence that she thought that a legally qualified
person ought to be the statutory chair of such
panels.
Ben
Bradshaw:
As I am sure hon. Members are aware, that
was one of the main recommendations to come out of the numerous
inquiries that Dame Janet Smith carried out into the Harold Shipman
murders. It is widely supported by everyone, with the exception of the
British Medical Association. The original motivation was the view that
the independent adjudicator should be given the genesis of this,
independent of medical professional interests. More recently, people
have begun to debate the exact status of the body, and I point out to
the Committee—we discussed this at some length on
Tuesday—that people do not suggest that the Healthcare
Commission, which itself is an non-departmental public body, or the
Independent Police Complaints Commission and the Human Fertilisation
and Embryology Authority, which are other NDPBs, are not independent of
the Government. I also noted from the questioning on Tuesday that
although Dame Janet expressed some sympathy with the concerns of the
GMC on its exact status and distance from Government, neither she, the
GMC, nor any other witnesses had a clear idea of what alternative
status they would recommend for
it.
On
the issue of the legal qualification of the chair, if there is wide
concern in the Committee about that, we are prepared to look at it.
However, it is important to bear in mind that the GMC was a bit iffy
about that issue because its view was that in some cases it is
important—particularly in complex medical cases—that the
chair has medical rather than legal expertise. That is why we
introduced the provision of having a legal assessor and the possibility
that the independent adjudicator may include a legal assessor. If there
is a way out that would mean we could specify that it could have either
a legal assessor or a legal chair, that might be a way to satisfy the
concerns of both Dame Janet and members of this Committee. We are
certainly happy to go away and think a bit further about
that.
Q
239
Judy
Mallaber (Amber Valley) (Lab): Can you explain why it is
necessary to change the standard of proof for establishing whether a
doctor or nurse is unfit
to practise from the criminal to the civil standard? Were you at all
concerned by the robust views put forward by the BMA on Tuesday that
such a change might mean that doctors would act more defensively in
future and that that could cause detriment to
patients?
Ben
Bradshaw:
I am afraid that I was not surprised by the
evidence given by the BMA on Tuesday. The BMA seems to want the
Committee to reject every single recommendation that Dame Janet has
made after looking into the issue for four long years. The reason why
we are doing this is because, first, it was one of the central parts of
Dame Janet’s report and, secondly, because all but two or three
other health care professions already use the civil standard, and the
others are quite willingly and happily moving towards the civil
standard. They, unlike the BMA, have recognised that it is sensible to
restore public confidence in the process. I do not accept that it will
lead to doctors being too careful; I thought the arguing was slightly
bizarre from the BMA there. Doctors should be careful, and one problem
with the existing system is that you have two extremes. Because of the
criminal standard, there is often reluctance to make a ruling when it
is a bit borderline; whereas the civil standard will allow a whole
range of sanctions, from serious sanctions to retraining or
help.
Doctors
should feel much more relaxed about the civil standard being used than
they do about the status quo, where there is a danger that some
mistreatments or mistakes go unaddressed, because you either do
nothing, or something incredibly serious and damaging to the long-term
career of the
doctor.
10
am
Q
240
Judy
Mallaber:
So where does that leave you on the argument
that there should be a sliding scale? If the potential is that the
doctor’s future career is at stake, should you have to have the
criminal standard? Does that argument impress you at all?
Ben
Bradshaw:
In practice, that is what happens under
civil law—as I think Dame Janet articulated so well. There is a
sliding scale. I also believe that the GMC has received that legal
advice, which was one thing that helped them to shift their position on
supporting the civil standard.
Q
241
Judy
Mallaber:
Do you expect to find more doctors and nurses
being found unfit to practise as a result of the change? What
monitoring systems will there be in practice?
Nick
Clarke:
Because of the discussion that we have just
heard about the higher level, I think that the standards of proof will
be virtually identical. Therefore, it is unlikely that it will lead to
more doctors being found unfit to practice, because we are talking
there about the higher level. On the monitoring, we have already asked
the Council for Healthcare Regulatory Excellence to advise on the
processes for implementing the change, and for making sure that people
have adequate training—all those sort of areas. We will also
continue to monitor the implementation of the change.
Ben
Bradshaw:
Also, because this new system will help us
to intervene earlier with problematic doctors, it should mean fewer
extreme sanctions in the medium and long
term.
Nick
Clarke:
At local level—and this is a similar
argument—we would expect more work to be done to stop it going
to fitness practice at all, through things like the responsible
officer.
Q
242
Anne
Milton:
Thank you, Mr. Clarke. You have just
brought me nicely on to what I wanted to ask the Minister about.
Responsible officers are, as I understand it, a crucial part of this,
in that they allow local resolution and intervention to stop the
process, as was said, from getting so far down the line. Who do you
envisage taking on that role of responsible officer?
Ben
Bradshaw:
We are not making a specific ruling as to
who it should be, just as to what qualifications the person should
have. We think that responsible officers must be senior doctors with a
current GMC registration. There was much discussion on Tuesday as to
whether it should be a medical director, and that would be perfectly
appropriate. In fact, a lot of the good medical directors are, in
practice, already doing this job on the ground. Yet we are not saying
that it has to be a medical director.
Q
243
Anne
Milton:
Do you see that as being an addition to their
existing role, or new posts being created?
Ben
Bradshaw:
Some of them—the best
ones—are already doing that work in practice. They are
incorporating it within their existing role, but we are making
provision in the Bill, if necessary, for them to take on assistants and
extra resources to help them do the job if they want
somebody.
Ben
Bradshaw:
We are giving extra money to PCTs all the
time. We gave them, across the board, something like a 5 per cent.
increase this
year—
Q
245
Anne
Milton:
You feel, then, that you are giving sufficient
additional resources: but what about training? The wording of the
question on our briefing papers is quite interesting. It
says:
“All
healthcare providers will have to designate a ‘responsible
officer’”.
Certainly, one concern expressed by some
doctors is that that is what you have to do—designate a
responsible officer, and their job is done. The training of medical
directors who may have no particular expertise in the field is a
crucial part of that being
effective.
Ben
Bradshaw:
Through an expert advisory group we are
developing the necessary competences for responsible officers, and once
we have agreed the competences we will negotiate with the providers to
deliver specific training needs for responsible
officers.
Q
246
Sandra
Gidley:
Moving to clause 119, the new health protection
powers can only be used in response to
a
“serious and imminent
threat to public
health”.
Who is going to
advise the Secretary of State on whether a threat of that type is
present?
Jonathan
Stopes-Roe:
First, it is not exactly the case that
clause 119 only provides for serious and imminent threats. The
regulation-making power in new section 45C in clause 119 allows the
Secretary of State—or, obviously, Welsh Ministers—to
make
“provision for the
purpose of preventing, protecting against, controlling or providing a
public health response to the incidence or spread of infection or
contamination”.
That
covers a far wider range of situations than those that are
“serious and imminent”. It is worth explaining that we
intend to use the regulation-making power to make regulations that will
enable quite routine actions to protect public health, as well as
responding to threats that may or may not be serious and imminent. For
example, we intend to use the powers in new section 45C to impose
standing duties on registered medical practitioners to notify cases of
specified infectious diseases, exactly paralleling the system that we
have at the moment, though working rather more effectively. That
requirement to report is certainly nothing to do with a serious and
imminent threat to public
health.
In
addition, clause 119 of course sets up the arrangements whereby a local
authority can apply to a justice of the peace for an order to place
requirements or restrictions on an individual—or indeed on
things or premises—if they may be infected or contaminated,
could pose a significant threat to human health, and are at risk of
infecting
others.
Ben
Bradshaw:
On the issue of advice, clearly the
Secretary of State would take advice from the HPA, experts within the
Department, the chief medical officer and the World Health
Organisation—there would be a number of sources of
advice.
Q
247
Sandra
Gidley:
So there is not one stream—advice would be
given depending on the situation at the time and the Secretary of State
would make a response. These situations are likely to be more
controversial.
Jonathan
Stopes-Roe:
Where regulations are made in
anticipation that a serious and imminent situation may
arise—that is provided for in new section 45D(4)(b)—the
regulations themselves could set out the nature of the threat, as well
as who is to take the decision and
how.
Q
248
Anne
Milton:
It is interesting in the evidence that the HPA was
100 per cent. happy with this and the Local Government Association was
very unhappy about it, and one can easily jump to the conclusion that
it, like many organisations, just sees this as a loss of power. What is
also interesting is that currently, local authorities and directors of
public health have a close relationship in terms of informal advice and
all the rest of it. Do you see local directors of public health having
that same relationship with
JPs?
Ben
Bradshaw:
Yes. I am not sure that the Local
Government Association was wholly against it, I think that it had a
particular issue with the role of JPs vis-Ã -vis their own
traditional role. We may come on to talk about that, but I think it was
based on a slight misunderstanding of the law. The point made by one of
the local government witnesses about the Litvinenko case—that
under our proposals, it would mean that we would have to make 40-plus
applications—is not the case. It actually makes it much easier
because a single
application would take in all those premises. What was interesting about
the Litvinenko case was that the local authorities did not have the
powers to do what they needed to do. It was based on a slight
misunderstanding and, on the part of the LGA, a misunderstanding about
the availability and speed of action of JPs. The HPA was right in that
case. It welcomes such a move, because in its current experience,
getting decisions made by JPs tends to be quicker than getting
decisions made by local
authorities.
Q
249
Anne
Milton:
What you said highlights the absolute need for
clarity. Such a series of events is rare. The LGA’s
misunderstanding of the existing situation in itself gives rise to
considerable cause for concern, because when such issues come up, they
do so suddenly. Absolute clarity about the role, and how advice will
flow among JPs, local authorities and directors of public health, would
be
crucial.
Ben
Bradshaw:
I
agree.
Q
250
Angela
Browning:
Can the Minister look at how the legislation
will fit with existing powers that are vested in the Department for
Environment, Food and Rural Affairs, with which he will be familiar in
terms of a large-scale contamination of the food supply that could be
injurious to human health? There are already powers in another
Ministry. Is what is being introduced under the Bill compatible with
existing legislation? I am not talking about withdrawing a batch of
something that has come out of a factory, but bigger things such as
large-scale contamination of milk supply or even as the result of
terrorist
activity.
Ben
Bradshaw:
There is an obligation under the Bill for
organisations such as the Food Standards Agency and others to work
together on such issues. I do not know whether Jonathan wants to add
anything.
Jonathan
Stopes-Roe:
That is correct. The Committee would
probably be much less happy if there were gaps between legislative
provision rather than overlaps when, according to the circumstances, it
may be appropriate to work under food legislation or health protection
measures.
Q
251
Angela
Browning:
In the drafting of the Bill, has the
compatibility with other existing powers, especially in respect of the
Department for Environment, Food and Rural Affairs’ powers, been
looked
at?
Jonathan
Stopes-Roe:
We have certainly worked closely with all
other Departments. Of course, much of the detail will be fleshed out in
regulations that will go through another whole
process.
Q
252
Mr.
Crabb:
Thank you, Mr. Conway. Minister, it
might be helpful if you state your understanding of the specific aims
and purposes of the grant. What do you anticipate will be the benefits?
What specific measures will you be using to monitor progress to achieve
those anticipated benefits?
Ben
Bradshaw:
The measure is aimed at helping pregnant
women who, as we heard this morning, face particular stresses and
pressures during pregnancy. It reflects the desire both to address the
serious problems of underweight babies in this country—although
a witness said earlier that help early on in pregnancy would make more
of a difference in that regard, she acknowledged that help later on
would make some general health improvements in respect of women and the
unborn child— and the still very stark inequalities in health of
both women and children. It has a multiple purpose. It is a model that
a number of other EU countries have followed. I am pleased that it has
been warmly welcomed by organisations that have concern for the welfare
and health of children and pregnant
women.
Q
253
Greg
Mulholland:
Following on from that, I wish to raise the
issue of how the money will be spent. As you are aware, that is a
matter of concern. Did you consider a form of voucher system? If so,
why did you reject it in favour of this proposal? Did you consider
extending the healthy start programme, which I believe is successful
and is very much targeted on lower-income families by delivering
something that they can spend specifically on
nutrition?
Ben
Bradshaw:
Yes. We considered all those things. I am
pleased that you have drawn attention to the healthy start scheme,
because that is not the only state help that is available to pregnant
women. There is a healthy grant scheme, as well as the Sure Start
scheme that is worth £500. We did consider that scheme, but we
wanted in this case something that was universal for the reasons that
our witness from the National Childbirth Trust gave this
morning.
A
universal grant will benefit all women and, given the existence of
specific, targeted grants that are based on a means test, the
Government judged that there was merit in giving a grant to all women.
On how they spend it, as I said and as our witness acknowledged, there
is clear evidence from both this and other countries that less well-off
people who experience an increase in their income—women in
particular—spend a higher proportion of the extra income on
their children’s, husband’s or partner’s welfare
and, lastly, on themselves. That, I am afraid to say, is contrary to
the Daily Mail myth that they blow it on booze, fags, bingo or
plasma screen televisions.
10.15
am
Q
254
Greg
Mulholland
:
Poor women spend a
large proportion of their income on food, so is there a danger that,
because the benefit is universal, richer people will spend the money on
an upgrade to a super-duper baby buggy, a plasma screen television or
whatever?
Also, I want
to tie you down on this matter. Going back to the question asked by the
hon. Member for Preseli Pembrokeshire, if, as the Government have said,
the measure is about pregnant women’s and children’s
health, well-being and nutrition—particularly those
disadvantaged people who do not have those things—is it the best
way of delivering those things?
Ben
Bradshaw:
We think that it is. One could make exactly
the same argument that you made—you spoke of better-off women
blowing the money on other things—about child
benefit.
Q
255
Greg
Mulholland:
You say that the measure is specifically about
nutrition—that is the
difference.
Ben
Bradshaw:
Yes, and I was going to on to
say—this has not been mentioned—that the impression is
being given that there is no conditionality attached to the grant.
There is conditionality attached to the grant—that the pregnant
woman seeks professional health and nutritional advice at the time of
receiving
it.
Q
256
Mr.
O'Brien:
Staying on the health in pregnancy grant, I am
sure that you are aware that the grant will not be received until the
29th week of a pregnancy. You will be aware, too, that I have tabled a
raft of parliamentary questions asking for the evidence that lies
behind the initiative to bring forward the health in pregnancy grant.
It would be helpful if I quote the Prime Minister’s original
assertion:
“I
have received powerful representations that in the last months of
pregnancy, when nutrition is most important, and in the first weeks
after birth, the extra costs borne by parents could be better
recognised if we did more to help through the universal
benefit—child benefit—which is paid to all. Maternity
grants are available to low-income mothers from the 29th week of
pregnancy. Help should be available to all mothers expecting a child,
so child benefit will be paid on that basis to every
mother—additional child benefit that now recognises the
important role, at this critical moment, that child benefit can
play.”—[Official Report, 6 December
2006; Vol. 454, c. 308.]
When
are you going to bring forward the evidence that supports that
statement and the terms of the health in pregnancy grant that we will
consider in the next few days? There is an absence of
evidence.
Ben
Bradshaw:
Perhaps I could begin by correcting what
you said. The grant will be made in the 25th week, rather than the
29th.
Ben
Bradshaw:
The reason why we are doing that is to link
the grant to the maternal health advice that women will receive at that
stage of their pregnancy. There is another issue that may or may not
have informed the decision of other EU countries that award similar
grants to deliver them at the same time—I believe that
Mr. Crabb raised it on Second Reading—namely, that
the grants will be made in the period after which there are few, if
any, miscarriages or abortions, so we will not be making grants to
women who subsequently, for whatever reason, lose their baby. We can
have a semantic argument on the matter. In a way, we could call the
measure “Child Benefit in Pregnancy”, but we are calling
it something
else.
Q
257
Mr.
O'Brien:
Can we actually expect to see
the evidence? There is a discrepancy between the origination of the
thought, which suggested that the grant would be made in the last weeks
or months of pregnancy, and the earlier time that we now hear about
and, indeed, the idea of its being paid
pre-conception.
Ben
Bradshaw:
I think we would all acknowledge that the
evidence suggests that the nutritional benefits, specifically to the
unborn child, are better earlier on in pregnancy. But for the reasons I
have already outlined—the other help that is available for women
earlier on in pregnancy; the fact that we want to tie this to specific
health advice from the 25th week of pregnancy; the general pressures
that women, particularly less well-off pregnant women,
are under; and the pressures immediately before and after birth, to
which the Prime Minister referred—on balance, we have decided
that this is the most sensible time to give the grant, as have the
other countries that have introduced similar measures, as I
said.
Q
258
Mr.
O'Brien:
I urge that, if possible, we see some evidence. I
accept that you have effectively given evidence by virtue of this
means, but to see any other evidence would be extraordinarily helpful.
While on this particular point, I note in the explanatory notes,
paragraph 32, that it
says:
“In
the Pre-Budget Report 2006, the Chancellor of the Exchequer announced
that additional financial support would be made available to all women
in the last months of pregnancy in line with the principle of
progressive universalism, delivering support for all pregnant women and
more help for those who need it the
most.”
I was wondering
what your interpretation of “progressive universalism”
is.
Ben
Bradshaw:
I think that universalism is something that
is paid to everybody, such as child benefit. Progressive is, in my
book,
redistributive.
Ben
Bradshaw:
Because everyone will get it. It will mean
a lot more to poor people. It might not mean very much to the media
commentators who were so sniffy about this when we announced it; but I
have to say that £190 to some of the women in my constituency
would make an awful lot of
difference.
Q
260
Anne
Milton:
I think “sniffy” is harsh. The
question is whether it could be better spent somewhere else. That is
what we were hearing from the NCT. You have acknowledged the fact that
pre-conceptual nutrition is more important than nutrition later on. You
are linking this to a point at which women get advice on nutrition.
Well, give them advice on nutrition at an earlier stage and link it to
that. The point is that the greatest benefits are delivered in the
pre-conceptual phase; if we want to improve the health of young women,
do it
differently.
Ben
Bradshaw:
That was a bit more of a statement than a
question.
Ben
Bradshaw:
I think that you are seeing this grant in
too narrow terms, Mrs. Milton. This is about a health in
pregnancy grant—it is not solely about nutrition. The mother may
choose, for example, if she has a
perfectly good diet, to spend the money on exercise, which is also
important in terms of her and her unborn baby’s health. I have
said that there is already considerable help out there for women
earlier on in pregnancy and, for the reasons I have already given, we
have decided that this is the most sensible stage of pregnancy to give
the
grant.
Q
262
Sandra
Gidley:
Could you clarify? There is talk about health
advice but it is not clear what form that will take or who will deliver
it. In theory, it could just be a leaflet from a health trainer. How is
it going to
work?
Jonathan
Athow:
The intention with the grant is that the
pregnant woman will need to have seen a health professional and to have
got advice on all aspects of health, including nutrition, in order to
receive the payment. We are trying very much to work with health
professionals. We have had some very constructive
conversations.
Jonathan
Athow:
Specifically, we have had some very helpful
discussions with the Royal College of Midwives, who have been very
welcoming of the proposal. We have been looking at how we can help them
and use them as a way of helping to promote awareness of the grant, but
also we want to minimise the burdens on health professionals. We do not
want them to see this as an extra bit of form-filling that they have to
do. We are working very closely to try to help them do that job. For
some women—a very small proportion of women who do not seek
regular contact with the health professionals—it may actually
provide an incentive for them to make contact with a midwife and
therefore to get access to the grant. Midwives are a group we are
talking with, trying to use them as a primary way of delivering the
grant.
Q
264
Sandra
Gidley:
You have clearly never had an antenatal
appointment. They are generally 10 minutes long. Other checks have to
be done. You cannot give that sort of advice in two or three minutes.
Antenatal classes are being cut around the country. I think that this
needs to be probed at a later stage as to how this is going to be
delivered.
The
Chairman:
Sandra, I have to cut you off and I cannot ask
the witness to respond because we have run out of time. May I thank the
Minister and his team for giving evidence? He can re-join the
Committee. Before I close the Committee formally, may I just remind
everyone that this afternoon the meeting will be in Committee Room
9?
Adjourned
accordingly at twenty-
five
minutes past
Ten
o’clock until this day at One
o’clock.
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