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Session 2007 - 08
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General Committee Debates
Health and Social Care

Health and Social Care Bill

The Committee consisted of the following Members:

Chairmen: Derek Conway, † Mr. Jim Hood
Bradshaw, Mr. Ben (Minister of State, Department of Health )
Browning, Angela (Tiverton and Honiton) (Con)
Burden, Richard (Birmingham, Northfield) (Lab)
Cooper, Rosie (West Lancashire) (Lab)
Crabb, Mr. Stephen (Preseli Pembrokeshire) (Con)
Gidley, Sandra (Romsey) (LD)
Hesford, Stephen (Wirral, West) (Lab)
Hopkins, Kelvin (Luton, North) (Lab)
Jenkins, Mr. Brian (Tamworth) (Lab)
Kumar, Dr. Ashok (Middlesbrough, South and East Cleveland) (Lab)
McCabe, Steve (Lord Commissioner of Her Majesty's Treasury)
Mallaber, Judy (Amber Valley) (Lab)
Milton, Anne (Guildford) (Con)
Moffatt, Laura (Crawley) (Lab)
Mulholland, Greg (Leeds, North-West) (LD)
O'Brien, Mr. Stephen (Eddisbury) (Con)
Wright, Jeremy (Rugby and Kenilworth) (Con)
John Benger, Celia Blacklock, Committee Clerks
† attended the Committee

Public Bill Committee

Thursday 24 January 2008


[Mr. Jim Hood in the Chair]

Health and Social Care Bill

Further written evidence to be reported to the House

H&SC 30 The Patients Association

Clause 121

Entitlement: Great Britain
9 am
Greg Mulholland (Leeds, North-West) (LD): I beg to move amendment No. 124, in clause 121, page 77, line 14, at end insert—
‘(2A) Payments shall be made under subsection (1) to women from the sixteenth week of pregnancy.’.
I am sure that all of the Committee are pleased that this is our last day of deliberations. I am not sure how far we have persuaded the Minister, but we shall see how we get on today.
The effects of diet on pregnancy is a concern to all of the Committee. Everyone is aware of the evidence, particularly of effects such as low birth rates, and the impact on health chances later in life. We are all fully committed to the aim of improving diet in pregnancy to address those health concerns, which the Department of Health has acknowledged are there when they should not be. The fundamental question that has not been answered is whether the new health in pregnancy grant is the best way to tackle the problem. Furthermore, is the payment actually a way of improving health in pregnancy at all? The evidence and the arguments are not clear.
The main Government arguments for bringing in the payment are, first, that health in pregnancy is a key issue that must be addressed, which is a view that we all share and the Government’s rhetoric on that point has been strong; and secondly, that the people who have the poorest diets in pregnancy are the most disadvantaged. The evidence from the nutrition panel has laid that out clearly. However, the simple reality is that the new payment is focused on neither of those arguments. There is no evidence, either from trials or from other countries, that that kind of payment will actually improve health in pregnancy. It is a universal payment and is therefore not targeted at those who need it most. The key question that the Government have not answered so far, which is my concern and what I want to press the Minister on today, is whether this is the best way to spend that large amount of taxpayers’ money and to achieve what the measure is trying to achieve. What are the concrete aims of the payment? The aims are confused, a point that is backed up by the National Childbirth Trust in its written memorandum:
“The NCT recommends that the Government should be explicit about what it intends to achieve through the health in pregnancy grant, that this objective should be realistic on the basis of existing evidence and knowledge about physiological and social processes and that the process and outcome effects of the new grant are evaluated in independent research studies.”
I am afraid that we are simply not in that position, in terms of the measure being explicit in its aims or based on a body of evidence.
All the rhetoric around that significant new payment has been about it improving diet and nutrition, without taking account of evidence or the views of the organisations that clearly have a direct interest. Only some—the Minister would not disagree with this—of the £120 million will be spent on measures to improve diet and nutrition. Due to the timing of the payment, as we heard during the oral evidence sessions, at 28 weeks people will be spending the money on prams, cots, clothes or, potentially, to pay off debts in preparation for birth. No one is suggesting that that is a bad thing, but it does not match with the claims made by the Minister, the Secretary of State for Health and the Prime Minister about how the new payment will improve nutrition and diet. The Government appear to have a policy solution to a problem, but the two do not match.
Kelvin Hopkins (Luton, North) (Lab): I have some sympathy with what the hon. Gentleman is saying. Is it not the case that if income is increased the potential mother will spend it on whatever is necessary at the time? If she does not have that money, she will have less to spend on food, prams and all the other things as well. If she has to buy the pram anyway, it means that she will have less to spend on food. The income will be increased, which will make it possible for her to have a better diet. I cannot understand the logic of the hon. Gentleman’s argument.
Greg Mulholland: I do not disagree with what the hon. Gentleman has said, but the logic is clear. No one is saying that the money is a bad thing, but it simply does not match the rhetoric. In fact, is the proposal a health measure at all? The reality—this directly answers the hon. Gentleman’s question—is that this is a universal pre-birth child benefit payment, which is paid to all pregnant women two months before birth. Although that is not a bad thing, it simply does not match the justifications given for it. Should the measure be in its current form in the Bill, should it be amended or should it even come under this Department? [Interruption.]
The Chairman: Order. I have to ask hon. Members to be a wee bit quiet. If there is a rabble and hon. Members are out of order, I cannot hear the hon. Gentleman who is moving the amendment.
Greg Mulholland: Thank you, Mr. Hood. It is interesting to see that hon. Members are very keen on a universal child benefit payment two months before birth, but why are the Government not being honest about what it is?
Greg Mulholland: I thank the hon. Lady for her intervention. There are many ways in which to address the real issues of nutrition in pregnancy, but this measure is not one of them. There are many different ways to look at the matter. To paraphrase the famous advertising slogan, the new payment simply does not do what it says on the tin. It is not a health in pregnancy grant. It is a universal pre-birth child benefit payment. There will be better ways of spending money directly to address diet and nutrition.
Mr. Brian Jenkins (Tamworth) (Lab): Let me get to the hon. Gentleman’s argument. Is he saying that the universal benefit is wrong?
The Chairman: Order. I think the hon. Gentleman is going broad of the amendment.
Greg Mulholland: Thank you, Mr. Hood. This is fundamental in showing that the payment will not deliver the claims made for it. Clearly, universal child benefit payments are a good thing. However, this measure is not a health in pregnancy grant. The National Childbirth Trust has suggested extending the healthy start programme. It stated:
“This would be a way to reach disadvantaged women at an earlier stage in their pregnancy.”
That is clearly the point of the amendment. The Government have not justified why the universal payment is being made. The arguments that they have given do not reflect what the payment is for.
I will turn now to timing, which the hon. Member for Tiverton and Honiton mentioned is clearly the main purpose of the amendment. On 7 January, the Department of Health issued the following statement, which is typical Government-speak. It stated:
“It is widely acknowledged that the health and general well-being of pregnant women in the last months is important for the health and development of a child later in life.”
That supposedly showed why the payment was to be made at a later stage, but what does “widely acknowledged” mean? Is there a body of evidence for the suggestion? The statement was also rather misleading, because it said that the matter “is important”. Of course it is important, but the implication is that it is somehow more important to pay the money at that late stage.
The Prime Minister, then the Chancellor of the Exchequer, said in the 2006 pre-Budget report that he had received “powerful representations” about the need better to recognise the extra costs faced by pregnant women in the last months of pregnancy and the few first few weeks after birth, but he gave no further evidence of what they were. We are still none the wiser. I ask the Minister whether we can finally see the body of evidence suggesting that the health in pregnancy grant should be paid so late in the pregnancy.
Lord Commissioner of Her Majesty's Treasury (Steve McCabe): On a point of order, Mr. Hood, is it in order for the hon. Gentleman to question whether there is an entitlement to the benefit, when the amendment mentions solely the time when it should be paid?
The Chairman: The hon. Gentleman will know that I am the person who is chairing the Committee, not him, and I shall make those judgments.
Greg Mulholland: It is interesting to see how rattled Labour Members are, because they know that their Government have been guilty of mis-selling on the health in pregnancy grant. That is the simple reality.
We have seen no evidence that the payment should be made two months before birth, as is currently proposed. There is plenty of expert opinion that suggests that it should be paid earlier, as the amendment suggests. The NCT has stated:
“In order to make a difference to women’s diets during pregnancy, and to the health of babies, this grant should be part of a wider, co-ordinated strategy to improve awareness on the importance of nutrition around the time of conception and during early pregnancy—when it would be more likely to have an impact.”
The Child Growth Foundation director Tam Fry has said:
“By the time a woman falls pregnant, she already needs to be eating well to give her baby the best chance. Tackling it halfway through the pregnancy is really a bit late”.
A spokesman for the Royal College of Obstetricians and Gynaecologists, Daghni Rajasingam, has said:
“If a woman is not already eating a healthy diet by that stage, then encouraging them to eat more fruit and vegetables from 29 weeks is too little too late. Even for small babies it is too late, there is very little you can do to increase growth at that stage.”
Niall Dickinson, the chief executive of the King’s Fund, has said:
“Quite how a limited cash payment seven months into a pregnancy will have any impact on the health of the child or the mother is hard to see.”
The arguments are clear and run against what the Government have been saying.
Richard Burden (Birmingham, Northfield) (Lab): I wish to be clear about what the hon. Gentleman is suggesting. Is he suggesting to the Government that they should pay the money earlier in pregnancy, without any commitment from the Liberal Democrats that they would do so in the unlikely event that they were part of a Government, or is he actually committing them to spending for the earlier payment in that unlikely event? Which is it?
Greg Mulholland: With the continuing fiascos in the Government, who knows what will happen at the next election? I am certainly not going to predict it. The reaction on the Government Benches is revealing.
Steve McCabe: Answer the question.
Greg Mulholland: I have not had a chance to answer the question yet, because of your chattering.
The Chairman: Order. The hon. Gentleman should address me.
Greg Mulholland: Apologies, Mr. Hood.
The purpose of the amendment is blatant: to bring forward the payment. We are here to amend the Bill. [Interruption.] Address the Chair, please. I have just been told off for that. Clearly the purpose is to make the payment at 16 weeks, when it would, without a shadow of a doubt, according to all the evidence and expert opinion, make more of a difference to health, which would better justify Ministers’ claims.
Judy Mallaber (Amber Valley) (Lab): Will the hon. Gentleman help the Committee by letting us know whether the Liberal Democrats would provide such a grant in the 16th week of pregnancy to all pregnant women? Would they make that commitment?
9.15 am
Greg Mulholland: As I have made clear, there are much better ways to achieve better health in pregnancy, an obvious one being to extend the healthy start programme. However, making the payment two months before birth will not deliver on the Government’s claims.
The NCT flagged up the explicit public service agreement target for all women to have started their antenatal care by the 12th week of pregnancy. Its memorandum states:
“Consideration should be given to starting the Health in Pregnancy payment once a woman has started her antenatal care, which should be by 12 completed weeks of pregnancy.”
The aim of all of us is to address health in pregnancy. However, if we are to do that through a universal payment, it must start earlier, otherwise we must consider different methods.
Whether Labour Members like it or not, the Government have provided no evidence to suggest that the new payment, paid two months before birth and costing £120 million, will deliver on their rhetoric. On the other hand, there is much evidence to suggest that, paid earlier in pregnancy, it would have a significantly greater impact on health. The Minister and his team need to justify the payment, make clear what it is trying to achieve and be honest about whether it is simply a child benefit payment two months before birth. If that is what it is, which would not be a bad thing, they should stop dressing it up as something that it is not. Having said that, I do not expect to hear any of those things in the Minister’s response.
Mr. Stephen O'Brien (Eddisbury) (Con): In the light of that discussion, it is clear that the appropriate time to discuss the evidence base is in a stand part debate, so I shall reserve my comments until then if I can catch your eye, Mr. Hood. In the meantime, this important debate is not dignified by a Liberal Democrat-Labour party scrap over a spending commitment that will let Labour Members supply a nice juicy nugget to their Prime Minister to help them in their little battle with the Liberals. I shall, therefore, let the matter rest.
Kelvin Hopkins: I strongly support the payments and am happy with their timing. However, during an evidence session, we were told that early pregnancy and conception are important times too—the hon. Member for Tiverton and Honiton made a point about vitamins during early pregnancy. Another important point relates to alcohol consumption around the time of conception and during early pregnancy; abstinence is very important, and I hope that my hon. Friend the Minister will use his good offices to ensure that the message gets across.
The Minister of State, Department of Health (Mr. Ben Bradshaw): I am surprised and disappointed by the Liberal Democrats’ approach to the health in pregnancy grant. I am sorry that the hon. Member for Romsey is not present—she is the usual Liberal Democrat Front Bench spokesperson on such matters—because I wanted to remind her that she described the grant as a gimmick. Instead, I shall remind her colleague, the hon. Member for Leeds, North-West. For many women, particularly the less well-off, the grant will provide an extremely welcome addition to their income, at what is often a very difficult and stressful time.
Greg Mulholland: Will the Minister give way?
Mr. Bradshaw: I want to make some progress first. I was unclear, from the hon. Gentleman’s remarks, whether the Liberal Democrats oppose the grant on principle, whether they oppose the name, the fact that it is universal—a strange approach for the Liberal Democrats to take, given that they are constantly criticising the Government over means-testing—or whether they simply object to its timing. Perhaps he would enlighten us.
Greg Mulholland: First, I point out to the Minister that the person who called the grant a gimmick was the consultant obstetrician, Darjney Rarjarsingham, who said, “It is gimmicky” and added that pre-pregnancy education would be more effective. The Minister, once again, is being overly defensive. He has not justified the arguments. To clarify his point, it is not a question of our opposing universal payment; I want the Government to be honest, and so far—
The Chairman: Order. An intervention cannot be too long.
Mr. Bradshaw: The hon. Member for Leeds, North-West has not cleared matters up at all. We still do not know where the Liberal Democrats stand. In response to the questions put by my hon. Friend the Member for Luton, North, I appreciate that if the grant was designed solely to improve the nutrition of pregnant women and through that, the health of the unborn child, there would be arguments for it to be paid earlier in the pregnancy. However, it is not only about that, it is much broader and comes on top of a number of other financial assistance measures that the Government have introduced to help pregnant women, including assistance earlier in pregnancy. The professional organisations involved have recognised that. The Royal College of Midwives said it was
“pleased that the financial costs of pregnancy for women and their families has been recognised. This will help women to make essential purchases before the baby’s arrival. Crucially it will also encourage pregnant women to live a healthier life, which is vital for them and the long term development of their babies.”
Dr. Peter Carter, the general secretary of the Royal College of Nursing, also welcomed the measure and said the college was
“particularly supportive of any policy measures to ensure that expectant mothers have improved access to advice on living a healthy lifestyle from healthcare professionals.”
That advice will, of course, be linked to the measure. Dr. Carter continued:
“It is also important for the grant to be non-means tested and available to all pregnant women, as their continued health during pregnancy is important for themselves, their baby and their family.”
Other countries, including Finland, France and Belgium, have introduced similar grants. Those grants are universal and are paid at the same time as we propose, with payment ranging between the 22nd week of pregnancy and the end.
We are aware of research by St. Thomas’ hospital that relates to a point made by the witness from the National Childbirth Trust during our evidence-taking session. She said that if we are talking only about nutrition, earlier payment would be better. However, she recognised that the measure would still benefit women, pointing out that particularly later on in pregnancy, women suffer more challenges and more stress. The Tommy’s research shows that women suffer more stress over money worries in the later stages of pregnancy, and specialists say that it is important to reduce stress to avoid risking complications in pregnancy. There is also evidence that low income can affect birth weight through psychosomatic means due to stress throughout the period of pregnancy.
I will go on to the reasons why, on balance, we have decided to pay the grant at 25 weeks, not 29 weeks as the Opposition keep claiming.
Kelvin Hopkins: It is very likely indeed that many women in later pregnancy will have to take time off work or even give it up entirely. Extra income at that time would be extremely helpful.
Mr. Bradshaw: My hon. Friend makes a very important point, which is another strong argument for making the payment when most women will give up work and experience a drop in income. He is right.
There are other reasons why we have chosen 25 weeks rather than an earlier time. It is partly because it coincides with the advice given to women by their midwives and doctors at that point in their pregnancy. We also know that only a relatively small proportion of women seek professional advice earlier in pregnancy—at the time the Liberal Democrats would like the grant to be paid—so we expect take-up of the grant to be lower earlier in pregnancy than it would be later. We can tie it to specific health advice and reduce the administrative burden for the midwives involved, because they will not have to secure two levels of certification for it, only one. On that basis, I urge the Liberal Democrats to withdraw the amendment.
Greg Mulholland: At least we are now getting somewhere in terms of some more honest justification for the payment, which is really—
The Chairman: Order. I ask the hon. Gentleman not to use words that imply dishonesty. I let it go once or twice, but I ask him not to do it at all.
Greg Mulholland: Okay, Mr. Hood. We are now getting some justification that fits the reality of what the payment can achieve—if that wording suits you.
The Government have backed themselves into a corner, although the contribution from the hon. Member for Luton, North was reasonable. Yes, people take time off work—absolutely; so the payment will be a child benefit payment. On that basis, it may be justifiable regarding the purchases that I mentioned, but it will not deliver the results set out in the Government’s rhetoric. Certainly, making the payment at the stage they propose will not deliver anything like the same health benefits, as the Minister just about acknowledged. He mentioned some of the organisations that say the grant is a good idea, but if we read the quotations more carefully, we see that any policy measures would be welcome. Of course, all those organisations welcome any attempt to tackle nutrition in pregnancy, but surely £120 million of taxpayers’ money that is spent, purportedly, to improve the health and nutrition of women in pregnancy should deliver a large chunk of that improvement. The amendment would enable the payment to do so. If the payment is really for other things, as was suggested, that is fine, but if that is what it is for, can we at least be honest about it?
The Chairman: Order. The hon. Gentleman has done it again.
Greg Mulholland: Mr. Hood, I said “we”, including myself, so I hope that is acceptable.
The Chairman: Order. I assure the hon. Gentleman that saying “we” is not acceptable.
Greg Mulholland: In that case I apologise, Mr. Hood.
We are about to move on to the amendments tabled by the hon. Member for Eddisbury. I was disappointed by his rather tetchy and unhelpful contribution earlier, so I hope that he will have something constructive to contribute to the debate. I shall withdraw my amendment, because the point has been made that the Government have still not justified the measure. I ask the Minister to do so. He has started the process so I hope we will get a clearer picture of what the payment is really for, and I look forward to hearing the comments on further amendments. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
The Chairman: Order. Before I call amendment No. 58, I remind hon. Members that chattering to themselves in wee groups is not acceptable; when the Chair can hear them they are out of order. That goes for Members on both sides of the Committee, so I hope that we can get back to the discussion and give due regard to the person who is moving the amendment or speaking to it.
Mr. O'Brien: I beg to move amendment No. 58, in clause 121, page 77, line 17, after ‘a’, insert ‘maternity’.
The Chairman: With this it will be convenient to discuss amendment No. 59, in clause 121, page 77, line 24, at beginning insert ‘maternity’.
Mr. O'Brien: The amendments would ensure that advice relating to maternal health came from a maternity health professional rather than someone who was qualified as only a health professional. As I shall outline in the clause stand part debate, although we think that there is little evidence of the nutritional benefit of the health in pregnancy grant to pregnant women and their babies, the grant has none the less been proposed, so we must plan on the basis that it will be introduced, and make it as worth while as we can.
9.30 am
The amendments, in conjunction with amendment No. 60, would establish that advice on maternal health was not just a tick-box exercise with a non-maternity health professional. I direct the Committee to the oral evidence of Jonathan Athow, the official who spoke about the topic at the oral evidence session. He is the head of the work incentives and poverty agency team at the Treasury. That title in itself shows how far the measure is, in reality, separated from health. He said:
“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.”
I would be interested to know what those constructive conversations were. I would also be interested to know how the Department of Health has been involved in them and through which teams. It transpired from the subsequent questions of the hon. Member for Romsey that those discussions were with the Royal College of Midwives. Jonathan Athow also said:
“Midwives are a group we are talking with, trying to use them as a primary way of delivering the grant...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.”
Revealingly, he also said that only
“a very small proportion of women... do not seek regular contact with the health professionals”. [Official Report, Health and Social Care Public Bill Committee, 10 Jan 2008; c. 106.]
The nutrition argument has been debunked by answers to parliamentary questions, and it seems that the health benefit argument has to some degree been debunked by Treasury officials. In passing and as a result of Mr. Athow’s responsibility for the poverty agency, I ask the Minister whether the measure is a sideways attempt to throw more money at the Government’s failing child poverty targets. As he knows, the Chancellor of the Duchy of Lancaster recently confessed that
“The fall in child poverty is short of the target we set ourselves”.
Last year, the Joseph Rowntree Foundation and the Fiscal Policy Institute argued that a minimum of £3.8 billion needs to be invested over the next two years to achieve the Government’s own target of cutting child poverty in half by 2010. Even if the health in pregnancy grant was directed solely at child poverty, it does not even come close to denting that figure.
The statutory instrument, which I am grateful that the Minister has made available in response to my request, defines a health professional for the purposes of subsection (3) as:
“a registered medical practitioner, a registered nurse or a registered midwife”.
Can the Minister clarify whether it is expected that the registered medical practitioner and the registered nurse will have particular skills in antenatal care? If not, surely it would be better to use midwives alone, and just to refer to midwives in the Bill. That would save paper, legislative time and the worry that the appropriate advice is not just a tick-box exercise. The only difficulty that I can see in just prescribing midwives in the Bill is that, under this Government, relative numbers of midwives are plummeting as the birth rate is rising. A shake of the head by the Minister does not recognise that situation. The Royal College of Midwives estimates that we need an extra 5,000 midwives by 2012 to support maternal choice and to offset the demands of a rising birth rate. According to Government figures—not mine—the number of midwives has increased by only 4.5 per cent. since 1997. I direct the Committee to Hansard column 176W on 16 July 2007. However, the number of births in England has risen by 12.5 per cent. since 2001.
Sandra Gidley (Romsey) (LD): Does the hon. Gentleman share my concern that not only has the number of midwives not increased, but the demographic of midwives is such that many will retire within the next 10 years, which will leave us with even bigger problems?
Mr. O'Brien: I am grateful to the hon. Lady; she is spot on. We are really facing a clove hitch.
The Chairman: Order. Before the hon. Gentleman responds, the hon. Lady’s intervention is a bit wide of the amendment so he should try not to be tempted to follow her down that road.
Mr. O'Brien: I am grateful for that guidance. I had just finished the sentence in which I had dealt with the intervention and confirmed that she had put her finger on a serious problem and that she is right.
The latest figures available show that numbers of obstetricians—obstetrics and gynaecology—have risen by 30 per cent. since 1997. However, because of pressure from the European working time directive, the number of hours each consultant works has been significantly reduced, which makes it necessary to increase further the number of consultants to maintain service levels—it is not rocket science. The Government’s commitment to offering women a choice over where to have their baby by 2009 has been derailed by woefully inaccurate estimates of the birth rate. The huge increase in the fertility rate in recent years vastly outstrips the Government’s estimates of the number of live births, and has placed intolerable pressure on midwives, the very maternity health care workers whom I am seeking, through the amendment, to say should be the ones who are used. Each midwife now delivers almost 25 per cent. more babies each year than the Royal College of Midwives believes is appropriate, helping to explain why there are so few home births and why so many midwife-led maternity units are threatened with closure.
The Chairman: Order. I have to tell the hon. Gentleman that he is going a bit wide. The amendment does not deal with manpower planning in the national health service. Somebody may wish to address the subject on stand part, but not on this amendment.
Mr. O'Brien: I am grateful for that, Mr. Hood. I hope that you recognise that my purpose was not to try your patience. The purpose of the amendment is to focus the advice.
Stephen Hesford (Wirral, West) (Lab): Whinge.
Mr. O'Brien: That comment is rather cheap.
The Chairman: Order. That is very much out of order. Members should not heckle from a sedentary position.
Mr. O'Brien: I am grateful, Mr. Hood. I thought that I was being straight in introducing the amendment. We genuinely and sincerely wish to focus on the health professional who will have the job of advising and giving support to the pregnant mother. It should be somebody who is experienced and qualified in maternity and antenatal health care. The capacity to deliver such support, given the number of midwives relative to the rising birth rate, is vital. The hon. Member for Wirral, West, who sought to make such a cheap and completely demeaning little intervention, should hang his head in shame.
The Chairman: Order. I am sure that the hon. Member for Eddisbury did not mean to commit an offence, and that he will withdraw his comment.
Mr. O'Brien: I am not sure what I have done.
The Chairman: You cannot accuse an hon. Member of behaving badly and cheating.
Mr. O'Brien: Obviously I was misheard. I said “cheap”, with a “p” on the end for “Peter”. I did not say “cheat”.
The Chairman: I have given my ruling. Carry on.
Mr. O'Brien: Had I said “cheat”, of course I would have withdrawn it. I would not have said it.
The important point is that we want experienced maternity and antenatal health professionals to be the ones who are directed to give the advice. The clause is too wide. The fact that there are added pressures on the capacity of health professionals, particularly midwives, has been properly demonstrated. That, coupled with the various pressures coming from demographics and the European working time directive, means that we need clarification from the Minister that the provision will be directed by professionals skilled specifically in maternal health. Without the involvement of people experienced in maternity and antenatal care, there is a real risk that, for all the aspirations, we will not secure anything more than a tick-box exercise. Surely, that is not the Government’s purpose. It is certainly not something that we want.
Mr. Bradshaw: Following your ruling, Mr. Hood, I do not intend to respond to the general remarks about midwife numbers, except to say that the figures given by the Liberal Democrats and the Conservatives were wrong. [ Interruption. ]
The Chairman: Order. The Minister was absolutely correct to say that he is not allowed to refer to the figures, so he should not do so.
Angela Browning: On a point of order, Mr. Hood, I wonder whether you could give me some guidance. It seems that if we are asking for a new and additional responsibility to be placed on a particular group of people, their numbers and existing responsibilities must be considered when deciding whether taking on yet another responsibility is doable. I would be grateful for your guidance on that.
The Chairman: The hon. Gentleman had gone too wide of the amendment. That is why I called him to order.
Mr. Bradshaw: The hon. Lady’s comments are absolutely relevant, because her amendments would place even more burden on midwives by insisting that only they, and not GPs or nurses, could give advice. I shall address that shortly. [ Interruption. ]
The Chairman: Order. I do not know whether hon. Members are a wee bit more excitable because this is the last day of the Committee, but I ask them to support the occupant of the Chair. It is usually easier and more productive without talking and muttering over other members of the Committee.
Mr. Bradshaw: I had no intention to go on at length about midwife numbers, unlike Opposition Members. I simply refer them to yesterday’s Hansard report of Prime Minister’s questions, where the figures are on the record.
The Government do not think that the amendment is necessary. In fact, given those earlier comments, we think that it would be unhelpful. We intend in regulations to define the type of health professionals who can give advice on maternal health. The amendment would reduce that flexibility, and it could also have the unintended consequence of creating confusion about who delivers advice on maternal health and when it is delivered. Unlike the term “health professional”, the term “maternal health professional” is not defined in any other legislation. During their pregnancy, expectant mothers can expect to receive advice on maternal health issues from their family doctors, GPs, nurses, and midwives at antenatal appointments.
We are working towards developing procedures whereby certification for the health in pregnancy grant can also be accepted for the Sure Start maternity grant. By proposing draft regulations, we are proposing a more flexible approach by which to enable the double use of health certificates for the health in pregnancy grant and the Sure Start grant. We do not want to restrict the measure to midwives, because that would rule out allowing doctors and nurses to give the same advice and certification.
We do not agree with the hon. Gentleman’s approach, so I urge him not to press the amendment to a Division because, if he does, we will vote it down.
Mr. O'Brien: In the light of the Minister telling us that there will be regulations, I dare say that we will pore over them when they are available. The regulations should be made available, so that we can have a sensible debate on the matter before the Bill becomes law. I urge him to publish the regulations before Report or at least before the Bill reaches another place.
Mr. Bradshaw: We have already published them.
Mr. O'Brien: The regulations to which the Minister referred in his reply are not complete, especially regarding the definition of “health professional”, to which he also referred. I am happy not to press the amendment to a Division, but better detail is required so that we can have a sensible debate on the matter. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Mr. O'Brien: I beg to move amendment No. 60, in clause 121, page 77, line 19, at end insert—
‘(3A) “Advice” given under subsection (3) must include advice on—
(a) nutrition,
(b) immunodeficiency,
(c) lifestyle,
(d) pre- and post-natal care,
(e) post-natal depression,
(f) breastfeeding.’.
The amendment follows on from the previous group. It would ensure that a pregnant woman receives advice, even if it is not from a maternal health professional. Among other things, the advice would be on nutrition, immunodeficiency, lifestyle, pre-natal and post-natal care, post-natal depression and breastfeeding. The proposal gives the Minister an opportunity to clarify what advice will be provided under proposed new subsection 140A(3) of the Social Security Contributions and Benefits Act 1992.
In an oral evidence session, the hon. Member for Romsey made the point that antenatal appointments generally last 10 minutes and, as such, offer little opportunity or time for detailed advice. She also made the point that antenatal classes are being cut up and down the country, and we have already discussed the shortage of midwives and health visitors. NICE has advised that women expecting their first child keep antenatal appointments at 12, 16, 18 to 20, 25, 28, 31, 34, 36, 38 and 40 weeks; but presumably, midwives do not have a responsibility to organise those appointments.
The health in pregnancy grant is partly an inducement to encourage people to take up at least one appointment, but we are concerned that the ad hoc nature of the arrangements will lead to a short visit to rubber stamp a claim, rather than a fuller discussion of pregnancy issues. I am sure that the Minister and his officials have considered that. We do not want an appointment to receive advice to become simply a qualification to receive a payment, because that would defeat the purpose of ensuring that advice is offered and taken.
9.45 am
The issue of time is inescapably linked to personnel, but there is also the question of training—a theme that we have returned to relentlessly in considering the Bill. In fairness, the Minister has acknowledged that that is a fair area that we need to focus on and put a lot of effort into and that has support across the Committee.
The submissions of the Twin and Multiple Births Association—TAMBA—and BLISS are relevant examples. They have noted the illogicality of the health in pregnancy grant as regards twin and multiple births, and have called for the grant to be paid per expectant child, rather than per pregnancy. They go on to state:
“Although these pregnancies are high risk, the interim results of a recent survey of multiple birth mothers by TAMBA found that only 9 per cent. were given advice on nutrition in multiple birth pregnancies. Of the 103 mothers whose babies required ‘special care’, less than 5 per cent. were given this advice.
We would welcome further clarification from the Government on how they intend to use this opportunity to improve awareness of the added importance of nutrition in multiple birth pregnancies.”
In the UK, about one in every 67 pregnancies results in a multiple birth. This equates to just over 10,000 births a year (10,533 in 2005).
Twins are four times more likely to die during pregnancy when compared to single babies, seven times more likely to die shortly after pregnancy, ten times more likely to be admitted to a neonatal special care unit and have six times the risk of cerebral palsy. The best chance of survival for a premature baby is a healthy birth weight so unborn multiple babies need to be well and fully nourished pretty much from the moment of conception.”
I am sure that the Minister will be aware of the advice in the book, “Everything You Need to Know To Have a Healthy Twin Pregnancy”, by Gila Leiter MD, at Dell in 2000.
TAMBA cites Professor Simon Langley-Evans, chair in human nutrition in the school of biosciences at the university of Nottingham, who raised the concern that, to be effective, the grant needs to be spent on improving the quality of pregnant mothers’ diets and added that
“paying the money in the final trimester is too late—the optimal time for any intervention will be in early pregnancy.”
Again, I am sure that the Minister will be aware of the e-mail message that was sent on 3 December 2007. So what plans does the Minister have for training? How long will the consultations last, and if longer than 10 minutes, where is he going to recruit and pay the midwives from? The issues mentioned in the amendment are cited and supported in the evidence that I have adduced. Will they be covered? Where will he do so? If nothing else, I strongly commend the amendment as being the best way to ensure that these matters are dealt with in a manner that I believe he intends them to be.
Mr. Bradshaw: Of course we agree that it is sensible that mothers receive advice on certain matters, but we are not convinced that it is sensible to prescribe in the Bill exactly what they should be. We would rather leave that to the good sense, experience and judgment of the professionals concerned.
Mr. O'Brien: Well, there we have it. I am sorry that the Minister has not taken the amendment more seriously. I dare say that it will get pursued elsewhere, and I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Mr. O'Brien: I beg to move amendment No. 61, in clause 121, page 77, line 31, leave out ‘Treasury’ and insert ‘Secretary of State’.
The Chairman: With this it will be convenient to discuss the following amendments: No. 62, in clause 122, page 78, line 2, leave out from ‘the’ to end of line 3 and insert ‘Secretary of State’.
No. 63, in clause 122, page 78, line 23, leave out from beginning to ‘may’ and insert ‘The Secretary of State’.
No. 65, in clause 128, page 84, line 36, leave out from ‘The’ to ‘responsible’ and insert ‘Secretary of State is’.
Mr. O'Brien: These amendments seek to make the Secretary of State for Health, rather than the Chancellor and the commissioners of Her Majesty’s Revenue and Customs, responsible for the regulations. I dare say that all members of the Committee will realise the import of what the amendments intend to achieve. If the Bill is a health measure—after all, that is why we are here—surely the Health Secretary should make the regulations on both the reasons for and the amount of the grant, although some hon. Members may feel that the Treasury should be in charge of absolutely everything.
Amendment No. 61 would ensure that the amount of the health in pregnancy grant is prescribed by the Secretary of State for Health rather than the Chancellor of the Exchequer. In addition, we will seek to amend proposed new section 140A(6) to the Social Security Contributions and Benefits Act 1992, which gives the Treasury
“the power to make regulations”
“the prescribed conditions in relation to a pregnancy”
and the circumstances in which a woman is to be treated
“as being, or not being, in Great Britain”
in proposed new section 140A(4).
Amendment No. 62 would give to the Secretary of State the power to make regulations in relation to the health in pregnancy grant under section 5 of the Social Security Administration Act 1992. I hope that everyone is able to follow me so far. As the Minister will no doubt point out, the inclusion of the commissioners of Her Majesty’s Revenue and Customs in clause 122(2) merely notes that the power to make regulations under section 5 of the 1992 Act lies with those commissioners, rather than granting them that power. I will not, therefore, press amendment No. 62 to a vote.
Amendment No. 63 would achieve that change by amending proposed new section 12A of the Social Security Administration Act 1992, which sets out the necessity of application for the health in pregnancy grant and opens the way for relevant regulations about time, manner and so on. Given that the section is concerned with process, rather than the substance, amount and circumstances of the grant itself, it could be argued that it would be better in the hands of the commissioners of the HMRC. However, if the paramount concern is the health of pregnant mothers—something that the Minister and even the Prime Minister have been at pains to impress upon us all—the primary conditions surrounding the grant should take precedence over the process by which it is awarded. Frankly, it is almost inconceivable that anyone could possibly object to that.
Under such a measure, the powers awarded under proposed new clause 140A would go to the Secretary of State for Health. Decisions about where other powers in respect of the health in pregnancy grant go should be made in relation to that. It is legislatively and practically tortuous to have, on the one hand, the Department of Health in control of regulations on the amount and prescribed conditions of the grant and, on the other hand, the commissioners of HMRC in control of regulations as regards process. Given that the health aspects of the grant should take precedence over the benefit aspects of the grant, the power in proposed new clause 12A should lie with the Secretary of State for Health, which is what amendment No. 63 seeks.
Amendment No. 65 would amend clause 128, which will make the commissioners for HMRC responsible
“for the payment and management of health in pregnancy grant.”
I will not strain your patience, Mr. Hood, by suggesting that we should not put HMRC in charge of anything that relates to most of the nation’s children at the moment, while it seems to be losing all sorts of data. The arguments for this amendment are similar to those for amendment No. 63. Although there may be an argument for HMRC to have powers that relate to the payment and management of such a grant, that should not be used as an excuse not to bestow on the Secretary of State for Health powers over the substance of the grant. I will be very surprised if the Minister does not agree with that in relation to his immediate superior.
These amendments also give me the opportunity to discuss the proposals that draw out the discrepancy of Treasury Ministers making regulations about a health matter. I thank the Minister for showing me the regulations in advance of these Committee proceedings. I hope that he will convey those thanks to his relevant Treasury colleagues. I am interested that the claim and payment dates are left blank under section 1. When does the Minister expect those dates to be announced and does he expect them to be different? I note in passing that any date in 2009 is about a year before the next general election, which has a strong bearing on how the purpose of the measure might be construed.
I am interested that the 25-week stipulation, about which there was such discussion on an earlier amendment, is left to regulations. Why is that? Under what circumstances does the Minister envisage that that would change? We have already discussed section 3 in relation to health professionals. I hope to have some discussion on section 4 in the stand part debate, as I have indicated.
Section 10 establishes the amount at £190. I flag up the National Childbirth Trust’s concerns, which were expressed in their written evidence, about the payment being a lump sum rather than a weekly benefit. The NCT contends that because child benefit is paid weekly or monthly directly to the mother,
“women can rely on it as a regular supplement to the household income for the payment of day-to-day expenses such as food and fuel costs. A lump sum would appear less likely to be used for weekly or daily costs, including food, and more likely to be spent on one-off payments for larger items. Following a recent visit to Australia, Professor Debra Bick of Thames Valley University informed the NCT that in Australia single payments to parents in pregnancy”—
the Committee has already heard this evidence—
“have been coined ‘plasma payments’ as they are typically used to purchase flat-screen TVs... The NCT believes that the Health in Pregnancy payments should be paid on a weekly or monthly basis as an extension of Child Benefit so that they are most likely to be used to increase the budget for regular household expenses, increasing the likelihood of there being more income available for a nutritious diet during pregnancy.”
That point was emphasised by the hon. Member for Luton, North when he intervened. Could the Minister tell the Committee why the Government moved away from their original plan of bringing child benefit forward into pregnancy?
I have some concerns about section 12. It is worryingly reminiscent of mobile phone salesmanship, where one has to claim cash back in a prescribed month so many months after signing up. Why has the Minister opted for a calendar month, which is quite a short period, particularly given the stresses of pregnancy? Surely, if the grant is to benefit the first weeks after birth as well, it should be claimable into the first few months of the baby’s life.
Of course the elephant in the room is the question of how long the process will take and whether families will get the right amount of money before their baby is a teenager. If there is any doubt about Government incompetence, the Department for Work and Pensions overpayment of £2.6 billion in benefits in 2005-06 is surely testimony to it.
Why is the power to make regulations with the Treasury? Does it not further undermine any claim that the grant is a health benefit? Will the Minister reverse that on Report? Under what circumstances would the 25 weeks or the £190 figure change? Why is there such a small window in which to make a claim? What evidence does the Minister have that the most disadvantaged people whom he hopes to target through the grant—those on whom we have all been trying to focus—will be able to claim it within the time constraints? How long will the period be between the initial claim and the grant payment arriving in a bank account?
Mr. Bradshaw: I shall just speak to the amendments, if that is all right. We think that there are good reasons why the Treasury and HMRC should be responsible for the health in pregnancy grant. All the main forms of financial support for families are administered by them in this manner, so it makes sense for the new payment to be brought alongside existing support for families, such as child benefit and child tax credit. That will bring the potential to simplify applications and administration, and it will build on the experience of those Departments that already make cash payments to a similar group of people. Asking my Department to manage a cash payment to pregnant women on this scale would be a major change in role and would bring none of the benefits that the existing links that HMRC has to the child tax credit and child benefit could bring.
Mr. O'Brien: The Minister says that all such payments originate with the Treasury and HMRC. He might be able to correct me if I am wrong, but I believe that the carer’s allowance is handled differently, and it is much more equivalent. Therefore, my point is valid. I am a little baffled by the Minister’s assertion. Whether he wishes to correct me now is a matter for him.
Mr. Bradshaw indicated dissent.
Mr. O'Brien: No. In that case, the situation causes us some problems. The matters are now set out on the record, and there are still the debates on Report and consideration in another place. If the Minister has not been able to secure sufficient advice and he has found that the question that I ask is worthy of consideration, let us try to get the matter under the control of the Department of Health—after all, it is proclaimed to be a health matter. However, if it is a benefit matter and therefore a financial matter that belongs to the Treasury, let us have Treasury rather than Health Ministers answer for it, and let us be straightforward about the Government’s proposals and their provenance. I leave the matter on the record, and I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
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The Chairman: Order. Although we have had a fairly thorough debate about the main proposition in the clause, I shall resist the temptation to deny the Committee a clause stand part debate, but I encourage hon. Members to be concise and not to repeat the debates that we have already had.
Question proposed, That the clause stand part of the Bill.
Mr. O'Brien: I shall do my best to heed your advice, Mr. Hood, but we should not be in any doubt that the appropriate place to discuss the evidential basis for the clause and how it tries to deliver what the Government have proclaimed—from the Prime Minister’s first utterances to today—is here. You noted that it was difficult to bring the issue into the debate on the first amendment, Mr. Hood, which I hope is an answer to the scratchy but perhaps early morning tetchiness of the Liberal Democrat spokesman, the hon. Member for Leeds, North-West.
The Liberal Democrat amendment was not about timing, which the Minister highlighted, but about the evidence base for the proposal. The Minister was focused on making the grant available from 25 weeks, so the Liberal Democrat proposal of 16 weeks did not get to the heart of the evidence-base matter. It was a testing approach, rather than a proposal for a scientific basis of 16 weeks. The Government’s lack of evidence, either underpinning the measure or put before ourselves as parliamentarians to aid the debate about the proposal, is a genuine indictment of the way in which they claim that they follow evidence-based policy making. The Committee will recall that the measure was first announced on 6 December 2006 by the then Chancellor of the Exchequer, now the Prime Minister, who said that he had
“received powerful representations that in the last months of pregnancy, when nutrition is most important”—
I emphasise those last five words—
“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.”
That is not a point with which I contend, but he continued:
“Maternity grants are available to low-income mothers from the 29th week of pregnancy.”
He said the 29th week at that point, and went on:
“Help should be available to all mothers expecting a child, so child benefit will be paid on that basis to every mother”—
it was all expressed as child benefit—
“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.]
The announcement was supported by notes, which said that the pre-Budget report
“provides further help for families and children, including from April 2009 every mother-to-be will be eligible for Child Benefit from week 29 of their that women will be up to £200 better off.”
That policy was mentioned on pages 1, 6 and 101 of the pre-Budget report 2006. The report also said:
“The Government recognises the importance of a healthy diet in the final weeks of pregnancy and the additional costs faced by parents when their children are born.”
In the interim, the payment through child benefit has morphed into a one-off payment and, although in proposed secondary legislation only, been pushed back to the 25th week of pregnancy—something that the Committee might wish to discuss in our continuing debates. Initially, the benefit was to be £200 for the first child and £130 for subsequent children; now, it is £190 for all births but not necessarily for all children. As we have already discussed, the £190 payment applies only to the birth—even if the mother has twins or more.
I have sought indefatigably the evidence on which the Prime Minister’s assertion was made, but neither the Department of Health nor the Treasury has seen fit to provide it. One must question what they have to hide. Or, perhaps there is no evidence, so they actually have nothing to hide except the Prime Minister’s embarrassment, and the fact that he has been found yet again to be the emperor without his clothes—not a pretty sight.
The Chairman: Order.
Mr. O'Brien: I agree that to go any further would be grossly out of order.
The move from a child benefit extension to a one-off grant was first made public when the Secretary of State for Health re-announced the measure in a speech at Toynbee hall—
Steve McCabe: On a point of order, Mr. Hood, I am mindful of the the former profession of the hon. Member for Eddisbury, but is it possible to indicate that he is not being paid by the word in this Committee?
The Chairman: That is not a point of order, as the hon. Gentleman should know.
Mr. O'Brien: The clause represents a Government promise to use many hundreds of millions of pounds of taxpayers money for something that they proclaim as a health benefit, but they have produced no evidence, so the Government Whip, the hon. Member for Birmingham, Hall Green, should not only withdraw the smirk on his face, but hang his head in shame. Arrogance is not appropriate in this Committee. We are seeking to scrutinise a Government measure—[ Interruption. ] I am sorry if he finds words difficult to tolerate, but we are parliamentarians—it is our trade. By April 2009—[ Interruption. ] One day, he may stop chuntering as well. It would be amazing if he ever learned manners.
The Secretary of State for Health re-announced the measure in a speech at Toynbee hall on 12 September 2007. He said:
“By April 2009, we will introduce a new Health in Pregnancy Grant, making a payment to each expectant mother. This will be in addition to Healthy Start vouchers... This substantial payment will be directly linked to improving nutrition — so it will be paid alongside nutritional advice, and the sum of money will be sufficient to help every mother eat healthily during her pregnancy.”
It is worth noting that, during the announcement, the Secretary of State focused solely on the nutrition arguments for the grant, in sharp contrast to the Minister’s contention in the oral evidence session that the Government
“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”.——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 105, Q257.]
That was the first indication of the Government shifting their position—they were beginning to find themselves all over the place on the measure. The measure was re-re-announced by the Financial Secretary to the Treasury on 14 November 2007. There is a telling discrepancy between the two press releases posted on In the first, the Financial Secretary to the Treasury said:
“We know that a healthy lifestyle, including a healthy diet, is important for all women in the later stages of pregnancy”.
That quotation was removed from the press release in a later, corrected copy. Again, in the first press release, the Financial Secretary said:
“The Health in Pregnancy Grant is designed to provide pregnant women with financial support, alongside important advice from a health professional to help them invest in their individual needs during pregnancy, whilst giving them the flexibility to choose how they budget and where they spend this money”.
However, that ministerial statement was later excised from the body of the press release. I contend that that shows that the Government were in a terrible mix-up about both the provenance and future shape of the policy.
Having failed to glean evidence from Government announcements, I pursued the matter through parliamentary questions, as the Minister knows. On 28 November last year, I tabled two named day parliamentary questions. The first asked for the evidence underpinning the initial announcement. The second asked for the evidence and what consultations were held between the first announcement and the final health in pregnancy grant proposal. The latter was answered on the named day. On the former, I received a holding answer on 18 December from the Financial Secretary, who told me that she would respond as soon as possible—no change there then. The answer arrived on the letter board yesterday, and appears in Hansard today. To delay publication until the eve of our debate on the topic is symptomatic—it is a hallmark—of the contempt in which the Government hold Parliament. Doubtless the Financial Secretary hoped that I would not be nimble enough to spot that I had received the answer for today’s debate.
I shall deal with the questions as I now find them. On my question seeking information on the representations received and meetings held since the announcement, I was told that
“it is not the Government’s practice to provide details of...meetings”
“Treasury Ministers and officials”
“a wide variety of organisations”—[Official Report, 4 December 2007; Vol. 468, c. 1197W.]
The answer also stated that representations on the grant received after the initial announcement were contained in the Treasury’s 14 November 2007 press notice on the grant. That referred to the second re-announcement of the measure on 14 November 2007. The press release quoted only the Royal College of Midwives and the Royal College of Nursing, and while I have the greatest respect for both of them as professional bodies, I would remind that Committee that they are also representative bodies for those professions. As such, their motives, quite rightly, are mixed and regard their members’ interests as much as the needs of pregnant mothers, which almost invariably coincide. None the less, there are those mixed agendas.
I asked the Secretary of State for Health
“what assessment he has made of the economic implications of the Health in Pregnancy Grant; if he will publish research (a) commissioned and (b) evaluated by his Department on the grant.”
The answer came back from the Treasury:
“HM Treasury received a wide number of representations before the 2006 pre-Budget report on tax and benefits issues, which formed part of the process of policy development for the 2006 pre-Budget report. The decision to make a payment to all women during pregnancy was announced in the 2006 pre-Budget report
It also said:
“The grant will help women meet the additional costs involved in pregnancy and in the run up to birth” —[Official Report, 17 December 2007; Vol. 469, c.1223-1224W.]
during the important last weeks of pregnancy. Once again, the Treasury refuses to provide any evidence. I also asked the Chancellor on 5 December
“what representations he received in favour of the introduction of child benefits in pregnancy before his 2006 pre-Budget speech; and if he will place copies in the Library.”
The answer came back:
“HM Treasury received a wide number of representations before the 2006 pre-Budget report on tax and benefits issues...”—[Official Report, 10 December 2007; Vol. 469, c. 283W.]
—blah blah, the same sort of stuff. [ Interruption. ] I am sorry, that was not very clear. I asked the Chancellor for what reasons benefits in pregnancy are to be provided through the health in pregnancy grant. This would have been a useful opportunity for the Treasury to explain to parliamentarians the reasons behind the shift to a one-off payment, rather than an extension of child benefit. The answer came back:
“The Government are introducing the Health in Pregnancy Grant from April 2009 as a one-off payment to expectant mothers to help them during the important last weeks of pregnancy. It will provide flexible financial support as a one-off payment, and will be payable per pregnancy. This recognizes the additional costs involved during pregnancy and in the run up to birth.”—[Official Report, 17 December 2007; Vol. 469, c. 1124W.]
Anne Milton (Guildford) (Con): Does my hon. Friend agree that the important weeks in pregnancy and nutrition are at the start of pregnancy and ideally, pre-conception?
Mr. O'Brien: That is what, I think, we understand from the evidence. I shall come on to that in a moment to ensure that it is on the record. What I am trying to understand is that this did not come from nowhere—the Prime Minister, then the Chancellor, announced it as being the answer to a recognised need. He framed it in the last weeks of pregnancy, and we have done no more than ask for the evidence. I am only asking where it is, and why we do not have it.
Hon. Members from both sides might be lulled into believing that this measure is somehow magically supported. I hope that the Minister has got the answer in his notes. It would be wonderful, at last, to get there. Having comprehensively failed with the Treasury—the Department which, as we have already discussed, seeks to administer the grants right down to regulations on a health provision—I turned to the Department of Health for answers. It was more forthcoming with substantive answers, for which I thank the Minister, although the evidence that it cited pointed away from the health in pregnancy grant as an effective public policy intervention. I asked the Secretary of State for Health if he would publish the information that his Department holds on the effect of diet before and during pregnancy, for the birth rate of babies. The answer that I was given by the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), stated:
“In 2000, the Committee on Medical Aspects of Food and Nutrition Policy in their report ‘Scientific Review of the Welfare Food Scheme’ recommended that improving the dietary intake of women of childbearing age has the potential to ensure that nutritional status at conception is adequate to support optimum fetal development.
Under the Healthy Start scheme, the Department currently provides nutritional support to low income and disadvantaged pregnant women and families with young children by offering vouchers to put towards the cost of buying milk, fresh fruit, fresh vegetables or infant formula at a participating retailer. Currently the Scientific Advisory Committee on Nutrition—Subgroup on Maternal and Child Nutrition is reviewing the effect of early maternal, fetal and child nutrition on the development of disease in later life. The report is due to be published by end of next year.”—[Official Report, 18 December 2007; Vol. 469, c. 1375W.]
10.15 am
I shall come to the scientific review of the welfare food scheme, but as to rest of the answer, although I accept the existence of the healthy start scheme, I do not see what relevance the information had to the question. It did not provide any conclusions on my question about the impact of diet on birth rates. I take no issue with the fact that the Under-Secretary seemed to use a strange spelling of the word “foetal”.
It was brave of the Department to flag up the review currently being undertaken by the Scientific Advisory Committee on Nutrition’s sub-group on maternal and child nutrition. Any evidence-based policy should surely be built on the conclusions of that review, not pre-empt them. Furthermore, the Minister or his officials should have taken the time to examine the committee’s submission, as recent as last summer, to the NICE review of maternal and child nutrition—another review that the health in pregnancy grant has pre-empted. We could not find agreement to call the committee’ representatives before us as witnesses. Had the Minister examined that submission, he would have seen that the committee stated that
“it is too strong to state in a NICE guidance document that early nutrition ‘may also reduce the risk in adult life of conditions such as coronary heart disease and obesity.’ It ‘may’ but there is very little hard evidence in humans that changing diet in pregnancy can reduce the incidence of chronic disease in later life.”
That somewhat undermines the impact of the last paragraph of the answer given to me by the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth.
I turn to the scientific review of the welfare food scheme by the Committee on Medical Aspects of Food and Nutrition Policy. Helpfully, the Library was able to provide me with a copy so that I could ascertain for myself whether, as the Under-Secretary had suggested in her answer to me, it had
“recommended that improving the dietary intake of women of childbearing age has the potential to ensure that nutritional status at conception is adequate to support optimum fetal development.”—[Official Report, 18 December 2007; Vol. 469, c. 1375W.]
The review, published in 2002, notes on page 14 that
“there are no national data on the dietary intakes of pregnant women”
and that the national dietary and nutritional survey of British adults
“specifically excluded pregnant women and only 10 lactating women were included”.
The report also notes:
“The only nutrient which has a specific Dietary Reference Value at the time of conception is folic acid...For most nutrients, no increment for pregnancy is given. This does not necessarily imply no increase in metabolic demand during pregnancy but rather that such extra demands should be met by normal adaption or increased efficiency of utilisation, or from stores of the nutrient”.
As the parliamentary answer noted, it states that
“the special nutrient demands and critical growth periods experienced by children and women of childbearing age de facto makes them nutritionally vulnerable”.
At first glance that supports the health in pregnancy grant, but women of childbearing age are a much larger constituency than pregnant women, and very different. If the Government were basing policy on that evidence, would they not be intervening in the diet of all women of childbearing age?
The Committee might be interested to know that the review states on page 34 that in 1999 in England and Wales,
“7.1% of live births were low birthweight”.
That is the proportion that we are dealing with. Paragraph 5.4.1.ii of the review examines in depth the role of nutrition. The hon. Member for Luton, North might be particularly interested in it, considering his line of questioning at the oral evidence sessions. He was pursuing with clear determination the point about foetal alcohol damage. That paragraph states:
“Although it has been argued that maternal nutrition during pregnancy has an important effect on fetal growth (Barker 1992) evidence of a relationship in generally well nourished populations like that of the UK is inconclusive (Haste 1991, Godfrey et al 1996; Matthews et al 1999). Smoking and high alcohol intake are probably more important environmental causes of fetal growth constraint in such circumstances...the relationship between dietary factors during pregnancy, outcome and birth weight are not strong.”
It goes on to note that
“improving the dietary intake of women of childbearing age has the potential to ensure that the nutritional status at conception is adequate to support optimum foetal development. Currently welfare foods are provided only after pregnancy is established though there is clear evidence that women are nutritionally vulnerable before conception.”
The review, which the Department prayed in aid as evidence for this measure, to all intents and purposes would see the health in pregnancy grant as at best, of little value, and at worst, counterproductive.
As I mentioned earlier, I only yesterday received the answer to my question, tabled on 28 November last year—plenty of time before this Committee—about the evidence for the basis of the original announcement by the Prime Minister in the pre-Budget report of 2006, and we are only here because he made that statement. That answer is in Hansard today. Specifically, I asked him to place in the Library evidence that nutrition for pregnant mothers is most important in the last months of pregnancy. The answer states that:
“There is a wide range of evidence that nutrition for pregnant mothers is important throughout pregnancy...The importance of maternal health during pregnancy was recognised by the Royal College of Midwives and Royal College of Nursing in HM Treasury’s 14th November 2007 press notice on the health in pregnancy grant, on the HM Treasury website.”
If that is the evidence that the Prime Minister backs, to refer to a Treasury press release that he was authorising, circularity is the nicest word that I can possibly think of for that.
It seems that Ministers and Treasury officials are going out of their way to stop the Prime Minister from being embarrassed and squirming; it is worrying, to say the very least. Not only has that answer failed to answer my specific question about the evidence that informed the budgetary statement, it gives no examples of the evidence that it claims exists on nutrition and it prays in aid a press release delivered a year after the initial announcement as evidence for it. Does any member of the Committee think that that is an adequate response? I hope that the Minister will speak to his colleagues in the Treasury and perhaps to the Treasury officials, whom I know will be in this room as we are talking, because after all they are in charge of this payment unless the amendment is accepted, which is another point. I hope that they will take this message back and answer the question properly, not in the obfuscatory manner that is patently ridiculous and demeaning for this process, particularly given that the response took two months to write. I shall also be pursuing the matter.
In their unwillingness to provide answers and in providing evidence that directly contradicts the measure, the Government have shown how lacking the evidence is for the health in pregnancy grant, as designed by the Prime Minister and his Government. This criticism has been endorsed by the evidence of third-party organisations. During her helpful and balanced oral evidence, Rosemary Dodds of the National Childbirth Trust stated that
“the intention of the payment has not been made clear.”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 85, Q197.]
She continued:
“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.”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 86, Q198.]
She also said:
“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.”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 87, Q202.]
We agree with that. The Kings Fund has called the measure “silly” and the written evidence from Bliss and the Twins and Multiple Births Association, which we have already discussed in some depth shows how ill-thought-through this measure is, as regards nutrition for women pregnant with multiple babies.
The Minister may stand up and argue that this is post-hoc, given his admission during his oral evidence, in direct contradiction to his own Prime Minister that
“the evidence suggests that the nutritional benefits, specifically to the unborn child, are better earlier on in pregnancy.”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 104, Q257.]
However, the fact remains that this intervention is based upon an announcement made by the now Prime Minister about which no Minister can supply any substantial evidence. One wonders what limits, if any, Ministers and Treasury officials will go to, to cover the embarrassment of the Prime Minister. Instead of bringing forward measures that address the issues of the real world, Ministers have chosen to bulldoze on, in the face of the evidence on which they say they are drawing, and in the face of the evidence that is brought out in a close reading of third-party comment on this measure, and which I have taken the trouble to ensure is on the record through the Committee’s proceedings. They have chosen to change their language, not the substance of the policy, which is spin at its worst. They have chosen not to be free and frank with their parliamentary answers, which is unfortunate. The House deserves an apology.
It being twenty five minutes past Ten o’clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.
Adjourned till this day at One o’clock.

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Prepared 25 January 2008