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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
Public Bill CommitteeThursday 24 January 2008(Morning)[Mr. Jim Hood in the Chair]Health and Social Care BillFurther written evidence to be reported to the HouseH&SC
30 The Patients
Association
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Clause 121Entitlement:
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?
Angela
Browning (Tiverton and Honiton) (Con): It seems important
that the nutrition to the mother, and subsequently through the mother
to the foetus, is
delivered as early as possible. We must guarantee as much as possible
that women will take something that will benefit both their own health
and that of her child. Does the hon. Gentleman not think that properly
balanced vitamin and mineral tablets provided at the point at which
pregnancy is agreed, regardless of whether there are abortions down the
track, give a much better delivery at the appropriate time than going
through the rigmarole that the Government are suggesting
now?
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?
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.
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.
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—
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?
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?
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.
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:
Obviously I was misheard. I said
“cheap”, with a “p” on the end for
“Peter”. I did not say
“cheat”.
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.
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.
‘(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”
regarding
“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.
None the
less, I hope that the Minister, if he smiles on the point that I am
making, will propose legislation to amend section 5 of the Social
Security Administration
Act 1992, to grant the power of regulation in relation to the health in
pregnancy grant only to the Secretary of State for Health. I hope that
that is a very straightforward way of wresting the power away from the
Treasury and giving it to the Department of Health. If Ministers cannot
sort it out, we can enjoy the spectacle of a battle between officials
behind closed
doors.
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.
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.
10
am
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
pregnancy...so 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 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?
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 wired-gov.net. 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”
between
“Treasury
Ministers and
officials”
and
“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.
It is strange that
the Treasury had not sought to liaise with NICE, the Scientific
Advisory Committee on Nutrition, academia or pregnancy-related
charities in seeking the best way to achieve healthy outcomes for
mothers. I was disappointed to be given a press release, rather than a
substantive response in answer to the question. Having had that
unenlightening answer on 4 December and leaving aside, for now, the
unanswered question of the evidence for the claims of the Prime
Minister and the Secretary of State for Health about nutrition in
pregnancy, I tabled another tranche of questions on 11 December, which
were answered on 17 December.
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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