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Session 2007 - 08
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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


[Derek Conway in the Chair]

Health and Social Care Bill

Further written evidence to be reported to the House

H&SC 31 Department of Health

Clause 121

Entitlement: Great Britain
Question proposed [this day], That the clause stand part of the Bill.
Question again proposed.
Mr. Stephen O'Brien (Eddisbury) (Con): We were galloping through clause 121 stand part, but over lunch we have had the opportunity to reflect a bit more. I shall not rehearse what I briefly alluded to before the break, although I recognise that over lunch we had the slight distraction of the demise of the Secretary of State for Work and Pensions. I draw the Committee’s attention to “Healthy Weight, Healthy Lives A Cross Government Strategy for England”, which was the obesity strategy launched only yesterday—I appreciate that is not as fresh as today’s lunch time news. If the Government seriously consider the health in pregnancy grant a proper nutrition and health-based initiative, surely it should be included in that document? It is not. Although on page 3 the document claims:
“A baby’s growth rate is in part determined by parental factors, with the period immediately after birth of particular importance”.
The Government’s obesity strategy makes no mention of that grant.
In conclusion, both the Prime Minister on 6 December 2006 and the Health Secretary on 12 September 2007 claimed that the grant is for maternal nutrition in the last weeks of pregnancy, alongside the unsubstantiated claim that in that period nutrition is most important. By the time the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) gave his oral evidence, that claim had become diluted to the grant supporting other things, namely:
“specific health advice from the 25th week of pregnancy”——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 104.]
A claim that is questionable given the oral evidence of the treasury official, Jonathan Athow, who on the same day said:
“a very small proportion of not seek regular contact with the health professionals”. ——[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 106]
The Minister referred to:
“the general pressures that women, particularly less well-off pregnant women, are under”.—[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 104.]
If that is the case, a more focused intervention on less well-off women would make more sense. The Minister also referred to
“The pressures immediately before and after birth”.—[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 105]
We have had no evidence from the Minster underpinning the choice of an otherwise apparently arbitrary figure of £190. Clearly that is a contribution rather than the full cost associated with the joyful event of having a baby. The Minister also referred to
“The serious problems of underweight babies in this country”
That is a serious problem affecting 7.3 per cent. of live births in 1999. The “Scientific Review Of The Welfare Food Scheme”, which I mentioned earlier, states that that problem is combated by impact pre-conception nutrition. It is also important to mention what the Minister referred to as
“the still very stark inequalities in health of both women and children”. —[ Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 103.]
I am absolutely sure that each one of those items will be recognised by the Minister because each one was a direct quote from his oral evidence.
Given the £3.8 billion that it is claimed is needed to achieve the Government’s target of cutting child poverty by half by 2010, the figure of £145 million does not even make a dent. In case hon. Members misunderstand me, particularly Government Back Benchers, I am not questioning the need to support pregnant mothers or the need to make a payment. We want to give the money; never let it be said that we do not. I am simply seeking to call the Government to account for the evidence for the health in pregnancy grant being the best way to spend £145 million per annum and whether that is the best way to achieve the best outcome for vulnerable pregnant mothers.
I believe that I have made my case, but I fear that I will be unable to persuade the Minister. I hope that Government Back Benchers will seek to call Labour party policy to account for the effective use of taxpayers’ money. Otherwise, there is a real danger that they will find themselves joining a bandwagon that an ill-advised Chancellor set rolling before he became Prime Minister. Officials and Ministers are now trying to cover up the Prime Minister’s considerable embarrassment at being seen to be a headline-grabber rather than someone who introduced a workable and effective policy based on hard-headed evidence. It is a policy that Ministers and officials are now desperately scrabbling around to post-rationalise, change by stealth, refuse to provide the evidence for and ram through. On that basis, we are looking genuinely and seriously for answers, and above all, at last, please, the evidence to substantiate what the Prime Minister said when he started the ball rolling. We are looking for the reason why we now find ourselves engaged in parliamentary scrutiny of the Bill.
The reality—something that no one, including the Minister, would disagree with—is that a considerable proportion of the large sum of taxpayers’ money represented by the payment will probably be spent on things that have nothing to do with diet and nutrition. A proportion, again, probably considerable, will be spent on things that have no direct effect on health in pregnancy. It remains unclear what the health in pregnancy grant actually aims to do, and we have got no further down that road during our discussions.
In reality, this is a pre-birth child benefit one-off payment, and if that is what the Government want to do, they should say so and be clear about what they hope to achieve. One specific point that I wish to pick up is the issue of multiple births. If this is, as it seems to be, a child-benefit payment, it should reflect the reality of multiple births. Not to recognise that at seven months into pregnancy seems absurd.
There should have been more consultation. The expert advice and views of the involved organisations should have been listened to, to see whether there was a better way of achieving this or whether the Government need to change their rationale. Either way there is still a lot of work to do, and that should not be the case at this stage of the legislation. The measure will undoubtedly go through, despite the fact that the arguments and the purpose are not clear. When the payment starts, there must be a lot of analysis to see if it delivers. I hope that the Minister will acknowledge that and tell us that that will happen and that we will have a sense of what the payment achieves once it is introduced.
Angela Browning (Tiverton and Honiton) (Con): I want to pick up on one or two issues that have been raised. I feel confused about the Government’s intention for the grant. It is over 40 years since I studied nutrition to an advanced level as a home economist. In the oral evidence-taking session I mentioned that as a former president of the then Institute of Home Economics, issues of nutrition and care of family welfare, food and budgeting and so on made up an important part of our deliberations. I agree, if it is a question of putting extra money into the family income at a time when a child is expected and there are additional expenses. The case has been made that the money might be used not just for buying more nutritious food and having more information about it, but also for other things such as paying off debts, or helping to relieve stress in pregnancy, and we can all understand that. However, I wish to focus on how the measure will help women who are pregnant to be healthier and to produce children whose health can be measurably defined as improved at birth. I assume that the Government would want to monitor that. We have heard a lot about birth weights, so one must assume that, however the money is used, it will have a direct effect, statistically, over a period, on the health of the child at birth and on birth weight.
I do not claim to be as up to date on such matters as I was 40 years ago. I am aware of the importance of folic acid in pregnant women’s diets, which I was not aware of some years ago. Equally, some things are still relevant today. For example, as I said in an oral evidence session, calcium and vitamin D in particular, as well as phosphorous, are important in the foetal development of teeth and bones. We know how the generation who lived through the second world war and did not receive adequate supplies of calcium were affected.
Those things are important, but I am not clear on who will deliver the information and advice, or whether that will mean that mothers take heed of the advice. I remember watching with horror the Jamie Oliver series in which he tried to improve school meals. I was not shocked that school children did not want to eat their greens—all parents have been through the battle of trying to get their children to eat cabbage and things like that. I was shocked, however, that the mothers not only did not buy fresh fruit and vegetables, but would not know how to cook them if they did. There is a large body of people out there, and among those people, particularly mums, it is probably the poorest who most need the information about introducing those things into their diet. They need to undergo the education process by which they will come to recognise the importance of nutrition as well as in what foodstuffs the essential vitamins and minerals that are important during pregnancy are to be found. It will be fine if we are talking about middle-class mums who will read magazines on such matters and attend antenatal classes frequently. However, I suspect that the Minister has in the back of his mind that large group of people, who are among the poorest, for whom it is not only a question of introducing money or information, but who have a mountain to climb because of what they regard as a normal, healthy diet.
Earlier in the debate we discussed who will offer the advice. The Minister said that that would be dealt with in regulations. I made a quick note of the options available for offering the advice. It included GPs, practice nurses, and midwives who are involved in antenatal care. However, I suspect that once the forms are filled in to trigger the grant, it will be a matter of pressing a leaflet into someone’s hand and saying, “There you are, that is what you need to know”. If that happens, we will not be able to say in five years time that there has been a demonstrable improvement in birth weights and the ongoing health of children who benefited from the grant in the womb.
We should remember that recently, for the first time in 100 years, we identified rickets in children. Rickets can be avoided if people have proper nutrition, particularly those things that lay down calcium, such as vitamin D and phosphorous. The debate has gone round and round on what the measure is for, but we have not talked about outcomes. If we went out on to Westminster bridge, we could do a little survey by asking people, “Do you think it is a good thing that the Government are going to give this grant to pregnant women?”, and perhaps everybody would say “Yes”. The reality is, however, that if public money is going to used to deliver an outcome, the Minister must focus much more on what the money is intended for and how he will deliver it, bearing in mind some of my points about the lack of knowledge and understanding and the somewhat limited time scale that will be available to the professionals who are going to be charged with delivering the information.
1.15 pm
I am going to congratulate the Government, something that I am always happy to do when they get it right. The Minister need not look surprised, he knows that I am a fair-minded person, he is my next-door neighbour. It is absolutely first class that the Government are going to introduce cookery classes into schools. I have lobbied for that for a long time; it was wrong to get rid of them in the first place. I hope that it will make a difference, but it will take some years to filter through, so let us start at the beginning, which is what the clause seeks to do, and ensure that the Minister gets it right. We are actually willing him to get this right, but at the moment I am not convinced from what I have heard that it will deliver what he intends.
Anne Milton (Guildford) (Con): I do not want to rehearse the arguments that have already been made, but there are a few issues that I want to raise. On the number of midwives, the Minister might have been under a misapprehension—he needs to look at the full-time equivalents. The figures for full-time equivalents demonstrate that the number of midwives is not keeping pace with the number of live births.
The other matter I would like to raise about the grant is inequalities in health. Under part 5 I have tabled an amendment that touches on some of the issues surrounding public health. The problem with the grant, to repeat what my hon. Friends have already said, is not whether it is spent, but how it is spent. As a poverty alleviation method, it is absolutely fine. As the National Childbirth Trust pointed out, it gives mothers some extra cash in the home at a difficult time in their pregnancies and one would hope that they would spend it on their own and their baby’s health. However, the grant does nothing to address the inequalities that exist in health, which are getting worse, not better. The distance between the health outcomes of poorer people and richer people is greater than it has ever been. I do not doubt the Government’s commitment to reducing those inequalities and the fact that they have been unable to reduce them demonstrates that it is extremely difficult to do so. The sad thing is that this is a substantial amount of money that is not being directed to closing that gap because we will be stuck with a group of people that are hard to reach. The trouble with antenatal care in particular is that the good old middle classes, the ones that actually think about what they eat and how they spend money, trot along, listen to the midwife, pick up leaflets and go home and do all the things that they are meant to. The ones that we really need to reach will not do that.
Sandra Gidley (Romsey) (LD): I am a little alarmed at the assumption that the middle classes will read magazines and do things well, and the working classes will not. I think there is probably a spread in any socio-economic group.
Anne Milton: I thank the hon. Lady for her intervention. She used the words “working classes”, I did not. I am saying that there is no denying the fact that there is a hard-to-reach group. They might be in the middle classes; they might be those members of the middle classes who are alcoholics sitting at home drinking themselves stupid, and whose babies will be born with foetal alcohol syndrome. We have to use generalities; there is a hard-to-reach group. They are not necessarily working-class, but the hon. Lady might pay more attention to inequalities in health than making comments about language. It is absolutely vital that we reach those women. [Interruption.] If the hon. Lady would like to make another intervention, I am happy to give way to her again.
My hon. Friend the Member for Tiverton and Honiton commented that the problem with introducing vegetables into diets is that some families—some mothers, some fathers—do not even know how to cook them. That is what we are up against. Recently somebody who works on a labour ward in south London told me that a substantial number of women are asking to stay in for the night after their baby is born because they want to go out clubbing on that first night. Talking from personal experience, when I had a baby, I was locked in a room with the curtains closed. I would never have been able to go to a club, probably even within four weeks of the birth of my children. However, a different sort of women is having babies nowadays, and they are extremely difficult to reach. I do not think that the Minister has listened to all that has been said in this debate, but I urge him to be non-party political about this. We are making genuine attempts, as are the Liberal Democrats—despite their comments—to ensure that the money is well spent and directed at the people who need it most.
The Minister of State, Department of Health (Mr. Ben Bradshaw): Mr. Conway, I am cognisant of the stricture of your co-Chairman this morning that contributions in the stand part debate should be brief. Given that we have spent about 50 minutes on it, and the hon. Member for Eddisbury spoke for more than 30 minutes, and that we had a good and comprehensive debate on the evidence base for the measure in response to the Liberal Democrat amendment this morning, I do not intend to repeat everything I said then in support of the evidence base. My comments will be in the record for Members to read tomorrow.
The hon. Member for Tiverton and Honiton raised a new issue about evaluation. I can assure her that we are developing an evaluation plan.
Question put and agreed to.
Clause 121 ordered to stand part of the Bill.
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