House of Commons |
Session 2007 - 08 Publications on the internet General Committee Debates Health and Social Care |
Health and Social Care Bill |
The Committee consisted of the following Members:John Benger, Celia Blacklock,
Committee Clerks
attended
the Committee
Public Bill CommitteeThursday 24 January 2008(Afternoon)[Derek Conway in the Chair]Health and Social Care BillFurther written evidence to be reported to the HouseH&SC 31 Department of
Health
Clause 121Entitlement:
Great
Britain
Question
proposed [this day], That the clause stand part of the
Bill.
1pm
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 Committees attention to
Healthy Weight, Healthy Lives A Cross Government Strategy for
England, which was the obesity strategy launched only
yesterdayI appreciate that is not as fresh as todays
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
babys growth rate is in part determined by parental factors,
with the period immediately after birth of particular
importance.
The
Governments 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 women...do 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
Governments 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 Ministers 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.
Greg
Mulholland (Leeds, North-West) (LD): I thank the hon.
Gentleman for reiterating and reinforcing many of the points that I
made at the beginning of the
morning sitting, particularly the stark reality that there is no
evidence to support this significant new policy. It is abundantly
clear, and will plainly remain the case, that the very pertinent and
important questions that have been asked, both today and previously,
about the new payment and its aims, have not been answered at any
stage. It is regrettable that that is still the case in
Committee.
The
realitysomething that no one, including the Minister, would
disagree withis 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
Governments 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 womens 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 greensall 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 someones 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 misapprehensionhe 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
babys 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
Governments 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 familiessome mothers, some
fathersdo 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
Democratsdespite their commentsto 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.
|
| |
©Parliamentary copyright 2008 | Prepared 25 January 2008 |