House of Commons
|Session 2008 - 09|
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Public Bill Committee Debates
The Committee consisted of the following Members:
Gosia McBride, Committee Clerk
attended the Committee
Fifth Delegated Legislation Committee
Wednesday 1 April 2009
[Ann Winterton in the Chair]Health in Pregnancy Grant (Entitlement and Amount) Regulations 2008
That the Committee has considered the Health in Pregnancy Grant (Entitlement and Amount) Regulations 2008 (S.I. 2008, No. 3108).
The Chairman: With this it will be convenient to take the Health in Pregnancy Grant (Administration) Regulations 2008 (S.I. 2008, No. 3109).
I preface my remarks by declaring an interest. My daughter is to have a baby, although she is 20 weeks pregnant today, so I do not think that the regulations will affect her at all.
We are taking the unusual step of praying against the regulations. The grant will give women in the 25th week of pregnancy £190 to
help with the costs of a healthy lifestyle, including diet, in the later stages of pregnancy,
according to the Department of Health. That will cost about £130 million a year, based on approximately 700,000 births a year in the UK. Although the grant will be welcome for helping people to deal with the costs of pregnancy and preparations for having a child, we are concerned that it is poorly targeted and that there is no evidence to suggest that it will be useful in improving maternal health.
The problems with the Governments public health programmes were highlighted recently in a report by the Health Committee, whose press release stated clearly:
While commending the Government for taking action to tackle health inequalities, the report is highly critical of policy design and implementation, which it says has made meaningful evaluation of initiatives impossible. In attempting to address inequalities, governments have rushed in with insufficient thought, a lack of clear objectives, have failed to collect adequate baseline data, made numerous changes and not allowed time for policies to bed in.
The Select Committee also commented:
The Government has not made even basic calculations about how much has been spent on tackling health inequalities. Along the way they kept on changing things and abandoning initiatives before it was possible to learn what the results of their initiatives were... Such wanton large-scale experimentation is unethical and needs to be superseded by a more rigorous culture of piloting, evaluating and using the results to inform policy.
Assistance packages already available to expectant mothers on low incomes, starting with the Sure Start maternity grant and Healthy Start vouchers to help with the cost of milk, fruit and vegetables during pregnancy. Parents who claim the grant will be required to seek health advice from a health professional, which we agree is a good thing, but we think that there are much better ways to improve maternal health. In
The NHS work force figures published on 25 March show that the number of health visitors has declined again this year and now stands at 11,19011 per cent. lower than in 1998. The number of district nurses has fallen this year to 10,446, a decrease of more than a quarter since 1998. The number of midwives has increased, but only marginallyby 2 per cent. They are the staff who are best placed to deal with the health inequalities and problems caused by poor diet, which the scheme aims to tackle. The fact that their numbers have declined is an indictment of the Government. The benefit of extra midwives and health visitors has been clearly demonstrated, and the health in pregnancy grant is the sort of initiative that diverts resources away from the proven ways of helping to improve maternal and child health for the sake of cheap headlines. It is, I am sorry to say, a gimmicky policy.
Mr. David Gauke (South-West Hertfordshire) (Con): It is a pleasure to serve under your chairmanship again, Lady Winterton.
I thank the hon. Member for Solihull for introducing this afternoons debate. It is fair and reasonable to ask a number of questions about the proposals before us. The hon. Lady mentioned that the likely cost would be around £130 million, and I will be grateful if the Minister can confirm that number; certainly, when this matter was debated a year or so ago, the figure quoted was £120 million. Either way, it is a reasonably substantial amount of money, and in the current climateindeed, at all timesit is important to ensure that we get value for money. I particularly note the hon. Ladys comments on health visitors, about which my party feels strongly, as they provide an effective way of providing targeted support to those who need itmothers and very young children.
As I understand the health in pregnancy grant, it essentially has two purposes. It was first announced on 6 December 2006 by the then Chancellor, now the Prime Minister, who made reference to providing support in the later months of pregnancy,
when nutrition is most important.[Official Report, 6 December 2006; Vol. 454, c. 308.]
He also made reference to the need to support families at that time, which may be expensive. I shall focus on the health issues and the health justification for the moment, and I hope that the Minister will be able to address those pointsI frequently debate with the right hon. Gentleman, but not so much on health matters. That statement was made by then Chancellor in December 2006, and the accompanying pre-Budget report stated that
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.
The policy was re-announced, as is the way with this Government, in September 2007 by the Secretary of State for Health, who said that
the sum of money will be sufficient to help every mother eat healthily during her pregnancy.
Will the Minister tell us when in the course of a pregnancy the Government consider healthy nutrition to be the most important? My understanding is that it is during the early monthsindeed, even at the time of conceptionthat nutrition is the most important, but the grant is targeted at the 25th week of pregnancy, which does not seem entirely consistent. The grant may not be the best use of resources in improving nutrition.
The grant is given in one lumpit does not pay for specific items of food or vitamins, nor is it paid weekly or monthly, which one might expect if the intention was to improve diet. That makes me think that the policy is driven by the desire to hand a large cheque to expectant mothers at a particular timethat it is more to do with providing some kind of financial assistance at a difficult time, as the Government argue.
That raises the question of targeting, which the hon. Member for Solihull rightly mentioned. There is always a tension between universal benefits and targeted, means-tested benefits. Although it is always tempting to argue for means-tested benefits on the basis that they are better targeted, there are problems with thatcreating poverty traps, for example. One way of targeting financial help that would not quite fall into that difficulty might be if a greater sum was paid for the first child than for subsequent children. Mothers tend to incur additional costs with the first child, when items such as prams and cots have to be purchased, so the demands for the first child tend to be greater. That principle is recognised in child benefit as well. Why is there to be a standard payment per child, as opposed to a higher payment for the first child and a lower payment for subsequent children, as I believe was originally envisaged?
The health aspect other than the payment to mothers that is supposed to help them eat in a more nutritionally beneficial way is set out in regulation 2(c) of the entitlement and amount regulations, which is the condition that mothers
have received advice from a health professional on matters relating to her maternal health.
Will the Minister tell us what percentage of mothers at 25 weeks are not receiving advice along those lines? I note the evidence that was given by the Treasury official, Jonathan Athow, to the Health and Social Care Public Bill Committee that:
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, Q263.]
If we are to introduce this policy, supposedly in an attempt to encourage expectant mothers to receive more advice on nutrition, what is the target increase? How will the Government assess whether it has had the impact that they envisaged in terms of mothers receiving advice? More generally, what criteria will the Government have in place to assess whether the measure is successful in improving the health of mothers and babies?
That leads me to implementation. We have the process set out in the orders whereby it is necessary for the expectant mother to have received the advice on nutrition, and then forms must be submitted and so on. The
Lorely Burt: The hon. Gentleman has made an important point about resources and midwives. If we accept the Governments figures that the cost of employing a midwifeI will not go into their trainingis in the region of £42,000, the £130 million that the grant will cost would facilitate the employment, supposing we could get them, of an extra 3,000 midwives, which would make a big contribution to the health of pregnant women.
Mr. Gauke: The hon. Lady makes her point well. It comes back to the essence of her argument as to whether the money will be well spent. We look forward to hearing the Minister respond to that question.
I should like to raise one or two slightly more detailed questions on the regulationsparticularly the Health in Pregnancy Grant (Entitlement and Amount) Regulations 2008. Regulation 4 states that in order to be eligible for the grant, it will be necessary for the expectant mother to be ordinarily resident, and have a right to reside, in the UK. Will the Minister give us some details as to what will be required for someone to prove that they are ordinarily resident in the UK? Presumably there is no obligation on a person who has received the grant to remain within the UK or to pay back the grant if subsequently they leave the country. I admit, that would be difficult to enforce administratively, but I am aware of anecdotal concerns of the ways in which the child trust fund payment, for example, is made to parents from other EU countries who then return to their home country, having arrived principally for the purpose of receiving the child trust fund money. I therefore raise the concern that that may occur in these circumstances.
I shall also be grateful if the right hon. Gentleman expands on regulation 4(3), which states that:
A woman who is in the United Kingdom as a result of deportation, expulsion or other removal by compulsion of law from another country to the United Kingdom shall be treated as being ordinarily resident in the United Kingdom.
I think that the Minister ought to enlighten the Committee as to why that provision is necessary.
I note that regulations 5 to 7 refer to the position of Crown servants, to whom different rules apply. Will the Minister explain why different rules apply to Crown servants, as opposed to British citizens who are working for someone else and who, because of work requirements, are outside the country? What is the cost of having that slightly different regime for Crown servants? Going through the detailed regulations, the principal question is: why £190? How has that been calculated and why is that sum considered to be appropriate?
The explanatory memorandum refers to marketing and media campaigns,
using national, consumer, specialist and regional press and broadcasters.
It also states that a
marketing campaign will continue to run in 2009/10 to raise awareness of the Health in Pregnancy Grant amongst eligible pregnant women and encourage take-up.
I have no doubt that the Government will run many media and marketing campaigns over the course of 2009-10, paid for with public money and highlighting the generosity of the Government. Will the Minister give the Committee details of the cost of such campaigns and tell us what the marketing budget is? Further, what do the Government envisage the take-up of the grants will be? What is their target?
In conclusion, I am grateful for this opportunity to debate the grant. We will listen closely to the Ministers arguments. The Government acknowledge that they will keep the policy under review and I shall be grateful if the Minister confirms that. We will watch with interest to see whether any of the trumpeted health benefits will be delivered.
Mr. Colin Breed (South-East Cornwall) (LD): I do not want to detain the Committee for long, but I support what my hon. Friend the Member for Solihull said. I should like to say a few things from personal experience, although my experiences are perhaps not quite as recent as hersthey go back to the thinking in the early 1970s, when my children were born.
I have been approached by people in my constituency about three things that would not have crossed my mind back in the 1970s when my wife went into hospital to have our children. The first was MRSA. I must tell the Minister that a significant number of young people today are almost frightened to go into hospital to give birth to their children because of the incidence of hospital-acquired infection. MRSA and clostridium difficile are a real worry for a huge number of people when thinking about how they will have their baby. If there is some spare money around, perhaps that problem should be addressed, as it would provide far more support to the health of expectant women, and put their minds at rest much more, at what is already a relatively stressful time when considering going into hospital. I do not think that I had even heard of MRSA in the 1970s. It would not have crossed my mind to think about a hospital-acquired infection when my wife went into hospital to have the children.
Secondly, I recall back in the 1970s a more than sufficient supply of people and health visitors who were only too keen both before and after the birth of babies to support, advise and give tremendous help. We know that there is a shortage of midwives today. Several constituents have written to me fairly recently about the lack of midwives. If there is some spare money around, perhaps the Government might like to consider supporting the role of midwives.
Thirdly, I draw attention to the area of intensive care beds.
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