Health and Social Care Bill

Memorandum submitted by the Royal College of Midwives (HS 41)

1 England has a shortage of midwives. The country needs the equivalent of an extra 4,700 full-time midwives, according to estimates using the independent Birthrate Plus midwifery workforce planning model; these are needed to give women the birth experience they want and deserve from the NHS. Last year David Cameron pledged to recruit 3,000 additional midwives. Since then the Government has produced the Health and Social Care Bill that places responsibility for workforce planning firmly in the hands of local health economies. In the absence of a national standard for maternity care provision, mothers will inevitably be faced with a "postcode lottery" in respect of the quality of midwifery care they receive

2 The Royal College of Midwives (RCM), which represents over 39,000 midwives across the UK, believes that the NHS needs a period of structural calm, not least so it can deliver on the requirement to achieve significant financial efficiencies over the next few years. This bill, sadly, is set to deliver the opposite: a prolonged period of massive, profound and expensive upheaval.

3 Despite these and other concerns, we do see opportunities in the bill to drive improvements in healthcare. The focus of this briefing, for the public bill committee stage, is therefore on the areas where we see those opportunities.

Government approach to maternity care

4 The Government has indicated that Maternity Matters (the comprehensive strategy for NHS maternity services in England, published by the last Government in 2007) is no longer government policy. That is unfortunate as that policy brought together all parts of the NHS and the public sector with a role to play in improving maternity care.

5 According to the NHS White Paper, published last summer, the only official policy of the current government is choice over where to give birth. We would like to see this assessment of Government policy on maternity care tested during the Public Bill Committee stage of the bill.

Opportunities for improving care

6 Whilst it is true that the RCM would prefer not to see the NHS reorganised in such a profound manner at this time, we do see some opportunities and potential within the planned changes for levers to drive improvements in maternity care.

7 The bill does create some new levers open to ministers to pull in an attempt to improve care; these levers include the standing rules (Clause 16), the mandate (Clause 19), and NICE quality standards (Clause 218).

Clause 16: The standing rules

8 The standing rules will enable the Secretary of State to impose rules on the NHS Commissioning Board and the GP-led consortia over how they carry out their work. By using these rules it may be possible to ensure that the Government’s commitment, made in its White Paper (Equity and Excellence: Liberating the NHS), to choice for women over the maternity care they receive – to include, for example, birth at home or in a midwife-led unit – is commissioned by all local consortia.

Clause 19: The mandate

9 The Secretary of State will be required to publish and lay before Parliament an annual mandate, setting out what s/he wants the NHS Commissioning Board to achieve in the coming year. Extra leverage is provided by Clause 104(9), which would require Monitor to consider this when setting tariffs.

10 Specific priorities could be included in the mandate, and the RCM would like to see improvements in maternity care and guidance on how the policy of choice in maternity care can be achieved in the initial and subsequent editions.

Clause 218: NICE quality standards

11 Clause 218 enables the Secretary of State or the NHS Commissioning Board to commission NICE to develop quality standards, which can help drive improvements in care. The RCM welcomes this, and would support the development of standards on maternity-related care to be commissioned at the earliest opportunity.

12 Those are the three levers – the standing rules, the mandate, and the NICE quality standards – that we see as key to achieving a step change in quality improvements in maternity care. Nonetheless, there are other aspects of the bill that we would like to see clarified with respect to their potential effect on maternity care.

Clause 136:

13 This Clause makes small changes to arrangements for foundation trusts’ boards of governors – to be renamed, councils of governors – and leaves in place the legal requirement in the National Health Service Act 2006 for at least three members of a foundation trust’s board of governors to be members of staff.

14 The RCM supports the retention of rules on the representation of staff on what are set to become councils of governors, but we believe that in the interests of engaging staff in the running of foundation trusts and potentially encouraging interest in establishing social enterprises, the minimum staff representation should be raised.

Clauses 242 & 243: Health and Social Care Information Centre

15 Fundamental to improving care and making choices about care is information. The RCM is therefore supportive of Clause 242, which will empower the Health and Social Care Information Centre to obtain information on clinical performance from any healthcare provider, including private providers. Clause 243, ensures the default position is that this information is made publicly available. This is very much welcomed by the RCM.

Clause 166 & Schedule 13: Healthwatch

16 Healthwatch England (established as a statutory committee of the Care Quality Commission (CQC) by Clause 166) and Local Healthwatch organisations (detailed in Schedule 13) offer a new opportunity for patients to have a meaningful role in addressing problems within the NHS.

17 Indeed, the Explanatory Notes accompanying the bill cite maternity services as an area of NHS care that could come under the spotlight of both the Healthwatch national committee and also the local organisations; we hope that there will be scope for the CQC or others to task Healthwatch at all levels to examine clinical performance in maternity services.

18 Many trusts have Maternity Services Liaison Committees (MSLCs), which bring into decision-making the voice of the women who have used local maternity care. The RCM believes that Local Healthwatch organisations should be actively encouraged to engage closely with these valuable groups, ideally embedding them in the systems established to generate feedback from service users.

February 2011