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Baroness Masham of Ilton: My Lords, does the Minister agree that if a women who is HIV positive is pregnant, it is wise to conduct a caesarean before 38 weeks to stop trauma to the baby and to prevent HIV infection?
Lord Hunt of Kings Heath: My Lords, I am not in a position to give clinical guidance in that area this afternoon. I believe that all actions in relation to caesarean sections should be based on the best clinical knowledge. That is one of the reasons that the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives are conducting an audit of caesarean sections under the auspices of the National Institute of Clinical Excellence. From that we shall expect to have much more effective guidelines in relation to the use of caesarean sections in the future.
Baroness Gardner of Parkes: My Lords, in these days of extreme litigation, is not a factor that has to be taken into account that, where there is any doubt whatsoever, the clinician may feel obliged to carry out a caesarean section? Has the Minister any evidence on that?
Lord Hunt of Kings Heath: My Lords, a number of factors relate to the rise in caesarean section rates. Certainly, it is a much safer option than it used to be. The change in the age profile of women having babies has also led to an increase and I believe there is anecdotal evidence of women's own choice in the matter. However, there is no doubt that there have been reports that fear of litigation has had an influence on doctors concerned. That is a matter of regret. We have looked at the practice of defensive medicine in the US and been horrified at the prospect of that in the UK. The result of the audit on which we are working with the Royal Colleges and the development of the guidelines will, I hope, help to ensure that decisions taken for fear of litigation, rather than in the best interests of the women concerned, will not occur in the future.
Lord Patel: My Lords, I doubt that there will ever be another occasion when I shall feel that I can answer the Question better than the Minister! However, I agree with the Minister. It is a fact that caesarean section rates are higher now than they were a decade ago. The factors that operate now are the same as a decade ago, but there are many additional factors now. I agree that the audit--
Lord Patel: My Lords, will the Minister support the Royal College of Midwives and the Royal College Obstetricians and Gynaecologists in the audit to reduce caesarean sections and reduce the regional variations?
Lord Hunt of Kings Heath: My Lords, that is the kind of question to which I am always happy to agree. I believe that the noble Lord is right to refer to the audit again. It is important that when we make statements and reach conclusions about current practice, they are based on the best possible evidence. I believe that the audit is the best way to obtain the evidence.
Lord Ewing of Kirkford: My Lords, is the Minister aware that I am in the Chamber especially because of this Question? I cannot understand why a House made up of old-age pensioners should be involved in childbirth issues. Returning to the question of the noble Lord, Lord Clement-Jones, is my noble friend aware that women going into Labour have substantially increased in number compared to those going into the Liberal Democrat or Conservative parties week by week? Does my noble friend welcome all those women who join Labour, especially New Labour?
Lord Hunt of Kings Heath: My Lords, we must always welcome new recruits to the cause of Labour. As for Members of your Lordships' House, it is worth pointing out that the average age of women giving birth has now increased to 29.1 years--a substantial increase over the years.
Lord Jenkin of Roding: My Lords, perhaps I may return to the serious issue of the Question. I draw the
Minister's attention to an interesting paper which was read last night by Professor Richard Feachem under the auspices of the CSE International Lecture. He ascribed some of the increase in the number of caesarean sections to what he described as perverse financial incentives, not on the part of the doctors, but on the part of the trusts which can increase the resources that they can claim because of the number of caesarean sections that they perform. I do not know whether or not that is correct. Is the Minister prepared to look at that evidence from a distinguished source?
Lord Hunt of Kings Heath: My Lords, I would be concerned if any financial regime in operation in the NHS led to perverse incentives in relation to clinical actions. I would be very surprised if that were the case, but I am happy to look into the matter.
Local Authority Social Service Departments
2.48 p.m.
Lord Ashley of Stoke asked Her Majesty's Government:
- What powers they have to influence local authority social services; and whether they intend to use or augment these powers to reduce the disparities between authorities.
Lord Hunt of Kings Heath: My Lords, under both the Local Authority Social Services Act 1970 and the Children Act 1989 the Secretary of State has powers to direct authorities to take action where they have failed to comply with statutory duties. The Secretary of State will also have new powers included in the Local Government Act 1999 from 1st April next year. Those will allow the Government to intervene where there are serious or persistent performance failures.
Lord Ashley of Stoke: My Lords, I thank my noble friend for his Answer. Does he agree that the Government's review of social service departments has exposed the negligence of some of them, especially the more than one in 10 that are failing in their duties to children, disabled people and old people? Can my noble friend assure the House that the Government will close down those failing social service departments and transfer their responsibilities to neighbouring local authorities unless they are prepared to improve?
Lord Hunt of Kings Heath: My Lords, the legal position is that from April next year it will be possible for the Government to transfer responsibility for the delivery of social service functions to a neighbouring local authority if serious issues arise in relation to the delivery of that service. However, many steps can be taken before that happens.
First, inspections by the Social Service Inspectorate should result in a proper audit of the performance of local authorities; secondly, through a voluntary scheme a process can be put in place whereby those authorities requiring special monitoring against agreed action plans are identified. Also, I commend to my noble friend the recent production of performance indicators which allow local authorities to compare the performance of their social service functions with that of others. Those indicators should encourage social service committees to benchmark their performance against that of other local authorities.
Lord Morris of Manchester: My Lords, does my noble friend share the unequivocally stated view of the noble and learned Lord, Lord Lloyd of Berwick, that disabled people needing social services in Bermondsey must not be treated less favourably than disabled people with the same needs in Belgrave Square?
Lord Hunt of Kings Heath: My Lords, my noble friend raises an important issue in relation to the different policies and priorities of local authorities throughout the country. A balance must be drawn. But we do not want a situation where disabled or other groups of people are being seriously disadvantaged in one local authority area as compared with another. Of course, it is not just a question of resources. Some local authorities are much more effective at spending their pounds than others. The whole approach of using performance indicators will help local authorities assess their performance and enable them to compare it with that of others. I particularly emphasise the role that members of social service committees can play in looking stringently at their performance compared with that of other local authorities.
Lord Ashley of Stoke: My Lords, is my noble friend saying that he is prepared to take many steps before taking action against local authority social service departments which are proved to be negligent according to the Government's own survey? When he speaks of the inspectorate conducting a review, does that imply that the Government's survey was inadequate? We have the facts; we have the figures. They show gross negligence towards children, disabled and old people. The Government should get on and do something about it.
Lord Hunt of Kings Heath: My Lords, in cases of gross negligence where people may be at risk because of the inadequacy of a local authority, intervention can take place immediately. Intervention is a policy that I am sure all noble Lords will support. Equally, the establishment of performance indicators is one of the tools by which we can measure the performance of local authorities.
The inspectorate has an important role in monitoring the performance of local authorities; in drawing the attention of local authorities to specific areas of concern; and, in relation to our ability specifically to monitor the performance of 17 local authorities under special measures, we are provided with an effective way to intervene. I am simply saying that there has to be an effective balance between the requirements of the Government that local authorities behave effectively and provide decent services to people who need them, alongside the local democratic nature of local government and its need to develop its own priorities.
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