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I have indicated that the Government have taken this issue seriously and have sought to determine whether there was a justification for any change on the basis of multiple births. In the light of these arguments, I hope that the noble Earl will feel able to withdraw his amendment.

Earl Howe: It is reassuring to know that the evidence provided by Tamba has been taken with due seriousness by Ministers and the department. I note what the Minister said about the value of the advice to pregnant mothers who are expecting more than one child. That will certainly provide an opportunity for relevant issues to be raised at that point. My noble friend will doubtless study the Minister’s remarks with interest. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 204B not moved.]

On Question, Whether Clause 125 shall stand part of the Bill?

1.30 pm

Earl Howe: I hope that the Committee will think it right to debate this and the subsequent two clauses in the round and, in doing so, examine the rationale for the policy that they embody. Perhaps I should begin by making it clear that I do not oppose these clauses. I am the first to recognise that health in pregnancy is an extremely important issue. However, some fundamental questions need to be asked about why the Government have chosen to do precisely what they are now doing in this part of the Bill.

The health in pregnancy grant is to be a non-means-tested, non-taxable benefit payable to all expectant mothers who have reached a specified stage of their pregnancy and who have received advice about their health from a health professional. When the current Prime Minister first announced the policy in December 2006, he said:

At that time, it was planned to make the grant an extension of child benefit, but the rationale for introducing it was specifically focused on maternal nutrition and the extra costs of having a child.

The Pre-Budget Report of 2006 said:

The Secretary of State for Health reannounced the grant in a speech at Toynbee Hall last September. He said:

That was odd. If one looks at the evidence about the effect of maternal diet on the health of the unborn baby, it tells us something very different. In 2002, the

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Committee on Medical Aspects of Food and Nutrition Policy published a review of the welfare food scheme. It said:

is,

The review also notes:

My first question to the Minister is what evidence did the Prime Minister rely on when he stated that nutrition in the last months of pregnancy was “most important”? The evidence that I have seen is rather different. One of the conclusions of the report to which I have just referred was that,

That conclusion was endorsed by Rosemary Dodds of the National Childbirth Trust in her oral evidence to the Public Bill Committee in another place. Why, therefore, did the Secretary of State say that the health in pregnancy grant would be directly linked to improving nutrition and receiving advice about nutrition? The truth is that giving advice to women at the 25th week of pregnancy about diet and paying them money to follow up that advice are unlikely to have any measurable effect on the health of babies. The original policy justification looks very weak indeed.

Since last September it is noticeable that Ministers have been rowing back quite strenuously from the nutritional arguments. A Written Answer in the other place last December was all of a sudden more vague and general, referring to,

and saying that the grant,

We are therefore now in rather different territory. The justification for the grant given by the Minister in another place, Mr Bradshaw, when he spoke to the Public Bill Committee, was that it would help women to “make essential purchases” before the baby’s arrival. He cited research from St Thomas’s Hospital that shows that women suffer more stress over money worries during the later stages of pregnancy. He said:

I do not think that anyone could disagree that women with financial worries are cheered up by having a dollop of money put in their hands by the taxpayer. But value-for-money considerations come into play. If you are setting out to relieve financially related stress, surely you do that by targeting money at those who need it. I am sure that there are many women who in

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late pregnancy would welcome a little more help in paying the bills, but by no means every pregnant woman needs that sort of help. If the Government had spoken of the need to reduce health inequalities and then created a grant directed at poorer and less healthy sections of society, that would have been much easier to understand. Sure Start maternity grants are already available to low-income mothers and those grants could perhaps have been enhanced in some way. But the Government have not made that argument. The HIP grant will be universal.

Therefore, the question raised by the policy is whether the Minister is satisfied that the grant represents value for money in terms of the health benefit that it will confer on better-off women. How will paying a lump sum of £190 to a woman on an average income or a higher-than-average income deliver benefits to society that are commensurate with the aggregate cost to the taxpayer? If the Government believe that there are likely to be such benefits, what are they and how will they be measured?

New policy has to be evidence-based. The evidence is that this grant cannot be justified in terms of its nutritional benefits, as was originally claimed. It cannot be justified in terms of improving health in pregnancy, other than in the loosest possible way. Nor can it be justified in terms of being a grant that will be targeted on the less well-off. We are therefore left with a rather nagging question: why are the Government doing what they are doing? I am sure that every pregnant woman can benefit from advice about healthy lifestyles—avoiding smoking and excessive alcohol consumption are the obvious examples—but do we need to pay them a grant in giving that advice? It could be given, and usually is, by health visitors and midwives during the ordinary course of their work.

The King’s Fund has called the measure “silly”. I am not sure that I am in a position to agree or disagree with that assessment, as I still need a better understanding of what the Government hope to get out of the policy. Rosemary Dodds of the NCT put it well in her evidence to the Public Bill Committee when she said:

What is the Government’s intent? Please can we have a clearer idea of their reasons?

Baroness Howarth of Breckland: The noble Earl reminded me of the third point that I wanted to make earlier. He has added another query to that question. My earlier question, which was in a way answered by the noble Baroness, was how she could be absolutely sure that the health professionals would give consistent clinical advice across the piece. If one talks to mothers or reads information from a number of organisations, one will learn that there is a great postcode lottery in the availability of clinicians in these groupings and that health visitors often do not have the required time to give the kind of advice that might be required.

My further query, following the noble Earl’s intervention, is on what basis the healthcare professionals would give the advice. If the evidence indicated that

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different nutritional inputs, apart probably from folates, which are evidenced but not mentioned here, did not make a difference, what would they advise, particularly as the Government have now said that the grant might be to provide items of clothing or other things—I use “things” in a different context here—to alleviate a mother’s anxiety in the early days of pregnancy? I am not against the grant. Everyone who is expecting a child is pretty anxious about the added cost, but, like the noble Earl, I wonder how the advice will be given. I have sympathy with his view that the grant, rather than being universal, might better have been directed to those who are in greater need. What is the Minister’s advice on that?

Baroness Cumberlege: I declare an interest as a patron of the National Childbirth Trust. It is an amazing organisation, with 72,000 members across the UK. It states in its response to the Government’s proposals that it strongly supports a universal benefit for the following reasons. First, a universal benefit has high take-up rates. Child benefit reaches more children living in poverty than any other benefit or tax credit. The trust cites, secondly, ease of administration. Universal benefits have fewer administrative or technical difficulties than means-tested benefits or tax credits. It mentions, thirdly, avoidance of the poverty trap. Increases in universal benefits benefit low-income families directly, as they are not offset against child tax credits and do not vary according to work opportunities. Those arguments are valid, but I share my noble friend’s view that the money should be targeted at those most in need. The Government’s intention to reduce inequalities in health is valid, but is this really a good use of public money? Are we getting value for it or would it be better if it were targeted?

As my noble friend said, the Government have to be explicit about how they intend to achieve the benefits from the grant. I listened to the noble Baroness, Lady Finlay, and my noble friend. There seems to be an extraordinary conflict and lack of evidence. Scientists seem not to be sure about nutritional benefits to the mother and particularly to the baby. I have taken advice from Professor Martin Wiseman from the Institute of Human Nutrition at the University of Southampton. He explained to me in detail how very slim is any evidence and that what there is seems to be conflicting. I go back to my noble friend’s question: what really is the purpose of the grant?

The National Childbirth Trust also questions the idea of a lump sum. It sets out clearly the benefits of regular payments versus a lump sum. It states in its response to the proposals:

When women receive the money—and one of the great benefits is that it goes straight into the mother’s purse, which is important—I do not want to be judgmental

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as to how they spend it. But if the purpose is really so that pregnant women can buy buggies or whatever other equipment they want for the baby, the Government need to be clear on that and tell us exactly why they are introducing this grant.

On the point raised by the noble Baroness, Lady Howarth, I have reservations about the idea that you cannot get a grant until you have had advice. We know that some of the most disadvantaged women are very late in presenting to antenatal clinics. They get a double disadvantage in that they do not get the grant and they do not have antenatal care. It is interesting that the NCT says:

and here they include the Royal College of General Practitioners and the Royal College of Midwives—

The NCT recommends that,

I have reservations about the grant. I am delighted that pregnant women should have their income increased, as clearly it is a time when expenses go up and income often reduces. Women stop working and in many cases only for a short period do they get their salaries or other income redressed by the company that employs them. I should like to ask about the amount. I know that it is part of regulations, but I should like to understand what sort of sum the Government are considering. New Section 140B(2) says:

What does that mean? Does it mean that there is some sort of means test, or is it simply a lump sum for a particular amount that will go to every woman?

1.45 pm

Baroness Murphy: I shall add my two pennyworth on this one. I have total incomprehension about why this benefit was decided on. It is like a benefit seeking a rationale. I am concerned about the opportunity costs of an allocation of this size from the Treasury. What alternative are we missing to promote equalities of health among pregnant women and equalities of access to antenatal care? Why have we decided to spend this money in this way? I should also like some notion of what we expect the Treasury to devote to this grant. What will we be spending on it? That will give us some notion of what we are missing in its place.

I am extremely sceptical when I hear it said that nutrition is not important. I remind the noble Baroness, Lady Howarth, that for folate to do any good it has to be present when a woman gets pregnant. In fact, evidence shows that we should be improving the health of grandmothers: it is what your mother eats when she is a child that really makes the difference, not what you

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eat when you get pregnant. Indeed, there is good evidence that action that we have taken in the past has improved the nutrition of babies, children and mothers in this country. Noble Lords may remember the wonderful free orange juice that some of us drank in the 1940s and 1950s and the lovely bottles of a third of a pint of milk, which I remember that I loved. During that time, with those measures we did away with rickets and we massively improved the health of children, particularly in the north of England.

Therefore, if we were to give away vouchers for nutritional food—my noble friend Lady Finlay has scribbled the words “fruit and veg vouchers”—that would be fine, but I do not really understand the purpose of the grant. Perhaps it is a bribe to get people to attend antenatal clinics. If it were a bribe to ensure that people registered, that might be legitimate, as word would go round quickly about how to get the grant. Can we say directly that this is a very effective way of encouraging people to take up antenatal care?

Baroness Finlay of Llandaff: I shall be quick, as I do not want to delay the Committee. The Government are providing an opportunity to improve the lot of pregnant women and their offspring. The evidence that I cited previously comes from women who were severely undernourished prior to conceiving and it is their female offspring who will pay the price when they become pregnant. Those people were effectively starved. The biggest problem that we have at the moment is malnutrition, often obese malnutrition. That problem is completely different from the problem of undernutrition, which is often protein undernutrition. This has been a terribly important debate. It would be helpful if between now and Report we could all have some clarity about what the Government hope to achieve. It seems that the grant would present us with a wonderful opportunity if it were used correctly.

Baroness Thornton: The noble Baroness is right: this has been a very good debate. Part 4 introduces the health in pregnancy grant, which will provide additional financial support to expectant mothers during the important last weeks of pregnancy. I welcome the opportunity to set out this policy in more detail and hope that I shall be able to address some of the specific questions raised by noble Lords about the grant.

We believe that for many women, particularly those less well-off, the grant will provide a welcome addition to their income at what is often a very difficult and stressful time. We know that life chances are impacted upon before birth and that the support provided to the expectant mother during pregnancy has an impact on those chances. We also know that maternal health and well-being are affected by a wide range of factors, from the behaviour of the expectant mother to her financial circumstances and the support she receives from professionals and her family and friends.

The Government’s wider strategy of providing support for women during pregnancy and the early years of their child’s life has seen statutory maternity pay increase from 26 to 39 weeks, the creation of a new right for

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fathers of up to 26 weeks’ additional paternity leave and pay and the extension of the right to request flexible working to carers of children under the age of six. The health in pregnancy grant fits into this wider strategy by providing additional financial support for women during pregnancy. Linking the grant to the advice available from health professionals during pregnancy will help all pregnant women to access adequate support, thereby helping to alleviate some of the strain that competing financial pressures can cause in the run-up to birth. Since the Bill was introduced, the Government have been clear that the health in pregnancy grant is intended to support a woman’s general health and well-being in the later stages of her pregnancy so, linked to the advice from a health professional, the grant will provide flexible additional financial support, enabling pregnant women to identify for themselves the best way in which to spend the money.

On the point addressed by the noble Baroness, Lady Cumberlege, about Australia, the Australian baby bonus is very different from the health in pregnancy grant and is more similar to our existing system of child benefits, so making a comparison with the new grant may not be very useful. The Australian baby bonus is worth the equivalent of approximately £1,900—in other words, 10 times the amount of the health in pregnancy grant. It supports women with the cost of bringing up a child, like the UK system of child benefit, and is not payable until after birth. It aims to reverse the decline in the fertility rate and to encourage Australians to have larger families. Now, there’s a thought! It is payable when someone has a child and is not linked to any other conditions of entitlement. Paid maternity leave in Australia is not compulsory, so it would assist women going back to work.

The grant was criticised at Second Reading and in the other place for being paid too late in pregnancy to have any beneficial effect on a woman’s nutritional needs during the early stages of her pregnancy and for not recognising that women expecting twins or multiple births have additional nutritional requirements. However, there is already support for nutrition from early in pregnancy through the Healthy Start voucher scheme. The health in pregnancy grant is not designed to duplicate Healthy Start; if the grant was just about nutrition, it would have been very differently designed in order to meet that express purpose. Because the health in pregnancy grant is intended to have a much wider purpose, the conditions of entitlement and the timing of the payment have been designed to help pregnant women with the costs of their individual needs for a healthier lifestyle and with the wider costs in the weeks leading up to the baby’s birth.

The noble Baronesses, Lady Cumberlege and Lady Murphy, raised the issue of the different amounts that may be prescribed in the Bill. The flexibility to vary the grant is for the future; it allows us to change the grant from £190, which we currently intend, if necessary. The total cost of the grant is £145 million per year.

At the beginning of his remarks, the noble Earl raised the issue of what my right honourable friend the Prime Minister said in his PBR 2006 speech. He said that the extra costs borne by parents should be

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recognised in the last months of pregnancy and that nutrition is important throughout pregnancy. I do not think that anybody would disagree with those words.

The noble Baronesses, Lady Howarth and Lady Cumberlege, raised the issue of the type of advice that might be given. It is health advice, not necessarily nutritional advice, although that would be contained within it. It would include lifestyle issues, such as smoking, weight, diet and so on. The grant may well encourage women who have not yet presented for support and antenatal care during their pregnancy to come forward into the system, which suggests that it is a very good idea. As has already been mentioned, research by the baby charity, Tommy’s, has shown that the stress that pregnant women face as the result of financial worries has an adverse impact on pregnancy and birth, and getting £190 at the 25th week may help with that.


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