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Lord Davies of Oldham: My Lords, the Government have been called many things, but I do not recall romantic being one of them. This concept is not a romantic one; it is concerned with factual issues to guide public policy to reduce the very problems which the noble Lord suggests arise from time to time. When we are in a better position to assess the population concerned, we will be better able to provide it with the necessary sites and make provisions in other respects and to avoid the tensions that occur when provision is not there.
Lord Lester of Herne Hill: My Lords, does the Minister agree that the 10 million Roma in Europe, as the European Court of Human Rights has made clear, are the most vulnerable and despised minority in Europe and that the states have a positive obligation to protect them?
Lord Davies of Oldham: My Lords, that is certainly an important consideration. However, the noble Lord will also recognise that they are a distinct group from the Irish Travellers, so the issue is about being able to identify accurately the resources that need to be attributed to these categories to reduce the pressure of past neglect which the noble Lord has correctly identified.
Lord Clinton-Davis: My Lords, do the Government plan to raise the racist maltreatment of Romany Gypsies in certain countries of the EU, with the special connivance of Prime Minister Berlusconi, who has boasted that his Government are the new Falange?
Lord Davies of Oldham: My Lords, this Question started off being about the British census, so it is a large departure to go to policy on eastern Europe. However, an example is the best illustration of what should be done, and the Government will set the right one.
Lord De Mauley: My Lords, how do the Government, and indeed local government, communicate formally with Travellers and therefore get the census forms to them if they do not have fixed addresses?
Lord Davies of Oldham: My Lords, it is quite a challenge, of course, but there is the National Federation of Gypsy Liaison Groups, the Cardiff Gypsy and Traveller Project and the Gypsy Council, and the Government have consulted all three.
Health: Maternity Services
3.28 pm
Baroness Coussins asked Her Majesty’s Government:
What is their response to the recent report by the Healthcare Commission on maternity services, Towards Better Births.
Baroness Thornton: My Lords, we welcome the Healthcare Commission’s report, which acknowledges that the majority of women have a positive experience
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Baroness Coussins: My Lords, I thank the Minister for that Answer, but will she reassure me that the Government’s intention to guarantee all women a choice of where to give birth will not mean that women with high-risk pregnancies can choose a home birth? Does she agree that it is unacceptable for women to feel pressurised into considering a home birth, as the Healthcare Commission reported last week, particularly if home birth is regarded as a default choice by women who are worried about understaffed or badly equipped labour wards but who might then expose themselves and their babies to danger should they need the emergency transfer service, which itself might be underfunded and unable to cope?
Baroness Thornton: My Lords, we want to ensure that women have as many choices as possible, and minimise the risks to themselves and their babies. Current evidence supports the fact that when healthy women are offered the option of home birth, there is every indication of success. However, the noble Baroness is correct: it is not, as she put it, a default position. The key to ensuring a safe childbirth is an early assessment of the mother’s and baby’s needs. We are trying to ensure that PCTs will be judged on whether they can increase the number of women who access maternity care by the twelfth week of pregnancy. This early access enables a healthcare professional to assess the mother’s and baby’s needs and, indeed, whether the pregnancy is high-risk. At that stage the mother will be advised about the risks of a home birth. Clearly, part of this equation is that, when things go wrong, PCTs need to have planned the right response to ensure the safety of mother and baby.
Baroness Tonge: My Lords, the Minister will recall the extremely good report Maternity Matters, which listed all that should be done in maternity services, and said that these would be implemented by 2009. Why, then, were there fewer training places for midwives this year than in the three previous years? Why are there not enough jobs in the National Health Service now for qualified midwives to take up?
Baroness Thornton: My Lords, I think we would agree that it is essential that staff providing maternity care are properly trained. We are committed to increasing the number of midwives, and the number of training places has increased by 20 per cent in recent years. We are pushing midwives through that supply chain into those jobs. It is the duty of PCTs to recruit midwives at the right level to provide the right services.
Baroness Pitkeathley: My Lords, have the Government also made a commitment to providing enough bathrooms and bedrooms? The report identified that some hospitals have an inadequate number of both.
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Baroness Thornton: My Lords, the report drew attention to this. We are investing £162 million a year in maternity services, and the £330 million I mentioned is in addition to that. There is no excuse for that extra cash not supporting the implementation of Maternity Matters and the modernisation of options for place of birth. We have examples of where the money is being well spent to improve facilities, but clearly there is more work to be done.
Baroness Cumberlege: My Lords, following the point made by the noble Baroness, Lady Tonge, about student midwives, I was interested to hear the Minister say that she believed there were more student places. That does not coincide with the reply given to one of her honourable friends in the House of Commons, according to the Royal College of Midwives, which states clearly that the number of training places fell last year compared to the previous years. Does the Minister agree that what is critical is not more government policy but implementing present policy and matching the increase in the number of births, which rose by 90,000 in the past six years, with the number of training places? How does the Minister propose to attract students to become potential midwives?
Baroness Thornton: My Lords, we have more midwives than ever before working in the National Health Service. We are committed to training and ensuring that more midwives are recruited, in recognition of the rising birth rate. SHAs are taking a number of actions, such as implementing “return to practice” programmes and providing flexible retirement schemes. We are encouraging more midwives to stay in the workforce and providing support workers’ programmes. I will check the statistics and get back to the noble Baroness, as I was not aware of the one that she mentioned. My brief says that the number of student places is increasing.
Baroness Finlay of Llandaff: My Lords, can the Minister explain what action the Government can take, given that 32 per cent of trusts fail to meet the standard of having a consultant on the labour ward—indeed, there is a national shortfall of consultants—and that 83 per cent of them do not have in place neonatal resuscitation training for midwives and obstetric staff? I declare an interest as I have been asked by both Royal Colleges to chair a working party to look at the learning environment.
Baroness Thornton: My Lords, the noble Baroness points to some important issues. The new RCOG Standards for Maternity Care published last week covers many of these issues and includes standards for obstetrician staffing and consultant presence on maternity wards. It provides that all obstetric units must have a lead obstetrician and a labour ward manager, as well as a minimum of 40 hours’ consultation presence, with 60 hours in larger units. At least twice a day, and during the weekend and bank holidays, there should be a physical round made by the consultant. We are pursuing that standard with great energy.
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Lord Winston: My Lords, as a happy grandfather, I am very grateful to the NHS at University College, London, where my grandson was born recently. Does my noble friend not agree that the terms “high risk” and “home delivery” together are something of an anathema to obstetricians and that there is a high risk of birth asphyxia, about which we are most concerned, which is quite unpredictable in some home births in high-risk cases? Does she agree that encouraging the wrong patients into that birth scenario is extremely unwise?
Baroness Thornton: My Lords, my noble friend is absolutely right, and his question reflects the aim of the original Question.
Earl Howe: My Lords, the report said that recommendations were not adequately adhered to for antenatal care and that women experienced poor communication, care and support after their babies were born. What do the Government have in mind to address those two points?
Baroness Thornton: My Lords, we are aware that sometimes mothers may have had an excellent experience during the birth but find that the postnatal care does not match up to it. That is why we commissioned NICE to undertake work on developing clinical guidelines for routine postnatal care as part of a series of guidelines related to maternity care. As ever, the key is getting the NICE recommendations implemented at the local level.
Liaison Committee
3.37 pm
The report can be found at http://www.publications .parliament.uk/pa/ld200708/ldselect/ldliaisn/142/142.pdf
The Chairman of Committees (Lord Brabazon of Tara) rose to move, That the 2nd Report from the Select Committee (HL Paper 142) be agreed to.
The noble Lord said: My Lords, the report relates to a proposal for a new, one-off, ad hoc committee on the Barnett formula, a proposal for the continuation for a further Session of the existing ad hoc committee on intergovernmental organisations, and a proposal that the Liaison Committee’s advice restricting the size of sub-committees of the European Union Committee to 11 be withdrawn. We also report to the House the fact that the House of Commons is not in favour of establishing a Joint Committee on the UK Statistics Authority, a proposal which we supported in our previous report.
The House will recall that the committee has previously not supported the case for a committee on the Barnett formula for reasons we set out in our report. The noble Lord, Lord Barnett, accordingly came back to us with a revised proposal, narrowing the orders of reference for such a committee and excluding the consideration of political aspects of the devolution settlements or the application of public expenditure within different regions of the United Kingdom. We
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We also considered a proposal by the noble Lord, Lord Soley, that the ad hoc committee on intergovernmental organisations, which the House established at the beginning of this Session, be continued for a further Session. We did not support this suggestion, for two reasons, as set out in the report. First, we consider it very important to uphold the principle that ad hoc committees are appointed for a specific purpose and for a specific and finite length of time. The appointment of an ad hoccommittee on an open-ended basis goes against this principle. Secondly, we are not convinced that the mechanism of an ad hoc committee with the terms of reference of the intergovernmental organisations committee is the right way to address the sorts of issue which the noble Lord, Lord Soley, has suggested as potential future subjects of inquiry. If the noble Lord wishes to pursue this, we suggest that he might reconsider how best to achieve it.
I should mention two other matters. The House will recall that in our previous report we gave our support in principle to the establishment of a Joint Committee on what is now the UK Statistics Authority. We noted that the Leader of the House had agreed to relay our views to the Leader of the House of Commons. The Leader of the House has now reported back to us that she has not been able to persuade her colleagues in the Commons of the merits of this idea. Given this, we do not see any practical way to pursue the suggestion further.
Finally, we endorse the principle that the maximum number of members of a sub-committee of the European Union Committee should be raised to 12—the same as that of other sub-committees. I beg to move.
Moved, That the 2nd Report from the Select Committee (HL Paper 142) be agreed to.—(The Chairman of Committees.)
Lord Barnett: My Lords, I offer my thanks to the Lord Chairman and members of the Liaison Committee for agreeing to my request that there should be an ad hoc committee to review the Barnett formula. It will be known that I have been pursuing this for quite a long time so I am naturally rather pleased at the decision. I am confident that the Select Committee will in due course provide a historic report of enormous value in making a sensible decision in this case and help prevent the break up of the United Kingdom, which I assume none of us wants to see but which was a danger without some review of this formula.
Obviously, I could not be a member of a committee to review my own formula. I wish the committee well—unless it is thought that I should be a member. I should be happy to be but it would be wrong to review my own formula. That should be done by others and I am happy to leave it in their most capable hands. I strongly support the recommendation of the Liaison Committee and recommend it to the House.
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Lord Soley: My Lords, I thank the noble Lord and the Liaison Committee for their helpful comments over the past year or two, and the members of the Clerks’ Department on the Intergovernmental Organisations Select Committee—the ad hoc committee referred to by the noble Lord. I place on record that I of course originally asked for a sessional committee. I share the Liaison Committee’s view that an intergovernmental organisations select committee should not be ad hoc but sessional. All members of the committee and other Members of this House who have discussed this with me believe there is a need for such a sessional committee. We will return to the Liaison Committee with such an application.
I have a couple of other points in relation to this. First, it would have helped if the report that will come out next Monday on the control of globally transmitted infectious diseases had been before the committee in time. It was not because—as I know the noble Lord fully accepts—the two Ministers could not give evidence on the date originally agreed at the beginning of June and had to delay until the end of June. It would have been wrong to produce the report without having the Ministers’ comments before the committee. The report will now be out next Monday.
When the noble Lord looks at the report—I hope that other Members of this House will do so—he will find that it meets the aims discussed at the last Liaison Committee and published in House of Lords Paper 118, which suggested a more thematic approach to this. By addressing the profoundly important question of infectious diseases we were able to focus not on the governance of intergovernmental organisations—I have always been clear that a committee of this or any House should not do that—but on the way British taxpayers’ money is used and how government departments focus on and use the decisions and functions of intergovernmental organisations.
The report on infectious diseases makes important recommendations. I make this point as clearly as I can. Members will see when they look at the report the welcome response we got from those who gave evidence to us; it came not only from people in this country—the British Government welcomed it—but also from the World Health Organisation and a number of other organisations. In view of the first Question this afternoon, I emphasise we had to go abroad only twice: once to Geneva and once to Paris. We took the rest of the evidence through video links. I hope to use the Skype system should we be able to continue our work in future.
In doing that, I again emphasise that many of the intergovernmental and non-governmental organisations involved in the spread of infective diseases told us how important this was and that they wished other Parliaments were doing it. Indeed, in the case of the United States, we not only took evidence via a video link but two people from separate organisations came over to see us, one of whom came entirely at the expense of the institution for which he worked. That is an indication of the seriousness and importance of the issue.
I share the view that it should not be an ad hoc committee. I say that again because that was my original application. However, the importance of the
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Lord Jenkin of Roding: My Lords, very briefly, I am sad that another place has declined to accept the unanimous view of the Liaison Committee of this House that the Statistics Authority should be monitored by a Joint Committee of both Houses. I am grateful to the Leader of the House, who sought to persuade her opposite number in another place that this was a good idea, and I regret that she was unable to prevail. The fact that it has taken nearly six months between the decision of the Liaison Committee and the communication she reported to it last week is not, I hope, a reflection of the attitude of another place towards this House. It is a sad moment but we will hear more of this because my right honourable friends in another place have said that they support us and I hope the Houses may be able to revisit the issue in a couple of years’ time.
Lord McNally: My Lords, I welcome the intervention of the noble Lord, Lord Jenkin. It may not appear from the rather polite minute just how much indignation there was in the committee at the actions of the other place in refusing to set up a Joint Committee. I remember that when the Bill went through this House much of the support for the concept of a scrutiny committee was on the basis that in this House there was particular and specific expertise. The noble Lord, Lord Moser, who is in his place, is one example of those who would have contributed to the work of such a Joint Committee.
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