Maternity Services

HC Deb 16 October 2001 vol 372 cc1037-41

7. Mr. Gareth R. Thomas (Harrow, West)

What action he is taking to improve maternity services. [3770]

The Minister of State, Department of Health (Jacqui Smith)

To improve maternity services we announced last week the details of an investment of £100 million capital to modernise maternity facilities. We are using the maternity and neonatal work force working group to make recommendations on the staffing and configuration of maternity services and taking special action to increase midwife numbers.

Mr. Thomas

I am grateful to my hon. Friend for her reply and for her decision to fund in full the £500,000 bid for vital new equipment at the maternity unit at Northwick Park hospital, which serves my constituents. Is she aware that the complete refurbishment of that unit has been necessary for some time and will she promise to be sympathetic when the business case for that bid is presented to her Department shortly?

Jacqui Smith

As my hon. Friend points out, we have been sympathetic to the full extent of the £500,000 investment in his local hospital, which is an important provision in terms of the improvements that will be made for low and high-risk mothers. We will, as always, listen sympathetically to well-made cases for extra capital investment, but I am sure that he will not expect me to provide an answer today.

Mr. Tim Boswell (Daventry)

All capital investment in this area is most welcome, especially that being made in my own part of the south midlands, but will the Minister also bear in mind the importance of maintaining the emphasis on research into the remaining killers of babies? Of particular importance are the studies of eclampsia and pre-eclampsia. They are the biggest remaining child killers, and also pose a substantial threat to mothers' lives.

Jacqui Smith

The hon. Gentleman makes an important point about the need to maintain research and to improve antenatal and post-natal care provision for mothers. The national service framework for children will include consideration of standards in maternity services to ensure that there are evidence-based guidelines and standards for the provision of maternity care, and that there is continuity of antenatal and post-natal care. Undoubtedly, issues such as those raised by the hon. Gentleman wil be part of that continuing consideration.

Dr. Phyllis Starkey (Milton Keynes, South-West)

On behalf of my constituents, I very much welcome the £421,000 that has been allocated to Milton Keynes general hospital. However, I remind my hon. Friend the Minister that pregnancy outcome depends greatly on matters such as smoking, poverty and poor housing. What is she doing to ensure that primary care trusts maintain an emphasis on public health as well on the very welcome investments being made in acute services?

Jacqui Smith

My hon. Friend makes an important point. The Under-Secretary of State for Health, my hon. Friend the hon. Member for Pontefract and Castleford (Yvette Cooper)—who, as the House will know, is carrying out intensive and personal research into maternity services at present—is leading work on the question of health inequalities. The aim is to ensure that precisely those public health issues mentioned by my hon. Friend are dealt with—both in respect of pregnant women and in terms of achieving healthy childbirth and healthy children later in life. The work will also ensure that those issues are taken into account in the way in which we provide, commission and deliver our health services.

Mr. Peter Lilley (Hitchin and Harpenden)

The Minister's claim to be improving maternity services will ring pretty false in my constituency and in neighbouring constituencies, as it coincides with the announcement that Hemel Hempstead maternity services are to close, with all women's and children's services being transferred to Watford. How can anyone be expected to believe that that closure is temporary, as the Government have claimed up to now, when today's announcement makes it clear that Hemel Hempstead will be the only hospital not to receive a penny for improvement or investment in its maternity services? Can the Minister tell us, hand on heart, that that unit will reopen in due course?

Jacqui Smith

Changes to the local provision of services can be difficult for individual areas, but they are matters for local discussion. It is for health authorities and trusts to decide on service provision, taking into account local people's needs, evidence of effectiveness, and available resources. However, I can assure the right hon. Gentleman that the new and independent reconfiguration panel will take those factors into account on reaching decisions on any future changes in local maternity services. Clear criteria exist for the assessment of any proposed changes, and I assure the right hon. Gentleman that they will be applied.

Ms Joan Walley (Stoke-on-Trent, North)

I thank my hon. Friend the Minister for the additional money made available for maternity services at the North Staffordshire Hospital trust. It is much appreciated, but I am concerned that women who want to deliver their babies at home should be provided for. Will my hon. Friend say what extra help will be given to allow women the opportunity to deliver their babies at home? Will she also review carefully the new proposals to increase the penalties when there is a problem with home delivery?

Jacqui Smith

My hon. Friend is right to highlight the important matter of choice for women. Some women have considerable choice in maternity care—including the ability to decide where they would like to give birth—but that degree of choice is not as widely available as perhaps it should be. Not everyone has a full range of options, such as home birth, even when those options are clinically safe. That is why, as I said earlier, maternity services are being included in the national service framework for children in a bid to ensure that every woman can exercise safe and informed choices throughout maternity and childbirth. It is also why the increased numbers of midwives that my right hon. Friend the Secretary of State announced earlier this year to the Royal College of Midwives will be important in helping to promote choice.

I undertake to consider seriously the points that my hon. Friend has made about the fine regarding lay assistance at home births.

Mr. Nicholas Winterton (Macclesfield)

The Minister will be aware of the excellent report that the Health Select Committee published in the early 1990s on maternity services—

Mr. Peter Luff (Mid-Worcestershire)

Under very fine chairmanship.

Mr. Winterton

Indeed, I was its chairman at the time. The report stressed the importance of midwives in maternity services. The Minister is clearly aware that there is a shortage of midwives, but there is also an increasing demand from women to deliver at home, as the hon. Member for Stoke-on-Trent, North (Ms Walley) said. What will the Minister do about dramatically increasing the number of midwives? Will she tell the House at whose behest the penalty for lay assistance at home births has been increased? Its dramatic increase is a great disincentive for women to deliver at home, which many wish to do.

Jacqui Smith

I undertook to consider lay assistance in response to my hon. Friend the Member for Stoke-on-Trent, North. I also undertake that if I find the time, I will read the report to which the hon. Gentleman referred, which I am sure is a major contribution to the issue.

The hon. Gentleman rightly emphasises the need for more midwives. That is why, speaking earlier this year at the Royal College of Midwives conference, my right hon. Friend the Secretary of State announced that by the end of 2002 there will be an extra 500 midwives working in the NHS, with an extra 2,000 on the wards within the next five years. To encourage more midwives to return to practise, we have recently announced a boost of at least £1,500 plus for returners and extra help with travel, books and child care. The hon. Gentleman will be pleased to know that training places have already increased substantially since 1997—there are now 235 more training places than in 1996–97—and we have recently seen a fall in vacancy rates for midwives.

Sandra Gidley (Romsey)

To follow the hon. Member for Macclesfield (Mr. Winterton), bearing in mind that the vacancy rate for midwives is 8 per cent. in the south-east and 17 per cent. in London, will the Minister say whether the cost of living allowance has made any difference to the retention of midwives and whether she has any plans to improve recruitment further? Will she also confirm whether the 500 extra midwives are full-time equivalents, or does the figure include part-time workers?

Jacqui Smith

Some of the proposals to which the hon. Lady referred have only been in place since April. It is important that we maintain our concern about and commitment to ensuring that extra staff enter the NHS and that midwives are in post. I have already outlined some of the considerable measures that we are taking to ensure that we attract midwives back to the profession. We have already seen some success in terms of falling vacancy rates and the number of extra midwives who are in training. I assure the hon. Lady that we will maintain that activity to deliver on the pledge that my right hon. Friend made to the Royal College of Midwives.

Ms Julia Drown (South Swindon)

I am pleased to hear that my hon. Friend wants to do more to support women who make an informed choice to have a home birth. Can she help clear the current confusion with regard to health authority duties? Some women who make an informed choice to have a home birth are told that their health authority does not have a duty to provide a midwife but must simply provide general maternity services. The regulations are not at all clear. Will my hon. Friend ensure that matters are clarified so that women who make an informed choice can be properly supported at home?

Jacqui Smith

My hon. Friend makes the important point that the extent of choice for women in their maternity care depends on the number of midwives and the resources in the system. That is why the increased number of midwives and the increased resources going into the system are important. However, my hon. Friend is right that we need to look further at how we extend maternity choices so that women in all parts of the country, not just some, have greater choice, including the choice, where it is appropriate, of having a safe home birth.

That will be part of the consideration in the national service framework for children on which work has already started.

Mr. Simon Burns (West Chelmsford)

Notwithstanding the extra money that the Government have announced—including some for St. John's hospital in my constituency—which is welcomed by the official Opposition, does the Minister accept that the level of post-natal care provided through community maternity units is far superior to that provided by overworked maternity units in our hospitals? In addition to funding, what will the Government do to raise the standards of hospital maternity units to ensure that they reach the high quality of care in the community units?

Jacqui Smith

I begin by welcoming the hon. Gentleman to his new post. This is our second meeting today and I am sure that it is only the second of many. He raises an important point about the need to ensure that, whether women receive their care in a hospital setting—perhaps because of the need for special care for their babies or a particular high risk—or have the baby in a community setting, that care is of an equally high standard. We need to tackle that in the national service framework, but in the short term our investment in maternity services in hospitals, in midwives and in community services, including devolution of more power and funding to those services, is important in ensuring that wherever women receive their care it is of a uniformly high standard.