Midwife and Maternity Services
Henry Smith (Crawley, Conservative)
Thank you, Mr Speaker, for the opportunity to hold this debate on midwife and maternity services. It is particularly important because, as I speak, there is a baby boom in the UK. Last year, a baby was born every 40 seconds—the highest number in 20 years—and in certain areas of the country maternity units are under considerable pressure and midwives are working harder than ever. England has seen a 22% increase in the number of births, compared to Wales at 17%, Northern Ireland at 15%, and Scotland at 12%. The number of live births in England in 2010—the latest year for which figures are available—was well over two thirds of a million, representing an increase of 22% since 2001.
The Royal College of Midwives recently published its “State of Maternity Services” report, and I was pleased to be at its launch in Westminster Hall. The report looks at a number of indicators of the pressures on maternity care and the resources available to cope, and for the first time it does so for all four nations of the Union. The report finds that a significant increase in the number of births in each of the UK’s constituent parts and a trend towards older mothers are increasing the pressures on maternity services significantly. The extra work load placed on midwives by more older women giving birth has been exacerbated by an increased complexity in their work load.
The number of births to women aged 40 or over rose by more than 70% between 2001 and 2010—a level not seen since 1948. In England that has led to a substantial deficit in the work force needed to provide a safe level of care to women and their babies. Furthermore, the existing midwifery work force in England is ageing. We can therefore anticipate an even greater strain on services over the next 15 years, if the situation is not properly addressed. One region of England actually cut midwife numbers between 2001 and 2010. Between those years, the north-west experienced a 19% increase in the number of live births, but a reduced number of full-time equivalent midwives.
The only way to get large numbers of new midwives into the profession is through training student midwives, yet the record on student midwife numbers is patchy. In the 2005-06 academic year, for example, there was even a 16% cut in student midwife numbers, and it took five years for those numbers to climb back up to their 2004-05 level. With an ageing profession, a substantial and consistent rise in student midwife numbers is the only way of rectifying the enduring problem that there are too few midwives working in the NHS in England.
I very much welcome the increased number of midwives and trainee midwives introduced by the Government. That is fundamental. I also very much welcome the increase in NHS funding over each and every year of this Parliament, including the greater investment in maternity care as part of the solution. However, the financial limits resulting from the historically high debts that the previous Administration left us mean that innovative ways to address the work force shortages need to be considered.
I know that the Royal College of Midwives, for its part, is realistic about the financial challenges facing the NHS. The “State of Maternity Services” report recommends, for example, providing more midwife-led units and appropriately integrating maternity support workers as two ways to make better use of the limited financial resources available. The report also recommends at least maintaining, and in some regions increasing, the number of student midwives to ensure that more midwives are available to meet future needs.
Maternity services in England are approaching a critical point. London, along with many parts of the south and east, is particularly overstretched, with some maternity units currently having a midwife vacancy rate of over 20%. Maternity services in Scotland, Wales and Northern Ireland are in better shape. According to the Royal College of Midwives, an average ratio of one midwife to 28 births is a safe level. At the moment the figures for the UK are as follows: in England there is one midwife for every 33 births, in Wales there is one for every 30 births, in Northern Ireland one for every 28 births, and in Scotland one for every 26 births. There are clear variations in care across the UK that need to be addressed. It is clear that with adequate midwife numbers to match the birth rate, mothers and babies receive a higher standard of care.
The situation in England is a concern, but it is certainly not hopeless. The midwifery shortage can be solved; it is simply a matter of policy will and using resources innovatively. For example, giving expectant mothers real choice when deciding where to give birth could alleviate the shortage problem in England. In essence, a mother has three main choices when choosing the location of birth: a midwife-led unit, a consultant-led unit or at home. Most women choose a local hospital, usually for convenience and because of the perception of safety and security. Encouraging more births at midwife-led units, however, would help with NHS work force planning. Births at home or in midwife-led units require fewer interventions and are less demanding on midwife time. According to calculations, for every 10,000 births moved from a consultant-led to a midwife-led unit or to the home, the required midwifery work force would be reduced by the equivalent of 71 full-time midwives.
There are significant variations in home birth take-up, which suggests that the message of choice is not getting through to all mothers. For example, in Somerset 11.4% of births are at home. At the other end of the scale, however, in Wansbeck, just 0.1% of births are at home. By encouraging real choice we could enable mothers across the country to receive higher levels of care during and after their pregnancy.
Choice of location of birth—that is, of course, a specific coalition policy set out in the NHS White Paper—is far too important to be denied to mothers, particularly when it is readily available in other parts of the country. According to the Office for National Statistics the percentage of home births decreased to 2.5% in 2010 compared with 2.7% the previous year.
Research by Oxford University’s national perinatal epidemiology unit has given further weight to the evidence that suggests women at a low risk of complications should be given full and frank options when it comes to
choosing where to give birth. The general secretary of the Royal College of Midwives, Professor Cathy Warwick, welcomed the research, saying:
“This ground-breaking research makes a very important contribution to the evidence base for women and health professionals about the safety of childbirth planned in different settings for women at a low risk of complications. The RCM hopes that its findings will be widely used and will help health professionals support women to make informed choices about their options when considering where to give birth. It should also influence the planning of high-quality maternity services across the UK.”
Maternity support workers who have been adequately trained, and are appropriately supervised and suitably deployed, can also provide a significant reduction of the pressure on midwife time.
Jim Shannon (Strangford, DUP)
I thank the hon. Gentleman for bringing this matter to the House. He will be aware that some 70% of midwives oversee the birth of a child without a doctor’s support. He has not mentioned that it can cost up to £45,000 to train a midwife. Some of our midwives, certainly some from Northern Ireland, are going to Australia to gain experience. Does the hon. Gentleman see some way of retaining midwives here in England, where, as he has said, there seems to be a shortage? Might there not be some way for the regions to help each other in this respect?
Henry Smith (Crawley, Conservative)
The hon. Gentleman has raised an important point, which reinforces my view that there must be proper investment—the Government are already making a good start—to ensure that student midwives learn how to help mothers give birth in a safe environment so that in most cases there are no complications. It should be emphasised that consultant-led maternity units, although obviously vital, do not represent the full picture, and that midwife-led units play an important role in increasing capacity. Midwife training in each part of the United Kingdom should be at least maintained, and in some regions increased. It is necessary to maintain the numbers who begin training to ensure that an adequate supply emerges at the other end, and I repeat my commendation of the Government in that regard.
Let me end by referring to a matter related to my constituency. Yesterday evening, during the Opposition day debate on the NHS, I mentioned that 10 years ago, in 2001, the maternity unit at Crawley hospital had regrettably been closed and moved nearly 10 miles up the road to East Surrey hospital. The move has created extra pressure at that hospital, and mothers and their families have a more difficult journey to attend the unit at for check-ups and for births.
I am personally very grateful to East Surrey hospital. It is where my children were born. My daughter Georgia was born there in 2003, my son Isaac was born there in 2006, and I feel that it is important also to mention that my son Ethan was stillborn there in 2005. The care that the hospital provided for us was second to none. Nevertheless, I think it important for mothers and families to have access to midwife-led services that are closer to their communities. It is certainly one of my hopes and desires that we may be able to establish a midwife-led unit for Crawley—and, indeed, many more such units throughout the country.
Anne Milton (Parliamentary Under Secretary of State (Public Health), Health; Guildford, Conservative)
Let me begin by not only congratulating my hon. Friend Henry Smith on securing the debate, but thanking him for raising the high-profile issue of midwife and maternity services. Those services, and the midwives who work in them, are extremely important to women, and the provision of high-quality maternity care is non-negotiable for a Government and a health service. I want to outline some of the measures that we are taking to improve the quality of that care, but let me first pay my own tribute to the midwives throughout the country who do such a fantastic job.
I hope that you will allow me a brief personal comment, Mr Speaker. My four children were delivered in four different hospitals, but in each of those instances the midwife had a profound impact on the experience, and a profound impact on the start that we made with a new little family member. I know that it will have been the same for many other families. The importance of midwives and maternity services cannot be overestimated.
We want to ensure that all pregnant women and new mothers receive the best care that it is possible to give. As my hon. Friend has said, and as other Members will know only too well, maternity services face increasing challenges, and they will have to evolve to meet those challenges. Over the last few years the birth rate has been rising, and the number of complex pregnancies is rising as well. There are also more high-risk births. Women are having babies when they are older, heart disease and obesity are increasing, and more mothers born outside the United Kingdom are giving birth here.
Impressive improvements have been made in many services. The Care Quality Commission’s 2010 survey of women’s experiences of maternity services found that 92% of the women surveyed rated their care during pregnancy as excellent, very good or good, 94% rated their care during labour and birth as excellent, very good or good, and 89% rated their care after birth as excellent, very good or good. I hate statistics as they can seem meaningless and dry. It is important to congratulate the midwives who achieved those satisfaction figures, but we should never forget that if 94% of women rated their care during birth as good or better, then 6% thought they did not get care that was good enough. That might not seem like a large proportion, but for the women concerned it is all that matters.
John Woodcock (Barrow and Furness, Labour)
I have written to the Minister about the high-profile problems at the Furness General maternity unit, triggered by personal tragedies. What reassurances can she give on the future of that unit? More generally, what can she do to ensure that trusts with poor performing services in need of investment get the resources they need to deliver the first-class care people in my constituency and the whole country rightly expect?
Anne Milton (Parliamentary Under Secretary of State (Public Health), Health; Guildford, Conservative)
I acknowledge that the hon. Gentleman has written to me about those issues, and I will come on to discuss the measures we want to put in place to ensure such past tragedies do not happen again. CQC reviews have corroborated that there are problems. It raises concerns about the safety and quality of maternity care in some areas. They are small but significant areas
of concern, and they must be of note to all involved in this area of care, especially as sometimes they involve personal and family tragedies.
Media and public attention on maternity services has picked up pace over the last year. In particular, there is anxiety about safety, capacity and changes to services. In many respects, there is a “perfect storm” of circumstances, which makes things difficult. The issue is how well we react, and how well services evolve and the work force are equipped to react positively.
We have put extending maternity choice as a key priority in the NHS operating framework. To help communities achieve the desired outcomes in the most individually suitable ways, when services change, that change will be led by clinicians, midwives, and women—the very people who run and use those services.
To make sure the maternity infrastructure is being put to best use, I want there to be maternity provider networks across the country, bringing together all the different elements of maternity services, so there are no gaps or hidden corners where mothers might get substandard care. The incident that John Woodcock raised involves precisely such hidden corners and gaps, and such incidents often result in a personal tragedy. Hospitals, GP surgeries, charities and community groups can all be linked up to share information, expertise and services.
We also want more efficient use of skills in maternity wards themselves. Obstetricians and gynaecologists, maternity support workers and, of course, midwives can come together and use their complementary skills and expertise to get the best results for mothers, with appropriately trained support workers providing valuable assistance, for example with breastfeeding, leaving midwives to concentrate on the more specialist areas. This is not just a numbers game; it is about getting the skills, expertise and team mix exactly right. That will mean the talents of all 27,000 midwives can be put to the best, most efficient, use. That number shows that more midwives are working in the NHS now than ever before. The picture looks good for the future, too, because it is backed up by a record number of midwives entering training. Subject to the number of forecast births, that will be maintained.
In July, we published “Supporting Families in the Foundation Years”. That report does not have the catchiest of titles, but it is important because it sets out how everyone who commissions, delivers or leads on something can work to support parents and families. We cannot overstate the importance of the health and well-being of women before, during and after pregnancy; it is a critical factor in giving children a good start and in continuing that good health and well-being as they get older. The latest data show that more than 90% of women who gave birth in the third quarter of 2010-11 saw a maternity health professional within 12 and a half weeks. That is another dry statistic, but it is crucial. Early intervention and early contact with a maternity health professional is crucial to the well-being of not only the mother, but the child. Those meetings are about more than just basic maternity care. Work will have been done on, and discussions will have been had about, things such as diet, exercise, smoking and drinking. This is about improving the health of the baby, the
mother and the whole family, and decreasing the kind of health inequalities that remain and are so persistent in our society. All those things affect the outcome for those women and their babies, and the lasting impact of those things cannot be underestimated.
To back all that work up, from April a maternity experience indicator will be introduced as part of the NHS outcomes framework. That will be an important part of identifying those gaps, as it will allow us to chart a woman’s experience of care throughout antenatal care, labour, delivery and post-natal care. It will also allow women and their partners to compare people’s experience of care and makes choices about what they want to do. It will be a valuable tool for midwives as well, as they will be able to see how they are doing in relation to peer organisations. If they are doing well, this will drive them on to maintain their level and if there are weaknesses, the experience indicator will show specific areas to improve. As I say, this is not about the numbers; it is about getting the team mix right. In one busy maternity unit that I visited, it was simply about moving women around the labour facilities effectively and efficiently.
The Department of Health funded the “Birthplace in England” study, which was published in November last year. It provided evidence about the expected outcomes for women and their babies at “low risk” of complications. It was the first study of its type in this country, and the findings will be a very important part in shaping maternity services, as well as other, linked parts of the NHS, such as ambulance services, so that every part of the system is working together. It is an extremely important body of evidence. In addition, we have asked the Centre for Workforce Intelligence to carry out an in-depth study of the nursing and maternity work force to determine whether we have the right skill mix and professional teams, and whether they are able to deliver what is needed. That will start this year and will inform the future commissioning of training places.
I hope that what I have said reassures my hon. Friend the Member for Crawley and other hon. Members in the Chamber that we are continuing to improve maternity services to women, whoever they are, wherever they live and whatever their circumstance; it is not good enough to give excellent care in one place and for services to be patchy elsewhere. We want consistently high-quality care and we will carry on with that process, making sure maternity services and midwives are fully prepared for the demands of the modern maternity landscape.
I know that my hon. Friend has had specific issues to deal with in his local area and that they have been ongoing for many years. I am also aware that the picture is complex in terms of the circumstances of the women who end up using the local services. I hope that I have reassured him, to some extent, that we have taken note of what is going on. There is no doubt that the birth of a baby is a very special moment and we want it to be a positive experience that shapes the future of not only the child and their mother, but the whole family.
Question put and agreed to.