Maternity Services

Part of the debate – in the House of Lords at 7:15 pm on 15th January 2003.

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Photo of Baroness Perry of Southwark Baroness Perry of Southwark Conservative 7:15 pm, 15th January 2003

My Lords, I, too, thank my noble friend Lady Cumberlege for introducing this important topic, and for her elegant and knowledgeable speech. I also declare an interest as the chair of the research governance committee of Addenbrooke's NHS Trust and Cambridge University Clinical School, and as a former non-executive director of Addenbrooke's NHS Trust.

Like so much of the NHS, maternity services are under severe stress—some might even call the stress in some areas intolerable. Despite the excellent work undertaken by consultants, midwives and technical and support staff, staff shortages mean that services are having to be cut back and wards are closing, decreasing the service available to women and their babies and causing mothers a great deal of anxiety and distress.

In the modern age, young mothers have high expectations—far higher than when most of us underwent our pregnancies. For the modern woman, scans, screening, blood tests and management of all kinds of abnormalities are available. Excellent though it is that those services are now available—many mothers and babies are healthy because of them—they all require a huge increase in specialised time, which is increasingly difficult to find. As my noble friend Lady Cumberlege said, the biggest issue is the shortage of midwives. The Rosie Maternity Hospital in Cambridge, part of the Addenbrooke's NHS Trust, is 20 per cent below its funded numbers—that is, it receives funding for 20 per cent more midwives than it can possibly find. That is a terrible waste of government funding.

No doubt, at the end of our debate the Minister will tell us about the large sums of money that have been invested in the NHS, but I hope that he will also acknowledge that there can be no adequate return of money supplied for services where the goods and services for which it is given are simply not available. Money for non-existent nurses or doctors and the beds that they make possible is a recipe for inflation and bad management and produces no improvement for patients.

According to the Government's research measurements for workforce planning, Addenbrooke's needs another 60 per cent more midwives than it has currently. At present, it has only 105 midwives; using the Government's workforce planning measure, it needs 169. That is a serious situation, but there is little hope that it will be solved, because the number of midwives entering training is also thinning to a small number.

The traditional route was 18 months of post-registration training. Those places are now not being taken up as people who have become nurses consider the stresses of the midwife's job. The shortage of other midwives, long hours and inadequate pay, especially for those who work in high cost areas such as London and Cambridge, are not an inducement, even though the 18-month route has the advantage of paying a full salary while in training.

In response to the low take-up of the 18-month post-registration route, the Government set up an alternative route of three-year direct entry training. That was a good idea, but unfortunately there is no funding for students on that course. That is a real difficulty, especially for the kind of person that the course was intended to attract: the more mature woman, who thinks carefully before undertaking three years of training that will be a heavy burden on her pocket and, perhaps, that of her family.

I am told by senior midwives that the profession aspires to the status of an all-graduate profession, but the lack of student support and the introduction of fees in higher education makes that a very distant prospect. What is more, there is developing a severe shortage of trainers of midwives. Midwives now have three alternative routes to promotion and to higher status. They can become teachers, as midwifery trainers; they can become managers; and, under a new government initiative, they can now become consultant midwives.

Of course, the consultant midwifery initiative was introduced with the best of intentions. It is a good idea to offer a promotional route to enable staff to stay in the clinical environment. Unfortunately—or perhaps one might even say fortunately—that has proved to be a very attractive route to midwives because most like to remain in the clinical area. However, because so many midwives are choosing the consultancy route, the teaching and management routes are experiencing severe difficulties in recruitment. Therefore, the number of teachers available—even if it were possible to recruit candidates for training—is becoming a major problem.

As other noble Lords have said, there is the related problem of the shortage of neonatal cots and neonatal nurses. Noble Lords mentioned the long wait for a government response to the report on neonatal services. Because of the delay and shortage of neonatal cots and neonatal nurses, women in labour find themselves being piled into ambulances—quite often at a late stage in their labour—to be taken to a hospital where provision is available for their baby. In one recent case, a new mother was even told to get on a train so that she could catch up with her baby who had been taken to a neonatal unit. That must be a terrible experience for a woman a few hours after childbirth.

The position on consultants also gives little cause for optimism. Recent changes in training conditions, and the results of the European Working Time Directive, mean that there are now fewer available hours of consultant time. Already the European Working Time Directive means that all time "on-call" is counted as working hours, which will be reduced to 48 hours by 2009. Working hours are being reduced with the best of intentions, but that reduces the number of hours of consultants being available to help in the most difficult cases.

For reasons best known to themselves, the Government reduced the number of consultants in obstetrics' training in 1998–99. There appears to have been no account taken in the 1998–99 report—which resulted in the reduction of training places—of the effects of the European Working Time Directive and the changes in training conditions. Therefore, the number of consultants in obstetrics training was cut back and the Royal College of Obstetricians and Gynaecologists in its 2000 report, Blueprint for the Future, predicted a major shortfall by 2003 as a result of that reduction in training places. That is already becoming apparent in key areas.

I ask Her Majesty's Government to act and act very quickly to remedy this situation. I hope that the Minister will give us some reassurances. Incidentally, by action, I do not mean throwing more money at the NHS; I mean a hard look at what is needed to solve some of the problems.

In spite of the problems, there is good news to report. With the leave of the House, I should like to pay tribute to the hospital that I know best—the Rosie Maternity Hospital—for the initiatives that it has managed to introduce and its achievements in recent years. In the past two years two new consultant posts—one, a professor in the university clinical school—have been established. That means that women who have difficulties with their pregnancy and birth are now being referred to the hospital from the whole region. At the same time, that has driven up the quality of provision for all women, including those with normal births.

A high dependency unit is being established for women with difficulties. The training is already in place; the unit will move into action soon. Plans are also moving ahead for a multi-disciplinary perinatal service, bringing together neonatology, neonatal-surgery, genetics and radiology. That means that a splendid service will be provided not only for women in difficulties but for all women in the region.

For the healthy—one might say—normal birth, a midwifery-led unit has been established which includes a birthing pool—a thought which I find terrifying, but which seems extremely popular with young mothers. A newly appointed consultant midwife is leading that service. There is closer collaboration with neighbouring hospitals enabling women to be cared for in the way which is most appropriate for them. As my noble friend said, every woman and every baby is individual and deserves individual, carefully tailored care.

With those initiatives the hospital and the trust are able to provide a service tailored to individual needs. All they ask is for less government direction and interference. They believe that the maternity services can deliver and should be left to do so.