My Lords, the number of registered midwives is not in decline. The Nursing & Midwifery Council figures showing that there are fewer practising midwives in the UK are wrong and have been withdrawn. There are 1,300 more midwives working in the NHS now than in 2000. The Government are increasing midwifery training places. In 2002–03, 2,110 students entered midwifery training; that is, 28 per cent more than in 1996–97.
My Lords, I thank my noble friend for that response. Is he aware that although the figures are being readjusted by the NMC, they will still show that there is a sharp reduction in the number of midwives taking up posts? What is being done to stop some students—I believe about one-fifth—dropping out of their courses due to inadequacies of support, particularly in respect of childcare arrangements and the low level of the bursary that they receive? That creates a risk for the maternity services and urgent action is needed.
My Lords, I am not sure that I accept my noble friend's position regarding numbers. The advice that I have received is that the NMC data—for example, in London alone—understated the numbers intending to practise by about 3,000 people. The council is working with the department, but I am advised that those figures are wrong and the number of midwives is increasing.
As regards student attrition rates, there are always some students who do not complete their courses, whether in midwifery or otherwise. If they are not qualified to do the job and have not satisfied those who verify their performance, it is appropriate that they should not qualify. The Government have substantially increased the money for NHS bursaries following action by the Chancellor in 2000.
My Lords, is the Minister aware that at birth centres and midwife-led units there are waiting lists for midwives who want to work there because they can give a quality of care that they cannot give elsewhere? As a result, there are fewer interventions and there is less anguish for mothers and less morbidity for babies. Is the Minister further aware that those units are under threat of closure and that some have recently closed? Indeed, a Labour Secretary of State and the Minister's predecessor, the noble Lord, Lord Hunt, intervened to stop those closures. Will the Minister work with his colleagues to do likewise?
My Lords, we want to have a wide range of different models of care and place of birth. We do not champion one model over another. Choice is important for all women. The birth rate has been falling substantially for 13 years. It has fallen from about 650,000 births per year to 540,000. In itself, that will mean that some adjustments of services may be necessary.
My Lords, does the Minister agree that whatever the figures there is certainly a perception in the health service that too few midwives are being trained? If we are to move to a more patient-centred form of treatment during pregnancy, we must ensure that we have enough trained people. Given those circumstances and the fact that most people undergoing midwifery training are mature students, will the Government please look long and hard at their training policy and at giving sufficient support to people who are also involved in raising their own families?
My Lords, I stand by what I said in my Answer about the increase in the number of midwives since 2000. The Department of Health has also funded 500 return-to-practice places. In March, we launched the 2004 recruitment campaign with television advertising. Of course, we want to generate more applications for midwifery, but the numbers of student places are increasing. Again, I make the point that the birth rate is going down.
My Lords, I do not have that information to hand, but I shall write to the noble Baroness.
My Lords, is the Minister aware that the shortage of midwives is evidenced by the vacancy rate which, in London and the south-east in particular, is acute? The vacancy percentage across the UK is around 5.4 per cent of funded establishment, but in London it is 18.3 per cent. Is there anything that the Government can do to ameliorate the situation, particularly in London and the south-east, where the cost of living is very high?
My Lords, we accept that across the country vacancy rates rose marginally in 2003. In part, that was because we increased the number of funded posts ahead of their being filled. Vacancy rates can be cut by cutting the number of posts, just as train punctuality can be increased by saying that journeys should take longer. We can play statistical games in that area. We accept that there is a shortage of midwives in some parts of London. Agenda for Change will give more flexibility for local PCTs and trusts to offer higher rates.