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2 May 2007 : Column 495WH—continued
There is no doubt that the Government have set out an ambitious programme to give women more choice and better maternity support, and they should be congratulated on that. However, there can be no substance to those proposals while the NHS continues to suffer a shortage of midwives and the closure of maternity units. Those problems cannot be denied and I shall be interested to hear the Minister’s response.
Those two themes run through all the issues facing maternity and midwifery services.
Let us start with the number of registered midwives working in the NHS. I agree with the Minister that the Royal College of Midwives has estimated that an extra 3,000 midwives are needed if the Government are to deliver their promises in the document, “Maternity Matters”. However, what do we find? We find that overall the number of midwives has fallen for the second year running, having fallen during the last year in question by 339. The number of full-time equivalents—in our opinion the best measure of the availability of a midwife at any time—has risen by 4.5 per cent. since 1997 according to Government statistics, but that has failed to keep pace with the birth rate, which has increased by 9 per cent. since 2001. If the number does not keep pace with demand, it puts increasing strain on midwives.
In this place, we often bandy figures about in the hope that they illustrate our arguments and so on, but I propose to the Minister that the situation is even worse than the figures suggest because midwives not only work shorter hours than 10 years ago, but the maternity case load is even more complicated, with more mothers giving birth earlier and later in their lives. That is complicating the casework.
At a result, understaffed maternity units are overstretched. According to a survey by the RCM, an estimated two thirds of department heads thought that their units were understaffed, with posts being cut and too much reliance being placed on maternity care assistants. As we have heard from a number of hon. Members, a BBC “Panorama” programme tomorrow will confirm that picture, with overworked midwives afraid that they do not have enough time to give patients the right level of care.
On top of that, vacancy freezes brought about by financial deficits will only make matters worse. Figures confirmed by the Government show that by November 2006, a third of all midwives who had completed training since May 2006 had not found their first job in the NHS—a total of more than 4,200. Apart from the consequences for the NHS generally, the cost of training those professionals for unemployment was around £230 million. That money could be better spent on patient care.
Perhaps most disheartening is the impact of understaffing on the Government's own pledge to provide women with one-to-one continuity of care by a named midwife by 2009. That is an important aspiration—the gold standard in maternity care—yet it cannot be achieved without a substantial increase in the number of midwives. In view of all those concerns, will the Minister take this opportunity to state clearly and for the record what estimate he has made of the number of additional midwives needed to meet the challenges set out in “Maternity Matters”?
It is doubly worrying that the fall in the number of midwives is taking place against the backdrop of maternity units being closed throughout the country, as a number of hon. Members have said. Last December, we identified up to 21 midwife-led units under threat. Those centres are often based in the community rather than in hospitals, and they offer women a less medicalised birthing experience. They tend to be well loved resources and should be protected. I suggest that
without local midwife-led units, the Government cannot realistically offer women alternatives to giving birth in a highly medicalised environment in hospital. Only by making those options more widely available can we enable women to question the received wisdom that medical intervention is the preferred option.
The only other alternative to hospital is home birth, but only 2 per cent. of women giving birth do so at home, although many more would like to. Again, the shortage of midwives impacts on that. There is already a striking north-south divide for women who are helped to give birth at home, with women in Devon seven times more likely to secure a home birth than women in Merseyside. The Government say that they want to make home births more widely available, but plans to reconfigure consultant and emergency services around fewer and larger regional centres works against that objective. As many as 15 per cent. of planned home births result in a transfer to hospital and those transfer times and distances are likely to be longer in future because of the Government’s plans to centralise services. That policy could put lives at risk.
Conservative Members are very concerned about the Government’s proposals to concentrate consultant services. First, there is still no clear evidence base or clinical model for the move towards fewer, larger maternity units, yet the Government seem to be hellbent on encouraging mothers-to-be to give birth in ever larger units. We are increasingly being told that larger, consultant-led units with more than 3,000 live births a year are safer for women, but the National Perinatal Epidemiology Unit is not due to report on the topic until 2009, so on what basis can those assertions be made?
Meanwhile, the move to larger units goes against the grain of maternity provision on the continent. The largest unit in Germany has only a little more than 3,000 live births a year and the largest in France has 4,000. In contrast, English maternity units, such as the one that is being investigated by the BBC at St. Mary’s hospital in Manchester, often deliver more than 5,000 babies a year. That is not to say that all larger units are worse, but the clinical case for ever larger units has not been made, and the Government should recognise that before they continue down the line of encouraging mothers to give birth in ever larger units.
I know that the Minister has taken issue with the Greater Manchester reconfiguration in his own backyard, but the problem is that the Prime Minister and the Secretary of State for Health have both endorsed the principle of larger, fewer units. Some people would argue that there is an element of hypocrisy in that state of affairs: the Minister who is present argues one thing in his own backyard while he peddles a national policy that goes against that local argument.
In the time allowed, I must mention independent midwives. The Government seem determined to ensure that independent midwives take out professional indemnity insurance, despite the fact that they are unable to obtain it because of the high premiums that reflect the potentially huge payouts involved. There is no clear evidence of a link between possessing insurance and being a safer midwife; if anything, the intuitive link runs the other way, because midwives
stand to lose everything in cases of negligence. Their services are especially valued by women who are either fearful of highly medicalised interventions during childbirth, or have had a bad experience in the NHS.
Will the Minister explain why the Government seem hellbent on pursuing that argument and policy on insurance without at least granting a consultation? We have requested one, but we have not received an answer from the Government. I raised the issue in a letter to the Secretary of State on 29 March, but so far, I have not had the courtesy of a response. Will the Minister now respond by promising the House and all independent midwives that the Government will consult on their proposal?
In conclusion, the principles of one-to-one care and choice in maternity are the principles on which the future of maternity and midwifery services ought to be based. However, the Minister must right now start explaining how we can deliver the Government’s pledges without the appropriate increase in midwife numbers, and while the Government pursue the policy of closing midwife-led units.
3.52 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): In terms of equal distribution, the hon. Member for Billericay (Mr. Baron) has left me with less time than I should have had to answer what has been a substantive debate. However, I do not think that he did so on purpose.
I congratulate the hon. Member for St. Ives (Andrew George) on securing this important debate during the international week of the midwife. I pay tribute to the tremendous work that midwives do every day on the front line of maternity services in this country, to the contribution that the Royal College of Midwives makes to these debates and to raising the profile of such issues in Parliament, and to the leadership of Dame Karlene Davis. The RCM has been consistently supportive of the vision and the plan that was outlined in “Maternity Matters”, despite expressing genuine concerns about some of the issues that have been raised during the debate.
We have heard from hon. Members that, during maternity, women and parents will experience arguably one of the most important periods in their life, and all that I ask for is balance in the debate about the state of maternity services. It is the height of irresponsibility to suggest that somehow, the majority or even a significant number of women will have a poor maternity experience in our hospitals.
Mr. Baron: Nobody has said that.
Mr. Lewis: The balance of the debate has suggested it, but it is not supported by one jot of evidence.
Let us hear some statistics. We invested a total of £1.67 billion in maternity services in 2005-06. Between 1997 and September 2006, the number of midwives employed in the NHS increased by 9 per cent.—a whole-time equivalent increase of 5 per cent. The number of students entering the profession rose by 44 per cent. between 1996-97 and 2005, and the projection is that 1,000 additional midwives will qualify
by 2009. How anyone in this debate can suggest that that represents a reduction in the number of midwives—
Martin Horwood: Will the Minister give way?
Mr. Lewis: I have no time to give way.
The number of consultants in obstetrics and gynaecology in England has increased from 1,032 to 1,506—an increase of 46 per cent. In summer 2005, when women were last asked, 80 per cent. of those surveyed said that they were satisfied with the maternity services that they had received. In 2001, we committed £100 million additional capital investment to improve maternity facilities, and we are still spending that money. So let us be clear: there has been a tremendous amount of investment and tremendous advances in maternity services. Do we still have many challenges ahead of us to achieve the gold standard in maternity services? Most definitely, we do.
To achieve the vision in “Maternity Matters”, we have made it clear that, in addition to the introduction of those 1,000 midwives, other measures will have to be taken in local health economies where the work force is not at the appropriate level to deliver that guarantee of choice to women. We have made it absolutely clear to primary care trusts in local health economies that they will have to commission additional midwives if they do not have a sufficient baseline number of midwives; they will have to consider all the professionals who contribute to the maternity experience and get them working together; and they will have to entice back to the NHS some of the midwives who have left.
The hon. Member for St. Ives and other hon. Members talked about the roles and responsibilities of the Department vis-Ã -vis the local NHS. I find it staggering that, time and again, we hear rhetoric from both main Opposition parties about maximum devolution, localism, local determination and being in the best place to respond to the needs of local communities, but that we are then criticised for not commanding and controlling every decision from offices in Westminster and Whitehall. It is a complete intellectual contradiction.
From the centre, we can make resources available, specify the outcomes that we expect, put maternity high up the NHS annual performance assessment framework, give the Healthcare Commission the power to inspect to ensure that maternity services are adequate and ensure
that the local health service leadership understands that maternity must have a new priority and that strategic health authorities commission and develop services to deliver “Maternity Matters”.
The hon. Member for St. Ives says that the Government appoint people to run health organisations. Does he not realise that the independent NHS Appointments Commission is a source of great angst to many Government Members?
The hon. Member for Enfield, Southgate (Mr. Burrowes) made a very personal contribution, and I congratulate him. The slogan that comes to mind is, “Cameron fails to deliver, Labour ends triumphantly,” but perhaps the hon. Gentleman would not necessarily accept that.
During the debate, hon. Members made several points about reconfiguration, but let us be clear that, whatever decisions are made locally, every woman must have access—through real choice—to a consultant-led service, a midwife-led service or a home birth. Wherever they live, in whatever part of England, such access is absolutely central to the “Maternity Matters” guarantee that will be in place by the end of 2009. Any decision about reconfiguration in Banbury or anywhere else must lead to a scenario in which any woman has access to such choice.
I say to the hon. Member for Banbury (Tony Baldry) that if the scrutiny Committee refers the decision—I do not think that it has been made, by the way—to the Secretary of State, she would of course consider the weight of evidence from a variety of sources in her determination about whether to send it to the independent configuration panel. I shall write to the hon. Gentleman about the membership of the working party and why there is no transparency in that respect.
I say to the hon. Member for Cheltenham (Martin Horwood) that change in some areas—in many areas—may be necessary for safety, quality and choice. Politicians should be frank and honest about that. However, not all proposed changes are right, and frequently, local communities do not like the proposals, which is why Parliament has laid down clear processes, so that local communities and commissioners have the right to say, “A proposal in our area does not best meet our needs.”
I say to my hon. Friend the Member for Stroud (Mr. Drew) and the hon. Member for Billericay that we are working with independent midwives to resolve the insurance issue.
Education Funding (F40 Group)
4 pm
Mr. Graham Stuart (Beverley and Holderness) (Con): It is a great pleasure to have this opportunity to address Westminster Hall and the Minister for Schools on an issue of such importance to my constituents. I am going to talk about the state of education in the East Riding of Yorkshire and the funding of that education system. I shall then discuss the F40 model, which is a mechanism by which the Government can better target funding towards those most in need. Finally, I shall touch on the school early years and 14-to-16 funding consultation that the Department for Education and Skills is currently conducting.
The structure of my remarks will be remarkably similar to that of a speech that I gave on a similar subject in March 2006. As the Minister knows from personal experience in his constituency, however, the problems do not go away easily. I am delighted to see a Minister here who led a delegation to meet the Secretary of State for Education and Skills in 2002, precisely to challenge what he described as the unfair distribution of funding among education authorities throughout the country. Although he has been the Minister now for a year, we have high hopes that he will eventually lead the transformation of the system and bring about the greater fairness that we want.
The East Riding of Yorkshire is an improving education authority. It is above the national average at key stage 2 and key stage 3. At GCSE, 62.2 per cent. of pupils gained five or more A to C grades, as compared with a national average of just 59.2 per cent. I want to highlight the performance of two schools in my constituency. First, Longcroft school and performing arts college in Beverley had serious weaknesses just three years ago, but it is now ranked as the country’s fifth most improved school, with more than 60 per cent. of its pupils achieving five or more A to C grades, including in maths and English. Secondly, Beverley high school for girls is, once again, the top performing comprehensive in the East Riding at GCSE, with 78 per cent. of pupils achieving five A to C grades. Even with the inclusion of English and maths, 71 per cent. of its pupils achieved five good GCSE grades.
I pay tribute to the pupils, staff and head teachers in the East Riding, as well as to the local authority, which does an exceptional job in challenging circumstances. When I met the Minister to discuss the issue last year, he accepted that low-funded authorities had made Olympian strides to improve standards in some cases. However, that does not change the unfairness of the funding formula, which he rightly identified back in 2002.
East Riding schools receive funding well below the national average. Last year, the East Riding received a guaranteed unit of funding per pupil of £3,322, through the dedicated schools grant, and it will receive £3,535 this year. That compares with nearby Hull, which will receive £3,999 per pupil, and with Tower Hamlets, which will receive £6,028. The national average, meanwhile, stands at £3,888—I do not know what a numerologist would make of the repetition.
If the East Riding were to receive the same amount of funding as Hull, an additional £21 million would be
available to share among the schools. How does that affect schools in my constituency? In 2005-06, Bilton primary school in Holderness received £2,458 per pupil, whereas Wansbeck primary school received £2,922 per pupil, yet those schools are less than a mile apart. Despite its rurality and areas of deprivation, the East Riding is the fourth-worst funded education authority in the country.
The East Riding’s allocation for this year represents an increase of 6.4 per cent. That sounds generous, and I am sure that the Minister will rehearse comments about increases in funding over the years—regardless of any pleas not to. However, that increase is below the national and regional average, as he knows. The national increase in 2007-08 will be 6.7 per cent., while the increase in Hull will be 7 per cent.
The cash gap between the highest and lowest funded authorities is therefore widening. Since 1997, although there has been a substantial increase in education funding, that gap has increased by more than £600. Even over the comparatively short period of the new funding arrangements, from the base year of 2005-06 to 2007-08, which the Under-Secretary of State for Education and Skills, the hon. Member for Corby (Phil Hope) mentioned last year, the gap between the funding per pupil in the East Riding and the national average has increased by a further £59 per pupil. That gap equates to £2.84 million missing from my constituents’ schools.
The Conservative-led local education authority has worked hard to make up for central Government’s inequitable distributions. It has maximised spending on schools, largely by reducing central costs, particularly on strategic management. Last year, for example, the proportion of the dedicated schools grant delegated to school budgets was more than £2.7 million above the average for similar-sized authorities. That was achieved by reducing spending on strategic management to £61 per pupil, as compared with the national average of £87 per pupil, which represents a saving of £1.3 million.
Using its excellence fund, the authority put £1 million extra into schools above the Government’s spending guidance.
The authority has managed to find the extra money to put into schools and demonstrated that it can be converted into improvement and genuine delivery for pupils throughout the area. However, there is no getting away from the shortages in funding, which are having a devastating impact on the ground. I have spoken to many head teachers in the East Riding, almost all of whom have told me that they will be forced to make substantial cutbacks in the near future.
Beverley grammar school, which I have visited, is currently £160,000 in the red. It has been hit with increased costs of £420,000, including a £51,000 rise in exam fees and a £28,000 increase in energy costs. The head teacher, Chris Goodwin, recently said:
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