Mr Robert Buckland (South Swindon) (Con): It is a pleasure to introduce a debate, which I believe is timely, on school governance. School administration faces radical reform. More schools are becoming academies, maintained schools face the prospect of changes in local authority control and free schools are on the agenda. In my opinion, the role of governors and governing bodies has never been more important. Apart from reforms resulting from changes made by successive Governments over the past 30 years, the system has not really changed for many more years than that.
The current system can best be described as committee-based. It involves volunteers coming together at various times during the school year. Gatherings of the full governing body, which is normally about 20 people, are often less well attended; and the committee structure is designed around the various disciplines that school leadership teams feel should be addressed.
I am happy to say that the model is not prescriptive. Each school has the freedom to set its own committee structure. For example, Ridgeway school at Wroughton in my constituency, where I served as governor for four years until the end of 2009, had what can best be described as a typical committee structure. We had a committee to deal with the curriculum, a committee to deal with student matters and a committee to deal with finance and premises-the traditional division of work. However, despite the excellent work done by school governors, despite the fact that more than 300,000 admirable volunteers serve as school governors, and despite what they do to support head teachers, staff and the wider community, I believe that more can be done to improve the effectiveness of their work.
I am not the only one to say that. Head teachers and governors whom I know and respect, along with national organisations, are making similar representations to the Government. I am delighted that, under the White Paper process, the Government are committed to reviewing the efficiency of governing bodies and to working with organisations and schools to improve things. I welcome that, and today's debate gives the Minister the opportunity to put some more flesh on the bones of that valuable commitment.
I say that the debate is timely because, under the previous Government, and despite a promising start, two years were lost during which there was much debate and discussion about the role of governing bodies. The former schools Minister, now Lord Knight, started that valuable work in 2008, but it was not until the eve of the general election that a report was published. I welcomed
that report; it contained much that was positive, and I am sure that the Government will bear it very much in mind when building upon it.
I pay tribute to the work of governors, and particularly to the chairs of governing bodies. They are entrusted with huge responsibility, and it is all done voluntarily. With good practice, they work closely with head teachers and senior leadership teams. They are regularly in and out of their schools, and they help set the school strategy. However, like it or not, I increasingly feel that governing bodies have split into two tiers. The inner tier of governors has the time and wherewithal to become involved in the strategic management of the school; the outer tier does much of the monitoring work: going to the school, meeting the teachers, getting to know the link subjects and following things up excellently, but I believe that we now have a spilt between those two roles.
Those two roles are the essential tasks of a governing body. They help set the strategy, aims and objectives, policies and outcomes of a school, and they monitor and evaluate progress in achieving those things. I am not talking about the crossover between operational work and strategy. I readily accept that governors do not and cannot have a role in the day-to-day management of the school. That would trespass on the province of the professionals employed to do that job-I am sure that the professionals would echo that. However, if the role of governors is to become more pivotal, more work has to be done to focus their energy, talent and time on the two tasks that I have set out.
Time is a valuable commodity. It is given freely by governors. I hate to think of them spending their time at long and unproductive meetings, feeling that nothing much has been achieved. I do not say that that is universally the case, but I would be telling an untruth if I said that there were not times during my service as a governor in various schools when I came away from rather long meetings feeling frustrated.
Justin Tomlinson (North Swindon) (Con): I congratulate my hon. Friend on securing this excellent debate. Between us, we represent the two halves of Swindon, so I am sure that we must often have spoken to the same people. Indeed, one governor to whom I have spoken supports what my hon. Friend says. I sum it up by saying that they are money-rich but time-poor in middle England. That is one of the biggest challenges, given that we presume that some schools would be awash with potential school governors. I wonder whether my hon. Friend has heard that from other governors.
Mr Buckland: My hon. Friend is right to mention middle England. Like me, he represents a seat with a wide spectrum of social indices. We have schools in leafy suburbs, schools in challenging areas and schools with a large percentage of black and minority ethnics. Time is a precious commodity wherever one lives, but energy is even more precious. It is incumbent on policy makers to lead the debate when it comes to focusing the valuable talents and energies of our school governors.
I mentioned earlier the frustrations that I felt about long and unproductive meetings, but those frustrations are often shared by head teachers. They spend a lot of time having to prepare long documents that are then read out to the governors. With the best will in the world, head teachers do not always have the time to do
the important early pre-meeting circulation that can improve accountability. It is rather like a half-baked cake; it has good content, but it has not set in a way that makes it digestible. I am sorry to say that that experience is repeated throughout the country.
I do not criticise the entire system, nor do I criticise volunteering. I am entirely in favour of the system, but we must maintain the important principle at its heart. With a little adjustment here and there, and a little imagination, we could get it right. We should fit the system around the talents of the governors rather than trying to fit the governors into a rather tired and stale system. That is the essential point that I wish to make today.
Guy Opperman (Hexham) (Con): I am fascinated by the idea of the half-baked cake, and where we are going with particular parts of it. May I raise the matter of special educational needs? My hon. Friend knows that I have experience in that field, and I am curious to know his view on it, and the interaction between what the headmaster and the governors are doing, on an ongoing basis.
Mr Buckland: My hon. Friend has a long history as a lawyer in dealing with SEN tribunal cases. He will know that my last role in my last school was to be the SEN link governor. Therein lies the essence of the dilemma often faced by governors. I was working with a dedicated and talented SENCO-a special educational needs co-ordinator-with years of experience. She would come to me with issues that sometimes strayed into operational areas. As the SEN link governor in a mainstream school, I felt that I had a duty to raise her concerns and to ensure that the issues of SEN and of those students who had statements or who were on a school action plan or school action plus were put centre stage of key strategic decisions. One of the issues facing us was that the SENCO was not part of the senior leadership team. There was a champion for special needs-an assistant deputy head teacher who was a talented and able person-but it would have improved things if the SENCO had been part of the senior leadership team. That ties in with some of the suggestions made by the National Governors Association, which takes the view that there is no need for a SEN link governor because that work falls under operational matters. I hesitated when I read those observations, because making such a move is all very well, but unless the SENCO is at the heart of the leadership team, a link governor is necessary to represent the interests of not just the special needs staff, but the children with special needs and their parents.
I am grateful to my hon. Friend the Member for Hexham (Guy Opperman) for his comments. It is important that we get down to detail when we consider that sometimes troubling division between setting strategy and operational matters. The same can be said about looked-after children. My hon. Friend the Member for Crewe and Nantwich (Mr Timpson), who sadly cannot be with us today, is campaigning assiduously to ensure that the needs of looked-after children in mainstream schools are properly represented. He is championing the cause for a link governor for those children. I make exactly the same observation as I have with SEN. The matter can be dealt with if there is proper representation
for looked-after children in the senior leadership team, with the deputy head teacher ensuring that their voice is heard and that their interests are taken into account.
I have talked about autonomy and the gradual decline in the role of local authorities, which places quite a significant role on governors. Many schools in my local area are considering academy status. Some have formally applied for it and others are considering it. Some schools are thinking about federation, which is a huge opportunity to enhance the strategic approach taken by the governing bodies. Moreover, it is an opportunity to enhance that division of work between strategy and monitoring.
With devolution of power to schools goes devolution of power within schools. That means that learning departments-whether English, maths or modern foreign languages-will have link governors to liaise with governors whose strategic role is to monitor the progress that each department is making. Many schools, including my own governing body, have such a system in place, but whether it is working as well as it could is another matter. If we accept the role of volunteers, we have to acknowledge that volunteers' time will depend on the nature of their other commitments. That is why it is vital that we understand the principle of matching the talent to the available roles.
Some governors have particular expertise in procedures to do with exclusions and complaints, particularly those made by parents. An increasingly important part of the role of governors is dealing with complaints. The Government are doing all they can to simplify and rationalise the exclusion system. I know that they quite rightly view exclusions as a last resort. It is the last option for a head teacher, who will use it as their ultimate sanction when dealing with a particular issue in the school, and that is the right approach. However, it means that more emphasis will be placed on pre-exclusion work, and the role of governors in that regard will become more and more important.
Guy Opperman: In respect of exclusions, does my hon. Friend welcome the fact that we will be doing less work on a long-term basis on exclusion procedures because they will be simplified as we move forward?
Mr Buckland: My hon. Friend is absolutely right. I was putting it in a slightly more roundabout way. Although there will be less work on formal exclusion procedures, there will be a growth in other types of intervention, most notably in parental complaints. I know that every governing body will have a policy on complaints, but they must be assiduous in ensuring that those policies are comprehensive and understandable to the parents themselves.
I have used that example of special work as a way of engaging people in the community who have a talent, a training or an understanding of such principles but who may not have the time to commit to regular committee meetings. Although I do not want to see visitors coming into the school with no knowledge of the environment, people with specialist knowledge have an important role to play. If they get the training to deal with specific procedures, they can help out schools with particular challenges. One example is the big issue of finance that faces school governing bodies and head teachers. There is no doubt that the most onerous part of the duties of academies, free schools and maintained schools will be
the maintenance of their budgets. It is already a big challenge for many schools. Some schools are getting it right; others are finding it more difficult. I am not casting aspersions on individual schools, I am simply stating a reality. Having spoken to many teachers and head teachers over the years, it is my understanding that they are always receptive and open to the sort of input that people with specialist financial training can provide. Although the Government are doing all they can to simplify financial structures, make financial information easier to understand and remove some of the labyrinthine documents that I have had to view over recent years in the context of SEN funding, I can see a key role for people with financial expertise in not just the strategic running of a school but in assisting head teachers and finance officers with the management of budgets.
Justin Tomlinson: Talking to school governors in my North Swindon constituency, I have found that many are attracted to the role because they are keen to get involved in operational issues, which they obviously cannot do. As the number of governors who are either interested in or have the necessary skills to deal with the finance side are in chronically short supply, they often get put on to those committees that drive them away. One of the biggest challenges is attracting people with the right skills, not necessarily parents, to come in and take that very important role in schools.
Mr Buckland: My hon. Friend has hit on a central issue in the debate on school governance-the balance between the need to have skills and the need to be representative of the wider community. The two are not mutually exclusive. Imaginative governing bodies-there are plenty out there-are striking that balance at the moment. Professionally skilled people who live in the local community, perhaps trained accountants, lawyers or doctors, can become partnership governors-if it is a foundation school-community governors or a representative of their local authority. We then balance them out with the parent governors, who play an important part in governing bodies. Indeed, some play a huge role in running their schools and that is welcome, but more can be done to engage the wider parental community. Loads of parents are out there who, because of their work and family commitments, do not have that precious commodity of time. However, if they were on a database of supporters, or friends, of the school, they would, I am sure, give what time they have on specific projects, such as enhancing the appearance of the school. They can be given something to match their own talents to enhance the life of the school. What better way of cementing the role of the school in the community than creating this wider support base?
Of course, with that support base comes the obvious imperative, which I know sensible governing bodies are addressing, of working with parent teacher associations and organisations that exist alongside them, to help raise funds for various school projects. There needs to be a lot more constructive thought about how we involve the wider community in our schools. With the end of the centralised role of local authorities, that imperative for schools to look outwards as well as inwards has never been more important.
It is said that every governing body is only as good as its clerk. Again, all of us in this room and others elsewhere will have known some experienced and hard-working governing body clerks. We must not forget
those clerks in this process. If there is to be the type of change that I envisage, they will need support, training and help to tackle what might become an increasing burden of work for them. The chair of the governing body should never be in a position where he or she is left, if you like, to do it alone. Succession management is a vital part of a functioning and effective governing body, and again more work needs to be done, if not to formalise best practice then to encourage it among governing bodies that might have had a chair for some considerable period and therefore need that change in order to continue in a successful vein.
The key points that I want to reiterate before retaking my seat are: respecting the difference between establishing strategy and operational management, a difference that has always been at the heart of the principle of school governance; understanding the different roles involved in the establishment of strategy and the monitoring of results, and trying to create a system that reflects the talents required for those different roles; involving the wider community in the work of governing bodies in a way that not only fits in with people's demanding lifestyles but that can do so much to enhance the life of our schools, and, importantly, encouraging everyone to move away from the idea that one or two meetings a term will cut the ice when it comes to modern school governance. There are so many better and more imaginative ways to do the job, and I am sure that my colleagues in Westminster Hall today will give more examples of that as the debate proceeds, hopefully stimulating an important and useful part of the process of change.
Andrew Percy (Brigg and Goole) (Con): I apologise in advance if I have to leave the debate early, Mr Dobbin. I have been appointed-joy of joys-to a Delegated Legislation Committee that begins at 10.30 am, so I mean no discourtesy if I have to leave the Chamber before that time.
I congratulate my hon. Friend the Member for South Swindon (Mr Buckland) on securing this debate. I know that he has a huge interest in school governance, and I agree with much of what he has said. I want to make a couple of observations based on my own time as a school governor. I have been a governor at the same school for the past 10 years, and before that I served on the governing bodies of two secondary schools. I serve as a local education authority governor in a school that I attended as a child and that is in the area where I was a councillor. Consequently, I felt that my role as a LEA governor was to be a link between the community and the school.
I associate myself with my hon. Friend's comments about the work that governors and governing bodies do in general. Very often, governing bodies are full of dedicated individuals who have the best interests of the school and their wider community at heart. As we change the education system in this country, however, the time has come to question whether we are necessarily doing things correctly. I have a couple of observations about some of the flaws in how governing bodies work at the moment.
My hon. Friend has discussed schools accessing the wider community, members of which might have particular skills in finance, law and such like. However, that is not
a scenario for all school catchment areas, particularly if the school is in a deprived area, where some of those skills might not be available-it is sometimes a challenge to attract people to be governors in such schools.
One way of tackling that problem, which my hon. Friend has touched on, is to set up a federation of schools, whether it involves a better performing school pooling and federating with a poorer performing school, or whether it involves a cluster of schools pooling and federating, such as a secondary school and its feeder primary schools. I say that because if there is a gentle criticism to be made of governing bodies-I make it very gently, because nobody here wants to attack or insult the work of people who at the end of the day are giving their time for free-it is that sometimes the governing body sees its role as being to support the head teacher in the decisions that they make. Often, governing bodies lack the robust challenge and scrutiny role that they are actually there to fulfil, and I have seen that myself as a governor. Frankly, that sometimes happens because governing bodies are full of educationalists. I say that as a former teacher who still serves as a school governor, but I have sat on governing bodies where the people who have fulfilled the parental governors' roles are people who might well be parents of children at the school, but very often they also work in the LEA or are teachers themselves. The question whether we get the wide representation on governing bodies that we desire is sometimes open to debate.
When I was a councillor in Hull, one thing that my local authority looked at was using the children's trust model as a way of changing the governance arrangements within the city. The idea was to bring together the primary schools and possibly one or two secondary schools through the children's trust, to try to get some of the more strategic thinking that has to be done within schools fed through that process. I supported that model, and I hope that we can build on it. Indeed, it is a model that becomes more important as we move towards the academy structure and increasing numbers of free schools.
The situation has changed in schools. At one time, head teachers saw themselves as looking after their particular parish, as it were-it was almost as if their responsibilities stopped outside the school gates and, perhaps quite reasonably, they focused on what went on within their own schools. However, that has changed, and secondary schools are much better at engaging with their feeder primary schools, and primary schools are much better at working with one another. There are initiatives that have helped that process along the way. One of those is school sports partnerships, which have brought together schools that would previously not have communicated with each other. Perhaps it is time to consider whether the current structure works and whether we should put a greater emphasis on schools' governing bodies to get their schools either to federate or to work more collaboratively with other schools in their area, so that we can introduce strategic thinking into the system and, perhaps, a more robust way of challenging of things.
As I have said, I am making a mild criticism of the way in which governing bodies work at the moment, because, as I have also said, people who serve as governors
tend to be incredibly hard-working, and I would not wish to besmirch them in any way. Nevertheless, we must accept that they do not necessarily always challenge things robustly. It can be hard to challenge things. If a motivated parent becomes a parent governor, their reason for doing so is often that they want to support the school, and it is a natural conclusion that supporting the school involves supporting the head teacher in the decisions that they take.
Another criticism concerns the links between the LEA and governing bodies. LEA governors often work in the LEA or as teachers themselves, and they sometimes serve as community governors or parent governors. However, governing bodies can sometimes become a little too LEA-centric. I have sat at many governing body meetings where we considered a paper from the LEA that included a recommendation. In such cases, people around the table often conclude that, because the recommendation has come from the LEA, they should, of course, approve it. Their reasoning is, "Why would the LEA suggest it if it wasn't anything other than in the interests of the school?" That process is sometimes reinforced by clerking services being brought in from the LEA, which further builds the link between the governing body and the LEA. In one sense, that link is important, but there needs to be a clear separation of power.
My hon. Friend the Member for South Swindon has touched very eloquently-much better than I could have done-on the roles that particular governors play. Those roles have changed in my time as a governor, and more governors seem to actually engage with the school. When I was a local councillor and a school governor at the same time, I always saw my role as providing a community link, but other governors were determined to get involved in the school and spend some time in it. For example, if they were the foundation link governor, they spent some time with the foundation stage teachers, or if they were the literacy governor they spent some time talking to the literacy co-ordinator. That situation has improved, but it is still open to debate whether it has improved scrutiny.
Guy Opperman: My hon. Friend is giving a good overview of the different assets provided by particular governors. Does he see an ongoing role for a pastoral support programme, and does he think that that would help us to go forward? It used to be in the programme, but it is not currently included.
Andrew Percy: That is absolutely vital. When we had a debate on disadvantaged children, I pointed out that in some ways pastoral care has been sidelined in recent years. Pastoral care is more important than ever, particularly where behaviour is concerned, and we all agree that we want to reduce the amount of exclusion.
I am straying a little from the topic, but I point out to the Minister that one of the biggest sadnesses of the changes in recent years is that classroom teachers, particularly in secondary schools, have often had their pastoral roles taken away and handed to other people in the school-albeit that those people are often very capable-including learning mentors and teaching assistants. I have always believed that classroom teachers are not just educators but part-time social workers, occasionally parents and sometimes, depending on the
class, just childminders. We have a multiplicity of roles as classroom teachers, and we have been losing our role in pastoral care. Hopefully, the Minister has heard my pleas on that issue.
I have identified some of the problems that I see at the moment, which I am good at, but I am not quite so good at identifying the solutions, which is why I do not hold ministerial office-that is a job for Ministers. The time has come, however, to question whether school governance arrangements work as they should, and if I had a solution, it would be, as I have said, to encourage federation.
Justin Tomlinson: My hon. Friend has made an exceptionally thoughtful contribution based on his experience in the teaching environment. Does he see federating schools as adding to governors' time commitments, or will that approach reduce them because the work load is spread out?
Andrew Percy: That is a difficult question. In some respects, federating would lessen the burden, because some people who join governing bodies want to take on that strategic role regarding the direction of the school but do not necessarily want to be engaged in the nitty-gritty. I have sat on governing bodies where it has been about who can outdo the others and who has been in the school the most, but that does not mean that that person has necessarily been the most effective governor. There is a role for both kinds of governor, which might be achieved through federation. You can have governors who give their expertise to the strategic direction of education in a particular area, and you can have others who play the community role or a much more involved role in a particular school. That is something that we need to look at.
I will not speak for much longer, because I know that other hon. Members wish to contribute. I associate myself with many of the thoughtful comments made by my hon. Friend the Member for South Swindon, who has a great deal of experience in this area. I am sorry that I will not be here to listen to the Minister, but I will, of course, read his speech in Hansard tomorrow.
I welcome the Government's plans to allow and encourage more schools to become independent of local authorities, but it has to be acknowledged that the role of governing bodies will therefore become more pivotal in the school system. With the increased freedom, there need to be clear guidelines, a coherent line of accountability and, should it be necessary, clear sanctions that can be imposed. Such clarity will add to the smooth running of a school, and to decisive action should there be a dispute.
I have personal knowledge of this matter, and am here today not just to seek clarity from the Minister but to share experiences-experiences that we could all
learn from and which could shape future school governance policy and accountability. I am proud to boast of exceptional schools and teachers right across the board in my constituency, and of a strong tradition of grammar schools, faith schools and specialist colleges. I was, therefore, greatly dismayed when a dispute began between the governors and head teacher at Calday Grange grammar, one of the best schools on the Wirral, with more than 360 years' experience and history. Over a year later, the matter is still not resolved. The school is without a permanent head teacher, which a school needs; parents and pupils are unhappy-rightly so-as well as confused by the whole affair; loyalties are spilt and Ofsted has downgraded the school's performance from outstanding to good. There have been parent demonstrations, newspaper coverage and a Facebook campaign to try to resolve the festering situation. In fact, in the local Wirral newspaper only yesterday there was yet another article on the ongoing dispute, about a survey that exposed that two thirds of parents quizzed did not believe that the governors were managing the school well.
I have a series of questions for the Minister, which I hope will be of use. What plans do the Government have to ensure that disputes between a head teacher and a board of governors are resolved amicably, quickly and for the benefit of the whole school? In this particular school, the head teacher became ill, creating further complications and a greater impasse. How would the Minister seek to resolve such a situation? When governors and head teachers have disputes, is there not a need for the utmost transparency, including fully informing teachers and parents? As more schools are freed from the direct control of local authorities, do we not require a better balance of powers and responsibilities, and in a dispute should parents perhaps not have the ultimate say? Under what circumstances could a board of governors be dissolved and a new one created? What would be deemed to constitute a fundamental breach of governors' duties and obligations to a school? When would a school be deemed to be failing, allowing for intervention by the Secretary of State or parents? The meaning of "failing" appears to be vague, especially when dealing with a large and outstanding school, such as Calday Grange grammar, that might take many months to reach that criterion. Perhaps a drop in standards of certain kinds might constitute a failing.
Guy Opperman (Hexham) (Con): I thank my hon. Friend the Member for South Swindon (Mr Buckland) for raising this subject for debate. The issue has been thought through well, and it is important in a week when we are trying to reassess education, bring a degree of change and bring things forward in a difficult field.
I know that many hon. Members are school governors; I confess that I have "failed" in that-I think that is the technical term. Some people would regard that as a deficiency in my background, but I regard it as an asset in some respects. I have spent the best part of 15 years attempting to advise school governors and head teachers, and have represented them on a special educational needs tribunal. When things got particularly feisty, I also represented the state and the individuals in a judicial review.
My last client, in spring of last year, was the then Secretary of State for Children, Schools and Families, the right hon. Member for Morley and Outwood (Ed Balls). I was co-defending with him in an action on this exact point: how school governors' role is being affected and how people are coming in and saying, "You're doing this wrong. How are you going to take it forward?" The way forward is vital, and I hope I can give the benefit of some wisdom regarding why changes should be made, how they might be made and what the context is in Hexham.
Hexham has four secondary schools, at Haydon Bridge, Ponteland, Hexham and Prudhoe. The constituency is vast, spanning more than 1,100 square miles. Haydon Bridge has probably the largest catchment area in that part of England; it is the size of the area within the M25, and is a huge superstructure that has to be taken in. It is one of the few secondary schools with a large number of boarders, because many students have too far to come every day. All those schools are struggling in different ways with a lack of investment. They are well supported by their governors and well led, particularly by school governors and head teachers, but attempting to introduce change is a struggle at present.
I lack experience as a governor, but I hope that my time at the Bar has helped me, as I fought for and against local education authorities, appeared on behalf of people who were suing LEAs and addressed various individual concerns. I could talk for a considerable period about the extent to which I have been involved.
My hon. Friend the Member for South Swindon-apart from his interesting analogy involving cake-baking, which I particularly enjoyed-asserted that the role and influence of school governors will take on new significance in the running of our schools. As we speak, heads and teachers are using academy or federation status to take their schools forward by reducing class sizes, improving the take-up of modern languages, targeting resources on the poorest and pioneering new discipline techniques. Surely it is now governors' responsibility to help newly liberated heads use their responsibilities and freedoms to best effect.
I do not want to be overly party political, but I have spent more than 13 years watching changes to school freedoms and responsibilities come before the courts to be decided. The legacy is a national curriculum-designed by ideologues and policed to a certain extent by bureaucrats-that has demoralised and demotivated our teachers and downplayed the vital role of knowledge. I applaud entirely what the Secretary of State is doing. Radical change was needed. The reforms to schools will put us where we need to be, which is unambiguously on the side of teachers as guardians of the best that has been thought and written, and who introduce each new generation to our precious intellectual heritage.
The head teachers of Hexham are nervous about applying for academy status. They have elected to watch the process during the original year, and perhaps for one more year, but I am hopeful that things will progress in the next couple of years and that they will go down the federation route. They are already integrated to a large extent: an art teacher might teach in one school and then go to another school for two days. They have
opportunities. They are excited about the possibility of long-term change, but without changes to buildings as well, they will struggle.
This is not the time to discuss Building Schools for the Future, but the Secretary of State discovered the state of schools in Northumberland recently when he visited the constituency of the right hon. Member for Berwick-upon-Tweed (Sir Alan Beith). One school was all but falling down. Two schools in my constituency, Prudhoe and Queen Elizabeth high school, are struggling. Those are long-term problems that the Secretary of State-my hon. Friend the Member for Brigg and Goole (Andrew Percy) put it beautifully-will have to deal with as we go ahead.
Turning back to school governance, governors' main responsibilities are providing a strategic view, acting as a critical friend and ensuring accountability. I see those as interwoven in all their activities. I was pleased to hear, when I asked about the pastoral support programme, that someone with a lot more experience of being a governor than me sees it as something that used to exist in the system, but was phased out. We must do the best that we can. Most governors have a direct interest in a school's success. Almost all are the type of person who is forced to get involved, and most either attended the school themselves or have children who attend it at present.
However, it is important during the reform process that we examine the model for school governance. We must consider how the governors' role might change as responsibility and power are decentralised from Whitehall and given to head teachers. It is a seminal change to take the large amount of power now in Whitehall and give it back to individual teachers. Teachers are excited. The ones I speak to are excited about the opportunity to take greater control.
The role of governors in holding heads to account will also take on a whole new meaning and level of responsibility. The process of examining their role is made easier by the fact that most are eager to know how they can be better at what they do. If the role of governor is to become much more crucial to a school's success, as I think it is, it is wise to consider who governors are and how schools attract them to the position. I endorse a huge amount of what my hon. Friend the Member for South Swindon said about taking governors on board and making ongoing use of them.
We cannot have top-quality schools without top-quality teachers, but that also requires top-quality school governors. We must continue to try to attract the best people to those roles. Must a governor always have attended the school in question, or have a child there? I do not consider that necessary, although it helps tremendously; sometimes, outside people are a good thing.
In these times, many people who might be interested in becoming more involved in the running of schools are put off by assumptions about why they want to. We must also be careful about whom we prevent from going into schools. There are ways to restrict governors' ability to get involved or commit to the extent to which they would like. School governors will often be new, and we will need the most competent individuals.
I finish by mentioning a couple of points relating to my specialism. Special educational needs provision has been under review for a considerable time. The hon.
Member for North Durham (Mr Jones) and other Members know what they are talking about when it comes to such issues; there are about five who know the issue well. We must retain SEN provision, but we can reform it. The amount of time devoted to SEN can be improved and be more focused. When the Minister winds up, I urge him to consider that SEN should be very much at the top of his agenda. If we fail the children who go into SEN, they will not be in as good a position as they could have been. The reality, therefore, is that the big society has a huge role to play in schools-or, should I say, that schools have the potential to play a huge role in the big society.
Mr Iain Wright (Hartlepool) (Lab): It is a pleasure to serve under your chairmanship again, Mr Dobbin. I congratulate the hon. Member for South Swindon (Mr Buckland) on securing an important debate. I recall how passionate and knowledgeable he was about special educational needs during our deliberations on the Academies Bill on the Floor of the House last summer. Indeed, he mentioned during that debate-as he has today-the role of the governing body in securing suitable provision. He has demonstrated that passion and knowledge again this morning and I thank him for it.
I also pay tribute to the high quality contributions from the hon. Member for Brigg and Goole (Andrew Percy), who drew upon his considerable knowledge of teaching and governance, and the hon. Members for Wirral West (Esther McVey) and for Hexham (Guy Opperman).
This has been a high quality debate and it gives us the opportunity to do several things. First, it enables us to thank governors throughout the country for their work in our education system. Secondly, I would like to build on some of the comments that have been made and ask the Minister with responsibility for schools about his vision for governors, governance and governing bodies as his Department radically alters education policy in our country.
As the hon. Member for South Swindon has said, there are more than 300,000 school governors at work today. Governors are one of the largest groups of volunteers and one of the best examples of civic engagement in this country. This quiet army of hundreds of thousands of people play an unheralded, and often unsung, but nevertheless critical role in providing the best possible environment for children to grow and learn. At their best, governing bodies set the ethos and strategic direction of a school; appoint a great head teacher and a high calibre senior management team to drive through that strategy and provide support, and challenge and scrutinise the leadership team, holding it to account on behalf of parents and the local community. They have a big responsibility in our education system.
As we have heard, there is a clear relationship between governance and the performance of a school. Good governance improves the quality of leadership and management in schools, as well as that of teaching and pupils' achievements. Conversely, where there is poor or unsatisfactory governance, and where the relationship between the governing body and the head teacher has broken down-as the hon. Member for Wirral West expressed so vividly-pupil potential goes unfulfilled.
Given the importance, therefore, that school governance plays in educational success, I am surprised that this Government have said so little about it.
In an education White Paper of nearly 100 pages, I counted only four small paragraphs on school governors, and one highlighted how the governing body could decide on the time of the school day. The publication of the White Paper was accompanied by a document, "The Case for Change", which provided a rationale for education reform, but did not mention the role of the governing body.
The recently published Education Bill has 79 clauses and 17 schedules, but I could find only two small clauses on the role of the governing body. Given the vital role that school governors play, I hope that when the Minister responds he will give a definitive reassurance that professional, passionate and high quality governors are an essential and valued part of our school system. I also hope that he will give the Chamber an explanation of why, in the first few months of the new Government, governors and school governance have been largely overlooked or ignored by his Department. I have several questions about specific parts of governance and the role that governors and governing bodies can play, and I hope that the Minister will be able to provide some answers.
"Smaller governing bodies with the right skills are able to be more decisive, supporting the head teacher and championing high standards."
That may well be the case, but the Government do not provide any evidence to substantiate that assertion. Why would smaller governing bodies necessarily be better? Where is the evidence? How does the Minister reconcile that view with last year's advice from the ministerial working group on school governance-I think that the hon. Member for South Swindon cited this in his own remarks-that 14 members can be the optimum size of a governing body? Surely the effectiveness of a governing body is more complex than sheer size, and takes into account matters such as turnover of governors, blend of skills, participation and work load. If the Government's movement of travel is to reduce the size of governing bodies, what will be done to retain corporate memory and expertise? It would be much more difficult to do that if a governing body with five members, as opposed to one with 15, lost a member.
The hon. Member for South Swindon mentioned the importance of retaining and obtaining skills such as finance, personnel and so on. How will a school with a much smaller governing body be able to obtain all that much-needed expertise, which includes marketing and strategic planning? I will be interested to hear the Minister's response.
The vehicle to reduce the size of governing bodies is the Education Bill, which was published last week and is due to have its Second Reading next week. I imagine that the Minister and I will have lots of discussions about many issues in the Bill, but I should like to draw his attention at this stage to one clause in particular. Clause 37 refers to the constitution of governing bodies in maintained schools in England, and it will amend section 19 of the Education Act 2002. This change ensures that governing bodies will consist predominantly of parent governors and the head teacher of the school.
"Many of the most successful schools have smaller governing bodies"-
"with individuals drawn from a wide range of people rooted in the community, such as parents, businesses, local government and the voluntary sector."
That point was expressed eloquently by the hon. Member for Brigg and Goole, who has left to attend a Delegated Legislation Committee. What precisely is the clause designed to do to help encourage a diverse range of potential governors to come forward? Given that the ministerial working group on school governance, which I mentioned earlier, concluded that governing bodies already have the flexibility to determine the best size for their school and for them, what does the clause actually do? What does it propose that the 2002 Act prevents?
The White Paper also states that from early 2012 the Government will allow all schools to adopt a flexible model of school governance, while ensuring that governing bodies have a minimum of two parent governors. Will the Minister further outline how he anticipates that to be undertaken? How will governing bodies do it? What will be the role of the head teacher? Will he or she outline to the governing body what they believe will be required, or will such a role be retained by the governing body? How will the process work?
Recruitment and retention are important and have already been touched upon. I think that the hon. Member for Brigg and Goole has already mentioned this, but some 11% of governor posts are vacant, and they are, disproportionately, in disadvantaged or inner-city areas. We have heard that schools with more vacancies on the governing body tend to perform more poorly due to the lack of challenge, scrutiny and support for the school's leadership team. What proactive steps is the Minister taking to ensure that vacancies on governing bodies, particularly in areas of deprivation, are filled?
The hon. Members for Hexham and for Brigg and Goole mentioned the importance of retaining and attracting good governors to governing bodies. Given the demands of modern life, what are the Government doing to recruit good potential governors? As the Government's focus on governance moves towards parent governors, does the Minister accept that the problems of recruitment and succession planning will increase because parent governors will inevitably leave after four or five years as their children move through the school? Parent governors might lose interest in being a proactive member of the governing body and leave that body. What does the Minister anticipate will happen about succession planning?
Common barriers to participation in school governance include lack of time, family or work commitments, lack of publicity and awareness of the opportunities for involvement, and a reluctance by some governing bodies to take on a governor who is not previously known to them. Will the Minister let hon. Members know what steps he is taking to remove those barriers as far as possible? Another important point mentioned in today's debate is that of having a federation of schools. Are the Government actively looking at having a federation of
governing bodies, whereby a single governing body can play a strategic role for a number of schools? If the Government agree with that approach, what additional initial support and assistance can they provide to allow that to happen?
That brings me to an important point that creates a bit of a paradox in the Government's education policy-the hon. Member for Brigg and Goole was good at hinting at this during his comments. Education policy is moving towards a position whereby schools stand alone and are independent of the local authority. The move is arguably-although I would dispute this to some extent-away from Whitehall. I think that the Education Bill will centralise matters between schools and the Secretary of State in a way that we have never seen before. However, how can we reconcile a situation in which schools stand alone with the fact that the previous Labour Government, through the former Department for Children, Schools and Families, moved towards collaboration and partnership, with the local authority helping to provide a strategic overview? The local authorities were not running schools, but they were providing strategic direction in an area. What steps will the Government take to ensure that that collaboration and partnership at a school governance level can be maintained, if not enhanced?
I would also like to ask about training and induction. It is very arduous to become a school governor, particularly a good and effective one. What are the Government doing to ensure that individual governors and collective governing bodies identify any weaknesses and help plug those gaps, either with additional training, additional recruitment to the governing body or focused training? Does the Minister agree with the concept of mandatory training for governing bodies? The hon. Member for South Swindon mentioned the important role of the chair of a governing body. What additional support can be provided to enable the chair to perform his or her duty to the best of his or her abilities? He also mentioned the vital but often overlooked need to have a high calibre, knowledgeable and experienced clerk to the governing body. What steps will the Government take to ensure that that is also very much a key part of school governance?
When I was a Minister in the Department for Children, Schools and Families, I was concerned about the role of information, advice and guidance, and the importance of interaction between schools and the outside community, particularly with business. The governing body can, through the high calibre business men and women who are active on it, provide that good interaction. Particularly with regards to information, advice and guidance, governors can come into a school and provide real life stories based upon their personal experiences of inspiration and motivation. They can tell students how hard work can help people succeed and achieve their ambition. Given the changes to the information, advice and guidance provision, what further steps can the Minister take to ensure that that interaction between schools, the governing body and outside business works effectively?
Finally, I shall talk about the role of the head teacher in the governing body. May I press the Minister on whether he believes that automatic inclusion of the head on the governing body as a full member can constitute a conflict of interest? I think that everyone would agree that heads should attend governing body meetings and have a right to speak, be challenged and
scrutinise. However, does that important role of supporting the head teacher while at the same time challenging mean that good governance should lead us to make the head a non-voting member who does not participate in decision making? In a similar vein, could the Minister confirm that, as indicated by his White Paper and the provisions of the Education Bill, the Government do not necessary agree with the concept of staff governors?
In the past few months, the Government have spoken a lot about their vision for education and how teachers, head teachers, parents and others can play their part in fulfilling student potential and ambition. The fact that they have not highlighted the essential role of the governor is a glaring omission and a further example of weakness in their education policy. However, given the high calibre of today's debate, I hope that the Minister will rectify that now and highlight more fully than he has in the past how governors and school governance can play an essential role in the education system of our country.
The Minister of State, Department for Education (Mr Nick Gibb): It is a pleasure to serve under your chairmanship, Mr Dobbin. I congratulate my hon. Friend the Member for South Swindon (Mr Buckland) on securing this important debate on school governance. I know that the subject is close to his heart because he served as a school governor for four years prior to his election to the House. I join the hon. Member for Hartlepool (Mr Wright) in pointing out the high quality of the debate and of the contributions of my hon. Friends the Members for Hexham (Guy Opperman), for North Swindon (Justin Tomlinson), for Brigg and Goole (Andrew Percy) and for Wirral West (Esther McVey).
There are some 300,000 school governors, which makes them one of the largest volunteer forces in the country. School governors work in their spare time to promote school improvement and to support head teachers and teachers in their work. They are an important part of the big society agenda and play a vital civic role. In the words of my hon. Friends the Members for South Swindon and for Wirral West, they play a pivotal role in our schools system. Every one of the 300,000 school governors deserves our thanks for their work and time and, more importantly, for taking on such important responsibilities. We all know how difficult it is to find people locally to take on such responsibilities. It is easy to get volunteers, but there is often a poor show of hands when it comes to taking on responsibilities. We owe a huge debt of thanks to those who are prepared to take on such a role.
My hon. Friend the Member for Brigg and Goole is right to question whether we are doing things in the right way. Our White Paper, "The Importance of Teaching", which was referred to by the hon. Member for Hartlepool, was published in November and sets out the coalition Government's intention to increase freedom and autonomy for schools and to remove unnecessary duties and burdens. It also states that we should allow schools to choose for themselves how best to develop, whether by acquiring academy status, by becoming multi-school trusts and federations-again, those were referred to by the hon. Gentleman-or by continued development as a maintained school. All of that is to be underpinned by clear accountability and strong and effective governance.
As we work through our programme of reform, those freedoms need to be extended to school governors, so that they are given the flexibilities, support and recognition they deserve. We know that the quality of school governance has a significant impact on how well schools perform. Good governance and leadership at school level is a key driver in achieving better educational outcomes. Academies provide examples of smaller, high-powered governing bodies that have demonstrated rapid improvements in standards. The arrangements for academy governance allow for greater levels of flexibility in the number and category of governors than in maintained schools, while ensuring that essential groups, such as parents, are always represented. They are charities, so it would not be appropriate or right for us to prescribe the exact composition and size of their governing body. That flexibility is a popular concept and there are many differing governance arrangements in converting schools. They are now able to constitute their governing body to suit their school and local needs.
As my hon. Friend the Member for South Swindon will recall, maintained school governing bodies, which include foundation schools, are constituted under the stakeholder model. That model prescribes representation from groups with an interest in the school: for example, parents, staff-including the head teacher-the community, the local authority and the foundation or trust, where schools have one. The model goes on to prescribe the level of representation from each group.
We want to make it easier for schools to adopt governance models that work for them and which clearly hold the school to account. That is why the Education Bill, introduced by my right hon. Friend the Secretary of State for Education last Wednesday, includes provision to free up the constitution of maintained school governing bodies. We are legislating to provide that governing bodies will mirror the academies model and be required to have at least two elected parent governors and the head teacher, unless the head teacher chooses not to take up his position as a governor. Then, as the hon. Member for Hartlepool mentioned, they should be able to attend the governing body as the head teacher, but not as a full member of the governing body.
The church or foundation will still be able to appoint the majority of the governing body in voluntary aided and foundation schools. Other governors, such as authority governors, community governors, staff governors, partnership governors and associate members will be appointed at the discretion of the governing body, and in numbers determined by them. Academy governing bodies have built-in safeguards to prevent particular categories of governor from dominating the governing body; for example, staff governors cannot exceed one third of the total membership, and charity law prevents those connected with local authorities from having more than 20% of the membership. We will consider the effect of such restrictions in maintained schools, but we want to move to a less prescriptive model overall.
Mr Iain Wright: I apologise to the Minister if he is coming on to this point, but will he respond to an issue raised about the constitution of the governing body? The hon. Member for Wirral West made important points about how to identify failure in school governance and what will constitute failure. What will be the mechanisms by which a local authority or some other body-perhaps the Secretary of State-can determine change within the governing body?
We do not intend to prescribe any particular model, which is the overarching policy direction, as we believe that governing bodies are best placed to determine what will work best for them locally. It is important to point out that the changes will be permissive rather than mandatory, and that there is no intention to force any change on governing bodies. We will therefore encourage governing bodies to recruit more governors on a skills basis and carry out skills audits to inform that task. Those were also the conclusions of the working group on governance referred to by my hon. Friend the Member for South Swindon and the hon. Member for Hartlepool. Its report recommended clear accountability and felt that size was not the key issue for a governing body; a more important issue for the report was the skills of the governing body. It recommended that governing bodies should be free to recruit by relaxing the stakeholder model, and that is precisely what the Government are introducing in the Education Bill.
We know that volunteers from a business background bring a valuable range of skills from the workplace to governing bodies, and are more likely to take on important responsibilities such as chairing committees or, indeed, chairing the governing body. To that end, we will continue to support the School Governors' One-Stop Shop in order to recruit and place governor volunteers from the business world in schools with vacancies. That has been very successful: by the end of December it had recruited nearly 11,000 governors and placed them on to governing bodies with vacancies. In addition, the Education and Employers Taskforce is working with CEOs of large businesses to develop partnerships between schools, colleges and employers. It encourages senior business leaders to visit schools, and encourages staff with the right skills and experience to become school governors. In fact, I recently joined Sir Terry Leahy in a school in Hertfordshire during the "visit our schools and colleges" week.
Research tells us that where governing bodies are effective, they take a strategic role, as my hon. Friend the Member for South Swindon pointed out, in guiding and supporting the school's work and challenging further improvement. They should not get drawn into the day-to-day management that is rightly the province of the head teacher and senior leadership team. In the White Paper, "The Importance of Teaching", we set out a series of 10 key questions for governors to ask to assist them in setting their schools' strategic direction and holding them to account, such as, "How are we going to raise standards? Have we got the right staff and the right development and reward arrangements? Do we have a sound financial strategy to get good value for money, and have robust procurement and financial systems? Does the curriculum provide for and stretch all pupils?" My hon. Friend is right to say that the committee-based decision-making structure is appropriate for our governing bodies. Governing bodies already have the freedom to bring people with particular expertise on to committees as associate members, and they can commission work from people outside the governing bodies.
My hon. Friend referred to the issue of complaints, on which I want briefly to touch. Parents should be able to send their child to school confident that they are
receiving the highest possible standard of education. Any problems should be dealt with by professionals in an appropriate and timely manner. There must be mechanisms in place for parents to express their concerns, secure in the knowledge that they will be dealt with quickly, effectively and fairly by all involved. Since September 2003, all schools have been required to have a complaints procedure, and that procedure has to be published. Generally, schools follow a three-part complaints procedure: investigation of a complaint by a staff member; investigation by the head teacher, or by the chair of the governors if it is about the head teacher; and a meeting of a panel of governors where the complaint has still not been resolved. Governing bodies must act in the interests of the children in their school and must rigorously ensure that those who serve on complaints panels conduct a fair and unprejudiced investigation. Challenge is part of the governor's role, and a pattern of complaints can inform them of incipient problems in the school's operation, in the same way that correspondence with an MP can alert us to an impending big political issue concerning how our country is run.
As my hon. Friend the Member for Brigg and Goole brought out in his speech, in recent years schools have increasingly chosen to collaborate with other schools in order to achieve more for children and young people. Partnerships have taken a variety of forms, including local area clusters, as well as more formalised arrangements involving shared governance through federation, shared trusts and shared leadership, with heads taking responsibility for leading more than one school. The benefits of those partnerships are clear in terms of extending the breadth and quality of provision; responding better to pupils' wider needs; widening the impact of the strongest school leaders, teachers and governors; widening opportunities for collaborative professional development; and delivering greater value for money. There is not a single, best collaborative model; instead, schools can consider a variety of models and adapt them to suit local needs and circumstances.
Mr Iain Wright: On that point and my earlier remarks about a move away from partnership and collaboration in the school family towards schools going it alone, how does the Minister reconcile his comments with the provisions in the Education Bill, most notably clauses 30 and 31, where the duty to co-operate with the local authority and the duty to have regard to the children and young people's plan are abolished?
Mr Gibb: Legislation is not necessary to require people to co-operate. The best co-operation is engaged in because professionals feel it is the best approach for their school. We need to move away-and the Government are moving away-from that tick-box, prescriptive and centralised approach to such issues. We believe that the best partnerships and collaborative arrangements are those that head teachers and governing bodies enter into voluntarily because they know they are in the best interests of their school. We do not want a school to feel bound to find a partner-in a behaviour partnership, for example-simply in order to fulfil a statutory requirement and to ensure that it has a box ticked when the Ofsted inspection comes.
My right hon. Friend the Secretary of State is always talking about collaboration between professional peers in our school system as a key to school improvement,
and that is why we are tripling the number of national and local leaders in education. Peer-to-peer mentoring is the key. Professionals working together and spreading best practice is the better way to ensure improvement in our school system, rather than a series of prescriptive statutory requirements for schools and bodies to enter into partnerships with other bodies.
I turn to the general context surrounding the important points that my hon. Friend the Member for Wirral West raised about Calday Grange grammar school. She asked about resolving disputes between head teachers and the governors. All governing bodies have grievance procedures which they must follow to resolve complaints. She then asked how the situation can be resolved if the head teacher is ill, which is the case in this instance. The governing body is the employer, and it has to follow grievance procedures in cases of challenge over employment law. It needs to allow the head teacher to present his case, but he cannot do that, of course, if he is ill. That does not provide a solution but presents the legal framework around the current position.
My hon. Friend asked whether parents should be kept fully informed about what is happening during a dispute. Unfortunately, that is not always possible due to the need for confidentiality in some disputes. She asked whether parents should be allowed to decide the way forward. The answer to that is no, unfortunately. Parental views are represented on the governing body, but the governing body itself is responsible for the school. Of course, a responsible governing body should take parents' views into account and expedite the resolution of matters, particularly when they are of enormous concern to the parents.
My hon. Friend asked when a governing body can be removed. There are three circumstances in which that can happen: when Ofsted has put the school in special measures; when Ofsted has found that the school requires significant improvement; or when the local authority has issued a warning notice and the governing body has failed to comply with it, or failed to comply satisfactorily. I know that she is concerned about the issue. Lord Hill of Oareford and I have corresponded with the governing body and the local authority about the matter, and we would be happy to discuss it with her further, if she would find that helpful.
In conclusion, I want to take the opportunity once again to pay tribute to our school governors, who are the unsung heroes and heroines of our education system. We should thank them for their work, and I am pleased to do that. I am sure that the increased freedom and autonomy for governing bodies, allied with our reduction of burdens and bureaucracy, will make a huge difference to their work as they seek to raise standards in schools, and will enable better deployment of their time and expertise.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): I wanted to have today's debate on maternity services for three reasons. One is the confidential inquiry into intrapartum-related death, conducted by the Perinatal Institute in Birmingham in October 2010. Incidentally, its director is one of my constituents, which, of course, adds to the quality of the report.
Secondly, I vividly remember an article in TheSun during the election campaign in 2010, in which the right hon. Member for Witney (Mr Cameron) clearly promised 3,000 extra midwives. The third reason is last night's debate on the Government's health reforms. The three are unfortunately related.
I will begin with the report. An enormous amount of good work is being done in maternity services and provision, and the Birmingham women's hospital in my constituency provides excellent care. The west midlands should not feel that it is being singled out. It was simply the first area that took a good, honest look at what is happening and, therefore, has produced figures from which the rest of the country can learn. The west midlands is an area of huge diversity, both in income and ethnic background. Roughly speaking, it has 70,000 deliveries a year, which account for 10% of live births in England and Wales. It also has something like 10% of babies who die from intrapartum-related causes, that is, events surrounding labour and child birth.
In 2006, the chief medical officer highlighted that one of his areas of particular concern was intrapartum-related death. In a national report in the 1990s, that was continually highlighted as requiring more attention, but the figures did not show any particular improvement. For that reason, the Perinatal Institute decided to look at that area. We know that in politics to be described as "brave" sometimes means "foolhardy". However, in this case the institute was brave to look at the figures honestly. It looked at 25 cases that caused concern. The full report is available on the institute's website. It found that of those 25 cases, in four cases there was substandard care and different management would have made no difference to the outcome.
Lorely Burt (Solihull) (LD): As another west midlands MP-the Heart of England trust covers my constituency-I wonder whether the hon. Lady has noticed any problems with care of parents after neonatal death. I have the charity Stillbirth and Neonatal Death Society, SANDS, in my constituency-as I expect she has-and it is most concerned about the quality of care for parents following the death of a baby.
Ms Stuart: I have come across SANDS. The Heart of England trust did some work, which I will consider later, whereby it looked at midwives' case load and found it to be far higher than required. Incidents are spread across an area and each of us probably sees only one or two cases occasionally. The real problem comes when we look across the city and the west midlands. We should pay tribute to SANDS and its work and to the bereavement nurses it has now put in hospitals. They are in east Birmingham and in my patch. However, it is not good enough.
Coming back to the 25 cases: in four cases of substandard care, different management would not have made a difference. In five cases, it might have made a difference to the outcome, but in 16 cases, different management would reasonably have been expected to make a difference to the outcome. In other words, 84% of the deaths were considered potentially avoidable. The overall conclusion that the report reached looking at the west midlands was that many deaths were avoidable and need to be avoided. That is why we need to discuss this report and decide what to do about that.
Andrew George (St Ives) (LD): I raised the issue of the Perinatal Institute in Birmingham in a debate I led on maternity and midwifery on 2 May 2007. I spoke to Professor Jason Gadosi before and after that debate. What he said then, nearly four years ago, was precisely what he appears to be saying now: there has been a failure fully to monitor and interrogate what went on and to draw conclusions that might better inform the improved care, and avoid the perinatal mortality levels that still exist.
Ms Stuart: That leads me to my next point. We have clearly not come up with systems in the NHS that allow us to learn properly from mistakes when things go wrong. I fully accept that we have the NHS Litigation Authority, and that the NHS insures itself. We try to deal with negligence effectively and efficiently. However, there is still a mentality of institutions, when something goes wrong, closing in on themselves. I wonder whether we should look at the way in which the aviation industry deals with accidents. Fault is not allocated; the facts are looked at, and the real outcome is what to do as a result of the problem. Rather than understanding the errors that have gone further and further, we should consider what is to be done as a result.
Going through newspaper cuttings, I found one over Christmas about Good Hope hospital. There was a very unfortunate incident when a lady who had miscarried was left four hours in sight of other patients. She complained to the hospital, which simply apologised and said it hoped to do better. Hoping to do better simply has not done us any good, if that experience is anything to go by.
It is not clear to me who has responsibility for this matter. In the current structure we have PCTs and strategic health authorities, where at least theoretically we could allocate responsibility. In the new NHS, who will do that? I will return to that later.
We need national maternity data sets that are much more standardised and allow us to make us comparisons across the country. That is not a question of money. Given that we are told that the NHS is one area which is ring-fenced, there is much we can do within existing provision.
I now come to the promise that the right hon. Member for Witney made during the election campaign. We all know what happens during elections; not keeping election promises is not particularly new. However, let us look at what he said in January 2010. Maternity and childbirth is an immensely emotive subject. It is not an illness; it is
one of the most joyful events in life. In the majority of cases, a healthy baby is born and we try to keep the medics out of the whole process as much as possible. When politicians go into election campaigns and talk about maternity services-particularly when they do so in TheSun-it is a pretty toxic mix. The right hon. Member for Witney went to a maternity unit and said,
"Having a baby might be the most natural thing in the world,"
"Every parent wants...to give birth in a relaxed local setting, where they get the personal attention they need. So, why isn't that happening? It's because after a decade of constant reorganisation, Labour are giving us bigger and bigger baby factories where mums can feel neglected and midwives are stretched to breaking point."
Daniel Kawczynski: The hon. Lady surely understands that after 13 years, the previous Administration had still not managed to achieve some of its long-term goals and aspirations. She almost indicates that the promises made by the Prime Minister should have been met seven or eight months into a new Administration. Given the state of the public finances, she must acknowledge that it will not be as easy to deliver on those promises as quickly as she-or I-would like.
Ms Gisela Stuart: I am sure the Minister will be grateful for that helpful intervention. However, have we not been told that the NHS is ring-fenced? That is how I understand it. Therefore, the financial argument really does not hold.
"It doesn't have to be like this...First, we're going to create new maternity networks...Second, we are going to make our midwives' lives a lot easier. They are crucial to making a mum's experience of birth as good as it can possibly be, but today they are overworked and demoralised. So we will increase the number of midwives by 3,000. This is the maternity care parents want: more local and more personal. And under a Conservative Government, it is what they'll get."
Lorely Burt: As the Prime Minister said, the aspiration should be for more local and more personalised services. However, in my local hospital at Solihull, the full maternity service has unfortunately been downgraded as a fait accompli, and instead of 2,700 births a year, we are led to expect only 300. Does the hon. Lady agree that that hardly offers the choice, localism and personal service that we should seek to achieve anywhere in the country?
Ms Gisela Stuart:
I will respond to that point before returning to my favourite subject of the Prime Minister's promises. The hon. Lady is right: there is always a huge tension between local and more centralised delivery. My first Adjournment debate in this Chamber as a junior Minister was about the closure of the William Courtauld maternity unit in Braintree in Essex. It had something like 300 deliveries, and there was always a tension about whether services should be offered there or in Colchester. We need both. However, when campaigning to keep local maternity units, we should note that the Royal College of Nursing looked at changes in maternity care. It stated that apart from the rise in numbers, there are more older mothers with higher rates of complications,
and there is a higher rate of multiple births and more obese women who are less fit for pregnancy. More women survive serious childhood illness and go on to have children, and they need extra care during pregnancy and childbirth. There are also increasing rates of intervention.
Therefore, apart from social and ethnic diversity, some births are becoming increasingly complicated. If the hon. Lady were to go to the Birmingham women's hospital, where women who have had heart transplants give birth, she would see that a safe delivery might require not only the expertise of the women's hospital, but that of the Queen Elizabeth hospital next door. There is always a natural tension between localism and the best care. The real answer is that we need both.
Andrew George: The hon. Lady makes a balanced case. However, the previous Government also promised thousands more midwives and failed to deliver on that. Is there is a general cross-party agreement that the choice of a home birth should be available, where that is a precautionary safe option and as far as it is possible to predict what is likely to happen during birth? Under such circumstances, two midwives are needed on site. In the "baby factories" that were mentioned earlier, the efficiencies that can be achieved are greater. If more home births are to be serviced and supported, even more midwives will be required.
Ms Gisela Stuart: They will indeed. I may risk alienating my own party a little here. Home birth is one of those nice, idyllic and romantic ideas but, frankly, when I had my children I would rather have had a small cottage hospital with a safe delivery, where I left for home after 24 hours, knowing that if I needed care it was on hand. Home births are probably not as romantic as people think they are.
Let us return to whether the Prime Minister meant what he said. He spoke of an increase in the number of midwives of 3,000. When the Royal College of Nursing challenged the Government, an unnamed Conservative spokesman said:
"There must of course be enough midwives to meet the demands arising from the number of births. The commitment to 3,000 midwives made in Opposition was dependent on the birth rate increasing as it has done in the recent past. It was not in the coalition agreement because predictions now suggest the birth rate will be stable over the next few years."
"Enough midwives to meet the demands".
We all agree with that. However, if one looks at the planning tool, Birthrate Plus, which estimates how many midwives are needed, and calculates the number nationwide, when that promise was made, according to that tool, there was already a shortage of 4,765 midwives. Even the promise of 3,000 fell short and far more midwives were needed.
The spokesman said that the commitment made in opposition depended on the birth rate increasing. However, nothing was said about that in the article in The Sun. Furthermore, if we look at the only figures that were available at the time the promise was made, they did not suggest any such thing-indeed, they suggested the opposite. The promise is not in the coalition agreement, but the newest figures were not available until long after that agreement. Therefore, there is no proper excuse. It is not about money, and the birth rates that were
predicted were not happening. The figures were not available, and I would like to hear why that promise was not in the coalition agreement. It does not stack up.
I can conclude only that when the Prime Minister made that statement, he did not mean it. It is callous to do such things. Maternity and childbirth are sensitive issues, and if something specific is promised during an election campaign, that promise should be kept. I shall return to maternity networks later.
I am not alone in this view-I am not making it up. In November last year, the country's leading midwife, Cathy Warwick, accused the Prime Minister and the Health Secretary of risking the safety of mothers and babies by backtracking on their pledges to hire more NHS midwives. She said that she was
"extremely disappointed...Both coalition parties supported a commitment to more midwives, now they have apparently changed their minds, and yet the economic situation was well-known before the election."
Not only was the economic situation well known, but NHS funding is ring-fenced. The money argument does not stack up. She went on to say that she had encountered a "deafening silence" from the Government when she asked whether they intended to honour the pledge. That is a broken promise.
Let us look at where we should go from here. If the record shows that figures on maternity have not improved for 20 years, we need to make some progress. There is a strong association between deprivation and stillbirth as well as infant mortality. The index of multiple deprivation for the west midlands between 1997 and 2007 gives an overall score of 29.9. In Sutton Four Oaks-Sutton Coldfield, the royal borough, still has not quite come to terms with being part of Birmingham-the score was 10.5. Washwood Heath, which I think has the highest levels of unemployment in the country, has a score of 65.1. In my constituency, the area of Bartley Green has a score of 40.3, while in Harborne it is 24.7. However, after the slight boundary reviews that remove the Welsh House Farm estate from Harborne, I expect that figure to be higher. There is a real link between deprivation and stillbirths and infant mortality. Those areas need far greater numbers of midwives to deal with the case load.
That highlights the fact that reducing perinatal and infant mortality is part of public health. That cannot be addressed just at GP level, and it requires a far wider view. As we still do not have national standards for collecting data, we are not even able to say to pregnant women how well the service is doing. That is why the Prime Minister's promises matter. If we want to create the big society, and if we are all in this together, we need to strengthen commissioning, which needs to go far wider than the current structure. The current commissioning is weak, and from what I heard last night, it will only weaken further. We do not even know how well we are doing, and we are now talking about GP-led commissioning-leaving it to the professionals.
In yesterday's edition of The Times, the Prime Minister said, "The NHS will sicken unless we modernise". For the moment, I will leave the use of English-"the NHS will sicken"-to others to comment on. The Prime Minister goes on to say that he wants to debunk five myths. He says:
"The fifth and final myth is the most important: the suggestion that patient care will suffer. The opposite is true. Our changes draw on some simple logic: that professionals, not managers or
politicians, are best placed to understand the needs of patients. Couple that professional freedom for doctors and nurses with choice and transparency for the patient, and you get a mix that will expose poor performance and drive standards up."
Will it really? What if the professionals are not doing a proper job? If we do not have the nationwide data that allow us to tell them whether they are doing a good job, it is not only the professionals who are not aware of whether they are doing a good job by comparison. The patient will not know that, either, and they will take the care that they get. How many of us have had feedback relating to hospitals in which the hospital's performance was based on whether people thought that the food was any good? Although that is important, it tells us little about clinical standards. I am sure that the parents of those babies who died where better care would have made a difference would not have been aware of that, because what are the comparisons?
Andrew George: I do not want us to repeat yesterday's debate on the Health and Social Care Bill. I took part in that debate, and my position on that Bill is reasonably well known. However, on the substance of the case that the hon. Lady is advancing, I fear that if we are going to be trading promises made by the previous Government on maternity care that were not delivered and similar promises made by a party leader that may or may not be delivered, we will not get what I hoped that we would get from this debate, which is a recognition that midwifery is under-resourced and that we should all be working together to acknowledge that we are putting a lot at risk. That includes the fact that we have high levels of litigation. If the bill of £1.4 billion that was apparently expended last year in meeting the costs of litigation in obstetrics were brought down, one could invest in the very services where such high levels of litigation arise.
Ms Stuart: The hon. Gentleman is absolutely right. That is why I have said that one of the things that we need to move to is much more serious consideration of no-fault investigations where something has gone wrong.
I return to the point that areas of higher deprivation that have high infant mortality rates require much higher numbers of midwives than areas of lower deprivation. There is no getting away from that. I am rather sad that the Perinatal Institute's report on community midwives is not ready for publication yet, but I will not be surprised if it finds that the case load of the majority of community midwives is too high and that they regularly work more hours than they are contracted to do. There are no national standards on the accepted case load for a midwife, but professional opinion is that the figure is about 110. The Heart of Birmingham Teaching primary care trust has found that case loads are about 150.
The question is what the right figure is in areas of deprivation. Strictly speaking, Bellevue is in the Edgbaston constituency, but it borders Ladywood. A two-year study there looked at case loads of 60 to 70. The sample was too small, but there is a link between deprivation and infant mortality, and deprived areas therefore require higher levels of midwife input than other areas, which cannot be picked up by GP commissioning. In the case of the west midlands, it certainly requires a Birmingham-wide view, if not a west midlands-wide approach to commissioning, because it is a public health function as much as anything else.
Andrew George: The hon. Lady is being extremely patient in allowing me to intervene. I want to support the point that she is making. The anecdotal information that I have been picking up from midwives is that a high number are, at the pinnacle of their career, retiring as a result of stress, because of the pressure placed on them. There are unreasonable expectations of them in terms of the case load that they are expected to undertake. Those are some of the best people, who are able to contribute the most to their local community and to the health service, yet we are losing them from the service as a result of poor staff management and the fact that they are expected to work under tremendous levels of stress.
Ms Stuart: Indeed. If we look at the findings of the work force assessment conducted by the Royal College of Midwives, we see that the hon. Gentleman is absolutely right. The issue is not only that we are short of midwives, but that many midwives leave early or are coming up to retirement, which is really worrying. There is no doubt that we need to strengthen the work force.
I want to bring all the strands together. We are told that the new health service will give the patient the say, and we are trusting the professionals to know better than the politicians and the managers. My argument is that, in some areas, the professionals themselves clearly do not know how well they are doing, and it is about time that they did-when they find out, they need to put in place mechanisms to put things right. Unless we have standardised maternity data that allow us to make comparisons across the country, the professionals, even if they are willing to do so, will not be able to respond.
The third point is that patient choice sounds really good, but in some areas of deprivation-we have them in Birmingham-the question of choice is something from fantasy land. People just want decent services. To say to them that they are driving up choice is an absolutely ridiculous aspiration. Even if all the other things were to happen, midwives on the ground are so utterly overworked that they would have very little time to drive forward the improvements that would be made.
I can see that the Prime Minister's vision of the new NHS will work perfectly well in Sutton Coldfield and in parts of Solihull, but not all of it. However, it will not work well in our big cities, where we need far stronger, coherent commissioning. I have four questions that I want the Minister to answer. First, the report from the west midlands is exceedingly important. What steps will she take to ensure not only that there is data gathering but that the lessons will continue to be learned not only in the west midlands, but throughout the rest of the country? I am referring to standardised data gathering and standardised analysis, so that we can get a true picture of how well the service is doing and so that we reach a position in which, when we ask how well we are doing, the professionals can answer that.
On my second question, I am fully aware that it takes x years to train nurses, midwives, doctors and consultants, and we have to start down the path of training them at some stage. Will the Minister therefore tell us whether the promise of 3,000 midwives was contingent on birth rates? If it was, can we say that it is no longer on the table? If it is on the table, what steps are being taken to start training and recruiting those midwives, on top of retaining the current ones?
My third question is about the Prime Minister's second promise in the article in The Sun,which related to maternity networks. What are they? Where are they? Will the Minister spell that out precisely? She looks rather surprised, but when I expressed my surprise about these new maternity networks and wondered exactly what they were, the professionals came to me and said, "It would be really helpful if the Minister could spell out during the debate precisely what these networks are and where they are." If I am being accused of ignorance, I plead that I am not alone in my ignorance.
My final question is the one that ultimately troubles me most. We are breaking up the units in the health service and moving down to GP commissioning-I have to say that I have far less faith in the universal wisdom of GPs, as opposed to other medical professionals-so how will everything hang together? There are pretty good GP groups in south Birmingham, and they will probably make the new arrangements work, as will some of the groups in other parts. However, in the areas with the highest deprivation and need, where people will be least able to exercise choice or make their demands known, I simply cannot see GP commissioning delivering for people on the ground.
Whose responsibility will it be to ensure equity in maternity care across regions? At one stage, there were thoughts that maternity commissioning should still be a national service, like the specialist commissioning services, but I gather that that is no longer the case. A fair number of MPs from Birmingham and the west midlands are present, so will the Minister explain which body will ensure in those areas that the findings in the Perinatal Institute's report and the consequent actions are brought together and rolled out so that we receive better care?
Daniel Kawczynski (Shrewsbury and Atcham) (Con): I congratulate the hon. Member for Birmingham, Edgbaston (Ms Stuart) on securing the debate. Maternity services are an extremely emotive issue. When my daughter, Alexis, was born at the Royal Shrewsbury hospital, it was the most emotional day of my life. As a non-smoker, I smoked two packets of cigarettes that day.
I pay tribute to the hospital's staff, whom I found extraordinarily professional, hard-working and dedicated. However, there has been a lack of funding for maternity services in Shropshire hospitals over the past 13 years. The hon. Lady talked about broken promises, and I want to highlight my concerns about the huge inequality in funding for maternity services around the United Kingdom. I sometimes go to Birmingham and I see the hospitals there, and there are huge differences between the quality of the buildings, equipment and resources in Birmingham and the quality of those in Shrewsbury and rural shire counties.
The Royal Shrewsbury hospital covers not only Shrewsbury and the whole of Shropshire, but the whole of mid-Wales, and I hope that my hon. Friend the Member for Montgomeryshire (Glyn Davies) will have the chance to explain the benefits of the maternity services for his constituents. The population of the whole of Shropshire and mid-Wales is not that much smaller than the population of Birmingham. Yes, the populations of those areas, even when combined, are smaller than that of Birmingham, but not by much. However, we have only two hospitals to cover our whole
area. I am not sure how many hospitals there are in Birmingham. The hon. Lady said that there was a hospital for women's services in Birmingham. My goodness me, I wish we could have a hospital dedicated to women's services covering my county and the whole of mid-Wales. I will find out how many hospitals there are in Birmingham, but I want to stress that my county lacks facilities.
As a result of the debate, I am also going to research the outcomes in Shropshire and mid-Wales versus those in Birmingham and to look at the resources that both receive. From all the league tables I have seen, many of the outcomes in maternity services are actually better in Shropshire than they are in Birmingham. Why is Shropshire so far ahead of Birmingham in the league table when it gets a fraction of the resources? The hon. Lady seemed to imply that greater resources needed to be provided, but I would say that we need to learn from Shropshire how it manages to provide such excellent maternity services when it receives such limited funding compared with Birmingham. When I have done that research, I will send it to the Minister.
During the 13 years of the previous Labour Administration-I briefed the Minister on this last night-there was a chronic lack of funding. I am not embarrassed to say that I think the previous Government deliberately targeted inner-city Labour areas with investment and deliberately stripped it from rural counties, which are predominantly Tory. That was done in a political way to put investment into Labour heartlands, and although the hon. Lady won her seat because she is an assiduous and hard-working MP, many other Labour MPs were re-elected because of that direct channelling of resources into Labour inner-city areas at the expense of rural shire counties.
As a result of that chronic lack of funding for Shropshire, a consultation is under way on proposals for a mass reconfiguration of maternity services. That will see in-patient children's services and consultant maternity services move from Shrewsbury to Telford. My constituents expressed extreme concern about that at a public meeting on Sunday, as they have over the past few weeks. In the six years that I have been an MP, I have never received as many e-mails, telephone calls and letters from concerned parents, clinicians and GPs as I have over these reconfiguration proposals-there is a lot of concern.
I should stress that I expect any proposals put forward by local hospitals and primary care trusts robustly to meet the stringent tests set out by the Secretary of State for Health in relation to support from GP commissioners, public and patient engagement, clinical evidence and patient choice. If those stringent criteria are not met, I very much hope and expect my local council's overview and scrutiny committee to refer the proposals to the Secretary of State, in anticipation of their being reviewed by an independent reconfiguration panel.
Today, I will write personally to all the GPs in Shropshire to find out their views about the reconfiguration proposals for maternity services, rather than being told by the PCT or the chief executive that GPs are in favour of them. If they are against the plans, I will share that information with the Minister, and I hope she will support me in challenging them.
Yesterday, I had a meeting with the deputy general secretary of the Royal College of Midwives, Louise Silverton, who has promised to help me get the Royal College of Midwives involved. I will also write to the
Royal College of Obstetricians and Gynaecologists to find out its views. I have spoken to the Minister, who has kindly agreed to meet me and a delegation of concerned constituents so that we can raise these issues with her.
I do not want to speak for too long, because I hope that my hon. Friend the Member for Montgomeryshire will get a chance to speak. I would not wish a reconfiguration of maternity services on my worst enemy. It is turning my hair grey and I am extremely upset about it. I am cognisant of the views of my constituents and I want to stress that they are very concerned at the prospect of Shrewsbury losing maternity services. People expect maternity services to be ever closer to them, not further away. Our services cover the largest landlocked county in the United Kingdom, with a vast rural expanse, as well as the whole population of mid-Wales, and we hope and expect that maternity services will stay in Shrewsbury and not be moved to the extreme east of the county, to Telford.
Andrew George: I do not want to intrude on concerns about reconfiguration in Shropshire. However, on the basis of yesterday's debate, the Government's intentions and the principle of "No decision about me, without me"-as well as the intention, at least, under the proposed Government health reforms, that many decisions will in future be made by communities working through their health and well-being boards with the GP commissioning consortia, and with the political support of the Government-presumably the community and GPs in Shropshire have a greater say in the present culture than they might have in the past. I should have thought that my hon. Friend might be reassured by that and would not necessarily need to get Ministers involved in the dispute.
Daniel Kawczynski: Yes, I concur with a lot of what my hon. Friend has said. However, I listen to members of the public, because I am directly accountable to them as their Member of Parliament, and often my voting and other decisions are affected by them. There is a bond of accountability between each one of us and our constituents. Unfortunately, chief executives and managers of trusts and PCTs do not necessarily have that bond of accountability. They are here one minute and gone the next. That is the problem. Many of my constituents are trying to engage in the consultation process and put questions directly to the PCT and chief executive, but they are not getting answers. I should like the Minister to be aware of that. If the Government are putting forward public and patient engagement as a stringent criterion of whether a reconfiguration service should go ahead, it is important that the Secretary of State should have confidence that that aspect of the process has been fully and robustly carried out. My understanding is that the only method of referral is by the council's local overview and scrutiny committee, but if the council is not minded to do it, what can local people who still have concerns do?
I have been approached about extraordinarily emotive cases, involving women who have major issues to do with maternity and paediatric services. They are very emotional about the prospect of those services being moved away from their community. I want them to be heard.
Ms Gisela Stuart: An important thing we have learned in the past 15 to 20 years is that when it comes to extremely complex and difficult clinical cases, a hospital must perform a particular function a minimum number of times if it is to be at its clinical best. Some of the hon. Gentleman's constituents will end up in Birmingham. He questions why Birmingham has received investment, but it is because we provide national centres of excellence. Some of the mothers from his area will come to the women's hospital because their case is so complex that only the women's hospital can deal with it. There can be only two or three centres in the country able to provide that clinical excellence. There is always that tension between the local and the centralised.
The hon. Gentleman is unhappy about the reconfiguration, but does he have an objective assessment of how good, clinically, his area's current maternity services are? He may feel good about them, but does he have a professional assessment of whether they could be better?
Daniel Kawczynski: That is a very good question. The chief executive of the trust and the PCT and many others believe that there must be a reconfiguration and specialisation at both hospitals. The argument is that without it, we shall lose services, which will go out of the county. We shall not get our NHS trust foundation status and services will be moved out even further away. That is the gun being pointed at my head-not to rock the boat too much on this issue, because there is the possibility of services moving away. I understand that. I feel that the maternity services at the Royal Shrewsbury hospital are good. When my daughter was born there I found the services tremendous. Speaking emotionally, obviously I want them to stay in Shrewsbury. I understand that we must have the reconfiguration debate and that the professionals and clinicians must make the decision, and that is why I shall write to local GPs and consultants to gauge their views. I shall keep the Minister informed.
Glyn Davies (Montgomeryshire) (Con): Thank you, Mr Dobbin. Clearly there are one or two procedures of the House that I am not yet wholly familiar with, and one of them is rising to speak in Westminster Hall. I will not forget that again, because I would have been quite miffed not to have the opportunity to speak in the debate. I am very grateful and shall always remember with fond memories my experience of speaking while you are in the Chair.
Glyn Davies: I congratulate the hon. Member for Birmingham, Edgbaston (Ms Stuart) on the timely raising of a hugely important issue. She asked important questions. I am looking forward to hearing the Minister's response as, I am sure, are other hon. Members.
I can reassure the hon. Lady on one point, because my wife and I had four children-well, my wife had them-and they were all born at home. That was because of the added reassurance it gave my wife. Clearly, had there been any difficulties there would have been a transfer to hospital. The births were not at our home, but our in-laws' home, which was very near the hospital-we wanted some reassurance.
The context in which I want to speak is cross-border services. It is relevant for several services, including maternity. My constituency is in Wales and health is a devolved issue. The commissioning of maternity services is clearly a matter for the Assembly Government; but because there is no district general hospital in my constituency or, indeed, anywhere in the whole of Powys, consultancy-led maternity service provision is in Shropshire. I therefore have a particular interest in the changes taking place over the border there.
The debate is timely because of the consultation document, "Keeping it in the County", which my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) mentioned. The local trusts are having to respond to pressure-not just financial pressure, although that is clearly an issue. There are two district general hospitals in Shropshire and the population is not really sufficient, given all the other considerations, to support them both. In addition there are the implications of the working time directive, and the specialisation that now exists among consultants. There is the added difficulty of accessing consultants from overseas, and there is greater expense in delivering specialist services at two hospitals. We have almost reached the stage of it being difficult to reassure everyone that services at these hospitals are clinically safe.
I support the principle of reconfiguration, the three most important aspects of which are consultant maternity and obstetric services, paediatric services, and trauma A and E. Those cover three highly contentious and emotional matters, and people have strong opinions on them. Today, I shall refer to consultancy-led maternity services.
My concern is that the proposals were prepared without sufficient consideration for mid-Wales. They were prepared in the context of Shropshire, and that is a huge problem. I was a member of the National Assembly for eight years. I accept that Wales is devolved, and I am most supportive of a strong and effective Assembly, but we do not want a barrier growing between Wales and England, rather like a Berlin wall along the line of Offa's dyke. When it comes to specialist services, we remain dependent on England, particularly for consultancy-led maternity services.
The proposals suggest that consultant obstetric services will be moved from the Royal Shrewsbury hospital to the Princess Royal hospital in Telford. As my hon. Friend the assiduous and hard-working Member for Shrewsbury and Atcham pointed out, that is causing huge concern-and not only in Shropshire but in mid-Wales. There will be three public meetings over the next three weeks. I expect hundreds to come along, and the main issue will be the provision of maternity services.
The Royal Shrewsbury hospital is just over the border from mid-Wales. All the traditional pathways from there have been to the Royal Shrewsbury. We are used to it, and it is relatively close. Nevertheless, mothers from many parts of my constituency have to travel for an hour to get to the Shrewsbury hospital; but if consultant
obstetric services are moved from Shrewsbury to Telford, we are talking about another half an hour. That is causing massive concern.
I support the principle of reconfiguring the two hospitals in Shropshire. The general principle is that instead of having two district general hospitals struggling to survive in the current environment, we have one hospital that is in effect on two sites. That probably is sensible, and I would support it. However, I want the proposals to take account of the whole catchment area of the Shropshire hospitals. Devolution should not rule out mid-Wales from those discussions, as it depends on hospital services in Shropshire. That principle is particularly important to my constituency.
I shall express my view at the public meetings. I want the proposals to be changed. In a sense, it is selfish to argue the case for our constituencies, but we inevitably do so. I do not want services to be moved to Telford. If we were satisfied that that was the only answer, we would reluctantly accept it. As it is, all my constituents will rise up and say that they are not satisfied. They believe that the decision is based on convenience and political balance in order to attract support, and that it is not being done in the best interests of all who live in the catchment area of those hospitals.
Emily Thornberry (Islington South and Finsbury) (Lab): I want to make three points about the provision of maternity services. The first is about the provision of extra midwives; the second is on the question of Sure Start; and the third is about health visitors.
It seems to me that maternity and antenatal services are provided not only at birth; they are also post-natal services, and new mothers rely upon them strongly. I had two babies under a Conservative Government and one under a Labour Government. At none of those births did I believe that there was sufficient investment in maternity services. That situation continues.
During the last three years of the previous Labour Government there was a massive increase in investment in maternity services, and a new strategy was put in place. Unfortunately-perhaps fortunately-that coincided with a great increase in the birth rate. There was increased investment in maternity services; for example, the number of midwives rose in 2007 by 624, in 2008 by 571 and in 2009 by 787. However, that coincided with one of the largest rises in the birth rate. Being able to keep up with the increase in the birth rate was a problem.
We passed the baton on to the present Government. They must build on our achievements and not let us down. We need to continue working on maternity services. Through an article in The Sun, the public heard loud and clear that the Prime Minister was promising 3,000 extra midwives. The fact of the matter is that 3,000 extra midwives would in any event not make up for the shortfall in their number. Even if the Government were to provide 3,000 extra midwives, we would still need at least another 1,700. The problem is that, having made that pledge and promise, the Government seem to be going back on it.
"There must of course be enough midwives to meet the demands arising from the number of births."
The Royal College of Midwives agrees; it calculated the national England-wide shortage of midwives in 2009 to be 4,756. If, as the nameless Conservative spokesman says, we should have enough midwives to meet demand, we need more than 3,000. The spokesman then said:
"The commitment to 3,000 midwives made in Opposition was dependent on the birth rate increasing as it has done in the recent past."
My hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart) asked-she put it so beautifully-what was his starting point? What did he mean? The whole piece was written in the present tense. Midwives are stretched to breaking point. They are overworked and demoralised, but the increase in the number of midwives was contingent on a continuing rise in the number of births.
"It was not in the coalition agreement because predictions now suggest the birth rate will be stable over the next few years."
The veracity of that statement does not stand up to proper analysis. There has not been a prediction since the Prime Minister made his pledge, so we do not know what the difference would be. If improvements are made, we need to continue to build on them. I suggest that the Government are letting everyone down.
"The midwifery workforce across the UK is ageing with 40%-45% of the midwifery workforce reaching the current retirement age in the next ten years."
Emily Thornberry: I respectfully agree with my hon. Friend. In a moment I shall be speaking about another part of the work force, health visitors. They suffer exactly the same problem. The majority of the work force is over 55. It is important to retain such valuable and experienced people-they are mostly women-but we cannot increase their number if we continue to lose existing staff at the current rate.
According to the Library, the number of births in the UK was projected to fall in 2009-10, in 2010-11 and in 2011-12. If the Prime Minister's pledge was based on the latest birth projections, perhaps he expects to cut the number of midwives. That is clearly nonsense. We need to consider what is needed and ensure that it is fulfilled. My hon. Friend the Member for Birmingham, Edgbaston made a devastating analysis of the difficulties that will be caused by the changes the Government propose. How can we make forward projections and how are we to manage the national health service if we give NHS commissioning to doctors? They will simply consider the needs of the local area and not our national needs.
In passing, may I briefly touch on the important issue of Sure Start? During the election, the Prime Minister claimed that Labour was scaremongering when we said that there would be difficulties in relation to Sure Start. He said:
"Yes, we back Sure Start. It's a disgrace that Gordon Brown has been trying to frighten people about this."
"It's unforgiveable that Labour has used the tactics of creating fear and anxiety amongst families and Sure Start staff".
"Sure Start is at the heart of our vision for early intervention"
If that is true, why did the charities 4Children and the Daycare Trust find out that 250 centres, which serve 60,000 families, are certain either to close or be earmarked for closure? There are 3,578 children's centres in England, 3,100 of which have been told that their budgets will be cut this year. About 2,000 services will be cutting their services as a result. The findings are based on responses from almost 1,000 Sure Start managers to a questionnaire sent out by 4Children and the Daycare Trust.
It is hugely important for a new mother to be able to find a friend, get guidance and go to a children's centre. Nevertheless, centres offering such services are being cut. The other friend that mothers need is the health visitor. Again, when the Prime Minister was in opposition, he made a big thing about increasing the number of health visitors:
"The substantial increase in the number of health visitors will mean that families get more support-from properly trained professionals. Health visitors will be able to spend time with families, have the opportunity to spot parenting issues, and build the trusted relationships needed to help with them. For instance, if they feel a mother is not bonding with her baby, and recognise the cause as post-natal depression, they might gently recommend that she visit her GP, or steer her towards a local counsellor."
He was absolutely right; no one can disagree with that. However, when I met London health visitors from the Community Practitioners and Health Visitors Association earlier this year, they told me that there was a huge problem in recruiting new health visitors. They were losing a lot of older, experienced staff through early retirement. Nearly a third of health visitors in London are over 55 and they have dangerous workloads. In some cases, there are more than 1,000 children per five health visitors. That is four times higher than Lord Laming-the writer of the Baby P and the Victoria Climbié reports-recommended. His recommendation is for health visitors to have a quarter of their current workload.
In an area such as London, which is very demanding, current workloads are dangerous. We need more health visitors. The Government recognise that a health visitor should have no more than 250 children under five and no more than 100 in highly vulnerable areas, as was recommended by Lord Laming and the Community Practitioners and Health Visitors Association. Will the Government consider that recommendation when they look again at how many health visitors are needed?
When I asked the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) whether the Government would take responsibility for recruiting and training the extra 4,200 health visitors promised, the answer I received was odd. She said that she will learn from the decisions on the case loads and they will be "locally determined". In the same answer, she says that the Department is shortly to publish plans to
"conduct a demographic and geographical analysis to establish location and population need and match with trainees and training
places; and ensure positive correlation between work force growth and population need."-[Official Report, 27 January 2011; Vol. 522, c. 460W.]
On the one hand, the Government say they will look nationally and decide what the need is, and on the other they say that it will be left to localities to decide. We really cannot have it both ways. What we have is a lack of health visitors.
Daniel Kawczynski: The hon. Lady talks about the need for more health visitors and staff and maternity services. If there were a Labour Government, the NHS would not be ring-fenced and there would be cuts in the NHS budget. Only our party has promised to ring-fence the NHS budget. How can she promise additional services when there would have been cuts in the NHS budget under Labour?
Emily Thornberry: Although the Government have said that, in principle, there is a ring fence to the NHS budget, a closer analysis will show that that is not true. The real position is that there is double-counting of over £2 billion-
Emily Thornberry: The hon. Lady is welcome to intervene if she wants to get into an analysis. The Government's promise of a ring fence and a year-on-year increase in the NHS budget is one that does not stand up to scrutiny. There is double-counting going on. Currently, given the level of increased demand, we must have 4% efficiency savings each year in the NHS. In fact, we will see cuts. It is simply not right for the Government to continue to say that the NHS budget is ring-fenced, that the NHS is safe with them and that services will not be cut. The reality is that the NHS is going through a very difficult time, and, on top of that, this Government are putting it through an absolutely needless reorganisation, which means that we will not get a national steer on things such as maternity services.
Simply giving commissioning to GPs will not help. It has been a matter of policy for years that we keep pregnant women away from doctors if we can, because they are not ill. We pass their care into the hands of the midwives, and hopefully everything will be fine. If a doctor is needed, bring the doctor in. Essentially, a woman goes to a GP to find out that they are pregnant. They then go to a midwife and the midwife looks after them. That has always been the case. GPs do not have an understanding of midwifery or services for pregnant women. The difficulty is that such services will be sidelined and that is not fair on women. That argument was made to the Government when the point was being made that midwifery and post-natal services should be commissioned nationally. I do not know why the Government have changed their mind about that, and it is one of the questions I want to ask the Minister.
The NHS is going through great economic trauma. It is used to having a year-on-year increase in budget. Now, its budget will be cut year on year at the same time as the whole service is being reorganised. Will we have proper tactical decisions on midwives, community nurses and all those things on which mothers rely, or will we simply allow such services to be given to GPs-at a time when a cold wind is blowing through the national health service?
I think I have got through most of my questions to the Minister. I have just a few more. How will she drive improvements in maternity services? Before the election, the Prime Minister talked about maternity networks. What levers does he have that will make them a reality? Why did the Government ignore the representations of professional bodies such as the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists in relation to commissioning? Furthermore, why has the Prime Minister handed over commissioning to GPs and maternity services? Will the Minister give us an assessment of the involvement of midwives in GP pathfinder consortia?
The Parliamentary Under-Secretary of State for Health (Anne Milton): May I say what a pleasure it is to be under your chairmanship, Mr Gale? I congratulate the hon. Member for Birmingham, Edgbaston (Ms Stuart) on securing this debate. She was right to emphasise the good work that goes on in our maternity services and to praise the staff for the care that they give to women and their families. Pregnancy is an exciting, but sometimes bewildering, time for us all. I have had four children in four different hospitals in four different parts of the country. As is the case for many women, the care that I received had a significant impact not only on me but on the care that I was able to give my children at the time.
The hon. Lady raised three issues. She referred to the excellent work of Professor Gardosi, an article from The Sun-much reference has been made to The Sun-and the debate yesterday on the Health Bill. The hon. Member for Solihull (Lorely Burt), who is no longer in her place, also mentioned the excellent work of the Stillbirth and Neonatal Death Society. Let me also take the opportunity to praise that organisation for its work in this difficult area. It would be an honour for me to be at the opening of the Forget-Me-Not suite at the Royal Surrey county hospital in my constituency.
My hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) made an important intervention. As he said, the birth rate rose by 19% between 2001 and 2009, and the midwifery work force rose by only 9% in that period. Listening to Opposition Members this morning, one wonders where the Government have been for the past 13 years. In that period, significant amounts of money were going into the NHS. So, as my hon. Friend asked, what exactly did the previous Government do in that time?
I want to mention some of the other points that my hon. Friend made. His dedicated service to his constituents is legendary and this morning he spoke with his usual passion. He has already raised his concerns about reconfigurations of services and I know that he will listen to what GPs, midwives and, most importantly, women and their families have to say about those reconfigurations. I know that he will use every tool at his disposal to ensure that his constituents' views are heard loud and clear.
My hon. Friend the Member for Montgomeryshire (Glyn Davies) also reiterated his concerns about reconfigurations. I must say, Mr Gale, that he should relax about parliamentary procedures, which confuse even the most experienced Members at times. As a new Member, you often feel that it is just you who is confused. But fear not-people who have been in the House for 20 years or more can also get confused by procedure.
I was very heartened to hear of my hon. Friend's positive tale of his wife's four home births. Clearly, they were successful and happy experiences, which were doubtless helped enormously by the excellent support of a midwife on the spot. He rightly raised the difficult issue of cross-border care and it is critical that we get that care right. Arbitrary lines do not wash with the public, and I am sure that people will listen to his contributions on this subject when the reconfigurations are considered. The first duty of maternity services is to provide safe, high quality care for mothers and babies. Women should rightly expect to receive consistently excellent maternity services, no matter what time of day they have their baby or where they are treated.
I did not have any home births, but I am very aware-this is slightly contrary to the hon. Member for Birmingham, Edgbaston-of what an important choice having a home birth is for many women. Personally, I am a little more nervous. I quite enjoyed my stay in hospital after each of my babies arrived; I put that down to the fact that I always feel the need to do housework if I am at home, so a hospital stay gave me a few days off. However, having a home birth is an important choice and I know that many women gain enormously from the opportunity to have a baby in their own home, and our aims reflect that. We have made provision of maternity services that are focused on improving outcomes for both women and their babies, along with improving women's experience of care, an absolute priority for the NHS. The Government set out our long-term vision for the future of health care in our White Paper and there was an extensive debate in the House on many of those issues yesterday.
By focusing on health outcomes and delivering maternity services through provider networks, we want to deliver high quality maternity services. Networks will bring together all the maternity services that a mother might need, linking local hospitals, GPs, charities, secondary and tertiary services, and indeed community groups, so that they can share information, expertise and services. Commissioners and providers will drive that process forward. Maternity networks will extend choice for women by encouraging providers to work together, offering expectant mothers and their families a broader choice of maternity services and allowing women to move between the services that they want or need seamlessly.
Ms Stuart: I am trying to understand these networks. How many will there be? I am concerned about the fragmentation of maternity services. Will there be one network in the west midlands, or will Birmingham have one network? Will there be 25 networks? How big are the networks?
Anne Milton: The important thing for central Government, and it is what we are doing, is to move away from being centrally very prescriptive. If I were to guess, I would say that networks will be on a regional level, but their size will depend on various things. Delivering maternity services in Birmingham is very different from delivering maternity services in Cornwall. We need a network that can offer all the services that women and their families need while not being too big and thus unresponsive to local need.
Ms Stuart: This issue is quite important. When we created primary care trusts, there was a kind of vision that they would each serve a population of around 250,000. That was a framework, but there were still some very small PCTs. Are we looking at a maternity network that would serve a million people, as in Birmingham, or a network that would serve 3.6 million people, as in the west midlands as a whole?
Anne Milton: The hon. Lady is already falling into difficulties. She wants central Government to prescribe what works on the ground. If one looks at the proposals for GP pathfinder consortia, one sees that the proposed consortia vary in size enormously. That is because local people on the ground know what size of consortium will work for them. We will see more details emerging as the Health Bill goes through Parliament and as the consortia get going. What matters is to be locally responsive. The hon. Lady mentioned accountability; having the right accountabilities in the system is important. What also matters is using the commissioners in particular to drive up quality.
Our focus on public health is also critical to maternal outcomes. Healthier women have healthier babies and for the first time we will ring-fence public health money. The hon. Lady was right to mention inequalities. Increased rates of stillbirths are associated with deprivation. I must say that, despite the previous Government having what was doubtless the best will in the world, during the 13 years that they were in power, health inequalities widened. I do not think that that was because they were utterly incompetent; it was partly because it is extremely difficult to do something about inequalities. However, I believe that our focus on public health and our ring-fencing of public health money will have a significant impact.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): Does the Minister agree that, although choice is very important, in a constituency such as mine, which is in the east end of London, public health issues, such as nutrition, access to advice and quite low-tech care during the course of a pregnancy are just as important to good maternal health outcomes? Underweight babies are one of the big problems in my constituency. They often have poor educational outcomes later, and cost the taxpayer tens of thousands of pounds, because they have to be put in incubators and so on. That problem is to do with the sort of advice that those young mothers receive and it is a public health issue.
Anne Milton: I thank the hon. Lady for her intervention; I think that we broadly agree on this issue. That is why we are focusing on public health. Preparation for pregnancy and having a healthy baby starts long before a woman actually gets pregnant. The education and support that women receive, the social networks that they are part of and improving the public's health all matter. Nothing could be more important than improving the outcomes for women and, indeed, their babies.
Choice is important and it is also important that women can make informed choices; choices must be well informed to improve the outcomes for women and their babies. Furthermore, it is important that women have access to maternity services at an early stage in their pregnancy. In fact, ensuring such access is probably one of the most fundamental characteristics of high
quality maternity care, which is why we have included the 12-week early access indicator as one of the measures for quality in the NHS operating framework for 2011-12.
Of course, it is also important that there are appropriate numbers of trained maternity professionals to provide the maternity service. The number of clinicians needed by mothers depends on several factors, ranging from the mother's medical circumstances, to the complexity of the pregnancy, to wider societal factors, which can have a considerable impact.
Looking at the bigger picture, the birth rate must be considered when we are planning maternity services. Although the number of births in England has been rising since 2001, as I mentioned earlier, the birth rate peaked in 2008 and actually fell, by just less than 1%, in 2009 to about 671,000 live births. We are determined that staffing rates should be calculated purely on how many staff are needed to provide safe, quality care. We are considering ways to improve midwife retention and recruitment, and the planned number of midwives in training in 2010-11 is at a record level of about 2,500. Therefore we expect a sustained increase in the number of new midwives who will be available for maternity services during the next few years.
Complete and absolute focus on staffing numbers is totally ridiculous. If the birth rate shot up, 3,000 extra midwives would not be enough. Ensuring that the maternity work force has an effective skills mix is also an important consideration. I was recently in an extremely busy maternity unit, and the midwife there made it clear that what they needed was not more midwives but more support staff. Doubtless in other units there will be support workers in place, but not enough midwives. We want to focus on using the whole maternity team, including obstetricians, anaesthetists and support workers. It is not just the number of qualified midwives that is important, but their experience, and one issue that we need to address is attrition. A newly qualified midwife does not have the experience, nor perhaps the skills, to lead the team in a way that a midwife who has been in practice for 10 years or so can.
Emily Thornberry: Although I agree with what the Minister says, surely the difficulty she has is that the Prime Minister promised us 3,000 more midwives. Although I accept that we need experienced staff to ensure that midwives are trained up properly-the same applies to a number of different skills-the Prime Minister promised us the 3,000, so is it right that the Government are rowing back on that promise?
Anne Milton: There is no rowing back. We have always made it clear that the number of midwives will be in proportion to the birth rate. In fairness to the previous Government, they made concerted attempts, although much too late, to increase the number of midwives in training, and, as I have said, we have 2,500-odd in training now. We will continue to ensure that we have the right staff mix and the right number of midwives to ensure that women have safe births.
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