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House of Lords

Wednesday, 20th December 2000.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Bath and Wells.

Maternity Services

Baroness Cumberlege asked Her Majesty's Government:

    What measures they are taking to improve the state of maternity services.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, we have an extensive work programme to develop and improve many aspects of maternity care. This includes improvements in safety through clinical guidelines on caesarean sections, foetal monitoring and induction of labour and improving midwife staffing levels, recruitment and retention.

Baroness Cumberlege: My Lords, I am grateful to the Minister for that Answer and I am encouraged that there is a work programme ahead. However, does he agree that one of the difficulties is that midwives are fed up, disillusioned and leaving the service because small maternity units are being closed and childbirth schemes are being discontinued? Will he and his colleagues intervene to prevent such closures and ensure that such units continue?

Will the Minister also ensure that the regulations which will come before the House in January reflect the wishes of the Royal College of Midwives? Those are: a distinct register for midwives; a distinct committee for midwifery under the UKCC; and a supervisor of regulation of midwives, with a small team to support her. Will he ensure that those provisions are included in the new regulations? Otherwise I fear that the safety and well-being of women and their babies will be in jeopardy.

Lord Hunt of Kings Heath: My Lords, I well recognise the contribution of midwives in the provision of services. The individual responsibility which they take provides a model for the way in which we want the workforce to develop. Therefore, it is important that we support midwives in their responsibilities.

I recognise the popularity of small maternity units both among women and midwives and I know that a considerable number throughout the country provide an effective service. The noble Baroness will know that there have been issues around the recognition of such units for training purposes which have brought into question their long-term viability. However, I want to reassure her that we are discussing with the Royal

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College of Obstetrics and Gynaecology, the Royal College of Paediatrics and Child Health and the Royal College of Midwives the best way to work together on broader issues around maternity units' staffing and configuration, which I hope will ensure that small units can be provided in future.

As regards regulation, we have recently finished the consultation exercise. I shall listen carefully to the views of the Royal College of Midwives. The regulations are concerned with upholding the public interest in the regulation of professionals but I believe that each profession must have confidence in those arrangements. I shall seek to ensure that that happens.

Baroness Northover: My Lords, does the Minister agree that good quality maternity care in the 21st century must more effectively address the post-natal needs of mothers? Does he also agree that although mothers may be effectively monitored up to childbirth, they may find themselves almost abandoned thereafter, isolated, depressed and anxious?

Lord Hunt of Kings Heath: My Lords, I hope that the picture is not as bleak as the noble Baroness has painted it. I believe that the role of midwives and health visitors and primary care generally is as crucial after the birth as it is before. As part of the comprehensive development of midwifery services, including aspects after the birth, we want to ensure that women receive support during what can be a challenging period. I also hope that the development of primary care trusts will enable us to ensure a consistency of approach in primary care throughout the country.

Earl Howe: My Lords, picking up the point made by my noble friend Lady Cumberlege, does the Minister accept that nothing that is done in setting up the new nursing and midwifery council should jeopardise the recruitment or retention of midwives?

Perhaps I may press the Minister further. In considering the new structure, will he bear in mind the need to establish a mechanism to ensure that issues pertaining solely to midwifery--in particular education and training--are overseen by a committee which is dedicated to midwifery?

Lord Hunt of Kings Heath: My Lords, the noble Earl tempts me to disclose the results of the Government's decision-making in relation to the consultation process. I am afraid that I am not yet in a position to do so. I understand the points he makes in relation to a statutory midwifery committee and can tell the House that that is being carefully considered alongside the views we have received from midwives and those in other nursing professions in relation to regulation as a whole. Perhaps I may reiterate that effective regulation in the public interest depends also on the professions having confidence in those arrangements. I am determined to ensure that they have such confidence.

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The Countess of Mar: My Lords, does the Minister agree that a distinction should be drawn between nursing and midwifery, in that in general nurses deal with sick people whereas one hopes that midwives deal with healthy young mothers who produce healthy babies? Does the noble Lord agree that the difference between the two professions should be maintained so that pregnant women are not regarded as being sick?

Lord Hunt of Kings Heath: My Lords, I understand the point that the noble Countess makes. I expect those issues which are solely concerned with the responsibilities of midwives to have a focus within the regulatory responsibilities of the new nursing and midwifery council and that the views of midwives in particular will come to the fore. Equally, there are many areas in which nurses and midwives can work together within the new council. That is also the key message at local level. Although midwives have a distinct role to play, they are also part of a team, and team-working between nurses, midwives and health visitors is absolutely crucial.

Baroness Trumpington: My Lords, are the Government in favour of or against women having their babies at home?

Lord Hunt of Kings Heath: My Lords, I have had two babies at home. I should say that my wife had the babies but I was an enthusiastic spectator. The Government want to ensure that, where it is clinically appropriate, if a woman wishes to have a home birth she should receive the appropriate support from the health service. At the end of the day, it must be the woman's choice.

The Earl of Courtown: My Lords, notwithstanding the Minister's earlier response to my noble friend, what can I tell the health visitor when she sees my wife next week about the future of her profession and how many people will enter it? In spite of the response of the Minister, people are not given any real hope that there is a future for this profession.

Lord Hunt of Kings Heath: My Lords, I hope that the noble Earl will reflect on this matter and give the health visitor or midwife encouragement, because both professions have an enormous future role to play. The Government's policy outlined in Saving Lives: Our Healthier Nation to develop health promotion programmes depends crucially on the role of health visitors. Midwives have set a model for other professions in the independent professional responsibilities that they undertake. We need to support that with professional education and training programmes and flexible working and build on the pay rises which have so recently been awarded to them. I believe that the future is good for them.

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London Underground: Investment

2.45 p.m.

Lord Ezra asked Her Majesty's Government:

    What progress has been made to ensure that investment in London Underground is facilitated speedily and in a manner that commands public confidence.

The Parliamentary Under-Secretary of State, Department of the Environment, Transport and the Regions (Lord Whitty): My Lords, the best and final offers for the two deep tube contracts were received by London Transport on 20th November and were invited for the subsurface contract on 18th December. The report of the National Audit Office into the financial analysis has been received, and London Underground will shortly submit its safety case for the PPP.

Lord Ezra: My Lords, is the noble Lord prepared to comment on whether the much-publicised proposals by Mr Robert Kiley, the new Transport Commissioner for London, who is credited with having revived the New York subway, are being seriously considered by the Government? Does the Minister agree that those proposals contain what appear to be some very considerable beneficial features, such as maintaining the unity of the management and responsibility for running the Underground, raising money externally without recourse to public funds and bringing in substantial private sector expertise?

Lord Whitty: My Lords, recently the Deputy Prime Minister and Mr Kiley had two useful and constructive discussions on the future of London Underground during which those points were raised, and they intend to have further contact in January. Both recognise the valuable work carried out by London Underground on the PPP. The Government want to consider the points that Robert Kiley put to the Deputy Prime Minister and have asked for further information. However, all of that is within the process of the PPP, which is going ahead.

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