BLISS CHARITY AND NEONATAL CARE IN ENGLAND

House of Commons Early Day Motions

Bob Spink [R]
Peter Bottomley
Bob Russell
Andrew George
Mr Gregory Campbell
Mr David Drew
	Dr Rudi Vis	Dr William McCrea	Ms Katy Clark

That this House notes that 70,000 babies were admitted to neonatal care in England in 2008, almost 20,000 of those being admitted to intensive care; further notes that Bliss is the only UK charity that helps care for premature and sick babies; congratulates Bliss on 30 years of campaigning that has resulted in an NHS neonatal taskforce conducting the most comprehensive review of neonatal care ever undertaken in England; and calls on the Government to implement fully the Taskforce’s recommendations in order to make a lasting improvement in the way babies and their families are cared for.

Departmental Public Expenditure – Health

Mrs. Maria Miller:

To ask the Secretary of State for Health how much his Department has allocated to Maternity Matters programmes in (a) 2009-10 and (b) 2010-11.

Ann Keen:

In January 2008, the Department announced an additional £330 million for maternity services to help support the implementation of Maternity Matters over the three years 2008-09 to 2010-11. This funding has been included in primary care trusts (PCT) baseline allocations. It is for PCTs to determine how best to use based on the needs of local maternity services.

Mrs. Maria Miller:

To ask the Secretary of State for Health how much his Department has allocated for NHS Baby Lifecheck in (a) 2009-10 and (b) 2010-11.

Gillian Merron:

Expenditure on NHS Baby Lifecheck in 2009-10 is expected to be approximately £1.3 million. The allocation for NHS Lifecheck in 2010-11 is still under consideration.

Home birth figures remain static across UK

Across the UK in 2008, 21, 211 (2.7%) of all births (787,032) took place at home, compared with 20,548 (2.68%) in 2007. This shows no rise in the home birth rate.

In England 18,933 women (2.8%) had a home birth, from 665,779 births.

Wales has the highest proportion of women having home births, 1,314 (3.7%) from 35,256 births.

In Scotland, 881 women (1.5%) had a home birth, from 60,366 births. And in Northern Ireland, 83 women (0.3%) had home births from 25,631 births.

In many areas community midwifery services are not being developed to increase access to home births and birth centres, and women are not being given balanced information to make well-informed choices. Low midwifery staffing levels mean home birth is either not being offered, or withdrawn at short notice. Every trust and board should ensure that choice of place of birth is available to all women.

Local administrative areas with highest and lowest home birth rates include:-

		HIGHEST		LOWEST
England		South Hamms – 13.6%		Alnwick 0.0%
Scotland		East Lothian – 5.0%		Eilean Siar – 0.4%
Wales		Bridgend – 9.5%		Merthyr Tydfil – 1.3%

New data provided by the Office of National Statistics, The General Register Office for Scotland and the Northern Ireland Statistics and Research Agency. Statistics analysed by BirthChoiceUK – available at www.BirthChoiceUK.com/HomeBirthRates.htm

Senior midwives report falling budgets despite rocketing birthrates

Despite the rapidly rising birthrate* well over a third (40%) of Heads of Midwifery (HOMs) say they have not had any budget increases in the past year. Worryingly, nearly a fifth (17.8%) report that their budget has been cut, and almost a third (30%) report that they have been asked to reduce their budgets. Just 42% report an increase in their budget, a fall from 47% last year.

The results – from a survey of HOMs across the UK by the Royal College of Midwives (RCM) are released on the final day (Friday, 27th November 2009) of the RCM’s annual conference in Manchester.

When asked about their staffing levels over two thirds (67%) of HOMs also reported that they do not have enough midwives to cope with the workload in their unit.  Well over two-thirds (72%) said they needed more midwives to bring their midwifery staffing levels up to an acceptable level. Over 90% of HOMs cite rising birthrates and the increasing complexity of births as the key reasons why their units are struggling to cope with the workload.

Despite recent and welcome increases in the numbers of midwives**, and plans to recruit more, the figures show that the increase is not keeping pace with the birthrate. There still remains a significant midwife shortage. The RCM still believes that the Government’s target of 3,400 more midwives will not be enough – if the birthrate continues to rise – to delver a high quality service. For this to become a reality the RCM estimates that over 5000 more midwives is the target that the Government should be aiming for.***

Thepicture however is not all bleak. Following a freedom of information request the RCM found that spending on maternity services is up on average by 7% across the UK. This is above the average NHS spending increase of 4%. But, this is a service playing catch-up, and that has seen historically low investment compared to other parts of the NHS.

Regionally there are significant variations in general vacancy rates. London (12.6%), the East of England (12%) and the South east (10.9%) all have exceptionally high levels. This is compared to the average vacancy rate for the UK of 6.5%, up from 5.4% last year, and this compares badly with an acceptable level of vacancies of around 3%.

A number of other regions have lower but still worrying levels of vacancies with South Central England (7%), the West Midlands (5.7%) and East Midlands (5%) all running well above acceptable levels. The RCM would want to see concerted action to chip away at these morale sapping levels of vacancies, and are hopeful that Maternity Matters, the Government’s blueprint for maternity services, will achieve this.

HOMs also report that they are struggling to recruit midwives, so even when they have the funding they are struggling to improve their staffing levels. Almost half (48%) say that recruitment and retention of midwives is quite a problem or a major problem. The number of HOMs who see recruitment and retention of midwives as no problem has fallen from almost 60% 2 years ago to just 25% this year.

Stress and heavy workloads top the table of reasons why HOMs say they are struggling to recruit and retain midwives.  A third of HOMs (33%) report that stress is a major issue, and nearly a third (30%) say heavy workloads are having an effect on recruitment and retention.

Cathy Warwick, general secretary of the Royal College of Midwives, said: “There is no doubting the Government’s commitment in word and deed to maternity services. The direction of their policy is good, more money going into maternity services and midwife numbers are increasing.

“However, on the ground midwives are having to work ever harder and longer to maintain a high quality service for women and babies.  I have to ask myself how long they can keep doing this, and it is obvious that there is still an awful lot of ground to cover.

“The RCM remains sceptical as to whether the planned increase in the number of midwives will match or even catch up with, the ever increasing birthrate. It is also an issue as to whether all the resources allocated to maternity services will reach the front line, given the financial pressure that the NHS is facing to save money.”

Notes:

The survey of Heads of Midwifery received 76 responses from a questionnaire sent to 203 HOMs across the UK, a 37.4% response rate. It was conducted by the RCM in July 2009. It was conducted to gather information to support the RCM’s contribution along with other unions, to the NHS Pay Review Body.

The full report can be found on the RCM’s website at http://www.rcm.org.uk/college/employment-relations/pay/ – ‘RCM Evidence to the NHS Pay Review Body 2009’.

*The birthrate has risen by 18.6% since 2001. See table below.

**The Government have pledged to increase the number of midwives by a total of 3,400 (whole time equivalent, equating to 4000 more as a headcount figure0) by 21012. They have recruited an additional 1000 (headcount) so far.  For midwife numbers since 2001, see table below.

***The number of midwives needed is calculated using a tool called Birthrate Plus. This takes into account the level of activity on a unit, including the number, type and complexity of births.  Birthrate Plus would suggest that the current birthrate requires 24,937 whole time equivalent midwives whereas there are currently just 19,639. This leaves a shortage of 5,298 whole time equivalent midwives.

The number of Headcount and WTE Midwives

Year	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008
Headcount	22,841	22,799	22,572	23,075	23,249	23,941	24,844	24,808	24,469	25,093	25,664
Whole Time Equivalent	18,166	17,876	17,662	18,048	18,119	18,444	18,854	18,949	18

The rising birthrate in the UK

	2001	2002	2003	2004	2005	2006	2007	2008	Percentage Increase (2008/2001 x 100)
England & Wales	594,634	596,122	621,469	639,721	645,835	669,601	690,013	708,711	19.2
Scotland	52,527	51,270	52,432	53,957	54,386	55,690	57,781	60,041	14.3
N. Ireland	21,962	21,385	21,648	22,318	22,328	23,272	24,451	25,000[1]	13.8
Total	669,123	668,777	695,549	715,996	722,549	748,563	772,245	793,752	18.6
Number of Midwives (England)	23,075	23,249	23,941	24,844	24,808	24,469	25,093	25

Midwives comment on Conservative maternity plans

Commenting on the Conservative maternity plans announced today (Thursday, 26th November 2009) at the Royal College of Midwives (RCM) conference, Cathy Warwick, RCM, general secretary, said:

“In some respects the Conservative plans  reflect a general consensus on the actions we need to take if we are to provide world class maternity services. The commitment to more midwives is positive and significant, as is the promise of more locally based services, but of course both will need to be funded.

“The focus on better antenatal and postnatal care is a promising step. These are the parts of the services to pregnant women that are often lacking and suffer when financial problems bite. However, I would like to see what the Conservatives mean by ‘providers’ of these services. Are they referring to a greater role for the private sector? The RCM has serious concerns about the risk that privatisation of maternity care will lead to the fragmentation of care for women.

“I would want to see more detail on the commitment on funding for maternity services. At the very, very least we would want to see funding matching the ever increasing demands on the service.

It is now generally accepted that the method we have of paying for maternity services does not support implementation of policy. The RCM would like to see a review of the funding structure to incentivise normal births and which recognises those services that can demonstrate high levels of maternal satisfaction.

“The Conservatives are putting forward a number of interesting proposals, but good words and good intent are one thing, and real and positive action is another. We want promises made to become promises delivered and the improvements we have seen so far in maternity services continuing.”

Premature Births: Death

Commons Written Answers – House of Commons – Health

Mr. Andrew Smith:

To ask the Secretary of State for Health what progress the NHS is making in reducing the number of babies who die following premature birth.

Ann Keen:

Advances in technology and health care expertise have led to increasing survival rates of very premature babies over the last 20 years. Over the past decade, survival has improved dramatically for babies born at 26 weeks of gestation and above so that now over 80 per cent. survive.

The EPICure Study (led by the university of Nottingham, Department of Child Health) was established in 1995 to determine the chances of survival and later health status by following up children who were born in the United Kingdom and Ireland at less than 26 weeks gestational age during a 10-month period in that year. This is now an ongoing study, which it is hoped will not only show survival and rates of disability but also identify factors at birth, which could give an indication as to the long-term outcome for the survivors.

A new study, EPICure 2, covers all babies born in England at 26 weeks of gestation or less during 2006. This study will demonstrate how effective advances in neonatal care have been since the first study in 1995. Preliminary findings, published in May 2008, found that babies born above 24 and 25 weeks of gestation were significantly more likely to survive in 1995 compared with 2006.

Details of the EPICure studies can be found on the EPICure website:

www.epicure.ac.uk

NCT reveals crucial choice guarantee set to be missed by a mile

Over 95% of women in the UK are not able to choose where to give birth, a new report released today by the NCT (National Childbirth Trust) has found. Offering women choice of where to give birth is government policy across the UK as it is proven to have a positive effect on birth outcomes.

The NCT’s report, ‘Location, location, location’ highlights the benefits of choice to parents and calls for governments and health professionals to act quickly to ensure women have these choices available to them.

The ‘Location, location, location’ results show:

95.8% of women do not yet have access to a real choice between the three options of home birth with a midwife, a local midwifery facility (birth centre) either stand-alone or attached to a hospital and an obstetric unit in a hospital (the choices defined in Maternity Matters1)

89% of women live in areas that realistically do not offer the choice of a home birth with a midwife2

With greater encouragement of home birth, choice could be offered to many more women without any significant investment or shift in the way maternity services are structured.3

Over 40% of women live in areas without reasonable access to both a birth centre and an obstetric unit in a hospital

Women are lacking in the information and support needed to make these choices.3

The research for the report was commissioned in light of the Government’s Maternity Matters1 promise that all women in England will have access to choice of place of birth by the end of 2009. NCT wanted to ascertain how many women in the UK actually have access to choice. Scotland, Wales and Northern Ireland have also made similar policies that support the provision of choice for women.

Belinda Phipps, Chief Executive, NCT, says:

“There is a huge task ahead for trusts and boards as many are very behind in implementing this policy. For every ten pregnant women, nine are not able to choose where they want to give birth. We know across the UK, government policies support women with this choice. However, in reality this is not even close to being delivered yet.

“We want the governments to act now. Although in a few cases more investment in maternity services will be needed, with a simple re-thinking of the way their maternity services are delivered every trust and board can ensure choice is available to all women.

We know there are some financial policy obstacles hindering the achievement of choice the NHS could make much faster progress if it corrected these.

“There are a few trusts and boards in the UK that are succeeding in offering women a real choice and these successes are to be celebrated. We now need the rest of the UK to catch up.”

As part of the ‘Location, location, location’ campaign launched today, the NCT is calling for the commitment to guarantee choice of place of birth by the Department of Health to be implemented fully, and for the governments of Scotland, Wales and Northern Ireland to make a similar commitment to guarantee choice.

To achieve this local and national governments will need to:

Review the financial framework surrounding maternity services

Recognise the importance of midwives in reducing costs and delivering choice

Make sure that women are aware of the options and understand that for healthy women with a low-risk pregnancy, all three options are equally safe places to give birth

Ensure all in the maternity services work together and have sufficient training so they are experienced and comfortable in all three settings.

Make sure parents are provided with unbiased information to help them make their choice

Sarah Banks from Derby says:

“The first thing the midwife asked me was ‘which hospital do you want to go to?’  There was no discussion about other options and no mention of the birth centre nearby.  I told her that I wanted to have my baby at home and she refused to discuss it as she said it was too early and wouldn’t be advisable as it was my first baby.”

Both women and maternity services benefit from choice of place of birth being available. For women it leads to better birth outcomes, increased likelihood of straightforward births and improves their satisfaction with the birth. This in turn leads to higher self esteem and can increase parents’ confidence in being able to look after their baby.

For maternity services, offering these choices is likely to lead to reduced costs. Currently most women give birth in an obstetric unit in a hospital which is an expensive option3. With greater choice provided for women, more are likely to give birth in a birth centre or at home with a midwife. Therefore the effort necessary to deliver all three options will be outweighed by the savings made through less women giving birth in hospitals.

Note:

Please follow link to access: Location, Location, Location report

http://www.dodsmonitoring.com/downloads/PlaceofBirthFINALFORWEB%5B1%5D.pdf

Please ofllow link to access: Research report

http://www.dodsmonitoring.com/downloads/Investigation%20into%20choice%20of%20place%20of%20birth.pdf

Location, location, location’ details access to obstetric units, birth centres and home births in the UK and calculates the rate of women of childbearing age in each area with choice. See below for the results of the top and bottom five Trusts.

Local Authorities that offer the least choice

Local Authority	% of women of childbearing age who have choice
Middlesborough	0.0%
Boston	0.0%
Copeland	0.0%
Carlisle	0.0%
Coventry	0.0%

 

Local Authorities that offer the most choice

Local Authorities	% of women of childbearing age who have choice
South Cambridgeshire	100%
Southwark	100%
Cambridge	100%
Derbyshire Dales	91%
Bath and North East Somerset	91%

Norman Lamb: Number of caesareans deeply worrying

Commenting on figures showing that one in four babies in England is delivered by caesarean section, Liberal Democrat Shadow Health Secretary, Norman Lamb said:

“The staggeringly high number of caesarean sections being performed in this country is a serious cause for concern.

“The fact that the rate is nearly double that recommended by the World Health Organisation is deeply worrying, especially given the concerns about the increased risks of the procedure.

“We urgently need to increase the number of midwives in this country so that mothers are given all the advice and support they need during and after pregnancy.”

NHS Maternity Statistics, England: 2008/09

The new NHS maternity statistics for England 2008-9 were released today.

Belinda Phipps, Chief Executive, NCT, says;
“Again we have a release of figures that show the situation for women and babies is getting worse – high caesarean section rates, increased medical interventions, and fewer women giving birth in a place appropriate to them.

“This clearly demonstrates the effect of the lack of progress on Maternity Matters, the governments choice of place of birth promise, which was highlighted in the NCT’s  Location, location, location research report this week. Choice of place of birth leads to better birth outcomes for women, increased likelihood of a straightforward birth and improved satisfaction with the birth. “

Key Points

The caesarean rate has remained the same at 24.6%, with a rise in the numbers of elective caesareans (0.1%) and a decrease in the number of emergency caesareans (0.1%).  This shows a halt in the trend of increasing caesarean rates.
The instrumental delivery rate has increased by 0.1% to 12.2%, with a rise in the forceps rate from 5.0% to 5.5% and a decrease in the use of ventouse of 0.4%.  This continues the trend of increasing instrumental rates.
The induction rate is down 0.2% to 20.2%.  This reverses the recent upward trend.  Since 1999-2000 there had been an overall downward trend, with a low in 2005 but the rate has subsequently risen again.
Normal delivery rates are not available at the moment.  It is hoped the Information Centre will make these available in due course.

68.8% of women had a spontaneous onset of labour, similar to the previous year which was 68.6%.  [Note: this calculation uses a different source for caesarean as method of onset of labour, which is shown as 11%, rather than the 9.8% shown in Table 32, and does not reflect the rise of 0.1% in elective rates over the year]

62.9% of women had a spontaneous delivery, the same as from 2007-08.  This is at an all-time low.

	2006/07	2007/08	2008/09
Caesarean Rate	24.3%	24.6%	24.6%
Elective	9.5%	9.7%	9.8%
Emergency	14.7%	14.9%	14.8%
Instrumental Delivery Rate	11.5%	12.1%	12.2%
Forceps	4.5%	5.0%	5.5%
Ventouse	7.0%	7.0%	6.6%
Induction Rate	20.3%	20.4%	20.2%
Care on GP/Midwife Ward	10.6	11.7	10.8%
Normal Delivery Rate	n/a	n/a

 

Highs and Lows

There are 8 trusts/maternity units with caesarean rates above 30%:

 

Chelsea and Westminster Hospital	33.3%
Imperial College Healthcare NHS Trust (St Mary’s Paddington and Queen Charlotte’s)	33.1%
East Surrey Hospital	30.9%
Barnet Hospital	30.8%
University Hospital, Lewisham	30.6%
University College Hospital, London	30.6%
Royal Sussex County Hospital, Brighton	30.5%
Royal Free Hospital, Hampstead	30.4%

 

There are 5 trusts/maternity units with caesarean rates below 19%.

Kings Mill Hospital, Sutton-in-Ashfield, Notts	15.8%
Royal Shrewsbury Hospital	16.9%
Pontefract Hospital (part of Mid Yorkshire Hospitals NHS Trust)	17.8%
Barnsley Hospital	18.1%
Salford Royal Hospital	18.8%%

Midwife led care

Data for the current years show no increases in births in NHS midwifery facilities – 9.5% in the current year compared to 9.6% in 2007-08.  Care on consultant wards has increased from 44.7% to 48.8%.

Background – Since 1989-90, data have been collected on the place of delivery.  This uses the following categories:

1. NHS consultant ward
2. NHS GP ward
3. NHS combined consultant/GMP/midwife ward
4. NHS midwife ward/other ward or with delivery facilities associated with midwife ward or unit without delivery facilities

These categories are historical and do not necessarily represent current configurations of alongside birth centres, standalone birth centres, midwife led care beds in an obstetric.  Nonetheless, they can indicate changes in patterns of care.

Year	Total deliveries	Total with known place of delivery	Record completeness	Consultant Ward	Consultant / Midwife / GP Ward	GP ward	Midwife ward / Other ward	Total of midwife plus GP led care
2005-06	611,337	360,273	59%	49.4	41.5	1.6	7.4	9.0
2006-07	629,207	378,439	60%	45.9	43.5	2.3	8.3	10.6
2007-08	649,837	305,930	47%	44.7	43.6	2.1	9.6	11.7
2008-09	652,638	495,535	76%	48.8	40.4	1.3	9.5	10.8

 

This shows a decrease in GP/midwife led care in the previous year, and an increase consultant led care. However, record completeness is much higher than in previous years and changes may reflect a more representative sample than in previous years rather than changes in configurations.

Nurses and midwives will take centre stage in delivering tomorrow’s healthcare

Prime Minister’s Commission sets out its vision for the future.

A vision that will allow nurses and midwives to transform the quality of care was set out today by the Prime Minister’s Commission on the Future of Nursing and Midwifery.

Its ultimate goal is that all nursing and midwifery staff fulfil their potential to help people who use NHS services, families and communities achieve the best possible health and well being.

It also sets out that in the future nurses and midwives will take centre stage in all aspects of health care and that nursing and midwifery practice will be rooted in compassion.

The initial vision has been agreed by the Commission following an extensive engagement exercise over the summer, which sought the views of professions and the public around the country on what they see as the future role for nurses and midwives.

Separate to the vision statement the Commission has identified ten hot topics through responses to the first engagement phase and their own deliberations, which they want further debate on. Included within the hot topics for discussion are the need to address the confusion over roles and title of nurses and midwives and the role of nurses and midwives in putting service users in charge of their own care.

The Commission is now seeking to encourage further views, discussion and debate on their initial vision and ten ‘hot topics’ through a second phase of engagement ahead of publication of their final report in the New Year.

The second engagement phase will last two months and will include meetings with nurses and midwives, stakeholder meetings, public events and seeking views online through the Commission’s website.

A final report will be produced by the Commission in early 2010 and presented to the Prime Minister and Health Secretary, Andy Burnham.