Webchat with shadow health secretary Andrew Lansley
This is an edited transcript of a live webchat with Andrew Lansley on 24 February 2009
AndrewLansley Hi, thank you for inviting me to join you today. I've been looking forward to our discussion. I've been reading a lot of your questions and views already. I can see that many of you share my concerns about the needs of our maternity services.
Q. BigTeuchLittleTeuch: From my personal experience, I would like to see some flexibility in the strict admission protocol that many maternity units have. While I suspect this is a symptom of lack of space/funding, it is seriously shortsighted when women (like myself) end up labouring without pain relief and having a more traumatic birth than was necessary. It was the strict "contractions must be closer than 2-3 minutes and lasting 1 minute" rules that meant I was turned away less than 2 hours before delivery (in the early hours on a very icy night) and only returning minutes before delivery. This was my 2nd child and despite repeatedly telling anyone who would listen that my contractions never regulated and never lasted more than 45-55 seconds NOBODY LISTENED. I was reluctantly readmitted, they refused to give me even gas and air, as I would 'need it later' apparently, and were reluctant to examine me. I know all of the justification for this approach, but surely listening to the woman would be top of the list? I gave birth a few minutes after I requested an examination. Rant over!
Q. SnowlightMcKenzie: In my area, women are guilted, blackmailed and turned away from their choice of birth place very regularly. Do the Tories support the right of women to birth at home? Do the Tories support the training of MW to feel confident and competent with home births? Do the Tories acknowledge that home births generally require less medical intervention and therefore would cost the NHS less overall if it were normalised, even with aditional midwives? As an aside, but extremely important with regards to maternity provision, there is currently a ridiculous drive to encourage women to breastfeed, but lack of support and help if a woman hits problems, resulting in many women experiencing misery for weeks and then guilt when giving up, or worse a dehydrated newborn (current news). Do you have any plans to address this?
A. AndrewLansley: You raised an important question about the right of women to give birth at home. One of my key aims for the NHS is to make it more centred on the needs of patients by making sure that the service is geared towards actually listening to their wishes. That means that women should be able to choose a home birth if they want it, and should know that they will be properly supported in giving birth at home. It does mean support for midwives too. In the Netherlands, where one-third of all births take place at home, there are three levels of support.
1. Maternity care assistants
2. Kraamszorg workers who support mothers at home
3. A consultant-led maternity unit within 30 minutes
I think BigTeuchLittleTeuch touched on this when she shared her story. In that situation, what was needed was for someone to actually take the time to listen to the mother. It is about empowering mothers with the right information and resources to make a choice about what's the best option for them and their baby. One way of doing this is to encourage more community-based midwifery teams who can provide continuity of care for mothers, and support home births.
Q. Maiakins: Hi, about home births and the Netherlands experience. In the Netherlands, one of the reasons they have a high number of home births is that the compulsory medical insurance system in the Netherlands (their equivalent to the NHS) does not cover the full cost of having a baby in hospital unless this is necessary for medical reasons. So, can you reassure us that the Conservatives won't move to a system whereby we have to pay any money to give birth in hospital if we want to (ie if there is no medical reason)?
A. AndrewLansley: Yes, I can assure you that the Conservatives are committed to an NHS free at the point of use, based on need and not ability to pay. This, of course, covers NHS maternity services.
Q. Quattrocento: There is a closely related issue, which I am not sure if Andrew Lansley is aware of, which is of women being taken into maternity units but not being assigned delivery rooms. This means they have to lie in antenatal delivery wards, which are in public, to do their labouring - a pretty shitty environment when all you want is a bit of privacy. Also some antenatal delivery wards (mine) are not fitted with gas and air. So imagine that level of physical pain being endured in public without any pain relief. In my case, this went on for eight hours. That's what happens when the units want to avoid the bad publicity of closure. Vile way to treat women, IMO.
A. AndrewLansley: Quattrocento, you asked if I was aware of the practice of women being taken into maternity units but not being assigned delivery rooms. First, let me say how sorry I am to hear about your experience; it sounds very distressing. Sadly, yours isn't the only story that I've heard about women being denied privacy and dignity in childbirth. I feel really strongly about this. Privacy and dignity should be basic rights for any mother. We have promised to provide new mothers with privacy and dignity during and after childbirth, by guaranteeing every women who wants one a single room in hospital. This pledge will be delivered as part of our plans to provide 45,000 more single rooms in the NHS.
Q. StripeyKnickersSpottySocks: Do single rooms include postnatal room as well? Just wondering how the hospital where I work will achieve this as we're on the third floor, take up the whole of the third floor and can't extend. Will we have to move to a new building? The expense will be huge!
A. AndrewLansley: Yes, I do mean postnatal as well, although choice should mean a single room for those mothers who want it - not everyone does. I know some units are constrained physically, but we have to look at how to accommodate expansion and higher standards, for example, by developing midwife-led units alongside an obstetric service.
Q. BoffinMum: Please could we have a view on what the Tories plan to do about independent midwifery? In some parts of the country the only way of being sure you can get a midwife when you need one is to actually hire your own, yet they are on the brink of being outlawed by the current administration because of the unavailability of indemnity insurance. Apparently, this situation rose because of a negligent private dental surgeon, and had nothing to do with poor midwifery practice and associated increased risk. Midwifery is, after all, one of the most closely regulated professions in the UK and many independent midwives work as NHS bank midwives concurrently with running their private practice, so are highly professional. Perhaps if a voucher system existed for midwifery care, women could vote with their feet and receive the care they deserved, instead of being herded like heifers into overstrained and inadequate maternity departments. We could probably save the cost of many caesarians as well.
A. AndrewLansley: BoffinMum, we have worked with independent midwives to tackle this problem. Independent practitioners should have access to indemnity insurance, but there is a major cost involved.
Q. BoffinMum: Thanks for responses, Andrew. There is a thread on MN at the moment which argues that high-risk mothers are being deprived of things like active birthing as a direct consequence of heavy investment in the Midwife-Led Birthing Units, even though there are no medical grounds for doing so. In other words, if you are diabetic or whatever, you are doomed to a passive birth and subsequent obstetric intervention for no good reason, whereas 'normal' women get mood lighting, birthing balls and a cosier environment. I am wondering if again, some sort of maternity services voucher system would help women vote with their feet. Are the Tories anti-vouchers?
A. AndrewLansley: Boffinmum, you mentioned Midwife-Led Birthing Units. These units are included in our data; we need to see how more mothers can have a 'home from home' birth.
Q. bizibee: Accommodation is short, but what women need is a midwife of their own in labour. If the Conservatives made this a manifesto pledge I think almost every woman of child bearing age would vote for them!
A. AndrewLansley: Yes, I agree. The Government promised one-to-one midwifery care but have failed to deliver it. Mothers should have the option and that's what matters.
Q. bizibee: Managers who change posts every three years and who are bound by strict financial targets will NEVER invest in quality. Neither will they have the balls to make courageous changes that could enhance real choice. Targets lead to bean counting and no emphasis on quality. The hospital/community divide fragments maternity care, making things like achieving breastfeeding rates we would like impossible. Have one-to-one midwifery care underpinned by the Clinical Negligence Scheme for Trusts and it would happen almost overnight. CNST has been effective in improving outcomes in those areas where it has produced a standard that trusts have to meet. As a recent mother and NHS worker I can see that small improvements in basic standards of care will enhance the experience for every mother, but this is a quality issue so not valued by managers striving to meet the budget. Good luck.
A. AndrewLansley: Thanks Bizibee, there are some things I wish to highlight. One is our intention to introduce universal and more intensive health visiting in the first weeks after birth, helping to get every family on the right track. This would help with everything from breastfeeding to family health and relationships - not least, working with father and the family to establish how a newly expanded family works.
bizibee: If you put one-to-one care in labour as a manifesto promise I would vote Conservative for the first time in my life. Promise!
Q. Maiakins: I agree with the women who have made the point about maternity wards temporarily closing being the tip of the iceberg when it comes to overstretched maternity wards. Many more hospitals do not close their doors, but let the women give birth in corridors, in waiting rooms, in any available space really. Several of my friends have given birth in the corridor of our local hospital as there were no beds available, with no access to pain relief and in full view of people walking up and down the corridor. It really is unacceptable in 21st-century Britain and this dimension of the maternity crisis should be considered alongside the issue of hospitals shutting their doors. Do the Conservatives agree that this related issue should also be addressed?
A. AndrewLansley: Yes, Maiakins, I do understand. Closed wards in some maternity units are also part of the problem. Closing units to mothers is the tip of the iceberg. We need to recruit more midwives, but we also need to ensure that the hospitals are given the right 'tariff' (ie the payment they get for providing services) to support maternity. The money they are paid should accurately reflect the costs and the level of standards we need.
Q. wasuup3000: Do you think the government needs to review its services to pregnant woman? Trouble is, will a review do any good or just be filled of hot air and money thrown at the problem? The main difficulty seems to be a baby boom and lack of midwives and by the time any review policies would make any difference in five or 10 years time the baby boom and midwife shortage difficulty may not exist anyway.
A. AndrewLansley: I agree, that the NHS is suffering from 'review fatigue'. The issues now are less about analysis and more about delivering (forgive the pun!). We have known for five years that the birth rate is rising. The number of midwives has simply not increased in line with this. We have to encourage midwifery training and those who wish to return to work. By giving more autonomy to midwifery teams - like the famous Albany Practice in South East London - we can give midwives more encouragement and stimulate recruitment.
Q. cmotdibbler: What do you think of a return to the domino system, where a community midwife was responsible for a woman throughout her birth and return home, no matter where that birth took place. For instance when I was born, my mother called the midwife team, someone met her at the hospital, stayed with her throughout, settled her onto the ward, and then met her when she came home - so total care. I understand that there is a team in London working in this way to the great delight of their patients
A. AndrewLansley: Yes, this is, I think, the Albany community midwifery team in Peckham, South East London. It is very important we enable midwives to act together as a team to provide the continuity of care which mothers clearly value.
cmotdibbler: But enabling them to work as a team is rather different to asking them and resourcing them to work in different ways. I, for instance, live in a rural area where the nearest maternity units are 30 minutes to regular care, an hour to SCBU level care on a good day. There is just not the density of women here to enable the kind of practice that Albany have. After all, we have a health visitor two hours a week for approx 300 sq mile GP catchment.
Q. hunkermunker: Hi Andrew, maternity services are underfunded and in many areas woefully inadequate. There are many decent, hardworking professionals in the service and it's often only their dedication that means things don't go wrong more often. One of the enormous issues is breastfeeding support and the conflicting messages that women get whilst pregnant and as new mothers. Health professionals are often poorly trained, have no idea how to support a woman to start to breastfeed or what to do if she hits problems. All too often the 'answer' is "here's a bottle". And then there's guilt. I'd be interested to hear your thoughts on breastfeeding support. And not just "oh, yes, there should be some" but what you'd do to increase it. Do you, for instance, support the ban on ALL formula advertising, which would make it far easier for eg parenting magazines to run better articles because they're not worried about upsetting their advertisers? How about infant formula advertising to health professionals? Why is that still allowed?
Q. SnowlightMcKenzie: Erm, what Hunkermumker said. Yes all of it!
A. AndrewLansley: On breastfeeding, which many of you raised, the discussions that went back and forth on were really interesting. There are clearly different views; I do believe that 'breast is best' for babies (although I know that isn't your favourite phrase Bluemary3000!) but it seems to me that the most important thing for government to do is empower women with the freedom and information to make the best choice. I think nannying and lecturing mothers about this is likely to be counter-productive. Providing information, examples, positive peer support and supportive role models will all help mums to make the decision that's best for them and their baby. Specifically, I do think that Government should be working with employers and businesses to tackle any stigma that surrounds breastfeeding. We have to encourage them to support mothers in their choice.
Q. ScottishMummy: Newly qualified highly trained healthcare graduates cannot find training posts eg medicine, nursing, allied health professionals. MTAS was a well documented disaster, and healthcare graduates are unemployed. Graduate entry level posts are over subscribed. This is a real waste of talent for graduates who have pursued vocational training and want to work for NHS.
A. AndrewLansley: Yes. It was a scandal in 2006 when newly qualified midwives couldn't find posts. Now we have unfilled vacancies. We need our nursing and midwifery education and training to be more consistently related to workforce plans. Unfortunately, it took several years before the Government woke up to the fact that the birth rate was rising after 2001.
Q. ScottishMummy: The NHS Next Stage Review - the Darzi Review - has recommended many changes to NHS manangement and the role and involvement of clinical staff, to boost staff input, staff influence at policies and procedures level. Concerns about PCT and foundation trust ability to achieve these aims have been raised by the Commons health select committee. Will PCT and trusts be compelled to accept the Darzi Review recommendations?
A. AndrewLansley: The Darzi Review contains of lot of good material about the kind of services we want. It is less clear about how it is to be delivered. Emphasising quality is right, but setting up a National Quality Board isn't enough. Quality comes from professional staff, empowered and equipped to provide the care, properly accountable to the public for the services they provide, responsive to choice, and accountable for outcomes.
AndrewLansley: Thanks for all your questions and input. Sorry I haven't been able to answer all of them in the time we've had available. But, HerBeatitudeLittleBella, you urged me to 'read and learn' and I certainly have learnt from all your stories and comments. The figures that I published about mothers being turned away from maternity wards were shocking in themselves, with an increase in closures from 400 in 2007 to 550 last year.
But hearing your stories has brought home to me the fact that every one of those numbers tells an awful story about mothers being turned away from hospital at a hugely emotional time. I've enjoyed our discussion and there's lots of issues here for me to look at further.
BoffinMum: Thank you for coming on, Andrew. You have responded to more questions than I thought you would be able to in the time, and it has been really helpful.