Health Bill [HL]

I will speak as briefly as I can in support of the thrust of Amendment 58 in the name of the noble Baroness, Lady Cumberlege. In doing so, I declare an interest as a trustee of the Michael Sieff Foundation, a child welfare organisation, and as a trustee of TACT, the Adolescent and Children’s Trust, a foster care organisation. I declare that interest because it is so important for a child’s welfare that there is a secure attachment between mother and child, which must be protected. We must protect a good start. Good maternity services must protect children later on, perhaps from family breakdown and dysfunction and being lost into care, so I strongly support the thrust of what the noble Baroness, the noble Lord, Lord Patel, and others have said about the importance of continuity of care for mothers. I visited the Albany midwife service in south London, which operates a caseload midwifery model and is similar to the independent midwives to which the noble Baroness referred. The midwives get to know the parents several months prior to the birth, providing the induction and pre-natal sessions. One midwife will work with a family until the birth of the child. She will carry a pager and, ideally, often will help at the birth, at which we found there were fewer interventions. Although this service takes place in a deprived area, it does not focus on those people who are most excluded. It was found that breast-feeding was far more prolonged and widespread, which is a positive indicator of the welfare of the child, both physically and emotionally in terms of the bond between the child and the mother. I welcome the thrust of that proposal. When sitting in on a maternity meeting run by the noble Baroness, I remember being distressed on hearing a mother describe giving birth in a hospital. She said that the midwives changed and that she was left alone for long periods after a difficult pregnancy. From the other side, I can see that it is important to have choice. My concern is that this new model might disadvantage those who are less aware of the new options being offered to them. There is a danger of reinforcing social exclusion because the most intelligent and proactive people will seek out independent midwives. I would appreciate reassurance that there will be a means to ensure that women from ethnic minorities who perhaps have not had the benefit of a good education will not be left in the lurch. Should many mothers opt for independent services, what impact would that have on caseload midwifery? I am not sure that I have explained that clearly, but I hope that I have. On the first day in Committee, I welcomed the reminder from the Minister that the constitution document puts great emphasis on support staff and on ensuring that they have a right to support. I take the point made by midwives about how often they work in departments where they do not get the support or supervision that they need. I am very grateful to the Minister for reminding me of the priority that the NHS document puts on supporting staff.