PARLIAMENTARY DEBATE
Maternity Services: Gloucestershire - 9 October 2024 (Commons/Westminster Hall)

I beg to move,

That this House has considered maternity services in Gloucestershire.

It is a pleasure to serve under your chairmanship, Sir Christopher. The hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown) sends his apologies; he was due to be here but he is counting the votes somewhere else at the moment in an important internal election. He wanted me to start by saying that he gives his full support to the comments that I and others will make in support of maternity services in Gloucestershire, so I hope Hansard reflects that.

It is not controversial to say that NHS services across the country are struggling. One of the services that impacts all of us at least once in our lives is maternity care. This service is at the heart of women’s healthcare; it must be treated with the utmost seriousness. Pregnancy and childbirth is a special moment for families. It is a memory I cherish—obviously I was not pregnant myself. It is something to be cherished by all. But for pregnant women it can also be an extremely stressful experience. If there are failures in the system, the consequences can be dire.

Some of those consequences were laid bare in the recent “Panorama” documentary on maternity services in Gloucestershire. In that documentary we heard too many harrowing stories. Brave whistleblowers from within the system and brave mothers told their stories—one brave father told a story too. Those stories were told in the most heartbreaking terms, and will stick with me for as long as I live. Gloucestershire Hospitals NHS foundation trust apologised for those failings. It has invested in increased staffing, worked to reduce staff turnover and has made changes to leadership in maternity care. But so much more needs to be done.

The service at Gloucestershire Royal hospital was rated inadequate in 2022 and again in 2023. The findings of a further inspection earlier this year are still awaited, but a section 31 safety enforcement notice was served in May. Cheltenham’s midwife-led Aveta birth unit serves a large chunk of our county. It was closed for births in autumn 2022, some time before six of our county’s seven Members of Parliament were elected. The closure was due to a shortage of midwives. The reorganisation by the hospital’s trust was carried out to ensure that one-to-one care across Gloucestershire’s wider maternity services could be achieved. It is an entirely understandable response; nobody would want to put mothers and babies at risk.

We were told, however, that the measures were temporary. Two years down the line they are still in place, and that is not an acceptable situation for people in our county. The NHS hospital trust suggests that the Cheltenham Aveta centre will not re-open for births before April 2025. Even then, nothing seems certain. The trust states that it is committed to reopening the centre when it is safe to do so. However, the byzantine way in which the NHS sometimes works means that it is difficult to work out who will be the ultimate decision maker. Sometimes decisions on resources are made by the integrated care board rather than hospital trust staff, and that collaborative process makes it difficult to work out who must be held to account for statements that have been made in the past.

I commend the hon. Gentleman on securing this debate. Everyone in this room will be very aware that the difficulties in Gloucestershire are unfortunately replicated in every part of the United Kingdom—certainly in my part of it. We have some of the best staff in the world in our maternity wards, and we rightly recognise the good work that they do, but they are being hampered in doing their job and caring by understaffing, budgetary restraints and an inability to get support from senior staff. I believe this needs a root-and-branch change across all the United Kingdom. Would the hon. Gentleman agree with that?

I would. The hon. Member makes a strong case, and I will come on to some of the evidence from the Royal College of Midwives later. It has done some important studies into the stress that midwives are put under in the system.

I will move on to Stroud—the hon. Member for Stroud (Dr Opher) is in his place. In Stroud, six post-natal beds were closed around the same time as the closure to new births at the Cheltenham Aveta centre. The reason given by the trust was that the temporary closure would consolidate staffing across the county and provide a safer level of care for births across the whole of Gloucestershire. I am certain the hon. Member will have more to say on this if he is called to speak later, and I am pleased to see him here.

In our county, the 6,000 families who rely on our maternity services each year view this as a significant downgrade in service, and it is a cause of worry for a large number of families. It is clear that these services can only reopen when staffing levels improve. At the moment, the trust says it is around 13% below the staffing level required to return to the previous level of service, with Cheltenham open and the beds reopened in Stroud. However, the nature of midwifery means that quite a lot of the midwives will be off on maternity leave themselves at any one time. Indeed, I will come on to talk about the stress that midwives are under and some of its causes, which have led to a larger proportion of midwives being off for a significant period of time each year than staff in the rest of the NHS.

Research into what is driving the recruitment and retention crisis exposes the scale of the challenge we face in Gloucestershire and across the rest of the country. We are told that recruiting to a trust under a section 31 safety notice is even more challenging than it is elsewhere. Midwives who are already under significant pressure are subjected to additional strains in the form of monitoring and bureaucracy, and that can have an impact on staff morale. Of course, monitoring and bureaucracy are important when we are trying to get trusts out of safety notices; however, we cannot look past the fact that that makes it more difficult to overcome those recruitment challenges.

If that were the only barrier, it would be somewhat simpler. The Royal College of Midwives conducted a randomised survey of weekly hours worked by midwives and maternity support workers. The findings were absolutely shocking. It found that the staff surveyed reported a collective total of nearly 120,000 unpaid hours that week. That is a stark illustration of the demands placed on frontline NHS staff, who go above and beyond in a system that appears to be falling apart at the seams.

It is no wonder that the Darzi review reports that there is a high rate of sickness absence among midwives at 21.5 days a year per midwife. The most common reasons cited for absence were anxiety, stress or depression, or other psychiatric illnesses. Midwives go into the profession because of a commitment to the health of women and babies and to giving care at a critical moment, and to be part of a joyful moment in so many families’ lives. The fact that they are collectively suffering such high levels of stress tells us just how badly wrong the system has gone.

As the Liberal Democrat spokesperson on mental health, I believe we should acknowledge and pay tribute to NHS staff in general and specifically midwives because we know that one factor that causes stress is overwork. We are also aware that the NHS very much runs on good will—people working extra hours and unpaid hours. That has been the norm for many years, but it is not sustainable. We need to acknowledge the support they need from a mental health point of view.

My hon. Friend makes a strong point. Employee assistance schemes have a strong role to play here. I understand that in the NHS there is quite good support in general. However, it is a massive struggle when people are working so many extra hours to ensure that they get the support they need. In the case of midwifery, it is a stressful job—a life-and-death matter in many circumstances.

There is a clear and obvious link between the extreme overwork identified in the RCN survey and the findings of the Care Quality Commission. Obviously, if staff are working so many extra hours, they will suffer. Gloucestershire Hospitals NHS Foundation Trust has identified staff turnover levels and low morale due to the workload as significant factors. The Darzi report also calls for a shift away from care in centralised hospital settings towards communities, and states that that is a likely route towards the recovery of our health services. That being the case, and with a Minister in the room, I say that there is a clear argument for restoring Cheltenham families’ access to a fully functioning birth unit in our town as soon as it is safe to do so.

I have three questions for the Minister, if she would be so kind as to answer them. First, what is the Government’s position on seeking to reinstate maternity services in places such as Cheltenham and Stroud, which have been recently downgraded? Secondly, what will the Government do to address the ongoing recruitment and retention crisis in midwifery? Thirdly, in cases such as Gloucestershire’s, where a section 31 notice is exacerbating recruitment and retention issues, what can the Government do to help local trusts improve their staffing position? I understand that there are examples of trusts around the country being supported to pay high wages and salaries to ensure that midwives can be properly recruited and to overcome shortages.

My local hospital, the Royal Berkshire hospital, is where my two children were born and many of our friends’ children were born. It has recently received an upgraded rating of good from the Care Quality Commission, and it is one of only nine organisations, out of 131, that got an upgrade to good over the last year, so I commend the Royal Berkshire leadership and staff for their diligence and dedication, and congratulate them on that result. Does my hon. Friend agree—

Order. Interventions should be short. If the hon. Gentleman wishes to make a speech, he can do so later. Let us hear the response to the intervention.

I am sure that I would agree with whatever my hon. Friend was about to say. He was making the point, I think, that it is easy to be down on our NHS and its staff. That is not the purpose of this debate at all; its purpose is to ensure that we give the support that is needed to our midwives, other NHS staff and, indeed, NHS managers, who are often maligned but, like other NHS staff, work long hours and are in it for the betterment of health services.

On a personal note, I offer my wholehearted thanks to the staff at Gloucestershire hospitals, who were there for my wife and me when our daughter was born in Gloucestershire Royal hospital in 2022. It was an important day for my family and for the country when we went into the operating theatre for the C-section: this country had no Prime Minister, and when we came out we had my daughter, Elodie, and we had Liz Truss. That is a memory that will live long for me. I particularly thank Fiona Liddle, the midwife who gave us the most care during my wife’s pregnancy, as well as all the doctors, nurses and healthcare workers who helped to make the experience so joyful for us.

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Cheltenham (Max Wilkinson) on securing the debate and bringing attention to the challenges that our maternity services face in Gloucestershire. I must declare that as well as being an important subject for my constituents, this is a personal subject for me, and I am privileged to contribute my family’s experience to the debate today.

My little boy, who turns one later this month, was born in the county and spent his first night at Gloucestershire Royal hospital. While it is clear that there are challenges facing our maternity services and that improvements are required, I want to start by sharing the positives of our experience.

First, the support and care provided by the community midwifery team was second to none. Our midwife Lynsey was with us throughout our journey, and was even on call the day my wife went into labour, so she was there to deliver our little boy. Lynsey looked after us throughout my wife’s pregnancy, answering our questions and signposting us to courses that would enable us to become advocates for the birth we wanted. From the outset, our experience was positive, although I know that is not the case for all families, and it is essential that their voices are heard in this debate.

Being able to choose where you have your baby is important. Having conducted our own research, we decided that we wanted to give birth in a midwife-led unit. There are of course differing views on that, but that was our choice as we had read that midwife-led care can lead to fewer interventions. At the time in Gloucestershire, Stroud was the only reliable option, as Gloucester’s midwife-led suite was frequently closed due to a lack of available midwives. As part of our maternity care, we were invited to Stroud maternity unit to visit the birthing suite so that it was familiar on the big day. I understand that is very important, as stress produces hormones that can actually stop or slow down labour.

Once my wife was in labour, however, our plans were nearly changed at the last minute due to a lack of midwives at Stroud maternity unit—stress we could have rather done without. That highlighted to me the great reliance currently placed on midwives working overtime to cover shifts across Gloucestershire. However, with Lynsey on hand and with minimal intervention, the birth itself was relatively quick and our baby boy was born. It was truly the best moment of my life.

Unfortunately, my wife needed an operation after the birth, so we were transferred to Gloucestershire Royal hospital: wife and baby in an ambulance, me following behind on what was, following the best moment of my life, the scariest car journey of my life. The care we received that night was exceptional. Not only were my wife and baby looked after, the unbelievably compassionate team looked after me too. Something as simple as a cup of tea and a reassuring chat when I had been up for 48 hours and left on my own with a newborn baby was transformative.

Unfortunately, things were not so positive the following morning. All was well with mum and baby, and we were told we would be going home in the afternoon. I went home to grab a quick shower, get some shopping in and make sure the house was ready for our new arrival. I was gone for at most two hours. When I got back, my wife told me she had been visited by over 10 different people in those two hours: pharmacy assistants, nurses and midwives, each adding new information about her discharge. She had just had a baby and undergone surgery under general anaesthetic. There were instructions for her and our baby. None of them were written down. For her, it was overwhelming, and something as simple as written discharge notes would have made a huge difference.

After we got home, our baby unfortunately developed some issues with his breathing. That can be quite normal, I understand, as babies are used to breathing fluid and getting oxygen via the umbilical cord. But as first-time parents who had been awake for 60 hours, we were worried, and there was no one to turn to. We phoned Stroud maternity unit, where we had given birth, but their post-natal unit is closed due to a lack of midwives, as the hon. Member for Cheltenham rightly pointed out. They advised us to call 111, and they told us we had to call Gloucestershire Royal’s delivery unit. They told us we had to call Stroud maternity unit because that is where we had given birth. We went back to Stroud, then back to 111, and no out-of-hours GP service was available. The only solution was to go to A&E.

Taking a newborn baby to A&E on a Saturday night is an interesting experience. The staff in A&E were wonderfully friendly, but their procedures limited what they could do. Our baby could not be seen by the neonatal unit as we had been discharged from the hospital. He would have to go to the paediatric unit, which the staff warned us was rife with covid. All we wanted was someone medically qualified to listen to his chest and let us know he was alright. There must be so many parents in a similar position, learning the art of being a parent for the first time and needing that little bit of assurance that their baby gasping for air is going to be okay. We need to find a better way for those parents to access that care.

Overall, I have to say a huge thank you to the team who looked after us from the early days of pregnancy right up until our son was born. How lucky were we to have our community midwife there at the birth—the person we had grown to know and trust? But in a way, that points to another problem: Lynsey is just one of many midwives across the county being pulled from the community to fill gaps in midwifery services.

Across Gloucestershire, vacancies and turnover rates in midwifery services remain high. The increased workload is causing low morale, and the workforce is struggling with the level and pace of change required for the service. Community midwives such as Lynsey regularly find themselves on call when too few midwives are available at midwife-led units in hospitals. Right now, there are vacancies for 32 midwives in Gloucestershire, which is 13% of the workforce. When we take into account sickness and maternity leave, that figure rises to 63 full-time equivalent vacancies. It is no wonder that midwives such as Lynsey are being asked to fill the gaps.

As the hon. Member for Cheltenham pointed out, the Royal College of Midwives estimates that across the UK, midwives give more than 100,000 hours of unpaid time to the NHS every week to ensure the safe running of services. While no one could doubt the dedication and compassion of those incredible midwives, that cannot be right. We cannot continue to rely on the commitment of midwives to their vocation to fill those gaps. If midwives are working more than 100,000 hours of unpaid overtime a week, it is inevitable that services will be affected, and that the safety of mothers and their babies will be put at risk. Midwives are being driven from the profession because the work and the pressure of work is just too much. It is no wonder my wife left hospital with no written discharge notes—where was the time left to write them?

While our experience of Gloucestershire Royal was largely positive, others have not been so fortunate. Many will have seen the harrowing instalment of “Panorama” that aired on the BBC in January this year, which focused on maternity services in Gloucestershire. The programme included the tragic deaths of the mother and two babies at the hospital between 2019 and 2021. Feedback from staff suggests that chronic staffing issues and a poor culture where midwives felt unable to speak out about unsafe conditions played a large role in what were avoidable deaths.

We also need to ensure that in a diverse city such as Gloucester, all residents—including those for whom English is a second language—can access the care they need. The recent CQC inspections of services in Gloucestershire have been very concerning, and Gloucestershire Royal hospital was issued with a section 31 enforcement notice by the CQC earlier this year. I raised this with the chief executive of the trust in my meeting with him in my first few weeks as the new MP for Gloucester. I understand that the trust has already made progress on its improvement plan, and I will keep a close eye on that on behalf of all Gloucester residents.

Earlier this year, the CQC published the national review of maternity services in England. It reviewed 141 units across the NHS and highlighted widespread issues with staffing, buildings, equipment and safety management processes. There are many deeply troubling takeaways from this report, but what stuck with me was the CQC’s stark warning that across our maternity services, preventable harm is at risk of becoming normalised. The last Conservative Government pushed our maternity services—our midwives—to the point where preventable harm could become a routine consequence of understaffing in units and on wards up and down the country. We cannot accept this for the future of maternity services in Gloucestershire or the UK.

I urge the Government to ensure that maternity services are given due attention when considering the Secretary of State’s 10-year plan for our NHS. Staff shortages are not the only issue we need to address, but it is clear that they are fundamental to the challenges our maternity services face in Gloucestershire and across the country. The Government have committed to training thousands of new midwives. We must honour that commitment to ensure that giving birth in the UK is safe, that parents have choice, and that midwives feel supported and valued for the incredible work they do.

It is an honour to serve under your chairmanship, Sir Christopher. In 2021, my daughter was delivered by caesarean section following a complicated pregnancy. Thanks to the diligence of the delivery team, which included English, Indian, Italian, South African and Spanish experts, we were spared the trauma that too many parents endure, and took our daughter home 24 hours later. I cannot thank those professionals enough for their care and application of expertise. The midwifery profession and those who join it should be celebrated in this House, as they should across the country.

I would like to provide some national context to the issue of midwifery in Gloucestershire, as my hon. Friend the Member for Cheltenham (Max Wilkinson) did. Against significant budgetary constraints in the last decade, the NHS workforce has increased by 34%, while full-time midwife posts have risen by only 7%. In that same decade, caesarean section deliveries such as ours have increased by 10% to 23%, meaning that mothers and babies stay longer in hospital, and require additional care by midwives.

As my hon. Friend mentioned, a Royal College of Midwives survey in March 2024 recorded that nationally, midwives and maternity support workers carried out 120,000 hours of unpaid work in a single week. As my ex-colleagues across the Royal Air Force will confirm, when more is continually expected of a diminishing workforce, both the workload and the mental load will increase on those who remain until ultimately they leave or they break. Mistakes become more commonplace. Let us acknowledge the unique emotional load carried by our midwives, while they also carry the workload of 2,500 others due to our national shortage.

The inspection of Gloucestershire maternity services in April 2022 makes for concerning yet predictable reading. Like the hon. Member for Gloucester (Alex McIntyre), however, I am pleased to have received assurances from the chief executive of Gloucestershire hospitals NHS foundation trust that improvements have been and continue to be made. I look forward to a full debrief on the report that will follow the external investigation into Gloucestershire maternity care; the report must be transparent, and retrospective action must take place accordingly. That backdrop creates additional pressure for Gloucestershire maternity care as we look to attract newly qualified midwives to our beautiful county. My call to graduating midwives, as to those already in post, is, “Help us get this right and be a part of the success story.”

The outcome of our efforts must be the permanent reopening of birthing units at Cheltenham and Stroud. Local efforts will take us only so far. Page 99 of Labour’s 2024 manifesto pledged to train “thousands more midwives”—a drive that will, I am sure, enjoy cross-party support. I invite the Minister to press the Chancellor to include a funded plan to train thousands more midwives in the autumn Budget.

I thank the hon. Member for Cheltenham (Max Wilkinson) for calling this debate. Maternity care in the Stroud area has been a big issue for the past couple of years in particular. I have been a GP for 30 years, and I have helped with antenatal and post-natal care and, indeed, intrapartum care for six months, which was the hardest work I have ever done in my life. I also delivered my second daughter in a Worcester hospital.

I know and have worked with fabulous midwives, who are the absolute key to maternity services, as we have been discussing. Doctors are occasionally called in for other reasons, but midwives run maternity services; they have to be central, and they have to make their decisions around women. That is one of the reasons I promote Stroud maternity unit: as my hon. Friend the Member for Gloucester (Alex McIntyre) said, midwife-based units have lower levels of intervention and better outcomes for babies.

As many hon. Members have said, the key problem here is the lack of midwives. We should not shy away from that, but I also want to talk about a number of other issues. Something that seems to have been missing from the discussion is women’s choice over where they give birth—we seem to have reduced that choice to just Gloucestershire Royal hospital. Although Stroud maternity unit is open for intrapartum care, it does not have post-natal beds, so women are generally choosing it less often. That is a pity, because it is a fantastic place to give birth and has a low intervention rate. Equity and equality also seem to have been lost from the discussion recently, and we need to get them back into the decision-making process.

Maternity care is actually a longer process than just where someone gives birth. I will outline where those interventions take place. Pre-conception and antenatal care tends to be done in GP surgeries by community midwives with the help of GPs. Intrapartum care can be done at home—a small proportion of people do give birth at home—or in midwife-led units, such as Stroud maternity, or in either midwife-led or consultant-led units, such as in Gloucester Royal and Cheltenham. They are the possibilities. When it comes to post-natal beds, the only choice at the moment is Gloucestershire Royal; there is no other option in Gloucestershire. Either mothers go there for their post-natal care or they have to go home and have a community midwife.

The last part, I always think, of the whole maternity service is the eight-week check of the baby by their GP. I have done thousands of those checks in my life, and it is one of the best things I ever do. The GP can check babies for problems and talk to mums about not sleeping and all the other issues.

That is the whole, rounded nature of maternity care. I now want to talk about Stroud maternity, because that is what I know about most and what we are missing most. First, it is a very much loved and valued service in Stroud and we are missing the six closed post-natal beds. As I have said, it is a stand-alone, midwife-led unit. That is unusual in this country, and it is a shame it is unusual, because it is a really good place to have intrapartum care, so it is something that I am really trying to promote. We have 1,000 live births in Stroud a year, and at the moment only about 300 take place at Stroud maternity unit, but as I have said, there are lower levels of intervention and there is increased maternal satisfaction. For that reason, we must get these beds open again; they have been closed since 2022.

I want to make a few points about post-natal care, because often people say, “Oh, it’s a luxury; we can’t really afford it.” It is not a luxury. There is very good evidence that for certain families, certain mothers, good post-natal care saves a huge amount of money later on. It is about making sure that the baby and the mother bond properly and that breastfeeding starts properly. It is about making sure that they have a couple of days away from, perhaps, a number of other children and properly bond and that mothers learn how to look after babies. A lot of my colleagues say, “Well, post-natal care, we don’t really need that,” but we do need it. If we lose it, it will cost the country more, but it is also part of the whole maternity service. That is the first thing I would say.

Secondly, the people at the CQC have stipulated various things. The CQC is about safety, which none of us can argue about. However, some of its decisions, I feel, do not make sense and all they do is give safety to the organisation and not to the mother. For example, postnatal beds are being closed because it insists on having two midwives on the unit at all times; that makes it safe. However, closing the post-natal beds means that all these mothers have to go home. Are they safer at home or are they safer at hospital, with maternity care assistants and other nursing staff? I would say that the safety of the mother is better served with those post-natal beds open, even if there is just an on-call midwife as a second midwife. I want to slightly question the logic of the CQC—we must go back to it—so one of the things that I will do after this debate is write to the inspectors and arrange a meeting with them, because we must consider the safety of the mother and the child first. This is not about covering the organisation and making that safe; it is about making the mother safe, so I would iterate that as well.

There is something else that we have been doing. The League of Friends at Stroud hospital in general and at the maternity hospital is fabulous and has been providing extra services for post-natal and antenatal mums for some time. We now have an interim plan whereby we are going to open a sort of day hospital in the maternity unit so that at least mothers can come and have a bath while someone else looks after their baby, for example, and they can receive advice from health visitors and midwives. That is an interim plan. I do not want to say that it is a good replacement. We must get those post-natal beds open, so I am also due to meet the maternity and neonatal voices partnership, which is a crucial agent that we must talk to.

In summary, we need to train and, crucially, retain more midwives, because we have trained quite a lot of midwives who have almost immediately left the profession, as the hon. Member for Cheltenham was saying, because of stress. We need to secure a better working arrangement for them, and I look forward to my hon. Friend the Minister outlining plans to train thousands more midwives. We need to review CQC safety and make sure that the stand-alone nature of midwife units is fully understood by the CQC. We also have to make midwife working much more flexible. There could be on-call systems for these stand-alone units, so a second midwife does not need to be present if they are available to be called in. I have talked to midwives about that, and they seem happy to run that type of service. We also need a commitment from the ICB and the Gloucestershire Hospitals NHS foundation trust to reopen all six post-natal beds at Stroud maternity hospital.

I thank my hon. Friend the Member for Cheltenham (Max Wilkinson) for securing this debate.

Although my constituency is in south Gloucestershire—which I have spent many years as a unitary councillor explaining is a unitary authority, not a district of Gloucestershire—some of my constituents access health services north of the border in Gloucestershire. The serious concerns about maternity services in Gloucestershire are causing people to travel the other way across the border, into Bristol, where many other of my constituents use services, so they have a significant impact on my constituency.

I welcome this debate because I know from my own experience the impact that overstretched maternity services can have on outcomes for the mother and baby. I had the misfortune of giving birth in a hospital that had too many simultaneous emergencies. Even now, more than 20 years later, I vividly remember the feeling of abandonment, the horror when my newborn baby was rushed to the neonatal intensive care unit, and the panic as I felt myself losing consciousness and a team of doctors rushed into the room to deal with me. It was many hours before I was reunited with my son, six months before he was discharged from consultant care, and more than two years before I was discharged. My experience of early motherhood was blighted by trauma, pain and seemingly endless follow-up appointments for both of us with a huge range of specialists. Five or more years later, doctors still considered my son’s birth relevant to his health. Sadly, for some families the outcomes are far, far worse. I cannot begin to imagine the pain of losing a child or partner in childbirth, but for some that is the tragic reality. How hard it must be to bear if there is the possibility that better care may have changed that reality.

Let us not forget the impact on the wider family. The hon. Member for Gloucester (Alex McIntyre) spoke about the support he received from staff when his son was born. The family, too, can be traumatised by what they see family members going through, so I understand how important it is to have good maternity services, and I am deeply concerned about the impact that the current shortage of midwives is having on outcomes for mothers, babies and their wider families. Stroud maternity unit is affected by the shortage, so people are choosing to travel to Southmead, which many of my constituents already use, and that extra pressure will make it harder for staff there to deliver the service that people need.

Being continuously supported by a midwife during labour can prevent a situation from escalating dangerously. Proper support after the birth, however it went, can set families up for the early months by helping mothers to recuperate, establish feeding, talk through concerns and get to know their baby in a supportive environment.

The hon. Member for Stroud (Dr Opher) made a very good point about the importance of choice. There can be a sense that it is a luxury—people make these choices because they have an idealised view of how birth should go—but, as my own experience demonstrated, the manner of the birth can have significant, long-term consequences for the mother and baby, so choice is not a luxury. It is important to understand that in childbirth feeling comfortable allows hormones to flow, and that promotes the best chances of a successful, uncomplicated birth, which is obviously the ideal. Some people take comfort in knowing that they have the very best, high-tech facilities on hand in case there is an emergency. For others, it is about knowing that they are in a familiar environment—their home or a birthing unit that they feel comfortable in. Choice is important, not because it is a nice thing for mothers to have but because it has potentially long-term consequences on the physical and mental health of the mother and baby.

I am concerned that two years after the joint report on safe staffing from the all-party parliamentary groups on baby loss and maternity, staff levels are still frequently inadequate. We want to see a cross-Government target and strategy, led by the Department of Health and Social Care, for eliminating maternal health disparities, providing guaranteed mental health support and establishing a new workforce plan, backed up with adequate funding and an expansion of the maternity and neonatal workforce.

I thank my hon. Friend the Member for Cheltenham (Max Wilkinson) for introducing this debate. The experiences that he and others have shared about maternity services in Gloucestershire are similar to those in my constituency.

In Carshalton and Wallington, the Epsom and St Helier trust has an overall good rating from CQC. However, its maternity services have recently been downgraded to requires improvement, and, more worryingly, the safety element of those services was downgraded from good to inadequate following the inspection. A critical reason for the downgrade was the state of the building, which makes it hard for staff to perform their jobs efficiently and for patients to have the comfort of quality services. Some examples highlighted in the report were that the bereavement room was not soundproofed, the ensuite facilities had a shower curtain instead of a door, and, at the time of inspection, the two operating theatres opened directly on to the delivery suite corridor and were not secured, allowing anybody using the service to gain access to potential deliveries and surgeries.

A hospital that is crumbling, where three quarters of the building is not up to standard and where infection control is tricky because of the cramped conditions, risks tragic consequences for maternity care. It is an exhausting atmosphere for staff to work in and has led to low morale. What we need is urgent investment in the hospital’s infrastructure. A new building was promised by the previous Conservative Government, but so far it has turned out to be unfunded and we are waiting to see what happens with the forthcoming review. I am due to meet the Health Secretary in the next couple of weeks, and I will make it clear that it is essential to deliver a new building for both A&E and maternity services. Preferably that site will be at St Helier, which serves a densely populated area with greater deprivation levels and higher health inequalities, which are particularly pertinent to maternity care.

The building is not the only issue; the phoneline is also an issue. I have noted other hon. Members’ remarks, and as one Member mentioned, having the ability to pick up the phone and speak to somebody to get simple advice after a baby is born is critical, and that is not functioning properly in our hospital either. Another point I wish to make, on staff retention and recruitment levels, has been well made already. Our staff, too, are hard-working, dedicated and doing their best, but they are under immense pressure, which is leaving them feeling burnt out and fatigued. The bottom line is that there are simply not enough staff members to go around.

The CQC report for the St Helier trust highlighted a shortage of midwifery staff with the necessary qualifications in lots of critical areas, and it further noted that not all staff had completed all the mandatory training. We have spoken to the chief executive officer of the trust about that, and he explained that it is not because staff are unaware of the problem, but because they are simply so stretched that getting them through those courses while trying to maintain a minimum level of care for people coming through the hospital has proved impossible. Childbirth, of course, waits for no one, and in that high pressure, life and death situation, it is a matter of working with the available staff or having no staff at all. If we can get the recruitment and training of midwives right, we can go a long way towards solving the conundrum.

The consequences of understaffed and underfunded maternity care are dire. In recent years, there has been a stark increase in maternal mortality, rising from around eight deaths per 100,000 to over 13 per 100,000. Women from lower socioeconomic and ethnic minority backgrounds are disproportionately affected, being twice and three times more likely to experience maternal mortality, respectively. Those last statistics are particularly harrowing in constituencies such as mine. It is an urban constituency, and we have a higher than average number of women from both ethnic minority backgrounds and more deprived areas.

Improving maternity care must be a key priority for this new Government as they seek to address the overall crisis in our healthcare system. Giving birth has been one of the most dangerous medical procedures for women throughout history and nobody wants to give birth in a crumbling and potentially unsafe hospital where there are not enough qualified staff to help them.

If the Government are serious about improving women’s equality and closing the gender healthcare gap, the UK’s serious decline in maternity care needs to be addressed. That is why the Liberal Democrats have called for the UK Government to ensure that the commitments made in the NHS workforce plan are backed by adequate funding and include the expansion of the wider maternity and neonatal workforce. In the meantime, I will continue to fight for the upgrade in maternity services that my area so desperately needs.

One of the biggest problems that has come up time and again in every maternity inquiry is that women are not being listened to, and too many times their concerns about their care are dismissed. That really needs to change, so we need to start prioritising the voices and experiences of women if we are serious about fixing this crisis.

I said earlier that I am the Liberal Democrat spokesperson on mental health, and I need to mention the shocking statistic that suicide is now the leading cause of death for women between six weeks and 12 months after they have given birth. World Mental Health Day 2024 is tomorrow and it is heartbreaking to think how many new mothers must be really suffering without the support they need.

We need to recognise the financial impact of this crisis. The NHS faces a £21 billion maternity negligence care bill—money that should be going into providing maternity care. When the negligence payout is three times the actual funding for the care, the system absolutely needs resources to be poured into it to ensure that we get that bill down and instead use the money to deliver safe and effective care.

In Winchester, people are particularly concerned about proposals to downgrade our consultant-led maternity services to a service that does not have consultants and surgeons on site. Unlike the hon. Member for Stroud (Dr Opher), who is a doctor, I am a vet, so I do not have his experience. However, I have done countless emergency caesareans, so I know that when something starts going wrong in childbirth, especially halfway through a birth, timing is everything. The thought of starting to give birth in Winchester but then having complications and having to be transferred up to Basingstoke is understandably concerning and terrifying for many constituents. We are therefore fighting to keep consultant-led maternity services in Winchester, because the problem in Gloucestershire arose partly because of the downgrading of services and the move to other hospitals.

The safety of maternity services is a concern nationwide, including in the Hampshire hospitals NHS foundation trust area. In 2023, the Care Quality Commission downgraded the trust’s maternity services from good to requires improvement after it found serious safety concerns. The trust’s amazing staff have been working really hard to improve things, and I am pleased to report that the trust exited the maternity safety support programme in July this year. However, there is still a long road ahead to restore public trust in these vital services.

I want to acknowledge the brilliant work of a Winchester resident who is here today. Jo Cruse launched the Delivering Better campaign, and I urge everyone here today, who will obviously have a particular interest in maternity services, to engage with and learn more from it. Jo has shared her story with me, and with her permission I will read it out:

“My daughter’s birth in October 2021 was the most terrifying experience of my life. I entered motherhood injured by a series of poor clinical decisions, and deeply traumatised by a three-day labour during which my calls for help and pain relief were repeatedly ignored or dismissed.

The experience eroded my trust in a healthcare system I have always revered, pushed my marriage to the brink, stripped me of my dignity, led me to develop suspected PTSD and many months of painful recovery. It has had a significant impact on how I feel about whether I will have more children. I cannot overstate how far the shockwaves of that experience have extended in my life.

I live with the knowledge that what happened to me was not only avoidable, but is happening every day in maternity wards across the country. This is not an issue localised to a few ailing trusts. This is a public health crisis being allowed to unfold in plain sight.”

It is a pleasure to serve under your chairmanship, Sir Christopher, and I congratulate the hon. Member for Cheltenham (Max Wilkinson) on securing this important debate. Childbirth is a really special event. It has been described today as the best moment of someone’s life, and that description is often used. It is a special moment in the lives of not just the parents and of course the child, but the wider family and friendship group—the birth of a baby is enjoyed by everybody.

I have been privileged to attend many births over my career as a doctor, although aside from the births of my own three children, they have generally been skewed towards where things have not been going to plan—it is not, I hasten to add, that that is a result of my presence, but more that my presence is a result of things not going to plan. The work of the NHS—its midwives, its obstetricians and the wider team that look after women and their babies—is by and large exceptional. However, we hear stories of where things go wrong and we need to minimise those as much as possible.

Essentially, the talk of whether Cheltenham needs a midwifery centre comes back to the pull and tug that I have seen throughout my career between the centralisation and the localisation of services in general. When services are centralised, it can be argued that there is an increase in expertise and an increased volume of cases, which makes people more familiar with emergencies because they happen more frequently. More specialist services can also be offered for those with high-complexity and low-volume problems. There can also be more support from staff, because there are more staff present in the unit. However, centralised services can feel more remote, they can be too far away for people living in rural areas and they can feel too impersonal, particularly for a procedure such as giving birth. In a local unit, people may feel more comfortable and know the staff, and there may be a close-knit team. However, as our veterinary colleague, the hon. Member for Winchester (Dr Chambers), so amply described, if things go wrong, people can be a long way from the help they need. So there is that balance and that push and tug.

As has been mentioned, choice is important to women who are making informed consent choices on where to give birth, based on the information they receive. The hon. Member for Cheltenham has made a good case for why the balance may not be as it ought to be in Gloucestershire; the Government should look carefully at that.

I was sorry to hear of the experience of the hon. Member for Gloucester (Alex McIntyre) with his new-born baby. As a paediatrician, I am familiar with the need to weigh all the factors in the balance: the fact that a baby has gone home and may have picked up a viral illness that has brought them back in again; the risk to the baby from going on a children’s ward where the impact of disease is more predominantly based in infection and infectious conditions than in older age groups and adult wards; and the risk of putting a baby on a neonatal unit and introducing the virus to that unit, which could make the babies already there so very unwell. We need to think carefully about a solution to that, so that people do not go round and round in circles, as the hon. Member for Gloucester described, being passed from pillar to post. I am sure that was a frightening experience for him and I am sorry that happened.

I now turn to other issues raised today. The hon. Member for Stroud (Dr Opher) talked about the importance of community midwives. Even though my eldest is now 17 and my youngest nine, I still remember my post-natal midwife Marie and the care she gave. Sometimes, maternity care focuses a little too much on what is going on in a hospital when what happens in the community is also very important.

The hon. Member for Thornbury and Yate (Claire Young) suggested that we could have a midwifery in-patient unit with mothers and babies and only one member of staff. I am afraid I do not agree with her on that. The hon. Member for Winchester raised the concept of two simultaneous emergencies. If there is only one member of staff, how do they go on a break, or what if they are in the bathroom when they are needed? If we have a unit, unless it is attached to a major centre with more staff, we need that second person.

As of December 2023, there were 2,361 full-time equivalent midwives working in the NHS’s trusts and other core organisations in England. That is an increase of 3,707—18.9%—since 2010. On the one hand, the birth rate is falling and the number of midwives is rising, but I recognise that the births that are taking place are more complex in some ways than they used to be. At the spring Budget, there was a further investment of £35 million to improve maternity safety over the next three years, including £9 million for brain injury.

I asked the Minister, at the previous debate on maternity safety on 4 September, whether she would commit to that money being spent and I have not received an answer. I asked her several questions during that debate, including whether she could confirm that the Government would proceed with the fortification of bread products with folic acid to protect babies from spina bifida. I asked her about the non-essential communications budget, which the Chancellor had said on 29 July would essentially be cut, and whether that was affecting public health budgets. Those budgets are very important, particularly around optimising public health messaging regarding chronic illness and conditions such as diabetes and obesity before conception. I have not received an answer to either of those questions.

I also raised the NHS saving babies’ lives care bundle, which was due to be updated on maternity early warning scores and tracking tools, to ask the Minister whether that was on track. Again, she has not written to me as promised with the answer to that question. I asked her whether she would be supporting the healthcare safety investigations branch and about the £35 million budget I have just described. I have not received answers to any of those questions more than a month later; none of my staff can find any correspondence from the Minister. Can she answer those questions today, or at least commit to doing so by the end of the week? We have waited quite a long time.

My final question last time was about the group overseeing maternity services nationwide, because following the East Kent report—I was the Minister when that was published—Dr Kirkup’s recommendations were accepted. Maria Caulfield, then Minister for Women’s Health, set up and chaired a working group to review the work being carried out by a whole range of programmes to improve maternity and neonatal care and implement those recommendations. I asked her who would go on to chair the group and whether she could guarantee that the work would continue, but I still have not received an answer. It would be helpful for the Minister to answer the questions raised in the last debate as well as in today’s.

It is a pleasure to serve under your chairmanship, Sir Christopher.

With your leave, I will start with a few words to mark Baby Loss Awareness Week. Many mums and dads across the country have suffered the heartbreak of losing a baby. Everyone deals with grief in a different way, but it has been moving to hear from parents how baby loss certificates have allowed them to process what they have gone through and have helped give them closure.

That is why this week we launched an extension to the baby loss certificate service, which is a voluntary scheme to enable parents who have experienced a pregnancy loss to record and receive a certificate to provide recognition of their loss, should they wish. Until now the service was only open to parents who had experienced a loss since 1 September 2018, but today we are removing that restriction, making the certificates available for every parent who has lost a child. We will update the House with a formal written statement shortly. The Government are committed to delivering compassionate care for women and support for parents who have suffered a baby loss. It is the right thing to do.

I think this has been a genuinely good debate. We have heard from experts—I commend the Opposition spokesperson the hon. Member for Sleaford and North Hykeham (Dr Johnson) and my hon. Friend the Member for Stroud (Dr Opher) for the work they do—and others have shared experiences. I knew that the hon. Member for Cheltenham (Max Wilkinson) would bring forward good points too, so I contacted the trust myself so that I could give the hon. Gentleman and hon. Members present my frank assessment of what is happening on the ground.

To reiterate, as of August 2024 the midwifery vacancy rate in the Gloucestershire hospitals NHS foundation trust stood at 13%—the equivalent of 32 full-time midwives. That level is high for the south-west, though roughly in line with the national average. In April 2022, the Care Quality Commission gave the trust a warning notice for the maternity service, and rated it “inadequate” a year later. In May this year, the CQC issued the section 31 notice—a severe warning that requires at minimum an immediate action and improvement plan, which, as colleagues will know, in some other settings could result in a closure. It issued that after seeing postpartum haemorrhage rates, poor foetal monitoring and high levels of agency staffing.

The hon. Member for Cheltenham and others from the area are right to be concerned. We can all agree that it is unacceptable when new mothers do not receive the highest possible standard of care. As my right hon. Friend the Secretary of State has said, we should be honest about the problems in our NHS and serious about fixing them. Maternity services are very far from where we want them to be. Childbirth should not be something that women fear or look back on with trauma. Safety is obviously paramount. As the hon. Member for Cheltenham said, it should be a special moment.

I thank the hon. Member for Thornbury and Yate (Claire Young) for sharing her experiences. I was in hospital for two weeks after having my first child, and it is a traumatic time, so the length of time she mentioned must have been very difficult. My second came out so quickly that I was in and out of hospital before we knew it. My third child, as has been mentioned, was almost delivered at home by my husband after we had chosen a home birth. He is not medically qualified, so I can tell you that the sound of the doorbell ringing for the midwives’ arrival was the best sound I have heard in my life.

To the second question asked by the hon. Member for Cheltenham, I will outline the steps the trust is taking to improve the situation. They include a new director of midwifery, an education and training midwife and a perinatal quality and governance lead. To improve retention, the new leadership has introduced a retire and return scheme and is holding monthly events for senior leadership to listen to staff and address their concerns. The trust has recruited 33 new midwifery starters since 2023, including from overseas. Ten midwives are due to start this month, with a further 10 expected in January. But there is still a gap. That is why the Aveta birthing unit and the postnatal beds at Stroud maternity will remain temporarily closed until they reach safe levels of staffing. The trust clearly felt that it could not continue those services without putting new mothers at risk, which is an impossible situation to be in.

I am pleased that the birthing unit at Stroud remains open, but the other closures have had an impact on women, their families and the local community, as has been eloquently expressed by my hon. Friend the Member for Gloucester and mentioned by my hon. Friend the Member for Thornbury and Yate. The impact goes further afield to my own city of Bristol. In addition to those measures, the trust is developing new apprenticeship schemes; building partnerships with universities, including Worcester and Oxford Brookes; and launching a midwifery attraction campaign in the autumn.

Although the trust has had positive feedback from last year’s new starters, I am pleased that it is carrying out regular assessments, as per the recommendations in the Ockenden review, to ensure that midwives have the right skills to serve the people of Gloucestershire. The turnover rate is now settling, and I know the hon. Member for Cheltenham and other colleagues will do everything they can to help convince midwives that his county is a great place to live and work. The passion for those units is very evident here today, which I am sure will be welcome to those trusts.

I know from my career in the NHS that such changes take a long time. It is too soon to make an assessment until all the new midwives have started. However, we are not waiting for the CQC to do the rounds to ensure that the picture is improving. The local maternity and neonatal systems team and the regional NHS England team are meeting with the trust on a fortnightly basis to review progress. The trust’s monthly board reports will report on progress; I know hon. Members will be watching carefully.

It is important to give the new team space to prove themselves. I am hopeful that we will see improvements in time. At a national level, whenever trusts and maternity units do not perform on our watch, we will steer them back to safer ground. That is why we are supporting Gloucestershire maternity services through the national maternity safety support programme. That means that the trust is supported by a maternity improvement adviser for midwifery and obstetrics, who helps the trust to embed the maternity improvement plan.

I know that the hon. Member for Cheltenham and others will continue to hold the trust to account, until it is delivering for women in their constituencies. I am grateful to him for obtaining this debate and giving me the chance to put the Government’s position on the record. With regard to his third question, like many trusts in this position, the trust does have the budget for establishment; it is the recruitment and retention of midwives that is the issue. Some trusts do different things with incentives; I do not know whether this trust is particularly doing that. That might be something he would wish to pick up with the trust at another time.

On more general maternity improvements, in September the CQC published a report that demonstrated how much the previous Government let down new mothers in this country. Lord Darzi’s report has shown that, despite some improvements, there is still a disgraceful inequality of outcomes for black and minority ethnic women, as we have heard again today. We will look at every recommendation in the CQC report, and if officials object to any of them, I expect to hear a very good reason why.

There is ongoing work to improve maternity and neonatal services across England. The NHS put in place a three-year delivery plan to make maternity and neonatal care safer, fairer and more tailored to every new mother’s needs.

I shall now discuss the Government’s wider ambition. Choice—which was mentioned today by my hon. Friend the Member for Stroud and the hon. Member for Thornbury and Yate—is for us absolutely a key part of maternity care. As the hon. Member for Winchester said, our NHS must listen to and work with women and families on how their care is planned and received, based on what matters to them.

To get maternity care back on its feet, we need to train thousands more midwives as part of the NHS workforce plan, while encouraging experienced midwives to stay in the NHS. Many hon. Members, including the hon. Member for Cheltenham, spoke of recruiting midwives, with regard to morale and workload. That was also mentioned by the hon. Members for Tewkesbury (Cameron Thomas) and for Carshalton and Wallington (Bobby Dean). The NHS will deliver the people plan, giving a stronger focus to a modern, compassionate, inclusive culture, which absolutely has to be part of our forward look in the 10-year plan.

We will ensure that trusts failing on maternity care are robustly supported into rapid improvement. We are setting an explicit target to close the black and Asian maternity mortality gap. NHS England is on the right track, boosting the workforce through training, apprenticeships, postgraduate conversion, return to midwifery programmes and international recruitment. I have been clear that the Government will build on those programmes, not replace them.

Finally, I want to end by restating our unwavering commitment to maternity services across the nation, including in Gloucestershire. We are actively working to improve staffing levels and are planning for the future needs of Gloucestershire’s maternity services. I say to the constituents of the hon. Member for Cheltenham that I hear his concerns and completely understand them, and I will work with him to set this right.

The Opposition spokesperson is an assiduous writer, and I have answered a number of her letters, but if I have not responded to particular points from the previous debate before recess, I apologise, and will ensure that that happens after this debate. She has raised important questions.

In the constituency of the hon. Member for Cheltenham and in mine, women have had to bear the brunt of inaction for the past 14 years, but this Government will deliver for women, not just in the south-west but in the country as a whole.

I call Max Wilkinson to respond to this very well-informed debate.

Thank you, Sir Christopher. I thank the Minister for her long and detailed reply. I appreciate the time that she has taken. I also appreciate her background in the NHS; we have spoken elsewhere about how she worked in the NHS for a long time, and I know that she will bring a lot of expertise to her brief. I also appreciate the specific references to the constituency, and the work that she has done to ensure that she could give a detailed response about Gloucestershire’s services, rather than a more general response on the national picture. That has brought a lot to the debate.

We have heard some powerful contributions, not least the contribution of my hon. Friend the Member for Thornbury and Yate (Claire Young), who told her personal story. We also had a contribution from a member of the public via my hon. Friend the Member for Winchester (Dr Chambers), as well as one from the hon. Member for Gloucester (Alex McIntyre), who had a harrowing few days, by the sounds of it, with a really good outcome. He referred to his son in his maiden speech the other day as well. That was joyful, so I thank him.

The Gloucestershire example is not unusual, as the Minister and others have pointed out. However, we suffer in Gloucestershire from an outsized problem; our NHS trust is suffering from a deficit of midwives in a way that other NHS trusts are not, and we need to address that. The Minister referred to the good work already being done by the trust, and it is important that in our contributions we recognise that work is being done, under new leadership, to try to turn things around. In my regular meetings with the trust’s chief executive, that has come through. An open and transparent communications culture is something that we will welcome as new Members of Parliament.

At its heart, this discussion must come back to the safety of women and babies, and to choice for mothers. Locally, we are suffering the symptoms of a widespread national issue, but it is not acceptable for people in Cheltenham and Gloucestershire to be denied that choice indefinitely. That is what we are dealing with. I urge the trust’s chief executive and others—who I know are listening to this debate, and who know that we are contributing in good faith—to keep members of the public and everyone else, particularly local MPs and councils, informed about what is happening next.

We know that there will not be a decision before April 2025, but it is important that there are milestones, so that people get updates and there is regular open, transparent reporting. That helps to maintain confidence in the system as the good work of supporting the rights of mothers, babies and families goes on, and ensures that our midwives are better looked after in the system. If we can keep this debate happening in public, we are more likely to reach a situation in which Gloucestershire families get the service from the local NHS that we all deserve.

Question put and agreed to.

Resolved,

That this House has considered maternity services in Gloucestershire.