Our political parties face a challenge. All agree that spending needs to be trimmed, if not cut substantially, and the extent of any changes in spending will be a defining political issue between now and polling day. At the same time, the NHS remains - in the words of Margaret Thatcher’s chancellor of the exchequer Nigel Lawson - something akin to a national religion.
Despite this tension, the main parties have committed the NHS to continued improvements in maternity care. I am extremely pleased by that, and thankful that this commitment - across the UK, not just England - has not faltered in the face of difficult financial circumstances.
It is slightly easier this year to know in advance of any election campaign broadly what the main parties have in mind for the NHS generally and maternity services in particular.
Labour is in government, so their policies are plain to see; the Conservatives are innovating by publishing their manifesto in draft form, chapter by chapter, with the health instalment released in early January; and the Liberal Democrats’ policy was brought out in the open at its conference. We have a good idea, therefore, of what is in store.
‘The RCM feels that some reconfiguration of services will be necessary if we are to achieve the highest quality of maternity care, but opposes very large obstetric units’
The thrust of this piece is about England, because it is only in England that the NHS is still governed by Westminster politics, and we face a Westminster election. Nonetheless, good work is going on around the nations, with the All Wales Clinical Pathway for Normal Labour and Scotland’s Keeping Childbirth Natural and Dynamic being two examples.
It is almost three years since the government published Maternity Matters, its blueprint for improving maternity care in England. Broadly speaking, all the main parties subscribe to the Maternity Matters agenda, promising women a range of new choices over their care.
Take home birth, for example. All three parties would like women for whom it is appropriate to enjoy the option of having a home birth. Provision continues to improve - the latest figures for 2008 show a rise in the proportion of babies born at home. The home birth rate has risen in England every year since 2001; given that with the number of births in England has also risen every year since 2001, we have substantially more home births now than we had at the start of the century.
That said, there is still much work to do here. England wide, the home birth rate is 2.8 per cent, yet in many areas it is substantially higher. In Devon - in the South Hams to be precise - almost 14 per cent of births are at home. In West Somerset, it is almost 12 per cent. Other areas are struggling to reach 1 per cent. The performance of some areas proves that it can be done and that there is a demand for home birth that is not being satisfied.
All three parties are committed to increasing the number of midwives, not least because the number of births in England has risen 20 per cent since 2001. Labour set a target of 1,000 extra midwives by 2009, with a further 3,000 by 2012, all against a 2006 baseline. The 1,000 target was met - and, indeed, exceeded - a year early. The Conservatives are committed to recruiting 3,000 more midwives between 2010 and 2014; the Liberal Democrats would also recruit an extra 3,000.
No party has agreed to recruit as many additional midwives as our number crunching at the Royal College of Midwives suggests is necessary. We recognise, however, that for all three parties to have a recruitment target for midwifery in this economic climate is excellent news not only for the profession but also for the service that midwives provide and the women who receive that service.
Unsurprisingly, the parties do not agree on everything. The Conservatives are more protective than Labour of smaller obstetric units in district general hospitals. Although perhaps not directly, the Liberal Democrats too would make the closure of smaller obstetric units less likely; the party has pledged to allow greater local democratic control of the NHS, which would almost certainly mitigate against top down service reconfigurations, to which local people are hostile or at least sceptical.
The RCM feels that some reconfiguration of services will be necessary if we are to achieve the highest quality of maternity care, but opposes very large obstetric units; where smaller obstetric units have to close, the RCM would want to see them replaced by midwife-led units.
Politicians are unlikely to relish their situation. The government is having to borrow almost £200bn in one year just to make ends meet, with only half of that likely to be cut purely through economic recovery. The men and women who will run the next government will face unpleasant choices.In such a climate, the RCM hopes and trusts the parties and politicians will stick to their word on maternity care. We will work hard as an organisation to ensure that, whatever the financial problems, the government does not trim and cut care for those right at the very start of life.
I say to all politicians from all parties: keep to your word and stand by maternity care. In return, the RCM will continue to work with midwives to ensure resources are used efficiently and effectively to build world class care across the UK.
Cathy Warwick CBE is general secretary of the Royal College of Midwives