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'Midwives must have powers to advise commissioning boards'

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Cathy Warwick is disappointed at the government’s lack of commitment to create policies that encompass maternity services

Here we are, nearly nine months into the coalition government that has now given birth to the Health and Social Care Bill.

This is said by many to herald the single biggest transformation of the NHS in its history. As many of you will have noticed, the Royal College of Midwives has been vocal in expressing our grave concerns about its contents.

We are deeply worried by the prospect of GP commissioning and by the reorganisation of the NHS architecture which we believe was, in the last few years, starting to deliver the possibility of significant improvement in maternity services.

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We are also very disappointed at the absence of a clear commitment by the government to policies that we consider vital to high-quality maternity services.

Choice and patient/women-centred care do remain high on the agenda - but where are one to one care in labour, a reduction in interventions or the contribution of midwives to public health?

For all its faults, the previous government had developed a policy framework for maternity services that addressed all these issues. Unfortunately, the present government gives the strong impression that it no longer considers policies such as Maternity Matters or the national service framework maternity standard to be relevant.

Sitting alongside these concerns about maternity services are the worries we share with other trade unions, especially the increasing spectre of a privatised NHS and the end of a national approach to pay bargaining and workforce planning.

On these latter issues we will continue to stand shoulder to shoulder with our fellow trade unionists to defend public services.

On the issue of healthcare policy, we have made it clear that our view is that maternity services could be put at risk if the passage of the bill goes unchallenged. The RCM will now be working with the government and MPs from all parties to try and get amendments made and commitments given that will mitigate these risks.

What will we be calling for? First, we believe that maternity networks need to be built into the legislation, with powers to advise the National Commissioning Board on the specifications against which GPs will be required to base their commissioning decisions.

Second, we want the development of maternity standards to be of the highest priority by the National Institute of Heath and Clinical Excellence so that these can be used by the NCB as a lever.

We note that, within the bill, the health secretary has a mandate that he declares each year, which informs and directs commissioners. We want to see some of the policies that we believe we have lost built into this mandate; we also want these picked up in the standing rules that will apply to the functions of the NCB.

We still want to see more midwives in the NHS. However, we believe if the right commitments are made in policy - for example a choice of place of birth and the right of each woman to know her midwife - this will in itself deliver more midwives because how else can the circle be squared?

We already know that services without enough midwives struggle to do more than cover the most acute services. If the government is really serious about improving the quality of maternity services, then we hope ministers will accept the compelling case for recruiting more midwives and putting the right policy levers in place.

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