My diary is a juggling act at the best of times. Recently it has been especially tough to fit everything in. The last couple of months have been a whirl of meetings with the health secretary, Downing Street officials, civil servants and advisers, the chair of the health select committee, dozens of MPs and many others.
The Health and Social Care Bill paused, but it was the opposite of a pause for all of us trying to influence it.
Midwives would like to see all women within their locality offered the choice of giving birth at home, in a midwife-led unit or in a hospital
The government does not always have to do what the professionals say, but it should start by at least listening to them; not following that course in the first place is a big part of why we ended up in such a mess.
We are happy overall with the direction in which the NHS Future Forum has pushed the government, but a few issues remain over which the Royal College of Midwives is seeking clarification or movement.
Take competition, for example. We are concerned that subjecting maternity services to greater competition may lead to not all women having access to good-quality local services, which would increase health inequalities and fragmentation of services.
We believe there is a good case - as there is for accident and emergency and critical care services - for exempting maternity services from competition. We agree with the NHS Future Forum’s recommendation that commissioning should cover the whole pathway. This would safeguard against private providers cherry-picking the most profitable elements of maternity care.
On choice, the NHS Future Forum has recommended that the health secretary issue a choice mandate, which the NHS Commissioning Board can use to set the priority on how choice is delivered. We believe choice in maternity services should be included within the mandate on the basis that it is about women being able to exercise choice of type of maternity care rather than choice of provider. Midwives would like to see all women within their locality offered the choice of giving birth at home, in a midwife-led unit or in a hospital.
We therefore recommend that the government commit to developing a choice mandate that is based on choice of type of care and treatment, not just choice of provider.
We would like to nudge the government a little bit in access to midwifery advice and expertise. The bill should set out a duty on all providers of NHS-commissioned maternity services to participate constructively in maternity provider networks. To achieve this, the NHS Commissioning Board should develop a national maternity service specification that commissioning groups would be obliged to implement.
We welcome the recommendations on maternity networks. Clinical commissioning groups must be able to access good-quality clinical advice and expertise from midwives. If networks are to be effective, clinicians must be more involved in providing advice and support during commissioning.
Finally, we believe that the recommendation on aligning boundaries is sensible. However, commissioning groups should band together to commission maternity services for an appropriate population of childbearing women. We suggest that commissioning groups should work together to commission services such as maternity care jointly where the size of the local population requires larger commissioning units.
Overall, the listening exercise has been a success, making the bill better than it was. There is still, however, a long way to go, and the battle in the House of Lords awaits.