Meeting of the Parliament

Meeting date: Wednesday, May 8, 2019

Official Report 1058KB pdf

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Support for Midwives

The next item of business is a debate on motion S5M-17191, in the name of Monica Lennon, on urgent support for Scotland’s midwives. This is a tight debate, so please keep your speeches to time.

16:23  

Sunday was international day of the midwife, and I enjoyed seeing my social media feeds filled with cute baby photos and lovely sentiments about the special work that midwives do to support women and their babies.

The baby theme has continued, with the Earl and Countess of Dumbarton announcing the safe arrival of their little one on Monday. I am sure that the Parliament wishes Meghan and Harry all the best.

All babies are special, and Scottish Labour shares the ambition of the Scottish Government to give all children in Scotland the best start in life. That is why we have called this debate, to seek urgent support for Scotland’s midwives, because we believe that they need extra help to keep delivering excellent care for women and babies.

I pay tribute to the Royal College of Midwives and thank its members for their input. I also thank Unison and many of my constituents, who have shared their experiences of midwifery and neonatal care and their ideas for innovation and improvement.

This morning, I had the pleasure of visiting University hospital Wishaw with Richard Leonard, where we listened to midwives telling us with great pride and passion about their work. We heard about the highs and the lows, and I was particularly struck by the care that has gone into developing dedicated bereavement and baby-loss support.

We met midwives who wake up in the morning wanting to make a difference and that is exactly what they are doing. I thank NHS Lanarkshire for allowing us to visit and for creating a supportive environment in which midwives are valued. That includes Lorna Lennox, who has developed the beautiful ribbon that I am holding. I know that members cannot read it, but it is a very helpful guide for mums who might be unsure about baby movements and so on, and it promotes the triage service. Those are the lovely little touches and innovations that we see when staff are truly supported.

The work of a midwife, however, is clearly demanding, and their jobs are made more challenging than they should be because of workforce pressures. Last year, there were 127 whole-time equivalent vacancies in Scotland and 45.5 of those posts were left unfilled for longer than three months. Overall, the vacancy rate has increased from 1.3 per cent in 2013 to 5 per cent in 2018. Those vacancies put additional pressure on the rest of the workforce.

Our midwifery workforce is highly experienced, which is a good thing, but more than 40 per cent of midwives are aged over 50. Their knowledge and experience are invaluable, but the ageing workforce gives rise to concern about succession planning as midwives start to retire. We picked up on that issue during our visit to Lanarkshire today and have done so more widely in conversations with the Royal College of Midwives.

Despite falling birth rates, midwives’ workloads are not diminishing, and we need a robust pipeline of midwives for the future. There are between 50,000 and 60,000 births in Scotland each year. There has been an increase in complex births due to a higher number of inductions of labour and a rise in the number of older women and women with a high body mass index becoming pregnant and giving birth.

That brings me to resources. I was worried to read a letter signed by community midwives at NHS Lothian, who described not having enough equipment, computers or pool cars. I expect that Lothian colleagues including Miles Briggs, Alison Johnstone and Alex Cole-Hamilton will share that concern and I hope that the minister will, today, commit the Scottish Government to carrying out an investigation. Nineteen Lothian midwives signed the letter and they say that the understaffed and stretched service relies on midwives’ goodwill to meet the growing case loads and ever-broadening remits.

Midwives, like all our national health service staff, deserve to be treated with respect and care, but weaknesses in workforce planning are contributing to reports of burnout and stress. It is our job, here in Parliament, to have an honest conversation about how to fix that. If colleagues support the Scottish Labour motion today, we will all agree that low morale, bullying and work-related stress must be urgently addressed.

Scottish Labour broadly welcomes the Scottish Government’s best start strategy. The continuity of carer throughout the maternity journey is valued by women and, if adequately resourced, it can improve outcomes in maternity and neonatal care. We pay tribute to NHS staff and service users, and organisations including Bliss and the National Childbirth Trust, which influenced the final strategy.

We are pleased that the Scottish Government’s amendment emphasises that the £12 million allocated to best start is an initial investment, but we hear the concerns of midwives who are anxious to see further resourcing follow quickly. That is why we are calling for an additional £10 million to be released towards the best start roll-out. Best start reforms, if they are adequately funded, could be transformative and lead to successful outcomes for women, babies and their families. Midwives do such an important and special job and they must feel valued. Pregnancy is a treasured time, but it can be challenging and it is imperative that all women receive the care that is right for them.

We will happily support Miles Briggs’s amendment, which recognises the positive work of the Royal College of Midwives. I am grateful that the Scottish Government’s amendment would not delete my points around workforce pressures and the need for an urgent investigation into the resourcing concerns in Lothian.

I note that the Scottish Government’s amendment would remove Labour’s call for an additional £10 million, which makes it difficult for me to support it, but when the minister gets to her feet I will look forward to hearing her clarification on the funding that it will make available. Scottish Labour welcomes the reforms that the Scottish Government is implementing, but believes that certainty of funding is essential.

I move,

That the Parliament acknowledges that the International Day of the Midwife took place on 5 May 2019 and commends the commitment and skills of Scotland’s midwives and their crucial role in caring for women and babies; recognises that a continuity of carer throughout the maternity journey is valued by women and that, if adequately resourced, can improve outcomes in maternity and neonatal care; is concerned that many midwives are experiencing significant workforce pressures; believes that action must be taken to address low morale, bullying and work-related stress; further believes that the concerns raised by midwives in NHS Lothian in an open letter, which claims that they do not have enough computers, equipment and pool cars, needs urgent investigation; understands that only £12 million has been allocated towards the implementation of the Best Start recommendations and believes that this funding falls short of what is needed to safely deliver the new transformative models of care that are required by the Scottish Government, and urges the Scottish Government to ensure that all midwives have adequate time, training and resources and to provide an additional £10 million towards the implementation of the Best Start recommendations.

16:30  

I thank Monica Lennon for highlighting the international day of the midwife.

In Scotland, we are very fortunate to have highly educated, skilled and compassionate midwives who lead and deliver the high-quality care that is so valued by women and their families during their pregnancies, as they prepare for birth and their first few precious days and weeks with their babies. Our midwives support a woman’s whole family. That matters, because all the evidence tells us that children’s experience in their early years can make a real difference to their health and wellbeing later in life, and that support for new parents needs to start pre-birth. Therefore, let me repeat the thanks that Jeane Freeman recorded on Sunday, on the international day of the midwife, to every midwife in Scotland and every young midwife in training for their commitment, compassion and dedication to their role.

It is two years since “The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland” was published. It describes a new model of maternity and neonatal care that is family centred and focuses on compassion and the best care, with the whole family being involved in the experience. One of the central pillars of the best start plan is the introduction of the continuity of midwifery carer. Under that model, women receive most of their care from a primary midwife and a small team throughout pregnancy, labour, birth and afterwards. That is what women told the best start review that they wanted, and midwives told us that that is how they want to work. The model is also supported by compelling international evidence of its positive impact, including improved satisfaction with care, fewer medical interventions during birth, improved breastfeeding rates, and reductions in pre-term birth and baby loss.

Last year, five early adopter boards were identified and given the task of leading the way across Scotland in implementing the new model of continuity of carer and local delivery of care. The first teams are now delivering continuity of care to local women. Capturing and sharing learning from those early adopters is helping the remaining boards to plan for change in their own areas, which will be tailored to local needs. The underlying principle of delivering individualised care, which is built around a woman and her family, and their circumstances and needs, will be at the centre of every midwife’s practice. Built into the model is the recognition that some women with complex needs will need extra care, and so midwives’ caseloads are reduced to give them the time to provide such care.

We know that the roll-out of the continuity of carer model and the delivery of the range of recommendations in the best start review will need investment in order that they can be delivered. That is why Jeane Freeman announced a funding package of £12 million over two years for implementation across the best start programme. That has allowed boards to invest in infrastructure, training and equipment for staff to be able to make the best start programme a reality. In recognition that the roll-out will take several years, the Government is also looking at future funding.

No one is in any doubt that the model will mean substantial change to ways of working, particularly for midwives, which is why our early implementer boards have invested time and energy in communications and change management, supported by our best start programme board and delivery groups. We expect all boards to roll out the new model in a planned and managed way, with safety at the forefront, and our maternity teams are working hard to deliver that. In addition, boards have been supported by national groups that have developed a range of guidance frameworks and training for staff to support implementation.

To support the roll-out, the best start programme executive team and the RCM are engaging with the early adopter boards and listening to their experience of the continuity of carer model to identify learning so as to improve implementation at national and local levels across Scotland. In March, a best start event was attended by more than 200 maternity staff, who were mainly midwives, from across Scotland; many more watched via a live stream. The event focused on sharing learning and experience of the roll-out of the best start programme, including the continuity of carer model, and giving staff the opportunity to ask questions.

Will the minister take an intervention?

Will the minister take an intervention?

Do I have time, Presiding Officer?

If you wish to do so, minister.

Yes, I will take an intervention.

I call Kezia Dugdale.

Does the minister recognise the role of midwives in providing postnatal contraception for women, particularly those in poorer communities? If so, how will she ensure that the money goes to deprived communities so that midwives there can do that crucial work?

I am sorry, minister—I believe that I called Kezia Dugdale instead of Monica Lennon. Would you like to deal with both interventions?

Do I have time?

I will give you time.

I appreciate the minister’s explanation of future funding, but I was struck by the use of the word “if” in the amendment with regard to the plans being successful

“if fully and appropriately resourced”.

I have not heard from the Government an absolute commitment that they will be “fully and appropriately resourced”. In our motion, we referred to the figure of £10 million, because stakeholders told us that that would give them some confidence. Can the minister give me and the chamber further assurance on that point?

I thank Kezia Dugdale and Monica Lennon for their interventions, which I will take in turn.

I would certainly support and echo what Ms Dugdale said. It is very important that we ensure that women are able to plan their pregnancies in a safe and manageable way. Indeed, that is why we have free contraception in this country and why we think it important that midwives also play a role in educating women about their fertility, particularly in the postnatal period.

As for Ms Lennon’s intervention, the £12 million is an initial investment in the four early adopter sites, and we expect additional moneys to come to the other boards. However, we must recognise that that is not an addition to current midwifery care—it is transformational funding that will turn this into the new normal for the delivery of maternity care.

Please wind up now, minister.

I know that the vast majority of midwives, maternity professionals and key stakeholders such as the Royal College of Midwives, the National Childbirth Trust and Bliss support the introduction of continuity of carer, and introducing that model will be important for the satisfaction of women and staff and from the perspective of improved outcomes. However, change on this scale will, as always, be difficult and challenging, and it is important that we listen to staff on the ground, learn from what is working well and work with boards to help them manage the change programme in the best way.

If I could also add—

No, minister.

In that case, I move amendment S5M-17191.2, to leave out from “understands that only” to end and insert:

“agrees that the contribution of 600 NHS staff, 600 maternity and neonatal service users, the NHS, the Royal College of Midwives, the National Childbirth Trust and Bliss, along with others, was instrumental in shaping the five-year plan for maternity and neonatal care; recognises that this expert input led to the plan taking a phased approach; further recognises that the initial budget of £12 million is only intended to support the initial phase, including implementation of the new model of continuity of carer at five early implementer sites across Scotland, and believes that the plan is the right way forward and, if fully and appropriately resourced, will result in mothers and babies being offered a truly family-centred, safe and compassionate approach to their care, with real continuity of care and carer.”

We are running out of time. Again, I apologise to all for the error that I made.

16:37  

I very much welcome this debate on Scotland’s midwives and maternity services, and I thank the Labour Party for bringing it forward.

I want to start by echoing Monica Lennon’s comments on the dedication, expertise and skills of our fantastic midwives, who offer world-class levels of care to mothers, babies and families across our country. Their contribution to our health service is massive, and we owe them a great deal of gratitude for the work that they do every day. I also pay tribute to the excellent work of the Royal College of Midwives, and I hope that members will support my amendment, which recognises their work and their campaigns.

I share the concerns that have already been voiced about the significant midwifery workforce challenges that are affecting so many of our hospitals and communities. According to the latest statistics, there are 114 midwifery vacancies across Scotland and the vacancy rate for midwives has doubled in the past five years. There are fewer midwives in post than there were five years ago, and less than 30 per cent of nursing and midwifery staff feel that there are enough staff. It is therefore little wonder that the RCM accused the First Minister, when she was health secretary, of making

“a spectacular error of judgment”

in cutting the number of nurse training places.

All of that is an indictment of the SNP’s running of our health services and its failure to put in place adequate national workforce planning in the 12 years that it has been in office. The midwifery shortage is another key example of just how damaging Nicola Sturgeon’s decision—

The member should be aware that we have more qualified nurses and midwives working in our NHS, with the figure up 7.9 per cent to more than 44,000 full-time equivalents—a new record high. Moreover, our nursing and midwifery student intake is up 7.6 per cent, which is the seventh successive rise. During this Parliament—

Minister, we are very limited for time. Mr Briggs, you still have only four minutes.

The key statistic that the minister needs to understand is the 114 midwives that we are short of and the pressure that that is putting on staff across our country.

In its attempt to rewrite history in its amendment, the Government does not recognise that the NHS workforce challenges that are being faced are its responsibility. Given our ageing midwifery workforce and the fact that a large proportion of Scotland’s current midwives are now over 50, extra midwifery student places should have been provided. Instead, the damaging cuts to training places that were made by Nicola Sturgeon have only exacerbated the current staffing crisis.

As an MSP for Edinburgh and Lothian, I agree with Monica Lennon that the open letter that midwives from across NHS Lothian have written is deeply concerning, and it should concern ministers as well. The letter refers to the shortage of key equipment, which should be urgently addressed by NHS Lothian. I hope that the minister will take forward those concerns, too.

The best start recommendations were widely welcomed by stakeholders and experts. The Scottish Conservatives back the focus on a patient and family-centred approach, and we agree that there needs to be continuity of care for mothers throughout and beyond pregnancy. It is up to Scottish National Party ministers to ensure that all required funding is delivered to implement the best start recommendations.

With regard to support for new mothers in my Lothian region, I have recently highlighted cuts to walk-in specialist breastfeeding services. Those cuts took place in 2017 and, since then, I have regularly been contacted by new mothers who do not know where to turn when they have problems breastfeeding. I welcome the recruitment of more health visitors by NHS Lothian. However, when a new mother is having trouble breastfeeding, they benefit from support straight away, which is why I propose the introduction of a dedicated telephone line for new mothers who are having issues with breastfeeding. That would allow new mothers to get instant support when such difficulties arise.

I again welcome this debate on maternity services and midwives. I am pleased to support Monica Lennon’s motion.

I move amendment S5M-17191.1, to insert after “work-related stress”:

“and applauds the work undertaken by the Royal College of Midwives to help midwives deal with these issues, address bullying in the workplace and encourage a more supportive workplace culture”.

16:41  

I welcome the debate and thank Monica Lennon for bringing the issue to Parliament. I, too, thank Scotland’s midwives for the incredible work that they do.

The motion and the Government amendment agree on the importance of the continuity of carer. The 2016 Cochrane review found that the midwifery continuity of carer model made women more likely to have a normal birth. The best start recommendations recognise that all women should have continuity of midwifery carer from a primary midwife. That gives midwives a real chance to get to know mothers and families and to take individual circumstances into account. That is key.

The relationship provides an opportunity to ensure that every growing family in Scotland that requires expert advice on or help with financial or other matters gets the help that they are entitled to. Midwives are ideally placed to identify, at the earliest stage, families where children are at risk of falling into child poverty, but of course those midwives require sufficient capacity, resources and time to do that. It must be acknowledged that serious concerns have been expressed about whether the best start recommendations can be implemented with current staffing levels. In December last year, there were more than 114 vacant midwifery posts in Scotland, and there has been a year-on-year increase in the number since 2015. Those serious concerns are described clearly in the open letter from midwives in Lothian to which the motion refers.

I recognise that the Government is taking steps to address capacity issues. It has increased the number of training places and has increased the student bursary, which I welcome, and I am optimistic that the Health and Care (Staffing) (Scotland) Bill will help to ensure appropriate staffing levels. However, those measures alone will not solve the problem. As we have heard, there are concerns about retention, as more than a third of midwives are over 50. Consistently, a significant proportion of the midwifery workforce is aged over 55 and could therefore retire at any time. That is a lot of invaluable experience that will be lost, and it means that new midwives are dealing with complex cases without essential back-up and support.

The birth rate in Scotland is falling but the demand for midwives is growing. As we have heard, that is due to a rise in older women and women with a high BMI accessing maternity services and requiring more complex care. According to the Royal College of Midwives, more than half of women accessing maternity services are now obese or overweight. We know that there is a well-established link between deprivation and obesity. Healthier mothers reduce midwife workload.

Maximising pregnant women’s income is one way that we can tackle the strain on midwifery services. In 2017, the Greens secured a commitment from the Scottish Government to roll out the healthier, wealthier children scheme across Scotland. I am keen that we do not lose momentum on that and I will continue to monitor progress on the roll-out. Midwives and other antenatal service staff as well as health visitors and others have played a huge part in the scheme thus far, so I offer my thanks for their hard work.

Miles Briggs was right to highlight the impact of community-based projects such as the Pregnancy and Parents Centre in my region. Such projects help parents to have the healthiest pregnancy possible and provide invaluable support to pregnant women and mothers, which can in turn ease the strain on midwives. However, cuts to services are undermining that.

In Lothian, as we have heard, vital face-to-face help for breastfeeding mothers has been slashed by 60 per cent. Five weekly, half-day specialist breastfeeding clinics in community centres were shut in December 2017. It would be very helpful if the minister could respond to those concerns when she closes the debate, because we should imagine what it would be like for someone to wait for a week, worrying that they will be unable to feed their baby.

You must close, please.

It is imperative that we do all that we can to properly fund and resource midwifery services.

16:45  

I am grateful to the Labour Party for bringing the debate to Parliament, and I assure it of our support. The debate comes hot on the heels of the international day of the midwife.

I cannot think of another healthcare professional, other than general practitioners, with whom every member of the chamber will have had some association. It is usually on the first day of our lives, but many people have subsequent interaction with midwives during the births of their children.

At 6 pm on Palm Sunday five years ago, my wife went into labour with our third child. The first two labours—those of our boys—had been protracted over a number of days, so we thought that we had quite a lot of time. I took a leisurely trip to Dalkeith to drop off the boys with their granny. When I was on the bypass, I discovered to my horror that Gill was timing her contractions at two minutes apart, so we realised that things were moving at pace. I got her into the car and got back on to the bypass, at which point she went into transition, which is quite terrifying when you are driving at 70mph.

My wife insisted that I phone the midwives at the Royal infirmary, and I said that we were coming in hot and that I would not be able to park the car. I said that I would need to dump the car at the door, because the baby was coming now. They said that that was fine and that I should pull up outside the door. When we pulled up, three midwives were ready and waiting for us at the door. It turns out that I had gone to school with one of the midwives. She told me that as I got out of the car, but she said, “That’s not important right now, because your wife is about to have a baby.”

There was 11 minutes between the doorway and the delivery of Darcy, our third child, who was happy, healthy and well cared for. During those 11 minutes, we were carried in very confident hands. We had an excellent experience, and I know that such experiences are replicated in hospitals around the country every day. The profession has our great thanks.

It is easy to think of midwives as working only in a hospital setting, but they do so much in our communities, too. My party makes a great deal about the need for more adequate perinatal mental health support services. We forget that midwives pick up the first signs of postnatal depression or other mental health difficulties that are associated with childbirth. We need to address that key issue, which affects the early days when we are trying to give our children the best start in life.

Given subsequent policy developments, we have asked midwives to do more with less. For example, a midwife will be the first named person that a child will get in their first days of life, before that role is handed over to a health visitor. As was the case with the best start grant, midwives were not involved in the creation of that policy initiative, which was a serious misstep.

We are asking midwives to do more with less. By “less”, I refer to the calamitous decision that was taken by the then health secretary and now First Minister, Nicola Sturgeon, in cutting the number of training places by a fifth, which has resulted in 300 places being lost to the profession. That point has been made several times during the debate. There is no doubt about the causal relationship between the myopic decision to cut the number of training places and the subsequent increase in the vacancy rate to 5 per cent.

I thank the Labour Party for securing the debate. We will support Labour’s motion, we will reject the Government’s amendment because it glosses over some of the problems that the Labour Party has rightly raised, and we are happy to support the Conservatives’ amendment.

It is important that we have more such debates, because we often forget about midwives. They are more than just healthcare professionals; they offer counsel, succour and crucial advice, on which we all rely in those first sleep-deprived days of early parenthood. We often forget how much of a good start they give not only to our children but to us, as new parents.

16:49  

The International Confederation of Midwives created the concept of the international day of the midwife, to which previous speakers have referred. Across the world, this year’s theme is:

“Midwives: Defenders of Women’s Rights”.

The organisation has a strong international message that is also applicable to Scotland here and now:

“Midwives uphold and protect the rights of women every day”,

“Midwives need safe and enabling environments to work in”

and

“Women have the right to make choices about their care during childbirth”.

It is worth repeating the truism that maternity and neonatal care are crucial to the health and wellbeing of Scotland’s people. As the Scottish Government’s report on the best start plan said last year:

“Services have largely developed over time, rather than being designed around the needs of women and families, leading to different approaches and care across Scotland.”

As previous speakers have said, we all know that the birth rate in Scotland has been falling, but work for midwives is not dropping proportionately, because of increased levels of birth complexities, more inductions and a rise in the numbers of older women and women with very high BMIs becoming pregnant, as we have heard from Alison Johnstone and others. That means that there are changing needs in the population and that services need to change and develop, because some are no longer fit for purpose. My colleague Rhoda Grant will shortly provide a case study based in the area around Caithness.

I know from my experience as convener of the cross-party group on diabetes that long-term conditions, such as obesity and mental health problems, need a strong pro-active response from health services. Other members around the chamber know that too.

I have referred to the concept of health inequalities many times in the chamber, and in the Health and Sport Committee. We all know that women from disadvantaged communities face particular challenges during pregnancy and birth. To address those problems, the best start plan has a number of key principles, such as the continuity of the carer, a particular focus on rural areas and the enhancement of telehealth and telemedicine, as well as wider targets like a single maternity network

“along with a single Neonatal Managed Clinical Network for Scotland.”

Is it working? One midwife working in Glasgow who gave me feedback about the best start plan said today:

“I just can’t see how it will work safely for both women and midwives. We are being failed as it is, completely rewriting the system won’t fix that. Honestly, this is the hot topic at work and people are so scared of this.”

We all know that midwives are on the frontline of the NHS. They bring new life into the world in a job that is heartbreaking, hard and beautiful. The fact that some feel that they have no choice but to leave the job that they love tells us that something must be done.

As we have heard from my colleague Monica Lennon, on this side of the chamber we believe that transformational change to midwifery is needed, but it is crucial that that is not done on the cheap. The existing midwifery workforce is already under significant pressure with a high level of vacancies and increasingly complex cases to manage. In addition, the “State of Maternity Services Report 2018 – Scotland” from the Royal College of Midwives found that the number of midwife vacancies had quadrupled over the previous five years.

I echo earlier speakers who called for an urgent investigation into the concerns raised by the midwives from NHS Lothian who believe that they do not have the resources needed to deliver the new models of care. The skills and commitment of Scotland’s midwives need to be recognised and celebrated today. Let us ensure that all midwives have the time, training and resources to do their job properly.

16:53  

I chose to speak in the debate because I am concerned by the Labour party’s motion.

I, too, acknowledge that 5 May was the international day of the midwife, and I thank all our incredibly skilled midwives across Scotland.

I was an active clinical educator and participated in education sessions for midwives learning to deal with the complex case issues that were highlighted by Alison Johnstone. Obese patients can have no peripheral venous access, so I had to support midwives to work with central venous access, which is completely unfamiliar to them.

NHS Dumfries and Galloway in my South Scotland region, as with other areas across Scotland, has its challenges with midwifery services, and I have been in communication with local midwives and the NHS Dumfries and Galloway board about that.

Will the member take an intervention?

Of course I will take an intervention from my colleague Finlay Carson.

First, I declare an interest: in the next 12 days, I will become a father again.

Does the member agree that, despite the incredible hard work of the midwives in Wigtownshire, people in the area are being badly let down by previous decisions of this Government, as there are only two midwives covering the whole of Wigtownshire, and there is the impending closure of the birthing unit in Stranraer—due not to improvements in the service but to concerns about safe and resilient staffing levels—which will require women in Stranraer to travel 70 miles to Dumfries?

I absolutely agree that there are real challenges in Dumfries and Galloway. A midwife charge nurse died and one retired, and there are major recruitment challenges. I am coming to the issue of the 75 miles of potholes that women who are in labour have to experience when they are going to Dumfries. I am not in disagreement with the member. I agree that there are challenges.

I have referred to recent casework that I have been involved with. When I read the motion, I reflected on the fact that, at the end of 2018, I wrote to NHS Dumfries and Galloway to communicate the concerns that have been expressed to me by midwives who are my constituents. I asked the head of midwifery about the challenges that were perceived by the midwives, because the issue is not just about recruitment and training; morale issues have been highlighted, too. I raised the issues of the Clenoch birthing suite, which I have just talked about, and Galloway community hospital. I was pleased to read in the response to my letter that the head of midwifery has met a representative sample of midwives across the area, from Stranraer to Dumfries, to speak to them about morale, the challenges that they face and how they feel overall. Those meetings were based on modules of communication from the good conversation programme, and midwives were able to rate their feelings about a number of areas of their experience, including morale. Most of the midwives rated service delivery at seven out of 10, which meets a satisfactory standard. It is worth noting, however, that no midwife who was asked said that staff morale was an issue. That conflicts a little bit with what has been conveyed to me.

The Nursing and Midwifery Council has declared that there has been a 13 per cent reduction in nursing and midwifery registration on the part of midwives from our European neighbour countries, and Brexit has been cited as a cause of that.

I want to quickly highlight that the Scottish Government is keeping the bursary and is supporting free tuition, which has been taken away south of the border. The Scottish Government is investing in the area, and I commend that. I would like to hear any further information from the Scottish Government about how we can support our midwives in Scotland.

16:57  

Midwives play an essential role in the NHS, and many women who have given birth will remember the names, if not the faces, of the midwives who took care of them on one of the most important days of their lives. I certainly remember all the help and support that I got as a 21-year-old first-time mum, when I was hundreds of miles away from my family. The support that I received before, during and after giving birth was greatly appreciated, particularly the emotional support, which we cannot put a price on. It is important that we give midwives our full support, so that they can work in an environment that helps them to do the vital work that they do.

The annual international day of the midwife was first celebrated in 1991 and, as we have heard, this year it took place last Sunday. It acts as an opportunity to celebrate and advocate for the many ways that midwives support women. Over the past two decades, midwives have rolled with changes in technology and society. More women than ever are getting pregnant via in vitro fertilisation, and more women are having children later in life.

Patient satisfaction with maternity services is high, with 74 per cent saying that their care in labour was excellent, and 61 per cent saying the same for antenatal care. That is not to say, however, that we are doing right by midwives, who are facing pressures on a daily basis.

As we have heard from my colleague Miles Briggs, statistics show that there is a shortage of midwives, with 114 vacancies across Scotland and fewer in post than there were five years ago. In a Scottish Government staff experience report, only 27 per cent of nursing and midwifery staff said that they felt that there were enough staff to allow them to do their job. We know that that is a long-term issue across the NHS workforce. In 2016, Audit Scotland highlighted a lack of workforce forward planning in health boards.

As well as recruitment, retention is a huge problem. Two years ago, the former head of the Royal College of Midwives put on record her concerns about an ageing workforce. The proportion of midwives who are aged 50 or older jumped from 34 per cent in March 2013 to 40 per cent in March 2018. She also stated that workforce behaviours were deterring trained midwives from staying in the profession. As we have heard, there have been reports of low morale, bullying and work-related stress. A Royal College of Midwives survey found that more than half of RCM members had experienced harassment, bullying or abuse from service users or their families in the past 12 months, and one third reported having been on the receiving end of that from a manager.

Although midwife unions have supported best start, they have expressed concerns about how it will be implemented. There are widespread concerns about the demands of being on call and the potential impact that it will have on work-life balance. That is why we lodged an amendment that highlights the work that the RCM has undertaken to improve workplace culture. Given that a study last year found that there were strong links in Scotland between the quality of maternity care and women’s health after childbirth, it is all the more important that we get the necessary support in place.

I again thank the midwives across Scotland who do such a cracking job. They are one of the most visible and valued professions in our hospitals and communities, and they deserve our full support. We must improve workplace culture and create an environment that supports the vital work that midwives do.

17:01  

I am delighted to speak in the debate, which highlights the vital work of midwives. I pay tribute to one very special midwife—my children’s grandmother, May Kane, who died a few weeks ago in her late 80s.

May was an old-school midwife who, between the 1950s and the 1990s, delivered thousands of babies across Coatbridge and Lanarkshire, including one of our own parliamentarians, Elaine Smith. Many of those babies, as adults, of course, were among the mourners who came to say goodbye to May in Coatbridge a few weeks ago, demonstrating the esteem in which she was held in her community, and indeed the high regard in which midwives are held. The priest said that some of the younger people who were there had not met her, but that they knew that her hands had brought them into the world, which is why they wanted to be there.

It is fitting to put her name on the Scottish parliamentary record. She often spoke of the importance of one-to-one care and the close relationship between mothers and midwives. Of course, that is exactly how she operated back in the 1950s and 1960s, when she set off on foot whenever she was needed, to what were often very poor homes. She would follow up with a lot of aftercare and she would have been the first to welcome the fresh focus on the continuity of care that the minister outlined. I pay tribute to her, and to all the nurses and midwives whose contribution is of critical importance to the NHS and should be valued and celebrated.

I am proud that, since the SNP came into office, there are now more qualified nurses and midwives working in the NHS in Scotland, with staffing levels at a record high; the number of qualified nurses and midwives is up by 7.9 per cent. I welcome the fact that, over this parliamentary session, the Scottish Government will continue to invest in education and training support, with £40 million of investment having been allocated to create up to 2,600 additional nursing and midwifery training places.

In addition to increasing places for students who are new to the profession, the Scottish Government also introduced the return to practice programme, which provides funding to encourage former nurses and midwives back into the profession. I understand that almost 460 former nurses and midwives have retrained through the programme since 2015. The Scottish Government is also funding the Open University to deliver a pre-registration programme, which currently supports around 116 nursing students.

As well as increasing places for new students, the Scottish Government will invest £11 million to expand the financial support that is available to nursing and midwifery students. It is particularly important that all eligible students who are on nursing and midwifery courses across Scotland will benefit from an increased bursary in 2019-20, which will rise to £10,000 a year in 2020-21. The core nursing and midwifery student bursary has been set at £6,578 a year since 2009-10, and it is increasing to £8,100 in 2019-20. Those bursaries are the best in the United Kingdom, and they are not means tested or repayable.

The First Minister’s announcement in October has been welcomed by experts and key organisations, such as Glasgow Caledonian University, which is among the largest providers of nursing education in Scotland. An additional discretionary fund of at least £1 million was launched in 2016 to provide a safety net for nursing and midwifery students in financial difficulty. That is, of course, in sharp contrast to the UK Government’s position in England, where the bursary and free nursing and midwifery tuition have been scrapped.

The measures that the SNP Government has taken to improve and safeguard the integrity of the NHS in Scotland demonstrate very clearly that it will deliver the best possible framework for continued support for nurses and midwives who are employed in the health service as well as students, who will be the next generation to provide world-class care and support for millions of new Scots.

17:06  

We have heard that the relationship between a family and their midwife is incredibly important. “The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland” lays out best practice and what we should expect from maternity services. Our motion highlights that provision is underfunded. As we read the report, it becomes more and more obvious that that is the case.

The report talks about multidisciplinary teams in communities following the mother and family through the stages of pregnancy, birth and beyond. However, only 10 per cent of Caithness births take place in the county; the rest take place in Inverness, which is more than 100 miles south, over treacherous roads.

A similar situation arose with Dr Gray’s hospital in Elgin. The situation there has slightly improved because of interim paediatric cover, but that cover cannot be guaranteed and the situation remains precarious, with about 60 per cent of births still taking place in Aberdeen.

In Caithness, there was no attempt to provide paediatric cover. Previously, there was obstetric cover, but there was no paediatrician. Tragically, a baby died. Had paediatric cover been available, that might have been prevented. Rather than the lack of paediatric cover being addressed, obstetric cover was also removed. The argument was that having obstetric cover gave a false sense of security, and that mothers were not transferred to Raigmore hospital quickly enough.

The arguments were also made that midwives were being deskilled and that birth was being overmedicalised. However, with only 10 per cent of Caithness births now taking place in Caithness, it is difficult to see how midwives can hone their skills under the new system. The truth is that the distances are so great that clinical staff will transfer the mum if there is any concern about the birth. I do not blame them for that, because they do not have local back-up.

Many mums will, if it is thought that there might be complications or risks during the pregnancy, opt for an elective caesarean section. That is the only way that they can plan for when they will be away from home, organise childcare for older children and organise for their families. Sadly, that involves even greater medicalisation of birth and, as with all major surgery, risks are attached. That flies in the face of what the best start approach states—an approach that also says nothing about giving birth in the back of an ambulance.

I have already raised in Parliament the case of a mum who gave birth to one of her twins en route to Inverness. The twins were born 50 miles apart, in different counties. That is distressing and unsafe. If it is unsafe to give birth to a child in Caithness maternity unit, surely it is much more unsafe to do so at Golspie community hospital, which does not have a maternity unit or facilities. The first twin travelled to Inverness, separate from its mother, who travelled in another ambulance and gave birth to the second twin in Inverness. NHS Highland has not risk assessed that journey, and I fear that a tragedy will occur before it does. If the Scottish Government is committed to best start, it needs to address that.

Another point of concern is the journey home with a newborn baby. The journey is a long three-hour one by bus, four and a half hours by train, or at least two and a half hours by car. Caithness health action team discovered that it is dangerous for a newborn baby to travel such long distances in a car seat. For a journey of that length home to Caithness, specialist baby cots should be used to allow the child to lie down during the journey. That surely would have been picked up, had NHS Highland carried out a risk assessment of the new pathway. The community had to raise funds to purchase appropriate travel cots, and Tesco stepped in and offered to store cots for families when the NHS refused to do so.

The truth is that current practice does not reflect what is proposed in the best start plan. That is unacceptable for the parent and the midwife. I ask that a risk assessment of the current practice at Caithness maternity unit be urgently carried out, whether in relation to the physical journey to hospital and back home, or the large increase in elective caesarean sections. The whole patient journey needs to be safe.

17:10  

It is always a pleasure to follow Rhoda Grant, who has said most of what I wanted to say in my speech, and it is good that we agree.

I am delighted that we are having a debate to acknowledge the international day of the midwife and to champion the hard work and devotion of all midwives across Scotland.

I begin by celebrating the passion and dedication of our Highland midwives, who were brought to national attention in a BBC television series. I was also pleased to see the first cohort of midwifery students enrol at the University of the Highlands and Islands this January. It is a ground-breaking course that will equip new recruits with the skills to provide care in remote and rural Scotland.

Where progress is being made, we should definitely celebrate it. However, we should not forget that under the Scottish Government all is not well with our health service. Our midwives are being let down by poor long-term planning that is resulting in serious staffing shortages; we have fewer full-time midwives in post than we did five years ago. Our health service is experiencing the devastating effects of the First Minister’s decision to cut drastically the number of training places for nurses and midwives between 2009 and 2012.

Also, the SNP’s efforts to repair the damage that it has caused is not inspiring the confidence of the health professionals. The Royal College of Nursing has criticised the SNP’s plan for its lack of detail, and for omitting to say how much money will be invested in growing the nursing workforce. Frankly, I say that that is not good enough. I believe that it shows a lack of seriousness about resolving a workforce problem that the SNP itself has created. We need the SNP Government finally and fully to support our hard-working midwives.

We do not need more of the ill-judged approach to saving money by downgrading local maternity services.

Will the member take an intervention?

I will make a little headway, first.

When I attended NHS Highland’s annual review, it was clear that the centralisation of services to Raigmore hospital and maternity provision in Caithness remain very big concerns across the whole region.

Does the member agree that the number of births might indicate why it is difficult to keep a small birthing unit open? Last year, the birthing centre in Stranraer had fewer than 20 births, so it is a challenge to maintain a midwife’s level of competence to provide the safest care.

Indeed. I am just coming on to that.

For too long, senior leaders at NHS Highland have held the belief that centralisation is the solution to all the problems. However, downgrading services such as the Caithness maternity unit—and the one in Stranraer that Emma Harper mentioned—is simply not the answer.

We talk about the lack of births at Caithness general hospital. It is a fact that last year there were 219 births to Caithness mothers, 18 of which took place at Caithness general hospital. Such numbers are of huge concern to families in Caithness who want to have children, many of whom would prefer to give birth locally and avoid the long stressful journey south to Inverness that Rhoda Grant mentioned. Women certainly do not expect to make that journey while they are in labour.

Centralisation is not working for new families. It puts intolerable pressures on staff—pressures that are made even worse by the alleged bullying in NHS Highland and the bullying that is now being talked about in other areas.

Our midwives deserve better than what the Scottish Government is currently giving them. Whether on cuts to training places, staff shortages or the deep problems with workplace culture, we need to do more for the midwives who are so critical to the future of Scotland.

17:14  

I join members in thanking our midwives for the work that they do and for the care that they give before and after birth, which is very precious to us all. It was not yesterday when I had my three kids, and I know that things change constantly. I think that things have improved immensely with regard to midwifery.

I have heard a number of members quote figures on midwives and older midwives. I accept that we need more people; more midwives and nurses are being trained. However, we should get together and congratulate the midwives who are 50, 55 or 60; they might have to work until they are 66 under what is being done at Westminster. As Monica Lennon said in her opening speech, many midwives have huge amounts of experience, so we should congratulate them on being there, regardless of their age.

I want to concentrate on “The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland”, which has been mentioned by Monica Lennon, the minister and numerous other members. If we are honest with one another, it is an ambitious and honest plan. The minister went through the whole thing, so I will not do that. I have only four minutes, anyway. The plan mentions what has taken place, covering the review, the engagement and the key recommendations. The process included engagement not just with professionals but with communities on what they want.

As I said, I will not go through the whole plan, but I will mention some of the recommendations and who actually took part in the review. The workforce took part in it. There were 14 NHS territorial board visits—a huge undertaking—and 600 staff were engaged. As I said, the plan is ambitious and honest, and I think that the fact that 600 staff took part says something about the engagement. There were 504 responses to the neonatal experience survey, and 2,000 women shared their experience of care in the Scottish maternity care experience survey in 2015. That shows that the Government is working. We might have a lot of work to do, and there are some very honest recommendations. However, the fact that 2,000 women could share their experiences which were put in a report is something that points the way forward.

I agree that engagement has been really important, but does Sandra White agree that we are now looking for certainty on funding of the next phase, and that the word “if” in the Government’s amendment is cause for concern?

I suppose that it depends on how we read the amendment. Given what the minister said, I do not think that the “if” causes as much concern as is perhaps being read into it. As I said, I am being honest, and the report is honest. We need more money to be made available for services, but that will depend on how things pan out. Maybe that is where the “if” comes from. That is how I am reading it, anyway. It might not be how Monica Lennon reads it.

When we look at the review and see how many people took part in it, we can see that have got honest answers from staff, from women, from the professionals and from the health boards. It might not make great reading for the Government, but it is honest, and we are replying to that in an honest way.

On the “if” that Monica Lennon mentioned, I do not know, but perhaps the minister will address that when she sums up. However, I am confident that although the plan is ambitious, we will get there in the end.

17:19  

First, I refer members to my entry in the register of interests, as my daughter is an NHS midwife.

I thank the Labour Party for bringing the debate to the chamber, although I add my disappointment at the short time that we have for it, as there is so much that I would like to say.

Very early on in my time in this place, I started working with a constituent of mine, Fraser Morton. Mr Morton and his partner, June, had gone through the unimaginable tragedy of losing their son, Lucas, in childbirth. The circumstances leading up to the death of their son had troubled Mr Morton and his response was to investigate. He is a lecturer in health and safety. To add to the trauma, it transpired that Lucas’s death was avoidable.

Mr Morton asked me to go with them to meetings with the health board, Health Improvement Scotland and the investigation team. I was shocked at the way in which Mr Morton and his family were treated. Mr Morton was insistent that there was a systemic problem, but there was a consistent wall of denial. At one point, it was suggested that one of the midwives would carry the can, but Mr Morton resisted that.

In the end, I organised a meeting with the health secretary at the time, Shona Robison. Mr Morton is a very knowledgeable and well-informed individual, as I am sure Shona Robison would have agreed, as would the Health and Sport Committee, to which he gave evidence. The result was a reluctant—and, in our opinion, less than satisfactory—investigation by HIS. That investigation resulted in an extra 24 neonatal staff being recruited into the department, which must mean that the department had been 24 staff short. Not only does that speak to patient safety and the high baby mortality rate at that time, it must also speak to the pressure that the department was under because it was so chronically understaffed.

Shona Robison made a commitment in the meeting with Mr Morton and in the chamber to make cardiotocography scan training compulsory twice a year for all neonatal staff. Given that the misreading of CTG scans is cited in a high proportion of childbirth mortality cases, that was a welcome step. Mr Morton managed to achieve more than all the members in here combined during that time. The problem is that that requirement is not being universally adhered to. Perhaps, in her summing up, the minister could tell parents and the chamber how the policy is being implemented and how its implementation is being measured.

Edward Mountain has been leading in addressing the bullying culture in his local health board. We now have another health board being accused of systemic bullying by almost 100 radiographers, who claim that staff have suffered years of bullying, harassment and victimisation in the very same hospital where the same issues were raised by Mr Morton three years ago. What has changed?

Bullying is a lack of respect and means that the work that is being done is undervalued. Creating an environment in which healthcare professionals want to work must be the primary priority. A bullying and blame culture has developed into an aversion to risk that is shutting down experiential learning. How can we learn the lessons if the evidence is swept under the carpet? Claim after claim is being made that the system is driven towards finding individual blame rather than looking at the flaws in the system. Until that issue is addressed, the chronic staff shortages in midwifery and many other healthcare professional disciplines cannot be solved. So many midwives are taking early retirement because they have seen their value and status eroded.

We are talking about the retention of staff. There is a hole in the bucket, and no matter how hard we try to fill the bucket, it will never be full. We need to fix the hole and look after the health and wellbeing of our professionals if we want to retain our staff.

Midwifery is a vocation. Twelve-hour shifts are common. To add the pressures of understaffing by creating a culture of blame and staff bullying will not encourage our midwives to stay for the longer term. We should look after their wellbeing first. It is time that the Government understood that.

17:23  

I thank Monica Lennon for lodging the motion highlighting the international day of the midwife and for the comments from other members. I also repeat my thanks for the incredible support that midwives give to women and families, and I assure them that we are listening to their concerns and taking them seriously.

As I close, I want to highlight some of the positive work that is being done in maternity services in Scotland. Maternal mental ill health is a key priority for me. It affects as many as one in five pregnant women. We know that it is underdiagnosed and that, without the right treatment, there can be serious, long-term effects on women and families. Our investment of £350 million shows that we are determined to improve the recognition and treatment of perinatal mental ill health in this country, including by improving community support, by offering better access to psychological assessment and treatment, and by having more specialist services for those who have the most severe illness.

I would like to respond to some of the points that have been raised in the debate. Some contributors have referred to the open letter from the NHS Lothian midwives. NHS Lothian has its first pilot team as part of its phased approach to implementation, with safety at its core. The board reports positive feedback on the new model and has confirmed that all midwives in the pilot team have their own equipment, including laptops. I know that senior staff at NHS Lothian met midwives who contributed to the letter to listen to their concerns and further meetings, events and workshops have been arranged with staff to explain the plans and listen to concerns. NHS Lothian has also established a staff group to feed into its best start programme board to allow staff to engage with and influence the best start agenda locally.

I turn to some of the points that have been raised about midwife numbers. I have heard the concerns that some members have expressed about the sustainability of the midwifery workforce. We will continue to work closely with the RCM and other stakeholders to address that. The Scottish Government has supported a range of actions that are under way to do that, including a return to practice programme in which 59 former midwives to date have undertaken training, a shortened midwifery course for nurses in the north of Scotland and a new programme for up to 100 retired nurses and midwives to train as professional practice advisers, sharing their knowledge, skills and experience with new recruits.

There has been a 99.2 per cent increase in midwifery support staff since 2007. Under the SNP, through the record high funding in our NHS, 1,000 more nurses and midwives are trained each year than were under the previous Administration. We are seeking to increase our midwifery student intake in 2019-20 from 226 to 257 to meet the projected future requirements.

NHS boards are also exploring a range of innovative approaches, such as bringing retired midwives back on reduced hours contracts. One example of that is in NHS Lanarkshire, which is bringing back 80 per cent of its retiring midwives on 15-hour contracts.

Finally, I underline the ethos of collaboration driving “The Best Start”. Recommendations were developed following the extensive consultation with more than 600 staff and 600 women who fed their views into the process. Key stakeholders such as the RCM, the National Childbirth Trust and Bliss have been involved throughout. Providing continuity of care is the right thing to do for women, families and midwives. I understand that many midwives in Scotland have never worked that way and that change is daunting. That is why it is so important that boards work in partnership with their local maternity staff to ensure that they feel safe and supported during the transition.

Reforming services is not easy, but we should not shy away from moving forward when we know that it is the right thing to do. That is why we have five early adopter boards leading the way and testing what the new model might look like for Scotland.

Both the best start team and the RCM are well into a series of listening visits to understand how continuity of carer is being rolled out and to hear any concerns. We will use learning from those visits to inform the way forward for Scotland.

This Government is committed to the aspirations that are outlined in “The Best Start” and, most importantly, to improving outcomes for women and their babies.

17:28  

The motion is simple. It is about an urgent review of the very serious issues that have been raised by not just one midwife but the 19 midwives in Lothian who put their names to the letter. I appreciate the update that the minister has given us, but the concerns that they raised go far deeper than the best start reforms, so we need an urgent review.

We have asked for £10 million of funding to be brought forward, on top of the £12 million that has been committed already. The word “if” in the Government amendment causes us concern. I know that Sandra White is feeling optimistic, but many of us are concerned.

I share Brian Whittle’s frustration that the debate was short, but members packed a lot in. We have heard considered speeches, constructive challenge and personal reflections from across the chamber that reminded us all how much we owe Scotland’s midwives.

Consensus around the importance of midwives and the skill, dedication and love that they bring certainly exists, but we have also heard about the challenges. Emma Harper, Finlay Carson, Edward Mountain, David Stewart and Rhoda Grant touched on the rural challenges. We heard about the importance of the road network—we heard that potholes are a real difficulty for women in labour.

Dave Stewart told me that his daughter, Kirsty, was the first baby to be born in Raigmore hospital one year. There have been lots of anecdotes today.

I believe that the royal baby now has a name—I congratulate baby Archie. I am sure that my colleague Jackie Baillie will invite the Duke—or the Earl; please keep me right, as I am not big on royal title convention—and Countess of Dumbarton to her constituency.

Annie Wells said that people remember their midwives. When Richard Leonard and I went to University hospital Wishaw today and met fabulous midwives, I had the lovely surprise of being reunited with Ella Sinton, who delivered my baby, Isabella, in 2006. She is one of those midwives who is still on the job and doing fantastic work after 38 years, although she will retire in the next few years. It is important that we capture such midwives’ knowledge and experience. We need to grow the pipeline of new midwives coming in, and we do not want midwives feeling stressed, burnt out or affected by low morale, because that will put people off. It is important that we do all that we can to ensure that midwifery is attractive.

I share the concerns of Tam Waterson, who is the chairperson of the Scottish health committee at Unison. He said:

“any changes to the provision of midwifery services should not be at the cost of hard-working, dedicated midwives paying with the erosion of their terms and conditions.”

I agree with Alison Johnstone that the continuity of carer model is the right approach, but that has to be backed up by the right investment. [Interruption.] I know that it is an exciting topic for members, Presiding Officer—perhaps they are looking at pictures of the royal baby.

As I said, Richard Leonard and I spent time in Wishaw with midwives this morning. They deal with some of the happiest occasions, but also some of the saddest. I cannot think of anything sadder than the loss of a baby.

We have not had the chance to mention some of the charities that support families and midwives. There are so many, including SiMBA, Bliss and Sands, that do very important work. In Wishaw today, I heard that the hospital is looking at ways to fund additional soundproofing—that might come in handy here in Parliament—so that mothers who experience stillbirth and baby loss have the right conditions. I would like to think that we will not rely on charitable donations for such work.

Aside from the reforms of the best start plan, there is a lot more that we can do. There was wide consensus today on support for Scotland’s midwives, mums and babies. I am pleased that we have had this good debate, and I hope that members support the Scottish Labour motion in my name.