In the UK, as across many countries at this time, the election takes place on Thursday for Members of Parliament for the next season. Neil Stewart, Editorial Director, looks into the Manifestos from the main parties and draws out what may be relevant for maternity services going forward.
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We know that midwives don’t just vote in their own interests. In the famous phrase from James Carville, Bill Clintons campaign chief in 1992, “it’s the economy stupid” and its knock-on effects that decide voting, and so it looks with the cost of living crisis dominating. But it is still important to see what the political parties are saying about maternity and midwifery in their manifestoes.
While the manifesto of the winning party is the key text the other manifestoes are important for showing where there is consensus or sharp disagreement, as these parallels and divergences tell you much about what can move quickly and what can turn toxic and contested.
- Looking at the health manifestos we can see that the anti-smoking lobby has lined everyone up behind Rishi Sunak’s rolling ban on purchasing tobacco products and that is likely to come back quickly.
- We can see that the Cancer lobby has done well to lock in a demand for new scanners and MRI machines for 130,000 more diagnostics.
- All promise to maintain NHS funding safe from cuts but with enough wiggle room to mean many health sectors may face change or challenge. You have to decide who you think is most likely to meet their financial promises and secure NHS funding.
- Given the high profile of maternity scandals, the growing discovery of the extent of birth trauma, the rising cost of compensation and the staff shortages you would think that all the manifestoes would address this issue; but the references only signal and need interpretation.
- Pay settlements are still likely to be hard argued and pay review bodies subject to change.
Maternity care affects around 1.2 million NHS patients – maternity being the only part of the NHS where 600,000 pregnant women patients go in and with a few twins and sometimes more, 1.2 million women and children patients come out.
Previously all the focus has been on tracking the health of the child. Only now are the impacts, the continuing impacts, on the mothers being recognised, with the realisation that they also need to be cared for and followed for at least a year. This thinking is beginning to appear in some of the manifestoes but not the two main parties.
So let’s look through them, identify what is in and what is missing and see what we can interpret about the future
I have picked out the written words and will reflect on what, if anything, we can conclude could be the implications for maternity and midwifery.
Labour Manifesto
“At the heart of every medical decision must be patients and their families. Too many are not treated with the respect they deserve or given the information they need to adequately access services and navigate the system.
Ensuring patient safety
“Childbirth should not be something women fear or look back on with trauma. Labour will ensure that trusts failing on maternity care are robustly supported into rapid improvement. We will train thousands more midwives as part of the NHS Workforce Plan and set an explicit target to close the Black and Asian maternal mortality gap.
“Labour will digitise the Red Book record of children’s health, improving support for new families. We will also enable vaccinations for babies and children as part of health visits.
“we will establish a Royal College of Clinical Leadership to champion the voice of clinicians.
NS: Childbirth and maternity is now framed through a patient safety prism which indicates that maternity can still expect high pressure, including intervention and continuing scrutiny on pay. If there is any love it will be tough love.
Conservative Manifesto
“By the end of the next Parliament, there will be 92,000 more nurses and 28,000 more doctors in the NHS than in 2023. We are also delivering record increases in training places for other clinicians, such as midwives and paramedics
We will prioritise women’s health, following publication of the first ever Women’s Health Strategy in 2022.
To support women further, we will:
❱ Bring forward a comprehensive national strategy for maternity care as recommended by the APPG on Birth Trauma’s inquiry.
❱ Deliver additional funding for maternal safety and improve access to mental health services for new mums, improve perinatal pelvic health services to prevent and support women with birth injuries and postnatal appointments dedicated to checking mums, not just their babies.
❱ Expand women’s health hubs so that every integrated care system has at least one hub up and running.
❱ Roll out fracture liaison services to every region, reaching 100% coverage by 2030 as osteoporosis disproportionately impacts women.
❱ Support continued research into disparities in maternity care through the National Institute for Health and Care Research.
“We will amend the NHS Constitution so that it recognises every patient’s right to request single-sex accommodation and same-sex intimate care. We will not allow the word ‘woman’ to be erased by health services.
NS: The Conservative Manifesto has the most detailed list on trauma and postnatal care taken from the work of Theo Clarke, a Conservative MP and Rosie Duffield a Labour MP – so the prospect that these recommendations will be picked up by any new government are good.
Interestingly what is missing is the APPG recommendation of a Maternity Commissioner to match the Children’s Commissioner or any reporting to the PM.
On language in maternity care the Conservatives are the most challenging to attempts to be inclusive which are seen to have gone “too far”. Even if Labour win this issue will not go away and may become more toxic
Both Labour and Conservative use language on pay systems that leave the future open, however, both promise nothing but hard negotiations and it will be interesting to see how the pay review bodies survive.
Liberal Democrats Manifesto
Train, recruit and retain the doctors, nurses and other NHS staff we need, including by:
- Establishing a properly independent pay review body.
- Retaining more staff across the NHS through a ten-year retention plan.
- Making flexible working a day-one right and expanding access to flexible, affordable childcare, as set out in chapters 4 and 9.
- Fixing the work visa system and exempting NHS and care staff from the Immigration Skills Charge, as set out in chapter 18.
- Ending the false economy of spending money on agency workers and encouraging the use of flexible staff banks.
Give parents genuine flexibility and choice in the crucial early months by:
- Making all parental pay and leave day-one rights, including for adoptive parents and kinship carers, and extending them to self-employed parents.
- Doubling Statutory Maternity and Shared Parental Pay to £350 a week.
- Increasing pay for paternity leave to 90% of earnings, with a cap for high earners.
- Introducing an extra use-it-or-lose-it month for fathers and partners, paid at 90% of earnings, with a cap for high earners.
- Requiring large employers to publish their parental leave and pay policies.
- Introducing a ‘Toddler Top-Up’: an enhanced rate of Child Benefit for one-year-olds.
“Introduce paid neonatal care leave.
NS: Again interesting how their proposals are framed through the challenges for parents in the postnatal period, the need for funding and hints at retention plans which might affect loans. While looking for more flexibility they promise to clamp down on agencies, which for many midwives are a route to more flexibility. Focus on the parents and cost of living.
Reform
End Doctor and Nurse Shortages All frontline NHS and social care staff to pay zero basic rate tax for 3 years. This will help retain existing staff and attract many who have left to return. End training caps for all UK medical students. Write off student fees pro rata per year over 10 years of NHS service for all doctors, nurses and medical staff
Scrap Interest on Student Loans Extend loan capital repayment periods to 45 years. Restrict undergraduate numbers well below current levels, too many courses are not good enough and students are being ripped off. Enforce minimum entry standards.
Choice for Stay-at-Home Mums or Dads The majority of mothers would choose to stay at home more if they could. Front-loading the Child Benefit system for children aged 1-4 would give parents the choice to spend more time with their children.
NS: Whatever you think of Reform their offer is different and while most commentators would write these off there is in fact a lot of thinking behind the scenes discussion of change or leverage of loans to keep newly qualified in the NHS for years.
Plus the demand for maternity pay and time off work in year 1 is visible in lots of other think tanks. If there are over 250 women MP’s in the next parliament this kind of thinking could move mainstream.
A three-year basic tax holiday would be quite an incentive for return to midwifery. Unfortunately no one knows how it could be made to work, a classic populist idea not worked through.
Scottish National Party
Increase maternity pay by bringing the UK into line with other European countries and promoting shared parental leave.
Defend free university tuition in Scotland. The SNP is the only party that will protect students and defend free education, meaning graduates in Scotland are thousands of pounds better off.
Increase paid maternity leave to one year, with maternity pay set at 100% of average weekly earnings for the first 12 weeks, then 90% for 40 weeks or £185.00, whichever is lower. The UK Government should increase shared parental leave from 52 to 64 weeks, with the additional 12 weeks to be the minimum taken by the father on a ‘use it or lose it’ basis, in order to encourage an increase in shared parental leave.
NS: Again, the policy is framed increasingly through the first year for the parents with proposals on maternity leave and maternity pay. This is the most radical funding proposal.
Tuition fee policy again highlighted as a contested area and, if reform comes in England, expect the Scottish parliament to take the chance to change its policy.
Green Party
Green MPs will push for:
- A year-on-year reduction in waiting lists.
- Guaranteed access to an NHS dentist.
- Guaranteed rapid access to a GP and same day access in case of urgent need.
- An immediate boost to the pay of NHS staff, including the restoration of junior doctors’ pay, to help with staff retention.
To meet these aims, we estimate that the NHS in England will require additional annual expenditure of £8bn in the first full year of the next Parliament, rising to £28bn in total by 2030. Additional capital spending of at least £20bn is needed over the next five years for hospital building and repair.
NS: The Greens are limited in what they have to say on health services, which is not surprising since their core issue is pollution, climate change and the future health of the planet and the species on it, – except the birthrate and birth methods of the main species, humans, is a key determinant of future impacts on our world.
Plaid Cymru
“would increase the availability of degree apprenticeships
NS: While making some of the strongest commitments to NHS funding, working with unions, reducing waiting times increasing degree apprenticeships is the one policy that will impact professions like midwifery, and is already in training across the country.
You can see across all the manifestos that where maternity and midwifery is mentioned outside pay and shortages which are common to all, the areas for actions are framed through patient safety or through fiscal and maternal support in the first year.
Across all the manifestos it is interesting how they refer or don’t to the dominant issues of staff shortages, maternity enquiries or the toxic arguments about inclusive language.
Sometimes you can tell as much by what is missing as what is promised. If it’s missing it is not fully worked out or strongly contested. If it is missing, you can be sure that it will be a continuing and often painful conversation.
You have to decide what, on balance, works for you, meets your values even if it is not comfortable for your profession. But the one key thing is to vote for what you value.
Neil Stewart
Editorial Director, Maternity and Midwifery Forum & Matflix
July 2024