:00:07. > :00:09.Hello it's Tuesday it's 9.15, I'm Joanna Gosling in for Victoria,
:00:10. > :00:15.Will giving pregnant women their own personal budget
:00:16. > :00:17.so they can choose their own maternity care help
:00:18. > :00:25.That's one of the reccomendations in a new review?
:00:26. > :00:32.I'm the chair of the maternity review for England and one of the
:00:33. > :00:36.things we are determined, is that our services should be safer; that
:00:37. > :00:40.runs right through the report, and part of that is giving women choice
:00:41. > :00:42.and continuity with the person looking after them.
:00:43. > :00:45.Really keen to hear your experiences this morning, do get in touch
:00:46. > :00:50.Also on the programme - calls from some gun owners to have
:00:51. > :00:53.firearms legislation in this country relaxed.
:00:54. > :00:56.I have absolutely no intention ever of using a gun in a bad way.
:00:57. > :01:02.What people jump to is I own guns for the illicit reason and it's
:01:03. > :01:06.frustrating for me that you tell someone you own a gun and you're
:01:07. > :01:12.And - fur is back - and has featured on most
:01:13. > :01:16.of the runways and catwalks at London Fashion Week.
:01:17. > :01:33.We'll talk to one woman who stripped off in protest.
:01:34. > :01:36.Hello, welcome to the programme, we're on BBC 2 and the BBC
:01:37. > :01:49.A passenger train has derailed in the Netherlands. Reports say it
:01:50. > :02:00.collided with a hydraulic crane. We'll keep you up-to-date on that.
:02:01. > :02:05.Get in touch on all the stories we are talking about. Don't forget,
:02:06. > :02:09.texts will be charged at the standard network rate. And you can
:02:10. > :02:11.watch the programme online wherever you are via the news app or on the
:02:12. > :02:14.website. The NHS in England is to offer
:02:15. > :02:17.pregnant women their own "personal budgets", worth at least ?3,000,
:02:18. > :02:20.so they can pick and choose Mums-to-be will be able to use it
:02:21. > :02:26.to pay for anything from one-to-one midwifery care to home births,
:02:27. > :02:29.the use of birthing It's part of a shake up of maternity
:02:30. > :02:34.care to try and increase Really keen to hear
:02:35. > :02:39.from you this morning if you're pregnant, or have
:02:40. > :02:42.recently given birth, how much control did you have over
:02:43. > :02:45.the care you recieved? Do tell us what you think
:02:46. > :02:47.about these proposals. Our health correspondent
:02:48. > :02:59.Nick Triggle is here to talk us Tell us why this report has been
:03:00. > :03:02.done and what the aim is? This report essentially sets out the
:03:03. > :03:07.strategy for England for the next five years. It covers two issues;
:03:08. > :03:11.choice and safety. On choice it says women aren't always giving birth in
:03:12. > :03:15.the way they would like to. Nearly nine in ten women give birth in
:03:16. > :03:26.hospitals, when only a quarter say that's where they would want to be.
:03:27. > :03:33.So, half of women can give birth outside of hospitals, research
:03:34. > :03:37.suggests. The strategy has come up with a plan to empower women to
:03:38. > :03:41.exercise choice. At the heart is the idea of creating personal birth
:03:42. > :03:47.budgets, a similar concept to a system that's been used for care of
:03:48. > :03:53.the elderly, disabled an long-term illness such as heart disease. The
:03:54. > :03:57.NHS has said it will start piloting this scheme next year and full roll
:03:58. > :04:03.out will follow if the pilots work out. The budgets could be as much as
:04:04. > :04:08.?3,000. Women will be able to use these to pay for one-to-one
:04:09. > :04:12.midwifery care, home births or to pay for a birthing pool if they
:04:13. > :04:18.wish. They could also be used to provide support after birth for
:04:19. > :04:22.breast-feeding or hypnotherapy to relieve anxiety. What about the
:04:23. > :04:25.safety issues, how safe is giving birth in England? The authors are
:04:26. > :04:30.clear, they say it's never been safer. The number of Ne-Yo natal
:04:31. > :04:38.deaths and stillbirths has fallen by a fifth over the past decade. There
:04:39. > :04:42.are still problems. In one in 17 births, there are incidents that
:04:43. > :04:48.cause harm to either the baby or mother, nearly half of maternity
:04:49. > :04:52.services are rated inadequate or requiring improvement by inspectors
:04:53. > :04:57.when it comes to safety and each year, the NHS spends over ?500
:04:58. > :05:01.million on clinical negligence claims. So the report says there's
:05:02. > :05:06.still some way to go before there's world class services for all women.
:05:07. > :05:10.They make a number of recommendations to improve this,
:05:11. > :05:14.including improving data collection, doesn't always happen in every
:05:15. > :05:19.hospital. Ensuring a speedier referral when problems arise too, an
:05:20. > :05:20.creating a nationally agreed system for investigating mistakes within
:05:21. > :05:37.they do happen. This review makes the point that
:05:38. > :05:38.women don't give birth in the way they would like.
:05:39. > :05:40.We can talk again now to Baroness Julia Cumberlege,
:05:41. > :05:52.the Chair of the NHS England Maternity Services Review.
:05:53. > :06:00.James Titcombe also joins us. Baroness, first of all, the two
:06:01. > :06:07.issues being addressed in the report, how does giving mums-to-be
:06:08. > :06:09.more choice improve safety? We are absolutely conrinsed that --
:06:10. > :06:13.convinced that mothers when they have the choice can really have a
:06:14. > :06:17.better birth, a birth that they are planning, and that will aid safety.
:06:18. > :06:23.The other thing is that, one of the choices will be continuity of the
:06:24. > :06:29.person looking after them. We have been all over England talking to
:06:30. > :06:34.women and we have heard them say that they have had different people,
:06:35. > :06:37.one had 42 different people attending to her before and after
:06:38. > :06:43.the birth. That is very, very difficult. That is unsafe. If you
:06:44. > :06:45.have the person that you trust, the professional who really knows you,
:06:46. > :06:52.your family, and professional who really knows you,
:06:53. > :06:58.are likely to have much, much safer care. The most recent research that
:06:59. > :07:02.we have seen actually shows that. How often is a failure of care an
:07:03. > :07:06.we have seen actually shows that. issue? Of course, it's a failure
:07:07. > :07:08.every time, and you've got James here who's really suffered over the
:07:09. > :07:13.years through the loss of here who's really suffered over the
:07:14. > :07:18.Joshua, and I'm really sorry about that, but one of the things that
:07:19. > :07:22.people are telling us and thank you James, you introduced us to all
:07:23. > :07:25.sorts of people who've suffered, and it's a scar for life,
:07:26. > :07:29.sorts of people who've suffered, and to get over having lost a baby,
:07:30. > :07:37.especially if you know that it could have been avoided.
:07:38. > :07:40.especially if you know that it could James what do you think about the
:07:41. > :07:46.report? James what do you think about the
:07:47. > :07:48.recommendations that I whole heartedly endorse. I have some
:07:49. > :07:54.concerns about the voucher scheme and around this push to increase
:07:55. > :07:58.community births. I think the evidence-base for that, and there
:07:59. > :08:02.are some questions about it, so my strong advice is if we are going to
:08:03. > :08:07.do that, it's important to measure the right outcomes so the services
:08:08. > :08:08.the women are commissioning really understand where their quality and
:08:09. > :08:11.safety is and understand where their quality and
:08:12. > :08:17.transparent. We cautiously and monitor the outcomes
:08:18. > :08:21.to make sure the safety is there. Would greater choice have made a
:08:22. > :08:25.difference for you? Well, this is my thing, I've had three children, been
:08:26. > :08:29.through the process three times, very sadly one of them isn't here
:08:30. > :08:32.and if you ask me what was my priority, it would have been that
:08:33. > :08:36.the local service was safe, it was available and it was a learning
:08:37. > :08:42.culture and we were safe when we went there. So I am sceptical about
:08:43. > :08:47.whether this particular scheme is going to improve safety, but at the
:08:48. > :08:52.same time, I respect the need for women to make informed choices. In
:08:53. > :08:56.the end, isn't it about really good local care and making sure everyone
:08:57. > :09:01.has that as the absolute priority? Of course it is. That's what we are
:09:02. > :09:05.aiming for. We've got a lot of recommendations in the report, and
:09:06. > :09:10.this one on personal budgets is actually NHS money spent on NHS
:09:11. > :09:16.services and it's voluntary. We are not pushing women to have home
:09:17. > :09:19.births or births in midwife-led units, it's their choice. But having
:09:20. > :09:23.this particular money which comes from the Health Service which would
:09:24. > :09:28.have been spent on them any how, is going to give them more clout and
:09:29. > :09:33.enable them to get the choices they want. You say it's not a push
:09:34. > :09:38.towards home births, but it's being reported in some places as being
:09:39. > :09:42.exactly that, a way of saving money by pushing people towards home
:09:43. > :09:47.births? No, it's not that at all. In fact, it's the women who're pushing
:09:48. > :09:51.us to try and give them more choice and so this is a mechanism that we
:09:52. > :09:57.think could work and James is right, we need to monitor it and see how it
:09:58. > :10:01.does work. How does saying to somebody, right, you've got ?3,000we
:10:02. > :10:05.are not giving you the cash but you have ?3,000 to spend on the type of
:10:06. > :10:10.birth you want, how does saying that to somebody change the reality,
:10:11. > :10:14.because there is choice in some areas, isn't there, but in other
:10:15. > :10:17.areas, it's just the reality that the services aren't there, that
:10:18. > :10:21.won't be addressed? It's not so much that the services aren't there, it's
:10:22. > :10:24.very often that women are told, and they have told us, we have been
:10:25. > :10:29.right round England talking to women and we have met thousands. They have
:10:30. > :10:38.told us that often they are given the choice of two on stoat trick
:10:39. > :10:41.units, two hospital births -- obstetric. When the women make the
:10:42. > :10:45.choice and get special continuity of the person looking after them, it's
:10:46. > :10:49.going to be a safe and better service for those women. Laura
:10:50. > :10:53.Dunning from Wirral on Merseyside, has two children, her first was born
:10:54. > :10:57.in her local NHS hospital, her second was a home birth which she
:10:58. > :11:01.much preferred. Laura, tell us what you think about the review, you
:11:02. > :11:06.obviously have experienced choice in your two experiences there?
:11:07. > :11:11.Yes. I'm fortunate enough that I've had obviously two babies, one in an
:11:12. > :11:16.NHS hospital and my second was born at home. I'm fortunate enough that
:11:17. > :11:21.the postcode lottery means that I had continuity of care with
:11:22. > :11:27.one-to-one midwives, so from about six to eight weeks in, I had one
:11:28. > :11:32.midwife, she had a buddy midwife if she was unavailable or away and I
:11:33. > :11:36.had her right through until six weeks postnatal check-up when she
:11:37. > :11:41.signed me off. She was so in tune with me that from me phoning her at
:11:42. > :11:47.11. 30 at night when my waters broke to her hearing me at 2. 30 in the
:11:48. > :11:50.morning when my husband phoned her, she knew how my labour progressed
:11:51. > :11:55.just from that relationship we built up. As it happened, I was at home,
:11:56. > :12:01.much more comfortable, I had a birthing pool which, had I gone into
:12:02. > :12:04.an NHS hospital, our local unit only has two pools and there's no
:12:05. > :12:08.guarantee you would get that. I obviously wanted that, not to
:12:09. > :12:12.necessarily deliver my baby in, but for pain relief because the one
:12:13. > :12:16.thing I was adamant about second time around was that I didn't want
:12:17. > :12:20.any drugs. First time round my daughter was born unresponsive as a
:12:21. > :12:26.result of me having quite a lot of pain relief. That was my one big
:12:27. > :12:30.goal second time around - no drugs. I would like it to have been at
:12:31. > :12:34.home. If that hadn't have happened, it wouldn't have been the end of the
:12:35. > :12:38.world but I knew that my midwife knew me, my family, she came in,
:12:39. > :12:41.made me feel so comfortable, reassured and literally 40 minutes
:12:42. > :12:46.after she walked through the door, our son was born and that to me was
:12:47. > :12:52.so special that she had been on that journey with us and she knew not
:12:53. > :12:59.just me but my family and knew what we needed and wanted. She delivered
:13:00. > :13:03.everything. As I said, I didn't even need any pain relief with being at
:13:04. > :13:08.home. Two paracetamol was all it took. When things go right, ensuring
:13:09. > :13:11.someone has the best experience possible is the best possible thing
:13:12. > :13:18.that the maternity services can do for somebody like Laura, the review
:13:19. > :13:24.was really triggered about where things went terribly wrong. Looking
:13:25. > :13:29.at stillbirth statistics, half of the pregnant women in one review of
:13:30. > :13:33.stillbirths found that half of the women whose babies died had told
:13:34. > :13:37.medical staff they were worried there was an issue, and the baby
:13:38. > :13:42.wasn't moving in the womb and in half of those cases there was either
:13:43. > :13:46.no investigation or warning signs were ignored. How does that change
:13:47. > :13:53.in what you are looking at? Elle well, it does change, we hope.
:13:54. > :13:57.You can write a very good report but what really matters is the
:13:58. > :14:03.implementation. So we are determined that that should happen. But you are
:14:04. > :14:07.right... Why is it happening? Why are people being ignored? People are
:14:08. > :14:12.not listening to what women want and it's not just women, it's their
:14:13. > :14:17.families as well. We've had a lot of interviews with dads. It's really
:14:18. > :14:22.interesting to find out what dads feel about this. It's a seminal
:14:23. > :14:26.occasion. But it's not just about what women want, it's about when
:14:27. > :14:30.there is an issue highlighting it and it not being picked up? Of
:14:31. > :14:34.course, and that is up to the professionals, to make sure you have
:14:35. > :14:38.really close team work. One of the things we are very keen on, is that
:14:39. > :14:42.when people work together, they should train together and learn
:14:43. > :14:47.together. This is what we found in Sweden. We went to Sweden, to
:14:48. > :14:53.Holland and Denmark. We just know that we can do a lot better. So it
:14:54. > :14:58.is about how you formed the teams, how they work together and the data
:14:59. > :15:04.that they produce, that it's accurate and we also want to see a
:15:05. > :15:09.much more electronic system. We want records that are electronic for
:15:10. > :15:13.companies to share with a lot of people, the woman and her family, so
:15:14. > :15:17.that everybody knows what is going on and that we have a proper
:15:18. > :15:21.investigation when things do go wrong that is open, honest,
:15:22. > :15:25.thorough, and that the family is brought in on it.
:15:26. > :15:29.Do you have confidence in open investigations going forward? I
:15:30. > :15:34.think this has been an issue that's gone back a very long time and if
:15:35. > :15:37.you go back to the Bristol Report in 2001, a reck men daiingts of that
:15:38. > :15:42.was we must have a standardised system for learning when things go
:15:43. > :15:52.wrong. So the NHS hasn't got a very good record of putting this right --
:15:53. > :15:55.the recommendations of that. In terms of data and transparency,
:15:56. > :15:59.there is the need for getting recommendations right, they have to
:16:00. > :16:04.be the right recommendations. They were similar to what Bill Kirk Hall
:16:05. > :16:08.made a year ago so it's taking a long time. Let's implement this and
:16:09. > :16:10.make sure the changes happen so we are not sat having a similar
:16:11. > :16:24.conversation in 12 months. Receive Sarah in a text message says a few
:16:25. > :16:29.days after a traumatic birth and I am still recovering. Another one
:16:30. > :16:34.says, I don't think I was given any choice over my antenatal care, I
:16:35. > :16:38.feel like it is my fifth child and not my first.
:16:39. > :16:44.Carol on Twitter says you can only have a choice in a system if there
:16:45. > :16:51.is spare capacity. Maternity units are turning people away because of
:16:52. > :16:56.the shortage of midwives. How is this gimmick rubbish supposed to
:16:57. > :17:01.help? There are about 2500 midwives on the maternity list, and nursing
:17:02. > :17:09.midwifery Council 's list. They are not practising and they are not
:17:10. > :17:14.working. Why is that? Some of them, it is family reasons and things like
:17:15. > :17:17.that, but a lot of them, they don't like working in the NHS and they
:17:18. > :17:25.don't have autonomy over their work. Whether it is good teamwork and it
:17:26. > :17:30.is not appreciated. A lot more would want to come back. We are also
:17:31. > :17:36.supporting maternity practices. What if they don't, is there going to be
:17:37. > :17:42.enough in terms of resources to make the difference? We have put in bids
:17:43. > :17:47.for some more funding, but we have to be more careful. At the moment,
:17:48. > :17:53.in maternity services, we are spending over 4.7 billion on
:17:54. > :17:58.maternity services. Nobody can tell me every single penny of that is
:17:59. > :18:04.well spent. I am sure if we had different ways of working, we can be
:18:05. > :18:07.much more efficient and also more caring, more professional and
:18:08. > :18:18.ensuring women get what they want. Thank you very much. Baroness and
:18:19. > :18:21.James, thank you for joining us. Later in the programme we will get
:18:22. > :18:34.more reaction to the review from new mums. So do get in touch.
:18:35. > :18:37.London Fashion Week has put fur and the debate over wearing it back
:18:38. > :18:57.The main news this morning. stripped off in protest.
:18:58. > :19:00.The NHS is being urged to give pregnant women in England a personal
:19:01. > :19:02.budget of around three thousand pounds to choose
:19:03. > :19:06.This could mean that women might pick a hospital near their work
:19:07. > :19:10.for routine scans, and a different one near their home to give birth.