23/02/2016 Victoria Derbyshire

Hello it's Tuesday it's 9.15, I'm Joanna Gosling in for Victoria,

Will giving pregnant women their own personal budget

so they can choose their own maternity care help

That's one of the reccomendations in a new review?

I'm the chair of the maternity review for England and one of the

things we are determined, is that our services should be safer; that

runs right through the report, and part of that is giving women choice

and continuity with the person looking after them.

Really keen to hear your experiences this morning, do get in touch

Also on the programme - calls from some gun owners to have

firearms legislation in this country relaxed.

I have absolutely no intention ever of using a gun in a bad way.

What people jump to is I own guns for the illicit reason and it's

frustrating for me that you tell someone you own a gun and you're

And - fur is back - and has featured on most

of the runways and catwalks at London Fashion Week.

We'll talk to one woman who stripped off in protest.

Hello, welcome to the programme, we're on BBC 2 and the BBC

A passenger train has derailed in the Netherlands. Reports say it

collided with a hydraulic crane. We'll keep you up-to-date on that.

Get in touch on all the stories we are talking about. Don't forget,

texts will be charged at the standard network rate. And you can

watch the programme online wherever you are via the news app or on the

website. The NHS in England is to offer

pregnant women their own "personal budgets", worth at least ?3,000,

so they can pick and choose Mums-to-be will be able to use it

to pay for anything from one-to-one midwifery care to home births,

the use of birthing It's part of a shake up of maternity

care to try and increase Really keen to hear

from you this morning if you're pregnant, or have

recently given birth, how much control did you have over

the care you recieved? Do tell us what you think

about these proposals. Our health correspondent

Nick Triggle is here to talk us Tell us why this report has been

done and what the aim is? This report essentially sets out the

strategy for England for the next five years. It covers two issues;

choice and safety. On choice it says women aren't always giving birth in

the way they would like to. Nearly nine in ten women give birth in

hospitals, when only a quarter say that's where they would want to be.

So, half of women can give birth outside of hospitals, research

suggests. The strategy has come up with a plan to empower women to

exercise choice. At the heart is the idea of creating personal birth

budgets, a similar concept to a system that's been used for care of

the elderly, disabled an long-term illness such as heart disease. The

NHS has said it will start piloting this scheme next year and full roll

out will follow if the pilots work out. The budgets could be as much as

?3,000. Women will be able to use these to pay for one-to-one

midwifery care, home births or to pay for a birthing pool if they

wish. They could also be used to provide support after birth for

breast-feeding or hypnotherapy to relieve anxiety. What about the

safety issues, how safe is giving birth in England? The authors are

clear, they say it's never been safer. The number of Ne-Yo natal

deaths and stillbirths has fallen by a fifth over the past decade. There

are still problems. In one in 17 births, there are incidents that

cause harm to either the baby or mother, nearly half of maternity

services are rated inadequate or requiring improvement by inspectors

when it comes to safety and each year, the NHS spends over ?500

million on clinical negligence claims. So the report says there's

still some way to go before there's world class services for all women.

They make a number of recommendations to improve this,

including improving data collection, doesn't always happen in every

hospital. Ensuring a speedier referral when problems arise too, an

creating a nationally agreed system for investigating mistakes within

they do happen. This review makes the point that

women don't give birth in the way they would like.

We can talk again now to Baroness Julia Cumberlege,

the Chair of the NHS England Maternity Services Review.

James Titcombe also joins us. Baroness, first of all, the two

issues being addressed in the report, how does giving mums-to-be

more choice improve safety? We are absolutely conrinsed that --

convinced that mothers when they have the choice can really have a

better birth, a birth that they are planning, and that will aid safety.

The other thing is that, one of the choices will be continuity of the

person looking after them. We have been all over England talking to

women and we have heard them say that they have had different people,

one had 42 different people attending to her before and after

the birth. That is very, very difficult. That is unsafe. If you

have the person that you trust, the professional who really knows you,

your family, and professional who really knows you,

are likely to have much, much safer care. The most recent research that

we have seen actually shows that. How often is a failure of care an

we have seen actually shows that. issue? Of course, it's a failure

every time, and you've got James here who's really suffered over the

years through the loss of here who's really suffered over the

Joshua, and I'm really sorry about that, but one of the things that

people are telling us and thank you James, you introduced us to all

sorts of people who've suffered, and it's a scar for life,

sorts of people who've suffered, and to get over having lost a baby,

especially if you know that it could have been avoided.

especially if you know that it could James what do you think about the

report? James what do you think about the

recommendations that I whole heartedly endorse. I have some

concerns about the voucher scheme and around this push to increase

community births. I think the evidence-base for that, and there

are some questions about it, so my strong advice is if we are going to

do that, it's important to measure the right outcomes so the services

the women are commissioning really understand where their quality and

safety is and understand where their quality and

transparent. We cautiously and monitor the outcomes

to make sure the safety is there. Would greater choice have made a

difference for you? Well, this is my thing, I've had three children, been

through the process three times, very sadly one of them isn't here

and if you ask me what was my priority, it would have been that

the local service was safe, it was available and it was a learning

culture and we were safe when we went there. So I am sceptical about

whether this particular scheme is going to improve safety, but at the

same time, I respect the need for women to make informed choices. In

the end, isn't it about really good local care and making sure everyone

has that as the absolute priority? Of course it is. That's what we are

aiming for. We've got a lot of recommendations in the report, and

this one on personal budgets is actually NHS money spent on NHS

services and it's voluntary. We are not pushing women to have home

births or births in midwife-led units, it's their choice. But having

this particular money which comes from the Health Service which would

have been spent on them any how, is going to give them more clout and

enable them to get the choices they want. You say it's not a push

towards home births, but it's being reported in some places as being

exactly that, a way of saving money by pushing people towards home

births? No, it's not that at all. In fact, it's the women who're pushing

us to try and give them more choice and so this is a mechanism that we

think could work and James is right, we need to monitor it and see how it

does work. How does saying to somebody, right, you've got ?3,000we

are not giving you the cash but you have ?3,000 to spend on the type of

birth you want, how does saying that to somebody change the reality,

because there is choice in some areas, isn't there, but in other

areas, it's just the reality that the services aren't there, that

won't be addressed? It's not so much that the services aren't there, it's

very often that women are told, and they have told us, we have been

right round England talking to women and we have met thousands. They have

told us that often they are given the choice of two on stoat trick

units, two hospital births -- obstetric. When the women make the

choice and get special continuity of the person looking after them, it's

going to be a safe and better service for those women. Laura

Dunning from Wirral on Merseyside, has two children, her first was born

in her local NHS hospital, her second was a home birth which she

much preferred. Laura, tell us what you think about the review, you

obviously have experienced choice in your two experiences there?

Yes. I'm fortunate enough that I've had obviously two babies, one in an

NHS hospital and my second was born at home. I'm fortunate enough that

the postcode lottery means that I had continuity of care with

one-to-one midwives, so from about six to eight weeks in, I had one

midwife, she had a buddy midwife if she was unavailable or away and I

had her right through until six weeks postnatal check-up when she

signed me off. She was so in tune with me that from me phoning her at

11. 30 at night when my waters broke to her hearing me at 2. 30 in the

morning when my husband phoned her, she knew how my labour progressed

just from that relationship we built up. As it happened, I was at home,

much more comfortable, I had a birthing pool which, had I gone into

an NHS hospital, our local unit only has two pools and there's no

guarantee you would get that. I obviously wanted that, not to

necessarily deliver my baby in, but for pain relief because the one

thing I was adamant about second time around was that I didn't want

any drugs. First time round my daughter was born unresponsive as a

result of me having quite a lot of pain relief. That was my one big

goal second time around - no drugs. I would like it to have been at

home. If that hadn't have happened, it wouldn't have been the end of the

world but I knew that my midwife knew me, my family, she came in,

made me feel so comfortable, reassured and literally 40 minutes

after she walked through the door, our son was born and that to me was

so special that she had been on that journey with us and she knew not

just me but my family and knew what we needed and wanted. She delivered

everything. As I said, I didn't even need any pain relief with being at

home. Two paracetamol was all it took. When things go right, ensuring

someone has the best experience possible is the best possible thing

that the maternity services can do for somebody like Laura, the review

was really triggered about where things went terribly wrong. Looking

at stillbirth statistics, half of the pregnant women in one review of

stillbirths found that half of the women whose babies died had told

medical staff they were worried there was an issue, and the baby

wasn't moving in the womb and in half of those cases there was either

no investigation or warning signs were ignored. How does that change

in what you are looking at? Elle well, it does change, we hope.

You can write a very good report but what really matters is the

implementation. So we are determined that that should happen. But you are

right... Why is it happening? Why are people being ignored? People are

not listening to what women want and it's not just women, it's their

families as well. We've had a lot of interviews with dads. It's really

interesting to find out what dads feel about this. It's a seminal

occasion. But it's not just about what women want, it's about when

there is an issue highlighting it and it not being picked up? Of

course, and that is up to the professionals, to make sure you have

really close team work. One of the things we are very keen on, is that

when people work together, they should train together and learn

together. This is what we found in Sweden. We went to Sweden, to

Holland and Denmark. We just know that we can do a lot better. So it

is about how you formed the teams, how they work together and the data

that they produce, that it's accurate and we also want to see a

much more electronic system. We want records that are electronic for

companies to share with a lot of people, the woman and her family, so

that everybody knows what is going on and that we have a proper

investigation when things do go wrong that is open, honest,

thorough, and that the family is brought in on it.

Do you have confidence in open investigations going forward? I

think this has been an issue that's gone back a very long time and if

you go back to the Bristol Report in 2001, a reck men daiingts of that

was we must have a standardised system for learning when things go

wrong. So the NHS hasn't got a very good record of putting this right --

the recommendations of that. In terms of data and transparency,

there is the need for getting recommendations right, they have to

be the right recommendations. They were similar to what Bill Kirk Hall

made a year ago so it's taking a long time. Let's implement this and

make sure the changes happen so we are not sat having a similar

conversation in 12 months. Receive Sarah in a text message says a few

days after a traumatic birth and I am still recovering. Another one

says, I don't think I was given any choice over my antenatal care, I

feel like it is my fifth child and not my first.

Carol on Twitter says you can only have a choice in a system if there

is spare capacity. Maternity units are turning people away because of

the shortage of midwives. How is this gimmick rubbish supposed to

help? There are about 2500 midwives on the maternity list, and nursing

midwifery Council 's list. They are not practising and they are not

working. Why is that? Some of them, it is family reasons and things like

that, but a lot of them, they don't like working in the NHS and they

don't have autonomy over their work. Whether it is good teamwork and it

is not appreciated. A lot more would want to come back. We are also

supporting maternity practices. What if they don't, is there going to be

enough in terms of resources to make the difference? We have put in bids

for some more funding, but we have to be more careful. At the moment,

in maternity services, we are spending over 4.7 billion on

maternity services. Nobody can tell me every single penny of that is

well spent. I am sure if we had different ways of working, we can be

much more efficient and also more caring, more professional and

ensuring women get what they want. Thank you very much. Baroness and

James, thank you for joining us. Later in the programme we will get

more reaction to the review from new mums. So do get in touch.

London Fashion Week has put fur and the debate over wearing it back

The main news this morning. stripped off in protest.

The NHS is being urged to give pregnant women in England a personal

budget of around three thousand pounds to choose

This could mean that women might pick a hospital near their work

for routine scans, and a different one near their home to give birth.