Mythical NHS maternity money

Funding promised by the Government to improve poor standards of care for mothers and newborn babies is failing to reach maternity units, The Times has learnt. A survey of NHS trusts has showed that nine out of ten cannot identify their share of the $660 million pledged by ministers. Leading midwives and doctors say the money could be lost on the NHS balance sheet or spent on other services because it has not been properly ring-fenced. Despite record increases in spending on the health service by Labour, critics maintain that the money is still not reaching the areas most in need of reform.

Alan Johnson, the Health Secretary, announced the extra spending over the next three years in January, following several critical reviews of maternity services by the Healthcare Commission, which is the NHS regulator. "From April 2008, trusts have access to this additional money," he said.

Rising birth rates and a shortage of midwives have put huge pressure on the system, meaning mothers are often left without care during labour.

The Times submitted questions under the Freedom of Information Act to all 152 Primary Care Trusts (PCTs) in England, the local bodies that distribute 70 per cent of the total NHS budget. Of 85 trusts who responded, only eight claimed to have received additional funding for maternity this year as Mr Johnson promised. The extra money was for the implementation of "Maternity Matters", a policy that recommends that every woman giving birth in England should have one-to-one care from a dedicated midwife. Ministers also aim to give greater choice over where babies are born, with more home births and deliveries in local units staffed by midwives rather than hospital consultants expected as a result.

One head of midwifery in the South West, who did not wish to be named, said: "Despite all of the Government's announcements, we have not seen any of this additional funding. "All the staff are aware of this additional funding and expecting to see changes and improvements in maternity service provision, but I have not seen any of the money." Instead, healthcare staff have to bid for the extra funds and have had no reassurances on how it would be spent.

Louise Silverton, deputy general secretary of the Royal College of Midwives (RCM), said that new mothers would still face a postcode lottery in the quality of care as a result. "It is not enough for the Government to say they have put money into maternity services, but then fail to make sure the money actually goes where it is supposed to. "Women keep hearing these excellent policy statements, such as one-to-one care from a midwife, but they are not getting that sort of treatment in many areas." Overall, NHS spending on maternity in England was cut by $110 million in 2006-07, while the birth rate has risen 16 per cent since 2001, she said. "Some trusts have managed to increase their spending but for the most part we don't know what PCTs are spending the money on, there's a lack of transparency."

Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, added: "Extra funds have been promised to improve maternity services and it is important for these to be ring-fenced within each trust. "NHS managers, clinical directors and head of services must present a case to their PCTs in order to secure more funds for their units." The RCM estimates that 5,000 extra midwives need to be recruited urgently, but the Government has promised only 3,400 full-time posts.

Of those surveyed, 33 trusts (38 per cent) could specify a figure for their projected spending on maternity services in 2008-09, but this was estimated from increases in their total budgets or from local plans agreed prior to the Government's investment. Asked what the money was being spent on, trusts' answers varied from specific numbers of posts for midwives and maternity support workers to more general promises to "increase midwifery capacity" or programmes such as sexual health services, breast-feeding support or smoking cessation for pregnant women.

"These are softer areas of care that do not address the core issue of staffing shortages," Miss Silverton added. "Large numbers of midwives are due to retire in the next few years and maternity support workers should not be used to substitute for them."

Anne Milton, a Conservative MP, added: "This Government has been more concerned with getting a good headline than delivering the services that patients need. It is unacceptable that at a time when the NHS is reporting record surpluses of nearly $4 billion that this funding is not reaching the front line, where it is so desperately needed by new mothers and their children."

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Waiting in pain

For women like Clare Payne, who experience complications during pregnancy, childbirth can be an agonising experience. Mrs Payne, 23, gave birth to her first son Harry in 2006 with few problems, but his brother Finley's birth last September was delayed repeatedly owing to a shortage of staff and beds.

At 18 weeks she developed SPD, a condition that causes pressure on the pelvis and extreme pain. Doctors said that she should be induced at 37 weeks, but when she arrived at hospital she was promptly sent home because there were not enough staff. "I was told I was a priority case, but every time I contacted the ward I was told I would have to wait hours, if not days."

Mrs Payne, a sales assistant from St Leonards, East Sussex, returned to hospital at least three more times. Finally she elected to have a Caesarean section after waiting for more than two weeks. "It was a totally disgusting way to treat a heavily pregnant woman," she said.

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