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Health and Social Care Bill

I am not disagreeing with that—there is no doubt that the cash will get to people. My argument concerns how the cash will be used and whether it will actually deliver the health outcomes that Ministers are saying it will. I turn to the timing issue and why there is this focus on such a late stage of pregnancy—the 25th week. That approach conflicts with a lot of expert opinion and practical wisdom out there regarding ensuring the well-being of a pregnant woman for the whole term of her pregnancy. Tam Fry, director of the Child Growth Foundation, was quoted in The Observer when this policy was announced as saying:"““By the time a woman falls pregnant, she already needs to be eating well””." Daghni Rajasingam, speaking on behalf of the Royal College of Obstetricians and Gynaecologists, said at the time:"““If a woman is not already eating a healthy diet by that stage””—" the 25th week—"““then encouraging them to eat more fruit and vegetables””" from 25 weeks"““is too late...Even for small babies it is too late, there is very little you can do to increase growth at that stage.””" So the emphasis on the 25th week is entirely misplaced. The Government should be stressing the need for pregnant women to learn good lifestyle and well-being habits and to unlearn some bad habits, such as those related to smoking and alcohol, at the earlier stages of pregnancy. I do not remember much of my National Childbirth Trust classes before my first child was born, but I do remember two things. I remember the women being separated from the boyfriends and husbands at the very first meeting, and the men being put to one side and given a game to play. We were given a diagram of a female body and about 25 labels, and we were asked whether, as a group, we could label a woman's body correctly. I think that we scored under 75 per cent., which suggests that men should tread carefully when talking about such issues. I also remember the emphasis that was put at the very outset of those classes on the importance of diet and good lifestyle. There was no discussion of the 25th week and of getting one's act together at a late stage of pregnancy; the focus was always on sorting out the issues—giving up smoking, cutting down on alcohol, watching what one eats and eating good quantities of fruit and vegetables each week—from the very start. So the focus on 25 weeks is misplaced. I want in a very gentle way to raise with the Minister a question that is not purely hypothetical. There is some discussion in all parts of the House of the termination of pregnancies at this time, and whether there is a need to look again at the upper-term limit and to reduce it. What would happen if, the two Houses in this Parliament being willing, the upper-term limit were reduced to, say, 22 weeks? Would there be a need, therefore, to move the timing of the cash payment back, in line with that? If not, in theory a pregnant woman could legally make a claim for the grant and also legally terminate a pregnancy. I am talking very hypothetically, but I would welcome a response from the Minister because termination limits is a live discussion. The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) spoke about the meeting with a health professional that a pregnant woman would need to have in order to claim this grant. I share her vision of how that would work in practice. She talked about an ongoing dialogue involving giving advice to pregnant women about diet and lifestyle choices, for example. However and as I said in an intervention, the Bill, which is vague on detail, does not provide for that. Rather, it refers to a woman receiving "““advice on matters relating to maternal health from a health professional””." She will have had that, anyway, from her health visitor or GP, so I do not see how we get from the Bill to the idea put forward by the hon. Lady, which I support, of an ongoing interface between the pregnant woman and a medical professional about diet and healthy choices. I turn to how the scheme will be administered. We know that it will be delivered through Her Majesty's Revenue and Customs—this huge, sprawling, merged Department that, as we now know, is beset with operational difficulties. If we did not need any other reminders, the events of last week have shown that yet again. However, there is another experience involving HMRC that is relevant here—that of tax credits. We all know from our constituency surgeries the number of people who are having to pay back money that the Treasury is clawing back as a result of overpayments. We know that when many people are given up-front payments, they spend them—that is in the nature of things. Those on low incomes or facing pressing expenditure needs, in particular, will spend them. Where is the evidence to suggest that a pregnant woman will use this one-off cash payment of the health and pregnancy grant in a planned way to meet their ongoing dietary needs and to ensure that they can pay for good-quality fresh fruit and vegetables? Will not human instinct take over if this money is paid in a one-off lump sum? The Secretary of State has talked outside this Chamber about the ““broccoli police””, who will not be coming round to check that all the money is being spent on what it is intended for. However, it is worth asking whether this money will just get burned up very quickly and will not be used in the way that Ministers intended. To conclude on this point, the Government are proposing to spend a significant sum—£120 million—and if one accepts the line from the Royal College of Midwives, that figure will increase significantly in the years to come. In the absence of any effective strategy for well-being during pregnancy or any prioritisation in respect of poorer women or women from areas where there is a higher incidence of diet-related problems, and when the maternity services of many communities are being eroded, could the money be put to better use? To my eyes, this is more part of a political strategy than a health one, and to many people it smacks of the Government trying to create a new tier and category of cash-receiving clients of central Government. There is room for contention and vigorous debate on this measure. On the national child measurement programme, the hon. Member for Caernarfon (Hywel Williams) knows that I am not the greatest devolutionist in this place, but I support the measures in the Bill to extend powers to Ministers in the National Assembly for Wales to introduce a similar scheme in Wales to the one that has been running in England and to bring it in line with the changes that will be introduced in England for measuring the height and weight of children with a view to feeding the information into body mass index calculations. Wales has a significant and growing problem of childhood obesity. It is not a new phenomenon. Ten years ago, groups of general practitioners in Wales were warning that an epidemic of childhood obesity was about to hit Wales. In the past eight years, since the establishment of the National Assembly for Wales, which has responsibility for these issues, precious little substantive action has been taken to tackle childhood obesity in Wales. I welcome this measure in the Bill. If it enables, and provides more tools to, Health Ministers in the Assembly to tackle childhood obesity, it has my support. I was excited to see the small section on social enterprise in the Bill. Some years before being elected to this place, I was involved in setting up a social enterprise in south London. It was attached to a large mental health charity working with people from the African and Caribbean communities. The idea was to create a social enterprise using some of this charity's clients in producing high quality frozen African and Caribbean food to sell to national health service primary care trusts, which were demanding such food as they moved towards having more ethnic choice in the meals that they provided. We faced huge hurdles in setting up the social enterprise. Trying to do business with PCTs, get contracts and negotiate all the different hurdles that we had to clear was a time-consuming and expensive process. We benefited from the fact that a PCT supported what we were trying to do, shared the vision of the social enterprise and put its resources behind it. If, as I understand it, the measures in the Bill will extend such provision, give more direction to it and enable far more social enterprises to crop up in the health and social care field, that can only be a good thing, because this is a rich environment for social enterprises. It would be good to hear from Ministers about their vision for social enterprise and how it can contribute to health and social care.