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Health and Social Care Bill

I hope that the Committee will think it right to debate this and the subsequent two clauses in the round and, in doing so, to examine the rationale for the policy that they embody. Perhaps I should begin by making it clear that I do not oppose these clauses. I am the first to recognise that health in pregnancy is an extremely important issue. However, some fundamental questions need to be asked about why the Government have chosen to do precisely what they are now doing in this part of the Bill. The health in pregnancy grant is to be a non-means-tested, non-taxable benefit, payable to all expectant mothers who have reached a specified stage of their pregnancy and who have received advice about their health from a health professional. When the current Prime Minister first announced the policy in December 2006, he said: "““I have received powerful representations that in the last months of pregnancy, when nutrition is most important, and in the first weeks after birth, the extra costs borne by parents could be better recognised if we did more to help through the universal benefit””.—[Official Report, Commons, 6/12/06; col. 308.]" At that time, it was planned to make the grant an extension of child benefit, but the rationale for introducing it was specifically focused on maternal nutrition and the extra costs of having a child. The Pre-Budget Report of 2006 said: "““The Government recognises the importance of a healthy diet in the final weeks of pregnancy””." The Secretary of State for Health reannounced the grant in a speech at Toynbee Hall last September. He said: "““This substantial payment will be directly linked to improving nutrition, so it will be paid alongside nutritional advice, and the sum of money will be sufficient to help every mother eat healthily during her pregnancy””." That was odd. If one looks at the evidence about the effect of maternal diet on the health of the unborn baby, it tells us something very different. In 2002, the Committee on Medical Aspects of Food and Nutrition Policy published a review of the welfare food scheme. It said: "““Although it has been argued that maternal nutrition during pregnancy has an important effect on foetal growth (Barker 1992) evidence of a relationship in generally well nourished populations like that of the UK is inconclusive … the relationship between dietary factors during pregnancy, outcome and birth weight””," is, "““not strong””." The review also notes: "““There are no national data on the dietary intakes of pregnant women””." My first question to the Minister is what evidence the Prime Minister relied on when he stated that nutrition in the last months of pregnancy was ““most important””. The evidence that I have seen is rather different. One of the conclusions of the report to which I have just referred was that, "““improving the dietary intake of women of childbearing age has the potential to ensure that the nutritional status at conception is adequate to support optimum foetal development ... There is clear evidence that women are nutritionally vulnerable before conception””." That conclusion was endorsed by Rosemary Dodds of the National Childbirth Trust in her oral evidence to the Public Bill Committee in another place. Why, therefore, did the Secretary of State say that the health in pregnancy grant would be directly linked to improving nutrition and receiving advice about nutrition? The truth is that giving advice to women at the 25th week of pregnancy about diet, and paying her money to follow up that advice, is unlikely to have any measurable effect on the health of babies. The original policy justification looks very weak indeed. Since last September it is noticeable that Ministers have been rowing back quite strenuously from the nutritional arguments. A Written Answer in the other place last December was all of a sudden more vague and general, referring to, "““the important last weeks of pregnancy””," and saying that the grant, "““recognises the additional costs involved during pregnancy and in the run-up to birth””.—[Official Report, Commons, 17/12/07; col. 1124W.]" We are therefore now in rather different territory. The justification for the grant given by the Minister in another place, Mr Bradshaw, when he spoke to the Public Bill Committee, was that it would help women to ““make essential purchases”” before the baby’s arrival. He cited research from St Thomas’s Hospital that shows that women suffer more stress over money worries during the later stages of pregnancy. He said: "““Specialists say that it is important to reduce stress to avoid risking complications in pregnancy””.—[Official Report, Commons, Health and Social Care Bill Committee, 24/1/08; col. 461.]" I do not think that anyone could disagree that women with financial worries are cheered up by having a dollop of money put in their hands by the taxpayer. But value-for-money considerations come into play. If you are setting out to relieve financially related stress, surely you do that by targeting money at those who need it. I am sure that there are many women who in late pregnancy would welcome a little more help in paying the bills, but by no means every pregnant woman needs that sort of help. If the Government had spoken of the need to reduce health inequalities and then created a grant directed at poorer and less healthy sections of society, that would have been much easier to understand. Sure Start maternity grants are already available to low-income mothers and those grants could perhaps have been enhanced in some way. But the Government have not made that argument. The HIP grant will be universal. Therefore, the question raised by the policy is whether the Minister is satisfied that the grant represents value for money in terms of the health benefit that it will confer on better-off women. How will paying a lump sum of £190 to a woman on an average income or a higher-than-average income deliver benefits to society that are commensurate with the aggregate cost to the taxpayer? If the Government believe that there are likely to be such benefits, what are they and how will they be measured? New policy has to be evidence-based. The evidence is that this grant cannot be justified in terms of its nutritional benefits, as was originally claimed. It cannot be justified in terms of improving health in pregnancy, other than in the loosest possible way. Nor can it be justified in terms of being a grant that will be targeted on the less well-off. We are therefore left with a rather nagging question: why are the Government doing what they are doing? I am sure that every pregnant woman can benefit from advice about healthy lifestyles—avoiding smoking and excessive alcohol consumption are the obvious examples—but do we need to pay them a grant in giving that advice? It could be given, and usually is, by health visitors and midwives during the ordinary course of their work. The King’s Fund has called the measure ““silly””. I am not sure that I am in a position to agree or disagree with that assessment, as I still need a better understanding of what the Government hope to get out of the policy. Rosemary Dodds of the NCT put it well in her evidence to the Public Bill Committee when she said: "““I think it is important to be clear about the intent in order to evaluate the impact … you cannot be evidence-based unless you have a reason for doing things””.—[Official Report, Commons, Health and Social Care Bill Committee, 10/1/08; col. 87.]" What is the Government’s intent? Please can we have a clearer idea of their reasons?