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Health and Social Care Bill

I declare an interest as a patron of the National Childbirth Trust. It is an amazing organisation, with 72,000 members across the UK. It states in its response to the Government’s proposals that it strongly supports a universal benefit for the following reasons. First, a universal benefit has high take-up rates. Child benefit reaches more children living in poverty than any other benefit or tax credit. The trust cites, secondly, ease of administration. Universal benefits have fewer administrative or technical difficulties than means-tested benefits or tax credits. It mentions, thirdly, avoidance of the poverty trap. Increases in universal benefits benefit low-income families directly, as they are not offset against child tax credits and do not vary according to work opportunities. Those arguments are valid, but I share my noble friend’s view that the money should be targeted at those most in need. The Government’s intention to reduce inequalities in health is valid, but is this really a good use of public money? Are we getting value for it or would it be better if it were targeted? As my noble friend said, the Government have to be explicit about how they intend to achieve the benefits from the grant. I listened to the noble Baroness, Lady Finlay, and my noble friend. There seems to be an extraordinary conflict and lack of evidence. Scientists seem not to be sure about nutritional benefits to the mother and particularly to the baby. I have taken advice from Professor Martin Wiseman from the Institute of Human Nutrition at the University of Southampton. He explained to me in detail how very slim is any evidence and that what there is seems to be conflicting. I go back to my noble friend’s question: what really is the purpose of the grant? The National Childbirth Trust also questions the idea of a lump sum. It sets out clearly the benefits of regular payments versus a lump sum. It states in its response to the proposals: "““Child benefit is paid weekly or monthly directly to the mother. This means that women can rely on it as a regular supplement to the household income for the payment of day-to-day expenses such as food and fuel costs. A lump sum would appear less likely to be used for weekly or daily costs, including food, and more likely to be spent on one-off payments for larger items. Following a recent visit to Australia, Professor Debra Bick of Thames Valley University informed the NCT that in Australia single payments to parents in pregnancy have been coined ‘plasma payments’ as they are typically used to purchase flat-screen TVs””." When women receive the money—and one of the great benefits is that it goes straight into the mother’s purse, which is important—I do not want to be judgmental as to how they spend it. But if the purpose is really so that pregnant women can buy buggies or whatever other equipment they want for the baby, the Government need to be clear on that and tell us exactly why they are introducing this grant. On the point raised by the noble Baroness, Lady Howarth, I have reservations about the idea that you cannot get a grant until you have had advice. We know that some of the most disadvantaged women are very late in presenting to antenatal clinics. They get a double disadvantage in that they do not get the grant and they do not have antenatal care. It is interesting that the NCT says: "““The text of the Bill refers to the women receiving ‘advice on matters relating to maternal health from a health professional’. The NCT and the relevant health professional bodies””—" and here they include the Royal College of General Practitioners and the Royal College of Midwives— "““pointed out when the Healthy Start vouchers were planned, that these health professionals were not experts in tailoring dietary advice to individuals and would need additional training. This was promised, in line with the implementation of the Healthy Start scheme, but never delivered””." The NCT recommends that, "““the Government commits ring-fenced funding alongside introduction of the Health in Pregnancy grant to nutrition training for health professionals””." I have reservations about the grant. I am delighted that pregnant women should have their income increased, as clearly it is a time when expenses go up and income often reduces. Women stop working and in many cases only for a short period do they get their salaries or other income redressed by the company that employs them. I should like to ask about the amount. I know that it is part of regulations, but I should like to understand what sort of sum the Government are considering. New Section 140B(2) says: "““Different amounts may be prescribed in relation to different cases””." What does that mean? Does it mean that there is some sort of means test, or is it simply a lump sum for a particular amount that will go to every woman?