Shake-up of perverse NHS ‘incentives’ in drive to curb caesareans
Plans to reduce the number of caesarean deliveries and give women greater access to home births are being considered by ministers. They want to remove incentives that see hospitals paid extra for surgical births, with or without complications. The payments mean that one in four babies is delivered by caesarean section – almost double the World Health Organisation’s recommended rate.
At around 155,000 babies last year, the figure is three times that of 1980 and one that flies in the face of efforts by the last government to encourage natural births.
Ministers say they do not want to ‘demonise’ C-sections or discourage doctors from performing them when clinically necessary. But they believe that equalising NHS payments for all kinds of birth, including those at home, could help bring down the number of surgical procedures. Extra costs of caesarean sections for high-risk patients will still be covered.
The Royal College of Midwives has expressed concern over the fact that the proportion of caesarean births is 15 per cent in some parts of the country while hitting 33 per cent in others. Although unplanned caesarean births can be life-saving, planned surgery is recognised as riskier.
Mothers are more likely to develop complications such as blood clots and spend twice as long in hospital as those having a natural delivery.
Infants delivered by C-section are more likely to suffer breathing difficulties and asthma.
The WHO recommends the level of caesareans should be 10-15 per cent, well below the 25 per cent rate now seen in England.
Another reason for more C-sections is the growing numbers of obese women who need surgery for their baby’s safety. Other women are said to elect the procedure, seeing themselves as ‘too posh to push’. And midwives have also blamed staff shortages and ward closures for the decline in natural births.
The compensation culture may be a factor too. A recent survey indicated that many doctors carry out more caesareans than in the past because of fear of litigation if a natural birth goes wrong.
There has been a slight rise in the number of home births but ministers want to improve payments to health bodies who help women who want one.
In its health White Paper, the Government promised to extend choice for pregnant mothers by creating maternity networks. These are designed to bring together all the maternity services in one area an expectant mother might need. Hospitals, GPs, charities, community groups and maternity consultants will be linked up so that they can share information, expertise and services.
Health Secretary Andrew Lansley said: ‘We want to improve maternal choice. So we are looking into ways to support mothersto-be, ensuring that they get safe and appropriate care. ‘Maternity networks will be central to this because they will ensure mothers get integrated support, from the outset and throughout their pathway. ‘A team will support them at every level from support at home to high level obstetric care.’
A hopelessly politicized public broadcaster
Is the ‘biased’ BBC now try to cosy up to the Con/Lib Coalition? Corporation boss lets slip notes for meeting at No 10
The BBC was caught in a political row last night after its boss Mark Thompson was apparently attempting to cosy up to the Government following complaints over Left-wing bias.
The corporation’s director general was photographed arriving at No 10 clutching a memo insisting the BBC is ready to put its coverage of public spending cuts into ‘context’. The move will prompt claims that the broadcaster is trying to curry favour with an increasingly hostile Coalition Government to preserve its generous licence fee funding.
Labour leadership contender Ed Miliband said Mr Thompson appeared to be offering to ‘showcase’ Government proposals for spending cuts in the middle of delicate negotiations over the future of the levy.
The Daily Mail understands Mr Thompson was hauled int o Downing Street for showdown talks with David Cameron’s strategy chief Steve Hilton amid increasing Government displeasure over the BBC’s coverage of the forthcoming spending review.
The Tories and the Liberal Democrats have become concerned that BBC reports rarely mention the reason for budget reductions – the £15billion deficit left behind by the Labour government.
A Government source said: ‘Coverage of spending cuts always seems to take the most negative slant possible and never sets out the context of why they are necessary or of how the mess we have been left to clear up is not of our making.’
As he arrived at No 10 yesterday, Mr Thompson was pictured with a memo from his head of news Helen Boaden clearly on view. It revealed she had met Mr Cameron’s press chief Andy Coulson for lunch, at which he had expressed ‘concern’ about the impartiality of a forthcoming BBC ‘season’ on the spending review. The memo promised to make viewers aware of the ‘whys and wherefores’, adding: ‘I said that’s what we always try to do.’
Miss Boaden went on to defend coverage of cuts over the summer – including claims that the poorest would be hardest hit and the possibility, now ruled out, of free school milk being axed.
She said the BBC had been ‘driven by news lines’. The document went on to list plans for various output, including Newsnight, the Today programme and Five Live, and suggest an interview with Chancellor George Osborne.
A BBC source said Mr Thompson had discussed upcoming coverage and which ministers might appear on various shows to explain the cuts. The source insisted the director general was ‘not embarrassed’ to have unwittingly revealed the content of his meeting.
As part of an apparently concerted charm offensive by the BBC, earlier this week Mr Thompson admitted the corporation had in the past been guilty of ‘massive’ Left-wing bias but said it was now a ‘broader church’.
The BBC governing body is also thought to be preparing to postpone a planned rise in the licence fee by 2 per cent next April, from £145.50 to £148.50, to fend off deeper cuts being imposed by the Government.
Mr Miliband said: ‘The BBC must remain a fully independent organisation without bias. It is deeply worrying that when he was summoned to Downing Street, the director general of the BBC had a list of programme ideas which appeared to showcase Tory economic policies of savage, indiscriminate cuts.
‘David Cameron must stop his bully boy tactics and threats to withdraw the licence fee now, before they undermine the status of the BBC as a valued and trusted institution.’
Labour MP Michael Dugher said: ‘The political independence of the BBC should be absolutely sacrosanct and it is very odd that the director general is going into Downing Street for this kind of meeting. The BBC is within its rights to publicise the cuts to public spending in whatever way it sees fit.’
Last night, a Downing Street source responded: ‘For the Labour Party to attempt to suggest that we somehow are trying to bully or control the BBC is a bit rich considering their track record.’
The BBC said it had regular meetings with parties of all sides. A spokesman said: ‘The director general has made it repeatedly clear that the impartiality and independence of the BBC is paramount.
‘In the meeting today, the director general, in his role as editor-in-chief, discussed the possible participation of a number of members of the Government in the BBC’s coverage of the spending review this autumn.’
No room at British schools for many of the 2010 baby boomers
As thousands more are taught in makeshift class rooms
Hundreds of children have no primary school place with term already started as the recent baby boom triggers an admissions crisis. Thousands of other children are having to be taught in makeshift classrooms because of the overspill, which has been further increased by a recession-fuelled exodus from fee-paying private schools.
Councils in many parts of the country, including London and Birmingham, say applications for places are still being received. Yet even some parents who applied in good time have yet to be allocated a school for their child.
Brent, in North West London, for example, has 210 four-year-olds still without a reception class place but only 24 vacancies in schools. The council is preparing to offer places in children’s centres if necessary.
Between them, councils including Ealing, Tower Hamlets, Haringey, Merton, Havering, Camden and Hammersmith and Fulham – all in London – as well as Kingston-upon-Thames in Greater London and Birmingham have hundreds of pupils yet to be placed: many of them late applicants.
Meanwhile officials in Newham, South East London, are considering putting four classes in a church hall following a sharp rise in children seeking places this year.
Hundreds of other schools across the country are using temporary prefabricated buildings on their own sites to accommodate additional pupils or are starting to construct permanent new classrooms.
In Hampshire, a school known for its eco-credentials, St Bede’s Primary, in Winchester, is seeking to concrete over a pond to accommodate a temporary classroom to cope with soaring pupil numbers. Meanwhile, in Brighton, temporary classrooms are being purchased at a cost of £125,000 each.
In Leicestershire, Lady Jane Grey Primary, in Groby, gained emergency planning consent for a temporary classroom on its site. Head Michael Fitzgerald said: ‘The school is facing a very difficult situation – there isn’t a spare cupboard in the building.’
Leeds is increasing capacity at 16 primaries from this month while in Bristol, six schools are gaining 22 temporary classrooms. Birmingham is expanding nine schools to create an extra 330 places this month. It will need an additional 3,000 by 2020.
In many areas, schools have agreed to accept ‘bulge’ classes – an extra reception class which continues through the school. They are meant to be a one-off but some schools have already taken them for two or three years running.
The Coalition has acknowledged the shortage of primary places is now ‘critical’ and claims the previous Labour government failed to make adequate preparations for the extra pupils despite warnings. More than 1,000 primary schools have closed since 1999 amid accusations some areas have taken a ‘short term’ view of likely demand.
Education Secretary Michael Gove plans to move cash from frozen secondary school building projects into providing primary places.
But the Mail’s survey of local education authorities reveals that many schools need huge sums of money to meet future demand. A spokesman for Kingston warned it would need as much as £70million.
Official figures show the number of babies born in 2006 – and now starting school – was the highest since 1993, with birth rates expected to continue to rise at least until 2018.
Latest projections suggest that primary school pupil numbers will rise by more than 500,000 in just eight years to 4,526,000, reaching their highest level since the 1970s.
The equivalent of more than 2,000 extra primary schools will be needed to cope, at a time of severe public spending cuts.
While classes for children in the first two years of school are limited in law to 30, teaching groups for older primary pupils could balloon as staff are diverted to teach the new influx of pupils.
In the meantime, pupils caught up in the crisis face being taught in overcrowded classes or travelling miles to their nearest school, and being split from siblings.
In Beaconsfield, Buckinghamshire, mothers had to mount a campaign to win an extra reception class at a popular school after being offered schools up to five miles away.