In the time allowed, I must mention independent midwives. The Government seem determined to ensure that independent midwives take out professional indemnity insurance, despite the fact that they are unable to obtain it because of the high premiums that reflect the potentially huge payouts involved. There is no clear evidence of a link between possessing insurance and being a safer midwife; if anything, the intuitive link runs the other way, because midwives stand to lose everything in cases of negligence. Their services are especially valued by women who are either fearful of highly medicalised interventions during childbirth, or have had a bad experience in the NHS.

Will the Minister explain why the Government seem hellbent on pursuing that argument and policy on insurance without at least granting a consultation? We have requested one, but we have not received an answer from the Government. I raised the issue before in a letter to the Secretary of State on 29 March, but so far, I have not had the courtesy of a response. Will the Minister now respond by promising the House and all independent midwives that the Government will consult on their proposal?

David Drew (Stroud, Labour)

My second national point relates to insurance, and it is the one about which I am really worried; indeed, I am a bit surprised that it has not come up yet. In the debate on Stroud, we got into the nitty-gritty of which unit should be the preferred one and what we meant by choice, but the backcloth to that debate was the issue of insurance. That issue has come up in relation to independent midwives, and I am unclear about what the Government are saying. What help might they offer independent midwives, who play an important role, not least because they can bolster the numbers in some of our units?

If I understand the picture clearly, it is a sad fact that more than half of litigation cases involve maternity incidents. That, of course, is a strong reason for people to have some form of indemnification against being sued. However, we cannot have it both ways. I very much support the choice agenda, and people want low intervention, starting with home births all the way through to midwife-led units, with consultant-led provision at the other end of the continuum. If people are offered choice, however, we must know that it is real choice. If deaths result because units cannot be kept open and midwives cannot keep operating because they cannot get insurance, that is not choice, and we need some clarity on the issue.

I have talked to midwives, I worry that they are beginning to practise very defensive medicine. That may be what any sensible practitioner should do, but if that is the only way in which people operate in their chosen profession, we will not have future generations of midwives, because they will be driven out of the profession. We need to know where we stand and we need to give a clear purpose to people who are doing a difficult job and offering choice. The choice should not entail their being held personally liable if things go wrong.

Ivan Lewis (Parliamentary Under-Secretary, Department of Health)

I say to my Hon. Friend the Member for Stroud (Mr. Drew) and the Hon. Member for Billericay that we are working with independent midwives to resolve the insurance issue.

The IMA say in response to the last statement:
Despite repeated public announcements by Ivan Lewis (the Minister responsible for Maternity Services) that the government is working with Independent Midwives to resolve the insurance issue, only one meeting has taken place last year, between the Chief Nurse and the Independent Midwives Association, when we were informed of the governments policy to make professional indemnity insurance mandatory for all healthcare professionals including midwives. We continue to seek meetings to discuss the issue.