Leading article: Midwives: end the crisis

The capacity of the National Health Service to absorb without noticeable effect the huge increase in public money that has been poured into it in recent years seems to have taken the Government by surprise. In many respects, the NHS has improved dramatically since the cash transfusion started in 1999. Waiting lists have fallen, and treatment for heart disease and cancers has saved thousands of lives and the quality of thousands more.

Yet there remains something haphazard about the setting of priorities. Mental health, on which this newspaper has campaigned for years, continues to be relatively neglected, while the new GPs' contract seems to have been negotiated by Mr Pushover. Today we report disturbing news from another front: maternity services.

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On the face of it, our findings are surprising. The patients in this sector range across the social spectrum, and include some of the most articulate, demanding and - it must be added - litigious with which the NHS has to deal. If any sector might be expected to grab a disproportionate share of extra resources, this would be it. Yet the figures tell a story that cannot be gainsaid.

The number of births has risen in recent years, while the number of midwives has remained unchanged. Whether or not there is any direct connection between these two statistics and the third, most troubling, one - the rise in the number of mothers dying in childbirth - it is apparent that priorities need to be adjusted.

Britain's record on childbirth has become worse over a long period predating the election of this Labour Government. But it has not improved during the Labour years of public spending, although the scandalous absence of up-to-date statistics makes it hard to be definitive. Our record also compares unfavourably with most of Europe. The Prime Minister's much-vaunted ambition to bring UK health spending up to the average for the European Union was less important than the implied promise to bring our health standards up to at least the average enjoyed on the Continent.

So why have maternity services fallen behind at a time of such brave ambitions and historically unprecedented resources? All specialists in the NHS tend to talk up the claims of their specialism for extra funding, but Professor Jason Gardosi, the director of the NHS Perinatal Institute, cannot be accused of shroud-waving when he identifies the shortage of midwives as the key. "You would not allow an aeroplane to fly without a full crew," he says, "but midwives are having to make do without a full staff, and with very heavy caseloads. It is little wonder that we see so many avoidable deaths."

The scarcity of midwives has been known for some time, and the complaints of lack of continuity of care have been persistent. A midwife is not merely an essential ingredient in the glue that holds society together - one of those "guardian" roles such as bus conductor or park keeper that falls too easily to cost-cutting. Midwives are also essential to best clinical practice, working with doctors to ensure systematic vigilance against mistakes.

Last year, The Independent on Sunday warned Patricia Hewitt, the Secretary of State for Health, against adopting the easy - and cheap - rhetoric of "demedicalising" childbirth. While it may be desirable to rely less on drugs in childbirth generally, we doubted that the NHS should become involved in promoting home births as preferable to those in hospital. In case of complications - and however "natural" childbirth may be it is also naturally dangerous - a hospital is likely to be a safer place to be than a home.

The obstacle, both to giving mothers a choice and to giving them the best possible standard of clinical care, is a shortage of qualified midwives. Among the myriad competing priorities for NHS funding, which will not grow so fast over the coming years, this is one that should be near the top of the list.