5. Will the Cabinet Secretary explain what services are available in Wales for mothers who suffer anal sphincter injuries in childbirth? (OAQ51126)

Maternity services in Wales work in collaboration with physiotherapy and specialist continence services. These services provide assessment and identify problems incorporating faecal and urinary incontinence, with referral to specialist services for treatment and individualised care planning.

Cabinet Secretary, I took note of the comments you made earlier. As you will have attended part of the meeting that took place in Tŷ Hywel last week, you’ll be aware that this is a major problem and is being highlighted by a new charity called MASIC, Mothers with Anal Sphincter Injuries in Childbirth. It was really arresting to hear the testimonials of three women who had suffered really life-changing injuries as a result of third and fourth-degree tears during birth. Their faecal incontinence has required them all to give up their careers—one of them was an accident and emergency nurse and another was a microbiologist—and obviously it’s had a huge impact on everything in their lives.

It is concerning to know that these injuries have increased threefold in the last decade. Overall, it’s estimated that one in 10 women is affected by faecal incontinence, particularly by the time of the menopause. So, the problem’s widespread and it’s only now being talked about. It’s good that we had an earlier question on the subject of incontinence; we don’t often talk about this sort of thing. I have two questions, really. One is: why is physiotherapy not available to all mothers following childbirth? It is routine in places like France. Secondly, why is it that Wales is the only part of England and Wales where mothers cannot have non-invasive sacral nerve stimulation, even though it’s been approved by the National Institute for Health and Clinical Excellence for over 10 years and is a successful treatment for faecal incontinence in three quarters of cases where conservative treatment like physiotherapy has failed?

Thank you for the follow-up questions. Again, I acknowledge that this issue was first brought front and centre for me by the Member for Cardiff Central. I think we need to start off with the point that I am genuinely very proud to have this job, to stand up and to work with the national health service, but I do have to balance that with the recognition that the service doesn’t always get it right. This is an area where I don’t think there has been the focus that there perhaps should have been in the past.

The challenge now is how we get to where we should be. That’s why the task and finish group being led by Julie Cornish is important, and I expect that to come up with a way forward for our service. You’re right: there has been a significant increase in the tears that are being detected but also the number of women coming forward with faecal incontinence in particular. The challenge there is how we then properly meet the understandable need that exists. It’s also about understanding that, I suspect, in the past we’ve had unmet needs.

So, that’s why I’ve outlined that there’ll be a task an finish group, and that’s why I’ve recognised that it’s not acceptable that, in the past, we have not been able to commission and provide enough sacral nerve stimulation services here in Wales. That does need to improve, because I recognise that, where the more conservative treatment of medication and physiotherapy in particular has failed, sacral nerve stimulation is effective in about 75 per cent to 80 per cent of cases, so it is a highly effective alternative treatment.

On your point about physiotherapy, there’s just a point here about what is and isn’t prudent. I think wholesale provision, without the prudent need being available, is not one that I’d necessarily accept first off, but if the evidence changed and it was the right thing to do, I’d be interested in how we then plan a workforce to meet that identified and evidence-led care need.

It’s also worth pointing out that there will be a national survey starting next week, where we’re asking women to talk about their experience of maternity and childbirth. We want to have a genuine understanding of the good, the bad and the indifferent, because this is actually being led by consultant midwives across Wales to try to ensure that we have the richest source of information with which to assess the effectiveness of our services and to improve them, moving forward.