The NHS could miss its target to expand choice in childbirth, the chair of the Department of Health's choice reference group has warned.

The NHS could miss its target to expand choice in childbirth, the chair of the Department of Health's choice reference group has warned.

Issuing a caution to the DoH, David Pink, also chief executive of the Long-term Medical Conditions Alliance, told HSJ that the government's 2009 target to enable all women to have a choice over where and how they have their baby would be 'seriously, seriously challenging'.

'We have been questioning officials from the DoH and NHS staff on all the areas where we want to extend choice: it is clear maternity services will have problems,' he said.

The idea of the patient choosing where and how treatment takes place has been common in maternity services since the 1993 Cumberlege report on childbirth.

Labour?s election manifesto promised that by 2009 all women will have a choice over where and how they have their baby and what pain relief they use. The government has also said that every woman should be supported by the same midwife throughout pregnancy. Choice in maternity services features as one of the six areas out for consultation as the government aims to extend personalised care to pregnant women.

Royal College of Midwives general secretary Dame Karlene Davies welcomed the DoH?s proposal in last week's document to open up choice at the initial booking stage by promoting direct access to midwives. But she said the idea had now appeared in 'five separate DoH policy documents over the last two years' without the government articulating how it would be achieved in practice.

The 2004 national service framework for children, young people and maternity services promised women 'easy access to supportive, high-quality maternity services, designed around their individual needs and the needs of their babies'.

Dame Karlene called on the government to keep its promise to publish a delivery plan this autumn for implementation of the standard, and urged ministers to do so before drawing up a new framework for choice in maternity.

And she said that in order to fulfil the government?s pledge to offer midwife-led care, local maternity services would have to offer 'far more than at present, for example in the greater provision of home births'.

The choice agenda: past, present and future

2002: Department of Health launches first choice pilot schemes offering patients waiting more than six months for surgery the choice to go to an alternative provider.

September 2003: Director of public and patient involvement Harry Cayton launches a national consultation on extending choice beyond elective care, under the stewardship of health secretary John Reid.

September 2003: Eight taskforce groups established to look at extending choice in eight areas: children's health; emergency care; maternity care; long-term conditions; elective care and older people's care.

December 2003: DoH publishes Building on the Best.

January 2006: patients offered choice of four or five providers, including one independent sector provider, when referred for planned hospital care by their GP.

May 2006: patients could also choose from a national menu of NHS foundation trusts and some independent treatment centres for elective treatment, as well as local providers.

August 2006: DoH launches consultation with NHS staff through SHA choice leads.

Autumn 2006: DoH aims to publish a choice framework to include policy guidance on free choice in elective care for 2008; support and information for patients and clinicians to inform choice about healthcare and services; and priorities for extending choice beyond elective care.