Virtual participation in proceedings commenced (Order, 25 February).
[NB: [V] denotes a Member participating virtually.]
9:25 am
James Gray (in the Chair)
I start with a few parish notices, as it were. First, we do all continue to wear a mask, apart from when we are speaking. Secondly, I am told that we are now allowed to intervene, if we are physically in the room, on one another, although perhaps we want to keep such interventions to a relatively minimal number. Thirdly, let me remind those who are with us virtually—welcome to you all—that you have to remain in the room with your television camera on throughout. You cannot turn the TV camera off and go off for a cup of coffee; you have to be here in the debate throughout—from beginning to end.
Cherilyn Mackrory (Truro and Falmouth) (Con)
I beg to move,
That this House has considered progress towards the national ambition to reduce baby loss.
Sir James, it is a pleasure—
James Gray (in the Chair)
Order. I regret to say I am not Sir James—perhaps one day. I am just Mr Gray.
Cherilyn Mackrory
Thank you, Mr Gray. I had just promoted you. It is a pleasure to serve under your chairmanship.
The ambition is to halve the rate of stillbirths and neonatal deaths by 2025 and to have achieved a 20% reduction in these rates by now. Every day in the UK, about 14 babies die before, during or soon after their birth. Baby deaths need to fall much faster if the Government’s national maternity safety ambition is to meet that important target. The ambition also includes halving maternal deaths and brain injuries in babies that occur during or soon after birth by 2025, and reducing the pre-term birth rate from 8% to 6% by 2025.
Earlier this month, the Health and Social Care Committee published its report about maternity safety. I co-chair the all-party parliamentary group on baby loss with the Chair of the Health and Social Care Committee, my right hon. Friend the Member for South West Surrey (Jeremy Hunt). The Select Committee report echoes much of what we have been hearing from hospital trusts, health professionals, bereavement charities, bereaved families and others throughout our work in the APPG. I pay tribute to everybody who speaks out on this most upsetting of topics. It is a crucial issue on which we must all work together to achieve success.
The Select Committee report notes that progress towards reducing the rate of stillbirths and neonatal deaths has been “impressive”, with its external expert panel rating it as good, although it notes that the baseline for the progress was low in comparison with other countries, such as Sweden, and that there is still a “worrying” level of variation in the quality of care. On stillbirth, the report from the expert panel notes:
“The Department has achieved the interim target of a 20% reduction earlier than the 2020 deadline. However, increased efforts are required to meet the final target”
of a halving in 2025. On neonatal deaths, the report states:
“Good progress has been made towards achieving a 50% reduction…by 2025. However, it has been difficult to determine the full extent of the Government’s progress due to a change in the measure of progress against the National Maternity Ambition on neonatal deaths, with concerns expressed about the validity and unintended consequences of this change. This change in measuring progress has potentially inflated the achievement in the data analysed and may inadvertently exclude extremely pre-term babies from the on-going national efforts to improve neonatal outcomes. We encourage the Department to continue to measure and drive progress towards reducing mortality in both the population of babies born before and after 24-weeks’ gestation.”
It is a pleasure to serve under your chairship, Mr Gray. I congratulate the hon. Member for Truro and Falmouth (Cherilyn Mackrory) on securing this timely and important debate, and on continuing to campaign on these issues. Her bravery in sharing her story is inspiring, and the work of the APPG should be commended. I agree with all her final points wholeheartedly. I was contacted by a number of constituents before today’s debate, and hundreds of people over the past year have shared harrowing stories of their own experiences of baby loss and miscarriage. I would like to thank all those who are campaigning for change.
The overwhelming feeling from all of those I have spoken to is that baby loss, like many other women’s health issues, still does not receive the attention, research or funding it deserves and so desperately needs. As a result, not nearly enough progress is being made. As the hon. Member for Truro and Falmouth mentioned, every day in the UK, around 14 babies die before, during or soon after birth. An estimated one in four pregnancies end in loss during pregnancy or birth. These statistics are difficult to read, but what is much, much worse is the fact that many of these deaths are preventable. According to the recent report by the Health and Social Care Committee, 1,000 more babies a year would survive in England’s maternity services if those services were as safe as Sweden’s.
While it is good to hear about improvements that have been made, my constituents and those who have experienced baby loss or miscarriage are more concerned about what more needs to be done to reduce the numbers experiencing loss, especially when the Committee’s report has shown that we are far from meeting our 2025 ambitions. Services are seriously overstretched, underfunded and understaffed, and huge health inequalities in perinatal outcomes remain unaddressed. If we are to buck this trend, the Government need to take the opportunity to reset and refocus perinatal services across England on meaningful and long-lasting transformation.
It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) for securing the debate. Her personal story, which she bravely told today and in a previous and moving Westminster Hall debate, has shone a spotlight on the pain and anguish faced by parents who suffer the tragedy of baby loss.
Almost 60,000 babies were born prematurely in 2019, with one in five pregnancies ending in miscarriage during the same period. The effects of miscarriage, stillbirths and neonatal deaths are devastating for parents, with impacts that can and do last a lifetime. It is essential that the Government continue with their 2015 ambition to reduce the rate of stillbirths, neonatal deaths and maternal deaths in England by 50% by 2030. I welcome the provision in the NHS Long Term Plan to bring forward that ambition to 2025. To this end, the Government announced only this month, on 4 July, that they were making an additional £2.45 million available for NHS maternity staff in order to improve safety in care settings.
As the son of an NHS community midwife, I know the care, dedication and effort that our amazing midwives, such as the incredible team serving my community in Darlington, put into their vocation. They are on the frontline of safety, bringing new life into the world, and all too often they are at the side of parents who have suffered the worst loss imaginable. We must ensure that our midwives are provided with the skills to give the most appropriate care to parents at their time of bereavement.
In Darlington, I recently met Claudia and her husband, Andy, who have suffered two late-term losses—first, at 20 weeks of pregnancy and, more recently, at 18 weeks. Although Claudia was thankfully entitled to statutory sick leave to recover, Andy was not entitled to leave and had to negotiate with his employers to take time off. I am thankful to the two of them for meeting me to talk about their experience, the impact of those losses and the challenges they have faced. I am glad that they have continued to work with me to gather information and understand the patchwork of provision by UK companies whose employees suffer miscarriages. For the sake of Claudia and Andy, I am hopeful that the threshold for statutory bereavement leave will be revisited. The impact of a loss in the second trimester will almost always be just as painful, devastating and hard to overcome as a loss in the third trimester.
I would like to focus on the progress towards safe births at my local trust. I wish I did not need to speak in this debate; I wish that Nottingham’s hospitals, Queen’s Medical Centre and Nottingham City Hospital, were safe places to have a baby. That is what parents in my constituency need and have a right to expect. But right now, that is not what they are guaranteed, as the trust’s chief executive admitted a few weeks ago:
“We fully accept that, although our staff are passionate about what they do, we have not created an environment where these same staff can provide a positive and safe experience for every family in their care, every time.”
A recent investigation by The Independent and “Channel 4 News” found that since 2010, there have been 201 clinical negligence claims against the trust’s maternity services—almost half lodged in the past four years. In those claims are 15 deaths, 19 stillbirths, 46 cases of brain damage and 18 cases of cerebral palsy. The trust has already paid out £79.3 million in compensation but, of course, the human costs are much higher.
In September 2019, Wynter Sophia Andrews was born at the QMC. She died 23 minutes later. It was only after the Healthcare Safety Investigation Branch’s findings were published that the trust admitted failings and that earlier intervention would have avoided Wynter’s death. Wynter’s death was the subject of an inquest, and in her verdict the coroner was highly critical of Nottingham University Hospitals NHS Trust. The coroner said that Wynter would have survived if action had been taken sooner. I will not read the detailed quote from the coroner, but she said that the incident reports and staff accounts demonstrate that
“this was not an isolated incident. An unsafe culture had been allowed to develop as these systemic issues had not been adequately addressed by the leadership team.”
It is a pleasure to serve under your chairship, Mr Gray, and to follow my hon. Friend the Member for Nottingham South (Lilian Greenwood). I congratulate and thank the hon. Member for Truro and Falmouth (Cherilyn Mackrory) for securing this incredibly important debate. I am so sorry for her loss but I thank her for her bravery in sharing it and for her ongoing campaigning in this area.
I also thank campaigning organisations, including the Stillbirth and Neonatal Death Society, Tommy’s and the Lullaby Trust, and all the members of the Pregnancy and Baby Charities Network, as well as bereavement organisations such as the Good Grief Trust for all they do to support parents and families and for their continued campaigns for change.
I thank all my constituents who have recently written to me about this important debate, underlining the reason for having this debate now and why we need to look again at the plan for the national ambition to reduce baby loss and at progress towards that. I am certain that all Members present share my ambition that the UK should be the safest place in the world to have a baby. However, as broken-hearted mothers and fathers across the UK can testify, it is not, and that is the reason for the debate today.
There are stark inequalities: background makes a difference, as well as where mothers have their babies. That should not be case—the highest standards should be equally available across our country. Recent reports from the Health and Social Care Committee, the Ockenden review of maternity services at Shrewsbury and Telford Hospital NHS Trust, the ongoing investigation at East Kent Hospitals University NHS Foundation Trust, and the devastating revelations from Nottingham University Hospitals NHS Trust—which have been outlined by my hon. Friend the Member for Nottingham South—plainly demonstrate just how much more there is to do.
Although huge strides have been made over the past two decades, that progress has now plateaued and we need to know why and address this. In 2019, the neonatal mortality rate in England and Wales was 2.8 deaths per 1,000 live births, the same as it was in 2017—the third consecutive year of no change. The latest statistics for neonatal mortality published by the World Bank rate the UK as the 37th country globally, making us one of the worst-performing countries in the developed world in this area. As the hon. Member for Truro and Falmouth highlighted, the recent report into progress on maternal mortality said that
It is an honour to serve under your chairship, Mr Gray. I pay tribute to the hon. Member for Truro and Falmouth (Cherilyn Mackrory) for securing this important debate, for her incredibly moving contribution and for her work on baby loss. I also pay tribute to my constituents in Liverpool, West Derby who have been in touch to ask me to speak today and raise their concerns, and to all those affected by the devastating loss of a baby. Nothing I can say here can do justice to the heartbreak they have been through, but I hope to do my best to raise some of the issues that constituents have shared with me.
It is truly heartbreaking that every day about 14 babies in the UK die before, during or soon after birth. The recent report by the Health and Social Care Committee notes the good progress made, but stresses the urgency with which actions must be taken to achieve the Government’s ambitions of reducing baby loss by 2025. The expert panel also raised serious concerns about aspects of continuity of carer, personalised care and safe staffing, and the Committee has made a series of recommendations, including for a Government commitment to funding the maternity workforce at the level required to deliver safe care to all mothers and their babies.
The report also states that the improvements in rates of stillbirth and neonatal deaths are good but are not shared equally among all women and babies. Babies from minority ethnic or socioeconomically deprived backgrounds continue to be significantly at greater risk, and as the charity Sands says in its report:
“Babies should not be at a higher risk of death simply because of their parents’ postcode, ethnicity or income.”
I wish to raise a case on behalf of one of my constituents today and to pay tribute to her. Can the Minister provide an update on the progress made since the important debate on covid-19 and baby loss in November and outline the steps the Department is taking on research and actions to make sure that nobody has to go through what my constituent has experienced?
It is a pleasure to serve under your chairship, Mr Gray. It is an honour to follow my hon. Friend the Member for Liverpool, West Derby (Ian Byrne), who spoke wholeheartedly on behalf of his constituents. I thank the hon. Member for Truro and Falmouth (Cherilyn Mackrory) for her courage and compassion, and for her campaigning throughout. She is an inspiration to so many women out there.
The last time we debated this subject, although it was in Westminster Hall, as opposed to here, we had a very emotional debate on baby loss. It was Parliament at its best. MPs from across the House brought their life experiences—and, yes, painful experiences—to benefit the people we seek to serve. That is Parliament at its best.
This has been a painful year for many women and families. We have heard from constituents who were forced to receive bad news apart, were unable to grieve losses together or were even unable to hug a friend or a loved one they saw in pain. Those of us who have experienced baby loss and miscarriages know the pain and anxiety that appointments and scans can cause. I remember breaking down into bits at just the first appointment. It was just a question-and-answer session with a midwife during my second pregnancy, but it can be a horribly anxiety-provoking, triggering experience to go back to a place you have received bad news in the past, let alone doing that during a pandemic. Many women this year have been robbed of the joys of pregnancy.
Although I have had two pregnancies that ended in miscarriage, I now speak from the fortunate position of having a beautiful rainbow baby, which is the term used for a baby following miscarriage or baby loss. That is a very different experience from before. I do not know how others have the strength to speak out while they are still on that journey or without their rainbow. I know I would struggle; you are truly inspirational.
10:13 am
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On maternal deaths, the report concludes:
“No discernible progress has been made towards reducing the 2010 rate of maternal deaths by 50% by 2025”,
which I find alarming. It continues:
“The factors contributing to maternal deaths are predominantly indirect, such as existing disease, and therefore complex to address. Tackling the causes of maternal death will require concerted efforts, with a focus on pre-conception interventions and improved post-natal support, particularly relating to mental health support…In addition, the worsening disparity in risk of maternal death for women from minority ethnic and socio-economically deprived backgrounds needs to be urgently addressed.”
On pre-term births, the report acknowledges that
“this target was only added to the National Ambition in 2017. Therefore, the window for newly introduced measures to impact on the data is very narrow…While the initiatives currently being implemented by the Department are welcomed, we anticipate that increased efforts will be required to counteract the setbacks to reducing pre-term”
deaths arising from the COVID-19 pandemic.
Great strides have been made in this vitally important space, and it is important to acknowledge that, but there is still more to do. Last week, I had the pleasure of speaking to some members of our excellent midwifery team at the Royal Cornwall Hospital in Treliske, in Truro. Because of continuing covid restrictions, that was conducted remotely, and it was a bittersweet meeting for me, not least because the tech let me down after about 20 minutes. I had a conversation with the fabulous consultant obstetrician, Karen Watkins, who was able to tell me how things were going at Treliske and what further things the team felt needed to be done to accelerate the national ambition.
It was Karen who had delivered the shattering news to my husband and me that our baby could not be saved, that she would have no chance of life. It was Karen who performed the procedure to humanely end Lily’s life—the most frightening point of mine. Last week, I had the privilege of thanking her, as face to face as we could get online, for her kindness, compassion and professionalism in such devastating circumstances. Not everybody gets the chance to do that. The entire bereavement midwifery team at Treliske are outstanding, and I continue to be in awe of our local team, of how they do such a difficult job, are able to support families at their lowest ebb, and continue to take special care of our babies after they have died.
The impact of covid on those issues seems to be a mixed bag, which is against the expectation. There was a peak in stillbirth and neonatal death in March 2020 and another in January 2021. Our team in Cornwall points to a slow and steady decline in the numbers since 2010. This year, there have been two stillbirths so far. In a so-called usual year, there would have been between eight and 12 by now. It is difficult to commend this figure, however, as the team do not yet really know what to attribute it to, apart from natural peaks and troughs. It could be a temporary irregularity; more research will need to be done to see whether we can find a pattern. This is no comfort at all to the two Cornish families who have suffered that unbearable loss.
The APPG has heard evidence from the sector about how covid has exacerbated existing inequalities. Inequality is the biggest issue that needs to be tackled to reduce the number of babies dying and to improve maternity safety. The Health and Social Care Committee report highlights the need to tackle “unacceptable inequalities in outcomes”. The report by the health and social care expert panel report notes that
“improvements in rates of stillbirths and neonatal deaths are good but are not shared equally among all women and babies. Babies from minority ethnic or socioeconomically deprived backgrounds continue to be at significantly greater risk of perinatal death than their white or less deprived peers.”
It is fair to say that mums and babies should not be at an unfair risk just because of their background.
The Select Committee’s recommendation that the Government introduce a target to end the disparity in maternal and neonatal outcomes, with a clear timeline for achieving that target, is exactly right. Work must be done urgently to identify a suitable target and ways to evidence the gap closing nationally, supported by the evidence of progress locally. The target must aim to achieve equity among all groups and ensure that those who currently have the least good outcomes have the best outcomes.
What needs to be done? I have taken it down to five or six points. First, on staffing, action is needed to address staffing shortfalls in maternity services. At a minimum, we need nearly 500 more obstetricians and nearly 2,000 more midwives. I welcome the recent increase in funding for the maternity workforce, but there will need to be further funding commitments to deliver the safe staffing levels that expectant mothers should receive. In Cornwall, when Karen Watkins started 14 years ago, there were eight consultant obstetricians. Today, there are still eight. None of them are dedicated bereavement obstetricians, and staff need to take on this role as part of their existing duties.
Secondly, on training, the 2016 maternity safety training fund has delivered positive outcomes. More funding is required to embed ongoing and sustainable access to training for all maternity staff, given changes in the practice, developments on how to deliver safely and aspects related to covid-19. Funding for backfill cover when training takes place is also desirable.
Thirdly, on parent involvement, after a patient safety incident, too often families are not provided with the appropriate, timely and compassionate support that they deserve. Involving families in a compassionate manner is a crucial part of the investigation process. The Healthcare Safety Investigation Branch has taken considerable steps to improve family engagement but must continue to pursue improvements in that area.
Fourthly, on clinician confidence, this is related to the earlier point about training, but is also about giving clinicians the confidence to report issues without worry. I welcome the Government’s proposal to review clinical negligence in the NHS more broadly. Elements of the rapid resolution and redress scheme have been implemented, but the scheme has not yet been implemented in full. Until it is, there is a high risk that the fundamental changes needed to improve the safety of maternity services may fail to be achieved.
Fifthly, carer continuity is close to my heart. I am a huge advocate for this, and it has been shown to improve the outcomes of those who currently have the worst outcomes. I would like to ensure that those involved in delivering carer continuity have received the appropriate training, and that all professionals are competent and trained in all the work they are able to do, particularly in relation to black mothers, where the disparities are the greatest. Carer continuity helps to point out other issues that might not be specifically or medically looked for such as domestic violence.
Sixthly, we need more research. If a baby dies at term, the parents ask why, and often there is no answer. I would like to see more money put into research and development so that we can understand more about this horrific phenomenon. There is more to say, and I am sure colleagues will add to the discussion today. I thank the Minister for her continued support in this area, and I know she is listening.
Group B strep is the most common cause of life-threatening infection in newborn babies, causing a range of serious infections including pneumonia, meningitis and sepsis.
Screening could save 50 babies a year, and protect a further 70 from life-changing issues. Our Minister has been a force in trying to ensure that all women can ask for the group B strep screening and that all hospital trusts can offer it.
We have just passed the halfway point in this important journey to 2025, and I would like to thank all the healthcare professionals who have contributed to the successes so far. I call on the Government to work with them to achieve the rest and save as many lives as possible in the future.
To begin this transformation and to ensure it results in meaningful change for all women, we need immediately to introduce enhanced data collection and sharing of all adverse perinatal outcomes. During my Adjournment debate earlier this year on the findings of The Lancet series, “Miscarriage matters”, the Minister committed to include the report’s recommendation to record every miscarriage in England in the Government’s women’s health strategy. This is a huge win for campaigners and a really welcome step, which I hope will come to fruition very soon.
However, we must ensure that there is consistent data collection on all adverse perinatal outcomes, including brain injury, and on loss during pregnancy before 24 weeks’ gestation. We must also ensure that all perinatal deaths are recorded within a 24-hour period, rather than the seven-day period that we currently have, to allow for more accurate and timely data collection.
Finally, and most importantly, we must ensure that data are consistently collected on ethnicity and social factors in pregnancy and the post-natal period, so that we can identify groups whose outcomes are worse than the average and set more robust targets. We know from the available data that stillbirth rates for black and black British babies are twice as high than those for white babies, and that the rates for Asian and Asian British babies are 1.6 times higher than those for white babies. Stillbirth rates for babies from the most deprived families are 1.7 times higher than those for the least deprived.
It is deeply upsetting that we still have no evidence-based interventions to reduce the risks that black, Asian and socioeconomically disadvantaged women face. I think we can all agree that we need a strategy in place to end the disparity in maternal and neonatal outcomes, but without available data on specific targets, we do not stand a hope of reducing the inequalities. Consistent data must be recorded and made accessible, so that collectively we can sound the alarm and set specific, tailored targets and strategies for meeting them. Although I welcome the forthcoming confidential inquiry into the deaths of black and black British babies, I am disappointed that Ministers feel unable to fund a similar inquiry into the deaths of Asian and Asian British babies, and I call on the Minister to look at that again.
For too long, baby loss has not received the focus it deserves, and it is dismissed all too often as an inevitability. Only by properly tracking baby loss will we be able to break the taboo, properly address the inequalities in health outcomes, and ensure that we have a foolproof strategy to reach our 2025 ambitions and improve outcomes. For those going through baby loss or still living with the trauma of prior experiences, progress cannot come soon enough.
Another constituent, Angela, has shared her tragic story with me. Angela suffered two ectopic pregnancies and two miscarriages, and now feels that she will never experience one of the most natural things in the world: the honour of giving birth. Angela described to me that she feels crushed, and would like to see more support for people in her position than was available to her in the first years of the 2000s.
Improving maternity safety, delivering personalised care and improving training will all help to improve outcomes for future expectant parents across the UK. I sincerely hope that a future review of bereavement leave will be extended to those parents who suffer a miscarriage in the second trimester of pregnancy. I look forward to hearing from the Minister what more the Government are doing to achieve our national ambition to reduce baby loss.
I am thankful that the Government have taken and are taking firm action towards reaching the 2025 ambition that will reduce the number of future parents experiencing the pain that Angela, Claudia, Andy and my hon. Friend the Member for Truro and Falmouth have experienced.
During the inquest, it also emerged that a letter from maternity staff at the trust was sent to the hospital board in 2018 asking for help and raising serious concerns about safety.
Following the coroner’s report, NUH maternity services were subject to unannounced inspections by the Care Quality Commission, which published its report last December. The inspector said:
“During the inspections, several serious concerns were identified. For example, risk assessments which women were expected to have undertaken during their care were not always completed in line with national guidance. Staff did not always use a nationally recognised tool to identify women at risk of deterioration. In addition, the service did not always have enough midwifery staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix but were limited to the resources available. Following this inspection, maternity services at Nottingham City Hospital and Queen’s Medical Centre are rated Inadequate overall. The services are rated Inadequate for being safe, effective and well-led. Maternity services were previously rated Requires Improvement.”
The worst thing about the situation is that it did not need to be like this. When I read Gary and Sarah Andrews’s account of Wynter’s death, I felt sick—not just because it is tragic and heartbreaking for anyone to lose a much wanted baby, but because there were striking similarities to an earlier case.
My constituents Jack and Sarah Hawkins’s daughter was born dead at Nottingham City Hospital in April 2016. Harriet was a healthy, full-term baby. She died as a result of a mismanaged labour. The trust initially claimed that her death was caused by an infection. Jack and Sarah were told to “try to move on.” It was only thanks to their incredible courage and determination to fight for the truth that the trust was finally forced to admit gross negligence.
I sat with Jack and Sarah in a meeting with the trust’s then chief executive, with photos of Jack, Sarah and their dead daughter on the table in front of us. He apologised and promised that the trust would learn the lesson. Following the coroner’s verdict in Wynter Andrews’s case, I read the comments from senior staff at the trust, apologising and promising to learn the lessons. They were the exact same promises that I had heard more than three years earlier.
Gary and Sarah Andrews wrote to me in March. They said:
“All we want is for other parents to be taking their children home.”
They, Jack, Sarah and other parents are calling for a public inquiry into maternity services at Nottingham University Hospital Trust. I am sure that the Minister will tell me, and them, to put their faith in the Care Quality Commission and the Healthcare Safety Investigation Branch, but they do not share her confidence that that will be effective. In Harriet’s case, there were numerous investigations, both internal and external, but things did not change or did not change enough.
As the Health and Social Care Committee report notes,
“Involving families…is a crucial part of the investigation process…Families must be confident that their voices are heard and that lessons have been learnt to prevent the tragedy they have endured being repeated.”
When I met the CQC investigation team in April, I was shocked to hear that they have not contacted bereaved parents or sought to hear their views. They claimed to be unaware of Harriet Hawkins’s case.
When I raised concerns with the Minister, her reply contained the news that NHS England, NHS Improvement and the clinical commissioning group are
“finalising the terms of reference for an independent thematic review of maternity cases going back to 2016”.
As Jack Hawkins told me, this has happened without any input from families. The review was due to go back to only 2016, although we know there were many improperly investigated baby deaths and harmed babies before then. That is why they want a truly independent review, not one where it is too easy to suggest that Nottingham University Hospital Trust has a hand in it, and where parents of dead and damaged babies are ignored and excluded from the process of deciding what needs looking at.
I hope that when the Minister meets me and other MPs she will also hear from the parents affected by some of these tragic failures to improve maternity services at Nottingham University Hospital Trust. I look forward to hearing her response both today and on that occasion.
“No discernible progress has been made towards reducing the 2010 rate of maternal deaths by 50% by 2025.”
There are huge inequalities in the experience of maternal mortality and baby loss that have gone unaddressed for too long. Babies from minority ethnic and socioeconomically deprived backgrounds remain at an increased risk of death: if a woman is black or poor, it is more likely that she will die or that her baby will die, which is absolutely unacceptable. In 2017, babies born to black or black British parents had a 67% increased risk of neonatal death compared with babies of white ethnicity, and babies born to Asian parents had a 72% increased risk of neonatal death compared with babies of white ethnicity. The 2020 MBRRACE-UK “Saving Lives, Improving Mothers’ Care” report shows that the risk of maternal death in 2016 to 2018 continued to be four times higher among women from black ethnic minority backgrounds than among white women, and that that risk is twice as high for women from Asian backgrounds as it is for white women.
The Office for National Statistics’ latest “Births and infant mortality by ethnicity in England and Wales” report, published in May this year, highlighted substantial inequalities in infant mortality rates among black and other ethnic minority groups. Some of this variation may be explained by other areas of inequality, including deprivation, but the association between social deprivation and child mortality is clear, and there are modifiable factors that can make a difference. This can be addressed—it can be changed. I have raised this issue with NHS South West London Clinical Commissioning Group, and it must be addressed in partnership with those who have relevant lived experience and build on the knowledge of specialist agencies in each area.
Two further issues that need action have been raised with me by constituents. The first is miscarriage: a constituent has raised with me the issue of access to information and support following a miscarriage, and Tommy’s is campaigning on this issue as well. I met with a constituent yesterday who told me that women in the UK have to endure three consecutive miscarriages before they are referred for full investigation. She feels very angry about this situation and how it has affected her and women across the country. It is simply unacceptable for a couple to go through that much suffering and uncertainty and for it not to be addressed until there have been three miscarriages.
Another issue is that of culture. We are talking a lot today about funding: there is a need for increased funding, for staffing in particular, but there is also the issue of culture, which was raised by my hon. Friend the Member for Nottingham South. One constituent wrote to me to say that there had been a lack of investment over a long period of time and that that had played a big part in why the services are what they are today, but she also wanted to highlight behavioural issues within maternity—with bullying and hostile attitudes among members of staff. She said that trainees in obstetrics and gynaecology report a high rate of being undermined, higher than other medical specialities.
It is also well known that, in some services, hostility between midwives and obstetricians contributes to services being unsafe. These issues, not only about resources but about culture, need to be addressed and understood: there needs to be a cultural shift. Reporting should be welcomed within NHS trusts, and change should result from such reporting.
I have some requests for the Minister today. First, I underline the calls from Members earlier in the debate about the need for enhanced data collection and sharing. What gets counted counts, and the first thing anyone sitting down and looking at this area sees is that there are big gaps. Secondly, there should be a review of the impact of covid on our neonatal services.
Thirdly, there should be a plan to increase staffing levels; as has been outlined, we need to increase those. How much will they be increased by next year, the year after and the year after that, so we can achieve those 2025 levels? There needs to be action on ethnic disparity and much more focus within every clinical commissioning group on why those differences exist, learning from each other and from best practice and building on that, with a change in culture where needed.
What additional measures is the Minister taking to achieve the national ambition to halve stillbirths, neonatal deaths, maternal deaths and brain injuries by 2025? As we have seen in the debate and from the recent reports and statistics, business as usual is not going to achieve those aims at all. Will the Government commit to publishing specific national targets before the end of 2022—earlier, ideally—that reflect a bold commitment to action on inequalities due to ethnicity and deprivation, underpinned by specialist pathways and workstreams in every local maternity system?
I pay tribute to all the midwives working so hard across our country for all that they have had to change and go through in the last year, and to all the families affected by the issue. Ambition is all well and good, but it needs to be matched by action and boldness. A lack of both is currently letting down parents and babies across the country and it has to change, starting today.
My constituent is a health worker who became poorly last year with covid, 36 weeks into her pregnancy. At 37 weeks, she attended hospital with reduced foetal movement, and her daughter was monitored for five hours. When she got to the delivery suite, her daughter had died.
The hospital completed an investigation and found that there were many lessons to be learned. Policies and procedures were not correctly followed. My constituent should have been reviewed by a senior consultant and was not. There were delays of hours in transferring her to the delivery suite due to low staffing levels. The cardiotocography traces showed that her daughter was in distress, but unfortunately at the time that was not acted upon or escalated. If it was, she would have been taken for a caesarean section earlier in the day.
I close with the words of my constituent:
“I have spoken to other women who have been in the same position as me with covid at the same time but their hospitals have acted fast and thankfully their babies have survived. I have also spoken to women in other areas who have sadly lost their babies because their hospitals did not act appropriately. A gold standard of care should be followed nationally. It should not be a postcode lottery if your baby lives or dies.”
It is because of that shared experience that I am especially proud of the teams at Luton and Dunstable University Hospital, who recognise the pain and stress this has caused. I thank the team at Luton and Dunstable for working with me and families to accommodate visitors at scans and appointments as soon as possible. I appreciate that they are under huge stress and pressure during the pandemic, but the difference they make to families is priceless. Thank you to the sonographers, the early pregnancy units, the admin staff, the midwives, the GPs and the consultants who have helped women through this difficult year. You have gone above and beyond—thank you.
To fast-forward to just a few weeks ago, I met some of the brilliant midwife team at the L and D to talk about the changes and the challenges of the future. One is always staffing. They are doing wonders, but to limit the burnout that this pandemic has caused, we need to ensure that we not only retain midwives but recruit adequate numbers. NHS staff have experienced increased stress and pressure, which would test even the toughest of heroes. Hospitals could delay some procedures and surgeries, but as one midwife told me, people do not stop having babies.
We know how important continuity of care is to the health of both mother and baby, so it would be great to get an update from the Minister on where we are on the target to improve continuity of care for women, especially for black and Asian mothers, for whom the maternal health outcomes have been particularly poor. We have heard that stillbirths have doubled for black women, and Asian women are more than 1.6 times as likely to experience stillbirth.
I hope the Minister takes a serious look at the proposals in the report of the Health and Social Care Committee, on which I sit. The Committee heard evidence from a range of parents, grieving families and health experts. I hope the Minister takes a serious look at the recommendations and takes steps to implement them. One of the crucial recommendations is about having adequate levels of staffing. How many midwife vacancies are currently unfilled? How many do we need to train and retain in position to meet future challenges and targets on providing continuity of care to all mothers?
To focus quickly on the pandemic, we know the devastating impact that covid can have on pregnant women. The Royal College of Obstetricians and Gynaecologists released shocking statistics relating to pregnant women and covid. One in 10 pregnant women admitted to hospital with covid symptoms needed intensive care. More than 100 pregnant women have been admitted to hospital with covid-19 in the past two weeks. No pregnant women who have received both doses of the vaccination have been hospitalised since vaccination programmes began. Those are startling statistics.
The Minister joined me to meet my constituent Ernest Boateng who lost his wife Mary more than a year ago, shortly after she contracted covid-19 and gave birth. Ernest has shown amazing strength after losing Mary to look after his two beautiful children. His campaign to see pregnant women prioritised for vaccination is inspirational and one I wholeheartedly support, as do the facts. Yet, throughout this year, and despite protestations from Ernest and MPs such as my hon. Friend the Member for Walthamstow (Stella Creasy) and others, the Government have failed to prioritise pregnant women for vaccination, relying on the Joint Committee on Vaccination and Immunisation recommendations. I feel the figures now show that that should change. I ask the Minister to commit that, should boosters be needed in future, pregnant women will be some of the first to receive them, and that alongside that there will be an education and information programme targeted at pregnant women.
Before we get to that stage, there is the issue about which my hon. Friend the Member for Sheffield, Hallam (Olivia Blake) has spoken so passionately from the heart: the ludicrously cruel requirement that women should suffer three losses before support is given specifically for miscarriage and baby loss. Let that sink in. In 2021, we are asking women to go through such a physical, emotional and painful loss three times before they qualify for extra tests, or even early pregnancy support in future pregnancies. How can that be right?
I was lucky to receive extra help and access to some of those tests, but only because a consultant was kind enough to count the losses that I had in the number of babies, rather than pregnancies. I am currently working with a constituent in a similar situation. I am pleased to say that she is now accessing the support she needs, but that should be the norm; it should not be extraordinary. Why are we making women and families go through such pain before they even get a simple blood test? It is cruel beyond belief.
To summarise my points: first, we should make pregnant women a priority for covid-19 vaccines and ensure that they are prioritised for any subsequent boosters. Secondly, we need to recruit, retain and reward midwives to ensure that we have adequate numbers, while being honest about the scale of the challenge ahead of us. That leads on to point three about continuity of care. We need to see continuity of care, prioritising those who are most in need, particularly black mothers, who are four times more likely to die during childbirth.
We must implement the recommendations in the Health and Social Care Committee report. Many of my colleagues on the Committee would have joined today’s debate, but that Committee is sitting at the same time. I pass on their apologies, knowing their strength of feeling and that we are united on those recommendations. Finally, we must end the requirement of three losses before intervention and support is given to women. Pregnancy can be a painful journey for far too many women. Let us listen to women, end that cruel requirement and support women through their joys and their losses, and so improve the statistics on baby loss and miscarriage for good.