Stillbirth

(Limited Text - Ministerial Extracts only)

Thursday 9th June 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this debate and on sharing her experiences so personally and powerfully with the House. I thank colleagues from all sides of the House for doing likewise. Sometimes this House, when it speaks with a personal voice on non-partisan issues, can strike a blow for democracy. I think anyone listening today will have seen their representatives doing their jobs and sharing here in Parliament that which is so often not well expressed in the land.

It is a great pleasure for me to stand in for the Minister for Care Quality, the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer). He is unable to be here today, ironically because his wife, who is pregnant, is having a check-up. I hope it will not be anything serious, and I am sure we all wish him well. I know how much he wanted to be here today, and a number of Members on all sides have paid tribute to his leadership and commitment to this issue, which is very personal. I know he would like to be nowhere more than here, other than beside his wife.

Being here is a particular pleasure for me, partly because I am the Minister responsible for research in the NHS, genetics and unleashing the power of our health system to use its daily footprint of treatment and diagnoses to help to prevent suffering for future generations. This is an area in which, as hon. Members have touched on, good research and intelligent use of data from our health system can help to support future care and improve standards of care and prevention.

On a personal note, I was a child of parents who lost a child. I was due to have a baby sister. She was stillborn very late, and it was a tragedy for the whole family, as hon. Members have talked about, and devastating for my mother. It created huge pressure on my mother and her then husband’s marriage, which did not survive, and led to a complex raft of mental health and domestic family issues, which, as a number of colleagues have said, is all too common. People suffer in silence, and I think all of us talking about this today will in itself help to give people courage to recognise that this is an important issue that people should feel free and able to talk about.

Before I address the specific points made by the hon. Member for North Ayrshire and Arran and other colleagues, I want to set the scene on the Government’s approach to stillbirths in England. I and the Minister for Care Quality, and the Department of Health and its officials, very much welcome the hon. Lady raising these issues today and her support for Sands awareness month, which is this month.

As a number of colleagues have mentioned, stillbirth is often a taboo subject that many people find difficult to talk about and, because of that, many people do not know the statistics. Stillbirth is a personal tragedy, but the statistics matter. Around 15 babies every day are stillborn or die in the first weeks after birth. Today, perhaps 15 families who are expecting a joyous life event will instead experience one of the biggest tragedies of their lives, with another 15 tomorrow and another 15 the day after, and so on. If there were 15 fatal car crashes every day, I dare say the country would be in uproar, but stillbirths remain an uncomfortable subject for people to discuss. It is important that here in Parliament we raise the issue and raise awareness of it.

I want to commend the all-party parliamentary group on baby loss, which is co-chaired by my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince). The APPG was established following one of the most moving Adjournment debates held in Parliament, last November, on bereavement support for families who have experienced the loss of a baby. Reducing the number of stillbirths is an absolute priority for the Department of Health, and we will continue to work closely with Sands and the health system to raise awareness of the risk factors and the clinical practices that can improve outcomes for families.

In fact, England is a very safe country in which to have a baby and it is encouraging that the stillbirth rate in England has fallen from 5.2 deaths per 1,000 births in 2011, to 4.7 in 2013; but we all know that there is much more work to be done. Compared with other similar countries, our stillbirth rates are frankly unacceptable. The Lancet stillbirth series was published in January and showed that the UK was ranked 24th out of 49 high-income countries. The same publication showed that the UK’s rate of progress in reducing stillbirths has been slower than that of most other high-income countries. The annual rate of stillbirth reduction in the UK was 1.4%, compared with 6.8% in the Netherlands. To be frank, that places us in the bottom third of the table—in 114th place out of 164 countries around the world—for progress on stillbirths.

We are aware, however, of the impressive work being done through the Scottish Maternity and Children Quality Improvement Collaborative that has resulted in a 15% decrease in the stillbirth rate in Scotland in just three years. That is another area where the devolution of responsibility allows healthy competition between the devolved Administrations and the best can inspire the rest. We want NHS maternity services to be an exemplar of the results that we can achieve when we focus on improving safety and the patient experience. We believe that, with a concerted effort, we can make England one of the safest places in the world to have a baby.

The Government are wholeheartedly committed to improving outcomes for mothers and babies. In November last year, the Secretary of State launched the national ambition to reduce the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 50% by 2030, with the short-term aim of achieving a 20% reduction during this Parliament by 2020. We were delighted that the royal colleges and maternity and neonatal professionals, as well as key third sector organisations, including Sands, have come together in this area and have welcomed that important yet stretching ambition; we know that to achieve it the health system, the Government, charities and the public all have to take action and work collaboratively.

We know from experience in some maternity services in England that making safety a priority can have an impact very quickly. Strong leadership in the service, good communication, implementation of evidence-based practices, learning from other services about what works and what does not, multidisciplinary team working and training can all have a real impact quickly.

To support the NHS in achieving that stretching ambition, the Government have also announced additional investment: £2.24 million to support trusts in buying monitoring and training equipment to improve safety. That fund was run at the beginning of this year and has now been completed. Over 90 trusts have been successful and received a share of funding, allowing them to buy the latest equipment. We are also putting £1 million into rolling out training programmes to ensure that staff have the skills and confidence they need to deliver world-leading standards of care.

We have also committed to fund the development of a new system—the standardised perinatal mortality review tool. Once that is complete it will be used consistently across the NHS to enable staff to review and learn from every stillbirth and neonatal death. We are developing the tool as many national reports have referenced—as colleagues have here this afternoon—the fact that the same mistakes are being made repeatedly, which is unacceptable. What is missing in these cases is a systematic approach to improving services. We must view individual failings as important and recognise the need for accountability, while balancing that with the need to establish standard processes that will prevent mistakes and avoidable incidents from reoccurring.

In November we also committed to work with Sign up to Safety—the national patient safety campaign launched by the Government in 2014—to support all organisations and to ensure that they can contribute to the national ambition and share best practice. In March we launched the Sign up to Safety sub-brand, “Spotlight on Maternity”. The new guidance asked all organisations with maternity services to commit publicly to placing a spotlight on maternity, to contribute towards achieving the Government’s national ambition and to improve maternity outcomes. It set out five high-level themes for services to focus on that are known to make care safer: building stronger leadership; building capacity and skills for all staff; sharing progress and lessons learned across the system; crucially, improving data capture and knowledge; and focusing on perinatal mental illness.

I want to deal, in particular, with a number of points that have been raised, starting with the investigation of stillbirths and neonatal deaths. The hon. Member for North Ayrshire and Arran raised two points about the investigation of stillbirths. The first was the suggestion that coroners’ powers should be looked at and could be expanded, so that they have jurisdiction to investigate the death of a child who is stillborn after 37 weeks’ gestation to try to understand why the death occurred and to inform best practice. The second point was about independent investigations about clinical care when concerns are raised about a stillbirth or neonatal death.

By law, coroners can only investigate the death of a child when the child has lived independently of their mother, and there are no current plans for the Ministry of Justice to change that. The points about the importance of parents being able to volunteer to have a coroner look at such cases have been well made this afternoon, and I am sure that Ministers at the Ministry of Justice will be watching this debate. If there is doubt as to whether a death was a stillbirth, it should be reported to the coroner to consider whether an investigation should be carried out. Expanding the remit of coroners would require a change in the law and would be an issue for the Ministry of Justice—I will make sure that this debate is brought to its attention.

The Royal College of Obstetricians and Gynaecologists’ guidelines on late intrauterine foetal death and stillbirth state that the right approach is for stillbirths to be reviewed in a multi-professional meeting, using a standardised approach to analysis for substandard care and future prevention. We believe that we should be pursuing that focus, led by clinicians. We are looking at all options to improve reviews into stillbirths and neonatal deaths, including investing half a million pounds to create a system to look at them more consistently across the country, so that staff can understand and learn from each incident.

In April we established a new independent healthcare safety investigation branch—HSIB—to carry out investigations and share its findings. It will operate independently of Government and the healthcare system, be transparent and support continuous improvement by using the very best investigative techniques from around the world, as well as fostering learning from staff, patients and stakeholders. We want that branch to act—in the same way as in the airline industry—as an exemplar to the system as a whole, so that investigations improve and clinicians are increasingly confident that when they speak up after a mistake the result will be learning and not blame.

I want to tackle the point the hon. Member for North Ayrshire and Arran made about collaborative care between clinicians—midwives and doctors—and mothers. She called for maternity care that is more collaborative and responsive to women. She is right. She mentioned the statistic from Sands that 45% of women who raised a concern with a health professional during pregnancy were not listened to and then went on to have a stillbirth. That is completely unacceptable. All women should receive safe, personalised maternity care that is responsive to their individual needs and choices. That is why the Minister for Care Quality has taken such a strong lead on this issue.

In February the report of the independent National Maternity Review chaired by Baroness Cumberlege, “Better Births”, was published. It set out the vision for maternity services across England to become safer, more personalised, kinder, professional and more family-friendly. As we work towards achieving the national ambition, the Department will continue to work closely with NHS England to ensure that this work is embedded in the maternity transformation programme that is delivering the “Better Births” programme.

Women and their partners and families also have a role to play. Evidence shows that this stretching ambition cannot be achieved just through improvements to NHS maternity services. The public health contribution will be crucial. In fact, The Lancet stillbirth series concluded that 90% of stillbirths in high-income countries occur antenatally and not during labour.

When starting pregnancy, not all women will have the same risk of something going wrong and women’s health before and during pregnancy is one of the factors that most influence rates of stillbirth, neonatal death and maternal death. We know that a body mass index of over 40 doubles the risk of stillbirth. A quarter of stillbirths are associated with smoking, and alcohol consumption is associated with an estimated 40%. In addition, the report, “Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the UK” published in June 2015 showed that the risk for women living in poverty is 57% higher, for babies from black and minority ethnic groups it is 50% higher and for teenage mothers and mothers over 40 it is 39% higher. Those striking statistics show why the Department of Health will continue to work closely with Public Health England and voluntary sector organisations to help women to have a healthy pregnancy and families to have the best start in life wherever they are and whoever they are.

As part of the national ambition, the Department is already developing a public-facing communications campaign with Sands and Best Beginnings to highlight the avoidable risk factors. It is vital that women and their families understand these risks and the impact they can have on outcomes for them and their babies, and the lifestyle changes they can make to increase their likelihood of a positive outcome. This campaign will be launched imminently and I encourage all hon. Members to support it during the launch period.

I want to touch on research as the Minister for research in the Department. Some hon. Members have asked that we support research into the causes of stillbirth and neonatal death so we can better understand how to identify babies at risk. Unless we invest in research, we simply cannot understand how to improve services. I welcome the fact that just this week Sands announced the launch of its 2016 research fund. In recent years, the Government have invested significant sums in support of research into important questions regarding stillbirths and neonatal deaths.

The National Institute for Health Research, for which I am responsible and on which we spend over £1 billion a year as the NHS research laboratory around the country, supports biomedical research centres at Cambridge and Imperial College, where it has invested over £6 million in research on women’s health, including research to increase understanding of stillbirths and neonatal deaths. Other NIHR funding pots are available for bids from researchers and charities. It is vital that we continue to encourage bids for studies on the causes of stillbirth and neonatal deaths and the identification of babies at risk, so we can learn how to improve services.

I want to touch on the importance of bereavement care, which has been raised. The death of a baby, whether during pregnancy or following birth, is a trauma and a tragedy for those involved. I can only begin to appreciate just how devastating it must be for the parents who experience that loss. It is important that we provide them with appropriate care and support at that time. It is our duty to them. The recent MBRRACE report stated that 60% of parents currently receive a high standard of bereavement care, but that means that 40% do not.

Since 2010, we have already invested £35 million in the NHS to improve birthing environments, including better bereavement rooms and quiet area spaces at nearly 40 hospitals. We have also conducted a survey to map the bereavement provision in England, which will allow us to build up a picture of current provision and identify where the gaps are. The qualitative data we have collected is also crucial in both highlighting areas of good practice and understanding the challenges that services face. My officials are considering all that information and working on setting out the next steps imminently.

In the time available, I want to try to deal with the other points that have been raised, including third trimester scans. The UK National Screening Committee is currently carrying out a call for new screening proposals. I can send hon. Members details of how to submit a proposal to that funding pot.

On routine antenatal care, the “Better Births” report by the National Maternity Review calls for safer care based on a relationship of mutual trust and respect in line with the woman’s decisions. The vision is for women from the antenatal period to receive care from a small team of midwives who work closely with an identified obstetrician. The relationship developed between the woman and the clinicians needs to ensure that the woman receives personalised and safe care that is responsive to their individual needs.

My hon. Friend the Member for Henley (John Howell) asked about ensuring that clinical commissioning groups are properly aware of their obligations. The “Saving Babies’ Lives” care bundle published in late March by NHS England brings together elements of maternity care that are recognised as evidence-based and/or essential for best practice. It is designed to tackle stillbirth and early neonatal death, and focuses on those four key areas. I am happy to take this opportunity to highlight the fact that CCGs should be aware of it and to make sure that NHS England ensures that CCGs are aware of their responsibilities and what is expected of them.

The hon. Member for Ellesmere Port and Neston (Justin Madders) asked about our commitment to report on the progress of our ambition of a 20% reduction by 2020. I am delighted to confirm that the standardised perinatal mortality review tool will be available to all trusts by 2017 and we will provide annual progress reports following the launch of the strategy. The annual progress report will include expert advice from all the royal colleges and we plan to publish the first this autumn.

Some hon. Members asked about counselling for families. We are committed and believe that good bereavement care should consider the needs of the whole family: mother, father and children. The Government are absolutely committed to improving bereavement care. We are working actively on setting out the next steps in due course.

In conclusion, I thank the hon. Member for North Ayrshire and Arran for securing the debate and hon. Members from all sides for sharing often personal and traumatic stories. It has allowed us to highlight some very difficult issues and to acknowledge the silent suffering of so many of our constituents—this condition does not respect party or geographical boundaries—and to stress the importance of tangible progress from all the agencies involved. I hope that I have reassured hon. Members that the Government are taking the matter seriously. We are putting in both investment and, importantly, leadership, which I think all hon. Members agree the Minister for Care Quality is showing. I look forward to seeing the progress of all this work and reporting on it later this year.