(6 years, 1 month ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Antoinette Sandbach (Eddisbury) (Con)
I beg to move,
That this House has considered baby loss awareness week 2018.
I rise to open today’s debate on Baby Loss Awareness Week, and if you, Madam Deputy Speaker, or others wish to read the account of Fiona Crack and her husband about their daughter Willow that is on the BBC site today, you will understand why this debate has continuing endurance and relevance. I am also extremely grateful to my colleagues and the charities that have worked with us on the all-party parliamentary group on baby loss. I want to use my time to highlight some of the successes, to describe how we can ensure that we build on them and to mention a couple of areas where we must focus our efforts more closely as they have become areas of concern.
Looking back over the past year, I am proud of the higher profile of parental bereavement issues. Whereas before many people felt that they did not know how to approach the subject or what to say, we are increasingly seeing people coming forward and offering words of sympathy, kindness and condolence, and the 60 charities working in this field have produced an excellent video, which is available on YouTube under the title “Baby Loss Awareness Week”. Members of the public and anybody watching this debate can watch and see how to approach and discuss the subject.
This change has come about because of a slow and steady change in how we in this country treat those who have lost a child. All of those involved in Baby Loss Awareness Week can be proud of this change, from those of us in this place today to the fantastic charities and voluntary groups, such as Sands, the Lullaby Trust and the 60 other charities that have been involved in the initiative. In addition, doctors, nurses and midwives on the frontline have been changing attitudes during the past few years.
It is not just attitudes that have changed in the past year, but policy. I am delighted that the past year has seen two major policy shifts: the implementation of a pilot of the national bereavement care pathway; and the passage of the Parental Bereavement Act 2018 into law. I am sure that my hon. Friend the Member for Colchester (Will Quince) will want to discuss that Act in more detail, and I pay tribute to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for his able stewardship in taking the Bill through Parliament. This is a significant step in ensuring that those who lose a child can mourn their loss while knowing that they have a period of paid parental leave from their employment. It marks the introduction of a new benefit such as has not been seen in this country for many decades, and I welcome the progress that the Government have made on that.
I want to spend a little longer concentrating on the national bereavement care pathway. Good care cannot remove parents’ pain and grief, but it can help them through this devastating time. In contrast, poor care can significantly add to their distress. The national bereavement care pathway sets out to deliver that good quality care and it was designed to address the previous postcode lottery in quality of care. The first wave of pilots was launched this time last year, during Baby Loss Awareness Week 2017. Eleven trusts were joined by 21 more when the second wave started in April of this year. This week, we take another step forward, as all the documents, tools and resources are being made publicly available for the first time. The national bereavement care pathway is paving the way for excellent care after pregnancy and baby loss. It aims to improve the quality of bereavement care experienced by parents and families at all stages. That includes miscarriage, stillbirth, neonatal death, molar and ectopic pregnancy, termination of pregnancy due to foetal abnormality, and sudden and unexpected death in infants of up to 12 months. This bereavement care pathway provides healthcare professionals with detailed guidance, training programmes, staff resources and simplified paperwork so that they can provide high-quality bereavement care when families need it most.
We are lucky because an evaluation of the first wave of pilots has taken place, and the results have been really positive. Parents have responded overwhelmingly positively, considering what they went through at the time. Some 95% of parents surveyed agreed that the hospital was a caring and supportive environment; 98% of parents agreed that they were treated with respect; 90% felt that they were provided with information that was easy to understand; 92% felt that the decisions they made in hospital were the right ones at the time; and 96% felt that they were communicated with sensitively. That is so important, because that shows that there has been a huge change in advice and support. I think my hon. Friend the Member for Banbury (Victoria Prentis) will be talking about the less encouraging statistics for areas that have not been able to roll out the pathway.
It is not only parents but medical professionals who feel the difference. At the beginning of the pilot, medical professionals were interviewed and asked what was preventing the delivery of the best possible quality bereavement care. One said that
“people were in their own little bubbles. There wasn’t much sharing, nothing was passed around as a standard.”
Medical staff also identified a lack of staff training, poor bereavement suite facilities, complex paperwork, long delays in getting post-mortem results back, staff not knowing how to communicate with parents about their loss, and different levels of awareness or knowledge between departments at the same hospital. The evaluation shows that significant progress is being made on a number of those concerns. Some 77% of the professionals who are aware of the pathway agree that, overall, bereavement care has improved in their NHS trust during the period of the pilot. That is something that our national health service can be really proud of, because it represents a significant change. Two thirds of professionals who are aware of the pathway agree that it has helped to raise the profile of effective bereavement care in their trust. The proportion of health professionals who feel prepared to communicate with bereaved parents, able to discuss bad news with parents and supported to deliver good-quality bereavement care has increased. If this were an exam, the student would have passed with flying colours.
The testimony of one parent who was involved in the pilot says it all:
“There was a doctor who was really, really helpful with me. It was such a shock and took such a long time for me to process why and how this happened; I must have gone in about five times, where she had to sit me down and tell me the same thing again and again. It was never too much trouble for her, and I needed that. Having patience with someone is really, really important—because you might have said it five or six times but I need you to say it again. She’s a doctor, she’s a very busy woman but she always made time to speak to me.”
This kind of care, and this kindness in care, is so important for parents in that position. They are going through the worst experience of their lives, and they are not always thinking straight. They are guaranteed to be sleep deprived and distraught. The kindness of a doctor or the concern of a midwife can be the first small building block on the road to recovery.
However, despite these successes and others, which I am sure colleagues from across the House will mention, we must continue with our work. In the most recent year for which figures are available, 5,500 babies were stillborn or died within 28 days of birth in the UK. Some of our European neighbours have managed to cut perinatal mortality rates by up to half, which shows there is still more to do. I welcome the Government’s target of halving perinatal mortality rates in the UK by 2025.
One thing I am becoming increasingly concerned about is the rising number of child death cases in hospitals. Although I am pleased that the light of transparency is being shone into these hospitals, I cannot help being concerned by the number of such cases in the last year. Shrewsbury and Telford Hospital NHS Trust has been the subject of horrific news, with the investigation into maternity care expanding to more than 100 cases. Likewise, in my own area, the Countess of Chester Hospital is the subject of a criminal investigation amid allegations that a member of medical staff was involved in 17 deaths and 15 non-fatal collapses. More broadly, a recent study found that the baby death rate was 10% higher than expected for a maternity unit.
Just last week, we saw the news from Wales that Cwm Taf University Health Board may have failed to properly investigate historical cases of stillbirth and neonatal deaths in its maternity units. I know that that case—the most recent—is devolved, and there will be things that the Minister cannot say while investigations are ongoing, but I would be grateful if he reassured the House about the steps that are being taken to address these specific issues, and what plans he has to ensure that when such issues arise in the future, there is a plan in place to support affected parents and ensure that the investigation is as quick and thorough as possible.
Lilian Greenwood (Nottingham South) (Lab)
The hon. Lady is speaking with great authority on this issue, as she always does. Does she agree that one thing the Government could do in this area, particularly when it comes to stillbirth, is to extend the power of coroners to investigate stillbirths of full-term babies? We have discussed that previously, and it is the subject of a private Member’s Bill. Does she think that that would help in the investigation, and therefore the prevention, of unnecessary deaths?
Antoinette Sandbach
I know that across the House there is a great interest in the need for coroners’ investigations, and I believe that the hon. Member for East Worthing and Shoreham (Tim Loughton) will be introducing a private Member’s Bill. I think that the idea has support from the Government. It is incredibly important for parents to give consent to post-mortems—that can be a very sensitive area, particularly for parents from ethnic minority backgrounds—because very often, medical findings assist with the research to discover the causes of stillbirth and neonatal death. The hon. Lady makes a very good point.
In closing, I hope that colleagues will recognise that this year has been one of significant policy wins.
Gareth Thomas (Harrow West) (Lab/Co-op)
I echo the point that my hon. Friend the Member for Nottingham South (Lilian Greenwood) made by commending the hon. Member for Eddisbury (Antoinette Sandbach) on her joint leadership of the all-party group on baby loss and her support for the charities that have come together once again to initiate Baby Loss Awareness Week. Will she praise the intervention of a councillor in my constituency, Sarah Butterworth, and her husband Jon, whose baby, Tiger Lily, was stillborn in June 2005? They have joined in the support for Baby Loss Awareness Week to encourage more debate about this sensitive issue.
Antoinette Sandbach
I certainly join the hon. Gentleman in praising his constituents’ work in memory of Tiger Lily. Let me also refer to the story of Fiona Crack and her daughter Willow. Fiona went to speak to the hon. Gentleman’s constituents, and there is a detailed account on the BBC’s website, highlighting the way in which they have turned a negative into a positive in commemorating the memory of Tiger Lily and the steps that they are taking to help other parents in their grief. I believe that they help with the memory boxes; I have a memory box at home, and I know how valuable that is.
I think that there has been a real uptick and a real positive story to tell this year, given the policy wins that have come from the Government. We know that we must address these challenges, but we have come a huge way in the last three years, and we have won important changes in policy.
Members may be wondering what they can do to drive the changes that we need. First and foremost, they can join me in encouraging the Minister to fully fund the national bereavement care pathway into 2019-20, so that it is embedded and becomes the national standard for best practice. I hope that the Minister will have something to say about that when he winds up the debate. Secondly, Members on both sides of the House can engage with their local charities who help those who have lost a child, as, indeed, many of their constituents have. I know that many Members are present because of the work that their constituents have done, or because of their own experiences.
Members can also help to promote the national bereavement care pathway in their constituencies. We have seen from the pilot that it works, but political support and public awareness are crucial to ensuring that it is embedded throughout the UK. If Members leave this debate with one thing in their minds, let it be the testimony of a grieving parent who experienced the pathway:
“I was shocked at the level of care. I thought ‘this is the NHS, why are they making such an effort for me?’ I didn’t know care like this existed and I was blown away by it—my expectations were exceeded in every way”.
We have all benefited from amazing care from our NHS, but sometimes it does not have all the tools that it needs. The national bereavement care pathway gives it the tools that it needs to deal with this very difficult issue, and we must work to ensure that it is put in place throughout the country.
Ben Lake (Ceredigion) (PC)
Let me begin by expressing my admiration for the hon. Member for Eddisbury (Antoinette Sandbach), who made such a powerful contribution to the debate and, in particular, for her personification of bravery when recounting what can only have been a painfully traumatic experience.
I speak as someone who has not lost a child and who, as such, cannot begin to imagine how harrowing, how devastating, such a loss must be. I cannot begin to understand what it feels like to have enjoyed the exhilaration of expecting a new addition to the family and the months of anticipation and preparation, and then to be deprived of such joy.
As a society, we must strive to reduce the UK stillbirth rate, which remains high in comparison with those of other wealthy countries. There is also a disparity within the United Kingdom that needs to be acknowledged: Wales still has the highest stillbirth rate, at 4.44 per 1,000 births. Others who are present this evening will have far greater experience and expertise than I—so I will keep my remarks brief—but it appears to me that a range of measures will be needed to reduce our rate significantly. For example, researchers from the University of Edinburgh have recently discovered that introducing a package of care when women report a change in foetal movements can help to reduce the stillbirth rate slightly. Raising awareness among expectant mothers is important, but we should also ensure that training for frontline maternity professionals is not only available but prioritised, so that they are best able to react to any change in movements reported by mothers. Training and resources must be made available to maternity units so that they can act promptly when necessary.
As I am sure will be mentioned later this evening, hand in hand with greater awareness of changes in foetal movement is the potential for an enhanced programme of ultrasound scanning into the third trimester—which occurs elsewhere in Europe—to measure a baby’s growth more effectively, potentially reduce the number of adverse perinatal outcomes caused by foetal growth restriction and prevent avoidable deaths. This is, of course, at the heart of the debate: the desire to represent the experiences of parents who have lost their child and, from their strength, endeavour to prevent others from having to suffer the agony of losing their child.
Let me express my admiration for the bravery of all the parents—some, I know, are in the Chamber this evening—who have lost a child. I am simply in awe of those who are able to speak so eloquently about their loss and work determinedly to improve things for other parents. I pay particular homage to the Members who are so active in the all-party parliamentary group on baby loss.
A young couple in my constituency embody such courage and fortitude. Having lost their little girl, Mari-Leisa Jên, this summer, Clare and Gareth have undertaken a range of initiatives to raise money to help to fund the purchase of additional “cuddle cots” for Ceredigion. The cots allow grieving families to have more time with their children— precious time in which to make lifelong memories—and I thank the charity Cariad Angel Gowns for enabling that to happen for Clare and Gareth.
The couple have climbed Snowdon to help raise money for the cots and to raise awareness of the causes of perinatal loss. Close friends completed the Cardiff half-marathon this weekend in memory of Mari-Leisa Jên. At a time of unimaginable grief, when most would understandably retire into themselves, Clare and Gareth have thought of helping others and, to date, have raised thousands of pounds. Such incredible resilience speaks for the strength and depth of their love for Mari-Leisa, and although her time with us was all too brief, the impact that she has had on family, friends and the local community is second to none. Mari-Leisa fach has brought them together to make a positive difference for others, and I, for one, cannot think of a more loving or a more worthy legacy.
Victoria Prentis (Banbury) (Con)
Thank you for letting me speak early in the debate, Madam Deputy Speaker. I should start by apologising for the fact that I have an unbreakable commitment elsewhere and have to leave before the end of the debate. It is the debate that I dread most during the year, but it is also one of which I am determined to be part.
It is a great honour to follow both the Members who have spoken so far, to speak in a debate that marks the beginning of Baby Loss Awareness Week and to serve as vice-chair of the merry band—largely—of people who form the all-party parliamentary group. We have been brought together by horrific circumstances, but we have had extraordinary success. There are hundreds of all-party parliamentary groups, perhaps even 1,000, but very few can boast the success that we have had in the past three years. We have really put baby loss on the agenda, and we have changed the law on, for example, parental bereavement leave.
Victoria Prentis
I gesticulate at my hon. Friend, who has joined us so enthusiastically in championing that issue.
We would not be where we are today were it not for the support that we have received from the Government, especially the Ministers in the Department of Health and Social Care, and, indeed, the hard work of the charities that work with us. This year is particularly special for Sands, which is celebrating its 40th anniversary. I am very proud of my constituent Karen Hancox, who has worked so hard for Sands in Oxfordshire since losing her first daughter, Kayleigh, in 2008. She was responsible for lighting up Banbury cross in memory of Baby Loss Awareness Week last year, and she also helped with the fantastically helpful service in St Mary’s, Banbury last year, which we are repeating this Sunday, and at which I hope any hon. Member passing on the M40 will join us.
Mr Jim Cunningham (Coventry South) (Lab)
I want to take the opportunity of this intervention to congratulate the hon. Member for Eddisbury (Antoinette Sandbach), who has been tirelessly campaigning on baby loss for many years now. I have listened to these debates before and they are very difficult for everybody, even those who have no experience of baby loss. I can remember the issues around cot deaths, when women were charged and accused of perhaps harming their babies. But there is also the fairly recent problem—I think there are some ongoing investigations and prosecutions—where parents have lost their child at birth but still do not know the reason for that. I congratulate the hon. Member for Eddisbury once again for her tireless work in this area.
Victoria Prentis
I thank the hon. Gentleman for his intervention, and, if I may on behalf of my hon. Friend the Member for Eddisbury (Antoinette Sandbach), I thank him for his kind words.
The hon. Member for Nottingham South (Lilian Greenwood) mentioned the issue of inquests into stillbirths. I have been leading on that area in the all-party group because of my previous legal background and the fact that I spent much of my legal life conducting inquests on behalf of the Government. There is a current private Member’s Bill on this issue. It is a very broad Bill; the Member in charge likes to refer to it as the hatched, matched and dispatched Bill, which gives some idea of its scope. This is an extremely difficult and sensitive area both legally and in terms of the messaging. Many interest groups are concerned that it touches on the law about abortions and the law about when babies become beings and part of society, but there is no need for much of that discussion in this debate; it does not in fact need to touch on those terribly difficult issues. We in the all-party group are working hard with the Department and the Ministry of Justice, which is also very involved in this, to push this issue forward and to try to ensure that that does not happen and that we are able to address any concerns in the very small number of cases where an inquest would be helpful and extra transparency is needed. I know from my own experience that inquests are very hard for families. The Scots are also working in this area, and, give us time, as next year we may have some announcements, I hope.
Returning to Sands, I want to mention the brilliant work of my constituent Karen. She is one of the 40 volunteers to be nominated as part of the charity’s anniversary celebrations, and I am looking forward to welcoming her to Westminster later this week at our parliamentary reception. I am also very much looking forward to the service we are having in St Mary Undercroft on Thursday and I encourage anybody who works in this House, whether as a Member or peer or any of our staff, to come to that service. It is extremely warm and friendly; everybody might weep throughout, but in a positive way.
I must also praise the BBC—wow, two Conservative MPs praising the BBC in successive speeches—for highlighting our awareness week. The slot on “The Chris Evans Breakfast Show” this morning meant I had to stop the car; it was about the amazing bereavement midwife Nicola Taylor and a couple she helped around the birth of their three babies, and it was incredibly powerful. Fiona Crack’s story is currently on the BBC website. If any Member’s concentration wavers in this debate, I ask them to look at it, or perhaps better to do so when they get home tonight. “Woman’s Hour” is also handling this issue extremely sensitively and well.
I want to touch on three points this evening. First, the bereavement care pathway is, as my hon. Friend the Member for Eddisbury said, a real success. I received some brilliant care but also some less good care when our baby died 18 years ago. Crucially, the national bereavement care pathway embeds the standards across trusts—across the nation—as a matter of course; that is very important. The situation at present is still patchy. According to Sands, only 46% of trusts with maternity units provide mandatory bereavement care training for maternity unit staff. Of those, 86% provide their staff with just one hour or less of training on bereavement care each year.
While it is of course right that we focus on families, we should also think a little about midwives and obstetricians, who are also very affected by the death of a baby in their care. They often build up an enduring relationship with families, and their future health and ability to function must be considered in thinking about what training they receive.
I want to focus on neonatal units, too. They are very stressful places. Anybody with a child on a neonatal unit is not a happy parent; it is not the place they want to be. Some 41% of neonatal unit patients have no access to a trained mental health worker, and many neonatal units still do not have dedicated bereavement facilities. The Government have funded better bereavement places in nearly 40 hospitals, but this is only the beginning. Prioritising the pathway within the new NHS long-term plan would make a real difference. Planning one year ahead is not good enough. We know that despite our best efforts to reduce neonatal death and stillbirth bereavements will continue to occur, and we need to plan for that. I hope the Minister will have some good news for us on this today. My hon. Friend described the Government as passing the exam with flying colours. I agree and am very grateful for what they have done, but I would say that if the Government want to be an A* pupil, further work is needed in this area so that this becomes the norm.
My second point is that better training is only possible if we have enough midwives. I hosted the launch of the Royal College of Midwives “State of Maternity Services” report recently, which found that finally more midwives are entering training. When I hosted it last year we were very concerned by the ageing of the profession. We are all getting older—we cannot help that—but I am pleased to say that we now have over 2,100 more full-time equivalent midwives in the NHS than we did in 2010, and the vast majority are in their 20s and 30s. It is also important that we focus on retaining these midwives and persuading former midwives back to work. This is progress in the right direction, but the situation remains critical. I really do wake up at night worrying about labouring mothers in my constituency in north Oxfordshire going to the Horton General Hospital to give birth only to be told that the unit has closed because the midwife who staffs it has been sent to cover gaps at the John Radcliffe. This been the case on at least three separate occasions in recent weeks. If anybody knows of anyone who is thinking of becoming a midwife, please encourage them to do so. It is a brilliant profession and it is important that the Department continues to encourage the training and retention of the midwives we need.
Finally, I want to touch on perinatal mental health. On the eve of world mental health day, it seems appropriate to focus on the mental health of mothers and fathers. Pregnancy presents the health service with a brilliant opportunity to engage with people who are becoming parents and to give them life lessons that will improve health choices for them and their children. Their mental health is as important as their physical health. We know that those who have had difficult pregnancies or have lost children will, understandably, struggle with subsequent births. We need to identify families at risk and pour resource in before it is needed. These families may not fit into the usual definitions of post-natal care.
The definition and structure of care in the six-week post-natal period has changed very little in the past 150 years, but during this time there have been dramatic changes in women’s health and our attitude to birth—and indeed in the outcomes of birth. It is critical that contraception is also discussed and is easily available during this time. Waiting months to have a long-acting contraceptive fitted is not helpful to new mothers. It might seem ridiculous to bring up the subject of contraception in a debate on baby loss, but it is important given the maternal mortality statistics. Some of the women who are dying while giving birth should not have been pregnant in the first place. It is critical that we deal with contraception early, where that is appropriate, and that we give people real choices so that they can get the contraception that works for them straight after they have given birth.
We in the all-party parliamentary group will continue to say the unsayable on issues such as baby ashes or the appropriateness or otherwise of inquests. These are dark areas for any society to deal with, but I believe that the APPG has been a force for good. I am really proud to play my part in breaking the silence.
Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)
It is a real pleasure to be here for this important debate in the Chamber today. I would like to pay tribute to colleagues across the House for sponsoring the debate and for the work they do to keep this important issue on the agenda. I do not want to speak for too long, but I do have a few words to say. Baby Loss Awareness Week is an important part of the calendar and provides important support networks for bereaved parents, their families and friends. I recall sitting in the House for the debate on this issue last year, and I know that all colleagues agreed that it represented Parliament and politics at their best. In its 16th year, I welcome Baby Loss Awareness Week 2018 and the 60 charities that support it. Those charities are based in all parts of our United Kingdom, and they are doing brilliant work.
Before talking about a link to my own constituency, I want to place on the record my own personal experience of facing the loss of a child. My son was eight months old when he took ill with meningitis and we were given 24 hours to see whether he would survive. Twenty-eight years on, he has survived, thanks to the NHS staff at Monklands Hospital. Today I thank them once again on behalf of my family.
Fifteen babies die every day in the United Kingdom either before, during or shortly after birth; the number of unexplained deaths in children aged over one is not easy to identify across the whole of the United Kingdom. I am particularly interested in the discrepancies in bereavement care. I am firmly of the view that there is a need for bereavement suites in all neonatal units, with increased training and improved staffing levels. This is because 41% of neonatal units have no access to a trained mental health worker and many still have no dedicated bereavement facilities. I hope that we will see the kind of policy decisions in all four nations of the United Kingdom that will allow progress to be made. I welcome the commitment in Labour’s 2017 manifesto that pledged to “significantly reduce infant deaths”. We support the Government’s commitment to reducing the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 50% by the year 2030.
I want to say a few words in honour of my colleague, Gordon Encinias. Gordon was a councillor in Coatbridge South and a colleague of mine in Coatbridge, Chryston and Bellshill. Gordon died earlier this year and I know that I speak for many in the Scottish Labour family—and, more importantly, North Lanarkshire Council—when I pay tribute to Gordon and thank him for all his work. I mention Gordon because he and his wife lost children to infant deaths themselves, and they committed themselves to championing this issue through supporting Bumblebee Babies, a charity based in North Lanarkshire. Gordon helped it to find a property and premises and gave it his support. It is led by Brenda Murray and now supports parents in all parts of our United Kingdom. I pay tribute to Brenda and all the staff at Bumblebee Babies, and to my late friend Gordon Encinias.
I want to pay tribute to all hon. Members involved in this, particularly my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft) and the hon. Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince). Importantly, I also pay tribute to all those parents who have lost children, and I pledge to use my office to do all I can to ensure that the right support is there at the right time. Finally, I pay tribute to my mother, Helen Gaffney, who recently passed away at 86. Her first job as a young nurse was to look after stillborn children, and she looked after those angels as if they were her own. Rest in peace, Mum.
Will Quince (Colchester) (Con)
It is a pleasure to follow the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney); I am pleased to say that his is one of the Scottish constituencies that I do not have a problem pronouncing. I should also like to thank all the previous speakers, particularly the hon. Member for Ceredigion (Ben Lake). He and the hon. Member for Coatbridge, Chryston and Bellshill have shown the importance of hearing men’s voices in the Baby Loss Awareness Week debate. I particularly want to thank the Backbench Business Committee for allowing the time for this debate, and my hon. Friend the Member for Eddisbury (Antoinette Sandbach), the co-chair of the all-party parliamentary group, for securing this important debate for the third year running.
In November 2015, when I was a relatively newly elected MP, I remember coming back after the recess and putting in for an end-of-day Adjournment debate. Based on my own experience, I thought we should have a debate on bereavement care in maternity units. Little did I think that we would have made such progress in just over three years. We now have the all-party parliamentary group, and we are in our third year of marking Baby Loss Awareness Week here in Parliament. That demonstrates the power of this place when we put aside the squabbling and party political differences and work together with a clear aim. It is clear that we are united and speak with one voice when we say that we are committed to reducing stillbirths and neonatal deaths—I include miscarriage in that description. We are also committed to ensuring that we have world-class bereavement care right across our world-class NHS for those who go through the huge personal tragedy of losing a child.
This is a particularly important and poignant week for me and my family, because it is four years ago this week that we lost our son, Robert. We will be marking his birthday on Friday, when he would have been four years old. On Sunday, my two daughters and I picked out the birthday cake that we will be sharing. Sadly, we are just one of the families who are going through this experience week in and week out, up and down our country.
We should not underestimate the importance of talking about baby loss. This is why debates such as these are so important and powerful. Totally wrongly, baby loss is a massively taboo subject. We have made huge efforts over the past three and a half years to try to break the silence and the taboo by working with charities, organisations and health professionals, but the taboo still exists. It exists because we do not like talking about death, full stop, and particularly about the death of children or babies. It is important that we talk about it, however, because that little baby was a huge part of somebody’s life. It is part of their story and their journey, and to ignore it can cause irreparable issues.
We must use the power of Parliament to break that taboo and talk about the issue, rather than crossing the street and avoiding someone who has suffered a stillbirth, miscarriage or neonatal death. We should talk to them about it. We should ask about their child and refer to them by their name, because people do want to talk. If they do not want to talk, they will tell us. It is really important that they should not be ignored.
Richard Graham (Gloucester) (Con)
I am so impressed by the work of the all-party parliamentary group. I rang my sister, who lost a baby a long time ago, to ask her what she would say if she were here. She asked me to encourage hon. Members to ensure that two things are available in hospitals. First, there should be someone practical to give advice on issues such as burials. The second, more important, thing was to have someone who can give emotional support to people who are in a moment of crisis and panic, and she felt strongly that in today’s era such services should be multi-faith and no faith. The chaplain’s offices in our Gloucestershire Royal Hospital can do that.
I should also like to mention a male constituent of mine who said that there had been a lot of support for his wife when they lost a child, but there had been no male support group. What does my hon. Friend think of those suggestions?
Will Quince
I thank my hon. Friend for raising those very good points, which are entirely valid. His points about support, both in hospital and post-hospital, and about the support available to fathers, are very important and I shall come on to them in a moment.
Just before we move on to the debate proper, I want to talk a bit about my right hon. Friend the Member for South West Surrey (Mr Hunt), because we have not had a chance since his elevation to the position of Foreign Secretary to praise him for the work he did on these matters when he was Health Secretary. From the beginning, we also felt supported by Ben Gummer—I think I am allowed to call him that now, as he is the former Member for Ipswich; he encouraged us to set up the all-party parliamentary group. However, the former Health and Social Care Secretary, now Foreign Secretary, could not have been more supportive, and we felt from the very beginning that we were pushing against an open door. He knew that the issue needed to be addressed, and he threw the full weight of the Department behind it. I thank him on the behalf of the APPG, and I know that all the charities feel the same way. He was hugely supportive and continues to be so.
We produced a video for Baby Loss Awareness Week, which is live now, and my right hon. Friend features in it, showing how passionate he is about tackling this issue. I also want to say how much the rest of the APPG and I are looking forward to working with the new Secretary of State for Health and Social Care, my right hon. Friend the Member for West Suffolk (Matt Hancock), who has already reached out to me and other members of the APPG, as have his special advisers, to continue that work, which they recognise is important.
Several colleagues have already referenced the hugely important work done by charities up and down the country. That includes both big charities such as Sands, which is marking its 40th anniversary this year, the Lullaby Trust, the Mariposa Trust, Tamba and so many others and small charities that provide support locally. The support that they provide to parents at the most difficult time in their lives is so valuable, and I thank everyone who works in and volunteers for those charities.
Lilian Greenwood
The hon. Gentleman is making a powerful contribution, as he always does, and I congratulate him and all the members of the APPG on their work. Will he join me in congratulating a local Nottinghamshire charity called Forever Stars? Not only is it doing fantastic work supporting parents who have lost a child, but it has managed to raise £300,000 to create two new bereavement suites at the two Nottingham hospitals over the past year. I know that that has already been touched on in the debate, but it makes such a difference to parents who have experienced the loss of a child when they have somewhere suitable to be with their baby and deal with the aftermath of a terrible situation.
Will Quince
I thank the hon. Lady for her intervention. I will absolutely thank and pay tribute to that charity. In so many cases, bereaved parents want to do something to make a difference and to provide a legacy for or mark the life of their child, however short, and raising money to support our NHS or to provide support for bereaved parents is hugely worth while. If I heard the hon. Lady right, an incredible £300,000 was raised: I pay tribute to the work that parents across the country do to raise such sums, which support the NHS in providing world-class facilities. I will discuss this further in a bit, but although we do have world-class facilities and bereavement suites some of our hospitals do not have them, which is an issue in and of itself.
I have thanked charities, but it is also important to thank the clinicians and support staff within the NHS who work so hard in this area. They really are heroes, and their work is incredible. Midwives do an incredible job, because although they are so often there at the best time in someone’s life—when a child is born—they are sometimes sadly also there at the very worst time in someone’s life. Their ability to, in effect, wear both hats and provide that caring, compassionate, empathetic support is a credit to them. We really do have world-class staff in our NHS.
I also thank all the clinicians who are working so hard on the national bereavement care pathway. Numerous colleagues have mentioned it already, and it is important to reference the progress made so far. I do not want this to be a back-patting debate, because I will move on to some areas where the Government could do more, but we have achieved quite a lot in just over three years. The first, and probably most significant, achievement was the Government’s commitment to reduce stillbirth and neonatal death by 20% by 2020 and by half by 2025. I note that that target has been moved forward—I think the target three years ago was 2030—thanks to the work of the Secretary of State for Health and Social Care, Health Ministers and clinicians. Having spoken to the Department and to clinicians up and down the country, I understand that those targets are realistic and achievable and that we are on track to achieve them, which is quite incredible.
However, it is important to note that even if we achieve the target of reducing stillbirth and neonatal death by 50%, that still means that around 2,000 or 2,500 babies are dying in the UK every single year and that a similar number of families will be going through a horrific personal tragedy, so we must ensure that we have world-class support. That is why the national care bereavement pathway, which I think it is fair to say was a concept initially drawn up based on the APPG’s work with charities, is game changing. The pathway is game changing, because what we had and continue to have across our NHS is world-class bereavement care, but it can be found only in pockets. It is not consistent across the NHS.
A particular hospital trust may have one or perhaps even two specialist bereavement suites and one, two or maybe more specialist bereavement-trained midwives or gynaecological counsellors, and all sorts of charities may be supporting bereaved parents within that hospital trust. In other hospitals, however, there may be no bereavement suite and perhaps just one or even no specialist bereavement-trained midwives or gynaecological counsellors. That is an issue, so a national bereavement care pathway that provides consistent, compassionate, empathetic care and support across our NHS, whichever hospital one visits, is so important.
Antoinette Sandbach
I congratulate my hon. Friend on that point. However, even where world-class care is not available, that can change, and the Medway NHS Foundation Trust is a great example of that. It received a negative inspection report, but it completely turned the situation around and now has absolutely first-class facilities. World-class care is achievable when hospital managers and NHS trusts are absolutely committed to delivering it.
Will Quince
My hon. Friend is absolutely right. The core purpose of the national bereavement care pathway is to show what good care looks like so that it can be rolled out across our NHS. My hon. Friend is right that we can do that by having bereavement suites and trained gynaecological counsellors and midwives, and we are seeing it. The pathway has now been launched in 32 sites, and I must again praise the Government for their initial funding, which supported the establishment of the principle and the pilots, and then the further funding for the roll-out into more sites.
I echo the comments made by my hon. Friends the Members for Eddisbury and for Banbury (Victoria Prentis) about further funding to roll out the pathway to ensure that it reaches the entire NHS nationwide, but 77% of professionals at the pilot sites who were aware of the pathway agree that bereavement care improved in the trust during the trial, and some 95% of parents interviewed agreed that the hospital was a caring and supportive environment. We therefore know that the pathway is making a difference and will work, which is why the Government have been so supportive. We just want to ensure that it is rolled out. The roll-out has deliberately happened in stages because ensuring that it is effective and embedded is just as important as the initial implementation.
Others have mentioned the Parental Bereavement (Leave and Pay) Act 2018, which is an incredible and ground-breaking piece of legislation. It is the first time that workers have had such a right, and it is one of the best rights in this area in the world. I pay tribute to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for so ably and passionately steering the legislation through the House of Commons and then ensuring its passage through the House of Lords and beyond. It is game changing, because it means that, from 2020, parents who lose a child up to the age of 18 will be entitled to two weeks’ paid leave. That is particularly important in relation to this baby loss debate, because it means that parents who lose a child to stillbirth will also be entitled to those two weeks.
For a mother, those extra two weeks may not be a huge change because mothers are entitled to their full maternity leave, but for a father it is game changing. Instead of two weeks’ paternity leave, he will get four weeks, because he will get the additional two weeks of paid leave. The Act will make a huge difference to fathers up and down the country who go through the awful experience of a stillbirth.
I said earlier that this was not a back-patting debate. Far, far more needs to be done. Earlier we had reference to bereavement suites. It is essential that we have bereavement suites in every hospital up and down the country. It is not acceptable that any parent should have to suffer a stillbirth or neonatal death in a maternity unit where they can hear happy families, crying babies and people with balloons and teddies—all the joy of that. People who are going through this most traumatic of experiences need somewhere quiet for reflection, to grieve and to spend time with their baby in peace. We know that we can provide this because NHS trusts up and down the country are providing bereavement suites. In Colchester we were lucky to have use of the Rosemary suite, and I am not quite sure what we would have done without it.
So we have to ensure, Minister, that we have a bereavement suite in every hospital away from the main maternity unit. Ideally, I would like another room to be available, because you cannot book in. You do not know when exactly you are going to have a baby—these things do come on, as my wife and I found out with our second, who was born at home, unexpectedly. It was also a pretty traumatic experience, but it ended well. The point is that people do not know and they cannot book suites out. They can just turn up at hospital. If, sadly, the suite is already being used, another room should be available. It might not have the full facilities of a bereavement suite, but it is important to have that room.
As was mentioned earlier, cold cots are also important. Not all parents will want to spend time with their child, but those who want to should be able to spend as much as they need after the birth, and for that cold cots are important.
As I mentioned earlier, it is important that bereavement-trained midwives or gynaecological counsellors are available in every hospital—not part time but full time, and available for parents when they need them. Let us not forget that many stillbirths and neonatal deaths are sudden and unexpected. It is a hugely traumatic experience and people need support immediately. A trained individual is so important. However, there is merit in ensuring that bereavement training is a module in the midwifery course so that every midwife is trained to an extent, because sadly we know that they will come across stillbirth and neonatal death in their career.
The other thing is to ensure that there is learning from every miscarriage and stillbirth. We still do not really understand why 50% of stillbirths happen. I will come on to it, but research is so important. I have already mentioned embedding the national bereavement care pathway.
I want to touch on the new pregnancy loss review, because it has not been mentioned so far. One of its heads is Zoe Clark-Coates of the Mariposa Trust. We often talk about stillbirth and neonatal death, but we do not talk enough about miscarriage and we still do not really know the true numbers of miscarriages. Colleagues in the Chamber have spoken emotively in previous debates about their experience of losing a child at less than 24 weeks. They said that their loss was not recognised in any way because it was classed as a miscarriage, not a stillbirth, even though they gave birth. This is why the pregnancy loss review is so important.
I echo the comments made by my hon. Friend the Member for Banbury about post-mortems. Too often, people are scared to have the conversation about a post-mortem. It is a difficult subject; I would not want to approach parents who have just lost a child and ask if they would consider a post-mortem. But it is so important that that question is asked, because post-mortems will enable us to start to understand why stillbirths happen. So changing cultures within NHS trusts to ensure that that question is asked as a matter of course is important. The parents can say no, but if they are not offered the opportunity, they may look back and say, “My child’s life could have made a difference to future children.”
I would like to see the national bereavement care pathway and bereavement support more widely included as part of the matrix and assessment regime for the Care Quality Commission. We do not put enough emphasis on bereavement and the support that parents are given. I would also like to see support for subsequent pregnancies. There is pretty good support in many NHS trusts at the point at which someone suffers a loss, but what about subsequent pregnancies? Often the mother and the father will be thinking every single day up until the 12-week scan, every single day up until the 20-week scan, “Is this going to happen again?” But at that point often no support is available unless they reach out. The support network is patchy across the country.
My hon. Friend the Member for Gloucester (Richard Graham) spoke about fathers, and he was absolutely right to do so. As I said at the beginning of the debate, it is important that men take part in it. So often, men bottle things up. They think they have to be the tough guy and hold it all in to support the family. I did it, and I have spoken to other fathers, so I know that it is a common reaction. Men are often treated like the spare part. That is by accident, not design. The chaplain or midwife will often be talking to the mother—understandably—but the father has just witnessed the woman they love give birth to a child they love and have now lost. They have been through the experience too. They are often the ones who will have to go off and tell family members, register the death and make arrangements for the funeral. So it is important to ensure that fathers have all the necessary support available to them, and it is one area that the NHS needs to get much better at.
It is important that we have more research into baby loss. The taboo nature of this issue means that charities that specialise in it—even the bigger ones such as Sands, the Lullaby Trust, the Mariposa Trust and others—do not get the financial support that other charities do. I implore people up and down the country to support baby loss charities, because they can fund vital research, which will lead to fewer babies dying.
Lastly, I want to touch on another passion of mine. We talk about 15 babies dying every single day in the UK. Every single one is a tragedy. But 7,175 die every single day worldwide. Every day 830 mothers die from preventable causes related to pregnancy, and 99% of them are in developing countries. So let us be passionate about reducing stillbirth and neonatal death here in the UK, but let us be equally passionate about tackling this issue worldwide. I am a big champion of UK aid because I know that it makes a difference around the world. UK aid is not sold, especially by some of the right-wing media, but it is so important in tackling issues such as this. I do not think that there is one person in this country who would say that spending money on reducing the number of deaths of babies is not money well spent. If we were to get the newborn mortality rate of every country down to the average of high-income countries such as our own, or even better below it, that would save 16 million lives a year.
UK aid is already making a huge difference to this issue. In 2015-16, something like £124 million was spent on maternal and neonatal health. That is equivalent to about 15% of aid spending. The Department for International Development is supporting programmes in about 16 countries, focusing on maternal and neonatal health. I recently made a visit with Unicef to Ethiopia, a country that has a high prevalence of baby loss. Although the number of deaths of children aged between one month and five years has dramatically fallen in recent decades, newborn death remains a massive issue. Think of the difference we can make worldwide if we can share some of the learnings from this country and others in the western world by using UK aid and support from clinicians in this country. Let me give an example of that.
One of the biggest causes of newborn death in Ethiopia is sepsis, which is relatively rare in the UK because we have high levels of hygiene and sanitation. UK aid water projects will make a huge difference on that, but we can do far more. At one neonatal unit there, the scrubs and clogs I was asked to put on were dirtier than the clothes I was wearing, which was a little worrying. There was a baby in there with sepsis, and I spoke to the doctor, who was a general practitioner, not a specialist in gynaecology or an obstetrician. There is a real need for some specialism and specialist training there. I asked, “Where is the hand wash? Where is your alcohol rub? This is commonplace. You can’t go about 10 feet along a hospital corridor in the UK without finding an alcohol rub dispenser.” He replied, “Ah, yes, I’ve got some of this” and he reached into a bottom drawer, underneath a load of stuff, and pulled it out. This is exactly the sort of intervention, on cleanliness, hygiene and sanitation, that we in the UK can share with countries around the world and that can make a difference. So I invite the Minister, and I will also be pushing the Secretary of State for International Development on this, to have a little more focus on tackling infant mortality, stillbirth and neonatal death on a global scale.
I have probably spoken for long enough, but I just want to say that this is a hugely important subject. We in the all-party group will continue our work, and I wish to thank all Members here from across the House, the Government and Members from all parties for their ongoing support.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
It is a great privilege to take part in this debate. The hon. Member for Eddisbury (Antoinette Sandbach) and others have set an almost unsurpassable standard in their comprehensive, thoughtful and moving accounts of the issue before us tonight. When I thought about what I was going to say today, I found myself strangely circumspect, reticent and shy about what I might or might not say, possibly because I am old fashioned—probably more so than I should be. At the back of one’s mind there is always the thought, “Is it in good taste? Should I go there? Should I not?” But in a flash it came to me: I have only one sibling, my younger brother, who is nine and a half years younger than me, and all my mother ever said about this—she is dead now—was that she had a number of miscarriages between me and my brother. It is very much to my detriment, to my dishonour, that I never broached this subject with my mother and said, “What happened?” I very much regret that. My parents were immensely British, and they got on with it and suffered in silence, but I wonder how many miscarriages she had and what that agony was like. It is too late now, and “too late” are some of the saddest words in English.
The point has been made about parents, and I am a parent, all three of whose children were born relatively easily and successfully. As one or two Members of this place know, I am also a grandparent and a brother-in-law, and for that reason am not untouched by the type of tragedy that has been described today. One thinks, “It is not going to affect me”, but it comes damned close. So I have the experience. The second thing I found to be almost like a searing wound to me personally: witnessing the extraordinary grief of what happened. This was a searing, dreadful, ghastly grief. The hon. Member for Colchester (Will Quince) has said that we must reach out, give people a hug and ask how we can help, but that grief has to be seen to be believed and it is terrible.
Victoria Prentis
I have really appreciated the hon. Gentleman’s input into our group. We should, of course, have mentioned the importance of grandparents and wider family. They have been present in the all-party group, in the form of my father, right from its inception in the middle of the night, when we were waiting for a late vote, and they play a crucial role in helping parents and others to get through the awful loss of a baby. Of course grandparents matter!
Jamie Stone
The hon. Lady makes the point much better than I can. I take great comfort in the thought that I may be slightly more than just a doddering old fellow who amuses the kids. I like to think, and I hope, that I helped my two daughters through their trauma.
The hon. Member for Colchester made the point about the partner—about the man in the equation—several times, and nothing was ever truer. How terrible it must be to witness a stillbirth—a child who arrives too early to survive. I would dare to suggest that the man is emotionally every bit as bruised as the woman.
I wish to conclude simply by saying that in a debate such as this the House is at its best, and I give credit to the hon. Member for Eddisbury and others for that. I hope and believe that if people out there chance upon this debate online or read the record of it, they will find some human comfort—some milk of human kindness—which shows that we care. The hon. Member for Banbury (Victoria Prentis) mentioned to me the service in the Crypt on Thursday, and I will take part in the service and contribute a reading with the greatest of pleasure. Finally, I cannot even begin to surmise how, but when we had my family traumas, to my great surprise several Members, from all parts of the House, came up to me and said, “We understand. We know what you are going through.” When a completely unexpected hand reaches out like that, it is pure gold and reminds one of what friendship is really all about.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I wish to join my colleagues in commending the Members who have so bravely recounted their own experiences of baby loss here tonight and at last year’s baby loss debate. As many have said, the loss of a baby is one that no parent should ever have to bear. I am fortunate not to have suffered such a loss, but as a children’s doctor I have, unfortunately, been the bearer of such bad news on too many occasions.
In my experience, the first reaction of a parent confronted with the tragic death of a baby is to ask, “Why? Why did this happen? Why my child? Why me?” In these agonising circumstances, answers as to why this situation has occurred can help to provide respite. The second reaction, one that is testament to the incredible empathy human beings have, even in the most difficult circumstances, is the desire to ensure that lessons are learned from their personal tragedy so that no one else has to endure that same heartbreak. I am in awe of colleagues, such as those here this evening, who have been through such a traumatic experience and found the strength not just to share that experience, but to use it to campaign successfully for improvements in care and to highlight areas to improve so that others do not experience such suffering in the future. I commend the work of the all-party group and my hon. Friends the Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach) and for Banbury (Victoria Prentis) for their work to develop the bereavement care pathway. I have worked in hospitals where there has been excellent bereavement care, with the bereavement suite that has been described, and in others where the care has been less well developed, and I have seen the importance of the national bereavement care pathway. I congratulate them on it.
Although he is no longer in his seat, I also congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on his private Member’s Bill, which has developed child bereavement leave. As my hon. Friend the Member for Colchester has said, it will enable mothers to have an extra two weeks of maternity leave and fathers to have a doubling of their leave—some extra time to reflect and be at home with their family.
One recent improvement that the Government have made is the introduction of independent investigations by the Healthcare Safety Investigation Branch, which will look at every case of stillbirth or life-changing injury. That will help to meet the needs of parents in respect of that first question—“Why did this happen?”—and to prevent it from happening again. When the lessons are disseminated throughout the health service, doctors and midwives will be able to learn from previous experience to ensure that problems do not occur in future. It will be important—I look to the Minister to respond on this—to ensure that health professionals can speak openly in investigations without fear of blame. A blame culture will deter people from speaking openly and prevent improvements to patient safety. I have spoken numerous times in the Chamber about patient safety, and I am hopeful that the national roll-out of investigations will help us to meet the NHS’s goal of becoming the safest healthcare system in the world in which to give birth.
One development in neonatal care that I have seen in my 17 years of practice is the increasing centralisation of neonatal care, with the smallest and sickest infants now transported to specialist centres. I have worked in these centres and, although they provide exceptional care, they are often many miles away from the hospital where the child was first admitted or where the family live. For example, if a baby’s family live in Sleaford and North Hykeham, their nearest tertiary centre is in Nottingham. If the centre in Nottingham is full, the family may be sent many hours away to Norwich, Sheffield or Leicester. For working families on low incomes, the need to visit their sick baby several hours away imposes significant travel costs. Some families go through intense financial difficulty to meet that need to travel, while others have the distress of being physically unable to travel to see their baby as often as they would wish because they do not have the money to get to the tertiary centres. I raised the very same issue in the debate last year and would be interested to hear an update from the Minister on any measures being taken to help struggling families, many of whom work, to meet the travel costs in such an extremely distressing situation.
Tim Loughton (East Worthing and Shoreham) (Con)
My hon. Friend makes a good point about safety. In respect of smaller hospitals retaining maternity services, some years ago there was an attempt to downgrade Worthing Hospital and St Richard’s Hospital, such that they would lose their maternity departments and the service would be centralised in Brighton or Portsmouth. Fortunately, we defeated those proposals, and Worthing maternity department is now rated outstanding. It is also rated as the safest maternity department in the country; indeed, many mums now come from Brighton to Worthing because of its success. There is clearly a case for larger specialised hospitals for particular ailments and problems that need specialist treatment, but in most cases we need a good-quality, safe and trusted maternity service closer to where the parents live.
Dr Johnson
I congratulate the hospital in Worthing for its outstanding success. My hon. Friend is right that there is a balance to be struck between the centralisation of care for babies who require very low-volume but high-specialist care, and the need for care to be delivered as close as is reasonably practical to the individual family concerned. That is true of all medical specialties, really. In the case of neonates, we probably have the balance roughly right, but a trend may be starting whereby people ask for things to be centralised that in my perception do not really need to be centralised. As a professional, I often see babies who are not returned to the step-down care as quickly as they could be. Babies are sometimes kept in the tertiary centres for longer than is absolutely necessary. There are complex reasons for that, but I would be grateful if the Minister looked into the issue so that babies can be returned closer to home as soon as possible.
I welcome the Government’s ambitious aims to halve the rate of stillbirths and neonatal deaths by 2025. That will be possible only by reducing the number of pre-term deliveries, which are the leading cause of neonatal death in the UK. The Department of Health and Social Care’s goal of reducing pre-term birth from 8% to 6% will require a lot more research and intervention. We have a healthier population of women, but the number of pre-term babies continues to increase. More funding is needed for pregnancy research, and particularly for research into the causes of pre-eclampsia, cervical length and infections such as group B strep, as well as for the identification of small babies with early scanning. There must also be more work to discourage smoking, which we already know is an established risk factor for pre-term delivery. I welcome the previous Secretary of State’s saying in November 2017 that the Government will reduce smoking during pregnancy from 10.6% to 6% and raise awareness of foetal movement. All those things will contribute towards the reduction of the number of neonatal deaths and stillbirths. Through that work, the Government are best placed to meet their “halve it” aim, and in doing so save 4,000 lives.
Finally, I wish to discuss those babies who die in the post-neonatal period—that is, under the age of one but after 28 days of life. Currently, 1.1 in every 1,000 babies die in the post-neonatal period. The major reason is babies having congenital malformations, and the second most common reason is sudden infant death, the rate of which has recently increased, although the cause is not clear. What is the Minister doing to identify the reasons for the recent increase in sudden infant deaths? What is being done to prevent the number of sudden infant deaths from rising further and, indeed, to bring it down?
Jim Shannon (Strangford) (DUP)
I thank Mr Speaker for granting this debate and the Backbench Business Committee for selecting the subject. I thank the hon. Member for Eddisbury (Antoinette Sandbach), who as always set the scene on a subject about which she is very passionate and knowledgeable, with her personal story. I thank all the right hon. and hon. Members who have made incredible contributions, every one of them straight from the heart. They have certainly set the scene for a very serious debate in which we acknowledge what has happened. The hon. Member for Colchester (Will Quince) put forward ideas that he thought would be helpful. Everyone did that, to be fair, but he did so especially.
I will never begin to speak in a debate of this variety without first expressing my sincere sympathies to all those who have been affected by the loss of their baby, at whatever stage. My thoughts are with those people today, and I pray that the God of peace and comfort will be their strength. Baby loss is an extremely painful topic, but it is one that is being spoken of more and more. Such debates enable some of the pain and hurt to be talked about, and that can only be a good thing. We must thank charities such as Saying Goodbye for raising the topic and saying that it is okay to speak out, remember and reflect. Whatever way a person deals with their pain is okay, as long as they know that they are not alone. Such debates allow us to express the message, “You are not alone.” The Members present who speak in these debates reflect the opinions of our constituents outside the Chamber, about whom we talk.
As I have said in previous debates, my mother suffered several miscarriages, as did my sister and a member of my staff—in fact, the member of staff who helps me to prepare my speaking notes. For me and for all of us in the Chamber, this is a matter that is very close to our hearts. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) spoke of the miscarriages that his mum had between his birth and that of his younger brother. That is probably very real to me, as well. As we spoke about my staff member’s workload for the coming week, we realised that it was Baby Loss Awareness Week. Might I suggest that if a debate ever came at the right time, this one did? We discussed how during the last two weeks of September, we had heard of six couples who live in my constituency who had suffered miscarriages. That is six children lost; six expectations never to be fulfilled; six homes filled with sadness; six women who felt empty; six partners who felt so helpless; and countless loved ones who simply had no words. Those six people were known to all of us very personally, and the fact that one in four pregnancies ends in miscarriage has never felt so real.
In the past eight months, I have known three ladies, who are also constituents of mine, who have carried their babies for the full nine months only to have them for just two hours. I can well remember my wife, Sandra, informing me that she was pregnant with our first son, Jamie. Like every parent, I had never felt such joy. I planned for our future and imagined what he would look like. I did not check whether the baby was a boy or a girl as I have always liked the element of chance. I just hoped that whatever sex the child was, they would be accepted. To be truthful, I did ask for three boys and I got three boys—I am not sure how that worked. As I held my child, I realised that the expectation could never meet the reality of having a child in my arms. I also remember very well holding my first grandchild, Katie—I know that there are other Members here who are grandparents as well. Katie is now nine years old. I remember when Del Boy, the character on TV, took Damian in his arms and he looked at him in wonder, and there was I at the Ulster Hospital in Dundonald. I said, “Next year, Katie, we will be millionaires.” Of course, we were not millionaires, but we were in a way as we had our grandchild. Such was the joy that we felt. Therefore, when I think of those families who have lost that hope for their future, my heart simply aches. Through my constituents, I have stared into the face of pure sadness and emptiness, and I would have given anything to change the outcome. That was never going to be in my power, or in the power of anybody in this Chamber, but, having spoken to many women, one theme is clear: they cannot forget their loss and they do not want others to forget it either.
I know that my parliamentary aide will not mind me saying that she lost her first baby abroad while on a church mission trip. She returned a few years later with her family—she now has two wee girls—and planted a tree with a simple plaque in remembrance of the wee child who had died. This simple act of remembrance, while not addressing her grief, helped her to move forward, as she knew that that tree would grow and be a testament to the life that began but could not flourish and grow. This is a desire that is reflected in the events that are organised to celebrate the short lives of babies. Women no longer feel that they must and should grieve in silence. The taboo that existed in my mother’s generation that kept women silent in their grief has gone now. One look on social media will reveal messages that say no more than a date, or a number of dates, and that is proof that it is good for some women to acknowledge and commemorate their loss. Balloon releases and services of remembrance indicate that those who grieve want to see their loss acknowledged.
There are, of course, other women who wish to grieve in silence and that is their right, and I absolutely respect that. Some pain can never find a voice. We may never know the people around us who have gone through baby loss—I am sure that a trawl of families of staff members in this place would show us all to be connected in some way to a loss of child—but what we must know is that there is a way in which we can remember and pay tribute to those lives, those hopes and those dreams that have been lost.
I want to take a brief moment to think about the fathers. This is something that my aide mentioned to me and that others have referred to as well. Fathers suffer emotional loss—not the physical emotional loss—and have to watch their loved one going through the physical and emotional trauma of loss and they need to be remembered as well. It is their loss as well and they have a right to grieve, and that should be said in this place, too. Others have also referred to grandparents and other family connections. There must be support available for the whole family, and I feel that this is lacking. I have heard it said that the leaflet that is handed to a mother when she miscarries does not help. It is often not read or thought about. A follow-up phone call offering help and advice may go a long way to dealing with the pain and the fear, and I am grateful to the charities that fill that breach when perhaps, with great respect, the NHS does not.
What words do I have for those who have lost babies?
Will Quince
I distinctly remember the intervention that the hon. Gentleman made in that speech back in November 2015 when he raised the importance of the hospital chaplain and the huge comfort that they give to families. Does he agree that the point he made then is as valid today as it was three years ago?
Jim Shannon
Absolutely, and I thank the hon. Gentleman for his intervention and for reminding us of that debate. Like many others in this Chamber, I am a man of faith who feels that it is important to have a chaplain available—to have someone to share one’s grief and hard times. The intervention that he mentions was right along those lines. I felt that it was so important to have that help at that time, just when one needed it the most. I thank him for his intervention and for his salient reminder.
Richard Graham
Chaplains play an incredibly important role, as do the volunteers who work with them. I think that we have more than 30 in Gloucester Royal Hospital, all of whom go through a significant amount of training for about a year. They are multi-faith, so we have Muslims and Sikhs as well as Christians. We also have chaplains of no particular faith, and they are very clear about not trying to differentiate so that a Baptist chaplain might only talk to a Baptist patient and all that sort of thing. Increasingly, there are secular patients who need someone who can engage with them without religion. Does the hon. Gentleman agree that it would be useful for the Minister to say a few words about the role of chaplains in hospitals and whether the encouragement that they and the volunteers who work with them get at our hospital should become best practice around the country?
Jim Shannon
I thank the hon. Gentleman for his intervention. He is right: the chaplain has a responsibility for all those of faith and of no faith, because that is the time when a person needs that wee bit of succour, support and compassion—perhaps even a shoulder to cry on. Those are important things, and he is right to mention them.
I have asked a few women for the things that have been said by them or to them, and this is the message that I want to leave with the House today, “What has happened to you is not okay, but you will be okay. Give yourself time. It doesn’t matter how much time you need. One day you will realise that the smile that you have faked for so long is now a real smile. It doesn’t mean you have forgotten your baby—it means that you can remember them while you live. Weeping endures for a night, but joy comes in the morning.
Patricia Gibson (North Ayrshire and Arran) (SNP)
I want to begin by echoing the words of the hon. Member for Banbury (Victoria Prentis), who is no longer in her place, that this is indeed one of the most difficult debates—if not the most difficult, debate—in the entire parliamentary calendar. It must be debated because it is too important for us not to. A number of my colleagues would have dearly liked to participate in this debate today, but, sadly, our conference is not accommodated in the recesses of Parliament, so therefore they were unable to be here.
As the hon. Member for Colchester (Will Quince) has pointed out, this is the third year that we have made a special effort in this House to mark Baby Loss Awareness Week, which culminates in International Pregnancy and Infant Loss Remembrance Day 2018 on 15 October. In a cruel twist of fate, sadly, that is the same date that my own baby was stillborn at full term in 2009. Kenneth would have celebrated his ninth birthday on that day. It is in his honour that I began to talk and to campaign—and will continue to talk and continue to campaign—about this issue. I want to shine a light on it to break the taboo around it and to break the silence that we all know exists and that we are all working to change.
I want to thank my fellow members of the all-party group—the hon. Members for Colchester, for Eddisbury (Antoinette Sandbach) and for Banbury. As a Scottish member of that group, I like to think that I am able to provide a Scottish perspective. Health in Scotland is devolved, but on this issue, as in all issues, I believe that where we can work together and learn from each other then we most certainly should do so, because this issue is certainly above politics. I also want to thank all those across the House who have championed the issue of baby loss and shared their personal and painful experiences and circumstances, as well as the charities that work on the frontline every single day, helping bereaved parents through this life-changing and traumatic event, as the hon. Member for Eddisbury reminded us and others in this debate have pointed out.
It is important for all the parents, grandparents, aunts, uncles, brothers and sisters who have been affected by such an appalling tragedy as baby loss to know that even though they feel isolated in their grief, they are not alone. Sadly, the tragedy of baby loss and stillbirth is terrifyingly common, with around 6,500 babies dying before or shortly after birth—one baby every hour and a half. During this debate, two babies have died. Some 4,000 of these 6,500 babies are stillborn, with another 2,500 surviving for less than a month after birth.
We are all working to the same end in this House and across the UK—to reduce these terrible statistics. Behind each one is a family devastated by grief, living under the shadow of the pain of this for the rest of their lives, while appearing to function normally on the surface, because the grief of losing a baby and all the hope invested therein does not go away. Families and parents simply find a way to learn to live with it somehow. However, I am pleased to say that progress is being made. The hon. Member for Colchester made a good point about back-slapping, but I do think that we have to acknowledge it when we make progress.
Although we are not yet there, Scotland is now close to the high standard set by Nordic nations in minimising stillbirths and early infant deaths. I was very pleased to read that, according to a University of Leicester study, rates have fallen across the entire UK, with Scotland leading the way, although of course there can be no room for complacency. The rate of stillbirths and deaths of babies within 28 days in Scotland was 4.72 per 1,000 live births in 2017, which compares with the Nordic rate of 4.3. Probably everybody here who has an interest in these matters—I think that we all do—will know that Norway, Sweden, Denmark, Finland and Iceland are generally regarded as having the gold standard in neonatal survival. The 2015 rate of stillbirths and deaths of babies within 28 days of birth for the entire UK was 5.61 per 1,000 live births—a drop from 6.04 in 2013. So, yes, improvement has been made, but this is not job done; far from it. Nevertheless, it is extremely welcome progress. Prevention is, and absolutely must remain, the key.
Mary Ross-Davie, director of the Royal College of Midwives in Scotland, has said that in recent years Scotland has undertaken very important work in this area that has improved outcomes for Scotland, with the national stillbirth group established in 2013. In addition, we have had the Maternity and Children Quality Improvement Collaborative since that time. Moreover—as we have heard about today with regard to England—the Scottish Government have funded the national bereavement care pathway, which will benefit bereaved parents across Scotland. I think that this is being rolled out in parallel with the care pathway in England.
The pathway is important because it seeks to improve the quality of bereavement care experienced by parents and families at all stages of pregnancy and baby loss, so that all bereaved parents across the UK can expect the same high-quality, sensitive bereavement care that they need and deserve. It is still in the process of being established, and it will involve collaboration and partnership with baby loss charities and stakeholders, and so it should. The stillbirth and neonatal death charity, Sands, is working with—and will continue to work with—the Scottish Government, other baby loss charities and other healthcare partners in Scotland to develop the approach over the next two years, with the plan to pilot, implement and embed the pathway across Scotland by March 2020.
When the worst happens and parents must face this nightmare, it is important that the correct support mechanisms are in place. That is the least that can be done, but sadly this was not always the case in the past, when bereavement care experienced by parents and families during pregnancy or shortly after birth could be patchy and variable, as the hon. Member for Banbury pointed out and to which I can personally testify. Support and the right kind of care in the immediate aftermath of such a life-changing event can make all the difference to those affected, as we heard from the hon. Member for Eddisbury.
I have lobbied the Scottish Government, who are now also investigating the provision of fatal accident inquiries for stillbirths in some circumstances, as was mentioned earlier. This is another mark of how far we have come and it is a huge step. Nobody should underestimate the complexity of this step forward—of the fact that the issue is even under discussion and investigation. It is also being explored by the Department of Health in England.
Currently, until a baby lives independently of its mother, any change in the law here would be profound and require the law around it to be looked at very carefully. Of course, no one would expect a fatal accident inquiry—in England, a coroner’s inquiry—to be carried out routinely following a stillbirth, although it may be appropriate in very specific circumstances, not as a way of seeking to punish anyone who may have made mistakes, but as a learning tool to better inform medical practitioners as they carry out and seek to improve antenatal care. The only reason that this idea has even been raised at all is that in the past many hospitals have been extremely reluctant to investigate stillbirths fully and transparently. Parents often report feeling excluded from the process and denied proper answers to the question, “Why did our baby die?” We know that sometimes it is not possible to answer that question; sometimes we just do not know. But when explanations or information can be given, they should be. Any relevant information needs to be shared with bereaved parents. The fact that it has not been in the past is not good enough, and it is hoped that the bereavement care pathway and a more transparent ethos around baby loss will help to address these issues.
Of course, we could not measure progress and the support that parents and families can access without mentioning the Parental Bereavement (Leave and Pay) Act 2018, which we heard about earlier in the debate. This legislation means that, for the first time ever, bereaved parents who lose a child up to the age of 18 years old are entitled to statutory paid leave under the law. Parents who go through a stillbirth are also protected.
An age-old wrong has been corrected in this legislation. The law has rightly recognised the enormity of losing a child and the protection in the workplace that parents should be entitled to expect as a right, not as a gift conferred on them by their employer. I thank everyone in the House whom I had the privilege to work alongside on this legislation, particularly the hon. Member for Thirsk and Malton (Kevin Hollinrake), whose approach was sensitive and reflective; for that, I think we all thank him. The Act is not perfect, but it is ground-breaking and I am sure that it will evolve over time.
Another measure that will help with baby loss is the move in England to permit the registration of babies lost before 24 weeks’ gestation. The Scottish Government are also actively looking at this with input from professionals in the field and baby loss charities, examining the current system, its effects and how a potential voluntary registration process or other kind of process could work in practice. Certainly, parents who lose their baby before the 24-week threshold—when it is classified as a miscarriage, rather than a stillbirth—often feel that their loss is dismissed, officially at least, because there is no documentation to testify to the fact that their baby existed, was eagerly awaited and that their loss has left a lasting impact on the entire family.
In such cases, the opportunity to register their baby’s death may provide many parents with some comfort at an extraordinarily difficult time. For that, if nothing else, such a provision must be seriously examined. We are all mindful of cases we have heard about whereby twins are lost—one before the 24-week threshold and the other after it—but only one baby is eligible for registration. Imagine being the parents going through that. It is not hard to see how much worse that makes parents and families feel. That is something that we are looking at in both England and Scotland—it is something that we should look at, and it is time that we did so. All that can be done to ease the trauma of losing a child must be done.
The speech that I have delivered today on this issue is, thankfully, more optimistic than previous speeches that I have delivered on it. Progress has been made, and I am delighted about that. Slowly—very slowly, but we are getting there—we are beginning to break the taboo on this issue, which demands that we move forward. We have come some way, but there is still much to do, and the hon. Member for Eddisbury pointed out some sobering examples in England and Wales. According to Embrace, 15 babies are stillborn or die within the first 28 days of life, and 80% of stillbirths and deaths that are investigated could have been avoided with better care. We can and must do better, and progress in recent years shows that we are capable of doing so. For my part, as a Scottish MP, I will continue to communicate with the Scottish Government and maintain a dialogue on this matter. I will also work with the all-party parliamentary group on baby loss.
We have discussed the emotional trauma of baby loss, but we should remember that there is also a social cost. Parents who lose a child, whatever the circumstances, are eight times more likely than their counterparts to divorce. They are more likely to drop out of the workforce, perhaps never to return. We have to do everything that we can to support parents in this position. The former Cabinet Secretary for Health and Sport, Shona Robison MSP, was receptive to concerns that I raised with her. Her successor, Jeane Freeman MSP, has continued very much in the same vein. I very much look forward to next year and continuing to work to challenge the silence, taboo and difficulties surrounding baby loss and neonatal death. Cross-party work has never been so constructive, I suspect, and on an issue that we all care about and which impacts all too often on too many families in every single constituency across the United Kingdom. We have a duty to work together, we have a duty to make things better, and we have a duty to break the silence.
Justin Madders (Ellesmere Port and Neston) (Lab)
I am humbled once again to respond to such an important debate on behalf of the Opposition. I would like to begin by congratulating the hon. Member for Eddisbury (Antoinette Sandbach) on securing today’s debate and on her continuing work in drawing from her personal experience to campaign on behalf of thousands of others who have been affected by this important subject. I also pay tribute to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), who could not be with us tonight. As we have heard, her contribution to the all-party parliamentary group is greatly valued, as is the work of all the members of that group who have spoken tonight. There are something in the order of 630 registered APPGs, but few if any can claim to have so much success in bringing attention to a vital subject and securing a tangible change in policy.
As several Members have said, today’s debate has once again shown Parliament at its best, and I would like to reflect on some of the contributions that we have heard. The hon. Member for Eddisbury spoke in positive terms about the success of the national pathway and gave interesting statistics on parents’ feedback. Some 98% felt that they had been treated with respect, which is really important and, critically, 90% felt that they had been provided with information that was easy to understand. She gave the example of a parent who had to go and speak to the doctor on about five occasions to get an explanation that they were comfortable with, which brought home how important it is in this difficult area for parents to be empowered to ask questions and understand what has happened. It was also interesting to hear that medical professionals gave positive feedback as well.
The hon. Member for Eddisbury expressed concern about ongoing investigations in the Shrewsbury area at the Countess of Chester Hospital, and I am sure that when they conclude we will both have questions to ask. It is worth saying that one of the things of which I have been aware, particularly in relation to the Countess of Chester issue, is the impact on the local community. Many parents, whether they are directly affected or not, have children who were born at the hospital, and were understandably concerned when the news came out. We need to take that on board for future learning.
We heard from the hon. Member for Ceredigion (Ben Lake), who gave specific examples of how we should improve outcomes, and raised the importance of training and awareness of foetal movements, and improvements in ultrasound scanning. The hon. Member for Banbury (Victoria Prentis) gave a wide-ranging speech. She always speaks with great personal knowledge and authority on this matter. She said that media coverage of this issue was pretty impressive and very sensitive, and that there was much more of it. She spoke positively, as did every Member who contributed, about the impact of the pathway. However, she pointed out that only 46% of maternity units provide mandatory bereavement training, some of which lasts only an hour or less. She was right to talk about the impact on staff of some of the issues with which they have to deal. She was right to highlight the fact that of course we need more midwives and that the focus should not just be on recruitment but on retention, and the serious challenges not just in midwifery but across the NHS workforce.
My hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) spoke from personal experience, and I thank him for doing so. He again raised access to mental health support and the lack of bereavement facilities in all units. He discussed the Bumblebee charity in his constituency, which was another example of how individuals turned their own experiences into a force for good. He ended with a tribute to his mother, who had to deal with stillborn babies in, presumably, the early years of the NHS, when things were treated very differently. We ought to pay credit to the service that she gave to the health service in a very different era for dealing with these issues.
It was a pleasure, as always, to hear from the hon. Member for Colchester (Will Quince), who gave a wide-ranging and compelling speech. He spoke about why it was important that we talk about these issues. No matter how short someone’s life, it is incredibly important to the parents. He will know of my own constituent, Nicole Bowles—the badge that I am wearing gives a signal that someone has suffered child bereavement and it is all right to talk about it. That is a really important message that we cannot repeat enough: it is okay to talk about these things, because it helps to raise awareness and discuss matters.
The hon. Gentleman was crystal clear that we need bereavement suites in every unit up and down the country, and he was right about having more midwifery training. He made a very fair point, which I presume comes from his own personal experience, about continuing support for parents when they are dealing with subsequent pregnancies. One can only imagine the anxiety that they face throughout the whole pregnancy in that situation, and I am sure the Minister will reflect on that. The hon. Gentleman also made one of the strongest arguments I have heard in support of international aid and what a difference it can make to tackling baby loss around the world.
The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) eloquently reminded us that this issue affects grandparents and the wider family, as well as the parents. The hon. Member for Sleaford and North Hykeham (Dr Johnson) spoke from her professional background and experience when she said that the first question the parents always ask is, “Why?” and the second question is, “What can be done to prevent this happening again?” We have heard countless stories of parents taking that second question and using it as a force for good. She raised, as she did in the last debate, the impact on families of having to go to specialist units a long way from their homes, and I hope the Minister will reflect on that. She was also right to highlight the recent increase in sudden infant death syndrome, which is of great concern and is certainly perplexing.
The hon. Member for Strangford (Jim Shannon) spoke with great sincerity about his own family’s experiences. He drew a contrast between how his mother’s generation dealt with such issues and how we are beginning to talk about them much more openly today. He was right to say that we are all probably connected in some way to someone who has suffered such a loss.
As we have heard, today’s debate coincides with the 16th year of Baby Loss Awareness Week, which is an important opportunity for us all to unite with bereaved parents and their families and friends to commemorate the lives of babies who died during, before or shortly after birth. I echo the comments made in praise of the more than 60 charities that now collaborate on this week. When I first spoke on this subject two years ago, around 40 charities were involved. That increase in numbers shows what an impact this week has had on raising awareness and bringing people together, which is what we want to see. Each of those organisations should be extremely proud of what they do and of the way they work together to drive through change on a national basis. It seems to be a characteristic of this issue that personal tragedy moves people to go to huge lengths to help others in the same position. In doing so, they display extraordinary levels of courage and resilience, and I pay tribute to them all.
As well as using today’s debate to raise awareness, this is an opportunity to take stock of progress and once again highlight the fact that although excellent care is available in the country, it is not available to everyone everywhere. It has been said many times before and during the debate that one of the key challenges for the Government is to tackle regional disparities. In England alone, there is still a 25% variation in stillbirths. Although there has been a reduction in the stillbirth rate and the perinatal mortality rate, it is quite a slight one, and sadly the neonatal mortality rate in England and Wales has increased two years in a row.
While we can rightly say that we are beginning to improve the approach to those dealing with the consequences of baby loss, it seems that we still have a long way to go in understanding and really tackling the causes of it. The example we have heard a number of times today is that 15 babies every single day are stillborn or do not live past the first month, and it is believed from studies that up to 80% of those deaths could be avoided. As the hon. Member for Colchester said, too many deaths remain unexplained, and as many Members have said, we are still a long way behind where we should be in terms of prevention. According to The Lancet, the annual rate of stillbirth reduction in the UK has been slower than in the vast majority of comparable high-income countries.
One measure that may hopefully make inroads into improving outcomes is the maternity safety training fund, but as a one-off limited fund, it was by definition restricted. I raised the concern last year that time might not be found for the training to reach all those who would benefit from it, so it was disappointing to hear from Baby Lifeline that workforce pressures meant that many staff could not access the training available under the scheme. It gave clear examples of where the training given has improved outcomes, but this must not be the end of the story. The fund needs to be repeated on an annual basis and, crucially, staff need to be given the time and space to take advantage of what is on offer.
In many areas of the NHS, workforce challenges are the biggest barrier to improving outcomes. The “Bliss baby report 2015: hanging in the balance” stated that 64% of neonatal units did not have enough nurses to meet safe staffing levels and 70% of units looked after more babies than is considered safe. That was three years ago, and on many indicators the staffing situation is more acute now than it was then. We know that we have a shortfall in nurses of more than 40,000. We have more nurses and midwives leaving the register than joining it, and registrations by people from the European economic area are dropping dramatically. We know that the demographics of the existing workforce are not in our favour, which is why the retention issues raised are so important. I would be grateful if the Minister updated us in his concluding comments on whether any progress has been made to improve the figures that Bliss set out in 2015.
It is also worth considering staffing challenges in the context of the worthy aim of introducing a continuity of carer model, when even the modest target of 20% of women being covered by March 2019 looks challenging. Can the Minister say whether we are on track to meet that and when he anticipates there being full coverage? There is ample evidence to show that continuity of care can make a big difference to outcomes as well as the patient experience.
Finally, I want to say a few words about the national bereavement care pathway, as it has been rightly trumpeted this evening. It is clearly making a big difference on the ground, but it needs to be rolled out comprehensively as soon as possible. The Prime Minister indicated some time ago that it would be rolled out nationally by about this time. Again, I wonder whether the Minister can update us on that ambition.
In conclusion, the debates that we have had over the last few years, and again tonight, underline the importance of the work undertaken by hon. Members and the many charities in the sector. It means that the silence that we talk about is now beginning to end. It is not possible to overstate how courageous those who have spoken out about their personal experiences are or how influential those interventions have proven to be. Having now spoken out, we must continue to talk about what we need to do to improve outcomes. This year my council will be joining the wave of light, and I am hopeful that other public buildings in my constituency will join in—I am doing what I can to encourage them. Such symbolism can only increase public awareness of this subject, and if actions like that reach just one grieving parent who may have felt that they were alone, but who now feels that they have someone to turn to, then it will have been worth it.
The Minister for Health (Stephen Barclay)
May I join colleagues across the House in paying tribute to my hon. Friend the Member for Eddisbury (Antoinette Sandbach) for securing this debate on Baby Loss Awareness Week? It is particularly appropriate, as today marks the start of the 2018 campaign. How we reduce the numbers of baby losses is an issue that unites the House, as has been very much reflected in the tenor of this evening’s debate. May I also say to my hon. Friend the Member for Colchester (Will Quince) that I am sure that all in the Chamber will be thinking of Robert and him on Friday, as he marks that particularly poignant fourth anniversary?
My hon. Friend the Member for Eddisbury raised a number of important points in her speech, including about the national bereavement care pathway and the ongoing investigations at the three hospitals in England and Wales. I will address those shortly. She is right to recognise the higher profile that this issue has received in recent years, this being the third such debate in the last three years. That is very much testament to the work of the all-party group on baby loss and in particular my hon. Friends the Members for Eddisbury, for Colchester and for Banbury (Victoria Prentis), who is not in her place, the hon. Member for Washington and Sunderland West (Mrs Hodgson), to whom my opposite number correctly paid tribute and who very much moved the House in a previous debate, and the hon. Member for North Ayrshire and Arran (Patricia Gibson), who quite rightly spoke of Kenneth, who is very much in her thoughts and reflects much of the work that she has done in this place. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) also made the point very well that this issue affects the family as a whole, including grandparents.
Martin Docherty-Hughes (West Dunbartonshire) (SNP)
I join the Minister in congratulating all the Members who have brought this issue to the Floor of the House today and especially the hon. Member for Eddisbury (Antoinette Sandbach) on securing the debate. The Minister has talked about the family, and we have heard much about the emotional journey for mothers and fathers who experience loss. We are living now in a more equal society, in which more lesbian women are becoming mothers, and they, too, experience loss through the death of a baby or young child. Will he ensure that that is reflected in the opportunities to learn about the lived experience of mothers, to which my hon. and good Friend the Member for North Ayrshire and Arran (Patricia Gibson) referred, whether they have a husband or a wife?
Stephen Barclay
The hon. Gentleman makes a valid point. He will have noticed that my colleague the Minister for Women and Equalities was in the Chamber for part of the debate, and I am sure that those sentiments are very much reflected in the work that she is doing. I am very happy to work with him to ensure that the Government’s approach takes those points on board.
Before coming to the wider areas of progress and considering what still needs to be done to deliver the improvements that we all want to see, I will address some of the specific comments made by Members across the House. My hon. Friend the Member for Colchester rightly mentioned the inconsistency between trusts. I understand that Sands is asking for the national bereavement care pathway to be included in the CQC’s inspection framework for maternity. I am happy to write to the CQC to request that this becomes part of the inspection regime. I think that can build on the point my hon. Friend the Member for Eddisbury made about recent progress in Medway.
My hon. Friend the Member for Colchester also suggested a training module for midwives on bereavement. Again, I am happy to write to Professor Ian Cummings, the chief executive of Health Education England, on that point and to share the correspondence with the all-party parliamentary group. One of the objectives of the pregnancy loss review is to recommend options to improve maternity care practice for parents who experience baby loss, so that is part of that work.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who so often brings her clinical expertise to debates, raised the issue of travel costs. The Patient Advice and Liaison Service can advise on eligibility for schemes, as this tends to be specific to individual trusts, but it can apply in certain instances, particularly when linked to benefit entitlement.
My hon. Friend the Member for Gloucester (Richard Graham), who is no longer in his place, mentioned the important work of the hospital chaplaincy, and I think that Members on both sides of the House recognise the support that chaplains can offer following baby loss. Indeed, the bereavement care pathway guidance recommends offering parents contact with the chaplaincy team, so the role of the chaplaincy will be given greater visibility as the pathway is rolled out across more trusts.
The hon. Member for Ellesmere Port and Neston (Justin Madders) rightly mentioned midwife numbers. We recognise that the workforce do face pressure, as is reflected in the 25% increase in the number of midwifery training places that the Government are committed to. Indeed, numbers have increased in each of the last four years. But he makes a valid point and we are focused on dealing with the workforce pressures.
As a number of Members have recognised, the Government have a clear ambition to halve the rates of stillbirths, neonatal and maternal deaths and brain injuries that occur during or soon after birth by 2025, and to achieve at least a 20% reduction in these rates by 2020. Since the launch of the national maternity ambition in 2015, the Government have introduced a range of evidence-based interventions to support maternity and neonatal services, under the leadership of the maternity safety champions, who are responsible for promoting safety in their organisations.
I am pleased to report that we remain on course to achieve our 2020 ambition. The stillbirth rate in England fell from 5.1 to 4.1 per 1,000 births between 2010 and 2017, representing a decrease of almost 20%, which equates to 827 fewer stillbirths. We currently have the lowest stillbirth rate on record. The neonatal mortality rate also fell from 2.9 to 2.8 per 1,000 live births between 2010 and 2016. Many Members will be aware that multiple pregnancies are at greater risk of perinatal death, so I welcome the findings in a recent MBRRACE-UK report showing that the stillbirth rate for UK twins almost halved between 2014 and 2016, with a fall of 44%. In addition, neonatal deaths among UK twins has dropped by 30%.
There are areas of progress, but as my hon. Friend the Member for Colchester rightly said, part of the focus of today’s debate is on the areas where we need to improve, not just on the areas where there has been progress. One key area relates to ethnic minority groups, where we know stillbirth and neonatal mortality rates are increasing rather than decreasing. The Government continue to work with others to develop and implement policies to tackle such inequalities. This is an area on which we would be very happy to work with the APPG. It is an issue of concern to Members on all sides of the House.
A number of Members raised the role of the Healthcare Safety Investigation Branch and the importance of identifying where there are lessons to be learned. My hon. Friend the Member for Sleaford and North Hykeham is right that clinicians must be free to speak up where mistakes have been made. Indeed, the former Secretary of State championed that in his work on patient safety. It is also why we are improving investigations into term stillbirths. There is a role for the Royal College of Obstetricians and Gynaecologists in terms of the Each Baby Counts programme. Considerable work is under way, part of which, as my hon. Friend the Member for Eddisbury recognised, is on ensuring that in respect of the investigations at the specific hospitals she mentioned the appropriate lessons are learned. She will appreciate that, as they are live investigations, I cannot comment on them in detail.
Evidence demonstrates that women who have a midwife-led continuity model of care are less likely to suffer baby loss. In March, the Secretary of State pledged that most women will receive such care throughout pregnancy, labour and birth by 2021, with 20%, or about 130,000 women, benefiting by 2019. This will help to bolster maternity safety and further improve care standards.
It is positive to see the impact that many initiatives can have on reducing baby loss, but the Government recognise the need to improve the care bereaved families experience. That is why the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Minister with responsibility for maternity care, recently announced full funding of £106,000 to the charity Sands to continue the roll-out of the national bereavement care pathway. I hope that reassures my hon. Friend the Member for Eddisbury that the value of the care pathway is very much recognised within Government. As my hon. Friend mentioned, this initiative has seen a positive response from parents and medical professionals, with 77% of professionals saying bereavement care has improved.
On pregnancy loss and the pregnancy loss review, which my Department commissioned earlier this year, the review has been considering the question of whether legislation should provide new rights to bereaved parents to register pre-24-week pregnancy loss, as well as investigating the impact of such losses on families and how care can be improved for parents who experience it. That review is currently scheduled to be completed in the new year. A number of very important points on that pre-24-week period were raised.
The Department of Health and Social Care and the Ministry of Justice have been consulting with coroners, patients’ groups and charities to consider the role of the coroner in relation to stillbirths. This is about ensuring that bereaved parents are given a full account of the events leading up to the loss of their baby and that important lessons are learned. The hon. Member for Nottingham South (Lilian Greenwood) in particular made a point on the role of coroners in an intervention. This work will continue over the coming months.
In conclusion, progress is being made. I think that was recognised in a number of the speeches this evening, particularly in respect of: the commitment to fund in full the national roll-out of the bereavement care pathway in 2018-19, for which guidance and resources have been released today; the ongoing pregnancy loss review, which is due to report in early 2019; the work being done by the Department of Health and Social Care and the Ministry of Justice regarding the role of the coroner in investigating stillbirths; the progression of the private Member’s Bill, which will have its Third Reading on 26 October, promoted by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on those last two issues; and the recent passage of the Parental Bereavement (Leave and Pay) Act 2018, mentioned by a number of Members, through the work of my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake).
I would like to close by making it clear that the Government are actively listening to concerns on this issue. This issue unites the House. On behalf of the Government, I very much look forward to working with the APPG, and Members across the House, to ensure that the progress we have seen in recent years continues, so that we can all tackle the most appalling loss that the families we represent can face.
Antoinette Sandbach
It is a pleasure to follow the Minister and the commitments he has made. As he said, this issue unites the House. The hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke about her dread about today’s debate, as did my hon. Friend the Member for Banbury (Victoria Prentis), and I did not go to sleep last night because of the worry and the feelings that it brings back. But the hon. Member for North Ayrshire and Arran also spoke about the optimism for this year and what we have achieved in the past three years. As the Opposition spokesman said, personal tragedy moves people to go to enormous lengths, and we have heard from Members across the House about constituents who have gone to enormous lengths to try and build on their experiences, ensure that lessons have been learned and make sure that things are better for those who follow.
Three themes emerged from the debate. The first, which is where we started three years ago, is about breaking the silence. My hon. Friend the Member for Colchester (Will Quince), in the week in which Robert has his fourth birthday, spoke about taking on the taboo of speaking about childhood death. We have all taken on that taboo in this House. Each year, different aspects of it emerge. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) spoke about his mother suffering in silence. So many people have suffered in silence; indeed, the hon. Member for Strangford (Jim Shannon) had his mother and sister share that experience. We are breaking that taboo, we are breaking that silence, working together with those 60 charities that cover all sorts of loss and that are embedded in our communities and supporting our constituents who have been through this.
There is some optimism and hope in Baby Loss Awareness Week, not least because on Saturday we have the wave of light, which travels across the world as parents light candles in memory of their children. The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) also spoke about the role of his mother. At that point in time, with the newly emerging NHS, looking after what are commonly referred to as angel babies must have been very difficult, and I know that my own mother suffered in silence from her own experience, although she was not looking after stillborn babies. That work is important, as was the work of his constituent, Gordon, with Bumblebee Babies.
The second theme was pregnancy support. The hon. Member for Ceredigion (Ben Lake) spoke about this, and particularly about ultrasound scanning in the third trimester. I campaigned on that in Wales when I was an elected Member of the Welsh Assembly, and I urge him to work with his colleagues in the devolved Assembly to try to deliver it. Ultrasound scans in the third trimester have been proven in other jurisdictions to reduce stillbirth and neonatal death, and they can make an important contribution to the debate going forward. He also spoke about the work of Gareth and Clare in memory of Mari-Leisa.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) was the only Member to mention Group B Strep Support, which forms an incredibly important part of this debate. A test for group B strep can be done for £11, and people can discover whether or not their baby might be vulnerable to it. That is an area that we can perhaps work on. I am grateful to her for raising the matter, in the light of her clinical experience, and I know that other Members of the House have campaigned on it.
The hon. Member for North Ayrshire and Arran said that prevention was the key. Pregnancy support—both around smoking and for BAME communities, who are, as the Minister mentioned, particularly vulnerable—is absolutely critical to that. The MAMA Academy wellbeing wallets have been used in the Countess of Chester Hospital trust, and they recently saved two lives. Because the women had on the front of their medical notes the areas of concern that they should look at, they went and sought help, and there are two babies alive today who might not otherwise have been. Prevention is key.
The third theme that came out of today’s debate was post-bereavement care and support. The Government have made huge strides, working together with the third sector. The best abilities of the third sector have been harnessed together with the drive and ambition of the Department of Health to deliver the national bereavement care pathway, and that is a really good example of co-operative working. I think it will lead to a huge change in the quality of care and help to end the postcode lottery that parents face.
I know that the previous Secretary of State for Health was absolutely committed to the idea that health professionals should not close ranks to try to protect other health professionals when things go wrong. The idea is to promote transparency and openness. As my hon. Friend the Member for Sleaford and North Hykeham said, it is about the “why?”—the desire to find out why something happened and make sure that it does not happen to anyone else. I think we should take forward such positive learning experiences to help to reduce the number of neonatal deaths, stillbirths and perinatal losses. There is work to be done, but there is much to celebrate. Many other events are taking place during Baby Loss Awareness Week, and I urge Members to get involved in them.
Madam Deputy Speaker (Dame Eleanor Laing)
Thank you. It has been an excellent, honest and constructive debate.
Question put and agreed to.
Resolved,
That this House has considered baby loss awareness week 2018.