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The Parliamentary Under-Secretary of State for Justice (Gareth Bacon)
It is a pleasure to serve under your chairmanship, Ms Elliott. I thank my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) for securing this debate. I pay tribute to his work in shining a light on the important but complex and extremely sensitive issue of stillbirth, which, despite the experience and incredible dedication of our medical professionals, continues to touch the lives of too many families.
Bereavement is never easy, but to lose a child through stillbirth is a tragedy. The Government are committed to supporting parents through such a difficult experience and ensuring that they have access to the support they need. More than that, one of our highest priorities is to reduce the number of stillbirths and other adverse maternity outcomes. To help to achieve that, we are committed to ensuring that, wherever possible, lessons are learned and care is improved to prevent avoidable stillbirths in future.
To put that aim into context, the Government set the national maternity safety ambition to halve the 2010 rates of stillbirths, neonatal and maternity deaths, and brain injuries occurring during or soon after birth, by 2025. Also by 2025, we want to reduce the pre-term birth rate from 8% to 6%. We are making good progress, but we recognise that more still needs to be done to achieve that ambition. Since 2010, the stillbirth rate has reduced by 23% and the neonatal maternity rate of babies born after 24 weeks’ gestation has reduced by 30%.
Although we can demonstrate clear progress, it is vital that we continue to learn from the tragedy of every stillbirth. Concerns about the consistency and independence of those investigations have given rise to the calls for a more transparent and independent process, for which my hon. Friend continues to advocate so consistently.
The coroner, as an independent judge, investigates deaths for which, among other things, the cause is unknown, so it is easy to understand the proposal that their role should be extended to include the investigation of stillbirths. However, I want to take a moment here to emphasise an important point: at present, coroners do not have jurisdiction to investigate a stillbirth because, sadly, as my hon. Friend said in his speech, where there has not been an independent life, there has not legally been a death. A child born who is showing signs of life has had an independent life, so that child’s death must be investigated if the coroner’s jurisdiction is engaged. When there is doubt about whether a child was born alive, that is a matter for the coroner to determine, and it is open to anyone, including the bereaved family, to report a case to the coroner if they believe there is a need for such an investigation.
In 2016, the Government committed to consult on whether, and if so how, the coronial investigation of stillbirths should be introduced. The commitment was made as part of a fresh maternity safety strategy. Since then, a range of important safety initiatives have been rolled out, including a perinatal mortality review tool, which is now available in every maternity service in the UK. The tool enables trusts to review all stillbirths and neonatal deaths by setting out a set of questions and principles to guide trusts through a standardised review process. The tool’s secondary aim is to ensure local and national learning to improve care and ultimately prevent future baby deaths. Collation and analysis of the data from the tool and the production of annual national reports on the key themes arising from the reviews and recommendations are intended to improve safe maternity care and safe outcomes for babies.
In addition, the maternity and newborn safety investigations programme, established in 2018 and now hosted independently by the Care Quality Commission, provides independent, standardised and family-focused investigations for families, which also provide learning to the health system. Alongside those initiatives, the consultation on coronial investigation was taken forward in 2019, again as my hon. Friend said. We are extremely grateful to everyone who submitted one of the 334 responses to the consultation document, to the 63 people who attended stakeholder workshops and, in particular, to those respondents who shared their personal experience of the pain of stillbirth.
The findings of the consultation were complex, as my hon. Friend said. The majority of respondents were supportive of the proposal for coroners to have a role in investigating stillbirths, but many did not agree with the proposals for how that should be implemented. Some were concerned that bereaved parents would not be able to withhold consent to the investigation or any associated post-mortem examination, that the investigation could be distressing and intrusive, that the length of the investigation could delay closure for the bereaved family, that the process might not fulfil the parents’ expectation of finding answers, or that they could feel like they were being blamed.
There were also significant policy and practical concerns, including the potential for duplication, friction and confusion between investigations by the coroner, the maternity and newborn safety investigations programme and the trust or health board, and the potential impact of that on clinicians’ behaviour. There was also a concern that the safety initiatives introduced in 2018 would achieve the same policy objectives as a coronial investigation in any event.
Tim Loughton
I am grateful to the Minister; I understand the points that he is making and I appreciate his points about the distress that it may cause to parents, and about blame and everything like that. Whether the child was stillborn or lived for a couple of minutes makes no difference to that potential distress. However, in the latter case, the coroner would have the power to investigate, which could cause the same distress to the parents as doing so could the child had been stillborn. Why is there that distinction?
Gareth Bacon
I thank my hon. Friend for his points; I am reflecting the points made in the consultation. His point is well landed, and officials and my hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) will have noted the case that he has just made.
In addition, there were concerns about the resource impact on the NHS and the locally funded coroner services. Crucially, there would be a significant increase in demand on already stretched paediatric pathology services, with a significant lead-in time to train new resource. Nevertheless, I note the comments that my hon. Friend the Member for East Worthing and Shoreham made in his speech.
In any event, some respondents felt that coroners would not be best placed to identify and disseminate clinical learning points at a regional and national level. Although many acknowledged that coroners could deliver investigations into stillbirths, there was no consensus on precisely how they would do so and some strong opposition to the specific proposals that we put forward.
Given the importance and the sensitivity of the issue, it is imperative that we get the response right. That means carefully considering the issues identified by the consultation and working through the complex questions that they raise. Work to publish a response was paused during the pandemic. Again, as my hon. Friend said, and as I have explained, the landscape of maternity investigations has changed significantly. One of the key questions that we are considering is whether the current maternity safety initiatives are already achieving, or have the potential to achieve, the overarching objective without the need for coroner investigations.
While the Government were developing and publishing their consultation proposals, Parliament passed the Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, which my hon. Friend introduced. As he has explained, section 4 places a duty on the Secretary of State to make arrangements for the preparation and publication of a report on whether, and if so how, coroners could investigate stillbirths. The Act also provides a power for the Lord Chancellor to make provision for coronial stillbirth investigations through secondary legislation if, following the publication of the report, that is considered appropriate. The fact that those provisions are on the statute book is a testament to my hon. Friend’s commitment to the issue, and I can of course understand his frustration that it has not yet been resolved, which he has eloquently expressed today and on other occasions.
As I have said, we have to get this right. To that end, in December the Ministry of Justice and the Department of Health and Social Care jointly published a factual summary of the responses to the 2019 consultation. I have set out the key findings this afternoon, and the two Departments continue to work through their complex implications.
As an immediate next step, my hon. Friend the Member for Finchley and Golders Green (Mike Freer)—he has now joined us—on behalf of the Ministry of Justice, and my hon. Friend the Member for Lewes (Maria Caulfield), on behalf of the Department of Health and Social Care, have told me that they would be happy to meet my hon. Friend the Member for East Worthing and Shoreham to share the latest thinking and discuss possible ways forward on the outstanding issues. I can confirm that by the summer recess, we will make a further statement that sets out the Government’s position on this policy.
To conclude, let me reiterate my thanks to my hon. Friend for the opportunity to respond to this important debate, as well as my thanks to all others in attendance and to all those who have made some very valuable contributions to this issue along the way.
Question put and agreed to.