Maternity Services

Tuesday 25th February 2025 Westminster Hall

09:30

[Jess Brown-Fuller (Chichester) (LD)]

I beg to move,

That this House has considered maternity services.

It is an honour to serve under your chairmanship, Sir Christopher. I thank all the Members in attendance for their interest in this important topic and the Backbench Business Committee for allocating time to debate maternity services in England.

On average, a baby is born in England every 56 seconds, over 1,500 babies each day, most of them delivered in an NHS setting with the help and support of a maternity department or at home with an NHS community midwife by their side. That is over 500,000 babies every year. I contributed to that statistic in 2014 and 2019 when I gave birth to my children at St Richard’s hospital in Chichester. Two very different births that I will not spend my valuable time in this debate reflecting on, because there are far more important voices that need to be heard and considered. A person is at their most vulnerable moment when they or their partner go into labour. We put our health, safety, and the safety of our unborn child into the hands of professionals who work in that setting—the midwives, obstetricians, anaesthetists, and neonatologists—to support us in the safe delivery of our child and get us all home safe. And in the majority of births that is the case.

However, several investigations have revealed fundamental flaws in how maternity care is delivered across England. A Care Quality Commission inspection of 131 maternity units found that 65% were not safe for women to give birth in, with studies showing that one fifth of all causes of stillbirth are potentially preventable. The Ockenden report, led by Donna Ockenden, investigated the maternity services at the Shrewsbury and Telford Hospital NHS Trust, but it also highlighted the flaws in maternity care across England. The report laid out immediate and essential actions which are key to reforming maternity services and ensuring that every mother and baby receive the care they deserve and should expect. In her report Donna reflected that sometimes that spotlight can feel harsh to staff on the front line, who are doing their very best in what are often extremely challenging circumstances.

In conversation with midwives and others working in the maternity care sector, I recognise that each one I spoke to entered the profession as a the result of a calling, vocation, or passion for supporting mothers to bring their babies into the world. They are frontline NHS staff who often go above and beyond the call of duty to support and care for their patients in those extraordinary hours and days. Midwives in particular spend significant time with expectant mothers, supporting them through all stages of pregnancy and birth. They see women at their most vulnerable. They act as therapists, teachers, friends and maternal figures. Yet across the country, staffing levels are inadequate. In 2023, midwives and support workers worked over 100,000 hours of unpaid overtime every week. The pressure and stress on them is immense and this leads to burnout, absenteeism, high staff turnover and the loss of experienced professionals from the field, and that ultimately puts patient safety at risk.

[Jeremy Hunt (Godalming and Ash) (Con)]

I congratulate the hon. Lady on bringing forward this debate and the excellent and persuasive way that she is making her case. On burnout, does she agree that one of the biggest issues is that when a tragedy happens, midwives and obstetricians often feel that if they speak out the risk is that they or their institution will get sued, or that they could get fired from their jobs? Does she agree that litigation reform to try and change the rules of the game, so that people are able to be open when they think they have made a mistake and learn from those mistakes, is one of the most important ways that we could improve the record on patient safety, which is as much a concern to her as it is to me?

[Jess Brown-Fuller]

I agree wholeheartedly that we need to change the way that we do litigation, because NHS trusts often argue that they want to learn and grow from poor experiences, but the litigation system means that they rarely have the opportunity to do so, because everybody is so afraid to speak out. We need to change that culture within maternity services and the NHS as a whole.

As a country, we are training more midwives than ever before, yet retention remains a problem and the pandemic exacerbated an already difficult situation, with highly trained midwives with families or caring responsibilities leaving the profession too soon.

[Dr Al Pinkerton (Surrey Heath) (LD)]

I congratulate my hon. Friend on bringing this debate here today. Frimley Park hospital in my constituency received an outstanding report from the Care Quality Commission in 2023, but it none the less identified that inadequate staffing remains one of the highest risks on the maternity register. That has daily implications; many midwives reported, for example, that daily checks were often incomplete, handovers were interrupted and not standardised, and mandatory training was often not completed.

Does my hon. Friend agree that to ensure high-quality maternity care, from admission to discharge, requires not only stringent oversight by trust boards, but far greater care for staff in the setting of the hospital, providing safe spaces where conversations can be had, handovers can take place, and nurses can rest? In that way, we will both retain and also hopefully recruit more of our vital nursing staff.

[Jess Brown-Fuller]

My hon. Friend is absolutely right; the key to providing strong maternity services that benefit both the staff and the patients is making sure that there is a full workforce so that they can do not just the “need to haves”, but the “nice to haves” in a maternity department, which can make such a difference to patients’ experiences when they are going through that service.

The retention issue that we have directly impacts training. Newly qualified and inexperienced midwives need experienced mentors, but if seasoned professionals leave, the next generation lacks the support necessary to transition into leadership roles. Midwives and other maternity staff must train together at every level to be fully equipped for every situation, and ensure that concerns can be escalated effectively. That is why the Ockenden report and the Royal College of Midwives seek a commitment to including midwives in the long-term workforce plan.

In 2017, bursaries for student nurses and midwives were ended, with the Royal College of Midwives warning that that decision threatened the future of our maternity services in England. It has led to one third of midwifery students having debts exceeding £40,000, with 80% of them knowing someone who has dropped out of their course due to financial hardship. Many also take on additional jobs to afford their studies, which detracts from their vital training. To mitigate those pressures on trainee midwives, I encourage the Government to explore alternative routes to support midwifery and nursing students, which have been laid out by the Royal College of Midwives, through new funding options or a scheme where student debt is forgiven after a defined period of service in the NHS.

A similar funding issue affects apprenticeship schemes in midwifery. Despite receiving overwhelmingly positive feedback from trusts across the country regarding the apprenticeship route, many trusts cannot afford to offer those positions due to a lack of backfill funds, so trusts often hand back their apprenticeship levy, as the scheme is undeliverable. I hope the Minister will work with her colleagues in the Department for Education to address this fundamental flaw in the delivery of level 6 and level 7 apprenticeships, which have proven to deliver the midwives of the future.

In preparing for today’s debate, I was invited to my local maternity unit at St Richard’s hospital in Chichester, where as I mentioned I had both of my children. University Hospitals Sussex had its maternity services inspected by the CQC in September 2021, which found all hospitals across the trust to be inadequate or requiring improvement. Although there has not been a formal inspection since, the trust assures me that all actions from the CQC have been completed, with the majority of the Ockenden immediate and essential actions implemented. However, to fully implement all the IEAs will require funding, which currently the trust does not have.

St Richard’s hospital confidently tells me that it is now fully staffed for the first time in a long time, and the director of maternity services is keen to look at how she can further improve patient experience and communication. I know Members across the House are keen to work with their NHS trusts constructively to ensure the best outcomes possible for their constituents. I was reassured by the senior leadership team, those working in the department, and the new parents on the ward, who I had the pleasure of congratulating. Introducing tiny babies to the world was probably the best moment of my recess—it was very bizarre for those parents when the MP walked in and said, “Can I say hello?” I am pleased that the trust is taking seriously its responsibility to provide a much improved service.

It would be a missed opportunity if I, as the chair of the all-party parliamentary group for infant feeding, did not mention how we could do much more as a society to support mothers to breastfeed, if they choose to. The UK’s breastfeeding rates are among the lowest in the world. Only 1% of mothers exclusively breastfeed at six months, despite the World Health Organisation recommending exclusive breastfeeding for this period and continuation, alongside nutritious foods, for up to two years. Some 44% of mothers surveyed wished that they had breastfed for longer and would have done so if they had received better and more tailored support. New mothers need time, expertise and evidence-based information to make informed decisions on their feeding choices, and maternity services play a key role in establishing a feeding plan that works for mother and baby before they go home. But, across the country, community midwifery and health visiting services have been vaporised, so support is patchy and often delivered by volunteers or midwives in their spare time. I hope that the Government will support improved community services such as milk support groups, to give all women, regardless of their feeding choices, somewhere to turn when they need support.

I will take this opportunity, perhaps selfishly, to get on record the name of one of the coolest kids I ever met. Benedict Henry Goodfellow was an absolute dude—[Interruption.] I am not going to cry—and I am proud to call his mum, Steph, one of my close friends and the strongest woman I know. This debate is so important to me because Bendy needed 24-hour care since birth after a case of extreme birth trauma left him with devastating neurological damage. Bendy was loved by everyone who came into contact with him until he died, aged 10. The experience left Steph traumatised and profoundly changed. Bendy was born nearly 30 years ago and yet Steph and Ben’s story is just as relevant today. It should not be.

I am immensely grateful to Donna Ockenden for putting me in touch with families from across the country—including from Leeds, Nottingham, Shrewsbury and Sussex—ahead of this debate to hear their personal experiences of failures in maternity care.

[Katie White (Leeds North West) (Lab)]

As I am the Member for Leeds North West, the hon. Member may have spoken to my constituents, Dan and Fiona, who tragically lost their baby Aliona after only 27 minutes. Despite the fact that the inquest found a number of gross failings, the figures for Leeds, which came out only last night, are horrifying. Does the hon. Member agree that there are grounds for an independent review of maternity services in Leeds?

[Jess Brown-Fuller]

The hon. Member is absolutely right to raise the case of Dan and Fiona. I was lucky enough to have them give up their time to share their heartbreaking story with me. They are at the forefront of the fight for an independent inquiry in Leeds. The Secretary of State for Health and Social Care said that he would look at whether there is cause for an investigation but those families are still waiting to find out if that will go ahead.

I met with families like Dan and Fiona to ensure that the questions I ask the Minister today are the questions that those families would ask if they had the opportunity. I cannot begin to imagine how exhausting it is to relive the moments that their lives changed forever, over and over again, in the pursuit of better outcomes for the next family. I will include a number of their questions to the Minister in my closing remarks, but I reflect that the families who were able to share their experiences with me were, overwhelmingly, white, middle class, often highly educated and that many had medical backgrounds or academic careers before going through this trauma. Lord Darzi’s report found that black women are almost three times as likely to die in childbirth as white women and that neonatal mortality in the most deprived areas is more than double that in the least deprived. Who speaks up for those families? Who ensures transparency and accountability for those with a fundamental distrust of the medical profession, or those who have learning disabilities, or English as their second language, because those people are not supported in navigating the complex systems that are in place?

Negligence claims in obstetrics account for just 13% of the volume of litigation received by NHS Resolution in 2023-24 but cost over £1 billion every year—nearly 60% of the total cost of clinical negligence claims. Beyond financial costs, those failures carry a devastating human toll. If we truly invest in our maternity services, in both professionals and facilities, more than money is saved; lives are saved.

In conclusion, I would like to ask the following questions of the Minister. First, the previous Government were supportive of the Ockenden review, and previous health Ministers had made assurances that maternity services were going to get the support they desperately needed. I know the Secretary of State for Health is supportive of the Ockenden review and has met many bereaved parents since the general election. He has assured those parents that fixing maternity is a priority for the Government, and that actions would be outlined publicly before Christmas 2024. He came back shortly after Christmas saying they needed more time. That response is now two months overdue. Can the Minister assure me that those families will hear an update in the near future?

Do the Government support all the Ockenden report’s immediate and essential actions arising from the review into the Shrewsbury and Telford trust? How will the Government ensure that all integrated care boards and trusts across the UK implement all the actions? What support will be provided to the trusts to achieve that, and prevent a postcode lottery of maternity care?

If those IEAs are implemented, what will be the Government’s measure of success? We currently have no national data regarding preventable deaths. It is the charitable sector that has determined that more than 800 baby deaths a year could have been prevented. One of the IEAs is a long-term plan to secure a safe maternity workforce and improve training. Can we expect to see maternity care professionals, including neonatologists, obstetricians and anaesthetists, included alongside midwifery colleagues in the refresh of the 10-year workforce plan for the NHS?

An overriding theme in my conversations with bereaved parents was the CQC’s hesitancy to prosecute. Cases were often supported in the first instance, but families were then informed, just days before the three-year statute of limitations expired, that the CQC would no longer be seeking a prosecution, with the families having no time to appeal that decision. Does the Minister believe that a three-year statute of limitations is appropriate when families dealing with bereavement are often not even considering a case in the first 12 months?

Does the Minister have any concerns about the CQC’s ability as a regulator? Or does she agree with the parents that there is a reluctance to prosecute by the leadership of CQC when there have been failures in patient care? Does the Minister support calls from Sands and Tommy’s charities for all triage phonelines to be recorded, as currently they are not?

Finally, parents repeatedly reported to me that the bereavement care they received felt like a tick-box exercise, with a lot of focus on the mother and a lack of communication and support for the father, when both have suffered that bereavement. Does the Minister agree that communication could be vastly improved across maternity services in all cases, so that both parents have the opportunity to understand what happened in those most vulnerable hours?

I would like to finish by thanking every Member who has come to talk about this important issue. I also thank Donna Ockenden and all who contributed to the creation of the review. My greatest thanks go to all the families who gave up their time to share their stories with me, reminding me that those babies were people, not statistics. They are loved, they are missed, and they deserved better.

09:48

[Dr Beccy Cooper (Worthing West) (Lab)]

I thank the hon. Member for Chichester (Jess Brown-Fuller) for calling this debate. As neighbouring parliamentarians on the south coast, we are both passionate champions of the health of our residents and want the best healthcare provision for all, and that includes maternity services.

Unfortunately, despite numerous reviews, plans and strategies, too many maternity services remain shockingly, stubbornly poor, as the hon. Member pointed out. Successive investigations into high-profile failures have described a pattern of dysfunctional and even dangerous cultures, with a failure to listen to families and missed opportunities to address known issues. As a result, too many mothers and babies have experienced substandard care and unacceptably poor outcomes.

In the past year, the number of maternity services in England receiving ratings of inadequate or requires improvement from the CQC increased from 54% to 67%. Of the 131 maternity services inspected from August 2022 to December 2023, only 4% were rated outstanding, and not one was rated outstanding for safety. In that context, we see stagnating progress on improving stillbirth and maternal mortality rates not seen in the UK for over 20 years.

As we have heard, black women are almost three times as likely, and Asian women almost twice as likely, as white women to die during birth or post-natally. Maternal mortality rates for women from the most socioeconomically deprived areas are twice those for women from the least deprived areas. Closing the black and Asian maternal mortality gap and tackling profound health inequalities such as those is rightly a priority for this Labour Government, and it is the reason I went into politics.

Poor outcomes exist, too, for the most vulnerable and marginalised women, such as refugees, LGBTQ+ women, prisoners, those who have been through the care system and those who have experienced domestic violence or sexual abuse. All of them are more likely to experience poorer maternity care and the resultant trauma. Poor standards in maternity services are part of a wider picture of a healthcare system that has not prioritised women’s reproductive health.

The Women and Equalities Committee highlights that gynaecological care waiting lists have grown faster than lists in any other specialty in recent years. As a public health professional, it saddens me to say this, but the NHS Confederation reports that the UK stands out as the country with the largest female health gap in the G20 and the 12th largest globally, with women spending three more years in ill health and disability compared with men. Those systemic failings underpin the poor outcomes and health inequalities that we see in maternity care.

As a public health doctor, I have worked in and led health teams, and as the proud MP for Worthing West, I have heard from dedicated staff across our local services. I understand that systemic issues fail staff as well as patients. In our hospital in Worthing, the maternity services are staffed by hard-working, capable healthcare professionals who want to get on with the job they have trained for. They are as frustrated and saddened as the rest of us when processes, equipment, staffing levels and governance are simply inadequate for the provision of excellent healthcare.

Our Government have pledged to recruit and train thousands more midwives, which is to be warmly welcomed. The forthcoming 10-year plan for the NHS is an opportunity to address the underlying problems of a deskilled and demoralised workforce, which impact maternity services. We must take action to improve midwife training and retention, address the numbers of qualified medical staff on maternity wards, improve patient voice and bring a relentless focus to safety and compassion.

There is an urgent need to transform the health and social care system. In doing so, we have a superb opportunity to look at innovative models of integrated and accessible “neighbourhood health” maternity services, delivered alongside hospital care. Finally, I welcome the recommendations of the APPG on birth trauma for a national maternity improvement strategy and a maternity commissioner to drive improved outcomes and rebuild our services.

09:52

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I commend the hon. Member for Chichester (Jess Brown-Fuller) for setting the scene so well. I thank her for sharing her personal stories; nothing sets out an issue better than a personal story. I am my party’s health spokesperson, but it is always good to give a local perspective too. I look forward to the responses from the Minister and Opposition spokespersons—the trio here today seem to be in all the debates on this subject, and I thank them for their contributions.

Our maternity services in Northern Ireland are crucial and, arguably, among the most consistent services offered by the NHS. Although all our services are important, everyone must be born and must be given the best start in life, and it is through our wonderful NHS maternity services that we are able to succeed.

My constituency resides within the South Eastern health and social care trust, which offers both midwifery-led and consultant-led care, with a fantastic focus on personalised support for mothers through their pregnancy and after labour. The trust also provides antenatal clinics, home visits and care options for expecting mothers.

Back home in Northern Ireland, in October 2024, an independent review concluded that a co-ordinated system-wide change is needed to radically improve maternity care. There are problems with maternity care not just here on the mainland, but with us back home. The Minister does not have a responsibility for that, but she has an interest in all things pertinent to Northern Ireland. Whatever the subject matter, and whenever I ask her for help, as I always do, she always responds in a positive fashion, and I appreciate that.

There are clear inequalities in services across Northern Ireland. It is no secret that the health service has witnessed extreme difficulties over the last couple of decades. More must be done to support staff and to ensure safe and quality care, so that women and families feel supported through their journeys during pregnancy and labour.

One of my constituents gave birth to her first baby just last week, and I want to record what she said, because I think that that is important. Her experience was made by the incredible student midwives who supported her and held her hand the entire way. When my three boys were born—that was not yesterday—I was there with my wife. She held my hand, and the blood circulation in my hand got less and less as my dear, loving wife’s pain increased. I say that because we have to give some credit to the student midwives who are there for what they do.

The Department of Health and Social Care has increased the number of commissioned pre-registration nursing and midwifery university places from 680 in 2013 to 1,335 in 2023. Those are good figures, but unfortunately, due to budgetary constraints, the number of places returned to the baseline of 1,025 in 2023-24. So there was an increase sometime back, but the numbers have levelled out again.

Thousands of people across Northern Ireland apply to study nursing and midwifery each year. The number of midwifery training places is extremely limited, and demand often exceeds the number of available spots. The Royal College of Midwives has noticed a downward trend in midwifery applicants and has stated that that is a concern, expressing apprehension about the significant drop in the number of applicants. For the record, has the Minister had an opportunity—she probably has—to get the opinion of the Royal College of Midwives on where we are and how we could help?

We must look at why this is happening. It could be said that, because midwifery is a challenging field to get into, many do not see the point in applying directly for it. Again, what are the Minister’s thoughts on how we improve things? Additionally, some have stated that it is easier to progress in a career by going in at entry level, as opposed to starting university after school and trying to get a job after.

There must be ambitious reform of these services to ensure that we can support expectant mothers and give them memorable and positive experiences. We often hear of horror stories, and we must allow for the best start in life for babies and families.

To conclude, we have some of the best staff in our maternity wards, and their work and dedication must be recognised. They are hammered day and daily in their jobs, due to budgetary constraints and the inability to get the support they need. I look to the Minister and the Government to give a commitment to our NHS—and, more importantly, to those who work in it—that more will be done to properly fund our wonderful maternity services across the whole of this United Kingdom of Great Britain and Northern Ireland and to give families and parents the best possible start to their children’s lives. I request that the Minister have discussions with the relevant Minister in Northern Ireland, Mike Nesbitt, on what we are doing back home, so that we can work better together.

09:57

[Josh Fenton-Glynn (Calder Valley) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the hon. Member for Chichester (Jess Brown-Fuller) for securing this important debate. I should note at the start my officership in the APPG for infant feeding and the APPG on single-parent families.

Women’s health is often an already under-prioritised area of our health system, with the UK found to have the largest female health gap in the G20, as my hon. Friend the Member for Worthing West (Dr Cooper) noted earlier. Women are falling through the gaps, which have been made worse by the past 14 years of austerity and reorganisations in the health system.

The situation facing midwifery and maternity services is even more dire. As a member of the Health and Social Care Committee I have met the Royal College of Midwives, which made clear its worries about the need for better investment in midwifery and maternity services, and its concerns about safe staffing levels in a workforce facing crisis.

Those real concerns are borne out by the national review of maternity services, which found that 47% of services were rated as requiring improvement on safety grounds. That is not to say there are not bright spots of positivity, and I have nothing but praise for the work of Calderdale’s maternity services, which were fantastic and supportive at the births of both my children. However, the national picture is one of services that are stretched and midwives who are working extra hours to plug the gaps. At the end of last year, figures showed that more midwives than before have left the profession after five years or less.

The story across the health service is, sadly, consistent, and that is the result of pressure in an NHS that Lord Darzi warned was on life support. That is why the NHS 10-year plan is even more vital and timely. It gives us not only a real opportunity to begin undoing 14 years of damage to our health service, but the chance to rebalance our health system and focus on different priorities that have been long neglected, be that maternity services or mental health. Women who access maternity services often do so at a time when they feel most vulnerable, and it is important that those services are there to protect them at that time.

10:00

[Helen Maguire (Epsom and Ewell) (LD)]

It is a pleasure to serve with you in the Chair, Sir Christopher. I congratulate my hon. Friend the Member for Chichester (Jess Brown-Fuller) on securing this hugely important debate. Today I will highlight both the excellence and the challenges of maternity services in my constituency of Epsom and Ewell.

Last year, the dedicated staff of Epsom and St Helier university hospitals delivered more than 3,400 babies. Their commitment to patient care is outstanding, with care being ranked No. 1 in London for patient experience. Both units have also achieved UNICEF UK baby friendly hospital initiative gold accreditation, reflecting their exceptional support for new mothers’ feeding choices. Those outcomes are testament to the experience, compassion and hard work of the staff, despite the conditions they work under.

Our maternity services are held back by infrastructure that is simply not fit for purpose. Some of the hospital buildings at Epsom and St Helier are older than the NHS itself. Those conditions make it harder to provide the high standards of care that mothers and babies deserve. At St Helier hospital, the maternity unit’s lift regularly breaks down, making it increasingly difficult to safely transfer maternity patients to intensive care or the main theatres. Both Epsom and St Helier hospitals lack waiting areas and suitable space to maintain privacy, making it harder to implement a nationally mandated triage system and to provide private spaces, which are vital for bereaved families.

Every year, the trust spends millions just on patching up these crumbling facilities, which is not sustainable. The cost of maintaining outdated buildings and equipment diverts critical resources away from the frontline. Furthermore, staff are stretched thin by running duplicate services across two sites, which affects patient outcomes. The promised new hospital in Sutton was meant to solve those problems by bringing together emergency care, maternity services and in-patient paediatrics in a modern, specialist facility. However, the Government have pushed construction back to at least 2032, leaving our community in limbo. Meanwhile, Epsom general hospital alone needs £44 million-worth of repairs, with 46% classed as high risk, meaning that failure to address them could lead to serious injury or major service disruption. If the UK is to be the safest place in the world to have a baby, we must do better.

Beyond the building, staffing remains a critical issue. A local midwife recently shared with me the reality of working in our maternity services. She described how the staffing problems in maternity continue to be dire. There simply are not enough midwives rostered each day to cover the work, which makes it unsafe for women and their babies, and creates an unsustainable working environment for those left behind. Midwives are working longer hours, starting early or leaving late, taking on more than they should just to ensure women are seen. This leads to burnout, and many midwives ultimately leave the profession as they feel that the stress and huge responsibilities are not matched by adequate support or fair pay.

As a woman, the midwife told me how deeply saddened she is that this is the service being offered to women in this country. The care a woman receives during childbirth has lifelong implications—not just for her, but for her children and for society as a whole. She worries that women’s choices, particularly around home births, are becoming increasingly sidelined. Women’s autonomy over their own bodies is becoming less relevant, and she fears what that means for the future of maternity care for our daughters and granddaughters. Her worries reflect those of so many across the country.

I have three children, all of whom were born successfully in London. I wanted a home birth for all of them. Sadly, we were only successful in having one home birth due to complications, but I am grateful that I had the choice. I thank Brierly midwives for that, but not every woman today has that choice.

The people of Epsom and Ewell, Leatherhead and Ashtead—and around the UK—deserve outstanding maternity care, unhampered by crumbling infrastructure, chronic understaffing and a lack of investment. As a first step, I urge the Government to release the full impact assessment of the delays to the new hospital programme and reconsider the decision. We cannot afford to let maternity services deteriorate any further. The safety of women, babies and midwives depends on it.

10:04

[Dave Robertson (Lichfield) (Lab)]

It is a pleasure to serve with you in the Chair, Sir Christopher. I thank the hon. Member for Chichester (Jess Brown-Fuller) for securing this debate. Fundamentally, it is about giving kids the best start in life and giving mums the best care. There are few subjects of more importance to us, right across the House.

The evidence is clear that midwife-led maternity units are great for babies and mums. They are every bit as safe as the big hospitals we have heard many hon. Members talk about today, and one of the benefits they offer is the option of a more natural birth, with less intervention from health professionals, unless it is necessary. Mums who deliver in a midwife-led unit are less likely to need a caesarean or help from forceps or a vacuum. While those procedures can be life-saving, and we should thank the people who use them every day to support babies into this world, they come with downsides. Caesareans increase the risk for mums, including haemorrhage, blood clots and infections in the womb, and they take much longer to recover from. The potential side effects of forceps and vacuums are less severe but are, nonetheless, very real.

As the hon. Member for Epsom and Ewell (Helen Maguire) said, choice is important for mums. So that people can have the birth they want, we should make sure that, when they come to the end of their pregnancy, they can choose where they want to deliver—be that at home, in a more clinical setting if there are additional risks, or in a midwife-led unit.

In Lichfield, we were lucky enough to have a fantastic midwife-led maternity unit at Samuel Johnson community hospital. The unit was closed during the pandemic for reasons we all understand, given the national crisis, but it has never reopened. The closest maternity unit is at Queen’s hospital in Burton, 11 miles up the A38. When High Speed 2 is not destroying the transport infrastructure in my constituency, that is not necessarily a significant trip in an ambulance, but it presents barriers to those who do not have access to their own transport. It is currently the only option available to people in Lichfield.

However, mums in Lichfield will soon not be able to choose that midwife-led unit because it is on the chopping block. That would be a huge loss. The service gives women in Lichfield, Burntwood and the surrounding villages somewhere close to home to deliver in a calmer, quieter setting than the big hospital. Where that is appropriate, I think everybody in this room, and people much more widely, would want to support it.

Shutting the midwife-led unit would mean less choice for mums, and potentially worse outcomes for mums and babies. I have met many people whose children were born in that unit and who are so happy to have had the option. When I mentioned that I was taking part in this debate, one of my staff members said, without prompting, that she had had four kids—two in the clinical setting of a big hospital, and two at the Samuel Johnson community hospital. She was so much happier with her experience in the midwife-led unit. She was not, in any way, talking down what happened in the other hospital, but the more natural, quieter and more relaxed environment was a benefit as she was going through childbirth.

I thank everybody who works in maternity services, and I particularly thank those who champion midwife-led units.

10:08

[Liz Jarvis (Eastleigh) (LD)]

It is a pleasure to serve under your chairship, Sir Christopher. I am extremely grateful to my hon. Friend the Member for Chichester (Jess Brown-Fuller) for securing this important debate, which is particularly important to my constituents Charlotte and James.

In April 2019, Charlotte gave birth to a daughter, Norah. Norah was given the all-clear by a doctor but quickly became poorly. Despite concerning oxygen saturation results, Norah was not rushed to the neonatal intensive care unit. She died very suddenly that same night. Charlotte and James are still fighting for the truth about why their daughter died.

The UK should be the safest place in the world to have a baby. However, according to the Care Quality Commission’s most recent figures, nearly two thirds of England’s maternity services are not safe enough. We must see an end to understaffed maternity units, and I am sure the Minister will agree that addressing disparities in obstetric care is essential for a fair society.

Women and their babies deserve better. All pregnant women in my Eastleigh constituency and across the UK should have access to safe and fully resourced maternity care. However, according to NHS data and the Royal College of Midwives, the number of people in the maternity workforce is shrinking. Midwives and maternity support workers are working in excess of 100,000 hours a week in unpaid overtime. The result is that many staff experience stress and burnout, with some midwives saying that they feel uncared for at work, unable to take breaks to get a drink of water or use the loo, and—with the best will in the world—unable to deliver the kind of maternity care that women expect and deserve. How can the NHS be expected to deliver a higher quality of care with fewer, already very overworked staff? Health outcomes for mothers and babies will only decline if commitments in the workforce plan are not ambitious and funded.

I also highlight the often overlooked factor of mental health in maternity care. According to the Maternal Mental Health Alliance, one in five women experiences a perinatal mental health problem, and 70% will conceal or underplay maternal mental health difficulties. Tragically, suicide is the leading cause of maternal death in the first year after birth.

As we have heard, on average a baby is born in England every 56 seconds. The Royal College of Midwives states that no other NHS service has as much contact over a prolonged period with so many normally healthy individuals. With a properly staffed and resourced maternity service, there is great potential to use this period to ensure that, after leaving hospital, mothers are mentally in the best possible position to care for their newborns. I fully support the Liberal Democrats’ manifesto commitment to transforming perinatal mental health and offering more support for those who are pregnant, new mothers and those who sadly experience miscarriage or stillbirth.

It is welcome that maternity services are important to the Government, but I share the view of the Royal College of Midwives that this priority must be reflected in how maternity services feature in the 10-year health plan, with a decade of ambition and focus, as well as a commitment to proper funding.

10:11

[Tom Rutland (East Worthing and Shoreham) (Lab)]

It is a privilege to serve under your chairmanship, Sir Christopher. I thank the hon. Member for Chichester (Jess Brown-Fuller) for securing this important debate.

Maternity services are a vital part of our national health service. They are unique in that they are entrusted not only with the care of newborns at their most vulnerable and mothers at their time of greatest need, but also with ensuring that the wondrous process of bringing a new life into the world is a safe one. For many families, it is, and I thank those in our NHS who work tirelessly to deliver the best care they can, especially against the backdrop of 14 years of chronic underfunding of services and of conditions that are not acceptable in a modern healthcare system.

However, for too many families in East Worthing and Shoreham, and others served by hospitals in the University Hospitals Sussex NHS foundation trust, maternity services are not performing as they should, despite the hard work of many staff. All four maternity units in the trust have been determined by the CQC to be inadequate or requiring improvement, showing just how urgently that change is needed.

Behind each rating and category are the devastating experiences of real people. I have met families in my constituency who have had to endure the most tragic and unimaginable suffering as a result of having received inadequate care from the trust’s maternity services. Some families are living through the devastation of stillbirth. In one case, a baby with no underlying conditions, who in the eyes of all involved was completely healthy, tragically died. Numerous issues should have triggered additional monitoring and alternative care pathways, but they were never acted on. In that case, the trust admitted failures in care to the parents, but I am aware of failures in other cases.

Another family—who were, again, due to welcome into the world a healthy baby with no underlying health conditions—suffered horrendously because of misdiagnosis, delayed treatment and a missed opportunity for a caesarean. These errors were compounded by poor communication and note keeping, which resulted in clinical staff not being aware of earlier events, and yet another unimaginable tragedy taking place. Sadly, these families are not alone. A group of bereaved families in Sussex, who no doubt wish they had no reason to know each other, have come together to call for action to ensure that no expectant parents have to endure what they have gone through.

I am glad that our Prime Minister and the Secretary of State for Health and Social Care have rightly prioritised maternity service improvements as part of their plan to change our NHS. They too feel the urgency for change that many of my constituents feel.

I am grateful to the families in my constituency who have channelled their grief into the courage to share their harrowing stories with me, and to the Health Secretary for meeting families previously in the care of the University Hospitals Sussex NHS foundation trust to hear their experiences and calls for action. We need action. With a new baby born every minute, we cannot delay or defer making our maternity services safe for all, including by tackling racial inequalities in care. The need is now and the urgency is clear.

10:15

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

It is a pleasure to serve under your chairship, Sir Christopher, and I congratulate the hon. Member for Chichester (Jess Brown-Fuller) on securing this important debate. We are here today because maternity services are not at the level that they need to be at. There are many, many fantastic services across the country, but we are here to highlight those that need urgent improvement to improve outcomes for all mothers, not just some.

The excellent report that the all-party parliamentary group for birth trauma produced last year is to be commended for the way that it highlighted the fact that, for a minority of women, the experience of childbirth is traumatic and has long-lasting consequences. The section about stillbirth and neonatal death includes a submission from one mother who reported:

“The scenes in theatre can only be described as chaotic and these along with subsequent events have left me traumatised and suffering with PTSD.”

I pay tribute to the Brontë birth centre in my constituency of Dewsbury and Batley, a midwife-led birthing centre in the Dewsbury and District hospital. It recently reopened in April after having been closed for two years because of staff shortages. Two of my children were born there more than 20 years ago, so it will always have a special place in my heart. I would not want my comments to be misconstrued as criticism of the services it provides.

We have heard about the difference between midwife-led and consultant-led services, and we have heard about positive examples of where midwife-led services are more appropriate and can deliver better care. I am not making a point about midwife-led versus consultant-led care: the APPG report also cites horror stories from women in childbirth where consultants were present. Rather, my point is that, in reviewing maternity provision and seeking to minimise the risk to women during childbirth, we should also ensure seamless obstetrician provision for midwife-led care if required. If mothers giving birth in the Brontë birth centre encounter complications that require more in-depth medical care—God forbid—they would need to be moved from Dewsbury to Wakefield, which is a journey of more than half an hour. That increases the risks to the mother and the unborn child, so I would like the Government to address that issue.

For many who have experienced emergency situations, the image painted earlier of sheer terror and panic is all too real. It is likely that maternity services will fail to meet the national maternity safety ambition to halve the 2010 rate of stillbirths by 2025—indeed, recent figures suggest the 20% decline in stillbirth deaths achieved between 2010 and 2020 is in reverse—so it is imperative that we explore every aspect of maternity provision to ensure it is as safe as it can be.

Although almost 61% of maternity services are rated good, only 1% are rated outstanding, and just under 38% are still rated as requiring improvement for safety. Improving maternity services in the NHS is a critical priority, and the many reports since 2010 have made several key recommendations to enhance care quality and safety. I would like the Minister to share what steps the Government are taking, or will take, to address workforce gaps where the need to recruit and retain more midwives and maternity staff is essential to provide adequate support for mothers and babies. What steps are the Government taking to reduce health inequalities, to tackle disparities in maternal health outcomes, particularly for black and ethnic minority women and those in deprived areas? How will the Government ensure that adequate funding—including the reinstatement of the bursaries for midwives and nurses—is available and allocated to deliver the best quality maternity services?

Enhancing maternal mental health support for women with long-term mental health conditions is crucial. Listening to women’s experiences is also key; the continuous gathering of feedback and acting on it are essential to improve care. What are the Government doing to implement anti-racism strategies so trusts can set clear standards of behaviour to support both staff and patients? If implemented, these improvements will help ensure that all mothers receive safe, high-quality care during pregnancy and birth.

10:21

[Chris Bloore (Redditch) (Lab)]

I congratulate the hon. Member for Chichester (Jess Brown-Fuller) on securing today’s debate. My constituents are watching at home and she eloquently set out the challenges that face our maternity services and the health of women across the UK, so I thank her for doing that so well.

When people in Redditch elect their Members of Parliament, they do so with a clear mandate on maternity services and the future of the Alexandra hospital. It would be remiss of me not to thank the shadow spokesperson, the hon. Member for Hinckley and Bosworth (Dr Evans) who did a tour of service at our hospital in the earlier parts of his career—we thank him for that.

Our maternity services are famed for delivering one Harry Styles many years ago—[Interruption.] Yes, just the one Harry Styles. More seriously, in 2015 our maternity services were closed and relocated to Worcestershire Royal. That temporary relocation was made permanent in 2017. That is the only site delivering such services across our entire county. That means many of my residents are forced to travel to Worcester or Birmingham to get the services they need.

Although the hon. Member for Chichester was brave enough to share some of the stories that she has heard from her constituents, I am quite frankly not strong enough to retell some of the stories I have heard—of stillbirths and, frighteningly, of parents giving birth to their children on the roadside—in the way that they deserve. Since 2015, the initial promises to return those services to my constituency have been forgotten. Despite signatories totalling over 50,000 from the local community, no parameters for the return of such services have been discussed by the ICB.

I want safe services for my constituents, but although I am concerned by the current configuration of services, I am deeply concerned about the future of services in my constituency. Worcestershire Royal has significant constraints on growth. Worcestershire is set to deliver tens of thousands of new homes and huge population growth in the next 10 years, with pressures on services set to rise substantially. As this Government seek to rebuild and reconfigure our NHS, it is time for those services to meet the needs of the present and, most importantly, deliver the services of the future. I urge the Government to review the decisions taken on the centralisation of services that may have made sense in the past, but will not in the future.

[Mr Angus MacDonald (Inverness, Skye and West Ross-shire) (LD)]

I am proud to represent Inverness, Skye and West Ross-shire. My colleague, my hon. Friend the Member for Caithness, Sutherland and Easter Ross (Jamie Stone), could not be here, but, on the subject of centralisation, our nearest maternity hospital is in Inverness, which is four hours each way from parts of Sutherland, Argyll, and the Isle of Eigg—around Muck, which I am sure the hon. Member is, or should be, familiar with. I wonder whether the hon. Member could support our case that centralisation is becoming a real problem for expectant mothers, who suffer enormous complications because of distance, given that smaller regional hospitals are no longer providing maternity care?

[Chris Bloore]

I thank the hon. Gentleman for his intervention and I am sorry to hear about the level of problems that mothers face his constituency. The hon. Member for Chichester started the debate saying that this is about services for women at their most vulnerable, when they are giving birth. It is clear from the experiences of the hon. Gentleman’s constituents and mine that services are not meeting the needs of those women when they need them the most. That is the challenge that we should now take up.

I conclude by saying that, in the past, the reconfiguration of services has been based on a financial envelope and the challenges of staff shortages, and that has dictated many decisions, but now is the time, with the Darzi report and the eloquent speeches we have heard today, to build that service for the future. We should all strive to meet that challenge, even if that means making difficult financial decisions to invest in the long term, so that we can give women and families the support that they deserve.

[Sir Christopher Chope (in the Chair)]

There are three speakers, and we have five minutes to go.

10:25

[Marie Goldman (Chelmsford) (LD)]

I thank my hon. Friend the Member for Chichester (Jess Brown-Fuller) for securing this important debate. I will keep this brief and not reiterate all the things that have been said before, but there are a couple of points I want to make about how important it is to talk about women at the most vulnerable point in their lives, as well as the most vulnerable point for the babies who are being born. There cannot be a more important time in their lives than the moment when they are born, which is why it is so important to talk about this. I speak as a woman and a mother, but also as a human being. We are discussing the birth of the human race; I do not think there is anything more profound than that.

However, I will focus on something that has not been raised very much today: the role of the CQC in keeping our maternity services safe. One of the hospitals that serves my constituency of Chelmsford is Broomfield hospital, the maternity services rating of which was downgraded to inadequate at the beginning of January. That on its own is shocking and worrying enough. I have met the staff at Broomfield hospital and been to the maternity services there. I want to give it help and support so that it can improve. However, what concerns me is that the CQC carried out its inspection in March last year and only released its report in January. That is utterly unacceptable. How can we be expected to hold our services to account and how can we help them to improve if we do not even know what is wrong with them in the first place?

It is the CQC’s job to tell us what is wrong with those services and lay it out bare so that we can learn from the things that go wrong and quickly put them right. It is not okay for the CQC to turn around and say “We have had technical difficulties with our new system and, therefore, we couldn’t get the report out”. That is not good enough. It is also not good enough for them to say “We shared some of our findings with the hospital, which is also making them public at the same time”. It is simply not good enough. We need to support the CQC to do much better.

I am conscious of time and I know other Members want to speak, but I want to underline the importance of the role of the CQC, as well as the leadership across all of the NHS. From the excellent job that the midwives and the support staff do in maternity centres to the leadership of the hospitals, including the chief executives and the ICBs, everyone has a role to play in improving maternity services. The CQC also has a huge role to play, and it must do better.

10:27

[Max Wilkinson (Cheltenham) (LD)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I will talk for about a minute. The Minister heard from me last autumn, when we had a debate about Gloucestershire’s maternity services. The background remains as it was before, but there is an important update. When I was elected, Cheltenham general hospital’s birth unit had been closed temporarily since Autumn 2022—I think we should now use the word “indefinitely”. That is simply not good enough. Cheltenham has a population of around 120,000 and it serves a much larger area. Since then, Gloucestershire Royal hospital’s maternity services have been downgraded to inadequate. They remain inadequate, and have done for a number of years.

There have been some really worrying bits of casework slipping into my inbox recently, which tells me that things are going wrong and there are ongoing issues with bad bleeds, which has been raised by the CQC. My hon. Friend the Member for Chelmsford (Marie Goldman) mentioned the CQC’s lag time. The CQC reported in January after a visit last spring, so there is clearly a long delay. I will end there to give my hon. Friend the Member for Winchester (Dr Chambers) a minute, but I hope the Minister can respond on those points and provide an update on what is going on with Gloucestershire Royal hospital’s maternity services.

10:29

[Dr Danny Chambers (Winchester) (LD)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank my hon. Friend the Member for Chichester (Jess Brown-Fuller) for securing the debate. She spoke movingly and eloquently, and reminded everyone that these are not just statistics, but people.

I will make three points very briefly. My hon. Friend the Member for Eastleigh (Liz Jarvis) touched on maternal mental health. As the mental health spokesperson for the Liberal Democrats, I was as shocked as anyone to know that the No. 1 cause of death for women in the 12 months post giving birth is taking their own life. That is tragic, and it is one reason why my team are organising an event in Parliament in April with the group Delivering Better to bring together women who have experienced mental health challenges during pregnancy and after childbirth. The event will provide a platform to share stories, raise awareness and discuss how we can improve support and services for mothers across the country.

I recently attended the 120th anniversary of the vet school at Liverpool, where I went to university. I spoke to the pro-vice-chancellor, Professor Louise Kenny, who is a consultant obstetrician and has done a lot of research on health during gestation and the months after birth, and we discussed the latest research. We have not touched on that today, but I will do so briefly now. Healthy gestation is the foundation of a person’s lifelong health, and it has a far greater impact than any lifestyle changes in adulthood. We need to look not just at birth itself, but at the care of the mother before birth—everything from stress to nutrition.

10:31

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Sir Christopher. I thank my hon. Friend the Member for Chichester (Jess Brown-Fuller) for securing this important debate and making such an excellent opening speech, in which she covered most of the ground that we need to cover.

It is important to acknowledge that the vast majority of babies arrive safely, despite the increasing number of complex pregnancies. My own experience of having a baby was 16 years ago, but I am sure that the thousands of women having babies now are having the same experience that I did. The staff of hospital maternity units make you feel simultaneously that you are the most important person ever to have given birth, and that you are the umpteenth person to have done so this week, they know exactly what they are doing and you can relax. I felt like that even when everything went wrong, which is a great testament to the professionalism of the staff at Wycombe general hospital all those years ago.

This is one of many debates on maternity services that I have attended in the last three years. The first followed the issuing of Donna Ockenden’s report on maternity services in Shrewsbury and Telford hospital trust, which serves my constituents, including Kayleigh and Colin Griffiths, who fought alongside Rhiannon Davies and Richard Stanton and others to give a voice to the many families who suffered as a result of the failings at the trust. But that was not the first scandal in NHS maternity services—Morecambe Bay had already been investigated and reported on by Dr Bill Kirkup—and, tragically, it was not the last either. Dr Kirkup has reviewed significant failings at East Kent, and Donna Ockenden is currently investigating a huge number of incidents at Nottingham. We have also heard the concerns of the hon. Members for East Worthing and Shoreham (Tom Rutland) and for Leeds North West (Katie White) about the state of services in Sussex and Leeds. I am sure that Members across the House are concerned that the tragedy at Shrewsbury and Telford will not be the last.

It makes me quite angry to say that that is not a surprise. We have heard that 65% of trusts were rated inadequate or requiring improvement when it comes to safety in maternity services in the latest CQC survey. That is despite the previous Government’s commitments from the Dispatch Box, which I believe were made in good faith, to deal with unsafe staffing levels and bring about cultural change across the country. The lack of action is unacceptable. Donna Ockenden described the Conservative Government as being “asleep at the wheel” when it came to making progress on the 15 immediate and essential actions she recommended for the whole of England in March 2022, despite their having accepted all those actions.

Each of the reviews into these heartbreaking tragedies has found the same recurring themes: poor management of incidents when things go wrong and, critically, a failure to learn from them, which is indicative of defensive management culture and sometimes toxic working arrangements, including a feeling among staff that they do not have the freedom to speak out and, when they do, inadequate protection for whistleblowers; failure to ensure safe and timely assessment at triage; reluctance to acknowledge the need for medicalisation for a C-section when one is in the best interests of the mother; unsuitable estates and a lack of access to equipment, as we heard from my hon. Friend the Member for Epsom and Ewell (Helen Maguire); and, underpinning all these issues, unsafe staffing levels.

That last point is really important, because staff are experiencing burnout. They are leaving the service in high numbers, and are unable to deliver the care that they really want to deliver to mothers at their most vulnerable moment. There are no excuses now—the issues have been identified time and again—but there is evidence that we are going backwards on maternity care. The 2015 national maternity safety ambition to halve rates of stillbirths and neonatal and maternal deaths by 2025 has stalled and is unlikely to be met this year.

There is a shocking disparity of outcomes between different ethnic groups. Black women are more than twice as likely to die than white ones, and other ethnic groups also carry an unacceptably high risk. No one really understands why; there has been no research into it. There are clear links to deprivation, because people in deprived areas also carry a much higher risk, but translation difficulties, certain health conditions and, shamefully, even racism may all play a part in this shocking disparity. The women’s health strategy for England proposed to address these disparities, but it is impossible to point to any measurable progress. Poor maternity care can have a devastating impact on families, and it makes no sense for the taxpayer either. As we have heard, 60% of the value of clinical negligence claims is related to maternity services, and that costs more than £1 billion a year. It makes no sense not to address these issues.

It is important to acknowledge the work of charities such as Sands and Tommy’s and the work of a number of APPGs in this place over the last few years, including the baby loss, maternity, and birth trauma APPGs, all of which I was involved in. They have campaigned tirelessly for safe staffing levels and to improve care across England, and indeed the UK. This debate relates to England because health is a devolved matter, but the whole of the UK must strive to become the safest place in the world to have a baby.

Addressing disparities in obstetric care is essential for a fair society. The immediate and essential actions of the Ockenden report must be implemented at once, because if they are not, more families will face the trauma of a birth injury or worse. The actions included a commitment to safe staffing, and in 2022 the Government made a significant investment in staffing; it is essential that that is continued. The commitments made in the workforce plan must be backed by adequate funding, and include expansion of the wider maternity and neonatal workforce. The UK Government must renew the national maternity ambitions beyond 2025 to include all four nations, and include a clear baseline to measure progress. They must also address this critical issue of health disparities. In her 2022 report into Shrewsbury and Telford hospital trust, Donna Ockenden said:

“The impact of death or serious health complications suffered as a result of maternity care cannot be underestimated. The impact on the lives of families and loved ones is profound and permanent.”

In my first debate on this subject, in March 2022—the day that report was issued—everyone in the Chamber contributing said that the scandal at Shrewsbury and Telford should be the last. It was not. I hope the Minister will today commit to a strategy to ensure that maternity care scandals are ended on the watch of this Government.

10:38

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I am pleased the hon. Member for North Shropshire (Helen Morgan) pointed out that many people actually do have a good birth. I think that is really important, as there is a danger we scare potential mothers. There is good-quality care up and down the country, but it could be better.

The hon. Member for Redditch (Chris Bloore) pointed to my work. I never actually served in Redditch in the obs and gynae and the paeds there; my time was done in the early 2010s over at Worcester. One of my favourite times as a doctor was being on the elective C-section list, and seeing the mothers go in, having the music there, and seeing birth after birth. It was fantastic. I also experienced one of the worst things that I have ever had to do as a paediatrician—being handed a lifeless baby and trying to sort that out. Worse still was an emergency C-section after a baby went into the mother’s bladder. Both went off to the intensive care units, and I had to go and speak to the father, who was expecting a normal delivery, to tell him what was going on.

This is the reality of what happens, because having a baby does carry inherent risks. What we are talking about here is what we can do to mitigate them. I think that is the heart of what the hon. Member for Chichester (Jess Brown-Fuller) so eloquently set out; this is about the safety of mitigation. Her story about Bendy and Steph will stick with many people, because that is exactly what this House and the NHS should be trying to avoid. The aim should be to mitigate as much risk as we can.

We have also heard talk about breastfeeding and post-partum mental health, which is really important. Those things should form part of a strategy. Not all patients receive a safe and timely assessment when they are being triaged, with instances of phone triage going unanswered and some women discharging themselves before even being seen or picked up, due to the delays. That was backed up by the Care Quality Commission, which found that unsafe practices in triage form the basis of 81% of the enforcement actions issued to providers and were found to be a safety concern in about a third of all inspections.

The hon. Member for Epsom and Ewell (Helen Maguire) pointed to the fantastic quality of care that exists, despite the conditions—we know that 18% of the NHS estate has been described as not fit for purpose and lacking the space for facilities. In my constituency, we have a plan to bring forward an improved maternity centre for Leicestershire. That, too, has been delayed in the future hospitals programme, but at least funding is coming forward to try to deal with that.

Looking at the record of the previous Government, from 2010 to 2022, the rate of stillbirth decreased by 19.3%, the neonatal mortality rate for babies born over 24 weeks gestational age of viability decreased by 36%, and maternal mortality decreased by 17%. In 2015, the then Government launched the national maternity safety ambition, which was to halve the 2010 rates of stillbirth, neonatal and maternal deaths, and brain injuries in babies occurring during or soon after birth by 2025. The current Government have not yet set out an updated ambition for the next decade, so I would appreciate it if the Minister would bring that forward.

As of December 2023, there were 2,361 full-time equivalent midwives working in NHS trusts and other core organisations. That was an increase of 3,700, or 18.9%, since 2010. On the other hand, the birth rate is falling while the number of midwives is rising. I recognise that births are taking place and are somewhat more complex than they used to be, due to things like diabetes, weight and age. It is really important that we have a plan to deal with that; I hope the Minister will comment on that going forward.

That leads me on to community midwives and continuity of care, which we know is inextricably linked to improved care. A report by Cochrane, a non-profit organisation that produces global research to improve health outcomes, showed that women who experience continuity of care—in other words, seeing the same midwife or teams of midwives in pregnancy—have far better outcomes. During the last Parliament, funding was provided for the implementation of continuity of care models. As of April 2024, an additional £186 million had been allocated to improve the quality of care for mothers and babies and to increase the number of available midwifes in post.

I further welcome the £6.8 million in funding provided by the previous Government to help to implement continuity of care for black and ethnic minority groups living in the most deprived areas. As we have heard in the debate, that is a real concern—the hon. Member for Worthing West (Dr Cooper), with her professional experience, pointed to the disparities we see in seeking behaviours among those from BAME backgrounds when it comes to having babies. We also saw that in our work on the Health Committee—I have asked the Minister to look at the two reports on litigation and the Ockenden report in the last Parliament. There is a lot of good cross-party work there that could help to inform current thinking.

Of course, far more remains to be done in the area of saving babies. NHS England published its own delivery plan for maternal and neonatal services in March 2023. Commitments included updating the “Saving babies’ lives” care bundle by 2024 and introducing a national maternity early warning score and updated newborn early warning trigger and tracker to follow up the babies in those cases. The “Saving babies’ lives” care bundle is helping to provide the best practice for providers to reduce neonatal mortality and is rightly a major component of NHS England’s maternal and neonatal services delivery plan. Will the Minister provide an update on the implementation of version 3 of the care bundle?

There are a few closing questions that I would like to pose. The maternal mortality gap has been reduced over the years, from five times to two times, but clearly we need to do more. What further action will the Government take to address the issue of the black and Asian maternal mortality gap, and what ambition will be set out? At the general election, the Government stood on a manifesto to recruit more midwives. Will the Government confirm how that fits into the long-term workforce plan? I am pleased that they have stuck with the previous Government’s plan, and are looking to amend it.

In the new operational planning guidance, NHS England has committed to implementing the key actions in the three-year delivery plan. Will the Minister update us on progress against some of those actions, including the commitment to introduce a national maternity early warning score system and an updated newborn early warning trigger and track tool? As part of their response to the East Kent review, the previous Government established a group overseeing maternity safety services nationwide chaired by my former colleague, Maria Caulfield. Will the Minister provide an update on the national oversight group’s work? Are she or any of her ministerial colleagues part of those discussions?

My final question is about litigation, which was raised by my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt). Under his chairmanship, the Health and Social Care Committee produced a report looking at different maternity models, including in the likes of Japan, and at how can we reduce the cost for taxpayers while improving clinicians’ ability to have the honest discussions we need, and to feel that they can come forward and blow the whistle.

Birth is not about making babies; it is about making mothers—strong, competent and capable ones. We do that by supporting, respecting and informing mothers every step of the way. That is an admirable aim for this House and the NHS, and I look forward to the Minister’s comments.

10:46

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I am grateful to the hon. Member for Chichester (Jess Brown-Fuller) for raising this extremely important issue. It touches so many of our constituents and so many families across our country, and I know how many of them she and other Members have spoken to. As the Secretary of State said, it is an issue that keeps him awake at night. The hon. Lady spoke very movingly about her friend Steph and Steph’s son, Bendy, whom I know she remembers very fondly. We have had too many decades of similar stories, but she did good service to her friend and Bendy today.

I will do my best to answer as many questions as possible—it has been a wide-ranging, respectful and thoughtful debate—but the Minister for Patient Safety, Baroness Merron, who leads on this issue for the Department, will be happy to write to colleagues where necessary.

The hon. Member for Chichester asked a number of questions at the end of her speech, and I hope that I will address most of them. I completely understand why she is pushing on behalf of the families that the Secretary of State met for the maternity services plan to be outlined. Families have waited long enough, but we want to make sure we get it right, so we are taking time within the Department to discuss the next steps with officials and ensure that any plans we put out are as strong and effective as possible; we have had too many plans that have not been. Those families will receive an update on the next steps very soon.

I will come on to some of the essential actions from previous reports, but I will re-emphasise that all Donna Ockenden’s recommendations were accepted and are being worked on. I will pick up on that later in my speech.

On workforce and training, we will publish in the summer the refreshed long-term workforce plan. That will set out how we will build a transformed health service over the next decade, and obviously it will include midwifery.

[Helen Maguire]

Will the Minister give way?

[Karin Smyth]

I will, but I will not be able to get through my speech if I keep giving way.

[Helen Maguire]

I will be very brief. La Retraite sixth form in London has a T-level qualification in health with midwifery, linked up with Guy’s and St Thomas’, and it is proving successful. Will the Minister consider working with the Secretary of State for Education to look at rolling that out throughout the country? It is proving really successful in getting new midwives into the system.

[Karin Smyth]

The hon. Lady raises something very close to my heart. I spoke frequently in opposition about apprenticeships and the need for the health service to work on that. I actually visited that centre with the chief nursing officer and met students there. It was a lovely visit; we had a fantastic morning with really enthusiastic young people who wanted to go into the profession. The hon. Lady makes an excellent point, and we will continue to work with Guy’s and St Thomas’ on that. Others could take note of what they are doing.

We understand the issues with the CQC. They are well documented and were further highlighted by the hon. Members for Cheltenham (Max Wilkinson) and for Chelmsford (Marie Goldman). We do not think now is the time to make changes to the statutory limitation power, because we want the CQC to prioritise improving its regulatory approach and focusing resources on the recovery plan in line with the Dash report. Once that is done and the CQC is working better, the Government have committed to reviewing that statute of limitation power.

With regard to phonelines, Sands and Tommy’s do fantastic work for bereaved parents across the country— I know that from my own Bristol South constituency. We are always open to new ideas and suggestions from the experience of people working on the ground. I will ask officials to consider recording triage phonelines as part of our longer-term work on maternity and neonatal services. Many hon. Members raised general points about communications. The hon. Member for Chichester was right to mention communication for parents—both mothers and fathers. That was a point well made, and I will pick it up later.

Donna Ockenden rightly commands huge respect across Government, parties and the NHS. She was right to say that previous Governments were “asleep at the wheel” on maternity care. We have heard already, but it is worth restating, that babies of black ethnicity are twice as likely to be stillborn as babies of white ethnicity. The maternity workforce is experiencing significant challenges and safety in maternity care is very far from where we want it to be.

Hon. Members highlighted their meetings with families. The Secretary of State and Baroness Merron have met a number of bereaved families over the past few months, as I know others have done. My hon. Friend the Member for East Worthing and Shoreham (Tom Rutland) talked about the families he has met. He highlighted that when he talked to me recently about issues in his constituency.

As with so many issues in healthcare, there is no quick fix to the challenges we face. There have been too many high-profile independent reviews into maternity services over the past few years. With remarkable consistency, they all point to the same thing: a culture that belittles women, downplays concerns and puts reputations above all else, even patient safety. We know that is wrong and we know what needs to happen. It is now time to crack on and deliver.

We are making steady progress on recommendations from all 15 areas of the Shrewsbury and Telford review, such as workforce accountability and bereavement care. Much of that progress has been made through NHS England’s three-year delivery plan. The plan seeks to make maternity and neonatal care safer, fairer and more tailored to every woman’s needs, by setting out expectations for informed choice and personalised care planning, to improve women’s experience in labour and birth.

Some of the initiatives have been highlighted today. The saving babies’ lives care bundle, helping to reduce stillbirths and pre-term births, has been rolled out to every trust in England. I am pleased that all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme, an initiative to promote and sustain a culture of safety. There are also initiatives to reduce inequality. As I know from my constituency, women living in deprived areas are more likely to suffer adverse outcomes. It is right that local systems are trying to bridge the gap through equity and equality action plans.

We have set clear expectations for escalation and accountability through the three-year plan. We are supporting staff to hold up their hands when things go wrong, through the freedom to speak up initiative. The public can monitor the progress of the three-year plan against the Ockenden recommendations, through their local maternity and neonatal systems and integrated care boards. Local women and families, should they choose, can see what progress has been made, who is accountable and how the system is changing. NHS England is also investing £10 million every year to target the 10 most deprived areas of England.

Safety must be the watchword at every step of the journey. NHS Resolution’s maternity incentive scheme is rewarding NHS trusts that prove they are taking concrete steps to improve the quality of care for women, families and newborns. As highlighted by the hon. Member for Hinckley and Bosworth (Dr Evans), since 2010 the neonatal mortality rate has shown steady signs of improvement, decreasing by a quarter for babies born after at least 24 weeks of pregnancy. The stillbirth rate in England has decreased by 22% and the overall rate of brain injuries occurring during or soon after birth has fallen by 3%.

We all know there is so much more to be done to improve outcomes for mothers and babies, and to ensure that they receive the safe care that they need. There are ongoing initiatives to ensure lessons are learned from every tragic event, to prevent similar events in future. Hospitals carry out internal perinatal mortality reviews, which aim to provide answers for bereaved parents about why their baby died, and give them some closure. The reviews also help hospitals to improve care and ensure we learn the lessons from every tragedy.

The maternity and newborn safety investigations programme conducts independent investigations of early neonatal deaths, intrapartum stillbirths and severe brain injury in babies after labour. All NHS trusts are required to report those incidents, carry out an independent investigation and make safety recommendations to improve services in future. For those parents who go through the heartbreak of losing a baby, we must do everything we can to support them in their grief. That is why the Government extended the baby loss certificates; as of last week, we have issued almost 100,000 to grieving parents. It is also why, through the three-year plan, we have made provision for seven-day bereavement care supported by investment, and why we will continue to support the work of Sands and Tommy’s, which do so much for bereaved mums and dads across the UK.

The hon. Member for Chichester rightly talked about the importance of workforce and meeting safe levels of staffing. Throughout the winter I have seen up close NHS staff doing their absolute best in appalling circumstances that were not of their own making. I know that however dedicated our NHS staff may be, they cannot provide the right care without the right support. That is why we are committed to tackling the retention and recruitment challenges in the NHS, and why work is under way to modernise NHS working cultures and make our hospitals more attractive for top talent. That includes a much stronger focus on health and wellbeing, more support for flexible working and a renewed commitment to tackling inequality and discrimination.

Bringing in the staff that we need will take time, but it is an absolute priority for this Government and for me personally. NHS England is leading a range of initiatives to boost retention of existing staff and ensure the NHS remains an attractive career choice for new recruits. I say to the hon. Member for Strangford (Jim Shannon) that we are keen to work with all devolved Governments to ensure that and to share learning.

There is a dedicated programme for the retention of midwives, an issue highlighted by the hon. Member for Chichester and my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn). The initiative contains a range of measures, including a midwifery and nursing retention self-assessment tool, mentoring schemes, strengthened advice and support on pensions, and the embedding of flexible retirement options.

NHS England has also invested in retention leads for every maternity ward. Alongside investment in workforce capacity, that has shown promising signs of bringing down vacancy, leaver and turnover rates. The leaver rate declined from 10.3% in September 2023 to 9% in September last year. There has been progress, but we know that there is more to be done. As of November, there were a record number of midwives working in NHS trusts, with around 24,700 working full time, up by over 1,300 compared with the year before.

While all this work is going on, we are also doing the hard yards of fixing the foundations of our NHS and making it fit for the future. I am pleased that the National Institute for Health and Care Research has commissioned over 40 studies looking at how we can prevent pre-term births and improve care for babies and women. It has launched a £50 million funding call, challenging researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes.

While that work is going on, we will continue to talk to staff about the 10-year plan. My right hon. Friend the Secretary of State is attending a staff event in Peterborough on Thursday, and I will be attending one next week. We want to know how we can better support our staff, ensure we unleash their potential and give patients the care they need. A central part of the 10-year plan will be our workforce—how we train them and provide the staff, technology and infrastructure the NHS needs to care for patients across our communities. The hon. Member for Epsom and Ewell (Helen Maguire) is right to highlight the estate, which is also a problem in this area. We need to consider all policies, including those that impact maternity and neonatal care.

Over 95,000 people have responded to the consultation so far, and we want to hear from more. We have heard in this debate about midwifery-led care from my hon. Friend the Member for Lichfield (Dave Robertson), and about mental health support from the hon. Members for Eastleigh (Liz Jarvis), for Winchester (Dr Chambers) and for Dewsbury and Batley (Iqbal Mohamed). I hope that they contribute to the consultation.

I am conscious that I need to give the hon. Member for Chichester a few moments to wind up. We know that we will not be able to fix these issues overnight. We are committed to investing in safety, workforce retention and tackling inequalities, and we are making steady progress. As was highlighted, most women have safe care with a healthy baby, and are made to feel special at a very special moment. That is a testament to the staff. We need to make sure that that happens for all women, everywhere. A lot of work has been done. There is a lot left to be done, but I am confident that we will build a maternity and neonatal system that delivers for every woman.

10:58

[Jess Brown-Fuller]

I thank all Members from across the House for their constructive approach to the debate. It is clearly an area where there is passion in all parts of the House. I thank the Minister for her replies to the questions, and I am sure that a lot of Members will be writing follow-up letters to Baroness Merron asking for further detail on particular areas. I will forgive the Minister for her “crack on and deliver” pun.

The Minister mentioned that lessons are learned from every tragic event. I will finish by saying that the parents I spoke to did not feel like lessons were being learned from their tragic events, because nobody was asking them what had happened. If just one thing comes out of this debate, let us send this message to all NHS trusts and ICBs: “When there are tragic events, please don’t cover them up. Please contact the parents, because they want to talk to you and they want to make it better for parents in the future and the babies that we lost too soon.”

Question put and agreed to.

Resolved,

That this House has considered maternity services.