Preterm Birth Committee Report

Baroness Blackstone Excerpts

Friday 6th June 2025 Lords Chamber

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of the trust of the Royal College of Obstetricians and Gynaecologists. I have another interest in that I am the grandmother of preterm twins born at 29 weeks’ gestation. They are an example of the success of the NHS in providing excellent care—they are now professional women with postgraduate as well as undergraduate qualifications.

I thank the excellent chair of the committee, the noble Lord, Lord Patel. I am also very grateful to the Government for the many positive replies they have provided for the committee in their response to the recommendations. There are, however, several issues where an update on progress would be valuable, and one or two where more detail would be helpful to build on somewhat vague promises.

The two important issues I want to raise concern staffing and research. I begin with the first of those. Undoubtedly, good outcomes in reducing the percentage of preterm births and in improving the care of infants and small children who are born prematurely, as well as supporting their parents, depend on better staffing. The services involved are complex and require first-class co-ordination between different professionals to be truly effective. I ask the Minister to answer a specific question concerning the need for adequate numbers of doctors where there are serious pressures on existing staff and those pressures reduce the quality of care. As part of a workforce planning exercise, the DHSC commissioned the RCOG to accurately quantify the number of obstetricians needed in maternity units in England. A tool was developed to enable trusts to compare their staffing levels with national averages, taking into account their local context, including the complexity of their case load. The department received the findings, including an estimate of the number of obstetricians needed, in 2023. Continuation of that work is now urgent but, so far, the DHSC has failed to confirm the next stage of the project—can it do so now?

For the Saving Babies’ Lives Care Bundle, properly staffed preterm birth prevention clinics are needed, with access to regional centres where that is not possible. Further training is needed for the specialist staff required in developing cross-specialty leadership, which includes internal and foetal medicine, as well as neonatal care and anaesthetics. Employers need to be resourced to free up specialist staff to get in-service training and to build a supportive learning culture.

There is also a crucial shortage of perinatal pathologists, who are needed to examine possible causes of preterm birth, as was referred to by my noble friend Lord Winston. We need to undertake placental histology of women who have given birth at less than 32 weeks’ gestation. Even when that service is provided, there is a lack of specialist postnatal clinics to follow up on the results. Can this be rectified?

So far, I have focused on doctors but, of course, nurses and midwives are also crucial, as others have said. So I welcome the current three-year delivery plan to boost the midwifery workforce. Perhaps the DHSC could start to consider what it will do when the three years is up next year. I also welcome greater attention being given to the retention of nurses and midwives through more flexible working arrangements. I first became aware of the acute shortage of neonatal nurses when I chaired the Great Ormond Street Hospital board—that was several years ago, yet the shortages continue. Perhaps the Minister can explain what the Government meant in practical terms when they said in their reply to the committee report that they would

“refresh the NHS workforce plan”.

Like other speakers, I also refer the Minister to the Royal College of Midwives’ survey findings that final-year midwifery students lack confidence that they will find work as a midwife when they finish their course. It really is puzzling given the apparent shortage of midwives and the large amounts of overtime they currently work. Can workforce planning in this area be improved?

I turn to research. It is recognised that the causes of preterm birth and its prevention are not as widely understood, as was set out so well by my noble friend Lord Winston. Without funding for more research, that will continue. I recognise that the call for more research is happening in many areas of medicine—it is widespread—but the costs of prematurity, especially when it is extreme, are enormous. Better research could produce savings for the NHS in the long term, as well as benefiting families. For high-quality research to succeed, more attention should be given to developing digital systems to improve data collection. The variation in digital systems across the country prevents the creation of a comprehensive national database of birth outcomes and their relationship to demographic characteristics. Without that, we cannot do the good research that is now needed.

Lastly, I will touch on socioeconomic and ethnic questions. It is well known that higher rates of preterm birth are linked to socioeconomic deprivation. Of course, policies way beyond healthcare are needed to address inequality. However, specific steps are needed to support women who are poor when they become pregnant; these include public health measures to tackle the advertising and promotion of unhealthy food, alcohol and tobacco. Prenatal and postnatal monitoring are especially important for women from deprived communities, to reduce the incidence and mitigate the effects of preterm birth.

Measures such as parental accommodation on neonatal units, although valuable for all parents, are particularly important for the socially deprived. This, of course, was mentioned by the noble Baroness, Lady Wyld. Can the Minister confirm that the necessary investment is in the Government’s plans for this purpose? This is just one way to help families who are suffering acute stress as a result of preterm birth.

I will end with a little anecdote. No one so far in this debate has mentioned siblings. After my premature twin granddaughters were born, I looked after their older sister, who was two and a half years old. I took her to visit my brother and his family. While no one was looking, she bit the baby in the pram. I think she was giving us a little message: “I’m distressed too. I’ve been displaced and I don’t like babies”. We need to end stories such as this.

Women’s Health Strategy

Baroness Blackstone Excerpts

Tuesday 4th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree with the noble Baroness. It is a disgrace that there is such a huge inequality in maternity care. Maternal mortality rates are some 2.3 times higher for black women and 1.4 times higher for Asian women, while those living in the most deprived areas have a maternal mortality rate nearly twice as high as that for those who live in the least deprived areas. That cannot be acceptable in 2025. I am glad that we have taken a number of actions to ensure that trusts who fail on maternity care are robustly supported. We will set an explicit target to close black and Asian maternal mortality gaps. Trusts are also required to publish a suitable plan to tackle this and to put it into action. It is a challenge, but not one that we shy away from.

[Baroness Blackstone (Lab)]

My Lords, I declare my interest as set out in the register. What is the Government’s timetable for a revised or updated version of the women’s health strategy? Can the Minister also assure the House that there will be adequate funding for its implementation when it is brought in?

[Baroness Merron (Lab)]

Let me assure my noble friend and other noble Lords that there are no plans to cancel the women’s health strategy. I know my noble friend did not say that, but it is very important to put that on record. We continue to implement it; for example, since I have been in post, through measures such as supporting pregnancy loss through a full rollout of baby loss certificates, introducing menopause support in the workplace, and boosting women’s participation in research and clinical trials. As I said, our priorities for delivering the strategy will be through the 10-year plan. Funding decisions will be announced in due course.

Musculoskeletal Health

Baroness Blackstone Excerpts

Thursday 30th January 2025 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords—

[Baroness Blackstone (Lab)]

My Lords—

[Lord Pannick (CB)]

My Lords—

Black, Asian and Minority-Ethnic Women: Maternal Mortality Rates

Baroness Blackstone Excerpts

Monday 29th July 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for his kind remarks; I am very pleased to see him again across the Dispatch Box. The duty of candour is extremely important in all this. Racism in this area is not just towards mothers and families; as the noble Lord said, it is also towards staff. Clearly, we need to tackle this for both patients and staff. The patient’s voice is key. Even at this early stage, it is quite clear to me that women, and people of black, Asian and minority-ethnic heritage, are not being listened to. We will bring forward plans to put this right. As part of the report to which I referred earlier, I will be glad to update the House in this regard.

[Baroness Blackstone (Lab)]

My Lords, I declare my interest as set out in the register. Given the complexity of the causes of these unacceptable mortality rates, what is the Minister’s department doing to ensure that there is a cross-government approach to ending the maternal mortality gap?

[Baroness Merron (Lab)]

My noble friend is quite right: this is a cross-government matter. There are complex reasons why black, Asian or minority-ethnic people are suffering far worse than those who are white. They include socio-economic factors such as deprivation and health inequalities being felt across the whole range. It is not going to be possible to solve this without cross-government co-operation. I look forward to working with my ministerial colleagues to put it right.