Queen’s Speech

Baroness Cumberlege Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Cumberlege (Con)]

I start by declaring that my interests are in the Lords register and saying what a pleasure it is to follow the noble Baroness, Lady Masham. In the gracious Speech, I was delighted to see that the Government are determined to address mental health. Fifteen months ago, I was commissioned by NHS England to review maternity services for England. In undertaking the review, my team and I visited every corner of England, listening to women, their husbands, their partners and health professionals. A conversation that I had with a particular father made a deep impression on me. He told me that when his baby was 10 days old he realised that his wife had just gone out for a moment when he was listening to the radio; he then heard that there was trouble on the trains—she was under the train. He had lost his wife and the mother of his newborn baby. Postnatal depression had taken its toll.

All the groups that we met around the country told us that mental health care for women during pregnancy and after the birth is not good enough. There are a few pockets where high-quality mental health care is provided, but it is rare. So mental health conditions are not identified and, in some cases, that has led to harm for the baby and suicide for the mother. One-quarter of maternal deaths between six weeks and a year after childbirth relate to mental health problems and one in seven of those women will have committed suicide. What a terrible tragedy for mothers, babies, friends, families and the nation.

Of course, not every suicide is preventable, but if we can provide continuity with the same person looking after the woman through pregnancy, birth and postnatal care, we can detect issues early and give the woman and her family the support that they need. Having the same midwife and obstetrician builds a positive and in some cases very precious professional relationship; it builds trust. Yet we heard from women that they could see between 20 and 30 health professionals during the course of their pregnancy, the birth and postnatal care. The research is clear and unequivocal: continuity of the carer prevents 24% of premature births and means that 19% of women are less likely to lose their baby before 24 weeks’ gestation and that 16% are less likely to lose their baby overall. So continuity of care is a no-brainer. It provides safer care—and, what is more, it is what women want and are asking for. The difficulty is that it requires a change of culture. Midwives will need to work differently, in small teams of four and six, and need to be dedicated to give total care to the women and their families. It can be done, and we have seen it working in a few places, but on the whole it means a very different approach to the shift systems in which the midwives work now.

I have heard the noble Baroness, Lady O’Neill of Bengarve, say that you can get the tone at the top and an echo from the bottom, but it is the “muddle in the middle” that is the challenge—the challenge of changing the culture. We also know that women are seeking choice about where to give birth and the type of service that they receive, but 33% get no choice at all. Many of them would prefer to give birth in a midwife-led unit or at home, and all the evidence shows that those choices are as safe as a hospital birth for healthy women who are not expecting their first baby, but those choices are being denied. One woman wrote to me:

“Please listen to me. Don’t overwhelm me with your paperwork. Treat me kindly, and with respect. Let me decide what is important to me. Don’t patronize me. It’s my body, my baby and my new family that I am creating with my partner. It’s our decision. Please honour that, and wrap your services around us”.


Sir Cyril Chantler, my vice-chairman, has worked tirelessly in the last 15 months to work up a scheme that will compensate parents. Last year the NHS spent £560 million on negligence claims, and the amount increases year on year—money which we cannot afford and which could be spent on providing better services. We have devised the rapid resolution and redress scheme, which will make a real difference, but it requires a change in culture, whereby blame is not the motive and saving the lives of babies is the prime and sole objective. The learning has to be passed on.

Outside observers have noticed that the culture of the NHS is too top-down. It stifles innovation, it is obsessed with blame, there is too little forgiveness, and it is overregulated. As Professor Don Berwick has written:

“The outsider can judge care, but only the insider can improve it”.


Nevertheless, in maternity services there are some remarkable achievements. NHS England, with energy and commitment, is implementing our report, Better Births. We believe that we can make maternity services as good as any in the world and, in five years, better births will become the order of the day.