Preterm Birth Committee Report

Earl of Effingham Excerpts

Friday 6th June 2025 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, it is always an honour and a privilege to participate in any debate in your Lordships’ House, but today that is particularly so for me as my children were born pre term. So please allow me to thank the noble Baronesses, Lady Blackstone and Lady Owen, my noble friends Lady Seccombe and Lady Wyld, and the noble Lords, Lord Winston and Lord Patel—who are all in their place—along with other noble Lords on the committee, for this compelling and measured report, and to thank all noble Lords who have made their valuable contributions today.

The evidence the report presents is sobering. There are clear challenges ahead, but with the help of this report, those challenges can be overcome. Preterm birth remains among the most pressing issues in perinatal healthcare. In 2022, nearly one in 12 babies in England was born pre term. These early births account for a disproportionate share of neonatal mortality and long-term health complications, placing considerable strain on families and the NHS alike. Despite repeated policy commitments to reduce this figure to 6% by 2025, the committee makes it clear that this target will not be met.

Preterm birth is not only a clinical issue, but one with profound implications for families and wider society. It is the leading cause of neonatal death and a major contributor to childhood mortality and long-term disability. Babies born too early face significantly higher risks of cerebral palsy, learning difficulties and developmental delay. They are more likely to struggle at school and more likely to require support throughout their life. Yet the impact does not end with the child. The report details evidence from parents whose lives were overturned in a matter of hours, whose babies were whisked into critical care, often in hospitals far from their home. Families are routinely separated, with little or no access to overnight accommodation. Many parents have highlighted that they were unable to stay near their critically ill child, as has been flagged by the noble Baronesses, Lady Blackstone and Lady Owen, and my noble friends Lady Sugg, Lady Penn, Lady Wyld and Lady Seccombe.

It is fair to say that childbirth itself is challenging for all concerned. Adding preterm birth into that mix and, further, not being able to stay near your just-born child is incredibly distressing. Further to the emotional havoc that this wreaks, there is also the financial strain: one in four families has to borrow money or take on additional debt to get through this period. Catriona Ogilvy, the founder of the charity the Smallest Things, summed it up perfectly when she said, “We know how hard it is to sit beside an incubator full of fear. We know how hard it is to bond with a baby covered with tubes and wires in intensive care and that parents still hear the hospital alarms when they close their eyes after coming home”.

There are also disparities amongst those affected. The preterm birth rate among black women is 8.5% and among Asian women it is 8.3%, which compares with 7.7% for white women. The committee rightly describes these inequalities as complex and interconnected, but we must be clear that they are unacceptable in a modern, equitable healthcare system. The Government have signalled their intention to refresh the maternity safety ambition, but this must be part of a co-ordinated intervention on all fronts. Alone, it will not suffice.

The report has given us a robust and compassionate road map, and His Majesty’s Official Opposition commends the report’s central message. While it is impossible to prevent all preterm births, it appears that far more can be done to reduce their number and mitigate their consequences. Key among the report’s recommendations is the call to revise national targets—not merely to lower the overall rate, but to tackle the specific inequalities that persist across ethnic and socioeconomic lines. This is not a partisan issue; it concerns the fundamental matters of equity and clinical necessity.

The report also highlights the inconsistent implementation of existing guidance. The Saving Babies’ Lives care bundle contains interventions proven to improve outcomes for preterm babies, yet access to these measures remains worryingly dependent on geography. My noble friend Lady Bertin flagged the postcode lottery. The noble Lord, Lord Weir, talked about a national rollout for best practice. We must ensure that provisions for such essential care are equitably distributed and maintained.

Staffing shortages in maternity and neonatal care continue to undermine even the best clinical intentions. The Government acknowledge this, as did the previous Government, and the long-term workforce plan aims to address these shortfalls, but training must include a specific focus on the care needs of preterm babies and their families. Health visitors, in particular, require dedicated support and protected time to deliver follow-up care effectively. Too often, follow-up assessments, especially at the ages of two and four, simply do not take place. This represents a clear breach of national guidance and a serious failure in our early years provision. The result is lost opportunities for intervention and avoidable suffering for families already under strain.

As highlighted by my noble friend Lady Wyld, investment is also required in the neonatal estate. The Government must publish the results of their maternity and neonatal estate survey without delay and ensure that phase two of the spending review includes funding to expand parental accommodation across the NHS.

Data collection and research was referred to by the noble Lords, Lord Winston and Lord Weir, the noble Baronesses, Lady Owen and Lady Blackstone, and my noble friend Lady Seccombe. We have to continue to strengthen our research effort. Many preterm births occur without any known risk factors. Understanding the biological processes of early labour and the social determinants that compound risk is vital to prevention.

Optimising women’s health prior to pregnancy was highlighted by the noble Lords, Lord Winston and Lord Weir, my noble friend Lady Sugg and the noble Baroness, Lady Blackstone. The Secretary of State for Health has rightly said that, holistically speaking, prevention is better than cure, and one of the key conclusions of the report is that optimising women’s health prior to pregnancy is a very important part of preterm birth prevention. In order to address risk factors such as obesity and mental health issues, we have to ask: when are the Government going to make a healthy diet and exercise a major priority in their programme of prevention, in both schools and the adult population at large? Currently, the statistics paint a frightening picture.

The committee’s findings have been welcomed by clinicians, researchers and advocates alike. In recent weeks, we have heard constructive challenges to the Government in your Lordships’ House regarding reviews and time delays, and in the same light we must challenge on any further reviews regarding preterm birth. We now have some of the answers. As the charity Bliss has rightly stated, this is a moment for action, not aspiration. We urge the Minister to provide clarity on how the Government will act on each of the report’s recommendations, so that families affected by preterm birth receive the care, compassion and clarity that they deserve.

Social Care Reform

Earl of Effingham Excerpts

Thursday 22nd May 2025 Lords Chamber

[Baroness Merron (Lab)]

I can say to my noble friend that the adult social care workforce is growing. Skills for Care data tells us that there has been an increase of 70,000 filled posts since 2022-23, that staff turnover is reducing and that the overall vacancy rate decreased to 8.3% in 2023-24 from 9.9% the previous year. While the direction is good, there is certainly more to do. As regards international care workers, it has indeed been factored in that we need a workforce, and that is one of the many reasons why the new measures that require care providers to prioritise recruiting international care workers are focused on those who are already in the UK, have visas and require new employment. I am sure we will talk about this as we discuss the Employment Rights Bill and all the directions it is taking to support professionalisation of the workforce and encourage those in the UK to take on adult social care roles.

[The Earl of Effingham (Con)]

My Lords, in July last year His Majesty’s Government scrapped the social care cap and curbed winter fuel payments. Sir Andrew Dilnot, author of the landmark Dilnot commission report on social care, said this was a “tragedy” and that

“we have failed another generation of families”.

With all due respect, the Government are doing a U-turn on the winter fuel payment; can the Minister rule out a U-turn on social care?

[Baroness Merron (Lab)]

Again, I do not recognise the characterisation of a U-turn on social care. The Prime Minister and the Secretary of State have been extremely clear, as I outlined earlier in response to the noble Lord, Lord Forsyth, about why this commission is in place. When it was brought to this House previously, I recall that many noble Lords, although not all, were positive about it because they saw the opportunity—which the previous Government did not, not least because they did not fund its suggestions. This Government are absolutely committed to having a lasting, practical answer that involves everybody concerned and will be supported in the right way. I would have hoped that the noble Earl would welcome that.

NHS and Care Volunteer Responders Service

Earl of Effingham Excerpts

Tuesday 20th May 2025 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, the NHS and Care Volunteer Responders service has completed more than 2.7 million tasks and shifts, including more than 1.1 million telephone support calls, over the past five years. It provides volunteering support seven days a week, underpinned by wraparound support and assurance, as well as safeguarding, problem-solving teams and helplines running from 8 am to 8 pm. Volunteers are ID checked, have role guidance, hold DBS checks when required and have their expenses paid by the programme. How will the Government ensure that volunteering in the NHS and social care is encouraged and facilitated, given that the need for volunteers across the country remains acute? When will the new scheme begin operating and can the Government guarantee that existing patients will not be left in the lurch?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I start by saying, as I am sure the noble Earl agrees, how grateful we are for the generous contribution made by volunteers. They play a vital role in supporting patients, staff and services in many ways. The national NHS and Care Volunteer Responders programme was first established as part of the Covid response, and the noble Earl helpfully set out its contribution. The fact is that a model that worked well in a national crisis is no longer the most cost-effective option, so there will be a new recruitment portal for NHS volunteers to be fully launched this year. This is all about expanding voluntary opportunities and getting more volunteer hours to further support patients even better than volunteers do already.

Valdo Calocane: NHS England Report

Earl of Effingham Excerpts

Thursday 6th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Baroness for the opportunity to clarify that my reference to the Mental Health Bill discussions was in relation to the three points raised by the noble Lord, Lord Balfe, rather than the detail of the report. As I said, the recommendations have been accepted in full, and there is a programme of work to take them forward and for full reporting back. In respect of the further comments the noble Baroness made, it is of course the care of the patient that matters and protection for both the patient—whoever they are—and the public.

[The Earl of Effingham (Con)]

My Lords, it is a tragedy that, on average, 120 people are killed every year in Britain by people suffering mental illness. As the noble Lord, Lord Hanson of Flint, flagged last night on a different but relevant topic, the risk of tragedy can never be zero, so mitigation of risk is key. I hope the Minister will commit, perhaps in the Mental Health Bill, that full and complete reports on crimes committed by those who have been treated under the Mental Health Act 1983 should always be published because that is the best way to decrease the likelihood of them happening again. I should flag that in 2006 the High Court refused a request to have a patient’s medical history deleted from a published report.

[Baroness Merron (Lab)]

I am grateful for the reflections of the noble Earl. I said earlier and am happy to emphasise again that the department is working with NHS England and partners to set out the next steps regarding how we will do exactly what he is speaking of, which is how future independent mental health homicide reports should be published, because it is so important to be transparent. Transparency is key, not just for bereaved families but to ensure that it drives improvements to services to help prevent tragedies. I certainly share the intention of the points raised by the noble Earl.

Mental Health Bill [HL]

Earl of Effingham Excerpts

Committee stage
Tuesday 14th January 2025 Lords Chamber

[Baroness Berridge (Con)]

My Lords, I rise to support the noble and learned Baroness, Lady Butler-Sloss, on Amendment 9. I know that there are other amendments in relation to the inclusion of parents and guardians. I raise just two small points in relation to this.

When one looks at where this amendment is inserted in the list, the last of the persons currently listed who would receive the report is

“the local authority in whose area the patient is ordinarily resident”.

That potentially will not always be the local authority where there is a care order. Therefore, in those circumstances, the local authority is caught with an

“other person who has parental responsibility”.

However, that is not how this is drafted in other parts of the Bill, where an

“other person who has parental responsibilities”

means guardians et cetera. For consistency of drafting, we need to look at that.

I know that the Minister has been very generous in the time that we have had with her and her officials, but we need a consistent phraseology within the Bill because with this amendment, if there was a special guardian the report would also go to the person with what is informally known as residual parental responsibility. Normally they are informed only, for instance, of the change of name of the child or if the child is going to leave the jurisdiction. We need to look at everybody with parental responsibility and have some consistent phraseology within the Bill when we are meaning the local authority when there is a care order and parental responsibility, to include all the different circumstances in which a child may have their status changed from the ordinary situation of living at home with parents when a court order is in place.

[The Earl of Effingham (Con)]

My Lords, this group of amendments aim to strengthen provisions for care (education) and treatment reviews—CETRs, as we have heard—for individuals with autism or a learning disability. These amendments collectively aim to address gaps in the current drafting and ensure that the needs and rights of these individuals are fully considered and respected.

This reflects the dignity, respect and patient-centred care principles that strengthen the Bill. Amendments 6 and 12, in the name of the noble Baroness, Lady Barker, highlight the importance of considering housing needs during care (education) and treatment review meetings. A stable, safe and appropriate home environment is a critical determinant of mental health and well-being. Failure to address housing can undermine the effectiveness of care plans, leading to avoidable crises, as the Minister put it earlier, and setbacks that can risk damaging the long-term success of these care plans. Can the Minister please clarify how housing needs will be integrated into the CETRs under the current provisions of the Bill?

Amendments 8 to 10 and 15 to 17 focus on ensuring that the CETR process is inclusive and transparent. These amendments expand the list of those who should receive CETR reports to include the patient, their nominated person, independent mental health advocates and, where relevant, their parent or guardian. These measures should help foster trust and collaboration in the care process and create a more holistic approach to care planning by ensuring that all key individuals are kept informed. Can the Minister please confirm whether the current drafting of Clause 4 sufficiently addresses these inclusivity concerns or whether these amendments are necessary to achieve that goal?

Amendments 19 and 20 address the issue of ensuring that recommendations from CETRs are acted upon. It is not enough for reviews to generate reports and recommendations: there must be a clear and enforceable duty on integrated care boards and local authorities to act on them. Amendment 19 would strengthen this by replacing the current requirement to “have regard to” recommendations with a “duty” to carry them out; while Amendment 20 ensures that “a compelling reason” must justify any deviation from these recommendations.

These amendments reflect the frustration often experienced by patients and families when well-intentioned recommendations are not implemented. A stronger duty to implement recommendations would not only improve outcomes but restore trust in the system. Can the Minister outline how the Government intend to ensure that recommendations from CETRs are indeed implemented effectively?

Amendment 13 highlights the importance of addressing communication needs during the CETR meetings. It is highly welcome that the issue of communication and language has been addressed by so many noble Lords. Effective communication is essential for patient-centred care, ensuring that patients can meaningfully participate in that very care. Ensuring that individuals’ additional or alternative communication needs are met is not merely a courtesy, it is a necessity and a must-have. This group of amendments highlights the importance of a holistic, inclusive and accountable approach to care and treatment reviews. They seek to ensure that the needs of patients, including those related to housing, communication or support networks, are fully recognised and addressed. They also emphasise the need for timely reviews and actionable recommendations backed by clear accountability mechanisms.

His Majesty’s Official Opposition are broadly supportive of the aims of these amendments, and we look forward to the response from the Minister.

[Baroness Merron (Lab)]

My Lords, I am grateful to noble Lords for their amendments and contributions today. It seems a while ago that the noble Baroness, Lady Barker, originally spoke, but I put on record that I hear her frustration about having been here before. I certainly acknowledge that; and I am grateful for the contribution and time that noble Lords have given to this really important matter, so that perhaps, finally, we will not have to keep going where we have been before.

Mental Health Bill [HL]

Earl of Effingham Excerpts

Committee stage
Tuesday 14th January 2025 Lords Chamber

I commend these amendments to the Committee and to the Government.

[The Earl of Effingham (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, my noble friend Lady Browning, the noble Lord, Lord Scriven, and the noble Baroness, Lady Hollins—who sadly is not in her place today—for their amendments in this group.

Given that it is now widely accepted that we should be moving towards a system of health and care focused on prevention, these all appear to be sensible amendments. They seek to understand how integrated care boards and local authorities are identifying those with autism or learning disabilities, the risk of them being detained and, if appropriate, the risk to the community, as well as ensuring that those with autism and learning disabilities receive the appropriate level of care.

Amendment 28, in the name of my noble friend Lady Browning, specifies that local authorities must seek to ensure the needs of people with autism and learning disabilities can be met without detention when they are exercising not only their market function but their commissioning functions. This acknowledges the roles that local authorities play in commissioning health and social care. Local authorities commission publicly funded social and healthcare services, many of which interact with mental health service provision, such as authorised mental health professionals and addiction services. By explicitly mentioning the commissioning functions of local authorities and not just the market functions which arise out of the Care Act 2014, this amendment gives the Bill greater clarity.

The noble Baroness, Lady Hollins, has tabled Amendments 36 and 37 in this group, which relate to the provision of community services for autistic people. These amendments are in a similar vein to Amendment 139 in the name of my noble friend Lord Kamall, which will be discussed in the next group and which seeks to ensure a greater availability of community services. Amendments 36 and 37 expand the duties on integrated care boards and local authorities to provide better and more responsive care to those on dynamic support registers.

Of particular interest is subsection (3)(a) of the new Section 125I proposed in Amendment 37. That new provision states that integrated care boards must

“establish digital systems to … assess, monitor, and address sources of inequality”

arising out of the current provision of mental health care. As my noble friend Lord Kamall has been keen to stress, digitalisation in health and social care is the way forward for improving productivity and ensuring the best possible care outcomes.

I know the Minister believes in the value of the expanded use of technology and digital systems, and it would be welcome if she could give some commitment here. When we hear from her, we would be interested in whether there are any legal reasons for not being able to accept what these amendments seek to do, such as around issues of privacy, or whether the barriers are financial. We very much look forward to the response of the Minister.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am most grateful to the noble Lords present for their contributions this evening. Perhaps I can make a general point to the noble Baroness, Lady Tyler, and the noble Earl, Lord Effingham, about the main pillars of change which we look forward to in the 10 year-plan. The noble Earl has just referred to one of them, which is the move from analogue to digital. In that context—the noble Baroness raised a point about parity between mental health and physical health—the moves from sickness to prevention, from hospital to community and from analogue to digital apply at least as much to mental health as they do to physical health. That is our way forward. I am looking forward to the 10 year-plan to really give structure to that.

Let me turn to Amendment 21, tabled by the noble Baroness, Lady Tyler. This amendment seeks to ensure that the register under new Section 125D includes autistic children and children with a learning disability who have risk factors for detention, so that they can be supported in the community. We absolutely agree with the intention behind the amendment, although I have to say that it is regarded as unnecessary because the current drafting does not limit the duty to adults; it includes anyone who meets the other criteria, including children, which I know the noble Baroness is rightly looking for. The register is designed to provide health and care bodies with additional information about the needs of those with a learning disability and autistic people who have risk factors for detention under Part II of the Act. That is to ensure there is a particular focus on their needs, so that they can be better supported in the community.

The noble Baroness, Lady Tyler, made the observation, which I understand, about too many children being left to reach crisis point and the increase in the number of children in need of mental health services, particularly over the last three years. I very much recognise this concern. We have seen an increase in referrals and access across children’s and young people’s mental health services, including crisis services. This is due to an expansion of the services to meet need but also to an increase in prevalence and intensity. It might be helpful if I indicate that NHS England is in the process of developing proposals for a new model of specialised children’s and young persons’ mental health services, supported by a new service specification and quality standards. This new approach would support delivery of specialised services in the community, as well as in appropriate in-patient settings close to the child’s or young person’s family and home. That is a matter that has been raised many times in this Chamber and one that I am very sympathetic to.

Amendment 22 was tabled by the noble Lord, Lord Scriven, and supported by the noble Baroness, Lady Browning. If taken forward, this amendment would require each local authority to assist the integrated care board in its duties in respect of support registers for people with a learning disability and autistic people. We certainly agree with the intent of this, and I am pleased to be able to provide reassurance that the clause already provides the Secretary of State with the general power to make further provision about the register in regulations. We expect this to include detail on how relevant information is to be obtained and from whom. This is to include the role of local authorities, alongside other relevant health and care bodies, in providing further relevant information.

We believe that it is most appropriate to include this detail in regulations rather than in primary legislation, since the way in which information is obtained, what information is obtained and who might be involved may change with emerging best practice. As noble Lords will realise, that point has been made in respect of a number of these amendments. Returning this to Parliament at every instance would be disproportionate.

However, it is important that the process actively involves health and care system partners. We are clear that the integrated care board must retain overall responsibility for the register. Providing a list of named bodies that have a role in providing information in the legislation may create an unintended diffusion of responsibility, which could negate the benefits of putting these registers on a statutory footing.

Support for Infants and Parents etc (Information) Bill [HL]

Earl of Effingham Excerpts

3rd reading
Friday 15th November 2024 Lords Chamber

[Baroness Berridge (Con)]

My Lords, on behalf of my noble friend Lord Farmer, I pass on thanks to all noble Lords who contributed to the Bill and for the assistance of the House for making the passage of the Bill so efficient. I note that the Bill is based on the early years review from the Department for Health and Social Care, which indicates that, at such a stressful time, many parents could benefit from some form of legislation to ensure that they are aware of the help available to them from charitable and publicly funded sources. I beg to move.

[The Earl of Effingham (Con)]

My Lords, I thank all noble Lords who gave of their time and effort to make a valuable contribution to the Bill. In particular, I pay tribute to my noble friend Lord Farmer, whose efforts on the Bill, as well as on hospices, special needs schools, prison reform and many other areas, will pay dividends for future generations.

By providing parents with accessible and reliable updates on infant care, the Bill empowers families to make informed decisions, fostering stronger family units. This aligns with our principles of personal responsibility and informed choice, helping parents independently to support their child’s development. It equips parents with early-stage guidance to help address any issues at the onset, potentially reducing future reliance on public services, which will enhance efficient government spending, with early support minimising the need for costly interventions later in life.

By offering parents resources on key topics such as nutrition, health and time-tested milestones, the Bill promotes stable and forward-looking early childhood experiences. We value family stability as a cornerstone of society, and many on our Benches view this as a proactive step towards creating responsible, well-adjusted citizens.

Finally, by providing parents with essential information, the Bill aims to reduce unnecessary visits to healthcare outlets, enabling resources to be allocated to those with more urgent and complex needs. This aligns with His Majesty’s Official Opposition’s aims to relieve pressure on the NHS and optimise efforts on the long-term sustainability and success of public services.

Hospices: Funding

Earl of Effingham Excerpts

Thursday 24th October 2024 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, I thank my noble friend Lord Farmer for balloting this QSD.

As we have heard, the modern hospice movement was pioneered by Dame Cicely Saunders at St Christopher’s Hospice, who told her patients:

“You matter because you are you. You matter to the last moment of your life and we will do all we can to help you die peacefully, but also to live until you die”.


Every year, hospices in the UK assist nearly a quarter of a million people who live with a progressive or terminal illness and then support them more closely as their lives draw to a close. We must support these hospices.

Let me share some concerning statistics with your Lordships. More than two in five deaths occur in hospital, with 41% of that group dying alone. While it is impossible to quantify the monetary value of giving people the opportunity to die with dignity, hospices can play an incredibly important role in both providing excellent end-of-life care and, at the same time, freeing up expensive hospital beds in a material saving for the NHS.

The Minister for Care repeated just this month that the Government are determined to shift more healthcare out of hospitals and into the community, including to hospices. However, currently the amount spent on children’s hospice care, for example, varies widely—from £28 per child in South Yorkshire last year to £511 per child in Norfolk and Waveney. Can the Minister explain how these disparities are occurring and how she will address them?

Last year we committed to extending the £25 million children’s hospice grant. However, in a response to a Written Question on 31 July, the Government stated that they

“are currently considering the future of this important funding stream beyond 2024/25”.

Can the Minister please give us a cast-iron assurance that this vital funding stream will be carried forward?

Currently, around a third of hospice income comes from the state and the rest is made up from charitable donations and fundraising. Do the Government intend to move to a model in which the state delivers the majority of funding for hospices? If so, will the Government seek greater control of hospice provision across the country? With increased government funding, Ministers may seek corresponding increases in control over services, so can the Minister confirm that the Government will protect the independence of our hospices, which they value so greatly?

Investing in co-ordinated community palliative care services such as hospices, to reduce unnecessary hospital admissions and provide superlative end-of-life care, should be a top priority for this Government.