Preterm Birth Committee Report

Lord Patel Excerpts

Friday 6th June 2025 Lords Chamber

Moved by

[Lord Patel]

That this House takes note of the Report from the Preterm Birth Committee Preterm birth: reducing risks and improving lives (HL Paper 30).

[Lord Patel (CB)]

My Lords, I am pleased and honoured to lead the debate today on the Preterm Birth Committee report. Before I do so, I thank most sincerely all those who gave evidence to the committee and, in particular, the mothers and parents of children born pre term who told us of their experiences, as well as the perspective of adults who were born premature. It is their powerful evidence that forms the backbone of our report and its recommendations, and I will come back to that. My sincere thanks go too to the specialist advisers, including Eleri Adams, consultant neonatologist and president of the British Association of Perinatal Medicine.

I give my and the committee’s thanks to the dedicated committee staff who supported us and did so brilliantly—Eleanor Clements, committee clerk; Babak Winstanley-Sharples, policy analyst; Mark Gladwell, committee operations manager; and Alec Brand, media and communications officer—a huge thank you to them all for their hard work and support.

I give my personal thanks to all the committee members. It was a privilege and fun to be their chair because of their dedication and help in making sure that we delivered an evidence-based report that helps improve the lives of mothers, parents and the families of children born pre term.

Thanks go also to the noble Baroness, Lady Bertin—I am pleased that she will speak today, and I look forward to her speech—who could not join us as a member of the committee but was instrumental in persuading the Liaison Committee to set up the inquiry. I enthusiastically look forward to the speeches of all noble Lords taking part today, including the Minister.

A committee was set up in 2024 to consider the prevention and consequences of preterm birth. The title of the report, Preterm Birth: Reducing Risks and Improving Lives, summarises it all. I declare my interest, which is probably no longer relevant, of 39 years’ experience of being an obstetrician who delivered a lot of preterm babies.

By definition, preterm births are babies born before 37 weeks, and the current incidence is 7.9% of all births. It is the main cause of neonatal deaths in the UK. Around 75% of neonatal deaths are in babies born pre term, mostly the very pre term. For most babies born pre term, the outcome is good. For many, it is not. Some 4.2% of those born preterm end up having a severe disability at age 18 and 18.5% have a mild to moderate disability. Children born pre term have a higher prevalence of need for special education: the lower the gestation at birth, the higher the incidence. Some 82.6% of those born at or near 24 weeks have a need for special education. Children born pre term also have lower educational attainment.

While advances in obstetrics and neonatal care have led to improved survival, there has not been a corresponding improvement in neurodevelopmental outcomes. Incidence of brain injury, for example, is 26 per 1,000 births in those born pre term compared with 3.5 per 1,000 births in those born to term. It results in disability, cognitive impairment, memory loss and other functions. Adults born pre term told us that issues they experience could be subtle but multiple. Added to this, a lack of awareness within the healthcare system of the long-term effects of prematurity means that informed or specialist support is difficult to access.

It is not only the children born pre term for whom we can do better but the parents who are to care for these children. A survey showed that 24% of parents showed signs of post-traumatic shock. As one mother said:

“Life before the neonatal unit is mostly irrelevant when you find yourself stood, post-partum, next to your baby in an incubator, hoping and wishing that you make it out safely … The vulnerability is beyond crippling”.


The impact of prematurity does not end upon discharge from the neonatal unit. The experience stays with you for life. As this quote demonstrates, preterm birth can be sudden, unexpected and have significant—sometimes lifelong—impact on those born pre term and on their families.

Many parents will spend weeks and months in hospital caring for their babies, often in hospitals that are a long way from home, incurring practical and financial difficulties. A mother of twins, who were born very pre term and cared for in two different hospitals because of lack of capacity of neonatal beds, described vividly to us her daily difficulties and the stress it caused her to travel between two hospitals as she visited and cared for her two tiny babies.

Some 75% of intensive neonatal care units do not have accommodation for parents. Most have poor facilities, even for mothers to express breast milk or rest. Evidence we received clearly showed the benefits of involving parents in the care of their preterm babies—so-called integrated care, where parents and all health professionals are involved in the care of the baby. The involvement of parents in the care of their babies not only improves outcomes but, importantly, gives parents the confidence they need when the time comes to take their baby home. There is a need to make integrated care more widespread.

Although we will not completely prevent preterm birth, our inquiry clearly showed that we can reduce its impact with better policies for the care of babies and support for parents. For example, the Saving Babies’ Lives Care Bundle, developed by NICE and NHS England, has guidelines that would improve outcomes if implemented in full. The evidence we got showed wide variation in the use of these guidelines in important areas such as the timing of the clamping of the umbilical cord—noble Lords might be surprised by the effect that has on the outcome for both preterm and term babies—the timing of the administration of steroids to mothers prior to birth, the use of non-invasive ventilation, and several other areas. The result is poor outcomes for babies. There is an urgent need to implement the guidelines more widely and eliminate the variation in care. What role does the Minister think the Department of Health and Social Care can play to bring about this change?

We also heard of the challenges parents face after discharge from hospital. Community services not only lack capacity but often do not have the training required to be of any help to parents. In his report, the noble Lord, Lord Darzi, highlighted the important role of health visitors in the early years development of children. Shortages of not only health visitors but midwives, specialist neonatal nurses, neonatologists, physiotherapists and clinical psychologists all impact on outcomes for babies born pre term. A recent report from the Royal College of Midwives says that newly qualified midwives are worried about not getting a job; that cannot be right when we want to expand the midwifery workforce. Can the Minister give an assurance that the workforce issue will be addressed in the NHS 10-year plan?

National guidelines stipulate the need for a series of assessments of children born preterm prior to starting school, particularly at ages two and four. Delivery of this is, at best, inconsistent; in the majority of cases, it does not happen at all. Figures show that at age two, 85% of babies born pre term are followed up, but this drops to 6.7 % at the crucial preschool age of four. There is a need to urgently address this issue; I hope the Government will take urgent action to do so.

I come now to the important issue of prevention and reducing the incidence of preterm births. The prediction and prevention of preterm births are challenging because of the wide range of factors that contribute to a woman’s individual risk, with many having no risk. Studies reported to us showed a strong association of preterm birth linked to smoking, the socioeconomic status of parents, and ethnicity. These need urgent attention if we are to reduce the incidence of preterm birth. I hope the Minister will comment on how the Government intend to address each of these issues. We explored the role of screening methods to identify women at risk of preterm birth. We came to the conclusion that better-designed, more focused studies to find the right screening methods are needed, if that can be done.

Despite this, there are opportunities to reduce the incidence of preterm birth. When will the Government revise the maternity safety targets and focus efforts to reduce the rate of preterm births across all groups of women? Do the Government have a target reduction for the preterm birth rate? Providing women with information prior to pregnancy about their general health and lifestyle should be an important part of reducing the incidence of preterm birth. Does the Minister agree that this should be part of the Government’s women’s health strategy? There is currently underinvestment in pre-pregnancy advice. The Government’s 2024 manifesto said:

“Labour will prioritise women’s health as we reform the NHS”,


and in her evidence to the committee, the Minister said that the Government intend

“that the health of women is optimised before we get to pregnancy”.

There is an opportunity today for the Minister to say how this will be done.

The consequence of being born pre term, particularly very pre term, weighing as little as 600 grams, with the body organs that sustain healthy life not fully developed, would be death or lifelong disability for many. With the provision of good care, the outcome for not just a few, but many, will be better, so why would we not put policies in place to do so? I beg to move.

--- Later in debate ---

[Lord Patel (CB)]

My Lords, I thank the Minister for her response. We often say, “This has been a good debate”. This has not been a good debate—it has been a brilliant debate. All the speakers showed a passion for making the service for mothers and babies better. I heard no political issues in any of the speeches. I heard one thing only, and that was to support future mothers and future preterm babies so that that their lives are made better. We heard the same passion from the noble Baroness, Lady Brinton—I thank her for her courage—that we heard from many, many witnesses.

I said at the beginning that the report was underpinned by the evidence we heard from mothers and the lived experience of adults who themselves were born pre term about how services were failing them—services failing them when not much in the way of resources are required. What is required is the dedication that is shown by the professional, but the professional is not supported, and I hope that we will do so.

I have to say that I think the Minister had a difficult task in answering all the questions that were raised, but they were all good questions. It will require careful reading of her response to know how far she showed the same compassion, or the Government show the same compassion—I do not mean her personally, as I know she is compassionate about it—that will deliver for future mothers and babies born pre term, because babies will be born pre term. I sadly have to say that I delivered my godson at 26 weeks; he is 54 years old and severely handicapped. I also delivered, 10 years later, a young preterm baby who weighed exactly 600 grammes, who I later, as a Chancellor, twice graduated in law. So there are people, as the noble Baronesses, Lady Blackstone and Lady Brinton, said about twins, who are born premature and survive.

I hope we will not forget this debate, because there are mothers and babies out there who need our support. I agree with the noble Baroness, Lady Wyld, that we must not let this be the only occasion on which we discuss this: having the same debate every year might help.

Motion agreed.