Baby Loss Awareness Week

Angela Crawley Excerpts

Thursday 23rd September 2021 Commons Chamber

[Cherilyn Mackrory]

I thank my right hon. Friend for her intervention and kind words.

I entered Parliament and suddenly had the opportunity to speak with many people who had experienced the loss of a baby. Unlike me, many have no idea why their baby had died. As well as prevention of baby loss, which I will come to later, my focus in this place is on the care for bereaved families. The all-party group was instrumental in the creation of the Government-backed national bereavement care pathway, which seeks to improve the quality and consistency of bereavement care received by parents in NHS trusts in England after pregnancy or baby loss.

There are different experiences from place to place. While the Department of Health and Social Care strongly urges the trusts to take part in the pathway, mandating it and its nine standards would lead to greater time, funding and resources being made available to healthcare professionals to deliver this. Poor bereavement care, from the moment of diagnosis and the breaking of bad news, exacerbates the profound pain felt by parents. Although approaches to bereavement care in the UK have greatly improved in recent years, inconsistency still remains, often resulting in a postcode lottery for parents.

As of last month, all NHS trusts in England have either expressed interest in, or formally committed to, implementing the pathway within their hospitals and their services. Trusts require additional funding, however, to fully implement the standards, especially to ensure that every hospital has an appropriate bereavement suite, specialist staff and training.

As I mentioned earlier, the care that we received in Cornwall on the weekend that we lost Lily was second to none. However, while I was able to access bereavement counselling through my work, my husband has never been offered anything. It is my opinion that supporting partners and the wider family are not being looked after in the way that we would hope. Because the mother births the child, dads and supporting partners often feel the need to be “strong”—to be there for them. People often ask how mum is, but may not ask how dad is. That is not healthy. What about the wider family? Grandparents are grieving for their lost grandchild and wondering how best to support. Siblings are wondering what has happened.

My daughter was only four when we lost Lily. She knew I was pregnant and we tried to explain what had happened in an age-appropriate way. She seemed to accept this as children do and did not mention it again—until a couple of weeks ago. Completely out of the blue and without warning, she said, “Mummy, when I was four, you were going to have a baby but then didn’t.” Crikey! Wham! What do you do? On the hoof, I needed to explain calmly to my now almost seven-year-old what had happened. I do not know whether I explained it in the right way, but she knows now that, if there are questions, we are always here. I do not want it to be a spectre on her childhood to wonder what happened to her mystery sister. It reminded me that a child’s mind can often make up what they do not know, and we need to make sure that siblings and the wider bereaved family are cared for long after the event.

[Angela Crawley (Lanark and Hamilton East) (SNP)]

I commend the hon. Member for her bravery in speaking about such a personal and intimate matter. She speaks about partners and the wider family. There has never been a more important point about ensuring that both affected parents are able to take leave. Does she support my Miscarriage Leave Bill, which will ensure that both parents can take paid leave during this traumatic time?

[Cherilyn Mackrory]

The hon. Member and I have spoken about this issue. Since that conversation, I have taken her Bill to the Employment Minister, so I hope that we will hear more about it later in the year.

Despite our making good progress, more needs to be done if the Government’s ambition to halve baby deaths by 2025 is to be met. If the current trajectory of reducing stillbirths is maintained, England may be off meeting that 2025 ambition. The Health and Social Care Committee report noted:

“The improvements in rates of stillbirths and neonatal deaths are good but are not shared equally among all women and babies. Babies from minority ethnic or socioeconomically deprived backgrounds continue to be at significantly greater risk of perinatal death than their white or less deprived peers.”

Babies should not be at higher risk simply because of their parents’ postcode, ethnicity or income. I will let my APPG co-chair and Chair of the Select Committee speak to the findings of the report. However, it appears that health inequalities in maternity outcomes have been known about for more than 70 years, yet there are still no evidence-based interventions taking place to reduce the risks.

Continuity of carer could significantly improve outcomes for women from ethnic minorities and those living in deprived areas. Way back in 2010, the Marmot review proposed a strategy to address the social determinants of health through six policy objectives, with the highest priority objective being to give every child the best start in life. Marmot noted that in utero environments affect adult health. Maternal health—including stress, diet, drug and alcohol abuse, and tobacco use during pregnancy—has a significant influence on foetal and early brain development. Midwives have a key role in promoting public health. Individual needs and concerns can be better addressed when midwives know the woman and her family, and continuity of carer is a key enabler of that. This public health work is of most benefit to vulnerable and at-risk families, who may require more time and tailored resources. Additional work is required to address the needs of these groups, because they are simply more at risk.

As well as improving clinical outcomes for mothers and babies, continuity of carer models can also result in cost savings compared with traditional models of care, because there are fewer premature babies, so fewer neonatal cot days are required; the incremental cost per pre-term child surviving to 18 years compared with a term survivor is estimated at nearly £23,000, and most of the additional costs are likely to occur in the early years of a child’s life; there are fewer obstetric interventions, with women 10% less likely to have an instrumental birth; and there are fewer epidurals and so on.

--- Later in debate ---

[Angela Crawley (Lanark and Hamilton East) (SNP)]

I did not expect to be called to speak so early in the debate; thank you, Madam Deputy Speaker.

I again thank my friend, the hon. Member for Truro and Falmouth (Cherilyn Mackrory), for her bravery and for sharing her experience on the Floor of the House. It matters to the people at home to know that we politicians are also human beings, and that we also feel grief and loss.

Whether a pregnancy was planned or a surprise, that moment of seeing two lines on a pregnancy test stick will stay with many parents for a lifetime. Equally, for many who are trying to conceive, a faint one line or “not pregnant” will stay with them also, each and every time they receive it. Pregnancy can be a joyous, happy celebration for many. Perhaps that is why we often choose not to speak of the sadness and heartbreak when a pregnancy loss happens. Tragically, one in four pregnancies will end in miscarriage. The experience of miscarriage, along with the grief and loss associated with the miscarriage or stillbirth, will resonate for one too many parents. Every pregnancy loss is different, and there is no right or wrong way to feel about it. Sadly, many patients feel stigma. They feel a sense of shame or a failure that they could not conceive or, even when they can, that the pregnancy does not result in a happy birth.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

My hon. Friend is making an excellent speech that resonates with so many of us who have suffered baby loss. Will she commend, with me, the campaign run by my constituent Louise Caldwell? She is campaigning for a dedicated miscarriage unit after having to give birth to her child who was sadly lost, not in a miscarriage way, and suffering real compounded trauma from having to be in the maternity wing of the hospital while other parents were celebrating and she was bereaved and her whole family were devastated? Will she also congratulate the Scottish Government on taking forward an initiative to have dedicated miscarriage wings?

[Angela Crawley]

I thank my hon. Friend for raising that very valid point. I commend Louise for her bravery and for making sure that the Scottish Government will adopt a new policy to prevent people in future from having to undergo that experience of happiness in among the sadness at that very tragic moment.

Many partners will blame themselves and often feel helpless in this situation. Thanks to the work of my hon. Friends the Members for North Ayrshire and Arran (Patricia Gibson) and for Glasgow East (David Linden), only last year bereavement legislation was introduced that entitles parents who lose a baby after 24 weeks to two weeks’ paid bereavement leave. However, there is currently no provision in place for parents who lose a baby before 24 weeks. Too many parents—mothers, fathers, partners and any parents who are facing this tragic incident—are forced to take sick leave or unpaid leave. Understandably, many do not wish to disclose these private and intimate details to their employer, especially in the early stages of pregnancy.

Grief is not an illness. In and of itself, it is a process that parents must go through. There is simply no timeline for grief. Every parent, regardless of whether the loss happens after 24 weeks or before, should be given the time to grieve that loss without a financial penalty. That is why I have introduced a private Member’s Bill that would allow parents who experience a miscarriage before 24 weeks to seek a minimum of three days’ paid leave. Some companies have already gone further, offering leave for seven to 14 days—an example that I hope many more employers will replicate and that I absolutely welcome. This compassion and recognition of the loss and the grief that comes with a miscarriage, whether in policy or in statute, would allow parents to approach their employer and seek a legal right to paid leave.

This traumatic life event will inevitably affect both parents differently. There is a cost associated with such a loss, as many parents opt to take unpaid or sick leave, so there is already a financial penalty for people up and down the country. Often an employer has no idea what the nature of their employee’s sickness is, or the ramifications for their business. Therefore, having a policy on this issue, or the right to take paid leave in statute, should not add any further burden to them. Rather, it would allow the conversation to take place where both employee and employer can understand the situation and hopefully seek to support their employee in the best way that they can. Many parents have spoken of feeling isolated and alone, without the opportunity to share their loss with colleagues for fear of the shame and stigma that have been associated with such a loss. Introducing a minimum of three days’ paid leave would not only give parents a chance to grieve and process their loss but show everyone that miscarriage is no one’s fault and help to break that stigma.

--- Later in debate ---

[Angela Crawley]

Does the right hon. Gentleman believe, as I do, that fathers, like mothers and like any parent, have the right to have a grieving process and should have the right to paid leave in order to do so?

[Jeremy Hunt]

I thank the hon. Lady for giving me a moment to recover. She makes a very powerful argument. Without committing to supporting her proposal, I would hope that all employers would listen to her speech and offer that leave voluntarily on compassionate grounds, because that is the responsible and kind thing to do.

I want, in my brief comments, to talk about another group of people less often talked about who also feel this grief—the doctors, nurses and midwives responsible for a child’s care. Some people have used the phrase “second victim” to describe the agonising sadness people feel when they are responsible for a child’s care and that child dies. When I was Health Secretary, many times I asked people working in hospitals what the biggest tragedy and professional shock they had ever had was, and they would often say that it related to the death of a child. Even more acute is when that death was caused by an error. Those doctors, nurses, midwives and frontline professionals, who go into their profession with the highest and noblest of motives, have to live with the fact that perhaps because of an ordinary human mistake—the kind of mistake that all of us can make—something really terrible happened.

We as politicians, and those in nearly every other profession, make mistakes the whole time—a media appearance goes wrong, a speech goes down badly, we lose an election, or whatever it is—but the consequence is not someone dying. Frontline health professionals have the courage to go into a profession where they are taking that risk every day. When those tragedies happen, those frontline professionals want nothing more than to be completely open, transparent and honest about what happened so that we can learn from the mistake and put in place processes and systems so that it never happens again. But, in truth, we make it practically impossible for them to do that. They are terrified about losing their job, about the Care Quality Commission, about being struck off the medical or nursing register, about the reputation of their unit, about the reputation of their hospital, and about lawyers, who get involved very quickly.

When I was Health Secretary—I do not think this has changed even now—every week I signed off a multimillion-pound payment to a family whose child was disabled for life because of medical error that the NHS accepted. Most weeks it happened twice. Overall, the cost of that compensation for medical error in the NHS is £2.4 billion a year. Just under half of that relates to maternity. We have got to the obscene situation where we pay more in compensation to families when something has gone wrong than on the entire cost of every doctor and every nurse working in maternity units up and down the country. Why is that? It is because of a simple problem that the Health and Social Care Committee—I am delighted to see members of the Committee in their places on both sides of the House—is urgently asking the Government to address.

If, because of a mistake, a child is born disabled, the parents quite understandably want financial support to deal with the unexpected costs that the family will face for the whole of that child’s life. However, under the law, the only way to get that compensation is if a court agrees that there was clinical negligence. Quite understandably, parents will fight to get that compensation and, also understandably, the doctors, nurses and midwives become defensive if they are accused of clinical negligence. It does not have to be that way. We need a system where people are entitled to compensation as soon as it is accepted that a mistake was made without the necessity to prove clinical negligence.

The country with the highest safety standards and the lowest number of baby deaths in Europe is Sweden, which has about half our level of baby deaths. In Sweden, compensation is given more quickly just on the basis of a mistake being made, with the result not that they pay more but that they pay massively less, because they have half the number of tragedies that we have. Surely those of us who are passionate about patient safety will support that, and those who are—as we all are—worried about baby deaths will support that. Even people in the Treasury should understand that the way to reduce the obscene compensation bill is to make it easier for families in those terrible situations to claim compensation. If we had the same maternity safety levels as Sweden, 1,000 more babies would survive every single year. Just think of the heartache and the transformation in the lives of families up and down the country were we to do that.

I turn briefly to the other recommendations in the Select Committee’s report, published in July. One of the most important recommendations relates to staffing. When it comes to medical error, if there are not enough staff on a ward, the likelihood of mistakes will self-evidently be higher. Eight out of 10 midwives say that there are not enough midwives on their shifts, and Health Education England—the Government’s own body—says that there is a shortage of just over 1,900 midwives across the system. NHS Providers thinks that there is a shortage of about 500 doctors in maternity units and the Royal College of Anaesthetists says that there is a shortage across the system of about 1,000 anaesthetists. The cost of putting that right is between £200 million and £350 million a year. That is a significant amount. The Government deserve credit for already agreeing to put in £95 million a year, but that additional cost is as nothing compared to the £2.4 billion that we are paying in compensation every year. I hope that the Government will agree to put right that staffing shortfall. They have said this week that they are considering that.

Training is another vital issue. It is so important for doctors, nurses and midwives to have the time to learn from things that go wrong and to improve systems, but they can do that only if there is protected time for training in their busy schedules. I commend Baby Lifeline for the fantastic, proven training that it does, which has saved many lives. It is led by the inspirational Judy Ledger, who was inspired to do what she does by her tragedies. The report also talks about more screening and health inequalities, both of which were mentioned by my hon. Friend the Member for Truro and Falmouth.

I finish with two brief points. First, it would be wrong to say that this is an NHS problem. It is a tragedy that happens in all countries all over the world, and this year the World Health Organisation has made maternal and newborn loss the theme of World Patient Safety Day. The WHO says that, every day across the world, 7,000 babies die and the majority of those deaths are preventable.

Finally, we should remember the tremendous progress that has been made. In the last decade, the number of neonatal deaths is down by 25% and the number of stillbirths is down 30%. I commend Jacqueline Dunkley-Bent and Matthew Jolly in NHS England, who are leading the maternity safety transformation programme, and the many doctors, nurses and midwives who are supporting them. I also commend charities such as Sands and the Lullaby Trust as well as many others. Most of all, I commend the families who have campaigned through thick and thin, including James Titcombe, remembering his son Joshua; Derek Richford, remembering his grandson Harry; Carl Hendrickson, remembering his son Chester and his wife Nittaya; and Richard Stanton and Rhiannon Davies, remembering their daughter Kate. There are many others. Five babies die every single day. This is our moment to put it right.