World Prematurity Day

Ben Gummer Excerpts

Tuesday 24th November 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to answer another debate on neonatal care. It demonstrates that there is a real head of steam behind this important issue. I cannot comment with any experience on the number of debates on this issue that there were in the previous Parliament, but it is clear that there is now a critical mass of Members in this House, and interest in all parties, to try to do something to improve neonatal care, whether that is for babies who are born prematurely or at term.

First, I add my tribute and thanks to those given by the shadow Ministers and spokesmen, the hon. Members for Ellesmere Port and Neston (Justin Madders) and for Airdrie and Shotts (Neil Gray), for the personal stories told by Members, and I will state on the record that I think the whole House is grateful to them for their personal bravery in explaining what has happened to them, and to other Members who have told the stories of their constituents.

It was with such a story that my hon. Friend the Member for Daventry (Chris Heaton-Harris) began his speech, discussing the account of Catherine and Nigel Allcott, and their son and daughter. He reminded us, as did many hon. Members later, that we can speak about statistics and percentages but what we are actually dealing with are newborn people, little ones and “the smallest things”, who deserve the greatest protection and care that we can possibly give, because they could not be more vulnerable.

In a 2014 study, The Lancet estimated that there were 5.5 million newborn deaths in the world every year and it is that stupefyingly large number that we are addressing today in discussing World Prematurity Day. I know that many speeches were addressed to the domestic situation, but I am very grateful to the shadow Minister, the hon. Member for Ellesmere Port and Neston, for pointing out that we have an international obligation in this regard, and I will certainly talk to my counterpart in the Department for International Development about the areas that our aid spending are being focused on in terms of healthcare and neonatal support, to see if we are doing all we can to try to spread the best practice in this country and Europe to those parts of the world that are beginning their journey in creating a universal healthcare system for their populations.

With that in mind, I turn to the current situation in the United Kingdom. In this country we have some of the finest neonatal care in the world, but what has been apparent in the speeches given today—accurately reflecting the facts—is that we have far too much variability. That is the principal reason why we are at the bottom of the pack in terms of developed countries when measuring rates of stillbirth, which is by means of proxy for the way that we look after premature babies. So I will outline what the Government plan to do about that situation, because it significantly touches—indeed, it does not just touch but covers—the ground that those campaigning to improve care for premature babies have so rightly highlighted, and the Bliss report is an important contribution to that work.

My hon. Friend the Member for Daventry and many other hon. Members have pointed to the announcement a couple of weeks ago by the Secretary of State that we wish to see the rates of stillbirth, neonatal death and maternal death reduce by 20% by 2020, and by 50%, or by half, by 2030. Within that target, we include a reduction in brain injury for babies.

It is worth pointing out that many of the contributory factors to stillbirth and to brain injury are the same for prematurity, which, in the round, are public health measures. They have not been covered much in this debate but I would like to raise them, because it is very important that we also understand the obligations of parents, to ensure that we can bring down the rates of prematurity and stillbirth.

We still have too many mothers in this country smoking. We know that smoking is a significant contribution to prematurity. If we were to improve the variability of smoking rates across the country, which is actually quite shocking, we would do much to reduce rates of stillbirth. In looking at the smoking rates across the country, it is quite interesting that there is not just a simple binary division between areas of affluence and areas of deprivation. There are some areas of significant deprivation where local public health partners have made considerable strides in reducing smoking rates compared with areas that are quite close by. Likewise, obese pregnant women are much more likely to experience miscarriage or pre-term birth than those women who are in the normal body mass index range.

Therefore, we have significant public health challenges ahead of us in reducing obesity, smoking, drinking and substance abuse, and if we are able to achieve those reductions in partnership with parents across the country we will have made the biggest stride that we can towards reducing rates of prematurity, ensuring that those babies that are born premature are as healthy as they can be and reducing rates of stillbirth, whether premature or term.

I wish to turn to the University of Leicester study and the “Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the UK”—or MBRRACE-UK—report that was published last week, which was touched on by the hon. Member for Ellesmere Port and Neston. The study highlights the challenge ahead regarding the care of neonates across the country. The figures are arresting. In half of all the cases highlighted, at least one aspect of antenatal care that could have had an impact on whether the baby was born alive could have been improved. In a third of cases, there were significant problems with bereavement care and in a quarter there were major issues with one or more aspects of intrapartum care.

For me, perhaps the most troubling statistic in the report is that in only a quarter of all the stillbirths it looked at was there an internal case review. We are not improving our position as quickly as we could because we are not reviewing cases in enough instances—we should be reviewing 100% of them—and we are not spreading the knowledge of the reviews across the system. That is one reason why the Secretary of State is so keen to turn the NHS into a learning organisation. Until we get the NHS to do well something that it currently does badly—spreading learning from places that have had a problem, a tragedy, and from those that have made significant strides—we will not make improvements. I refer hon. Members to the experience of St George’s hospital in Tooting, where they have undergone that journey in the past few years, just through dogged clinical persistence, and have been able to change the outcomes for children attending the maternity unit.

I was interested in the remarks made by the hon. Member for Croydon North (Mr Reed) on support for parents, and I shall certainly take his valid point about maternity leave—to which my hon. Friend the Member for Colchester (Will Quince) added comments about paternity leave—to my colleagues in the Department for Work and Pensions. I would hope that all employers—not that they will know about or watch this debate—would have the consideration to behave properly with parents of a premature child. The hon. Gentleman’s point about the need to reflect the development of a baby who has been born prematurely in maternity pay arrangements is interesting and important. I shall certainly take his comments back to colleagues but I can make no promises about what we can do.

The hon. Gentleman also talked about mothers’ mental health, which is something that the Government put a lot of emphasis on in the previous Parliament. We know about the importance of investing in perinatal mental health and that it pays significant dividends if done successfully. That is why we announced in March that we will invest an additional £75 million in it over this Parliament. The services, as provided, are not sufficiently good and we need to do much to improve them.

I hope that many of the instances that hon. Members have mentioned of the lack of support for parents with a premature child who is either living or has died and the lack of counselling for both mother and father—along with the important points made by my hon. Friend the Member for Daventry about marriage counselling and the powerful ones made by my hon. Friend the Member for Banbury (Victoria Prentis) about the difficulty of maintaining a marriage through a premature or stillbirth—can be addressed through the additional money. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is now in his place, was critical in securing that funding in March.

Various hon. Members also made important points about parking charges and travelling. I hope that NHS England’s 2014 neonatal critical care services review and service specifications will lead, in the next few years, to ensuring that we have more comprehensive neonatal cover. There will be instances when that is not possible—we cannot predict every occasion on which there will be stress on a maternity service—but I hope that the services specifications will come to correct that in the next few years. Hospitals should follow the Department of Health guidance on parking, which contains specific recommendations to ensure that people who have to park for long periods are catered for.

I know that hon. Members raised additional issues that I have not been able to cover in this fascinating debate but I shall ensure that they are responded to afterwards. I thank all hon. Members for their interesting and personal accounts regarding this important subject.