Maternity Services

Helen Maguire Excerpts

Tuesday 25th February 2025 Westminster Hall

[Helen Maguire (Epsom and Ewell) (LD)]

It is a pleasure to serve with you in the Chair, Sir Christopher. I congratulate my hon. Friend the Member for Chichester (Jess Brown-Fuller) on securing this hugely important debate. Today I will highlight both the excellence and the challenges of maternity services in my constituency of Epsom and Ewell.

Last year, the dedicated staff of Epsom and St Helier university hospitals delivered more than 3,400 babies. Their commitment to patient care is outstanding, with care being ranked No. 1 in London for patient experience. Both units have also achieved UNICEF UK baby friendly hospital initiative gold accreditation, reflecting their exceptional support for new mothers’ feeding choices. Those outcomes are testament to the experience, compassion and hard work of the staff, despite the conditions they work under.

Our maternity services are held back by infrastructure that is simply not fit for purpose. Some of the hospital buildings at Epsom and St Helier are older than the NHS itself. Those conditions make it harder to provide the high standards of care that mothers and babies deserve. At St Helier hospital, the maternity unit’s lift regularly breaks down, making it increasingly difficult to safely transfer maternity patients to intensive care or the main theatres. Both Epsom and St Helier hospitals lack waiting areas and suitable space to maintain privacy, making it harder to implement a nationally mandated triage system and to provide private spaces, which are vital for bereaved families.

Every year, the trust spends millions just on patching up these crumbling facilities, which is not sustainable. The cost of maintaining outdated buildings and equipment diverts critical resources away from the frontline. Furthermore, staff are stretched thin by running duplicate services across two sites, which affects patient outcomes. The promised new hospital in Sutton was meant to solve those problems by bringing together emergency care, maternity services and in-patient paediatrics in a modern, specialist facility. However, the Government have pushed construction back to at least 2032, leaving our community in limbo. Meanwhile, Epsom general hospital alone needs £44 million-worth of repairs, with 46% classed as high risk, meaning that failure to address them could lead to serious injury or major service disruption. If the UK is to be the safest place in the world to have a baby, we must do better.

Beyond the building, staffing remains a critical issue. A local midwife recently shared with me the reality of working in our maternity services. She described how the staffing problems in maternity continue to be dire. There simply are not enough midwives rostered each day to cover the work, which makes it unsafe for women and their babies, and creates an unsustainable working environment for those left behind. Midwives are working longer hours, starting early or leaving late, taking on more than they should just to ensure women are seen. This leads to burnout, and many midwives ultimately leave the profession as they feel that the stress and huge responsibilities are not matched by adequate support or fair pay.

As a woman, the midwife told me how deeply saddened she is that this is the service being offered to women in this country. The care a woman receives during childbirth has lifelong implications—not just for her, but for her children and for society as a whole. She worries that women’s choices, particularly around home births, are becoming increasingly sidelined. Women’s autonomy over their own bodies is becoming less relevant, and she fears what that means for the future of maternity care for our daughters and granddaughters. Her worries reflect those of so many across the country.

I have three children, all of whom were born successfully in London. I wanted a home birth for all of them. Sadly, we were only successful in having one home birth due to complications, but I am grateful that I had the choice. I thank Brierly midwives for that, but not every woman today has that choice.

The people of Epsom and Ewell, Leatherhead and Ashtead—and around the UK—deserve outstanding maternity care, unhampered by crumbling infrastructure, chronic understaffing and a lack of investment. As a first step, I urge the Government to release the full impact assessment of the delays to the new hospital programme and reconsider the decision. We cannot afford to let maternity services deteriorate any further. The safety of women, babies and midwives depends on it.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I am grateful to the hon. Member for Chichester (Jess Brown-Fuller) for raising this extremely important issue. It touches so many of our constituents and so many families across our country, and I know how many of them she and other Members have spoken to. As the Secretary of State said, it is an issue that keeps him awake at night. The hon. Lady spoke very movingly about her friend Steph and Steph’s son, Bendy, whom I know she remembers very fondly. We have had too many decades of similar stories, but she did good service to her friend and Bendy today.

I will do my best to answer as many questions as possible—it has been a wide-ranging, respectful and thoughtful debate—but the Minister for Patient Safety, Baroness Merron, who leads on this issue for the Department, will be happy to write to colleagues where necessary.

The hon. Member for Chichester asked a number of questions at the end of her speech, and I hope that I will address most of them. I completely understand why she is pushing on behalf of the families that the Secretary of State met for the maternity services plan to be outlined. Families have waited long enough, but we want to make sure we get it right, so we are taking time within the Department to discuss the next steps with officials and ensure that any plans we put out are as strong and effective as possible; we have had too many plans that have not been. Those families will receive an update on the next steps very soon.

I will come on to some of the essential actions from previous reports, but I will re-emphasise that all Donna Ockenden’s recommendations were accepted and are being worked on. I will pick up on that later in my speech.

On workforce and training, we will publish in the summer the refreshed long-term workforce plan. That will set out how we will build a transformed health service over the next decade, and obviously it will include midwifery.

[Helen Maguire]

Will the Minister give way?

[Karin Smyth]

I will, but I will not be able to get through my speech if I keep giving way.

--- Later in debate ---

[Helen Maguire]

I will be very brief. La Retraite sixth form in London has a T-level qualification in health with midwifery, linked up with Guy’s and St Thomas’, and it is proving successful. Will the Minister consider working with the Secretary of State for Education to look at rolling that out throughout the country? It is proving really successful in getting new midwives into the system.

[Karin Smyth]

The hon. Lady raises something very close to my heart. I spoke frequently in opposition about apprenticeships and the need for the health service to work on that. I actually visited that centre with the chief nursing officer and met students there. It was a lovely visit; we had a fantastic morning with really enthusiastic young people who wanted to go into the profession. The hon. Lady makes an excellent point, and we will continue to work with Guy’s and St Thomas’ on that. Others could take note of what they are doing.

We understand the issues with the CQC. They are well documented and were further highlighted by the hon. Members for Cheltenham (Max Wilkinson) and for Chelmsford (Marie Goldman). We do not think now is the time to make changes to the statutory limitation power, because we want the CQC to prioritise improving its regulatory approach and focusing resources on the recovery plan in line with the Dash report. Once that is done and the CQC is working better, the Government have committed to reviewing that statute of limitation power.

With regard to phonelines, Sands and Tommy’s do fantastic work for bereaved parents across the country— I know that from my own Bristol South constituency. We are always open to new ideas and suggestions from the experience of people working on the ground. I will ask officials to consider recording triage phonelines as part of our longer-term work on maternity and neonatal services. Many hon. Members raised general points about communications. The hon. Member for Chichester was right to mention communication for parents—both mothers and fathers. That was a point well made, and I will pick it up later.

Donna Ockenden rightly commands huge respect across Government, parties and the NHS. She was right to say that previous Governments were “asleep at the wheel” on maternity care. We have heard already, but it is worth restating, that babies of black ethnicity are twice as likely to be stillborn as babies of white ethnicity. The maternity workforce is experiencing significant challenges and safety in maternity care is very far from where we want it to be.

Hon. Members highlighted their meetings with families. The Secretary of State and Baroness Merron have met a number of bereaved families over the past few months, as I know others have done. My hon. Friend the Member for East Worthing and Shoreham (Tom Rutland) talked about the families he has met. He highlighted that when he talked to me recently about issues in his constituency.

As with so many issues in healthcare, there is no quick fix to the challenges we face. There have been too many high-profile independent reviews into maternity services over the past few years. With remarkable consistency, they all point to the same thing: a culture that belittles women, downplays concerns and puts reputations above all else, even patient safety. We know that is wrong and we know what needs to happen. It is now time to crack on and deliver.

We are making steady progress on recommendations from all 15 areas of the Shrewsbury and Telford review, such as workforce accountability and bereavement care. Much of that progress has been made through NHS England’s three-year delivery plan. The plan seeks to make maternity and neonatal care safer, fairer and more tailored to every woman’s needs, by setting out expectations for informed choice and personalised care planning, to improve women’s experience in labour and birth.

Some of the initiatives have been highlighted today. The saving babies’ lives care bundle, helping to reduce stillbirths and pre-term births, has been rolled out to every trust in England. I am pleased that all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme, an initiative to promote and sustain a culture of safety. There are also initiatives to reduce inequality. As I know from my constituency, women living in deprived areas are more likely to suffer adverse outcomes. It is right that local systems are trying to bridge the gap through equity and equality action plans.

We have set clear expectations for escalation and accountability through the three-year plan. We are supporting staff to hold up their hands when things go wrong, through the freedom to speak up initiative. The public can monitor the progress of the three-year plan against the Ockenden recommendations, through their local maternity and neonatal systems and integrated care boards. Local women and families, should they choose, can see what progress has been made, who is accountable and how the system is changing. NHS England is also investing £10 million every year to target the 10 most deprived areas of England.

Safety must be the watchword at every step of the journey. NHS Resolution’s maternity incentive scheme is rewarding NHS trusts that prove they are taking concrete steps to improve the quality of care for women, families and newborns. As highlighted by the hon. Member for Hinckley and Bosworth (Dr Evans), since 2010 the neonatal mortality rate has shown steady signs of improvement, decreasing by a quarter for babies born after at least 24 weeks of pregnancy. The stillbirth rate in England has decreased by 22% and the overall rate of brain injuries occurring during or soon after birth has fallen by 3%.

We all know there is so much more to be done to improve outcomes for mothers and babies, and to ensure that they receive the safe care that they need. There are ongoing initiatives to ensure lessons are learned from every tragic event, to prevent similar events in future. Hospitals carry out internal perinatal mortality reviews, which aim to provide answers for bereaved parents about why their baby died, and give them some closure. The reviews also help hospitals to improve care and ensure we learn the lessons from every tragedy.

The maternity and newborn safety investigations programme conducts independent investigations of early neonatal deaths, intrapartum stillbirths and severe brain injury in babies after labour. All NHS trusts are required to report those incidents, carry out an independent investigation and make safety recommendations to improve services in future. For those parents who go through the heartbreak of losing a baby, we must do everything we can to support them in their grief. That is why the Government extended the baby loss certificates; as of last week, we have issued almost 100,000 to grieving parents. It is also why, through the three-year plan, we have made provision for seven-day bereavement care supported by investment, and why we will continue to support the work of Sands and Tommy’s, which do so much for bereaved mums and dads across the UK.

The hon. Member for Chichester rightly talked about the importance of workforce and meeting safe levels of staffing. Throughout the winter I have seen up close NHS staff doing their absolute best in appalling circumstances that were not of their own making. I know that however dedicated our NHS staff may be, they cannot provide the right care without the right support. That is why we are committed to tackling the retention and recruitment challenges in the NHS, and why work is under way to modernise NHS working cultures and make our hospitals more attractive for top talent. That includes a much stronger focus on health and wellbeing, more support for flexible working and a renewed commitment to tackling inequality and discrimination.

Bringing in the staff that we need will take time, but it is an absolute priority for this Government and for me personally. NHS England is leading a range of initiatives to boost retention of existing staff and ensure the NHS remains an attractive career choice for new recruits. I say to the hon. Member for Strangford (Jim Shannon) that we are keen to work with all devolved Governments to ensure that and to share learning.

There is a dedicated programme for the retention of midwives, an issue highlighted by the hon. Member for Chichester and my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn). The initiative contains a range of measures, including a midwifery and nursing retention self-assessment tool, mentoring schemes, strengthened advice and support on pensions, and the embedding of flexible retirement options.

NHS England has also invested in retention leads for every maternity ward. Alongside investment in workforce capacity, that has shown promising signs of bringing down vacancy, leaver and turnover rates. The leaver rate declined from 10.3% in September 2023 to 9% in September last year. There has been progress, but we know that there is more to be done. As of November, there were a record number of midwives working in NHS trusts, with around 24,700 working full time, up by over 1,300 compared with the year before.

While all this work is going on, we are also doing the hard yards of fixing the foundations of our NHS and making it fit for the future. I am pleased that the National Institute for Health and Care Research has commissioned over 40 studies looking at how we can prevent pre-term births and improve care for babies and women. It has launched a £50 million funding call, challenging researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes.

While that work is going on, we will continue to talk to staff about the 10-year plan. My right hon. Friend the Secretary of State is attending a staff event in Peterborough on Thursday, and I will be attending one next week. We want to know how we can better support our staff, ensure we unleash their potential and give patients the care they need. A central part of the 10-year plan will be our workforce—how we train them and provide the staff, technology and infrastructure the NHS needs to care for patients across our communities. The hon. Member for Epsom and Ewell (Helen Maguire) is right to highlight the estate, which is also a problem in this area. We need to consider all policies, including those that impact maternity and neonatal care.

Over 95,000 people have responded to the consultation so far, and we want to hear from more. We have heard in this debate about midwifery-led care from my hon. Friend the Member for Lichfield (Dave Robertson), and about mental health support from the hon. Members for Eastleigh (Liz Jarvis), for Winchester (Dr Chambers) and for Dewsbury and Batley (Iqbal Mohamed). I hope that they contribute to the consultation.

I am conscious that I need to give the hon. Member for Chichester a few moments to wind up. We know that we will not be able to fix these issues overnight. We are committed to investing in safety, workforce retention and tackling inequalities, and we are making steady progress. As was highlighted, most women have safe care with a healthy baby, and are made to feel special at a very special moment. That is a testament to the staff. We need to make sure that that happens for all women, everywhere. A lot of work has been done. There is a lot left to be done, but I am confident that we will build a maternity and neonatal system that delivers for every woman.