Maternity Services

Jess Brown-Fuller Excerpts

Tuesday 25th February 2025 Westminster Hall

[Jess Brown-Fuller (Chichester) (LD)]

I beg to move,

That this House has considered maternity services.

It is an honour to serve under your chairmanship, Sir Christopher. I thank all the Members in attendance for their interest in this important topic and the Backbench Business Committee for allocating time to debate maternity services in England.

On average, a baby is born in England every 56 seconds, over 1,500 babies each day, most of them delivered in an NHS setting with the help and support of a maternity department or at home with an NHS community midwife by their side. That is over 500,000 babies every year. I contributed to that statistic in 2014 and 2019 when I gave birth to my children at St Richard’s hospital in Chichester. Two very different births that I will not spend my valuable time in this debate reflecting on, because there are far more important voices that need to be heard and considered. A person is at their most vulnerable moment when they or their partner go into labour. We put our health, safety, and the safety of our unborn child into the hands of professionals who work in that setting—the midwives, obstetricians, anaesthetists, and neonatologists—to support us in the safe delivery of our child and get us all home safe. And in the majority of births that is the case.

However, several investigations have revealed fundamental flaws in how maternity care is delivered across England. A Care Quality Commission inspection of 131 maternity units found that 65% were not safe for women to give birth in, with studies showing that one fifth of all causes of stillbirth are potentially preventable. The Ockenden report, led by Donna Ockenden, investigated the maternity services at the Shrewsbury and Telford Hospital NHS Trust, but it also highlighted the flaws in maternity care across England. The report laid out immediate and essential actions which are key to reforming maternity services and ensuring that every mother and baby receive the care they deserve and should expect. In her report Donna reflected that sometimes that spotlight can feel harsh to staff on the front line, who are doing their very best in what are often extremely challenging circumstances.

In conversation with midwives and others working in the maternity care sector, I recognise that each one I spoke to entered the profession as a the result of a calling, vocation, or passion for supporting mothers to bring their babies into the world. They are frontline NHS staff who often go above and beyond the call of duty to support and care for their patients in those extraordinary hours and days. Midwives in particular spend significant time with expectant mothers, supporting them through all stages of pregnancy and birth. They see women at their most vulnerable. They act as therapists, teachers, friends and maternal figures. Yet across the country, staffing levels are inadequate. In 2023, midwives and support workers worked over 100,000 hours of unpaid overtime every week. The pressure and stress on them is immense and this leads to burnout, absenteeism, high staff turnover and the loss of experienced professionals from the field, and that ultimately puts patient safety at risk.

[Jeremy Hunt (Godalming and Ash) (Con)]

I congratulate the hon. Lady on bringing forward this debate and the excellent and persuasive way that she is making her case. On burnout, does she agree that one of the biggest issues is that when a tragedy happens, midwives and obstetricians often feel that if they speak out the risk is that they or their institution will get sued, or that they could get fired from their jobs? Does she agree that litigation reform to try and change the rules of the game, so that people are able to be open when they think they have made a mistake and learn from those mistakes, is one of the most important ways that we could improve the record on patient safety, which is as much a concern to her as it is to me?

[Jess Brown-Fuller]

I agree wholeheartedly that we need to change the way that we do litigation, because NHS trusts often argue that they want to learn and grow from poor experiences, but the litigation system means that they rarely have the opportunity to do so, because everybody is so afraid to speak out. We need to change that culture within maternity services and the NHS as a whole.

As a country, we are training more midwives than ever before, yet retention remains a problem and the pandemic exacerbated an already difficult situation, with highly trained midwives with families or caring responsibilities leaving the profession too soon.

[Dr Al Pinkerton (Surrey Heath) (LD)]

I congratulate my hon. Friend on bringing this debate here today. Frimley Park hospital in my constituency received an outstanding report from the Care Quality Commission in 2023, but it none the less identified that inadequate staffing remains one of the highest risks on the maternity register. That has daily implications; many midwives reported, for example, that daily checks were often incomplete, handovers were interrupted and not standardised, and mandatory training was often not completed.

Does my hon. Friend agree that to ensure high-quality maternity care, from admission to discharge, requires not only stringent oversight by trust boards, but far greater care for staff in the setting of the hospital, providing safe spaces where conversations can be had, handovers can take place, and nurses can rest? In that way, we will both retain and also hopefully recruit more of our vital nursing staff.

[Jess Brown-Fuller]

My hon. Friend is absolutely right; the key to providing strong maternity services that benefit both the staff and the patients is making sure that there is a full workforce so that they can do not just the “need to haves”, but the “nice to haves” in a maternity department, which can make such a difference to patients’ experiences when they are going through that service.

The retention issue that we have directly impacts training. Newly qualified and inexperienced midwives need experienced mentors, but if seasoned professionals leave, the next generation lacks the support necessary to transition into leadership roles. Midwives and other maternity staff must train together at every level to be fully equipped for every situation, and ensure that concerns can be escalated effectively. That is why the Ockenden report and the Royal College of Midwives seek a commitment to including midwives in the long-term workforce plan.

In 2017, bursaries for student nurses and midwives were ended, with the Royal College of Midwives warning that that decision threatened the future of our maternity services in England. It has led to one third of midwifery students having debts exceeding £40,000, with 80% of them knowing someone who has dropped out of their course due to financial hardship. Many also take on additional jobs to afford their studies, which detracts from their vital training. To mitigate those pressures on trainee midwives, I encourage the Government to explore alternative routes to support midwifery and nursing students, which have been laid out by the Royal College of Midwives, through new funding options or a scheme where student debt is forgiven after a defined period of service in the NHS.

A similar funding issue affects apprenticeship schemes in midwifery. Despite receiving overwhelmingly positive feedback from trusts across the country regarding the apprenticeship route, many trusts cannot afford to offer those positions due to a lack of backfill funds, so trusts often hand back their apprenticeship levy, as the scheme is undeliverable. I hope the Minister will work with her colleagues in the Department for Education to address this fundamental flaw in the delivery of level 6 and level 7 apprenticeships, which have proven to deliver the midwives of the future.

In preparing for today’s debate, I was invited to my local maternity unit at St Richard’s hospital in Chichester, where as I mentioned I had both of my children. University Hospitals Sussex had its maternity services inspected by the CQC in September 2021, which found all hospitals across the trust to be inadequate or requiring improvement. Although there has not been a formal inspection since, the trust assures me that all actions from the CQC have been completed, with the majority of the Ockenden immediate and essential actions implemented. However, to fully implement all the IEAs will require funding, which currently the trust does not have.

St Richard’s hospital confidently tells me that it is now fully staffed for the first time in a long time, and the director of maternity services is keen to look at how she can further improve patient experience and communication. I know Members across the House are keen to work with their NHS trusts constructively to ensure the best outcomes possible for their constituents. I was reassured by the senior leadership team, those working in the department, and the new parents on the ward, who I had the pleasure of congratulating. Introducing tiny babies to the world was probably the best moment of my recess—it was very bizarre for those parents when the MP walked in and said, “Can I say hello?” I am pleased that the trust is taking seriously its responsibility to provide a much improved service.

It would be a missed opportunity if I, as the chair of the all-party parliamentary group for infant feeding, did not mention how we could do much more as a society to support mothers to breastfeed, if they choose to. The UK’s breastfeeding rates are among the lowest in the world. Only 1% of mothers exclusively breastfeed at six months, despite the World Health Organisation recommending exclusive breastfeeding for this period and continuation, alongside nutritious foods, for up to two years. Some 44% of mothers surveyed wished that they had breastfed for longer and would have done so if they had received better and more tailored support. New mothers need time, expertise and evidence-based information to make informed decisions on their feeding choices, and maternity services play a key role in establishing a feeding plan that works for mother and baby before they go home. But, across the country, community midwifery and health visiting services have been vaporised, so support is patchy and often delivered by volunteers or midwives in their spare time. I hope that the Government will support improved community services such as milk support groups, to give all women, regardless of their feeding choices, somewhere to turn when they need support.

I will take this opportunity, perhaps selfishly, to get on record the name of one of the coolest kids I ever met. Benedict Henry Goodfellow was an absolute dude—[Interruption.] I am not going to cry—and I am proud to call his mum, Steph, one of my close friends and the strongest woman I know. This debate is so important to me because Bendy needed 24-hour care since birth after a case of extreme birth trauma left him with devastating neurological damage. Bendy was loved by everyone who came into contact with him until he died, aged 10. The experience left Steph traumatised and profoundly changed. Bendy was born nearly 30 years ago and yet Steph and Ben’s story is just as relevant today. It should not be.

I am immensely grateful to Donna Ockenden for putting me in touch with families from across the country—including from Leeds, Nottingham, Shrewsbury and Sussex—ahead of this debate to hear their personal experiences of failures in maternity care.

[Katie White (Leeds North West) (Lab)]

As I am the Member for Leeds North West, the hon. Member may have spoken to my constituents, Dan and Fiona, who tragically lost their baby Aliona after only 27 minutes. Despite the fact that the inquest found a number of gross failings, the figures for Leeds, which came out only last night, are horrifying. Does the hon. Member agree that there are grounds for an independent review of maternity services in Leeds?

[Jess Brown-Fuller]

The hon. Member is absolutely right to raise the case of Dan and Fiona. I was lucky enough to have them give up their time to share their heartbreaking story with me. They are at the forefront of the fight for an independent inquiry in Leeds. The Secretary of State for Health and Social Care said that he would look at whether there is cause for an investigation but those families are still waiting to find out if that will go ahead.

I met with families like Dan and Fiona to ensure that the questions I ask the Minister today are the questions that those families would ask if they had the opportunity. I cannot begin to imagine how exhausting it is to relive the moments that their lives changed forever, over and over again, in the pursuit of better outcomes for the next family. I will include a number of their questions to the Minister in my closing remarks, but I reflect that the families who were able to share their experiences with me were, overwhelmingly, white, middle class, often highly educated and that many had medical backgrounds or academic careers before going through this trauma. Lord Darzi’s report found that black women are almost three times as likely to die in childbirth as white women and that neonatal mortality in the most deprived areas is more than double that in the least deprived. Who speaks up for those families? Who ensures transparency and accountability for those with a fundamental distrust of the medical profession, or those who have learning disabilities, or English as their second language, because those people are not supported in navigating the complex systems that are in place?

Negligence claims in obstetrics account for just 13% of the volume of litigation received by NHS Resolution in 2023-24 but cost over £1 billion every year—nearly 60% of the total cost of clinical negligence claims. Beyond financial costs, those failures carry a devastating human toll. If we truly invest in our maternity services, in both professionals and facilities, more than money is saved; lives are saved.

In conclusion, I would like to ask the following questions of the Minister. First, the previous Government were supportive of the Ockenden review, and previous health Ministers had made assurances that maternity services were going to get the support they desperately needed. I know the Secretary of State for Health is supportive of the Ockenden review and has met many bereaved parents since the general election. He has assured those parents that fixing maternity is a priority for the Government, and that actions would be outlined publicly before Christmas 2024. He came back shortly after Christmas saying they needed more time. That response is now two months overdue. Can the Minister assure me that those families will hear an update in the near future?

Do the Government support all the Ockenden report’s immediate and essential actions arising from the review into the Shrewsbury and Telford trust? How will the Government ensure that all integrated care boards and trusts across the UK implement all the actions? What support will be provided to the trusts to achieve that, and prevent a postcode lottery of maternity care?

If those IEAs are implemented, what will be the Government’s measure of success? We currently have no national data regarding preventable deaths. It is the charitable sector that has determined that more than 800 baby deaths a year could have been prevented. One of the IEAs is a long-term plan to secure a safe maternity workforce and improve training. Can we expect to see maternity care professionals, including neonatologists, obstetricians and anaesthetists, included alongside midwifery colleagues in the refresh of the 10-year workforce plan for the NHS?

An overriding theme in my conversations with bereaved parents was the CQC’s hesitancy to prosecute. Cases were often supported in the first instance, but families were then informed, just days before the three-year statute of limitations expired, that the CQC would no longer be seeking a prosecution, with the families having no time to appeal that decision. Does the Minister believe that a three-year statute of limitations is appropriate when families dealing with bereavement are often not even considering a case in the first 12 months?

Does the Minister have any concerns about the CQC’s ability as a regulator? Or does she agree with the parents that there is a reluctance to prosecute by the leadership of CQC when there have been failures in patient care? Does the Minister support calls from Sands and Tommy’s charities for all triage phonelines to be recorded, as currently they are not?

Finally, parents repeatedly reported to me that the bereavement care they received felt like a tick-box exercise, with a lot of focus on the mother and a lack of communication and support for the father, when both have suffered that bereavement. Does the Minister agree that communication could be vastly improved across maternity services in all cases, so that both parents have the opportunity to understand what happened in those most vulnerable hours?

I would like to finish by thanking every Member who has come to talk about this important issue. I also thank Donna Ockenden and all who contributed to the creation of the review. My greatest thanks go to all the families who gave up their time to share their stories with me, reminding me that those babies were people, not statistics. They are loved, they are missed, and they deserved better.

--- Later in debate ---

[Jess Brown-Fuller]

I thank all Members from across the House for their constructive approach to the debate. It is clearly an area where there is passion in all parts of the House. I thank the Minister for her replies to the questions, and I am sure that a lot of Members will be writing follow-up letters to Baroness Merron asking for further detail on particular areas. I will forgive the Minister for her “crack on and deliver” pun.

The Minister mentioned that lessons are learned from every tragic event. I will finish by saying that the parents I spoke to did not feel like lessons were being learned from their tragic events, because nobody was asking them what had happened. If just one thing comes out of this debate, let us send this message to all NHS trusts and ICBs: “When there are tragic events, please don’t cover them up. Please contact the parents, because they want to talk to you and they want to make it better for parents in the future and the babies that we lost too soon.”

Question put and agreed to.

Resolved,

That this House has considered maternity services.