World Prematurity Day

Justin Madders Excerpts

Tuesday 24th November 2015 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is an honour to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Daventry (Chris Heaton-Harris) on securing the debate and on how he introduced the subject, which, as he rightly said, does not receive enough attention in the House or in the media. Hon. Members from all parties have made excellent and sometimes very moving contributions to this debate; I am pleased to have the opportunity to respond on behalf of the Opposition.

World Prematurity Day on 17 November gives us the opportunity to raise awareness of premature birth and concerns involving pre-term babies and their families. The landscape is ever changing; advances in medicine mean that many more babies survive than ever before, and many survive at very young ages that even a few years ago would have seemed impossible. We should warmly welcome those advances, while acknowledging the extra demands that they bring. We should also use this debate as an opportunity to take stock of the progress that we have made in improving outcomes for premature babies and, more importantly, to focus on the challenges that we face and what more we can do to ensure that progress continues.

This issue is extremely significant, and I am pleased to see it receiving attention and a good turnout by Members. As the hon. Member for Daventry said in his opening remarks, an estimated 15 million babies around the world are born prematurely each year, and pre-term birth problems remain the leading cause of death among children under five, responsible for nearly 1 million deaths in 2013 alone. The World Health Organisation estimates that if everyone had access to the same kinds of intervention that we in the developed world enjoy, three quarters of those babies could be saved. This country has a proud cross-party tradition of supporting international development, and I hope that world prematurity day will provide a catalyst for us to redouble our efforts to support programmes to improve outcomes worldwide.

Turning to matters closer to home, in 2013 more than 50,000 babies were born prematurely in England and Wales, meaning that tens of thousands of families faced one of the most terrifying and physically and emotionally exhausting experiences imaginable. I recently spoke to one of my constituents about the issue, and I wanted to share her story with the House, as I am sure that it will be familiar to many who have, sadly, faced the same issues. She told me:

“My twins were born nine weeks prematurely, and seeing your tiny poorly babies hooked up to machines and wires, having to watch while your baby’s heart has stopped and seeing them helped back to life, praying the machine will pick up a rhythm again, isn’t something that I would wish on my worst enemy.”

I am sure that some Members will recognise the intensity of that statement. She goes on to say:

“All we want is for all premature babies to be looked after and given the best chance possible, with the best medical care available to help them to survive”.

Who can disagree with that? I am pleased to say that my constituent’s twins are now four years old, fit and healthy and attending a local primary school, which by coincidence I visited last Friday.

We have made significant progress on increasing the number of premature children who go on to live full lives. Mortality rates have improved year on year, falling by 15.5% between 2006 and 2012. Thousands of people are alive now who would simply not have survived in previous decades. That is the impact of the progress that we have made in recent times, and particularly of advances in treating the most premature babies. We should be rightly proud of that.

However, there is no room for complacency. I am sure that hon. Members share my concern about the recent report by the charity Bliss, which has already been highlighted, particularly by the hon. Member for Daventry. The report, “Hanging in the balance”, argues that neonatal services are “stretched to breaking point” and states that two thirds of neonatal intensive care units do not have enough doctors and nurses, with 2,140 more nurses needed to fill the gap. It also identifies a shortage in junior doctors, a situation that could worsen if the Government do not reverse their current antagonistic stance toward the profession.

The Bliss report goes on to state that more than 850 babies were transferred between hospitals last year because there was not enough space or staff at the units where they were. More than 100 of those babies were ventilated. Such transfers are unnecessary and risky. Frankly, at such a time, the family has quite enough stress already, so I hope that we can work to reduce the number of transfers needed in future.

A report by the Royal College of Midwives states that more than 40% of wards became so busy last year that they were forced to close their doors. The average unit closed its doors on five occasions, with some closing more than 20 times. That situation cannot be allowed to continue. One key issue is training. Trusts currently face the Catch-22 situation of having insufficient qualified staff to cover for nurses on training, while the lack of training contributes to the shortage of qualified staff.

It is clear that a co-ordinated approach is required from the Government, the NHS and local managers to tackle the issue. We welcome the announcement by the Secretary of State on 13 November of extra investment in high-tech digital equipment and training, but we question just how far £4 million will go, particularly when we consider that the shortfall in nurses has almost doubled in the last five years, while during the same period the proportion of nurses with specialist qualifications has fallen by 19%. I would welcome any comments from the Minister about when we can expect that investment to come on stream, and what impact he expects it to have on the number of staff available in our overstretched neonatal units.

However, the biggest issue is without doubt a lack of adequate funding for neonatal services across the board. We welcome the work being done by NHS England and its partners to review the payment model for neonatal services and the priority being given to this area in next year’s NHS plans. I hope that the Minister will be able to reassure us that that will result in the increases in funding that are required to provide the right level of care for premature babies. I also hope that he can reassure us that we will be able to provide that care in the right place, with the number of transfers being minimised as far as possible.

As I set out earlier, there has been a huge amount of progress in reducing the rates of stillbirths and infant deaths. Sadly, however, we know that there is further work to do. The national confidential inquiry, which was led by the University of Leicester, found that more than 60% of stillbirths might have been avoided with better care. As the hon. Member for Daventry said, Britain is currently ranked 33rd out of 35 countries in the developed world for stillbirth rates. As the hon. Member for Colchester (Will Quince) said, that is a national scandal, and there is an urgent need for improvement. He also quite rightly pointed out the massive regional variations that exist. Those variations should be avoidable, and they inform us that best practice should be disseminated further so that improvements can be made across the board.

We welcome the Secretary of State’s declaration of his ambition to reduce the rate of stillbirths and neonatal and maternal deaths in England by 50% by 2030. However, as the hon. Member for Strangford (Jim Shannon) pointed out, the rate of stillbirths has remained stable for the last 10 years and 2030 is clearly a long way off, so we hope that some of the issues can be tackled in the much shorter term. I would welcome any comments from the Minister about what progress is expected within the next five years.

I will return to the experience of my constituent for a moment. In addition to telling me about the obvious pain that she experienced during the time that her babies were in hospital, she went on to express to me something that appears, sadly, to be common among mothers of premature children—a sense of guilt for not being able to carry their children until full term. My hon. Friend the Member for Torfaen (Nick Thomas-Symonds) quite rightly raised the issue of parental health, as did the hon. Member for Banbury (Victoria Prentis), and we have heard that up to 40% of mothers of premature babies are affected by postnatal depression soon after birth. So it is not just the premature babies who need the care; it is the parents as well. That is why it is so concerning that a third of neonatal units have no overnight accommodation, 41% have no access to a trained mental health worker and 30% are unable to offer psychological support.

My hon. Friend the Member for Croydon North (Mr Reed) highlighted the challenges set out in the campaign The Smallest Things, including the financial, emotional and developmental challenges that premature births create, and the impact that those challenges can have on the mental health of parents. Interestingly, he also touched on the need for greater flexibility in maternity and paternity leave. Although we have legislation on such leave, it is a fact that working mothers still face considerable workplace discrimination, and from what my hon. Friend said it seems that those problems are exacerbated when a mother is dealing with a premature birth. I hope we will see some recognition of that issue by the Minister.

I also hope that the Minister can confirm to us what steps he will take to expand access to mental health services in neonatal units. We should also point out that services have been stretched, so a significant allocation of resources is required if progress is to continue to be made.

We will continue to hold the Government to account to ensure that the vision of England as one of the safest places in the world to have a baby becomes a reality, and while the Government continue to make progress they will have our support.