Black and Minority Ethnic Babies: Mortality Rates

Lord Markham Excerpts

Wednesday 15th November 2023 Lords Chamber

[Baroness Thornton]

To ask His Majesty’s Government what steps they are taking to reduce the mortality rates of black and minority ethnic babies, following the publication of research from the National Child Mortality Database.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government are committed to tackling disparities for parents and babies. We are addressing this through the National Health Service three-year delivery plan for maternity and neonatal services, which sets out how care will be made more equitable for women, babies and families. Support is also provided through the universal public health programmes and programmes that target vulnerable families.

[Baroness Thornton (Lab)]

My Lords, what is very worrying in a rich country such as the UK, with a universal, mature healthcare system, is that this figure of infant mortality rates for babies and children from black and minority ethnic backgrounds is going up and not down. What does the Minister believe the drivers of this data show and how will the Government reverse it? For example, the Apgar score for testing the health of babies, which is a skin tone test, does not work for black and brown babies.

[Lord Markham (Con)]

I thank the noble Baroness for her Question and for her work in this space. I have tried to delve into the numbers. It seems that roughly half the reasons why black and ethnic minority people have higher death rates are to do with socioeconomic and lifestyle factors: where they live, levels of obesity, drinking, smoking and those sorts of factors. Clearly, behind that there is a lot that needs to be done in terms of education and support, folic acid in bread and folic acid generally. The other half is more to do with racial factors. English as a second language is a key thing behind that. I hate to make generalisations, but the fact that black and ethnic minority mothers can often be less assertive means that clearly there you need training of staff to take more time, listen more, make sure that they are understanding and asking the questions to find out whether the issues are there.

[Lord Sewell of Sanderstead (Con)]

My Lords, to what extent is the research programme of the Office for Health Improvement and Disparities looking into this area of health disparities in childbirth and death in childbirth?

[Lord Markham (Con)]

The database from which all the evidence and data have come has just been published. That is exactly why we are publishing the database: so that we can understand the reasons behind it. We are also tying that to the NIHR to see what research is needed in those areas.

[Lord Allan of Hallam (LD)]

My Lords, behind every figure in the national child mortality database lies a personal family tragedy, which we all need to try to understand and reduce as far as we can, as the Minister said. The regional breakdown of the figures shows that there is much less variation between different ethnicities in London than in other English regions. Will the Minister look into that to see whether there are things we can learn from London—perhaps there the staff follow procedures where they are more responsive to people from varied cultural and ethnic backgrounds —so that those lessons can be applied in the rest of England?

[Lord Markham (Con)]

Yes, absolutely. One main reason for that is that in London there is generally a more ethnically representative mix of staff, who are better placed to understand and work in that way. Clearly, we need to increase training as well as recruitment across the rest of the country to make sure that they achieve the same levels.

[Baroness Chakrabarti (Lab)]

My Lords, the Minister will know how highly regarded he is in this place as one of the most caring members of the Government, but what does he say to the comments of the president of the Royal College of Paediatrics and Child Health about how troubling these figures are in a wealthy nation such as ours and about child poverty in this country being a driver of child mortality? What will the Government do about that?

[Lord Markham (Con)]

That is specifically what the Best Start for Life programme is all about. It is a joint Department of Health and DfE £300 million initiative focused on the 75 most deprived areas and local authorities. As the noble Baroness might be aware, the whole reason Andrea Leadsom wanted to come back as a Minister—I was talking to her about this yesterday—was to drive this programme, which she is passionately behind. That work is being done through family hubs, making sure that the whole family is involved and bringing in the dads. That sort of action is very much focused on making sure we tackle this.

[Baroness Blackwood of North Oxford (Con)]

My Lords, every year 4,000 babies die due to pregnancy-specific conditions such as pre-term birth and pre-eclampsia, but 73% of drugs given to pregnant women do not have any safety information and only one drug has been developed specifically for use in pregnancy over the last 30 years. During that time, 600 drugs have been developed for cardiac conditions. Will the Minister look at the report Safe and Effective Medicines for Use in Pregnancy: A Call to Action from the University of Birmingham, which offers sensible and effective ways to put this right and reduce deaths in pregnancy?

[Lord Markham (Con)]

Yes, I would be very happy to take up my noble friend’s suggestion and will make sure that the regulators, NICE and the MHRA, are linked into that as well.

[Baroness Whitaker (Lab)]

My Lords, research has shown that the mortality rate among Gypsy, Roma and Traveller children is far higher than among any other minority-ethnic group, yet this is hardly ever reflected in any account of the situation. Will the Minister get his department to recognise more explicitly the disproportionate mortality rate in this often unrepresented ethnic-minority group?

[Lord Markham (Con)]

Yes. Obviously, we want to find every group and then understand the targeted action around them. Noble Lords will have often heard me say that one of the most effective bits of joined-up government I have ever seen was the Troubled Families initiative, led by the noble Baroness, Lady Casey, and I am interested in the 13 local authority pilots that are using wraparound services to identify community groups and troubled families in particular and provide them with cross-government help.

[Baroness Manzoor (Con)]

My Lords, my noble friend will know that over the last four years the NHS workforce has grown by over 14%, but in the workforce for midwives there is a shortage of 2,500, according to the Royal College of Midwives. Can the Minister say what the Government are doing to ensure that we have sufficient midwives on the wards and, more particularly, a diverse workforce from ethnic minorities who will become midwives and health visitors? The numbers do not look great and of course this plugs in to the prevention strategy the Government have in place.

[Lord Markham (Con)]

Yes, it absolutely does fit into it. We have increased the number of maternity staff by about 14% since 2010, and the long-term workforce plan is all about making spaces for 1,000 extra students and having many routes into it. Noble Lords have often heard me talk about how my mother got into nursing as an older mum—she got into maternity services. There are apprenticeships and later-life opportunities. You should not only be a graduate; you often know much more about life when you are that bit older, especially if you are a mum.

[Lord Scriven (LD)]

My Lords, child mortality rates in all high-income countries, apart from this one, are improving. What is it about this country that is causing this, and what evidence do the Government have to show that there is a specific problem here? What measures will be used to tackle this, and by what dates will this be done?

[Lord Markham (Con)]

I have specifically investigated infant mortality rates. If you look at it, you see the increase is in pre-24-week term cases. Post 24 weeks, the number of cases has remained stable, the data has shown. I have been trying to drill down to understand why it happens within less than 24 weeks. Clearly, more work needs to be done. We are also changing the way this is being measured. We are looking for more indications of whether there are early signs of life, and if there are no early signs of life, that is not recorded as a death. Now there is a lot more investigation to understand those early signs of life, so the change in measurement could be increasing the numbers. I am happy to go into more detail on that.

[Baroness Lister of Burtersett (Lab)]

My Lords, further to the question from my noble friend Lady Chakrabarti, the recent Joseph Rowntree Foundation report on destitution found that minority ethnic groups are disproportionately affected by destitution. What steps are the Government taking directly to reduce destitution among this group?

[Lord Markham (Con)]

Again, noble Lords will know that housing, to my mind, is key to so much of that, and the whole building programmes and the million extra houses are a key part of that. If you look into health across the board, you see that the homeless, for instance, use and need A&E services more than ever. Clearly, it is a root cause we need to tackle.