Baby Loss

Philip Dunne Excerpts

Thursday 13th October 2016 Commons Chamber

[Victoria Prentis]

I thank my hon. Friend for his helpful intervention.

We in the all-party group welcome the MOJ’s consultation and the subsequent response, which was published just before the summer. It seems that we are—I really hope we are—on the cusp of making some very important changes in this area. I ask that we push for these changes to happen speedily, because they are really important.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am very grateful to my hon. Friend for letting me intervene during her impressive and important speech. On the back of that comment, I want to inform the House that my colleague the Under-Secretary of State for Justice, my hon. Friend the Member for Bracknell (Dr Lee), announced last month the formation of a national cremation working group. It is now working with all interested parties, and it intends to take evidence from Members of the House. I strongly encourage all hon. Members with such an interest to participate.

[Victoria Prentis]

I very much thank the Minister for that intervention. We in the all-party group were thrilled about the formation of that group.

In that contest, may I give the House a few more examples from the response of the MOJ that we feel are particularly important to take forward speedily? We hope that the MOJ will provide a statutory definition of ashes to make it clear that everything cremated with a baby, including personal items and clothing, must be recovered. We hope that the MOJ will amend cremation application forms to make explicit the applicant’s wishes in relation to ashes that are recovered. Crucially—I know this point is very important for many Members in the Chamber—we hope that the cremation of foetuses of fewer than 24 weeks’ gestation can be brought within the scope of the regulation, where parents wish that to happen. There is some positive news in this very sensitive area.

Moving on to the future of maternity services more generally, my overriding constituency concern at the moment is the future of the Horton general hospital. In fact, if I am honest, it occupies most of my waking moments, and my children complained during our summer holiday in August that I cannot formulate a sentence without the word “Horton” in it, which I fear is true. This summer, I found the lid repeatedly lifted on my own experiences, as we have real safety concerns about the downgrading of our obstetrics unit at the Horton general hospital.

Since last week, a midwife-led unit remains at the Horton general hospital, but all mothers who might—might, not necessarily will—need obstetric care, which is of course the majority of them, have to go under their own steam or be transferred as an emergency to the John Radcliffe hospital in Oxford. In a blue-light ambulance, that journey of between 22 and 27 miles, depending on the route taken, takes about 45 minutes. If my labouring mothers travel in their own car—of course, not all of them have one—the journey can easily take up to an hour and a half, depending on where they live and on the state of the Oxford traffic. The decision to downgrade the service was taken on safety grounds, as the trust had failed to recruit enough obstetricians, but I must say that I have severe safety concerns for the mothers and babies in our area. In 2008, an Independent Reconfiguration Panel report concluded that the distance was too far for our unit to be downgraded. As I see it, nothing has changed except that the Oxford traffic has worsened. I am keen, generally, that we start to be kinder to mothers during pregnancy and birth, and in my view, that does not mean encouraging them to labour in the back of the car on the A34.

We know that personal care leads to better outcomes. We need to take very careful note of Baroness Cumberlege’s recommendations in her “Better Births” report. She said that births should

“become safer, more personalised, kinder, professional and more family friendly”.

We must use the impetus of events such as this week to drive through her major recommendations.

Chief among these recommendations must be the recommendation for continuity not of care but of the carer, which has been shown to reduce premature deaths by 24%. Professor Lesley Regan, recently elected the first woman president of the Royal College of Obstetricians and Gynaecologists for 64 years, has done a plethora of well-evidenced research on miscarriage, demonstrating again and again that a system of reassurance and continuity, with weekly scans and meetings with a midwife, has reduced the rate of recurrent miscarriage by 80%. That figure of 80% is for women who have miscarried three or four times.

My hon. Friend the Member for Eddisbury mentioned the excellent work being done at Queen Charlotte’s as well. In this context, I am troubled that the sustainability and transformation plans might push us towards larger and larger units with less personal care. I may be wrong— I hope I am—and perhaps it is safer for such giant units to deliver the majority of babies, but I worry that in our case in Banbury decisions are being taken about my constituents without their views being considered and without real evidence of the risks involved.

Everyone in the House today is clearly committed to reducing baby loss, and I have never heard such emotion in a debate. We have evidenced-based research to show us how, in part, to do that. I refer the Minister very firmly to Baroness Cumberlege’s report. Yes, better bereavement care is important. Sadly, some babies will always die, as mine did, but let us really now make a commitment to reduce miscarriages and deaths from prematurity.

I need to be able to tell my constituents that they will not have to suffer as I did.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am humbled to be responding to this debate. It is undoubtedly the most moving debate that I have participated in during the 11 and a half years I have been in the House and I pay an enormous tribute to all those who have spoken, particularly those who spoke of their own personal experiences. I shall touch on that further in a few moments. I want to start by congratulating my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince) on initiating this debate during baby loss awareness week. I also commend them on the remarkable progress they have made in launching the all-party parliamentary group on baby loss and on securing cross-party support for it. The group has had an unusually large impact compared with the plethora of other groups, and it has managed to achieve a Commons Chamber debate within a few months of being set up. That is an unusual and impressive achievement by them and the other officers of the group on both sides of the House.

Yesterday, hon. Members from across the House showed tremendous support for the work of the group. This was evidenced by the support from Mr Speaker in hosting a reception in his state rooms which was attended by many of the 21 pregnancy and baby loss charities that are dedicated to arranging support and care for families that go through this terrible experience. Events such as those that have taken place throughout the week here in the House—and indeed on Twitter, as the hon. Member for Ellesmere Port and Neston (Justin Madders) mentioned earlier—help to raise awareness for the families who suffer this loss, often in silence. One of the things that has struck me most about this debate is the determination of those who have experienced such loss, either directly or through their families or constituents, not to allow the issue to remain in the closet.

I would like to address some of the comments that have been made and to applaud the contributions and interventions that we have had today from the more than 30 hon. Members who have spoken of their own personal experiences and those of their constituents. Interestingly, although we have had contributions from 17 Back-Bench women, we have also had contributions from 13 Back-Bench men, some of whom have had personal direct experience as well. Particularly moving have been the contributions from Members who have not raised their experience of this issue in public in this place before. They included the hon. Members for Lewisham, Deptford (Vicky Foxcroft) and for North Ayrshire and Arran (Patricia Gibson), my hon. Friend the Member for Banbury (Victoria Prentis)—she might have mentioned it before, but she made another moving contribution today—my hon. Friend the Member for Gower (Byron Davies) and the hon. Member for Glasgow North West (Carol Monaghan). Such personal testimony obviously touches the heartstrings of everyone who hears it, and there was barely a dry eye in the House when they were speaking. I pay tribute to their courage in making so clear the pain that they went through, either recently or some years ago. Foremost among those Members are my hon. Friends the Members for Eddisbury and for Colchester, who brought this matter so vividly to our attention with their speeches nearly 12 months ago.

I shall not go through every contribution that has been made today, but I shall try to refer to many of them in my remarks. In particular, I should like to pay tribute to the hon. Member for Ellesmere Port and Neston for his very thoughtful contribution and for the spirit in which he made it. I shall try to address most of his questions as I continue. Before I forget, I should like to address the question put by my right hon. Friend the Member for Crawley—

[Sir Nicholas Soames]

Mid Sussex.

[Mr Dunne]

I am sorry. Have I got it wrong again?

My right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) asked about progress on screening for group B streptococcus, and I can reassure him that the UK national screening committee is reviewing its recommendation on antenatal screening for GBS carriage as part of its three-yearly review cycle. It will be taking new published evidence into account. We are anticipating that a public consultation will be held on this topic shortly, and I am sure that my right hon. Friend will want to participate in it. Once it has been concluded, we will review the recommendations that emerge.

The loss of a baby is clearly devastating for its parents and the family, regardless of when or how the death occurs. Those experiencing the heartbreak of miscarriage, stillbirth, the death of an infant or the decision to terminate a much-wanted pregnancy need our support and kindness, and the acknowledgement that their child was here for a short time and was loved. I have been deeply struck by the comments about the lack of sensitivity that can occur when such a loss takes place, and it is absolutely right that the Department of Health should encourage best practice across the NHS in order to minimise the distress caused by insensitive conduct on the part of those involved in supporting families at this time.

Such feelings of loss are real, but as has been said, in particular by my hon. Friend the Member for Gower, who explained this dispassionately and clearly, the issues are often not discussed. Many of us do not realise that on an average day in England around 32 women will be diagnosed with an ectopic pregnancy, 15 babies will be stillborn and eight babies born on that day will die before their first birthday. Most of those infants will probably be less than a month old. It is therefore important that we in Parliament discuss the issues around baby loss and the care for those families experiencing such tragedies.

I want to talk about the steps we are taking with the NHS to reduce stillbirths and other adverse maternity outcomes. I also want to talk about what we are doing to support families who experience this loss. England is a very safe country in which to have a baby, and it is encouraging that the stillbirth rate in England has fallen from 5.2 per 1,000 births in 2011 to 4.4 in 2015. In 2014, the neonatal mortality rate was 2.5 deaths per 1,000 births, and the rate of deaths in babies aged 28 days to one year was 1.1 per 1,000 births. Those rates have been steadily declining and are now at their lowest levels since 1986. There is, however, as we have clearly heard from every contribution today, more that we can do, and, as a Government, we are determined to do so.

It is important that we do not accept all miscarriages, stillbirths, pregnancy terminations or neonatal deaths as inevitable, or simply nature taking its course, as has been touched on by a couple of contributions today, because many of them might have been prevented.

When compared with similar countries, our stillbirth rates remain unacceptable. In the stillbirth series of The Lancet, which was published earlier this year, the UK was ranked 24th out of 49 high-income countries. The same publication showed that the UK’s rate of progress in reducing stillbirths has been slower than that of most other high-income countries. The annual rate of stillbirth reduction in the UK was 1.4% compared with 6.8% in the Netherlands. That places us, as we heard from my hon. Friend the Member for Eddisbury, in the bottom third of the table, in 114th place out of 164 countries around the world, for progress on stillbirths.

We also know that the rates of death in some higher risk groups are not coming down. Again, that was referred to by my hon. Friend the Member for Colchester. According to the Twins and Multiple Births Association, stillbirth rates for pregnancies involving twins, triplets or more increased by 13.6% between 2013 and 2014. Multiple births make up 1.5% of pregnancies in the UK—around 12,000 pregnancies each year—but a disproportionate 7% of stillbirths and 14% of neonatal deaths.

We want NHS maternity services to be an exemplar of the kinds of results we can achieve when we focus on improving safety. With a concerted effort, we can make England one of the safest places in the world in which to have a baby. That was why, last November, the Secretary of State launched a national ambition to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 2030, with a shorter-term aim of achieving a 20% reduction in each of these rates by 2020. I am glad that that was recognised by my hon. Friend the Member for Eddisbury and pleased that she will be keeping an eye on the progress that we make each year to achieve those targets.

To support the NHS in achieving this stretching ambition, the Government have announced plans for investment. There will be a £2.24 million fund to support trusts to buy monitoring or training equipment to improve safety. More than 90 trusts have been successful in receiving a share of the fund, enabling them to buy equipment such as training mannequins, and foetal or maternal monitoring equipment such as carbon monoxide monitors and portable ultrasound equipment.

As my hon. Friend the Member for Colchester acknowledged, we are also investing in the roll out of training programmes to support midwives, obstetricians and entire maternity teams to develop the skills and confidence they need together to deliver world-leading safe care. We hope to be able to say more about how maternity services can apply for this funding soon.

We are also providing funding via the Healthcare Quality Improvement Partnership for developing the new system—the standardised perinatal mortality review tool—which, once complete, should be used consistently across the NHS in Great Britain to enable maternity services to review and learn from every stillbirth and neonatal death. That was an important element of the APPG’s vision for the future. We need to develop proper learning and understanding from what goes wrong, and then the lessons learned should be spread to maternity services across the country. As my hon. Friend the Member for Grantham and Stamford (Nick Boles) emphasised, many reports have highlighted that we do not effectively learn from our mistakes. Indeed, the guidelines of the Royal College of Obstetricians and Gynaecologists state that all stillbirths should be reviewed in a multi-professional meeting using a standardised approach on analysis for substandard care and future prevention. That is something that we would like to see taken up.

We must view individual failings as important and recognise the need for accountability, but balance that with a need to establish standard processes that can prevent avoidable mistakes from happening again. In April we established a new independent healthcare safety investigation branch to carry out investigations and share findings. The HSIB will operate independently of Government and the healthcare system to support continuous improvement by using the very best investigative techniques from around the world, as well as fostering learning from staff, patients and other stakeholders.

An important improvement in maternity care is care that is more collaborative and responsive to the needs of women. Several Members referenced the investigations by Sands, the stillbirth and neonatal death charity, which has revealed that 45% of women who raised a concern with a health professional during pregnancy were not listened to and then went on to have a stillbirth. Clearly, that is not acceptable. All women should receive safe, personalised maternity care that is responsive to their individual needs and choices.

The hon. Member for Ellesmere Port and Neston asked where we are on supporting those with mental health conditions through pregnancy. I draw his attention to the announcement in January in which the Government set out that an additional £290 million will be made available over the next five years to 2020-21 to invest in perinatal mental health services. That is funded from within the Department of Health’s overall spending review settlement, and it will go a long way to providing support for women who are pregnant and need mental health counselling both before and after birth.

Last November we asked the national patient safety campaign Sign up to Safety, which was launched by the Government in 2014, to support all NHS trusts with maternity services to develop plans to improve safety and share best practice. In March this year we launched “Spotlight on Maternity”, with guidance for maternity services to improve maternity outcomes. This set out five high-level themes that are known to make maternity care safer that services could focus on: building strong clinical leadership; building capability and skills for all staff; sharing progress and lessons learned across the system; improving data capture and knowledge; and improving care for women with perinatal mental health problems.

In February this year, “Better Births”, the report of the independent national maternity review that was chaired by Baroness Cumberlege, was published, and hon. Members have touched on it today. It sets out that the vision is for maternity services across England to become safer, more personalised, kinder, more professional and more family-friendly. The Department of Health is leading the promoting good practice for safer care workstream of the maternity transformation programme that was launched last July to deliver the vision set out by the national maternity review, and we will set out our action plans shortly.

As my hon. Friend the Member for Eddisbury highlighted, it is vital that we support research into the causes of stillbirths and neonatal deaths so that we can better understand how to identify babies at risk and improve services. In recent years, the Government have invested in research, looking at important questions regarding stillbirths and neonatal deaths. From 2012, the National Institute for Health Research biomedical research centres at Cambridge and Imperial College will have invested £6 million over five years in research on women’s health, including research to increase understanding of the causes of still births and neonatal deaths. We continue to encourage research bids for new studies that will help us to identify babies at risk.

The evidence shows that this stretching ambition cannot be achieved through improvements to NHS maternity services alone. The public health contribution will be crucial. As The Lancet stillbirth series concluded, some 90% of stillbirths in high-income countries occur antenatally and not during labour.

We heard from a number of hon. Members about the need to do more to highlight risks during pregnancy so that women are aware of what they can do while they are pregnant to minimise the risks. When starting pregnancy, not all women will have the same risk of something going wrong, and women’s health before and during pregnancy is one of the factors that influence rates of stillbirths, neonatal deaths and maternal deaths. We know that a BMI of over 40 doubles the risk of stillbirth, that a quarter of stillbirths are associated with smoking, and that alcohol consumption is associated with an estimated 40% increase to stillbirth risk. In addition, the MBRRACE—Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries—report published in June last year showed that women living in poverty had a 57% higher risk, babies from BME groups have a 50% higher risk, and teenage mothers and mothers over 40 have a 39% higher risk.

[Tim Loughton]

I sense that the Minister is coming to the end of his speech—if you have anything to do with it, Madam Deputy Speaker. Will he give me a guarantee that he will look into the registration of stillbirths? He has not mentioned that yet.

[Mr Dunne]

I will come back to my hon. Friend’s point just as I conclude.

These striking facts are why the Department of Health will continue to work closely with Public Health England and voluntary sector organisations to help women to have a healthy pregnancy and families to have the best start in life. A new information campaign will be launched shortly, and I encourage all hon. Members to support it during the launch period.

I would like to say a few words before I conclude about the importance of delivering good bereavement care for those families who have experienced baby loss, which was a topic raised by many hon. Members. Having not gone through the experience myself, I can scarcely comprehend how devastating it must be for parents to lose a baby. It is important that parents receive appropriate care and support as sensitively as possible when that occurs. The MBRRACE report that I referenced stated that 60% of parents currently receive a high standard of bereavement care, but that clearly leaves 40% who do not, which is not good enough.

Since 2010, we have invested £35 million in the NHS to improve birthing environments, including better bereavement suites and family rooms at some 40 hospitals, to support bereaved families. I have seen some of those rooms, including the superb suite opened last month in the Medway Maritime hospital, which I think was one of those that indicated that it did not have such a suite when my hon. Friend the Member for Eddisbury undertook her research. We have heard from my right hon. Friend the Member for Broxtowe (Anna Soubry) about the recent improvement in Nottingham.

We have been working with Sands, the Miscarriage Association, the Lullaby Trust and others to understand the challenges that maternity services face and to highlight areas of good practice. I am pleased that the all-party group’s report, which was published this week, recognises the work that we are supporting to develop an overarching bereavement care pathway to help to reduce the variation in the quality of bereavement care provided across the NHS.

In response to the comments made by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) in his intervention and elsewhere during the debate, I should like to say that I have been impressed by comments made about the distress caused by the registration of post-24 week baby loss, often in the same place where mothers with young babies are registering births. I can well imagine that that compounds the sense of grief. It is appropriate that we look at best practice and the common-sense delivery of registration to see whether it could be spread more widely, so I will ask officials to look at that, but I am not promising legislation.

I again thank again all hon. Members for participating in the debate and their deeply moving contributions. In particular, I thank those who secured the debate for their work in driving the all-party group and raising awareness across the nation. It is important that we as a Government try to drive an improvement in outcomes, and I reassure hon. Members that the Government are fully committed to reducing the number of babies who die during pregnancy or in the neonatal period, and to supporting those families who are bereaved. Although the Baby Loss Awareness Week events here in Westminster culminate with today’s important debate, other events are continuing to take place throughout the United Kingdom and internationally. I should like to encourage everyone to join in the global wave of light, which we heard about earlier this afternoon, by lighting a candle at 7 o’clock this Saturday 15 October and letting it burn for one hour in remembrance of all the babies who have died during pregnancy or at, during or after birth.