[Mr Philip Hollobone in the Chair] — World Prematurity Day

– in Westminster Hall at 9:30 am on 24th November 2015.

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Photo of Chris Heaton-Harris Chris Heaton-Harris Conservative, Daventry 9:30 am, 24th November 2015

I beg to move,

That this House
has considered World Prematurity Day.

It is a pleasure to serve under your chairmanship, Mr Hollobone. This subject does not get enough attention in this place, or indeed in the media. In the previous Parliament—in a Westminster Hall debate and elsewhere—I raised the subject of stillbirth, as I have a very good friend who suffered possibly one of the worst stillbirth events that I have ever heard of. I asked lots of questions in this place on that subject, including at Prime Minister’s questions, because I truly believe that we need to raise awareness of these matters. I worked very closely with Sands and with a charity called Bliss, whose strapline is,

“for babies born too soon, too small, too sick”.

Those organisations really care passionately about neonatal issues.

Photo of Nick Thomas-Symonds Nick Thomas-Symonds Shadow Minister (Work and Pensions)

It is a pleasure to serve under your chairmanship, Mr Hollobone. I warmly congratulate the hon. Gentleman on securing this very important debate. I have received a number of emails about the debate, including from a constituent, Samantha Evans, whose son Dylan was born in the 27th week of pregnancy. Across the emails I have had, there is a wonderful sense of how great the care provided by the NHS to premature babies is. I absolutely praise that, but suggest that perhaps in policy development in future, it might be useful to look at what support can be provided to the parents of premature babies.

Photo of Chris Heaton-Harris Chris Heaton-Harris Conservative, Daventry

I thank the hon. Gentleman for his intervention. He is absolutely right, and I will come on to that later. I, too, have had a lot of contact from my constituents on this issue. In fact, at my very first surgery—or advice centre—as a Member of Parliament back in 2010, a lady called Catherine Allcott came in, and it is through her that I got involved with the charity Bliss. I asked whether she would mind if I read out a couple of paragraphs about what happened to her and why this issue is so important to so many parents such as her and her husband, Nigel. She very kindly agreed, so to set the scene for Members, I will read out Catherine and Nigel’s story.

Their twins, Luke and Grace, were born in the early hours of the morning of 4 May 2006, at 26 weeks’ gestation. The twins’ premature birth caused serious health problems, including brain bleeds, suspected meningitis, necrotising enterocolitis and heart problems. Although Grace is now a happy, healthy child, sadly, Luke died nearly four months after being born. Catherine tells me:

“One of the things we found hardest to deal with at that time was the fact that there was often only one nurse in the NICU”— the neonatal intensive care unit—

“usually to three or four babies.”

She was on the unit so much because of the issues she was experiencing and because she felt so uneasy about that situation, and that is why she has been involved ever since.

Catherine says:

“When I was there sometimes I would have to help the nurse on duty by running into the next room to fetch help. I often wondered what happened when I wasn’t there. When the nurses would tell me not to spend so much time on the unit, what was I to do? Tell them I didn’t trust them with so many babies to look after?”

She goes on to say:

“As a committed campaigner for high quality neonatal care I am saddened to think that in ten years very little has changed in terms of staffing units safely and effectively. How many babies have died or now endure life changing illnesses because there simply weren’t enough nurses to care for them appropriately, and what cost is that to the NHS?”

Catherine’s story is really significant. She took me on to the Gosset ward—the neonatal ward—in Northampton general hospital. I was told by a junior doctor who works there that it has all completely changed; it has been refitted and is a much nicer space. There is no doubting the passion and the care that the staff on the ward give, but equally, there is no doubting the pressure that they are under and the fact that we can help to improve the conditions for them.

World Prematurity Day takes place on 17 November every year—we have just missed it, but this was the closest time to World Prematurity Day that I could get for the debate. The day is aimed at raising awareness of the issues facing premature babies. It is co-ordinated by a global coalition of charities and groups, including Bliss, each year.

The global statistics are quite astonishing: 15 million babies are born prematurely worldwide each year—that is 29 babies every minute, and one in 10 of all babies born—and in the UK, that equates to nearly 60,000 babies born prematurely each year. Bliss estimates that 113 babies who need specialist care to help them survive and thrive are born every year to parents living in my constituency. About 61 of those babies are born prematurely, at under 37 weeks’ gestation. Those born at under 32 weeks’ gestation are considered very pre-term. Those babies are born before they are fully developed and often spend the longest time in neonatal care.

Obviously, most premature births have no clear cause, whereas others are induced due to medical necessity. There is evidence that risk factors for premature birth include smoking, drinking alcohol, substance abuse, low or high maternal age, infection, high blood pressure and multiple births. There is lots of research—although we could always do more on this subject—showing that socio-economic factors also have an impact.

I want to underline the fact that prematurity is a global issue, which is why we have World Prematurity Day. It is the world’s biggest cause of death for young children. Of the 15 million babies that are born prematurely worldwide each year, more than 1 million do not survive. We are fortunate in the UK to have the resources to care for all babies born prematurely, but there is a long way to go before babies and their parents are given the best possible chance.

Photo of Julian Knight Julian Knight Conservative, Solihull

I congratulate my hon. Friend on securing this important debate and on his unstinting work for the families of those who are facing the challenges of a premature birth. Often, one of the most acute problems facing families in that situation is meeting the costs of constant hospital visits. Will he join me in calling on all hospital trusts across the country to follow the Government’s guidelines on hospital parking charges, which would see concessions and even free parking for families of babies who often stay in hospital for months on end?

Photo of Chris Heaton-Harris Chris Heaton-Harris Conservative, Daventry

I concur with my hon. Friend on that matter. I have heard many a story about that. I have also visited the John Radcliffe hospital to see its neonatal unit and talked to parents. In Northampton general hospital’s case, there is a way for someone to get their parking charge back, although actually, if they are the parent of a premature child who is not doing very well, the last thing they think about is where they are going to park and how they are going to pay for the ticket. The grandparent of a baby born prematurely who is not very well does not think about the parking charge when they go in, but it is one of their worries when they leave. We need to do better on that issue and spread some of the best practice that exists in the NHS when it comes to parking charges. Those charges seem like a minor element in the scheme of things, but they are such a big deal to parents, grandparents, friends and family—the support mechanism that builds around a family when a baby is born prematurely and especially when a baby is born unwell. My hon. Friend is completely correct to raise that issue.

As I said, we have a long way to go before all babies born too soon have the best possible chance of survival and of living a good-quality life. The UK mortality rate for babies is quite high for a western European country. I have previously raised in this place an article in The Lancet, going back probably five years now, saying that we ranked 33rd of the 35 top western countries in stillbirth mortality rates. We were in a very poor place, and I struggle with the massive regional variation across our country. I would like to think that we have best practice that spreads across the NHS, but there will always be somewhere that has a number of staff sick and where there is pressure on a unit. However, there should not be a massive regional variation. The Lancet article said that stillbirth was a third more likely in the east midlands than in the south-west, so there are significant issues to deal with. Surely that rate should be equal across the piece.

If the UK could match the mortality rates achieved in Sweden and Norway, for example, the lives of at least 1,000 babies could be saved every year. One thousand babies—that is such a significant statistic. I have met parents of stillborn children and know what they have gone through. Some 1,000 babies each year could be saved with best staffing and better equipment, although the issue is not so much about resources. It is about spreading throughout the whole NHS the best practice that I have seen in various hospitals up and down the country. Concerns about variation in care were highlighted in this year’s Bliss baby report, which found that two thirds of neonatal units do not have enough nurses and two thirds do not have enough medical staff to meet Government standards for safe, high-quality care.

We must talk about this significant issue and raise awareness of it. I sat on the Public Accounts Committee for five years and raised it there when we had the chief maternity officer in front of us, because we should talk about such issues whenever we get the opportunity. I know that those working in the NHS get it—I have spoken to all sorts of people from the top to the bottom of the NHS, and they obviously all care passionately for the parents and want the best outcome for their babies—but we have a long way to go to improve the care available to mothers, fathers and their babies. We need to raise the matter at every opportunity, and when I did so in the Public Accounts Committee the chief maternity officer took me to one side afterwards and said, “We are really working hard on this. This is an issue that we know we can do better on. The Government have announced a strategy to reduce infant mortality by, I believe, 50% by 2030. That is obviously welcome and recognises that we could and should be doing better.

I want to raise a few points about the 2015 baby report by Bliss, which has done so much work in this area. I know that plenty of other charities do fantastic work, but Bliss is one of the biggest, and I have worked closely with it through my constituents, the Allcotts. I very much respect its work. The report, entitled “Hanging in the balance”, found that funding shortfalls, national skills shortages and problems with training and recruitment are leaving many neonatal units without the staff they need to meet Government and NHS standards for safe, high-quality care. It states that 64% of neonatal units do not have enough nurses to meet national standards of safe staffing levels; two thirds do not have enough specialist nurses; two thirds do not have the medical staff they need to meet national standards; and 41% have no access to a trained mental health worker—one of my hon. Friends will raise that point, so I will not go into it in detail—leaving parents and staff without the vital support they need to help them cope.

I emphasise that it is not only parents who need help. When I went to the John Radcliffe hospital, I unfortunately went on a morning when three babies had died the night before. None could have been helped, but although the staff are professional people who know exactly what they are doing and the situation they are working in—they have a huge passion for their role, deliver a huge amount of care and become attached to families in a big way—it was palpable that the unit was feeling down that morning. In fact, I felt that I was getting in the way, so I left as soon as I could. It is not just parents who need trained mental health workers available to them; the staff also need them to help them cope in such situations.

There are insufficient funding accounts for three quarters of nursing shortfallsin neonatal units, and 72% of units struggle with at least one aspect of nurse training and development. From all the time I have been involved with the matter, especially when seen through the glasses that I have put on as Daventry’s MP and from standing beside Catherine Allcott on Gosset ward at Northampton general hospital, I know that attracting people to go into this area of nursing is quite a job. Those who go into it find it remarkably rewarding, but it is also a remarkably tough role. That is one reason why vacancies in this field of nursing specialism have historically been high, and we must address that. The rewards are massive, but occasionally there are unbelievably bad days at work.

We should have a whole host of ambitions nationally. I want to be able to look my constituents, Catherine and Nigel, in the eye and say that I have done everything I possibly can to ensure that what happened to them does not happen to anyone else.

Photo of Gregory Campbell Gregory Campbell Shadow DUP Spokesperson (International Development), Shadow DUP Spokesperson (Cabinet Office)

I congratulate the hon. Gentleman on securing this debate. He is talking about improvements nationally, and I hope that we all concur. Does he agree that the Government should ensure that international best practice and improving statistics in several countries are closely investigated and, where possible, replicated?

Photo of Chris Heaton-Harris Chris Heaton-Harris Conservative, Daventry

I thank the hon. Gentleman for his intervention, and he is absolutely right. Statistics regularly prove that we are not doing as well as our Scandinavian colleagues, and we should look at that. I know that we are doing so—a lot of work is going on in the Department of Health and elsewhere to see where we can improve.

I really want to be able to say to my friends who suffered from a full-term stillbirth that the care available to parents in similar situations is much better than it was for them. I said in my 2010 speech that the mother of the full-term stillborn baby was told at the beginning of a weekend that her baby had passed away, but she was sent away because an anaesthetist was not available, so she had to come back on the Monday to have the baby delivered.

I do not deny that there will always be stillborn and premature babies, but what matters is how we look after the parents and how neonatal units look after the babies. I am absolutely sure that in this Chamber and this Parliament, and across society, we all want to deliver the best possible care in those situations.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

The format in Westminster Hall is that we have the Back-Bench speeches and then, no later than 10.30 am because we are due to finish at 11, we will have the first of the Front-Bench speeches, from the Scottish National party, and then hear from the official Opposition and from the Minister, but if we get to the Front-Bench speeches before that, so be it.

Photo of Steve Reed Steve Reed Shadow Minister (Communities and Local Government) 9:50 am, 24th November 2015

I offer warm congratulations to Chris Heaton-Harris on securing the debate. This is a very important issue, but, as he made clear, it does not get the attention that it deserves. It is right and proper that it is being raised in Westminster Hall today, so close to World Prematurity Day.

I want to refer to a campaign that is based in Croydon North, the constituency that I represent, and that is calling for better support for the parents of premature babies. Called The Smallest Things, it was set up in 2014 by Catriona Ogilvy after her two gorgeous little boys, Samuel and Jack Smith, were born prematurely. She and her husband, Mike, were delighted to be parents. They were excited and full of joy as one would expect, but their lives were turned upside down because of the needs of their children and the fact that they did not feel that they were adequately prepared or supported to provide the care and love that their children needed.

The babies were cared for at the special care baby unit at Croydon university hospital. I had the opportunity to visit that unit with representatives from Bliss, about which the hon. Gentleman spoke. It is a fantastic unit, and I think that it is typical of many across the country. The quality of the care that is given at those special units is fantastic, but when someone walks into one even as a visitor, let alone as a parent, they are overwhelmed by an incredibly emotional feeling, because what they see is wires, tubes, boxes with portholes and bleeping machines and then those tiny little babies, vulnerable and needy, with all that paraphernalia around them. When we talk to the parents there, they are so delighted and relieved to have that support, but also so terrified and traumatised by what their little newborn baby is having to go through. At a time when they are desperate to hold that child and give them the physical love that they need, they cannot touch the child because of the intensity of the care that is being provided. That is incredibly difficult for parents, but we should pay tribute to all the staff who work in those extraordinary and wonderful live-saving units.

However, although the medical care is fantastic, the support for parents is, frankly, inadequate. The Smallest Things campaign is calling for maternity leave to be extended for mothers of premature babies. That is the primary purpose of the campaign and the point to which I hope the Minister will respond. The campaign organised an online petition that secured 10,000 signatures. Many comments that were made, but I will read out just one, which was put on the petition by a mother talking about her experience. She said:

“We had a baby born 11 weeks early and it crippled us. I lost my job because of the time I had taken off. We racked up huge debts on credit cards and 9 months on” are

“still struggling immensely to keep a roof over our heads.”

No parent should be put in that position when they have the stress of a little baby struggling for their life at the same time. As a society, we owe better care to parents in that situation.

There are five reasons why The Smallest Things campaign is calling for maternity leave to be extended and they are as follows: financial; bonding with the child; the child’s development; the mother’s mental health; and employment. I will quickly run through each of those issues. On average, the parents of a premature baby spend an additional £2,255 in the course of the hospital stay, but very little financial support is available to parents in those circumstances. They cannot, for instance, apply for disability living allowance, and there is little flexibility to take additional paid leave from work. Therefore, many parents of premature babies, particularly if they are not earning a great deal of money in any case, are pushed into very difficult financial circumstances and even into debt, which is not a problem that parents in that situation should be forced to live with.

The second reason is about bonding between parent and child. A child can spend months in a neonatal unit and, in those circumstances, it can be near impossible for the parent to spend as much time with the child as they would if they were able to take the child home, but the physical bonding between mother and child is critical to the future healthy development of that child and can continue having impacts even in later life. Extended maternity leave would allow mothers to make up for the loss of that very important physical bonding once the child is no longer enclosed in the way that is necessary in a neonatal unit.

The third point is about development. Premature babies have different development patterns from babies born on their due date, so parents returning to work, perhaps after six months’ maternity leave, may well know that their child has reached the development stage only of a three-month-old. They go back to work worrying that their child has not had the support that they needed to reach the stage of development that they should have reached. Often, that can slow down the child’s development for years afterwards. Added to that is the fact that the child’s physical development is often slowed down. That can lead to much more frequent and regular visits to hospital during the first few years of a child’s life. All of that places further demands on the parents and, if they are working, on the employers to give the parents time off. Where employers refuse to do that, we need more flexibility to be permitted under law. The Government need to make that change, as some employers will not or are not able to do that themselves.

The fourth point is about maternal mental health. There is a huge risk of depression for mothers of premature babies. That arises from the anxiety and stress that they experience in having a child who has to struggle for their life for such a long period in their very early and very formative years. The additional financial pressures to which I have referred can add to that stress. Many mothers, struggling in incredibly difficult circumstances to cope, experience mental ill health, but they may not have been alerted to the signs of that and therefore do not seek treatment early enough. That is damaging not only to the mother but to the whole family, and can be damaging to the child.

The fifth point to which the campaign refers is employment. A planned return to employment can be disrupted by a premature birth. Often, a mother who originally planned to return after six months cannot, which can put people in extremely difficult financial circumstances. We need greater flexibility around periods of paid maternity leave for parents of babies who are born too soon.

The name of the campaign, The Smallest Things, comes from a quote from “Winnie-the-Pooh” by A. A. Milne:

“‘Sometimes,’ said Pooh, ‘the smallest things take up the most room in your heart.’”

It is time for these smallest things to take up more room in the Government’s heart as well. Maternity and paternity support for parents of babies born too soon is currently inadequate. I hope that the Minister will address the need for greater financial support for parents in those circumstances, better provision for paid parental leave and better support for the mental health issues that arise among parents whose babies come into the world too soon.

Photo of Victoria Prentis Victoria Prentis Conservative, Banbury 9:58 am, 24th November 2015

It is a pleasure to serve under your chairmanship, Mr Hollobone, although it is not a great pleasure to listen to the debate. The quality, of course, is excellent, but the subject matter is so sad. I am very grateful to my hon. Friend Chris Heaton-Harris for organising the debate.

It is fair to say that when our son died because he was born prematurely 15 years ago, the focus was, rightly, on the medical situation. I was extremely unwell with pre-eclampsia and HELLP syndrome, which is a leading cause of maternal death worldwide; I am now the patron of the charity in this country. Bliss has reported, and others will speak, about funding and skills shortages in neonatal units. My own experience is that skilled staff worked hard and did all they could for us medically. More could and probably should have been done to create memories. I have spoken and corresponded with my hon. Friend the Minister about that and hope that his excellent work on it will bear fruit. The Minister for family justice is also doing great work for the families of babies who die to ensure best practice during the cremation and burial process.

Today, I want to focus on the other medical services that can make such a difference to premature babies and their families in the long term. This is an issue of growing importance. Just as the elderly are living longer, the very young are surviving in cases where even a few years ago, they would not have done. That is, obviously, good news but, just as with the very old, prematurity presents its own challenges.

First, I turn to mental health, which my friend Mr Reed has mentioned. According to Bliss, 40% of mothers of premature babies are affected by postnatal depression soon after birth, compared with 5% to 10% of mothers generally. For those whose babies die, I suggest that 100% need access to counselling, for both the father and the mother, and possibly for siblings and grandparents as well. It is not acceptable that on 41% of neonatal units, parents have no access to a trained mental health worker and on 30% of neonatal units, parents have no access to any psychological support at all. Not only is allowing mental health problems to go untreated needlessly cruel, but it has wider implications.

The Prime Minister made it clear how important family is to him in a speech last year, when he said that

“for those of us who want to strengthen and improve society, there is no better way than strengthening families and strengthening the relationships on which families are built.”

Sadly, however, a very large number—so large a number I am not even going to mention it—of marriages and relationships break up under the strain of a bereavement or the birth of a very sick baby, and more must be done to face that problem head-on.

Photo of Stephen Hammond Stephen Hammond Conservative, Wimbledon

I am on a Bill Committee upstairs, but I wanted to come down to this important debate. I raised some issues about summer-born children in a debate recently. Does my hon. Friend agree that in the long term, unless a family’s wishes about delaying the start of education are recognised, and unless that is embedded in the code by the Department for Education, significant problems will be experienced not only by the premature child but by the family?

Photo of Victoria Prentis Victoria Prentis Conservative, Banbury

I agree, not least because I am the mother of a daughter who was born on 28 August. Although she was not premature, I am very aware of the difficulties that prematurity carries with it throughout the lives of children who are born too early.

Photo of Julian Knight Julian Knight Conservative, Solihull

My hon. Friend touched on the question of divorce following the sad death of an infant. I wonder whether she would like to reflect on the need for more marriage guidance and support structures for those who face that awful situation, and more widely on how working towards a seven-day NHS will help to alleviate many of the problems that come about with premature birth.

Photo of Victoria Prentis Victoria Prentis Conservative, Banbury

Turning first to the difficulties in relationships, it is true, as I have found out personally and with great difficulty, that fathers and mothers grieve differently. The interface between two very unhappy people can be, as I know from personal experience, very difficult indeed to manage. I am fortunate that my husband and I had been married for a long time before our son died, and we were able to hold it together. We also come from very stable families who were able to provide us with a great deal of support, as was the Church. It is an enormously difficult area for people, however. On the seven-day NHS, yes, it is always terrifying to look at the units at weekends with lower numbers of staff on duty, and to wonder how those people are coping.

I return to poor mental health. It is important to focus not only on the parents but on the babies. From my work with the Parent-Infant Partnership UK, I know that long-term difficulties emerge from a lack of bonding between depressed parents and their children. The sad by-line “two is too late” is substantially true. If prematurity is not to have a multi-generational impact, early action must be taken quickly.

There are simple, practical solutions that would ease the strain on families. My hon. Friend Rehman Chishti has been working hard to ensure that more beds are provided in mental health mother and baby units nationwide. We heard, at an excellent lecture that my hon. Friend hosted last week in this place, from a psychiatrist who admits women from Cornwall to his unit in Birmingham. Travelling puts additional burdens on families under strain. Probably 50 or 60 more beds are needed nationwide to meet the commitments we have made to give mental health parity of esteem.

Other associated health professionals need to be in at the off, working with premature babies and their families. Professionals such as physiotherapists, occupational therapists, dieticians and speech and language therapists form a vital part of the care that premature babies need. Such care can have an enormous effect on development and quality of life. I will give the example of a child who is well known to me—a little boy born very prematurely to well-informed parents, who were not told about the importance of physiotherapy to his development. That must be seen in the context of the fact that 20% of premature babies have a cerebral palsy diagnosis. That little boy is now 10, and, rather than playing football with his friends, he has had a punishing sequence of operations and casts on his legs. His parents were told at their last appointment that physiotherapy from babyhood might have alleviated the need for all that. According to Bliss, 43% of neonatal units had no access to an occupational therapist, even via referral to another service, and 12% of units had no access to a speech and language therapist. As ever, early intervention saves trauma, time and money.

The Government have wisely seen the need for co-ordinated care for the elderly, with named GPs and someone in charge of the entire patient experience. So often, we speak of the need for a joined-up approach to end-of-life care. Only a few weeks ago, the Minister responded to a debate on palliative care and spoke of the importance of integration between sectors. We are making great progress on that front; the Economist Intelligence Unit recently reported that we have the best palliative care in terms of access to services and the quality of those services. Perhaps the time has come to look at the needs of premature babies and their families as a whole and to do some joined-up thinking to ensure our neonatal care is also the best in the world.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Equality) 10:07 am, 24th November 2015

It is a pleasure to be involved in this debate. I commend Chris Heaton-Harris on bringing the matter to Westminster Hall for consideration and giving us all a chance to participate. Looking back, one of the greatest joys we have all had—I hope we have all had it—is the birth of our own children. Those special occasions are full of joy at the birth of a new child.

I was present when my three children were born, and I did not feel any pain at all; my wife experienced all the pain. The only pain I felt was when she grabbed my hand and would not let go, and the blood circulation got very tight. The births of the grandchildren were all great occasions as well. In this debate, we are hearing about those who did not have the same sort of experience, and I want to add some thoughts about that.

The World Health Organisation promotes World Prematurity Day to raise awareness of the one in 10 babies worldwide who are born prematurely. World Prematurity Day was just last week, so it is not too late to remember it. We are not just talking about babies who are born prematurely and die prematurely; I want to concentrate my remarks on those who are born prematurely and survive.

In addition to the risk they face to their lives, infants who are born early are prone to serious long-term health problems including heart defects, lung disorders and neurological conditions such as cerebral palsy, which Victoria Prentis referred to. They may reach developmental milestones later than other children do, and they may struggle at school. Premature birth may lead to all those things, and it may mean that some people do not have the privilege of having children.

In 2013, there were 51,000 pre-term births—around 7% of live births—in England and Wales. We have had a couple of Adjournment debates in the Chamber in the last while. On both those occasions, very personal stories were told that resonated with all present. We have similar problems in Northern Ireland; the matter is devolved, but the figures are the same. We can be under no illusions—this issue is a problem not only in third-world countries, but in our country, and it remains an issue that needs to be addressed in the United Kingdom of Great Britain and Northern Ireland.

Of the 15 million babies born prematurely worldwide each year, around 1 million die from complications due to their prematurity. More than three quarters of those babies could be saved through better access to quality care and medicines for the mother and the baby, so something can be done. It is important that we try to address those issues.

Complications of pre-term births are the leading cause of death among children under five years of age. Earlier I made a point about the medical conditions sometimes present in those who are born prematurely. Without the appropriate treatment, those who survive often face lifelong disabilities including learning, visual and hearing problems, and their quality of life is greatly affected. Fortunately the United Kingdom has relatively world-class healthcare. Indeed, we are more prepared and more able than many to deal with such complications, but that does not mean that more cannot be done to address this important issue.

Photo of Gavin Newlands Gavin Newlands Scottish National Party, Paisley and Renfrewshire North

I praise Chris Heaton-Harris for securing this important debate. My first child was born more than six weeks premature as a result of an emergency caesarean in the Southern general hospital in Glasgow. Luckily, Emma is now a healthy nine-year-old—touch wood—but, as has been mentioned, not all parents are as lucky. I have friends who have experienced the horrendous strain of a stillbirth. Putting aside party politics, does Jim Shannon agree with me that special care baby units should be insulated from the cost pressures on NHS hospitals and trusts, no matter what those pressures are?

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Equality)

I thank the hon. Gentleman for the personal story that he told us, as others have today. The Minister will address that issue and mention how best he can do that. I would like to see that measure in place; we probably all would. The Minister is the man with the responsibility, so let him earn his money and give us the answer that we need to hear.

I welcome the Health Secretary’s announcement that his new ambition is to reduce the rate of stillbirths and neonatal and maternal deaths in England by 50% by 2030. He has set a goal to be achieved, which indicates a commitment to try to address those issues. Although the Minister will be the one to respond today, the man in charge at the top has indicated that he wants it to happen.

Worryingly, Christine Carson, the clinical practice programme director of the National Institute for Health and Care Excellence, has said:

“Despite medical advances, rates of premature birth have remained constant over the last 10 years.”

There is a clear issue to be addressed. The hon. Member for Daventry is right that although there seems to be a commitment to change and to doing it better, we have not seen much evidence of that—at least not through the statistics.

Christine Carson continued:

“An early labour—one that occurs before the pregnancy reaches 37 weeks—can pose numerous health risks to the baby, and these risks increase the earlier that child is born.”

I commend, as others have, the work of many charities. I would say to the hon. Member for Banbury that, in the worst of circumstances, it is always good to have faith and the support of the Church. Perhaps the shadow Minister and the Minister will comment on the importance of faith groups and churches, and of the availability of church ministers to offer emotional and perhaps even physical support at a time when families need it most. That is personally important to me, and I know that it is for others.

Christine Carson also said:

“Although more premature babies are surviving, rates of disability among these children remain largely unchanged. The way to tackle this is to provide consistent and high-quality care to prevent early labour”.

If we can do that, we can prevent disabilities and long-term health conditions. We cannot take our eye off the ball when it comes to this issue. It is not good enough that for a decade premature birth rates have been stagnating, rather than improving with advancements in medical science. One of the best ways to promote equality is to give each and every child the best possible start in life with the most equal opportunities possible.

NICE and the World Health Organisation, among others, have produced guidelines on how best to address the problem. We have to recognise that we are short on funds at the moment but some of those recommendations provide good guidance on how best to move forward and how to make inexpensive, cost-effective changes to help to improve outcomes.

I think it was said in the news this morning that the Health Minister is going to raise some more money for the NHS—that is probably in England. Will the Minister give some indication of what that money will be focused on? Maybe it will be focused on A&E or on direct care. Is it possible that some of that funding could go towards this issue?

Some of the recommendations of NICE and the WHO include:

“When to offer progesterone…or a cervical ‘stitch’…to prevent or delay the onset of preterm labour; How to diagnose if a woman’s waters have broken prematurely before labour has begun and which antibiotics to offer to avoid infection; Which drugs will help to delay labour and to whom they should be offered; When to safely clamp and cut a premature baby’s umbilical cord.”

Those four recommendations and thoughts from NICE and the WHO are simple, yet effective measures that could make a real difference in addressing the issue.

I thank the hon. Member for Daventry again for bringing the issue to the House for consideration, and I thank all Members who have contributed. We can and should come together and get the right approaches to improve outcomes for prematurely born children in a way that is compatible with the current state of the Treasury. I look forward to the replies of the shadow Minister and the Minister, but I apologise in advance as I have to go to the Defence Committee at quarter to 11, so I have to be away at about 20 to 11.

Photo of Will Quince Will Quince Conservative, Colchester 10:16 am, 24th November 2015

I congratulate my hon. Friend Chris Heaton-Harris on securing this incredibly important debate. I will start by picking up on some of the points made by Jim Shannon that focused on mortality, because our prematurity rates are a national scandal. He is absolutely right when he says that they have stagnated for about a decade. We have one of the worst records in the western world; I believe we are positioned 33 out of 35 countries. That is totally unacceptable considering we have one of the best health services in the world. It is a scandal.

When we talk about statistics and about being 33rd out of 35, we forget that we are actually talking about babies—more than 5,000 babies a year. More than 5,000 families go through the absolute tragedy of stillbirth or neonatal death. I very much welcome the fact that the Government now have a focus on the matter. Statistically, the third biggest cause of stillbirth and neonatal death is prematurity, and that is poignant to this debate.

The Government have recently made an announcement on stillbirth and neonatal death, as the hon. Member for Strangford rightly pointed out, with an ambition to reduce rates by 20% by the end of this Parliament and by half by 2030. That is a huge number—more than 2,000 babies who will be saved and 2,000 families who will not have to go through this most traumatic and awful experience. My wife and I have been through a full-term stillbirth, and it is a traumatic experience. As a Government, we should do anything we can to avoid those tragedies. I am glad that there is that renewed focus. That is key— it is the driver to ensure that we have the training and the best possible equipment.

Looking at the whole NHS, some of our hospitals have the best maternity units and are doing the best work anywhere in the world—second to none. Sadly, that is not consistent across the country. The situation is patchy. That is something that I very much hope the Minister will address as part of this programme. We must ensure that we have the later-pregnancy monitoring equipment that can save lives and, more importantly, the training so that midwives know what to spot and have the confidence to stand by what they believe in terms of diagnoses.

There is also the question of what we do when things do not go well; of course, as my hon. Friend the Member for Daventry suggested, we cannot avoid stillbirths or neonatal deaths. We can reduce the numbers, and the Government have measures in place to do so, but, sadly and tragically, there will always be stillbirths and neonatal deaths. I secured an Adjournment debate a few weeks ago in which I said that we must have the right procedures, processes and facilities to ensure that those who go through a stillbirth or neonatal death, particularly the parents, have a support network.

My hon. Friend Victoria Prentis talked about gynaecology counsellors and bereavement-trained midwives, and it is important that we have such facilities providing support in every maternity unit in the country. She rightly said that a huge number of marriages fail because of a stillbirth or neonatal death—I think the figure is a staggering 90%, which is enormous; I know the huge pressure that it put on my family and my relationship with my wife. I can entirely see how relationships can be broken up by that hugely traumatic experience. When I talk about the NHS, I know that we have the best facilities in the world, but we have to ensure that those facilities are available across the country. I am talking about specialist suites, bereavement-trained midwives, specialist nurses and psychological support, which is also important.

I am conscious of the time, but I will pick up on two other points. My hon. Friend Julian Knight mentioned hospital car parking, which was almost flippantly talked about, but it is hugely important. We forget that not everyone can afford to pay the £20 or £30 a week that some hospitals are charging. My hospital in Colchester has a reduced rate of £10 a week, I believe, but for some people even £10 a week is a huge amount of money. It is not only the parents but the families, the grandparents and the carers who are paying, so it is important that hospitals follow the guidance to ensure that hospital parking is affordable—or, even better, free so that families who are going through the most traumatic experience of their lives are not worrying about money. That is really important.

Mr Reed touched on an interesting point about the pressure on parents from prematurity and from having to go to the hospital. The mother is likely to be in hospital on an ongoing basis, but we forget about the importance of the father’s role. A father gets only two weeks’ paternity leave, after which he will be going back to work and either thinking all day about his premature child and then racing up to the hospital to try to squeeze in time with the baby in the morning and evening, or putting his job at risk by taking that time off, regardless of the consequences. Government guidance on the importance of employers understanding and recognising the pressures of prematurity on families is important.

I am conscious of the time, so I will conclude by saying that we have one chance to get this right. I welcome the steps that the Government are taking. When they announced their ambition to reduce by half the number of stillbirths and neonatal deaths the week before last, it was my proudest moment in the six months since I was elected to this place. I welcome those steps, but we need to go further and ensure that people have the facilities, the processes and the places to go to as they go through this incredibly traumatic experience. We must also make sure that stillbirths and neonatal deaths are as rare as possible. I welcome this debate, and I congratulate my hon. Friend the Member for Daventry on securing it. This is an incredibly important issue that we can all get behind and support.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

If the Front Benchers can keep their speeches to 10 minutes, and if the Minister can conclude his remarks just after 10.55 am, Mr Heaton-Harris will have three minutes in which to offer us a pithy summary of the debate and I will have 30 seconds to put the motion to the House. We will then have achieved everything we set out to achieve today.

Photo of Neil Gray Neil Gray Shadow SNP Spokesperson (Fair Work and Employment) 10:24 am, 24th November 2015

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to Chris Heaton-Harris and congratulate him on securing the debate. I am delighted to make a small contribution on behalf of the Scottish National party.

The hon. Gentleman started by saying that the House does not give enough attention to this issue, so again I pay tribute to him for securing the debate and for his dedication to this issue over a number of years. He delivered an excellent speech, citing examples and stories to highlight the issue. I was incredibly touched by his personal example from Catherine and Nigel. I put on record my sympathy for the loss of Luke—what an incredibly touching and harrowing story. As a father, I find it impossible to comprehend how difficult that time must be, not only for Catherine and Nigel, or for any of the other parents we have heard about today, but for all those who have experienced pre-term birth, whether or not their child has survived. It is an incredibly traumatising time for all those parents.

The hon. Gentleman said that if we were to match the pre-term survival rate of Sweden, we would save 1,000 babies a year in the UK, which would save 1,000 families from tragedy, so I hope the Minister will look at that. I absolutely agree that we must ensure that stillbirths and pre-term babies are as few as possible and that parents are properly supported. On one of his visits to his local hospital, the hon. Gentleman learned that three babies had passed away the night before. We cannot imagine the pain felt by the families, but as he said, we must also recognise and pay tribute to the work of our NHS staff, who will share that pain and trauma. I take this opportunity to pay tribute to those staff, who do an incredible job for all of us. I sincerely congratulate the hon. Gentleman on doing a great service to his constituents and friends.

Mr Reed, in another good speech, cited the excellent unit at Croydon university hospital, which he visited with Bliss. He said that the families were delighted to receive excellent NHS support but were also terrified and traumatised by not being able to hold their babies—babies who had survived but required extra help—because they were so fragile. When a child is suffering, it is the most natural maternal and paternal thing for their parents to want to hold them. The difficulty experienced by those parents cannot be comprehended, and we must ensure that the necessary emotional and practical help and support is in place. The hon. Gentleman gave the example of the family of an 11-week pre-term baby being forced into debt, which is an absolute tragedy that must be sorted out. I hope the Minister will touch on that in his contribution.

Victoria Prentis brought her personal experiences to the debate in a very touching way. She cited some excellent but harrowing statistics that are difficult for us to understand. Some 40% of mothers of children born pre-term experience mental health problems, compared with 5% to 10% of mothers of children born at full term. That takes us back to the support required by parents of premature babies. It is absolutely right that extra support should be available for all parents if their baby passes away, but we must also consider the support that is available to parents whose children survive. She also mentioned the link between pre-term babies and cerebral palsy, which my family has experienced. She is right to draw attention to that, because it needs wider consideration. I thank her for her contribution.

Jim Shannon made a typically reasoned and measured contribution, touching on the long-term health problems to which surviving pre-term babies are susceptible. That point was in tune with many of the other contributions made today. He mentioned one statistic that startled me: three quarters of the 1 million babies around the world who, tragically, die after pre-term birth could have survived with adequate care and support. We must address that not just here in the UK but internationally. Surely we could consider it in our aid budget.

My hon. Friend Gavin Newlands made a passionate personal plea to the Minister in an intervention, and I hope that the Minister will respond. Finally, Will Quince also brought his personal experience to the debate in a touching manner; he made a great speech. He is absolutely right: it is a national scandal that we have one of the worst pre-term mortality rates in the western world. He reminded us that when we talk about that mortality, we are talking about babies. Hopefully that brings the issue home to all of us. He also recognised the difficulties experienced by employees, and the fact that employers must take better cognisance of the fact that their employees in that situation will need extra support. I hope that the Minister will take note of that too, and refer back to it when he sums up.

The World Health Organisation promotes World Prematurity Day to raise awareness of the one in 10 babies worldwide who are born prematurely—that is, before the 37th week of pregnancy. It is the leading cause of death in newborn babies and the second most common cause of death in children under five. According to Bliss, a charity that supports families with premature babies and helps raise funds for adequate hospital equipment, 15 million babies worldwide are born prematurely every year, or 29 every minute, and 1 million of those will not survive. In the UK, 60,000 babies are born prematurely every year, which is one in 13.

A motion has been lodged in the Scottish Parliament commemorating world prematurity day and congratulating Sarah Brown on launching a new £1.5 million study on improving educational outcomes and life chances for premature babies. The study is called the Theirworld Edinburgh birth cohort. It was launched last week at the University of Edinburgh, and it will involve researchers at the university following 400 newborns from birth to adulthood, collecting biological samples and brain scans as well as information about socioeconomic status and educational attainment. There is a lot of work going on in Scotland at the moment that I would have loved to mention if there had been slightly more time.

From a local perspective, my constituency is served by the maternity and neonatal unit at Wishaw general hospital. In 2013, there were 5,988 births, 426 of them premature. Some 13% of those premature babies were born weighing less than 1,500 grams. Wishaw general hospital has had its problems in the past, but I am proud to say that NHS Lanarkshire is the only health board in Scotland to have received nominations for the Royal College of Midwives’ annual midwifery awards, which are coming up in March. My local health board has been shortlisted in two categories: the better births award, for which Maureen McSherry and Carole Burns have been nominated for their post-delivery debriefing, and the Pregnacare award for maternity support worker of the year, for which my constituent Leigh-Ann Johnstone from Airdrie has been nominated.

Earlier this year, NHS Lanarkshire implemented Scotland’s first heart rate observation system. Equipment has been installed in Wishaw general hospital to monitor the heart rate of premature and sick babies. It provides early warning of irregularities and can indicate the development of infection, a leading cause of death in vulnerable babies. I again pay tribute to the hon. Member for Daventry for securing this debate, and I thank everyone for their contributions.

Photo of Justin Madders Justin Madders Shadow Minister (Health) 10:34 am, 24th November 2015

It is an honour to serve under your chairmanship, Mr Hollobone. I congratulate 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 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 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 Nick Thomas-Symonds quite rightly raised the issue of parental health, as did 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 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.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health 10:43 am, 24th November 2015

It is a great pleasure to answer another debate on neonatal care. It demonstrates that there is a real head of steam behind this important issue. I cannot comment with any experience on the number of debates on this issue that there were in the previous Parliament, but it is clear that there is now a critical mass of Members in this House, and interest in all parties, to try to do something to improve neonatal care, whether that is for babies who are born prematurely or at term.

First, I add my tribute and thanks to those given by the shadow Ministers and spokesmen, the hon. Members for Ellesmere Port and Neston (Justin Madders) and for Airdrie and Shotts (Neil Gray), for the personal stories told by Members, and I will state on the record that I think the whole House is grateful to them for their personal bravery in explaining what has happened to them, and to other Members who have told the stories of their constituents.

It was with such a story that my hon. Friend Chris Heaton-Harris began his speech, discussing the account of Catherine and Nigel Allcott, and their son and daughter. He reminded us, as did many hon. Members later, that we can speak about statistics and percentages but what we are actually dealing with are newborn people, little ones and “the smallest things”, who deserve the greatest protection and care that we can possibly give, because they could not be more vulnerable.

In a 2014 study, The Lancet estimated that there were 5.5 million newborn deaths in the world every year and it is that stupefyingly large number that we are addressing today in discussing World Prematurity Day. I know that many speeches were addressed to the domestic situation, but I am very grateful to the shadow Minister, the hon. Member for Ellesmere Port and Neston, for pointing out that we have an international obligation in this regard, and I will certainly talk to my counterpart in the Department for International Development about the areas that our aid spending are being focused on in terms of healthcare and neonatal support, to see if we are doing all we can to try to spread the best practice in this country and Europe to those parts of the world that are beginning their journey in creating a universal healthcare system for their populations.

With that in mind, I turn to the current situation in the United Kingdom. In this country we have some of the finest neonatal care in the world, but what has been apparent in the speeches given today—accurately reflecting the facts—is that we have far too much variability. That is the principal reason why we are at the bottom of the pack in terms of developed countries when measuring rates of stillbirth, which is by means of proxy for the way that we look after premature babies. So I will outline what the Government plan to do about that situation, because it significantly touches—indeed, it does not just touch but covers—the ground that those campaigning to improve care for premature babies have so rightly highlighted, and the Bliss report is an important contribution to that work.

My hon. Friend the Member for Daventry and many other hon. Members have pointed to the announcement a couple of weeks ago by the Secretary of State that we wish to see the rates of stillbirth, neonatal death and maternal death reduce by 20% by 2020, and by 50%, or by half, by 2030. Within that target, we include a reduction in brain injury for babies.

It is worth pointing out that many of the contributory factors to stillbirth and to brain injury are the same for prematurity, which, in the round, are public health measures. They have not been covered much in this debate but I would like to raise them, because it is very important that we also understand the obligations of parents, to ensure that we can bring down the rates of prematurity and stillbirth.

We still have too many mothers in this country smoking. We know that smoking is a significant contribution to prematurity. If we were to improve the variability of smoking rates across the country, which is actually quite shocking, we would do much to reduce rates of stillbirth. In looking at the smoking rates across the country, it is quite interesting that there is not just a simple binary division between areas of affluence and areas of deprivation. There are some areas of significant deprivation where local public health partners have made considerable strides in reducing smoking rates compared with areas that are quite close by. Likewise, obese pregnant women are much more likely to experience miscarriage or pre-term birth than those women who are in the normal body mass index range.

Therefore, we have significant public health challenges ahead of us in reducing obesity, smoking, drinking and substance abuse, and if we are able to achieve those reductions in partnership with parents across the country we will have made the biggest stride that we can towards reducing rates of prematurity, ensuring that those babies that are born premature are as healthy as they can be and reducing rates of stillbirth, whether premature or term.

I wish to turn to the University of Leicester study and the “Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the UK”—or MBRRACE-UK—report that was published last week, which was touched on by the hon. Member for Ellesmere Port and Neston. The study highlights the challenge ahead regarding the care of neonates across the country. The figures are arresting. In half of all the cases highlighted, at least one aspect of antenatal care that could have had an impact on whether the baby was born alive could have been improved. In a third of cases, there were significant problems with bereavement care and in a quarter there were major issues with one or more aspects of intrapartum care.

For me, perhaps the most troubling statistic in the report is that in only a quarter of all the stillbirths it looked at was there an internal case review. We are not improving our position as quickly as we could because we are not reviewing cases in enough instances—we should be reviewing 100% of them—and we are not spreading the knowledge of the reviews across the system. That is one reason why the Secretary of State is so keen to turn the NHS into a learning organisation. Until we get the NHS to do well something that it currently does badly—spreading learning from places that have had a problem, a tragedy, and from those that have made significant strides—we will not make improvements. I refer hon. Members to the experience of St George’s hospital in Tooting, where they have undergone that journey in the past few years, just through dogged clinical persistence, and have been able to change the outcomes for children attending the maternity unit.

I was interested in the remarks made by Mr Reed on support for parents, and I shall certainly take his valid point about maternity leave—to which my hon. Friend Will Quince added comments about paternity leave—to my colleagues in the Department for Work and Pensions. I would hope that all employers—not that they will know about or watch this debate—would have the consideration to behave properly with parents of a premature child. The hon. Gentleman’s point about the need to reflect the development of a baby who has been born prematurely in maternity pay arrangements is interesting and important. I shall certainly take his comments back to colleagues but I can make no promises about what we can do.

The hon. Gentleman also talked about mothers’ mental health, which is something that the Government put a lot of emphasis on in the previous Parliament. We know about the importance of investing in perinatal mental health and that it pays significant dividends if done successfully. That is why we announced in March that we will invest an additional £75 million in it over this Parliament. The services, as provided, are not sufficiently good and we need to do much to improve them.

I hope that many of the instances that hon. Members have mentioned of the lack of support for parents with a premature child who is either living or has died and the lack of counselling for both mother and father—along with the important points made by my hon. Friend the Member for Daventry about marriage counselling and the powerful ones made by my hon. Friend Victoria Prentis about the difficulty of maintaining a marriage through a premature or stillbirth—can be addressed through the additional money. My hon. Friend Dr Poulter, who is now in his place, was critical in securing that funding in March.

Various hon. Members also made important points about parking charges and travelling. I hope that NHS England’s 2014 neonatal critical care services review and service specifications will lead, in the next few years, to ensuring that we have more comprehensive neonatal cover. There will be instances when that is not possible—we cannot predict every occasion on which there will be stress on a maternity service—but I hope that the services specifications will come to correct that in the next few years. Hospitals should follow the Department of Health guidance on parking, which contains specific recommendations to ensure that people who have to park for long periods are catered for.

I know that hon. Members raised additional issues that I have not been able to cover in this fascinating debate but I shall ensure that they are responded to afterwards. I thank all hon. Members for their interesting and personal accounts regarding this important subject.

Photo of Chris Heaton-Harris Chris Heaton-Harris Conservative, Daventry 10:55 am, 24th November 2015

May I thank, through you Mr Hollobone, the Backbench Business Committee for allowing me and the House the time to discuss this important issue. I thank Mr Reed, my hon. Friend Victoria Prentis, Jim Shannon and my hon. Friend Will Quince for their contributions, and also the Front-Bench spokespeople for the consensual and cross-party basis on which they made their speeches, which is the basis from which we should attack issues about premature babies.

Many important issues have been raised, including mental health care and the acknowledgement of the Government’s ambition to halve the rate of stillbirths and neonatal and maternal deaths by 2030. The Royal College of Paediatrics and Child Health issues an annual national neonatal audit programme report, and the 2014 report came forward with some interesting points, some of which we have talked about today. Sometimes, unfortunately, in Britain in 2014 we were still missing development checks for premature babies, and that is raised in the report. It also mentions something I find shocking, which is something we have all talked about in our speeches today. We are doing better, and we are focused on the ambition of doing the best we can for parents with a premature baby, but one in 10 families is still not recorded as having a consultation with a senior member of the neonatal team within 24 hours of their baby’s admission. It is unbelievable that that can happen when the parents are at their most stressed and worried.

I thank the Minister for his reply and thank everyone who has taken part. I thank Bliss and other charities for their work in this area, and I especially thank my constituents Catherine and Nigel for their magnificent work in trying to ensure that no one else goes through what they had to go through.

Question put and agreed to.

Resolved,

That this House has considered World Prematurity Day.