Thank you, Mr Gray. I had just promoted you. It is a pleasure to serve under your chairmanship.
The ambition is to halve the rate of stillbirths and neonatal deaths by 2025 and to have achieved a 20% reduction in these rates by now. Every day in the UK, about 14 babies die before, during or soon after their birth. Baby deaths need to fall much faster if the Government’s national maternity safety ambition is to meet that important target. The ambition also includes halving maternal deaths and brain injuries in babies that occur during or soon after birth by 2025, and reducing the pre-term birth rate from 8% to 6% by 2025.
Earlier this month, the Health and Social Care Committee published its report about maternity safety. I co-chair the all-party parliamentary group on baby loss with the Chair of the Health and Social Care Committee, my right hon. Friend Jeremy Hunt. The Select Committee report echoes much of what we have been hearing from hospital trusts, health professionals, bereavement charities, bereaved families and others throughout our work in the APPG. I pay tribute to everybody who speaks out on this most upsetting of topics. It is a crucial issue on which we must all work together to achieve success.
The Select Committee report notes that progress towards reducing the rate of stillbirths and neonatal deaths has been “impressive”, with its external expert panel rating it as good, although it notes that the baseline for the progress was low in comparison with other countries, such as Sweden, and that there is still a “worrying” level of variation in the quality of care. On stillbirth, the report from the expert panel notes:
“The Department has achieved the interim target of a 20% reduction earlier than the 2020 deadline. However, increased efforts are required to meet the final target” of a halving in 2025. On neonatal deaths, the report states:
“Good progress has been made towards achieving a 50% reduction…by 2025. However, it has been difficult to determine the full extent of the Government’s progress due to a change in the measure of progress against the National Maternity Ambition on neonatal deaths, with concerns expressed about the validity and unintended consequences of this change. This change in measuring progress has potentially inflated the achievement in the data analysed and may inadvertently exclude extremely pre-term babies from the on-going national efforts to improve neonatal outcomes. We encourage the Department to continue to measure and drive progress towards reducing mortality in both the population of babies born before and after 24-weeks’ gestation.”
On maternal deaths, the report concludes:
“No discernible progress has been made towards reducing the 2010 rate of maternal deaths by 50% by 2025”,
which I find alarming. It continues:
“The factors contributing to maternal deaths are predominantly indirect, such as existing disease, and therefore complex to address. Tackling the causes of maternal death will require concerted efforts, with a focus on pre-conception interventions and improved post-natal support, particularly relating to mental health support…In addition, the worsening disparity in risk of maternal death for women from minority ethnic and socio-economically deprived backgrounds needs to be urgently addressed.”
On pre-term births, the report acknowledges that
“this target was only added to the National Ambition in 2017. Therefore, the window for newly introduced measures to impact on the data is very narrow…While the initiatives currently being implemented by the Department are welcomed, we anticipate that increased efforts will be required to counteract the setbacks to reducing pre-term” deaths arising from the COVID-19 pandemic.
Great strides have been made in this vitally important space, and it is important to acknowledge that, but there is still more to do. Last week, I had the pleasure of speaking to some members of our excellent midwifery team at the Royal Cornwall Hospital in Treliske, in Truro. Because of continuing covid restrictions, that was conducted remotely, and it was a bittersweet meeting for me, not least because the tech let me down after about 20 minutes. I had a conversation with the fabulous consultant obstetrician, Karen Watkins, who was able to tell me how things were going at Treliske and what further things the team felt needed to be done to accelerate the national ambition.
It was Karen who had delivered the shattering news to my husband and me that our baby could not be saved, that she would have no chance of life. It was Karen who performed the procedure to humanely end Lily’s life—the most frightening point of mine. Last week, I had the privilege of thanking her, as face to face as we could get online, for her kindness, compassion and professionalism in such devastating circumstances. Not everybody gets the chance to do that. The entire bereavement midwifery team at Treliske are outstanding, and I continue to be in awe of our local team, of how they do such a difficult job, are able to support families at their lowest ebb, and continue to take special care of our babies after they have died.
The impact of covid on those issues seems to be a mixed bag, which is against the expectation. There was a peak in stillbirth and neonatal death in March 2020 and another in January 2021. Our team in Cornwall points to a slow and steady decline in the numbers since 2010. This year, there have been two stillbirths so far. In a so-called usual year, there would have been between eight and 12 by now. It is difficult to commend this figure, however, as the team do not yet really know what to attribute it to, apart from natural peaks and troughs. It could be a temporary irregularity; more research will need to be done to see whether we can find a pattern. This is no comfort at all to the two Cornish families who have suffered that unbearable loss.
The APPG has heard evidence from the sector about how covid has exacerbated existing inequalities. Inequality is the biggest issue that needs to be tackled to reduce the number of babies dying and to improve maternity safety. The Health and Social Care Committee report highlights the need to tackle “unacceptable inequalities in outcomes”. The report by the health and social care expert panel report notes that
“improvements in rates of stillbirths and neonatal deaths are good but are not shared equally among all women and babies. Babies from minority ethnic or socioeconomically deprived backgrounds continue to be at significantly greater risk of perinatal death than their white or less deprived peers.”
It is fair to say that mums and babies should not be at an unfair risk just because of their background.
The Select Committee’s recommendation that the Government introduce a target to end the disparity in maternal and neonatal outcomes, with a clear timeline for achieving that target, is exactly right. Work must be done urgently to identify a suitable target and ways to evidence the gap closing nationally, supported by the evidence of progress locally. The target must aim to achieve equity among all groups and ensure that those who currently have the least good outcomes have the best outcomes.
What needs to be done? I have taken it down to five or six points. First, on staffing, action is needed to address staffing shortfalls in maternity services. At a minimum, we need nearly 500 more obstetricians and nearly 2,000 more midwives. I welcome the recent increase in funding for the maternity workforce, but there will need to be further funding commitments to deliver the safe staffing levels that expectant mothers should receive. In Cornwall, when Karen Watkins started 14 years ago, there were eight consultant obstetricians. Today, there are still eight. None of them are dedicated bereavement obstetricians, and staff need to take on this role as part of their existing duties.
Secondly, on training, the 2016 maternity safety training fund has delivered positive outcomes. More funding is required to embed ongoing and sustainable access to training for all maternity staff, given changes in the practice, developments on how to deliver safely and aspects related to covid-19. Funding for backfill cover when training takes place is also desirable.
Thirdly, on parent involvement, after a patient safety incident, too often families are not provided with the appropriate, timely and compassionate support that they deserve. Involving families in a compassionate manner is a crucial part of the investigation process. The Healthcare Safety Investigation Branch has taken considerable steps to improve family engagement but must continue to pursue improvements in that area.
Fourthly, on clinician confidence, this is related to the earlier point about training, but is also about giving clinicians the confidence to report issues without worry. I welcome the Government’s proposal to review clinical negligence in the NHS more broadly. Elements of the rapid resolution and redress scheme have been implemented, but the scheme has not yet been implemented in full. Until it is, there is a high risk that the fundamental changes needed to improve the safety of maternity services may fail to be achieved.
Fifthly, carer continuity is close to my heart. I am a huge advocate for this, and it has been shown to improve the outcomes of those who currently have the worst outcomes. I would like to ensure that those involved in delivering carer continuity have received the appropriate training, and that all professionals are competent and trained in all the work they are able to do, particularly in relation to black mothers, where the disparities are the greatest. Carer continuity helps to point out other issues that might not be specifically or medically looked for such as domestic violence.
Sixthly, we need more research. If a baby dies at term, the parents ask why, and often there is no answer. I would like to see more money put into research and development so that we can understand more about this horrific phenomenon. There is more to say, and I am sure colleagues will add to the discussion today. I thank the Minister for her continued support in this area, and I know she is listening.
Group B strep is the most common cause of life-threatening infection in newborn babies, causing a range of serious infections including pneumonia, meningitis and sepsis.
Screening could save 50 babies a year, and protect a further 70 from life-changing issues. Our Minister has been a force in trying to ensure that all women can ask for the group B strep screening and that all hospital trusts can offer it.
We have just passed the halfway point in this important journey to 2025, and I would like to thank all the healthcare professionals who have contributed to the successes so far. I call on the Government to work with them to achieve the rest and save as many lives as possible in the future.