Preterm Birth Committee Report
(2 days, 12 hours ago)
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Lord Patel
That this House takes note of the Report from the Preterm Birth Committee Preterm birth: reducing risks and improving lives (HL Paper 30).
Lord Patel (CB)
My Lords, I am pleased and honoured to lead the debate today on the Preterm Birth Committee report. Before I do so, I thank most sincerely all those who gave evidence to the committee and, in particular, the mothers and parents of children born pre term who told us of their experiences, as well as the perspective of adults who were born premature. It is their powerful evidence that forms the backbone of our report and its recommendations, and I will come back to that. My sincere thanks go too to the specialist advisers, including Eleri Adams, consultant neonatologist and president of the British Association of Perinatal Medicine.
I give my and the committee’s thanks to the dedicated committee staff who supported us and did so brilliantly—Eleanor Clements, committee clerk; Babak Winstanley-Sharples, policy analyst; Mark Gladwell, committee operations manager; and Alec Brand, media and communications officer—a huge thank you to them all for their hard work and support.
I give my personal thanks to all the committee members. It was a privilege and fun to be their chair because of their dedication and help in making sure that we delivered an evidence-based report that helps improve the lives of mothers, parents and the families of children born pre term.
Thanks go also to the noble Baroness, Lady Bertin—I am pleased that she will speak today, and I look forward to her speech—who could not join us as a member of the committee but was instrumental in persuading the Liaison Committee to set up the inquiry. I enthusiastically look forward to the speeches of all noble Lords taking part today, including the Minister.
A committee was set up in 2024 to consider the prevention and consequences of preterm birth. The title of the report, Preterm Birth: Reducing Risks and Improving Lives, summarises it all. I declare my interest, which is probably no longer relevant, of 39 years’ experience of being an obstetrician who delivered a lot of preterm babies.
By definition, preterm births are babies born before 37 weeks, and the current incidence is 7.9% of all births. It is the main cause of neonatal deaths in the UK. Around 75% of neonatal deaths are in babies born pre term, mostly the very pre term. For most babies born pre term, the outcome is good. For many, it is not. Some 4.2% of those born preterm end up having a severe disability at age 18 and 18.5% have a mild to moderate disability. Children born pre term have a higher prevalence of need for special education: the lower the gestation at birth, the higher the incidence. Some 82.6% of those born at or near 24 weeks have a need for special education. Children born pre term also have lower educational attainment.
While advances in obstetrics and neonatal care have led to improved survival, there has not been a corresponding improvement in neurodevelopmental outcomes. Incidence of brain injury, for example, is 26 per 1,000 births in those born pre term compared with 3.5 per 1,000 births in those born to term. It results in disability, cognitive impairment, memory loss and other functions. Adults born pre term told us that issues they experience could be subtle but multiple. Added to this, a lack of awareness within the healthcare system of the long-term effects of prematurity means that informed or specialist support is difficult to access.
It is not only the children born pre term for whom we can do better but the parents who are to care for these children. A survey showed that 24% of parents showed signs of post-traumatic shock. As one mother said:
“Life before the neonatal unit is mostly irrelevant when you find yourself stood, post-partum, next to your baby in an incubator, hoping and wishing that you make it out safely … The vulnerability is beyond crippling”.
The impact of prematurity does not end upon discharge from the neonatal unit. The experience stays with you for life. As this quote demonstrates, preterm birth can be sudden, unexpected and have significant—sometimes lifelong—impact on those born pre term and on their families.
Many parents will spend weeks and months in hospital caring for their babies, often in hospitals that are a long way from home, incurring practical and financial difficulties. A mother of twins, who were born very pre term and cared for in two different hospitals because of lack of capacity of neonatal beds, described vividly to us her daily difficulties and the stress it caused her to travel between two hospitals as she visited and cared for her two tiny babies.
Some 75% of intensive neonatal care units do not have accommodation for parents. Most have poor facilities, even for mothers to express breast milk or rest. Evidence we received clearly showed the benefits of involving parents in the care of their preterm babies—so-called integrated care, where parents and all health professionals are involved in the care of the baby. The involvement of parents in the care of their babies not only improves outcomes but, importantly, gives parents the confidence they need when the time comes to take their baby home. There is a need to make integrated care more widespread.
Although we will not completely prevent preterm birth, our inquiry clearly showed that we can reduce its impact with better policies for the care of babies and support for parents. For example, the Saving Babies’ Lives Care Bundle, developed by NICE and NHS England, has guidelines that would improve outcomes if implemented in full. The evidence we got showed wide variation in the use of these guidelines in important areas such as the timing of the clamping of the umbilical cord—noble Lords might be surprised by the effect that has on the outcome for both preterm and term babies—the timing of the administration of steroids to mothers prior to birth, the use of non-invasive ventilation, and several other areas. The result is poor outcomes for babies. There is an urgent need to implement the guidelines more widely and eliminate the variation in care. What role does the Minister think the Department of Health and Social Care can play to bring about this change?
We also heard of the challenges parents face after discharge from hospital. Community services not only lack capacity but often do not have the training required to be of any help to parents. In his report, the noble Lord, Lord Darzi, highlighted the important role of health visitors in the early years development of children. Shortages of not only health visitors but midwives, specialist neonatal nurses, neonatologists, physiotherapists and clinical psychologists all impact on outcomes for babies born pre term. A recent report from the Royal College of Midwives says that newly qualified midwives are worried about not getting a job; that cannot be right when we want to expand the midwifery workforce. Can the Minister give an assurance that the workforce issue will be addressed in the NHS 10-year plan?
National guidelines stipulate the need for a series of assessments of children born preterm prior to starting school, particularly at ages two and four. Delivery of this is, at best, inconsistent; in the majority of cases, it does not happen at all. Figures show that at age two, 85% of babies born pre term are followed up, but this drops to 6.7 % at the crucial preschool age of four. There is a need to urgently address this issue; I hope the Government will take urgent action to do so.
I come now to the important issue of prevention and reducing the incidence of preterm births. The prediction and prevention of preterm births are challenging because of the wide range of factors that contribute to a woman’s individual risk, with many having no risk. Studies reported to us showed a strong association of preterm birth linked to smoking, the socioeconomic status of parents, and ethnicity. These need urgent attention if we are to reduce the incidence of preterm birth. I hope the Minister will comment on how the Government intend to address each of these issues. We explored the role of screening methods to identify women at risk of preterm birth. We came to the conclusion that better-designed, more focused studies to find the right screening methods are needed, if that can be done.
Despite this, there are opportunities to reduce the incidence of preterm birth. When will the Government revise the maternity safety targets and focus efforts to reduce the rate of preterm births across all groups of women? Do the Government have a target reduction for the preterm birth rate? Providing women with information prior to pregnancy about their general health and lifestyle should be an important part of reducing the incidence of preterm birth. Does the Minister agree that this should be part of the Government’s women’s health strategy? There is currently underinvestment in pre-pregnancy advice. The Government’s 2024 manifesto said:
“Labour will prioritise women’s health as we reform the NHS”,
and in her evidence to the committee, the Minister said that the Government intend
“that the health of women is optimised before we get to pregnancy”.
There is an opportunity today for the Minister to say how this will be done.
The consequence of being born pre term, particularly very pre term, weighing as little as 600 grams, with the body organs that sustain healthy life not fully developed, would be death or lifelong disability for many. With the provision of good care, the outcome for not just a few, but many, will be better, so why would we not put policies in place to do so? I beg to move.
Baroness Goudie (Lab)
My Lords, I thank the noble Lord, Lord Patel, and the members of the committee for this really important report, and for the time at which it has come, because the situation in this country for pregnant women, babies and preterm babies is a huge risk. This is the future of our country and the future of the world, and we do not treat the situation in the way it should be treated.
I will remind Members of a few points. The report is titled Reducing Risks and Improving Lives; to do that, we have to work much harder than we are working at the moment. Women’s health is at the worst position that it has ever been. I helped launch a report recently in the House of Lords—some Members were there—where we set out a manifesto for women’s health. The Minister was extremely helpful at that meeting and has helped us since.
As for the current landscape for preterm births in England, in 2022 some 7.9% of births in England were pre term, with 45% of babies born before 37 weeks. Those babies will need a lot of help and support not just in the very beginning but for the whole of their lives, certainly until they are through the whole of secondary school and into university. They also need to have proper checks as adults as well. When you are born and not fully developed, it affects the lungs, the brain—it affects everything. So, it is really important that we have a way in which people are checked regularly.
A number of preterm babies are born to mothers who have pre-eclampsia. Pre-eclampsia has a huge effect on the mother not only while she is pregnant but in the long-term, including heart conditions and other conditions. All mothers who have had pre-eclampsia should be seen by their doctors every 12 months, having heart checks as well. They are the future too—they are looking after children and keeping homes—so it is really important that we look at the state of mothers.
Preterm birth is the leading cause of neonatal morbidity in the UK. Outcomes for preterm infants remain uneven across the country. In most places, it is not registered when a child starts nursery or school; it should be, so that teachers have an understanding of what the issue may be if a child is not doing well, and how that can be helped.
There are disparities in the rates of preterm births. Preterm births disproportionately affect marginalised groups. Among black women, the rate is 8.5%; among Asian women, it is 8.3%; and among white women, it is 7.7%. These disparities are rooted in structural inequalities such as poverty and unequal access to proper healthcare for pregnant women. Women should be being seen regularly. They should know that they must keep these appointments, and if they do not, this must be followed through.
Further, we should have much more advertising and education for women and young girls about becoming pregnant, how you must be looked after and how you have to look after yourself. If something is not right when you are pregnant, you know yourself that it is not right. It should not be for the nurses to say, “Oh, go away and come back next week—it’s nothing”. They should let you come in and be checked. I know some people will be more nervous than others, but that would also save lives and prevent other awful things from happening.
There are poorer maternal health outcomes due to unconscious bias in healthcare settings. Addressing preterm birth requires confronting the underlying social determinants of health. We need much more understanding by social workers and counsellors. We also need more understanding of what is needed and for people not to be isolated. Sometimes, if someone has a problem—if they lose a baby or take a baby home that needs help—they are isolated and left on their own, sometimes in pretty terrible accommodation, and they do not see anybody. Again, we should be giving support. The Government should do that, because of the impact it has on families and the other children in the family.
Parents of preterm babies experience high levels of trauma, anxiety and uncertainty, and an increased risk of postnatal depression. That has a terrible effect on the marriage, on the other children and on how the baby is being looked after. Nearly 40% of mothers with preterm infants report clinical symptoms. There are challenges due to separation, impacting emotional and developmental outcomes. People leave them alone. The husband or partner does not always come home because they cannot always understand what is wrong. It is really important that we try and get these clear messages out that everybody needs to support each other.
There is also the financial strain of travelling, as the noble Lord, Lord Patel, mentioned, when babies are miles away from where their parents live. They are kept separately, and their parents are expected to come back and forth, where there is no accommodation for them in the hospital. They should be able to stay at the hospital, even if it is nearby. This is really bad. One has known what this is like—we have all had people we have had to support.
There is the loss of income, and parents get exhausted. They have to apply for extra entitlements, which take a long time to come and with which nobody is very helpful. They have to do it online, but they are not always capable or up to it because, emotionally, they are worried about what is happening to the baby and to themselves. This places additional emotional and administrative pressure on families.
As I said earlier, social isolation is a real problem. We really have to look at pregnancy in a completely different way than it has been looked at in the past. It is not just the case that you have a baby and then you will be fine. Today, we have to give much better care both to the baby and to the mother and father.
Baroness Bertin (Con)
My Lords, I cannot tell noble Lords how delighted I was when this issue was selected to be the subject of a special committee. I had witnessed families, including friends of mine, go through utter heartbreak. Many women can lose so many babies due to preterm birth. Of course, there is huge joy at the babies that do survive, but their general outcomes are not talked about enough nor about the journey that those families have to go on. So, I give huge praise to the committee. What a credit to this House that there was a committee with such huge expertise, which the noble Lord, Lord Patel, led remarkably. I also praise the staff who worked on the committee as well.
I was very disappointed not to be able to sit on the committee myself. Regrettably, I had started work for the Government on my harmful pornography review, so I felt that I could not do both, but I am very grateful to my noble friend Lady Wyld for keeping me very much updated on the progress of the report. I praise the report; it is so powerful. I welcome and support the many recommendations put forth by the committee, particularly those focused on improving long-term outcomes for babies and families. The noble Baroness, Lady Goudie, raised so many brilliant points about the emotional toll that this takes.
As the report rightly highlights, the devastating consequences of preterm birth do not end at the hospital doors. For many families, that is only the beginning. With one in 10 preterm babies going on to develop a permanent disability, life often becomes far more complex, both for the child and for their parents. Many developmental delays and long-term health conditions emerge only over time and, as has been mentioned in previous speeches, can be identified only through regular, structured follow-up by clinicians and community health professionals, particularly health visitors.
Yet, we are witnessing a troubling decline in the number of community health visitors—a workforce that is critical in identifying early signs of difficulty and providing support in the home environment. I feel personally about this, as it happened to me. I am lucky in that I have had three children, but I did not see a health visitor with my third baby at all; I had to push and push to see one, and I can remember thinking to myself that there were lots of problems with this. Luckily, I knew what I was doing, I was not having any postnatal depression or issues and I knew my baby was roughly hitting his milestones. But I can remember thinking, “My God, for new, fragile, mothers—particularly those who have been through a very difficult time—that would be unacceptable”. It absolutely has to be raised. These checks are not optional extras; they are lifelines, and without them, early developmental problems are missed and the window for effective intervention begins to close.
We must ensure continuity of care, not only for the children whose life chances depend on timely support in those critical early years but for the parents, who too often bear the troubling impacts of preterm birth in silence. The noble Baroness, Lady Goudie, also discussed relationship breakdowns; I do not know the figures, but I imagine that it puts an enormous strain on relationships, and that then makes the whole situation even more difficult.
Further, I am very pleased that the committee has reiterated what many in the field have long known: despite remarkable advances in neonatal care—which we absolutely must acknowledge—we are failing to make meaningful progress in mitigating the real risks of preterm birth. Without adequate and sustained funding, the field remains fragmented and under-researched. The reality is that pregnant women, quite rightly, do not want to take drugs, so there is not as much money going into the pharmaceutical research element because they cannot sell as many drugs as they might like to. I am not being cynical; that is the reality.
When I first proposed this inquiry, only 2% of the health research budget went towards reproductive health per annum, and I suspect that this figure has not massively shifted in the last two years. Clinicians and researchers continue to find themselves competing for diminishing pots of money, leading to vital projects faltering. This is of course not the only sector that has this issue.
However, there is hope. I draw your Lordships’ attention to the work of the medical research charity, Borne. I declare an interest in that its medical lead, Professor Mark Johnson, delivered my third baby. He has set up an amazing charity that focuses on preterm birth and I am very grateful for its work. It recently launched the Borne Collaborative, an initiative bringing together leading experts from across the globe, not to compete but to co-operate. These experts have given their time and expertise to help set clear strategic priorities for research and investment, helping to deliver evidence-based road maps to prevent preterm birth. I highlight and welcome that work.
This is precisely the kind of strategic direction that we lack at a national level. The current governmental proposals do not yet go far enough. The data speaks for itself. That is why I urge His Majesty’s Government to consider alternative and more rigorous approaches to preterm birth reduction. Among them should be the establishment of a national task force, a central body charged with the oversight of research, prevention, and intervention strategies, and supported by experts. Such a task force could ensure coherence in research funding, reduce variation in care across the regions—we know that there is always a huge postcode lottery—and develop effective therapies and care bundles. With better co-ordination, real-time data collection and resource sharing, we can move from reactive care to proactive prevention, which is what we need. This sort of strategy applies across many issues in government.
We must act now, not just with warm words and symbolic gestures but with meaningful and clear commitments. Without them, women and families will continue to bear the burden of a system that often forgets them.
Lord Winston (Lab)
My Lords, I pay tribute to my noble friend—to misuse the convention—Lord Patel, who, as usual, was an outstanding chairman, as he has so often been for the past inquiries with which I have been associated. I thank him very much indeed.
There is no point in making a treatment unless you can make a diagnosis, and the diagnosis must depend on the understanding of the cause. The problem, frankly, is that various causes have been postulated for over 40 years in this area. I will take a slightly different line, because, otherwise, I will only repeat what the report said and what will be said by others in this debate. I suggest that we need to link much more closely the loss of babies in the uterus well before term, in the early stages of pregnancy—namely, miscarriage—with preterm birth, because the causes are almost certainly related and important. I will discuss this in my short speech.
So many causes have been suggested: chromosome abnormality; changes in the DNA; different genetic predispositions; abnormalities of gene expression; hormone imbalances; metabolic problems; immune changes; molecules that affect implantation; the insufficiency of the placenta or afterbirth; anatomic abnormalities of the genital tract; failure of the eggs to mature properly; blood flow abnormalities; vaginal, oral, uterine and gut bacteria; and infections by either viruses or bacteria and parasitic infections. The fact is that it is very difficult to decipher where we are going with this research. I regret to say that much of the scientific evidence we have received has been rather confusing. The evidence has not been well focused, and we need to consider why that is the case.
There are also associations with the environmental factors that my noble friend Lord Patel mentioned, including pesticides; pollution; smoking; poor diet; alcohol; ingestive toxins; aberrant weight, such as obesity; male and female age; and, obviously, the link with infertility, which is the area in which I am particularly interested. We do not understand why it is more common in some animals than others. We know, for example, that it is not particularly common to lose pregnancies in primates. That seems to be associated with stress in primates and may be related to changes in family circumstances, particularly with the dominant male, which is quite interesting. I am not pretending to suggest that it is relevant here; the point is that it is just another example of why we are very much at a loss.
In 1987, I met a lady called Pamela, who had three preterm babies. They all died. She had one boy who died a few weeks after birth, in addition to the three who died before birth. She also had at least six miscarriages; she thought that she had had more, but she felt that the doctors were not regarding them as miscarriages. She had this constant problem. At one stage, her partner, not surprisingly, left her.
Pamela went on, finally, to deliver James. He was born premature and severely disabled at birth. It became obvious much later, when the medics came to look at him, that there was a genetic disease. The diagnosis of Lesch-Nyhan syndrome, a rare disease which usually affects boys but not girls, was finally diagnosed. Indeed, he was so disabled that he lived strapped in a wheelchair. He was not able to move his arms deliberately, because if he did, he would mutilate himself. Eventually his teeth were extracted because he was biting off his lips and tongue. That is the nature of that disease, which of course causes miscarriage.
After the diagnosis was made, we started to get very concerned about whether we could do some research to understand what was going on. We took three years to identify the diagnosis of Lesch-Nyhan syndrome in embryos. Two embryos were transferred at different stages, but Pamela did not get pregnant. Eventually, she had a normal baby, free of the disease, some four years after we started the research. Her NHS treatments, as noble Lords might imagine, were pretty costly. In fact, the costs of looking after that woman and her children were very considerable. Our research was not funded; in fact, we got our inadequate funding mostly by persuading women to cycle around the world on different bike rides. Those women raised huge sums of money because they felt very compassionately about the cause.
There are at least 23 million miscarriages annually, which means that about 44 pregnancies are lost every minute. The pool of single miscarriages is very high: over 15% of pregnancies are lost in this way. It is a massive medical problem, which is indeed linked to premature birth; sometimes it is a marker for premature birth. That is why we therefore have to consider these things together and why I am focusing on this in my speech today. If you add in premature births, you start to see the colossal consequences in handicap that we have seen, as well as the grave psychological problems that affect people. We need to consider this and ask: why is this happening?
When you look at world figures, it is very puzzling. In the studies of miscarriage, for example, prevalence varies across the world. You might expect it to be much more common in areas with poverty, but let us look at this in detail. Ethiopia is the country with the most serious miscarriage rate that I could find; it is about eight times more common there than it is in the United Kingdom, and the country is certainly very poor. It is also far more common in Guyana and Bolivia. In Eritrea and Zambia, miscarriage is quite prevalent, but in Malawi, which is perhaps the poorest African country of them all, the rate is actually not much dissimilar from that in Britain. That is very interesting, but quite unclear. It is clearly not related to the causes that we imagine are associated with poverty—poor nutrition, smoking and so on. There are a lot of other things going on.
There are many things that we could do which have not been mentioned here. One is this: we have to understand, and have much better recognition of, people who are going through miscarriage, with the proper recording of what is going on and, indeed, with much more investigation at the expense of the health service. I plead with my noble friend Lady Merron that she might see how we could do that. These investigations are not that expensive, but pathology should certainly be part of it. Unfortunately, that is often missed out. We do not look at the products of conception when the miscarriage occurs; they are just ignored. Women come out of hospital without any idea of what has happened, feeling absolutely desperate and bereaved.
It is worth bearing in mind that these women remember the date of the miscarriage years afterwards. They do not have a funeral and they do not have any recognition from other people of what they have gone through; they do not even tell people at work, because of course they cannot. They, along with their partners, have to suffer alone, and sometimes with the very serious problem of continuing infertility, blood loss, and generally feeling really unwell from having had an anaesthetic and an operation, having never been in hospital before for any serious disease. We have to recognise that this is so important.
We have a great opportunity here to do that which we do so well in Britain. We are extremely good at cohort studies. We have, among other things, one of the best examples in Biobank. Biobank is making a massive difference at the moment. If you take the world of ophthalmology, we now begin to understand that Biobank is giving us clues as to the causes of macular degeneration, which has a whole range of causes, just like infertility and other such things. We can now see specific genetic predispositions, which in the next few years is going to lead to much better treatment of this blindness, which prevents people being in work, for example.
I urge the Government to think about this, because this scientific research is much needed. There is a strange paradox here. In the data Bill, we have discussed science, but we have forgotten that science is often due to serendipity; it is not related to careful recognition. Looking at figures in the right way is serendipitous. It is very likely indeed that, if we did that properly, with proper data collection, we would end up with some very useful hypotheses. If we did that then we would be able to focus research on the areas that are most relevant, and we would make real progress in treatment.
This would be so much more than a blanket funding of lots of research. I do not think that that is what is needed. The research councils show that they have been funding up to 35% of grant applications, which is a very high number and much higher than in most other areas of medicine. What we need is much better research, and we need to do it if we are going to change the heartache and suffering, which is so often ignored, with totally healthy women going through this and being ignored. We need to do something about that. It would not mean masses of expense, but it would mean looking at how we do data collection in the NHS a bit better—which we can do—and trying to focus where we are going with better research, which, at the moment, is not in fact present.
Baroness Wyld (Con)
My Lords, I add my thanks to the noble Lord, Lord Patel. The committee could not have wished for anybody better qualified to be our chair. He did it with his unique blend of professional brilliance and deep compassion, and we were very lucky to have him. I thank my noble friend Lady Bertin, who proposed the committee. As we have heard, she challenged your Lordships’ House to show ambition in its approach to this issue, and I know she made me even more determined to fight for better outcomes for women, their babies and families. She kept telling me to remember who we were doing this for.
On that note, it has been an absolute privilege for me to get to know some of the parents who gave evidence to us. I want to take a moment to acknowledge the strength it took for those parents to come and tell their stories to a public hearing of a Select Committee and to allow us to question them in order that we could find recommendations that would, we hope, improve the experience for others.
I have three general observations. First, given that, as we have heard, we still do not know enough about preterm labour, we owe it to women to do better research, as the noble Lord, Lord Winston, said. Secondly, where we do know a fair bit about ensuring the best possible quality care, women still cannot trust that this will be delivered consistently. Thirdly, as our recommendations show, it should be possible to reduce risk and improve outcomes.
It seems to me that there is a disappointing lack of pace and grip from the Government, despite very warm words in their response to our report. I emphasise that I am very grateful to the Minister for the time that she has given me to discuss these issues. I have said in the national media that I was convinced that the will is there to tackle this issue, and I am very happy to put that on the record here. I accept that the Government are making progress on preventive health care. I was very grateful for the smooth way in which they delivered the regulations to implement the Neonatal Care (Leave and Pay) Bill, which I took through this House in 2023. It is in that spirit that I come to this debate. I will never play politics on this, and I will be delighted if the Minister is able to contradict me in her summing up, because I will now be more critical on the response to our recommendations.
Our committee acknowledged the complexity of preterm birth. Witnesses expressed different views about the usefulness of just one overarching target of a reduction to 6% by 2025, which the Minister has acknowledged will be missed. None of this means that, from a policy perspective, preterm births should be put in the “too difficult” category. The Government have rightly accepted the principle that we need to address focus on tackling the stark and unacceptable inequalities, including the rate of preterm births, that exist for black and Asian women and babies, and women and babies from the most deprived backgrounds. The Government therefore need to set out how they intend to get there. Given that it is almost seven months since publication of the report, I would be surprised if the Minister was unable to say where the Government have landed on targets or whether they have come to a view.
I want to focus in the main on several recommendations from chapters 4 and 5 of the report, in which we examined how to improve the outcomes for preterm babies and the experiences of their families. As we have heard, many babies who are born early flourish, but during our committee sessions we heard from witnesses for whom that has not always been the case, including Francesca and Nadia, both mothers of preterm twins. I cannot do justice to that session in the time available today, but their campaigning call for all parents to be properly supported in the care of their babies born in hospital and on their return home must be acted on by the Government.
It seems to me astonishing that so many of us will stand up today in Parliament in 2025 and have to argue the case that all parents must be able to stay overnight with their tiny and unwell babies in neonatal units, including neonatal intensive care. They should be involved in their baby’s care as much as possible and should be able to hold them. They must be listened to when their instinct tells them that something is wrong. The charity Bliss outlined evidence showing that family integrated care leads to a range of benefits, including increased weight gain, improved breastfeeding, and reduced rates of mortality and morbidity.
If the Government and the NHS agree with this, why have they not yet published the review of the NHS maternity and neonatal estate survey, as requested by the committee and promised “early in 2025”? In answer to a Written Question I tabled in April, the DHSC said that NHS England would do this “shortly”, and we are now in June. Is the Minister able to give a definitive date for this to be published? Given that we await the NHS 10-year plan, can she say what consideration has been given to the need to extend and improve accommodation in neonatal units?
As we have heard, we made it clear that the impact of preterm birth does not end once families go home. Despite the fact that up to 40% of mothers experience symptoms of post-traumatic stress disorder six months after a preterm birth, witnesses told us that counselling after a preterm birth is either “not in place” or “not offered as standard.”
I raised the wider issue of perinatal mental health in the House last month. Can the Minister expand on the answers she gave then to address the committee’s recommendation that the Government and NHS England should detail the steps they are taking to ensure equitable access to neonatal outreach and perinatal mental health services for all families who experience preterm birth?
This ties closely to recommendation 8 on the need to develop specialist knowledge of the needs of preterm babies and their families into health visitor training and continuous professional development, with protected training time. As my noble friend Lady Bertin mentioned, it is people and relationships that can help others turn corners.
Finally, I turn to one of the most disappointing findings of the report, which is that the follow-up assessments for children born pre term that are recommended by NICE
“are not being consistently delivered, in particular at age four”,
as was outlined by the noble Lord, Lord Patel. I think I speak for the whole committee in saying that we were highly dismayed that neither NHS England nor the DHSC could explain why this was the case or who was going to grip it. I know that the Government are in the process of an NHS restructure; I am certainly looking not to open up that debate today but, rather, to emphasise the committee’s desire to see swift resolution here. I would be most grateful for a precise answer from the Minister.
To sum up, although there was a huge amount of specialist knowledge and experience in this report, at its core, it is very simple: we can and must do better for babies, mothers and families. The most powerful evidence comes from those parents who have campaigned with a quiet dignity to spare others the pain that they have experienced. I feel a huge responsibility to keep up the momentum to deliver change for them; I reiterate to the Minister my commitment that I will work cross-party to try to do just that.
Baroness Owen of Alderley Edge (Con)
My Lords, I begin by paying tribute to my noble friend Lord Patel for his excellent chairmanship of the Preterm Birth Committee, as well as his huge compassion throughout, and to my noble friend Lady Bertin for proposing the subject of the inquiry.
My time on this committee brought one of the most poignant moments of my time in your Lordships’ House, when the committee had the chance to visit a neonatal unit at a local hospital to gain an insight into the plight of babies born pre term and the experience of their families. Even a year on from my visit, the sight of a tiny baby, born at 23 weeks, in an incubator remains in my mind and emphasises to me the importance of bringing about real, positive change for those born too early. I hope that the work of the committee and the report do justice to those who gave evidence and bravely shared their experiences; I also hope that they can be used by government to improve the lives of those born pre term.
I will focus on a few aspects of the committee’s findings. One thing that struck me most during our evidence sessions was the seeming simplicity of some of the interventions, as well as the frustration that great improvements could be made if those interventions were implemented consistently. On perinatal optimisation interventions, we heard specifically that delayed cord clamping can reduce mortality by up to half for preterm babies, yet it has not been implemented consistently. In a recent briefing, the charity Bliss warned that variation in practice remains rife.
Another example that formed part of the committee’s recommendations—this was highlighted by my noble friend Lady Wyld—is the importance of family integrated care, where parents play a key role in their baby’s care. Evidence from Bliss found that this leads to better outcomes for babies, reducing mortality and morbidity as well as requiring fewer days in neonatal care. Despite the great benefits associated with family integrated care, sadly, it is not always possible due to the lack of facilities for parents and access to overnight accommodation. A 2022 study from Bliss found that 75% of parents did not have access to overnight accommodation when their baby was critically ill. On a visit to a local hospital, the committee saw for itself family integrated care in action and was privileged to speak with parents and hear about their experience. I am pleased that, given the committee’s recommendation, the Government have said that they will publish early next year the findings of the maternity and neonatal estate survey, detailing parental accommodation. However, I would be grateful if the Minister could give a better idea of when this will be.
Finally, I wish to focus on the observation made by the committee around research. During an evidence session, I was particularly surprised by the lack of both research and funding for research taking place into the causes of preterm birth. The committee rightly highlighted the need to push for more research into pregnancy and to further our knowledge of the mechanisms of preterm labour. Not only is greater knowledge of this area critical to improving the life outcomes of those who are born too early but, importantly, from a government perspective, the evidence from economic modelling for England and Wales suggests that, if we could delay preterm birth by one week across gestational ages, it would lead to a cost saving of £1.41 billion per year. The British Association of Perinatal Medicine suggested that investment in simple, low-cost interventions will engender longitudinal cost savings in healthcare and education many times over.
I am pleased with the positive response from the Government on the report’s findings, but it is vital that we continue a watching brief, ensuring that commitments are followed through and recommendations are implemented as quickly as possible to improve the lives of babies born pre term in our society so that they can not only survive but go on to flourish.
Baroness Bennett of Manor Castle (GP)
My Lords, I join in the general and fervent thanks to the noble Lord, Lord Patel, and his committee for this terribly important report. I also thank the noble Lord for his introduction to this debate.
The noble Lord, Lord Patel, mentioned an issue that I would like to start with: the situation of our current final year midwifery students. The Royal College of Midwives did a survey and found that 84% of them said that they are not confident that they are going to find a job after graduating this year. This makes no sense at all. We are in the middle of calculating the formula for exactly how many midwives we need, but, if we look at the figures from the Royal College of Midwives, we see that a survey of members recently found that midwives and maternity support workers were working an estimated 118,000 unpaid hours of overtime each week to meet the needs of their patients. We should be grabbing those graduating midwives with both hands and making sure that they have a secure future because, of course, they now face the enormous weight of student debt, with many of them being previous graduates who are doing this as a second degree. There is a risk that they will go and do something else because they need to put food on the table and keep a roof over their head. Of course, this is a situation that many resident doctors and anaesthesiologists already face; as the Minister will know, I have put down Written Questions on that issue.
I turn to the specific issue of preterm births. Here, I will focus not on the care but on the public health issues. We have heard in this debate a great deal from many expert figures about the fact that, in many cases, we do not know the cause of a preterm delivery. However, one thing we do know is that poverty, inequality and discrimination increase the level of suffering around preterm births. The most recent figures show that the neonatal mortality rates associated with preterm birth in the most deprived areas have just increased for the third year in a row. We are going backwards.
The data on preterm birth and neonatal mortality is not nearly good enough, but it is clear that minority communities are suffering a double, intersectional disadvantage. Let me make a statement of the obvious: reducing deprivation and poverty would reduce preterm birth. I do not believe that anyone would disagree with that. Drawing on the Bliss briefing, I ask the Minister this: in terms of the Government’s response to the committee’s first recommendation, what are the future metrics, targets and ambitions? Are the Government making progress in that area?
Most of my speech will address an issue that no noble Lord has yet addressed—nor, I suspect, will address. I am going to focus on One Health and the environmental health aspects that undoubtedly contribute to preterm birth, even if we do not understand the precise details.
Our environment is in a terrible state, and those who are pregnant are particularly vulnerable to that disastrous environment. Our planet has been choked in plastics and soaked in pesticides. We have seen drugs ending up out in the environment, creating antimicrobial resistance and other deleterious medical effects.
I start with a deeply shocking study, which came out after the committee reported. It is only one study, but it is seriously indicative. It was presented to the Society for Maternal-Fetal Medicine’s annual meeting early this year—the pregnancy meeting. Investigators at the University of New Mexico analysed 175 placenta, 100 deliveries at term and 75 pre term. The level of microplastics and nanoplastics in the placenta was significantly higher with the preterm births and much higher than previous levels of microplastics and nanoplastics that have been measured in human blood. Clearly, the placenta is concentrating microplastics and nanoplastics in the maternal blood. However, what is deeply concerning is that the preterm births have higher rates than the full-term births, which is counterintuitive. If this was a gradual accumulation over a time that was not associated with the preterm birth, you would expect the longer-term ones to have more plastic.
I come now to PFASs, generally known as “forever chemicals”. Two studies were published in 2023 showing an association between the level of PFAS in maternal blood and the rate of preterm birth. The study in environmental health, Siwakoti et al, showed that it was particularly affecting male babies, and that the accumulation in male babies was higher than that in female babies. Noble Lords here who are experts will tell us that male babies are more fragile at birth. PFAS is concentrating more in those babies, with potential effects which we do not yet understand but which are deeply concerning. Another study, from the Emory University, found that mothers with higher levels of PFAS in pregnancy are 1.5 times more likely to have a baby born three weeks before their due date or earlier—the preterm babies we are talking about. The early term, one to two weeks before, is also raised.
We also know that we have pesticides all around our environment. Noble Lords might have seen a recent environmental study which showed extraordinarily high levels of glyphosate—the chemical to which we are all very heavily exposed to—in tampons. Glyphosate in maternal blood levels is associated with higher levels of preterm birth. More broadly, on pesticide exposure, a lot of this is uncertain, and all of it is very complicated, but another a meta-analysis suggests some of the ways in which pesticides might be having impacts on preterm birth. They might be triggering inflammation and oxidative stress and disrupting endocrine functions.
Finally, there is the microbiome. The noble Lord, Lord Winston, mentioned our starting to understand that the vaginal microbiome is significant in terms of preterm birth and many other aspects of health. A study from 2023 showed that there was a unique genetic profile in the microbiome of preterm births. There was a higher richness of diversity of microbes and a greater diversity of antimicrobial resistance genes. We have here a real problem with the vaginal microbiome and issues that we do not yet have much understanding of. Unfortunately, the noble Lord, Lord Leong, is not currently in his place, but I cross-reference here the debate that the noble Lord and I had, and an amendment that this House voted on, about regulating period products. An issue that I raised in the context of period products was reusable period products that have high levels of silver and nanosilver, which demonstrably have negative effects on the vaginal microbiome. Also, with the tampons I was talking about earlier, there are the pesticides but there is also evidence of heavy metals, which will have impacts on the vaginal microbiome.
I apologise for this having been a rather depressing speech. However, this situation is not inevitable. Companies are making products that are threatening the health of all of us very broadly, but particularly the most vulnerable in our society—those who are pregnant and the young babies who will be born prematurely. This is an area in which we need urgent government action. I have cited very recent studies, and the knee-jerk reaction to the Government from the Civil Service on these kinds of issues tends to be, “We’ve got to wait for more data and information”. However, if noble Lords look at the list of things that I have gone through, they will see that each one was a case where researchers were looking at one product and one factor, in isolation. No pregnant person is exposed to just one of these factors; everyone is being exposed to all of these as a cocktail, and the levels of all of them are going up all the time. Once we have put them out into the environment, we are unable to take them out. Surely, on preterm birth, on the state of the health of the nation, we need to apply the precautionary principle and take urgent action to rein in the corporates who are exposing us to all these threats.
Baroness Penn (Con)
My Lords, this has been an excellent debate so far, based on an excellent report. That is unsurprising, since it has taken place under the expert chairmanship of the noble Lord, Lord Patel. I will focus my remarks on the support that we give to parents who have had preterm babies, but first I want to touch on another aspect of the report—staffing levels.
We have had chronic shortages of maternity and neonatal staff for years, which affects so much of the delivery of what is in this report. The noble Lord, Lord Patel, and the noble Baroness, Lady Bennett, have raised the concerns of the Royal College of Midwives that the current cohort of midwifery graduates are not confident of getting roles in the NHS when they graduate. I know that the Government are refreshing their long-term workforce plan, but when we can expect to see an updated plan? Will it specifically address midwifery? How will abolishing NHS England affect the delivery of that plan? Who will be responsible and accountable for delivery? How will that transition take place?
I turn to my main focus—the support that we give to parents at that very difficult time following a preterm birth. The report makes clear that many parents will spend weeks or months caring for their baby in a neonatal care unit. They have to deal with the alien environment of a neonatal care unit and the feeling of daily amputation in being separated from their babies, but witnesses also emphasised the practical and financial challenges that parents can face in these circumstances. Babies might be being cared for at multiple hospitals, sometimes a long way from home. The charity Bliss found that one in four families with a baby on a neonatal unit have to borrow money or increase their debt to manage. The introduction of neonatal care, leave and pay, which became a right in April this year, was a really important step forward in supporting parents at such a difficult time, and I pay tribute to all those—particularly my noble friend Lady Wyld—who worked to make that a reality.
With any such scheme, there are some limitations. If your baby spends six days or fewer in neonatal care, you do not qualify for any additional leave, despite mum and baby possibly having significant health concerns that need proper support. The leave is paid only at the statutory rate that we have for all parental leave, which is currently at around £187 a week.
Because we have such a poor system of paternity leave in the UK, with fathers entitled to only two weeks of leave, this has a particular impact on dads’ and second parents’ ability to support mothers and their new babies at such a crucial time.
I will give an example from the charity Bliss. A baby is born struggling to maintain their temperature and spends three days receiving transitional care in hospital before being discharged. A few days later they are readmitted, as they are struggling to feed and have jaundice. They receive six days of care in hospital before being discharged. Neither episode of care lasted seven days or more, so no neonatal care leave is accrued. It is perfectly possible that, at precisely this point, a dad’s paternity leave has run out and he has to return to work, despite a premature and vulnerable baby who has had repeat hospitalisations being at home, and despite a mum who may have had a traumatic birth, or even if not, if she had a C-section she will still be in recovery from surgery, being left alone to care for herself and her vulnerable baby.
This is not to criticise neonatal care leave or pay in any way, but to say that parents of preterm babies, and indeed of all babies, would be far better supported if we had a proper system of paternity leave and pay in this country, which neonatal care leave and pay came on top of. We have the worst paternity pay and leave system in Europe, and the biggest barrier to dads taking proper time off when their babies are born is affordability.
As my noble friends Lady Wyld and Lady Owen have highlighted, family integrated care can make a huge difference for babies who are born pre term. But the report notes the potential disparity in access to that family integrated care for those on lower incomes. As a parent advisory group highlighted, fathers and non-birthing parents often have to return to work while their baby is still in neonatal care. Even mothers and birthing parents who are self-employed face this dilemma. This has a detrimental impact on implementing family integrated care and on parent-to-child bonding. If we increase paternity leave to six weeks paid at 90% of salary, with a cap for higher earnings, that will resolve the dilemma for so many families who experience preterm births.
The Employment Rights Bill currently being debated in your Lordships’ House gives us the opportunity to make that change. What is the Minister’s view on the impact that Bill will have on parents, particularly fathers and second parents of preterm babies? I think we have an opportunity to ease the burden for thousands of parents who struggle with the practical as well as emotional impact of having a baby pre term, whether or not they are in neonatal care, and I hope she will join me in seizing it.
Baroness Seccombe (Con)
My Lords, it was a privilege and indeed a pleasure to sit on the committee under the chairmanship of the noble Lord, Lord Patel. He is an absolute master of his brief, and with his deep knowledge of all medical matters, he was able to procure witnesses who shared their expertise and experience with us.
Research into this harrowing issue is crucial. As foetuses can abort at any stage, we need to understand why that occurs in order to prevent as many tragedies as possible. I refer to previous comments from Members of this House on expanding and supporting research, which I fully support. My small contribution concentrates on midwives—those dedicated professionals on the ground—and the fundamental role that they should play in any birth.
First, I was shocked to find that we currently have a shortage of 2,500 midwives. This is extremely worrying and I would encourage the Government to act fast to address this. For instance, I would like to think that assistance could be given to those nurses wishing to enhance their career by becoming fully qualified midwives. This should be a priority for all of us. Midwives are essential to the care of expectant mothers and mothers of newborn babies, as well as providing the link to increased medical care. As with all medical professionals, it is their manner which is just as important as their professional skills.
However proficient parents may be, actually holding your baby for the first time makes you realise the responsibility you have taken on and how dependent this tiny, fragile person is on you. It is essential that parents have someone to help cope with this miracle that has taken place in their lives. A midwife can be that person, or the link to a local person assigned to that role.
This is even more important in preterm babies, who often have special needs. Midwives give much-needed help and confidence to parents who return home with a baby who needs exceptional care. Many of these parents might not have known that their baby would have special needs and will be in a state of shock as they comprehend the impact this will have on their family’s life for many years to come. Is it not our duty to help these parents as they navigate a difficult time by ensuring we have trained and dedicated midwives available for all?
Things were very different when I was having children in the early 1950s. I was in a nursing home for two weeks and then returned to stay with my mother with my first baby. For my second, I had a dedicated midwife to live at home with us for a month. She soon got me organised and was a brilliant cook, so we all flourished. Of course, family life has changed since then. Nowadays, grandparents are often still working, and parents live far away from them. So, while I would like to encourage whole-family involvement where possible, we should, as a society, give extra care where the parents need it.
My second ask is around improving hospital accommodation for new parents. As we know, preterm babies often spend a long time in hospital so that their development can continue as they strive to reach the correct weight. Some hospitals have staying facilities for mothers, but often not for fathers, and it is patchy nationally. I would like to see more facilities available, so that parents can be near and bond with their baby. Spending time away from your baby in those first days is harmful for the baby and the parents.
I will finish here. This has been a fascinating debate. I hope that it has become obvious that I am fully behind midwives and their roles before and after the birth of all babies. I hope that the Government will do all they can to encourage more of these pillars of society to sign up for this vital work.
Lord Weir of Ballyholme (DUP)
My Lords, I am only the third male Member of this House to speak in this debate, following on from the noble Lords, Lord Patel and Lord Winston, which, in addition to the other excellent contributions that have been made, gives me a slight feeling of being woefully inadequate to comment on this subject.
But I will start by commending what is an excellent report. While the scope of the report deals with England and Wales, the lessons that are drawn from it are applicable in all parts of the United Kingdom. It focuses on the two critical points, which are the incidence of preterm births and how we can optimise care for both the babies and their families in the days after birth.
It is critical because it goes to the heart of one of the two great nightmares that any parent can face. The second-worst situation for any parent is to be left in a situation in which your child is faced with a life-threatening condition, where you are left with weeks or months of trauma, not knowing whether your child will survive, not even being able to give that child comfort, and often then being faced with a situation in which that baby is faced with lifelong conditions. That is the second-worst situation for any parent. The worst situation, which sadly also pertains to a number of parents in preterm births, is the death of their child. There is no greater trauma that any parent can face, and that is why this this issue is so vital.
In the time available to me I want to look at three aspects of the report. The first is the incidence of preterm births. We are, thankfully, living in an era in which we have seen consistent improvement on a wide range of medical issues. No more so is that the case, over the decades and centuries, than for issues around birth and maternity. In human history, not that long ago, mortality rates for babies and mothers were extremely high. That applied not simply to those with socioeconomic problems but equally, quite often, to the most privileged and richest in the land. Thankfully, we have seen considerable improvements in that.
This is why the statistics produced in this report are quite worrying. As indicated earlier, a target was set 10 years ago to reduce the number of preterm births from around 8% to 6%, yet, in that 10-year period, figures have remained stubbornly high. Currently, the figure in England is 7.9%; in Wales, it is 8.1%. As indicated in the report, those figures mask further underlying problems, in the higher level of incidence for mothers from both lower socioeconomic backgrounds and ethnic minorities. The statistic is stark that a black mother is twice as likely as a white mother to have a very preterm birth. Similarly, the figures have not shifted for neurodevelopment issues.
As indicated, there is a multitude of reasons, of risk factors, for this. Mention has been made of smoking, drinking, mental health issues and diabetes. There is a wide range. One key aspect, on which I know the Government are focused, is the wider public health message, because a lot of these problems can be eased prior even to pregnancy taking place. We know the risk factors, but one of the areas highlighted in the report is the job of work still to be done, with greater levels of research, to work out the level of causality between risk factors and the end results.
Secondly, a wide range of screening, treatments and scanning takes place but, while new technologies can make improvements, we need to drill down in this area, with a much greater level of research, to try to make sure that what we provide prior to birth is the best possible situation to avoid preterm births.
A further area is the very welcome recognition that, while birth and the weeks after it are important, issues with preterm birth go well beyond that. It is important, particularly when we are looking at targets, that we acknowledge the number of cases where preterm births are medically induced, where it is both necessary and virtuous because it produces a better result for the mother and baby. However, we also know that around 75%—another statistic referred to in the report is 79%—of neonatal deaths are preterm babies. Beyond that, the figures also suggest that 46% of deaths of children under 10 were preterm babies. We know that, among preterm babies, there is a greater incidence of severe and milder disabilities, such as ADHD and cerebral palsy. The figures suggest that the incidence of children with severe brain injuries is around seven times higher than it is for babies who have gone full term. So there are important repercussions beyond the initial period in a neonatal unit.
The report is also very good at establishing some of the problems that are created not just for the babies themselves but for their families. We know that this can be a very traumatic experience and that it is rarely anticipated by the parents. Many mothers and fathers are left with a high level of anxiety—a traumatic period of separation when they are not able to give comfort to their children or hold their newborn babies. That can create a feeling of separation and alienation; the report indicates the number of parents who have PTSD as a result.
A point made very well in the report is that this is not simply in the first few weeks of birth but, as sometimes happens with trauma, can kick in much later, maybe months or even a year or two afterwards. It is clear that there are not necessarily the right levels of support for that. Counselling is also not always given to parents as follow-up support.
My third and final point, which is writ large throughout the report, is on the level of variations. While there has been a considerable improvement in the number of trusts embracing a bundle of interventions, there are still gaps. We need to work on best practice models, such as the PERIPrem model, and see where we can roll them out.
A range of other issues relates to that. The extent to which training can be given is sometimes dependent upon how much trusts are able to release staff, which varies. We have seen that family integrated care is not always universal, and some trusts, according to the report, water down that national guidance.
Beyond that, a range of staff shortages has been highlighted, from obstetrics to gynaecology departments to midwifery. Indeed, the gaps in terms of midwives also mean that there is no consistency of care.
Finally, as is highlighted in the report, we have also seen sporadic follow-up in, for example, the level of knowledge of health visitors, the position on two-year and four-year follow-up and the lack of counselling for parents.
So there is a lot to be done, and we need to see a greater level of consistency. One of the startling statistics highlighted in the report, which shows the need to further prioritise this issue, is that, for every pound spent on pregnancy care in this country, less than a penny is spent on pregnancy research. This report is a very good road map and I welcome the commitments that the Government have made but, if this is not simply to be an excellent report that gathers dust on the shelf, we will need to see those commitments turned into reality by the Government implementing the report.
Baroness Sugg (Con)
My Lords, when the House of Lords Preterm Birth Committee released its report in November last year, it was an important contribution to our national conversation about preterm birth. It brought overdue attention to a complex but urgent challenge that affects over 45,000 babies born prematurely in England each year.
As the report highlighted, while many premature babies go on to thrive, the reality is that preterm birth remains the leading cause of neonatal mortality and morbidity in the UK. It is also a contributor to long-term disability, childhood illness and immense emotional and financial strain on families. The report highlights the importance of action across this area.
In 2015, the then Government set an ambition to reduce the preterm birth rate to 6% by 2025. As we have heard, the most recent figures show that it is still hovering around 7.9% in England: that target will not be met. This is a failure not of will but of equitable access, resources, infrastructure and consistency.
We now look to the Government’s upcoming 10-year health plan as a real chance to change course. The Royal College of Obstetricians and Gynaecologists has joined others, including the charity Bliss and the Inequalities in Health Alliance, in calling for clear, detailed and funded targets that address not only the rate of preterm birth but the inequalities that shape it. As we have heard from other noble Lords, rates remain highest among black and Asian babies and among families from deprived communities. These disparities are not inevitable; they are the result of systemic inequalities that we must confront directly. Like others, I am very interested to hear from the Minister where the Government have got in their consideration of future ambition.
The Preterm Birth Committee was absolutely right to stress that reducing the preterm birth rate is only part of the story; we must also improve the outcomes for families experiencing it. Too often preterm birth happens very suddenly, without warning or identifiable risk factors. The noble Lord, Lord Patel, in his comprehensive introduction to the debate, highlighted that parents can spend weeks or months in neonatal units, often in hospitals far from home, with limited accommodation, scarce emotional support and inconsistent follow-up after discharge.
The committee’s call to improve postnatal assessments and invest in accommodation on neonatal units is a powerful ask. The Government’s commitment in their response to the report to review funding in the next spending review is very welcome, but timelines and delivery are, again, key here. That is also true of our maternity workforce. Without adequate staffing and support, even the best-intentioned policies will fall short. As the Royal College of Midwives highlighted in its briefing, we need workforce planning to be much more joined-up. My noble friend Lady Seccombe highlighted the crucial role that midwives play. We need more midwives; therefore, we need to train more midwives, as well as retaining the existing ones, and we need to make sure that they are employed when they qualify. The revised NHS workforce plan, due this summer, should specifically address midwifery. Like my noble friend Lady Penn and others, I ask the Minister to confirm in her response that midwifery will be explicitly addressed.
We must also recognise that maternity safety does not begin and end in the labour ward. A life-course approach to women’s health that includes pre-conception counselling, support for mental health, smoking cessation and access to reproductive services is essential. Nearly one in five preterm births in England can be linked to socioeconomic inequality and, again, if we are serious about that prevention, we need a cross-government strategy that really tackles the root causes of poor maternal health. I welcome the Government’s commitment to revise the national maternity safety ambition and to include disparities in preterm birth rates among their priorities. As the RCOG president, Dr Ranee Thakar, said earlier this year, we need timelines, funding and accountability.
Looking outside the NHS to how employers can help on preterm birth, I welcome the implementation of the Neonatal Care (Leave and Pay) Act and acknowledge my noble friend Lady Wyld’s important role in taking it through this place. But we should also look to employers to do more to support their employees dealing with preterm births. They can do so more effectively by adopting compassionate, flexible and proactive HR and workplace policies. They can do this through enhanced parental leave—offering extended paid maternity and paternity leave in cases of preterm birth, starting from the actual birth date rather than the expected due date—and, through improved flexibility with remote working, phased returns to work, and improved emergency and compassionate leave policies. There are many excellent examples of best practice here, and I hope the Minister will discuss this further with her colleagues in the Department for Business and Trade.
I thank my noble friend Lady Bertin for proposing this report, the noble Lord, Lord Patel, who has obviously been an excellent chair, and all the members of the Preterm Birth Committee, many of whom have made powerful speeches today. The Preterm Birth Committee has laid out a blueprint for change and, if we act on all its recommendations and align that ambition with delivery, we can make meaningful progress not just in reducing preterm births but in transforming how we care for women and families at every stage of their life.
Baroness Blackstone (Lab)
My Lords, I declare an interest as the chair of the trust of the Royal College of Obstetricians and Gynaecologists. I have another interest in that I am the grandmother of preterm twins born at 29 weeks’ gestation. They are an example of the success of the NHS in providing excellent care—they are now professional women with postgraduate as well as undergraduate qualifications.
I thank the excellent chair of the committee, the noble Lord, Lord Patel. I am also very grateful to the Government for the many positive replies they have provided for the committee in their response to the recommendations. There are, however, several issues where an update on progress would be valuable, and one or two where more detail would be helpful to build on somewhat vague promises.
The two important issues I want to raise concern staffing and research. I begin with the first of those. Undoubtedly, good outcomes in reducing the percentage of preterm births and in improving the care of infants and small children who are born prematurely, as well as supporting their parents, depend on better staffing. The services involved are complex and require first-class co-ordination between different professionals to be truly effective. I ask the Minister to answer a specific question concerning the need for adequate numbers of doctors where there are serious pressures on existing staff and those pressures reduce the quality of care. As part of a workforce planning exercise, the DHSC commissioned the RCOG to accurately quantify the number of obstetricians needed in maternity units in England. A tool was developed to enable trusts to compare their staffing levels with national averages, taking into account their local context, including the complexity of their case load. The department received the findings, including an estimate of the number of obstetricians needed, in 2023. Continuation of that work is now urgent but, so far, the DHSC has failed to confirm the next stage of the project—can it do so now?
For the Saving Babies’ Lives Care Bundle, properly staffed preterm birth prevention clinics are needed, with access to regional centres where that is not possible. Further training is needed for the specialist staff required in developing cross-specialty leadership, which includes internal and foetal medicine, as well as neonatal care and anaesthetics. Employers need to be resourced to free up specialist staff to get in-service training and to build a supportive learning culture.
There is also a crucial shortage of perinatal pathologists, who are needed to examine possible causes of preterm birth, as was referred to by my noble friend Lord Winston. We need to undertake placental histology of women who have given birth at less than 32 weeks’ gestation. Even when that service is provided, there is a lack of specialist postnatal clinics to follow up on the results. Can this be rectified?
So far, I have focused on doctors but, of course, nurses and midwives are also crucial, as others have said. So I welcome the current three-year delivery plan to boost the midwifery workforce. Perhaps the DHSC could start to consider what it will do when the three years is up next year. I also welcome greater attention being given to the retention of nurses and midwives through more flexible working arrangements. I first became aware of the acute shortage of neonatal nurses when I chaired the Great Ormond Street Hospital board—that was several years ago, yet the shortages continue. Perhaps the Minister can explain what the Government meant in practical terms when they said in their reply to the committee report that they would
“refresh the NHS workforce plan”.
Like other speakers, I also refer the Minister to the Royal College of Midwives’ survey findings that final-year midwifery students lack confidence that they will find work as a midwife when they finish their course. It really is puzzling given the apparent shortage of midwives and the large amounts of overtime they currently work. Can workforce planning in this area be improved?
I turn to research. It is recognised that the causes of preterm birth and its prevention are not as widely understood, as was set out so well by my noble friend Lord Winston. Without funding for more research, that will continue. I recognise that the call for more research is happening in many areas of medicine—it is widespread—but the costs of prematurity, especially when it is extreme, are enormous. Better research could produce savings for the NHS in the long term, as well as benefiting families. For high-quality research to succeed, more attention should be given to developing digital systems to improve data collection. The variation in digital systems across the country prevents the creation of a comprehensive national database of birth outcomes and their relationship to demographic characteristics. Without that, we cannot do the good research that is now needed.
Lastly, I will touch on socioeconomic and ethnic questions. It is well known that higher rates of preterm birth are linked to socioeconomic deprivation. Of course, policies way beyond healthcare are needed to address inequality. However, specific steps are needed to support women who are poor when they become pregnant; these include public health measures to tackle the advertising and promotion of unhealthy food, alcohol and tobacco. Prenatal and postnatal monitoring are especially important for women from deprived communities, to reduce the incidence and mitigate the effects of preterm birth.
Measures such as parental accommodation on neonatal units, although valuable for all parents, are particularly important for the socially deprived. This, of course, was mentioned by the noble Baroness, Lady Wyld. Can the Minister confirm that the necessary investment is in the Government’s plans for this purpose? This is just one way to help families who are suffering acute stress as a result of preterm birth.
I will end with a little anecdote. No one so far in this debate has mentioned siblings. After my premature twin granddaughters were born, I looked after their older sister, who was two and a half years old. I took her to visit my brother and his family. While no one was looking, she bit the baby in the pram. I think she was giving us a little message: “I’m distressed too. I’ve been displaced and I don’t like babies”. We need to end stories such as this.
Baroness Brinton (LD)
My Lords, it is a pleasure to follow the noble Baroness, Lady Blackstone. I congratulate the noble Lord, Lord Patel, and his committee on this excellent report. It takes the recommendations of Lady Cumberlege’s 2016 report, Better Births, on to a new, more detailed, more expert level—including, very importantly, experts by experience—by assessing our hospitals preterm birth services in the light of the decade that has followed.
I talked to Lady Cumberlege late in 2016 about the Better Births report, because my first two identical granddaughters were born in May 2016 at 29 weeks, just like those of the noble Baroness, Lady Blackstone. They were at heightened risk because they had twin-to-twin transfusion across the placenta, which is dangerous to both twins, and the status of one of them was already serious prior even to that point. My son and my daughter-in-law lived the full experience of preterm birth and its after-effects full on for four years, so although I want to focus on the recommendations and the Government’s response, it is in the context of probably the most intense period of our family’s lives.
I need to say at the start that these two now nine year-old twins are healthy, active and intelligent, which is only possible because Kingston Hospital, the Evelina hospital and their local community services, as well as organisations such as the Twins and Multiple Births Association and Bliss, delivered everything that they needed to survive and grow. The noble Baroness, Lady Seccombe, talked about the importance of health visitors; they are as pressurised as our GPs and we need more of them.
The committee’s report is excellent, and the expertise of its members, especially its chair, the noble Lord, Lord Patel, is evident in the recommendations. But, as I have said, I want to look, from these Benches, at the Government’s responses to the report. It is good that they have in principle accepted the report’s recommendations, but it is their implementation that I want to ask about. I echo the question from the noble Baroness, Lady Bennett, about staffing levels and working practices for midwives, which other noble Lords have also spoken about.
The Government’s response begins by assessing the challenges ahead for maternity services, reporting frankly on the “broken NHS”, as well as the very specific problems in a number of maternity services. Only yesterday, the Health Service Journal said that an analysis of the extra money for the NHS this year showed that it is effectively all spent already. Can the Minister say whether there is sufficient resource this year and in future years to effect the changes that the Government aspire to, not just during this Parliament but immediately, this year and next year?
At the start, the Government’s response speaks about the excellence of the NHS’s Saving Babies’ Lives Care Bundle, but notes that its application is inconsistent. Is there specific funding to ensure that the bundle can be delivered consistently across the country by April 2026? The same is true of the key targets to reduce the rate of preterm births, given that the previous target of reducing the rate to 6% by this year will not be met, as others have said. The Government’s response is silent on new targets to replace this, citing only the challenges. Can the Minister tell us when new targets will be announced?
The Government cite the £50 million NIHR challenge fund, created a year ago by the previous Government to provide researchers and policymakers with resources to assess new ways to tackle maternity disparities and poor pregnancy outcomes. I agree that this is vital, but when will the reports be concluded and published? The noble Lord, Lord Winston, spoke of the importance of more research on miscarriage. He is right. That should be considered too.
The noble Baroness, Lady Goudie, set out how important early advice and guidance is to help to reduce rates of preterm birth, and recommendation 2 sets out the advice and access to information that future parents need long before the pregnancy. I welcome the Government’s endorsement of this, but much of it is funded through the public health budget, which is notoriously under pressure. The noble Baroness, Lady Bennett, highlighted this, and the noble Baroness, Lady Sugg, and the noble Lord, Lord Weir, also talked about the real problems of financial inequalities.
There is also a reference to the GP postnatal check-up six to eight weeks after birth being carried out in full. The proposals are excellent, but do our currently hard-pressed GPs have the capacity to deliver this vital check-up in the detail that is actually needed?
Recommendation 3 focuses on clinical guidance for preterm birth care. My daughter-in-law’s experience of a complex pregnancy, with twin-to-twin transfusion and not just one but both girls’ lives at risk, was absolutely textbook. The delicacy with which the risks were explained to her and my son and the care before, during and after the operation in utero at 16 weeks on her girls, were breathtaking. Things seemed to happen so fast, but all the staff we encountered as a family were caring and careful. When the girls arrived at 29 weeks we were all ready, but a couple of days beforehand we were warned that there might not be two NICU incubators at Kingston, and one of them might have to go to Southampton, the nearest NICU with a space—yes, Southampton. Can you imagine two new parents, one of whom has had a caesarean, trying to manage two babies in NICUs 60 miles apart? The noble Baroness, Lady Penn, was right to raise this issue. Luckily, on the day, they had two incubators at Kingston; I suspect that another family was sent to Southampton. Will there be a review of the number of NICU incubators to prevent this happening?
We were warned that one of the twins might have severe problems or not survive. She did—all 700 grams of her. The noble Baroness, Lady Bertin, spoke about the tiny size of these babies. My son could hold baby A—her whole body—in the palm of his hand. The care for both in those first few days in NICU was outstanding and supportive. The other baby—all of 1.5 kilograms—came home, but A’s issues, which were not unusual for a baby of her size and problems, continued. After a few weeks, she moved to the Evelina hospital and remained there until she was 10 months old. NICU, PICU, and then the long-term Snow Leopard ward were all extraordinary. Yet we watched our children manage one twin at home in Barnes and the other in hospital in Waterloo, as well as my son holding down his job and the stress that it put on the pair of them.
I thank the noble Baroness, Lady Wyld, for her Neonatal Care (Leave and Pay) Act, which will undoubtedly help families. The noble Baroness, Lady Penn, said that we need better parental leave, and she is right. The legislation that Jo Swinson led in coalition was a start, but we all knew that it was just a first step.
Recommendations 5 and 6 on parental accommodation for neonatal support are just the tip of the iceberg. We—the grandparents, aunts, uncles and friends—all had the privilege of supporting our children. In my case, I was able to be at the Evelina most mornings, but this was a first for us, too. As the noble Baroness, Lady Bertin, pointed out, the start of the report quotes a parent saying:
“The impact of prematurity does not end upon discharge from a neonatal unit”—
so true. A had a ventilator, and a nasal and then gastric tube, until she was nearly four. We were trained by the Evelina Hospital to manage these so that we could babysit both girls and stay overnight to give their parents a break. Without it, they could have had no respite. Care was not available from the local community.
Recommendation 9 suggests that NHS England should take action to deal with follow-up assessments, especially the one at the age of four. Our family had the benefit of an effective series of follow-up assessments, even though by that stage, A had a clear dislike of people in white coats—and who can blame her? At her final assessment she walked firmly and bravely through the door. We were thrilled that she did not have to return again. By then, the speech and language therapists had supported her into excellent speaking. Her hole in the heart had healed, and she no longer needed that damn ventilator, although she still finds running difficult, unlike her twin.
The baby who used to wave over the river at granny’s office, also known as the House of Lords, every night from her ward, Snow Leopard Ward, now has a passion for wild cats and sponsors snow leopards at Marwell Zoo. She has no memory of what happened, but she would not be with us without every single one of the professionals who were there for her, her twin and their parents from the moment of that first scan at Kingston Hospital. My hope is that the report by the noble Lord, Lord Patel, and government action will ensure that this is the case for all families facing this extraordinary time in their lives, because a consistently delivered service will not just save the lives of preterm babies, but improve the quality of their lives.
The Earl of Effingham (Con)
My Lords, it is always an honour and a privilege to participate in any debate in your Lordships’ House, but today that is particularly so for me as my children were born pre term. So please allow me to thank the noble Baronesses, Lady Blackstone and Lady Owen, my noble friends Lady Seccombe and Lady Wyld, and the noble Lords, Lord Winston and Lord Patel—who are all in their place—along with other noble Lords on the committee, for this compelling and measured report, and to thank all noble Lords who have made their valuable contributions today.
The evidence the report presents is sobering. There are clear challenges ahead, but with the help of this report, those challenges can be overcome. Preterm birth remains among the most pressing issues in perinatal healthcare. In 2022, nearly one in 12 babies in England was born pre term. These early births account for a disproportionate share of neonatal mortality and long-term health complications, placing considerable strain on families and the NHS alike. Despite repeated policy commitments to reduce this figure to 6% by 2025, the committee makes it clear that this target will not be met.
Preterm birth is not only a clinical issue, but one with profound implications for families and wider society. It is the leading cause of neonatal death and a major contributor to childhood mortality and long-term disability. Babies born too early face significantly higher risks of cerebral palsy, learning difficulties and developmental delay. They are more likely to struggle at school and more likely to require support throughout their life. Yet the impact does not end with the child. The report details evidence from parents whose lives were overturned in a matter of hours, whose babies were whisked into critical care, often in hospitals far from their home. Families are routinely separated, with little or no access to overnight accommodation. Many parents have highlighted that they were unable to stay near their critically ill child, as has been flagged by the noble Baronesses, Lady Blackstone and Lady Owen, and my noble friends Lady Sugg, Lady Penn, Lady Wyld and Lady Seccombe.
It is fair to say that childbirth itself is challenging for all concerned. Adding preterm birth into that mix and, further, not being able to stay near your just-born child is incredibly distressing. Further to the emotional havoc that this wreaks, there is also the financial strain: one in four families has to borrow money or take on additional debt to get through this period. Catriona Ogilvy, the founder of the charity the Smallest Things, summed it up perfectly when she said, “We know how hard it is to sit beside an incubator full of fear. We know how hard it is to bond with a baby covered with tubes and wires in intensive care and that parents still hear the hospital alarms when they close their eyes after coming home”.
There are also disparities amongst those affected. The preterm birth rate among black women is 8.5% and among Asian women it is 8.3%, which compares with 7.7% for white women. The committee rightly describes these inequalities as complex and interconnected, but we must be clear that they are unacceptable in a modern, equitable healthcare system. The Government have signalled their intention to refresh the maternity safety ambition, but this must be part of a co-ordinated intervention on all fronts. Alone, it will not suffice.
The report has given us a robust and compassionate road map, and His Majesty’s Official Opposition commends the report’s central message. While it is impossible to prevent all preterm births, it appears that far more can be done to reduce their number and mitigate their consequences. Key among the report’s recommendations is the call to revise national targets—not merely to lower the overall rate, but to tackle the specific inequalities that persist across ethnic and socioeconomic lines. This is not a partisan issue; it concerns the fundamental matters of equity and clinical necessity.
The report also highlights the inconsistent implementation of existing guidance. The Saving Babies’ Lives care bundle contains interventions proven to improve outcomes for preterm babies, yet access to these measures remains worryingly dependent on geography. My noble friend Lady Bertin flagged the postcode lottery. The noble Lord, Lord Weir, talked about a national rollout for best practice. We must ensure that provisions for such essential care are equitably distributed and maintained.
Staffing shortages in maternity and neonatal care continue to undermine even the best clinical intentions. The Government acknowledge this, as did the previous Government, and the long-term workforce plan aims to address these shortfalls, but training must include a specific focus on the care needs of preterm babies and their families. Health visitors, in particular, require dedicated support and protected time to deliver follow-up care effectively. Too often, follow-up assessments, especially at the ages of two and four, simply do not take place. This represents a clear breach of national guidance and a serious failure in our early years provision. The result is lost opportunities for intervention and avoidable suffering for families already under strain.
As highlighted by my noble friend Lady Wyld, investment is also required in the neonatal estate. The Government must publish the results of their maternity and neonatal estate survey without delay and ensure that phase two of the spending review includes funding to expand parental accommodation across the NHS.
Data collection and research was referred to by the noble Lords, Lord Winston and Lord Weir, the noble Baronesses, Lady Owen and Lady Blackstone, and my noble friend Lady Seccombe. We have to continue to strengthen our research effort. Many preterm births occur without any known risk factors. Understanding the biological processes of early labour and the social determinants that compound risk is vital to prevention.
Optimising women’s health prior to pregnancy was highlighted by the noble Lords, Lord Winston and Lord Weir, my noble friend Lady Sugg and the noble Baroness, Lady Blackstone. The Secretary of State for Health has rightly said that, holistically speaking, prevention is better than cure, and one of the key conclusions of the report is that optimising women’s health prior to pregnancy is a very important part of preterm birth prevention. In order to address risk factors such as obesity and mental health issues, we have to ask: when are the Government going to make a healthy diet and exercise a major priority in their programme of prevention, in both schools and the adult population at large? Currently, the statistics paint a frightening picture.
The committee’s findings have been welcomed by clinicians, researchers and advocates alike. In recent weeks, we have heard constructive challenges to the Government in your Lordships’ House regarding reviews and time delays, and in the same light we must challenge on any further reviews regarding preterm birth. We now have some of the answers. As the charity Bliss has rightly stated, this is a moment for action, not aspiration. We urge the Minister to provide clarity on how the Government will act on each of the report’s recommendations, so that families affected by preterm birth receive the care, compassion and clarity that they deserve.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am sure I speak for all of us when I say that it feels somewhat overwhelming at the end of a debate such as this, not least because noble Lords have been very generous and open about their personal experiences and those of their friends and families, and I am grateful to all noble Lords for being willing to do that. Of course, I join in all the thanks to the noble Lord, Lord Patel, not just for his expert chairing of the committee, which has given us the quality of report that we have got, but for his introduction today. My thanks are also due to all members of the committee; I am sure they are proud of the report.
I heard that this is a report that should not sit on a shelf, and I quite agree. It has shone a light on many of the challenges. As the noble Earl, Lord Effingham, said, no one action on its own will make a difference. Having given evidence to the committee, read the report and overseen the response of the Government, I feel that that the more we look into this, the greater the complexity we find.
We have sought to take each item as best we can. Is there more to do? Completely. Do we start in a difficult place? Yes, we do. So I am grateful for the report. I also associate myself with the thanks that were given to all those who provided evidence. I am sure it will have been an extremely affecting experience to hear from parents and others who have been affected in this way. What the report is about, and what I wish to be about, is protecting the most vulnerable—the babies, the women and their families—and I know that everybody has come from that place today.
I say to the noble Baroness, Lady Wyld, that, as she knows, I welcome the challenge that she and the committee make to the Government, and I will seek to be as helpful as possible today. I know I will not be able to provide every answer, but it is right that the questions are answered. If there are particular areas that I do not get to address, I will of course pick them up afterwards.
I say to the noble Baroness, Lady Brinton, who I know was deeply affected by the words she shared, that she affected us all. I am sure it was hard for her, but the noble Baroness brought into the Room exactly why we are here.
What is the scale of the problem before us? In 2023, the year for which we have the most recent figures, there were almost 4,600 preterm births. That is just over 8% of all births, a very considerable amount. I share the view that rapid improvements are needed to improve not only outcomes but the experience of women and their babies.
We have heard today about the many risks that contribute to preterm birth, which include pre-existing health conditions such as high blood pressure and diabetes, multiple pregnancy, factors such as smoking and obesity, maternal age, and assisted reproductive technology such as IVF. We also know that preterm birth is more prevalent for women from black and Asian groups and for those women living in the most deprived areas, and that situation cannot be allowed to continue.
The impact of being born pre term is significant, as we have heard. Not least, preterm babies are more likely to die in their first 28 days or their first year of life, and in fact the number of child deaths from prematurity rose between 2019 and 2023. We know the scale of the challenge before us. Preterm birth increases the risk of chronic conditions, and babies born pre term require more hospital-based care in infancy and childhood. I was interested to hear put on record by noble Lords, including by my noble friend Lady Goudie, that preterm birth can place significant emotional, financial and logistical stress on families. I welcomed and was glad to support the launch of the Create Health report that shone a light on many of those matters.
This is an important point to make, and it was made to some extent in the debate, but in some cases preterm birth is medically appropriate—this is something I can recall discussing with the committee—because, in that instance, it is safest for mother and baby. One of the difficulties with the target from the previous Government, I felt, was that it did not make that distinction, so it is important that we get any further targets right.
So what actions are under way? My department works with NHS England and across the sector, including with the charities referred to by the noble Earl, Lord Effingham, and I add my thanks to those charities and third-sector organisations. We are working on a range of actions for now and into the future to tackle some of the deeply entrenched issues.
The noble Lord, Lord Patel, and others made positive reference, which I share, to the Saving Babies’ Lives care bundle. This has been co-developed with clinical experts and professional societies, and it draws very much on front-line learning and experience to provide a package of interventions to reduce variations in care, which we know are out there, and to improve neonatal care quality and outcomes. The implementation of the care bundle is one of the conditions required to ensure compliance with safety requirements.
The noble Baroness, Lady Brinton, raised the point that, as of May this year, some 97% of maternity services were fully compliant with the care bundle. That figure has increased by 10% since last year. I assure her that the remaining small percentage is nevertheless significant, and we are following up with them to ensure that they will become fully compliant. The elements of the care bundle address the committee’s recommendation, but we seek to go further.
Noble Lords, including the noble Earl, Lord Effingham, raised the two-year and four-year assessment checks for children who were born pre term. They are extremely important and we are looking at what further actions are needed to ensure that children receive those follow-up assessments, because of their importance.
All 150 maternity and neonatal units in England are taking part in the NHSE perinatal culture and leadership programme. A number of noble Lords, including the noble Lord, Lord Patel, and the noble Baroness, Lady Wyld, were absolutely right to highlight the importance of the maternity and neonatal estate in supporting parents being fully involved in their babies’ care. So I am glad that, just last week, the allocation of some £750 million through the estates safety fund was announced. This is to start tackling—it can only be a first step—the maintenance backlog. The £750 million will support 400 hospitals, mental health units and ambulance sites. I say very specifically that it includes over £100 million for maternity units to enable better care for mothers and their newborns. I know that the noble Baroness, Lady Seccombe, is rightly exercised about this.
I say to the noble Baroness, Lady Wyld, and other noble Lords that I understand the frustration about the time that has been taken for NHS England to publish the findings of the maternity and neonatal estates survey. Noble Lords will not have to wait much longer for that, and I too look forward to seeing it.
A number of interventions rightly centred on the workforce. There are still shortages across the workforce. Overall, the refreshed workforce plan, which will be published in the next few months—in answer to the questions—will seek to transform the services over the next decade to ensure better care for patients.
My noble friend Lady Blackstone asked what is happening to understand obstetrics staffing and managing the workforce more broadly. As I say, that will be covered by the workforce plan. However, it is the responsibility of trusts to ensure that they have the right staff in place.
On the workforce, the noble Baroness, Lady Wyld, asked about professional development, and other noble Lords, including the noble Baroness, Lady Sugg, asked about the inclusion of midwifery. I completely agree that it is crucial that staff have the training they need to make sure that they have the right knowledge to provide the right care. The new workforce plan will follow the 10-year health plan and the spending review. Noble Lords will understand that I cannot pre-empt exactly what it will say, but I can say that it will look at the wide range of issues that face the workforce, and that will of course include midwives. Colleagues across NHSE and the department remain committed to delivering on this in respect of the workforce, and I will be very much focused on having the midwifery service that we need.
On the survey, I understand the concerns that were raised about trainee midwives being very worried about their future employment prospects. This was raised by a number of noble Lords, including the noble Baronesses, Lady Bennett, Lady Penn and Lady Sugg, and my noble friend Lady Blackstone. I can share with your Lordships’ House that there is, in some way, a positive position—this is not a way of glossing over the difficulties—in that there are fewer vacancies currently because of improved retention. In fact, the NHS nursing and midwifery workforce has grown in recent years, so we have branches of nursing and midwifery where the new graduate supply is greater than the number of posts available this year. I appreciate the tension, and I assure noble Lords that NHS England is working with educators, employers and regional teams to support newly qualified nurses and midwives in securing employment. This includes developing resources to support learners through the recruitment process and identifying suitable opportunities and support.
The noble Baroness, Lady Penn, asked about NHS England’s abolition and where responsibility will lie. The specifics are being worked through, but the central team leading the change will ensure that nothing is lost in terms of what we need to do. The service that we are concerned about here—provision—will remain a priority. The abolition of NHSE will remove duplication, and I therefore expect to see improvements in this area.
The noble Baroness, Lady Seccombe, made an important point about nurses training to be midwives. I am grateful that the noble Baroness spoke to me about this separately. I agree that nurses who train to become midwives bring a whole wealth of experience, and NHSE offers funding to support this shift. However, I recognise that we may need to go further in order to support nurses to remain on the relevant courses and to take up posts in maternity units. So the funding offer for this will be reviewed later this year.
The noble Lord, Lord Patel, spoke about the importance of community services and health visiting services. Through our plan for change, we will ensure that children and their families are cared for by the right professional. We will strengthen health visitor services.
The noble Baroness, Lady Bertin, spoke very sensitively about mental health issues, as well as a number of other points. Specialist perinatal mental health services are now available in all 42 integrated care systems, and very important they are indeed.
I agree with noble Lords, including the noble Lords, Lord Weir and Lord Patel, on the importance of a woman’s health before pregnancy. More work is required to improve awareness of pre-conception health and pregnancy, taking into account—this is another key point—that many pregnancies are not planned. That is why the point about early education and support is so crucial. The 10-year plan, which we will see shortly, will set out how we will tackle the inequities that lead to poor health.
Research was raised by my noble friend Lord Winston, the noble Baronesses, Lady Owen and Lady Bertin, and the noble Lord, Lord Weir. Since the committee hearing in September 2024, the NIHR has commissioned three new research awards, including research to investigate the prevention of preterm birth as well as interventions to improve health outcomes for preterm babies. Over the last five financial years, research programmes invested in 77 research awards focusing on preterm birth. Again, across their full duration, that was a total of £93 million of funding—and, yes, I totally agree about the importance of research. I will write to my noble friend Lord Winston, following up on his point urging the Government to use opportunities that the biobank presents.
On the important matter of miscarriage, I share the view that my noble friend Lord Winston and other noble Lords set out. We are taking steps to improve data on miscarriage and fill the very considerable current gaps. There is a new digital standard which will record new information on previous miscarriage and baby loss. I am looking at how effectively that is being applied, and I am also looking forward to the review of the Tommy’s graded model of care in respect of miscarriage, so I very much take the points on board.
A number of further actions are being taken to improve maternity safety, including the maternity outcomes signal system, the maternity safety support programme and the avoiding brain injury in childbirth programme. I am pleased to say that all local areas have published equity and equality action plans, which set out tailored interventions for those from ethnic minority backgrounds and those living in the most deprived areas. This will be another important focus for the 10-year plan. Fourteen maternal medicine networks have been set up across England, made up of 17 specialist medical care centres, and high-quality neonatal care is being networked together across England. We are investing £45 million in increasing neonatal cot capacity and assigning care co-ordinators. We are taking further actions to tackle obesity and smoking—and again, that will be referred to in the 10-year plan.
I say to noble Lords, in closing, that there was much richness in the committee report and in today’s debate, for which I am entirely grateful. I look forward to using what has been written, what has been said and further discussions, so that we can provide the service that we all want to see.
Lord Patel (CB)
My Lords, I thank the Minister for her response. We often say, “This has been a good debate”. This has not been a good debate—it has been a brilliant debate. All the speakers showed a passion for making the service for mothers and babies better. I heard no political issues in any of the speeches. I heard one thing only, and that was to support future mothers and future preterm babies so that that their lives are made better. We heard the same passion from the noble Baroness, Lady Brinton—I thank her for her courage—that we heard from many, many witnesses.
I said at the beginning that the report was underpinned by the evidence we heard from mothers and the lived experience of adults who themselves were born pre term about how services were failing them—services failing them when not much in the way of resources are required. What is required is the dedication that is shown by the professional, but the professional is not supported, and I hope that we will do so.
I have to say that I think the Minister had a difficult task in answering all the questions that were raised, but they were all good questions. It will require careful reading of her response to know how far she showed the same compassion, or the Government show the same compassion—I do not mean her personally, as I know she is compassionate about it—that will deliver for future mothers and babies born pre term, because babies will be born pre term. I sadly have to say that I delivered my godson at 26 weeks; he is 54 years old and severely handicapped. I also delivered, 10 years later, a young preterm baby who weighed exactly 600 grammes, who I later, as a Chancellor, twice graduated in law. So there are people, as the noble Baronesses, Lady Blackstone and Lady Brinton, said about twins, who are born premature and survive.
I hope we will not forget this debate, because there are mothers and babies out there who need our support. I agree with the noble Baroness, Lady Wyld, that we must not let this be the only occasion on which we discuss this: having the same debate every year might help.
Arrangement of Business
Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)
My Lords, the time is now 12.25 pm. I am conscious that we now have two PMBs. I am also conscious that it has been a long week for everybody. I want the House to rise, if we can, at around 3 pm, so I say to colleagues who intend to speak on the first PMB that I hope we will be able to bring that to a close by around 2 pm, if not earlier, to allow at least an hour for the second PMB. I want to get them both done today, and I do not want to keep the House after 3 pm unless I have to.
Complications from Abortions (Annual Report) Bill [HL]
(2 days, 12 hours ago)
Lords ChamberRead Hansard Text Read Debate Ministerial Extracts
Baroness Thornton (Lab)
My Lords, it was a great honour to listen to the last debate. I commend my noble friend Lord Patel for leading a wonderful debate. However, we move on, and I shall explain to the Committee why I am opposing this clause standing part.
First, I have always understood that a Private Member’s Bill in either House should seek to remedy one problem or issue which needs primary legislation to do so. I say respectfully that I do not think that the Bill of the noble Lord, Lord Moylan, fulfils this criterion. It is not a necessary solution to a problem or lack of something, because there is not a problem to be solved that requires primary legislation. That is why I have not sought to amend the Bill.
The reason why there is not a problem to be answered is that the information about complications from all medical procedures, including abortions, are already collected. We might question the efficacy of data collection, the fact that systems do not talk to each other across our NHS, and all of those things; they definitely need to be improved, but we do not need primary legislation to do so. In the case of abortions, it is the only kind of healthcare in the UK that is governed by specific criminal law. Regulations issued under the Abortion Act 1967 require that for every abortion, a woman’s name, date of birth or personal identifier is submitted and provided to the Chief Medical Officer via the abortion notification system. NHS numbers are not required. This data includes complications which are identified before patients are discharged from clinics and the information is managed by the Department of Health and Social Care.
My second reason is, why should abortion be singled out as a medical procedure? This particular and singular primary legislation would require the UK Government to publish
“an annual report on complications from the termination of pregnancy in England”.
Why not knee replacements, appendicitis operations, operations to remove tumours, heart bypasses, cataracts, hernias and the many other everyday or complex procedures, all of which carry both cures and risks which are explained to patients and whose outcomes are recorded?
The Secretary of State will be required in this case to include the complication rate for abortions by the age of the woman, by the method of abortion, by gestation and by complication type as a minimum. The Royal College of Obstetricians and Gynaecologists is very clear that the proposal in this Bill is neither practical nor deliverable and, if passed, this Bill would therefore require the Secretary of State to produce an annual report using data collections that are inadequate to fulfil its aims.
Lord Moylan (Con)
My Lords, it might be helpful if I spoke next so I could update the House on various developments that have taken place since Second Reading. I am grateful to the noble Baroness, Lady Thornton, for her remarks about the importance of improving data and the importance of that data for women’s health. Nearly all of the other points she made were dealt with and debated at Second Reading, which the noble Baroness was unable to attend.
However, the fact is that there is nothing in the Bill which exceptionalises abortion, because the statistics on abortion complications already have to be collected under the existing abortion regulations using a system that relies on data provided by the abortion provider. That might have been sensible when the regulations were put in place, but currently the majority of abortions take place by the use of pills at home. Therefore, if there are complications, they are presented, in most cases, at hospitals in A&E and they are not part of the abortion notification system, so the majority of those complications are no longer captured by the current system.
The royal college says it is impossible to capture the complication statistics, but it seems to be completely unaware that, in November 2023, the Office for Health Improvements and Disparities produced a report that, with some labour, did actually capture them and showed that it could be done. All that is in this Bill is a requirement that that report, which is being treated by the department as a one-off and not to be repeated, should be repeated. It is wrong to suggest that this cannot be done; it has been done, and it can be done again.
I want to be brief, as I am conscious of the words of the Chief Whip before we started. I will move on to some developments that have occurred since Second Reading, because at the end of Second Reading, thinking that perhaps the Bill would not proceed to Committee, I tabled some Written Questions on this matter. I had one reply from the noble Baroness, Lady Twycross, on behalf of the Cabinet Office, which effectively introduced me to Mr Ed Humpherson, the director-general for the Office for Statistics Regulation, with whom I have since had correspondence.
Before I read from his letter to me of 20 February, I will remark that, as was mentioned at Second Reading, these statistics are referred to as national statistics and they are required to comply with the statistics code. In that light, the last compliance check was carried out in 2012 and because of that, Mr Humpherson says: “We have agreed with DHSC that a compliance check of the statistics would be beneficial”. A great deal of what the Bill seeks to achieve is likely now to be pursued by the Office for Statistics Regulation in consultation with the DHSC. Since it is very unlikely that any compliance check would consider that the current system was successfully capturing complications arising from abortions, I am therefore very pleased with what Mr Humpherson said.
I will continue with his letter a little bit, because my pleasure at his agreement to carry out a compliance check is slightly modified by his timetable and approach. He goes on to say: “We plan to carry out this review in the first quarter of 2026/27, giving DHSC time to undertake its planned developments. These include supporting data providers to move to DHSC’s digital submission system and working with digital experts and system users to improve the design of the Abortion Notification System”. I am certain that the noble Baroness, Lady Thornton, and I would agree that that work would be very welcome. My only quibble with Mr Humpherson—and I have written to him to say this—is that I would have thought the sensible thing would be to have the compliance check first, in order to identify the deficiencies and agree between DHSC and the regulator what the deficiencies are, and then for the department to invest in the digitisation of the collection of the statistics in such a way that they will comply with the regulator’s requirements.
When the Minister comes to reply, I am sure she will say that she will collaborate fully with the Office for Statistics Regulation and its work, because I fully expect the department to do that—it is the responsible thing to do. Can she agree that she will consider whether this is being done in quite the right order? Would it not be sensible to bring the compliance check forward so that the developments being carried out, which will involve investment and time, are not wasted but achieve what the regulator will be satisfied with at the end of the day?
Baroness Finn (Con)
My Lords, I apologise for not being able to attend Second Reading. I begin with the observation that, as a healthcare service, abortion is highly regulated and subject to the same oversight as any other care. As a result of the Abortion Act 1967, it is also subject to additional oversight which predates many of the regulatory and monitoring systems in place across the health service today.
This context is relevant to the Bill before us, which seeks to build on this 58 year-old framework. I am wholly in favour of monitoring all forms of healthcare provision and entirely agree that further work needs to be done on the collection and analysis of large datasets relating to women’s reproductive health. However, I have concerns that this Bill in primary legislation is not the best way to approach this important work.
I am aware that both the Royal College of Obstetricians and Gynaecologists—the RCOG—and the British Pregnancy Advisory Service have shared with noble Lords their concerns that, as the noble Baroness, Lady Thornton, has said, singling out abortion for new legislation in this way exceptionalises it and fails to treat it like other forms of healthcare. This would potentially stigmatise abortion care for both women and the medical professionals who provide the care. It would also indicate that abortion is considered to be such a high-risk intervention that it is in need of particular oversight.
The RCOG points out that abortion is a “safe and effective procedure”. Some one in three women in the UK will have had an abortion before the age of 45 and international studies have repeatedly found that abortion is of less risk to women than complications that can arise from continuing a pregnancy to term and giving birth. As a result, I am concerned by any indication that this House considers abortion to require increased monitoring and oversight, over and above that of comparable healthcare, and indeed the message that it would send to the nearly 300,000 women who access abortion services across the UK every year.
I agree with my noble friend Lord Moylan that we need to improve collection of data, but this must be done across women’s healthcare more broadly, and I would be interested to hear from the Minister about what plans the Government have to achieve this. We know that in many areas, women wait a disproportionately long time for diagnoses of devastating conditions, such as endometriosis, and in that time often suffer complications that come from lack of treatment.
It was for this reason that the previous Government published the widely welcomed, first ever women’s health strategy for England, to take a holistic approach to women’s healthcare. I pay particular tribute to my former colleague, Emma Dean, for her tireless and excellent work to make this happen. We also appointed the brilliant Dame Lesley Regan as the first women’s health ambassador to support the implementation of this strategy. I was pleased to note that the Minister for Secondary Care confirmed in the other place the Government’s commitment to the women’s health strategy, though I am concerned about the lack of progress against the strategy’s widely welcomed commitments, especially the Government dropping targets for ICBs around the creation of women’s health hubs. The RCOG has said that the existing hubs have reduced unnecessary referrals, provided training opportunities for professionals and enabled women to access support quickly.
The NHS 10-year plan and monitoring of the women’s health strategy would, I hope, offer an opportunity to address the challenge of good monitoring without adding unnecessary legal burdens to the healthcare system. I hope that we can all agree that the purpose of this monitoring has to be to improve information and care for women, and that singling out abortion is unfortunately likely to do more harm than good.
Before I close, I want to touch on the practicality and operability of this legislation. I understand that the information currently used by the department to produce abortion statistics, such as the type of abortion, gestational age, and information about women accessing care, is separate in the majority of cases from a woman’s broader healthcare record. It seems incredibly important to protect this right to privacy for women accessing abortion care, particularly for women at risk of domestic abuse, honour-based abuse or reproductive coercion. I know that my noble friend will not want to place women at risk as a result of this legislation, so I wonder if the Minister can confirm that the department is able to link abortion records with wider healthcare records in the way this legislation would require, and if so, whether that would mean that abortion care would appear on a woman’s medical record, whether or not she had given consent.
Given my concerns about the impact of the proposals in the Bill on women and the wider healthcare system, I am not able to support it in its current form and support the noble Baroness, Lady Thornton, in her opposition to the clause standing part.
Lord Weir of Ballyholme (DUP)
My Lords, I join others in apologising for not being here at Second Reading—on medical grounds, in my case—which seems to be a consistent theme in this debate. In looking at the amendment and legislation today, it is important that we actually focus on what is there rather than debating—I appreciate that the noble Baroness does not intend to push this to a Division—something that is not there.
Baroness Freeman of Steventon (CB)
My Lords, as part of my work in Cambridge, which is in my register of interests, I was involved, and still am, in the making of decision aids to help NHS patients make decisions about their healthcare treatments. Part of my work was to find the evidence about the risks and benefits of different treatment options, so I am very familiar with the lack of data in many respects on the efficacy and, in more cases, side-effects of different treatment options.
I would absolutely stand by any Bill that aimed to improve the data for individuals to make decisions, but I do not see why abortion is being singled out in this way in this particular Bill. I am bearing in mind the Chief Whip’s notes, and although I could speak for some time on the lack of data for side-effects in many treatments I will give just two examples. I was involved in the decision aid for osteoarthritis in hips. Hip replacements are an example where, again, we have large numbers of treatments being done outside of NHS clinics. We are really lacking in long-term follow-up, particularly asking patients about the really important patient-reported outcome measures—the things that are important to them. Cataracts are another example. It is one of our biggest and most numerous operations, and more than half of them are done outside of NHS clinics. Again, you would think that actually asking how many people would say afterwards that their vision has improved would be a very basic thing, but we are lacking that data.
I would absolutely love to have more data on side-effects and the efficacies of these things, including side-effects that are not expected and not on the official list to be collected. I did a decision aid on gall bladder surgery. Diarrhoea is a very common outcome of this surgery—in more than 10% of cases—and yet it is not often recorded. Sexual dysfunction is a side-effect of many treatments, but it is not something that patients want to bring up. These are all really important.
There are so many issues about data, but if you look at the data on abortion statistics and complications, you find that the 2023 report is very good. It highlights the numbers that patients would need to make decisions. The rates are not changing every year. We do not update our decision aids every year. The data remains stable, unless there is a very dramatic change in clinical practice.
I would absolutely support the better collection of data, and I am hoping there are opportunities to do that in the future. But on this particular occasion, I very much support the noble Baroness, Lady Thornton.
Baroness Lawlor (Con)
My Lords, I do not support the noble Baroness’s opposition to Clause 1 standing part of the Bill. My noble friend Lord Moylan has mentioned the 2023 analysis by the Office for Health Improvement and Disparities. It based its evidence solely on NHS England statistics: the database of admissions, A&E attendance and outpatient appointments. Using this data, different outcomes were recorded. It used only the data contained in records for patient admissions and for abortion-related complications as the primary or secondary diagnosis, not those for incomplete abortions that did not have a further complication. We see, therefore, that the complication rate varies depending on the evidence that is before the statistician.
For these reasons, there is little disagreement among the groups concerned that we all, whether parliamentary or non-parliamentary, want good data collection. Some of us are more concerned with data collection on one kind of procedure, and others with another, but, now that we are updating and digitising the NHS system, this seems an opportunity to improve data right around the system. But this should not be excluded, and I do not think that noble Lords should suggest an exception. It is an exceptional thing to require accurate data where possible and where it can be obtained, so that we can use the digitisation of the system to encourage the best statistics.
My noble friend referred to some of the changes that we have seen. The position has changed since the statistics were last checked for compliance with the code of practice for statistics in 2012, with the increase of medically induced abortions from 48% to 85%. In England and Wales, 75% of abortions were completed at home. As a result, complications may not be recorded on the HSA4 forms that are the basis for the present statistics under the abortion notification service. With women administering medication at home, if there is a complication, they may go to their GP surgery, dial 111 or go to A&E. The fact that these episodes are complications will not necessarily be recorded on the HSA4 forms that are used to compile the reports we have. But it has been used, which is why I find this a statistically interesting debate, by the 2023 analysis, which I mentioned on opening, and it can be used.
For these reasons, I welcome that the statistics regulator is going to check on the compliance and that the Department of Health and Social Care has agreed to this—I applaud that. The timing is quite important. As the NHS system is digitised, it can prepare things so that the records can be read digitally, accurately and cheaply, with the data on complications from abortions entered into the system. I suggest that, as my noble friend Lord Moylan proposed, the compliance check should be instituted in advance of digitisation so that the statistics authority can then report on—and, as a result, the Department of Health can be made aware of—where and what digitisation is needed, so that the records can be used in digital form cheaply and with the transparency that we need for statistics. This will save money on any further necessary updates later.
I do not take the point that some noble Lords have made about confidentiality. Confidentiality is extremely important—I agree with all confidentiality requirements; it is vital if one is to have trust in one’s health service and provider—but these things are done by codes. As far as I know—I ask the Minister to correct me if I am wrong—every operation has codes. People are not named, but there are codes for referring to whatever procedures take place. This is very useful for digitisation.
Baroness Bennett of Manor Castle (GP)
My Lords, I offer Green group support for the proposition from the noble Baroness, Lady Thornton. I almost feel that I do not need to, given that the noble Baroness, Lady Freeman of Steventon, very powerfully made the argument that the Bill unnecessarily exceptionalises abortion when there are very comparable procedures conducted in similar procedural ways—hip replacements and cataract operations. Yes, we need to improve the collection of statistics, but we do not have a Bill before us to do that. By definition, the exceptionalising that is going on is very obvious.
I want to pick up on two comments made by the noble Lord, Lord Weir of Ballyholme, and most respectfully to disagree with him. The noble Lord said that what is happening in the US is not relevant here. I spoke at Second Reading about the influence and money flowing from the United States of America into the UK. I can update your Lordships’ House on that. I was going back as far 2014, and a chapter of a book I wrote addressing these issues. This has been highlighted by Peter Geoghegan, who wrote Democracy for Sale, and others. The so-called Alliance Defending Freedom from the US provides massive funding. In 2020, it put £324,000 into a similarly named organisation in the UK. By 2024, that had risen to £1.1 million of the organisation’s total income of £1.3 million. We are debating this Bill in the context of that flood of US money seeking to influence what is happening in the UK.
I put Written Question HL6542 to the Government about this. I am afraid that the Government are not taking this with the seriousness that it deserves for defending our democracy. The Answer referred to lobbying of the Government and what measures the Government have in place. We need to think about the measures that we need across our society to deal with the inequality of financial arms that is occurring in these debates because of the money flooding in from certain forces within the US.
The noble Lord, Lord Weir, also said that the context did not really matter. However, this Bill appears before us in the context of more than 60 MPs in the other place backing one amendment—there is another one too—to decriminalise abortion, to end the exceptionalisation of abortion right across our law. That would make this Bill look particularly strange and ill-fitting. For those reasons, I support the proposition from the noble Baroness, Lady Thornton.
Baroness Brinton (LD)
My Lords, unfortunately, I too was unable to be at Second Reading. I speak today to support the stand part notice from the noble Baroness, Lady Thornton, and on what the noble Baroness, Lady Finn, said about the important review of data collection—actually, across the health sector, as I will explain, but particularly of data relating to abortions.
The noble Baroness, Lady Thornton, spoke of how some elements of this short Bill are inconsistent, which makes it unable to deliver what the noble Lord, Lord Moylan, hopes for, despite what he said—I will come on to explain why—even if it were the right thing to do. I agree with the points that the noble Baroness, Lady Thornton, made.
One issue at the heart of this inconsistency is the use of patients’ confidential health personal data. There is an absolute presumption by patients that their health personal data will always be kept confidential between them and their medical practitioners. Indeed, noble Lords may remember, when the then Government proposed care.data plans a few years ago, it became clear that we were likely to move to a US-type system of allowing researchers, insurers et cetera access to anonymised and pseudonymised data. I can tell the noble Baroness, Lady Lawlor, that, during that debate, it was important to note that it is possible to reverse most anonymised and pseudonymised data, particularly when dealing with an unusual circumstance. Once you have one or two identifiers, you can get to a very small geographic position very quickly—sometimes to a postcode, frankly. Therein lies the problem: confidentiality is lost.
More worrying were the original proposals in the Bill that became the Police, Crime, Sentencing and Courts Act 2022, which gave the police and the Home Secretary—then Priti Patel—the power to demand from any relevant person or authority, which included health authorities at the time, to see data that might be of interest in an investigation. I was working on that Bill and, when I queried this power in your Lordships’ House, it transpired that it was not just for suspects of crime but for anyone connected with the incident, who might or might not be a witness. That went completely against everything in a doctor’s sacred oath of confidentiality with regard to their patient. I am pleased to say that, following my amendments to that Bill and pressure from doctors, the then Clause 16(4)(a) was modified to prevent access to health data compared to data from other bodies, where it still sits.
That was followed by a debate, on the Health and Care Bill, about the use of patients’ personal health data for research. My noble friend Lord Clement-Jones, other noble Lords and I made it very clear that assuming that anonymised or pseudonymised data could not be reverse-engineered was not acceptable. Out of that, a new system of a black box, where the anonymity of patients is guaranteed, was introduced.
However, abortion data is different because it is not within these safeguards. The Abortion Act 1967 requires that the woman’s name and date of birth or a personal identifier must be submitted on every abortion and provided to the Chief Medical Officer via the abortion notification system. While, as others have said, this data includes complications prior to discharge, the “Hospital Episode Statistics” referred to in Clause 1(3)(b) of the Bill from the noble Lord, Lord Moylan, are based only on abortion data from trusts, which are not linked to abortion records. This means that the data is coming from two different sources, which are collecting different data. As the briefing from BPAS tells us, neither dataset actually captures all abortion complications, nor can the hospital episode statistics be analysed by methods of gestation or abortion—another difference, yet again. I do not think that the noble Lord, Lord Moylan, covered that point of disparity when he spoke earlier. My worry is that the annual report would not actually reflect the wider picture.
The second issue that I will raise is of those other delicate areas that might inadvertently be drawn into this type of reporting on complications of abortion. In the debate earlier today in your Lordships’ House, we discussed miscarriages and preterm births. Nearly 50 years ago, I had an early miscarriage and, when I went to the hospital, I was told that I was having a “spontaneous abortion”—a ghastly phrase. I still had remnants inside my body that needed to be removed to ensure a “complete abortion”—an even more ghastly phrase. In the middle of my grief at losing my first baby, the medics were talking about “abortion”.
The very helpful briefing from the Royal College of Obstetricians and Gynaecologists points out that the differing terms that can be entered into hospital coding are “induced miscarriage” and “spontaneous abortion”. It says:
“This can result in a code being applied for an abortion complication when it should have been for a miscarriage complication and vice versa.”
This is not just about words such as “spontaneous abortion”. Following on the speech from the noble Baroness, Lady Bennett, in the USA, since the Dobbs case, miscarriage has increasingly been brought into the debate about abortion. West Virginia has one of the toughest sets of abortion laws, allowing it only for cases of rape, incest or if the woman has an ectopic or totally non-viable pregnancy. But it gets worse. Last week, in Raleigh County, West Virginia, the prosecuting attorney, Tom Truman, advised women to get in touch with police, law enforcement or a doctor if they were worried that they might be charged with mishandling foetal remains. The example cited was the arrest of a woman for disposing of foetal remains in her bins. He said that a number of criminal charges under state code, including felonies, could be levied against a woman who flushes foetal remains, buries them or otherwise disposes of them following an involuntary abortion, also called a miscarriage. A West Virginian woman in my situation, which I talked about earlier, could well be prosecuted. The miscarriage that I referred to is not unusual. I lost the tiny foetus down the toilet, and I was distressed beyond measure. In West Virginia, you would now have to retrieve the foetal remains or be at risk of prosecution.
I am sure that there is absolutely no intention in the UK for this to happen, but the debate happening in the US is beginning to colour the debate we are having here. I am very clear that the problem is that some people want miscarriage to be treated as suspicious. They clearly are not medics. It is thought that 15% to 20% of pregnancies end in miscarriage. It is surprisingly common, and good luck to that prosecutor in West Virginia. He is going to spend his entire time on people reporting miscarriage. Above all, the issue of miscarriage and spontaneous abortion is yet another that muddles the data proposed in this annual report and demonstrates, sadly, that it is not fit for purpose.
Baroness Miller of Chilthorne Domer (LD)
My Lords, I was here for Second Reading and I was here to hear the noble Lord, Lord Moylan, tell us about how the abortion landscape is shifting quite rapidly. Between Second Reading and today, we saw a vivid example of just how that landscape is shifting and why it needs to shift very rapidly, because we saw the conclusion of the trial of Nicola Packer. Thankfully, the jurors recently cleared the 45 year-old of illegally terminating her pregnancy. She suffered more than four years of police and criminal proceedings.
In fact, the number of women being prosecuted on suspicion of breaking abortion laws has increased over recent years, so the landscape is getting worse. That is partly why I am very pleased to support the noble Baroness, Lady Thornton, in opposing the clause standing part, because the Bill does nothing to improve the abortion landscape. Personally, I am quite surprised that the noble Lord, Lord Moylan, has brought it back today to Committee, because it was made evident to us at Second Reading by the Minister and other speakers, including my noble friend Lord Scriven, that it was absolutely unnecessary and very unhelpful. Indeed, we heard from the noble Baroness, Lady Freeman of Steventon, today exactly why that is.
I hope that this House will soon have the opportunity to debate and enact real change, along the lines of the two amendments tabled in the other place, referred to by the noble Baroness, Lady Bennett. I want to check something with the noble Lord, Lord Moylan. He said at Second Reading—and I expect he is thinking it again today:
“What is so strange about the advocates of choice in this debate is that they are so defensive; they speak as if they are surrounded by conspiracy ... If I thought I was surrounded by conspiracy, I would want to live in a world of facts and not hide myself from them”.—[Official Report, 13/12/24; cols. 1994-5.]
Baroness Barker (LD)
My Lords, I, too, spoke at Second Reading and I welcome the opportunity to speak again to set in context what the Bill is part of and is all about. I, too, have to disagree fundamentally with the noble Lord, Lord Weir of Ballyholme, though not on the necessity for accurate data and statistics. You cannot separate the Bill from the wider context of what is going on in the politics of reproduction, reproductive health and gender identity.
I spoke last time about the international campaign being organised largely by religious nationalists across the USA, Europe and Russia, which has a specific aim to destroy human rights, reproductive rights and the international organisations responsible for upholding them. If people wish to doubt me, I suggest they read any number of reports, but the one that sets out the fundamental basis of the campaign is from 2018 by the European Parliamentary Forum on Population and Development, Restoring the Natural Order, which sets out how a small group of people have set out to overturn the human rights framework that we developed following the horrors of World War Two and over the past 50 years in order to “restore the national order”. They have a number of specific objectives within that. Key among them are making sure that the definition of marriage and family pertains only to heterosexual people, and definitely overturning access to abortion and contraception. Overturning divorce laws is part of what they want to do as well as rejecting compulsory sex, reproductive and health education and, perhaps most interestingly of all, making sure that the first and primary educators of children must always be the family, even if that is to the exclusion of public education. It is a clear agenda.
The noble Baroness, Lady Bennett, was right. If you want to see how it is unfolding, just look at what is happening in states in America and in Hungary and Poland, because what is happening in the USA is not stopping there. It is funded by billions upon billions of dollars in Europe, mostly emanating from America but also from Russia, and in Africa. This is part of that.
It is important and relevant that we look at that today because the data you get relies entirely on the questions you ask, and the questions you ask are determined by the outcomes you want to achieve. As some of us watch this campaign unfolding in its different manifestations, one thing we have noticed is that it is moving on. The people behind it—the Alliance Defending Freedom, the Heritage Foundation and all those massive Christian nationalist organisations and Catholic and other religious institutions in Europe—have realised that, to make to make their campaign more widely palatable, they have to move away from being largely a bunch of male-led organisations. They have removed themselves through a number of different front organisations and changed the language they use to talk about rights and so on.
From those of us who have fought for human rights for 50 years, they have learned the importance of having your messages framed in terms of rights—the rights of people to resist a liberal elite that argues for things such as equality and equality laws, which are inevitably disproportionately affecting some people, particularly poorer people. They say, “Rather than relying on what we’ve done so far, we actually need to go further. We need to create the information that will back up our campaign”. Interestingly, in some cases they have set up private universities which produce research that appears to be proper academic research but is in fact grey research, always leading inevitably to the conclusions that support their back-up. They produce books and reports. This is not new. Noble Lords in this House have for years seen the dodgy dossiers that come from the Christian Institute—all that kind of stuff. That is what is happening and that is why it is important that we make sure that the statistics that we get on abortion—and, incidentally, access to contraception—are timely and accurate.
Noble Lords have mentioned this, and they are absolutely right: the politicisation of data in this area is really important. The increase in the number of women being prosecuted because they have had a miscarriage comes as a direct result of this campaign. I do not think that those of us on our side of the argument have anything to fear. We kept statistics when we introduced telemedicine and medical abortion. In advance of it, those on the other side of the argument were full of dire warnings that all sorts of crimes would be committed. They were not; the statistics and the data have shown that.
I have nothing against the improvement of the collection of data in the health service, but my plea to the noble Baroness, Lady Merron, is that, when the Government look at this issue—and I believe that we should—I ask her to ensure that the statisticians are able to resist the political pressure being exercised across all the different parts of government and organisations because of this campaign, which is being waged on a number of different fronts. Ultimately, it is a pernicious campaign that will damage all sorts of people, including minorities, but will be particularly harmful to women and girls.
Baroness Boycott (CB)
My Lords, I join this debate to follow up the powerful speech by the noble Baroness, Lady Barker. I have been involved in women’s rights for a very long time; I started a magazine called Spare Rib in 1972 and within that we campaigned all our lives for things such as abortions. I can honestly say that I think the life facing a young woman today is more frightening than the life that faced me as a young woman.
I look at what is happening online, where you can download a very simple app. I had a lunch for Laura Bates the other day, which many noble Lords came to. She explained that I could download an app, take a photograph of the noble Baroness, Lady Freeman, right beside me, press a button and have a photograph of the noble Baroness naked—not with Kate Moss’s body, but with the noble Baroness’s body. You can do this at 11 or 12. It is really threatening being a young woman today. There are many things that are out of our control. We, as older women who have had successful lives, have to fight fantastically hard to protect this next generation from a lot of the stuff that is coming down the pipe.
I very much listen to and know about the conspiracies and the power happening in America to try to alter fundamental rights such as abortion. I find it extremely distressing that measures such as this should come to the House of Lords and even be debated seriously, and that there should be a politicisation of women who face abortion. Frankly, nobody wants an abortion; I cannot think why people ever thought that. Nobody wants one. There are several things you do not say when you ask yourself, “What do I want to do in my life?” No one says, “I want to be an alcoholic”, or, “I want to have an abortion”, or, “I want to be a druggie”. You do not put those on your wish list. They happen and we should protect women and support them all the way through, as the noble Lord, Lord Patel, spoke about in his fantastic debate earlier. These are people who need our protection and our love. I really support the noble Baroness, Lady Thornton, in bringing this forward. I will take part in any further debate because this is vital, and we are vital to this. Our voices really matter here.
Lord Sandhurst (Con)
My Lords, I thank my noble friend Lord Moylan again for bringing to our attention the issue of the reliability of statistics on the complications of abortion. It is absolutely right that, in all healthcare, we have correct and accurate data that health service providers can use to understand the safety of procedures.
It is the usual practice for Committee to include discussion of the amendments that have been tabled to the Bill, but here, of course, there is only the proposition that the only substantive clause should not stand part. This, therefore, has necessitated a general discussion of the underlying principles behind the Bill in a restatement on this side of the Chamber of our positions.
At Second Reading, I said that our view was that the Bill performs “an important service” by highlighting
“the absence of accurate, comprehensive statistics in respect of abortions”,—[Official Report, 13/12/24; col. 1990.]
but I explained in the same speech that improved data collection and reporting does not require legislation for it to be delivered. In short, I do not depart from that view, but this Bill has allowed an informed debate to emerge about data in this field. It presents an opportunity to urge the Government to do more to rationalise data recording and collection, so that proper evidence-based medicine can be implemented. In this respect, I endorse what my noble friend Lady Finn said about data collection and statistics more generally.
In answer to a Written Question asked by my noble friend, the director-general of the Office for Statistics Regulation stated that that office—the OSR—had not completed a compliance check on the abortion statistics collected by the Office for Health Improvement and Disparities since as long ago as 2012. That raises important issues of data quality. I am glad to note that it has now been agreed that the OSR will carry out a long-overdue compliance check on those statistics, but only after the Department of Health and Social Care has been able to update the design of the abortion notification system. This seems, to me and to others on this side, the wrong way round. Surely it would make more sense to complete these compliance checks before making alterations to the ANS. That way, the department will be able better to understand any deficiencies in the system—and we know there are some. I hope the Minister will be able to comment on this and address it.
Overall, my noble friend has raised an important concern. I suggest that the Government must now take steps to ensure that the data are gathered on a more reliable and consistent basis.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I thank the noble Lord, Lord Moylan, for tabling this Private Member’s Bill and my noble friend Lady Thornton for tabling an amendment. I very much appreciate the contributions made by a number of noble Lords.
The stated main purpose of the Bill is to impose a legal duty on the Secretary of State to
“publish and lay before Parliament an annual report on complications from the termination of pregnancy in England under the Abortion Act 1967”.
The purpose of such an annual report, as I understand it, would be
“to inform policy and safe practice regarding the termination of pregnancy”.
I know that noble Lords appreciate that this Government are entirely committed to the priority of patient safety.
Lord Moylan (Con)
For clarification, is the Minister saying that the digitising and adapting of the abortion notification system that her department plans to carry out will be done in collaboration with the Office for Statistics Regulation? Or is the intention that the department does the work in its own box, so to speak, and then the Office for Statistics Regulation comes in and checks it? She seemed to hint that, for the first time, it might be the former, which would be quite encouraging.
Baroness Merron (Lab)
As I said, we are developing work with the OSR. As with all ways of developing work, that means working in a way that will get us to the place we wish to get to. I do not quite recognise the latter way forward that the noble Lord referred to, but I will be happy to write him further on this matter.
I can assure the noble Baroness, Lady Finn, that our focus in the women’s health strategy is on turning those commitments into action. I draw the noble Baroness’s attention to the provision of free of charge emergency hormonal contraception at pharmacies from October this year. We are also setting out how we will eliminate cervical cancer by 2040 through the new cervical cancer plan, we are and taking urgent action to tackle gynaecology waiting lists through the elective reform plan. Those are all tangible improvements to women’s health. I assure the noble Baroness that the women’s health strategy is very much kept under review to see how and where it can be improved.
The noble Baroness, Lady Finn, asked about the linking of records. It is not currently possible to link the abortion notification system with wider health records data, because of the unique identifiers on the abortion notification system data. However, as I said earlier, we are reviewing the wording of the form so that it will be easier for clinicians to complete, which will, I hope, bring about some improvements.
I say to the noble Baroness, Lady Freeman, that the Government are focused on moving the NHS from analogue to digital across all areas of healthcare, in order to provide the improved data collection that many noble Lords have called for during the debate.
The noble Baroness, Lady Bennett, called on the Government seriously to consider the implications of money flowing in from the USA with a view to obtaining influence—a point also referred to by the noble Baronesses, Lady Brinton and Lady Barker. I can confirm that this matter is being considered more widely across government.
As noble Lords may remember, the Government have expressed reservations about the Bill as legislation is not required to produce an annual report. We believe that the aims of the Bill can be achieved through existing routes, thereby rendering further legislation unnecessary. In 2023, the department published a report on abortion complications and could choose to do so again. However, it has no plans to publish ongoing separate additional annual reports on abortion complications as there is no operational need to do so. I hope noble Lords will understand—some have made this point—that we have to uphold a duty of care not to legislate when other reasonable processes are available, as there are in this case.
Crown Estate (Wales) Bill [HL]
Lord Harlech
Member’s explanatory statement
This amendment would ensure that any revenues from the Welsh Crown Estate would still be paid into the Exchequer.
Lord Harlech (Con)
My Lords, in opening this group of amendments in my name, I declare my farming and land management interests in Wales.
I pay tribute to the noble Lord, Lord Wigley, for his long-standing service to Wales and his clear and consistent advocacy for greater Welsh autonomy. There is much that we agree on, and I like to think we work together in raising Welsh interests in your Lordships’ House, not least in hoping to see the Welsh rugby team resurgent in the not too distant future. The noble Lord’s passion is beyond question and his commitment to Welsh interests is evident in this Bill. However, while I respect its intent, I regret to say that it is the wrong Bill introduced at the wrong time with the wrong outcomes for the people of Wales.
Amendments 1 and 6 stand in my name and seek a straightforward but essential safeguard: that revenues from the Welsh Crown Estate should continue to be paid to the Exchequer. At a time when public finances are under enormous strain, diverting these vital funds away from the UK Exchequer is neither prudent nor responsible. These revenues are used not just in Wales but across the United Kingdom, for the benefit of all our citizens.
Let us ask plainly: will these funds be better managed by the Labour-run Welsh Government, whose track record is one of failure and misplaced priorities? Just look at the 20 mile per hour speed limit debacle, a policy that has stifled economic activity, hit small businesses and left the public exasperated—as I can see the noble Baroness, Lady Bennett of Manor Castle, is at the moment. What confidence can we possibly have that the same Ministers will not use Crown Estate revenues to fund yet more policies that the Welsh people do not support?
Without stealing his sandwiches, I note that Amendments 2 and 8, proposed by my noble friend Lord Moynihan, seek to retain the Crown Estate’s borrowing cap at 25% of its net asset value. This is not ideology but basic financial stewardship. The Crown Estate is not a plaything; it manages critical assets such as our seabeds and land. A financially secure estate is vital to its long-term success, and excessive borrowing puts that future at risk. Whether devolved or not, that principle must hold.
Amendment 3 introduces a necessary backstop: the power for HM Treasury to impose conditions if the devolved Crown Estate in Wales fails in its functions. Again, this is an act not of hostility but of responsibility. Sadly, we have seen time and again that, when left unchecked, the current Welsh Government do not always act in the public interest. This safeguard would ensure that the Crown Estate’s essential duties—environmental, economic and fiduciary—were upheld to the standards the public expect.
The Clause 1 stand part notice exists because the Bill, at its core, is premature. We have only just passed the new Crown Estate Act, and it is simply not wise to begin carving out individual devolved frameworks before we have seen how the new national reforms bed in. This is a constitutional experiment based more on politics than on policy.
Although I defer to my noble friend Lord Moynihan on the reporting amendment, I will say this: any serious consideration of devolving the Crown Estate must be preceded by rigorous evidence and not ideological aspiration. A report on the impact on finances, land management and environmental standards should be the starting point, not an afterthought.
To conclude, although I respect the ambition of the noble Lord, Lord Wigley, I must urge caution. The people of Wales deserve better than what the Bill contains. They deserve good governance, sound management and real accountability. Sadly, the Bill does not offer that. I beg to move.
The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)
My Lords, the noble Baroness, Lady Harris of Richmond, is taking part remotely, and I invite her to speak.
Baroness Harris of Richmond (LD) [V]
My Lords, I am speaking to the amendments in this group on behalf of these Benches and, in doing so, I confirm the strong support we expressed at Second Reading for the Bill. There was a sense of outrage when President Trump attempted to squeeze an agreement for the extraction of rare minerals out of Ukraine without payment. His argument was that capital and equipment sent to Ukraine by Congress under the leadership of President Biden was not a grant, as had previously been thought, but a loan. That is the outrage felt in Wales when its natural assets are exploited without any benefit to the people of Wales.
At Second Reading, the noble Lord, Lord Wigley, referred to the flooding of Tryweryn and the political consequences that followed, including, very probably, his presence in this House. The purpose of the Conservative amendments is to ensure that none of the assets or income of the Crown Estate in Wales, whether property rights in land or the highly valuable rights in relation to the Welsh zone, should fall under the control of the Senedd or its Ministers. Rents and profits should whizz up the motorway to lodge in the Treasury as they always have, even when it was called Watling Street. Perish the thought that some Welshman, in the tradition of Owain Glyndŵr, would get his hands on the loot. You might call that the Conservative principle.
Baroness Bennett of Manor Castle (GP)
My Lords, I rise briefly to speak on behalf of the Wales Green Party against all the amendments in this group. The noble Lord, Lord Harlech, perhaps misinterpreted my reaction: I was astonished that he is not taking seriously the statistics showing that 20 mile per hour speed limits stopped about 100 deaths and serious injuries on Welsh roads when they were in force. Those saved lives and people’s lives being transformed for the worse by serious injury should not be taken in any way lightly, and it is a great pity it is not continuing. Similar figures from TfL show a 34% decrease in serious deaths and injuries in London. A range of measures affect that —around 15% perhaps from other measures—but 20 miles per hour is a significant factor in reducing deaths and injuries on roads. Surely everyone wants that to happen.
It is a great pleasure to follow the noble Baroness, Lady Harris of Richmond. She has far more personal connection with this than me, and the passion in her speech leaves me with little to add, except to say that the Crown Estate in Wales is drawing on Welsh resources. The resources surely should stay in Wales. This is a basic democratic principle. The concentration of power and resources here in Westminster is a problem all around the country, but particularly for the nation of Wales. There is a fast-growing interest in independence for Wales. Those who wish to maintain the union might like to think about what position they are taking on this Bill, because not being able to have the returns from their own resources is something about which there is increasing anger in Wales.
I spoke at Second Reading in favour of—
Lord Harlech (Con)
My Lords, what guarantee can the noble Baroness give that, were this Bill to pass, the revenue from it would be distributed equally throughout Wales and not just be concentrated in Cardiff and the surrounding area, as revenues currently are?
Baroness Bennett of Manor Castle (GP)
In response to the noble Lord, Lord Harlech, I note that Wales has a democratic electoral and political system, unlike Westminster, where we have a Government who won the support of 34% of voters and are now in control. If he is looking for a democratic distribution of resources, he is a lot better off in the Senedd than in Westminster.
I was about to finish, so I repeat that the Wales Green Party strongly backs this Bill and opposes the amendments. More power to Lord Wigley’s elbow.
Lord Moynihan (Con)
My Lords, I will speak to Amendments 2, 3, 8 and 9, which are in my name, and explain why I oppose Clause 1 standing part of the Bill. I declare my interests as set out in the register, particularly my chairmanship of Amey and Acteon; although they are not contracted in offshore wind projects in Wales, they work in this space worldwide.
Before I concentrate on my amendments, I place on record the considerable sadness I have in finding myself in opposition to the noble Lord, Lord Wigley, who saw me through my Back-Bench and ministerial career in another place. I have always viewed him as a trusted friend and outstanding politician, and he is recognised as such across both sides of both Houses. I put that down to the English influence on him, which, if I am not mistaken, came from his birth in Derby and education in Manchester.
Amendments 2 and 8 seek to ensure that the Bill is in line with the same borrowing limits as the Crown Estate. Ostensibly, it is reasonable to ask why such borrowing limits are prudent. The answer is that there is considerable political, strategic and commercial risk associated with devolving and transferring the functions of the Crown Estate in Wales to Welsh Ministers.
The most recent publicly available figures for asset values in Wales are from the August 2023 freedom of information request, which stated—in property values in sterling—that offshore wind and marine accounted for some £793 million out of a total of £853 million of assets. Our focus is therefore on those offshore opportunities—particularly but not exclusively wind—with marine energy being some 93% of those assets. That is what we need to focus on when considering this Bill. Taking a 25% debt-to-asset value would mean borrowing up to £213 million, which would need to be against Welsh assets to that value. Currently, as I understand it, Crown Estate Scotland does not have access to borrowing powers, so even if my amendment were accepted, this would create further asymmetry of opportunity.
The difficulty of making sense of these figures, and therefore the security required for borrowing, is further compounded by a number of economic factors. The first is the creation of global instability in the sector. The international renewable energy market is experiencing that instability, no small part due to the changes of US tariff and green subsidy policies. In challenging global conditions, it is crucial that the UK market can present a united and stable environment to give confidence to investors in the sector and developers to commit their capital and their projects in the UK.
However, there is already difficulty in doing so. For noble Lords following this area of net zero, the Ørsted cancellation of Hornsea 4 only last month because of the economics of the project proves just how volatile and uncertain the sector is at present. The benefit of the current structure of the Crown Estate is an ability to balance investments and reduce risk exposure across England and Wales, ensuring more robust and sustainable growth in a way that a devolved Welsh entity would struggle to replicate at the pace necessary to capitalise on the immediate opportunity that exists. Neither balance sheet strength nor economics of scale would exist if this Bill went through. Any further fragmentation could signal political and regulatory uncertainty, reducing the UK’s attractiveness as a destination for clean energy investment and harming both the Welsh and the broader UK economies.
My second point, and the second reason behind the amendments, is that the UK systems-wide approach to tackling energy security and the net-zero ambition of the Government gives a basis to the fact that the Crown Estate is, first and foremost, involved with the energy transition across the UK and in Wales, and with the development of offshore wind in particular and ground-breaking new technologies, which are even more risky, particularly the ones that are considered for floating offshore wind generation in the Celtic Sea. In this context, the UK’s transition to renewable energy, particularly offshore wind, requires a highly co-ordinated approach. Fragmenting seabed management through devolution would disrupt the collaboration currently in place between the Crown Estate, the National Energy System Operator and the UK Government. This could delay grid connection decisions and undermine the strategic coherence of the contracts for difference auctions. My genuine belief is that a transfer to Welsh Ministers would be counterproductive to the Welsh economy—which is what we should be thinking about in the context of this Bill—Welsh jobs and growth in the sector.
I would like briefly to address the comments of the noble Baroness, Lady Bennett. The Celtic Sea—what we are talking about at the present time—and the role that the Crown Estate can play in de-risking and stimulating the supply chain in those projects is critical. I am afraid that those who believe in transferring the Crown Estate assets from the UK back to Wales may find themselves misguided if they feel that the Welsh acreage of the Celtic Sea represents some sort of 530 carat Cullinan diamond—the great star of Wales.
The reality, as I found to the cost of many months, if not years, of negotiation as Minister for Energy in another place on the Frigg treaty—which went across the median line of Norway and the UK—is that the proposed Celtic Sea developments create a similar issue, with a pretty even split between English and Welsh waters. The delineation is highly complex; it is not a straightforward North Sea divide. If you look at a map, you see that there is a kaleidoscope of different ownership interests, and fragmentation of the control of the project would be counterproductive, in my view. It would take more time, it would be economically inefficient, and it would be politically sensitive if two different organisations were trying to make sure that that economic opportunity—which would benefit the people of Wales, as well as the people of the United Kingdom—was curtailed or sent into a political quagmire of negotiations and differences.
The round 5 project development areas in the Celtic Sea are equally important to both the south-west of England and to Wales. That is a critical factor when you consider the scale of this project in the totality of the Crown Estate assets. With this scale in mind, it is important to reflect on the integrated and complex nature of the supply chain which would back up that project. It is unrealistic to expect that every component of the supply chain would be available in Wales.
That is the reason I tabled these amendments. It is not just the major port of Port Talbot which is critical to the Celtic Sea leasing round; Bristol is equally important. Transfer operations in Wales could create jurisdictional and logistical bottlenecks, impeding the rollout of offshore wind infrastructure. My concern, and my reason for tabling these amendments, is not principally political; it is to make sure that there is no inhibition to the development of these interesting opportunities, particularly the offshore opportunities that exist, which will benefit the people of Wales and the people of the south-west.
The evidence presented in the Future of Offshore Wind illustrates that the majority of future opportunity in the Celtic Sea is further away from the Welsh coast and not in Welsh water. I add that an aspect of this is covered by Northern Ireland as well, so there is a triple lock on this project which would need to be looked at. That is the reason I tabled my amendments. The Welsh coastline presents a significant opportunity, regardless of the position of projects in the seabed. It is in the best interests of both Wales and the Crown Estate to ensure this potential is fully realised, so that coastal communities can benefit from the offshore resources. It is important to contrast this, for example, with the Scottish seabed and Scottish waters, which are materially distinct, creating no operational overlaps nor conflicting regulation and contrasting financial systems.
Finally, I emphasise my beliefs not only that this is important, as was heard during the passage of the then Crown Estate Bill, but that the operational independence of the Crown Estate is critical in enabling it both to maximise the economic opportunities and to take an apolitical, long-term decision in line with its statutory purpose. Imposing oversight from Wales through either Welsh Ministers or the Treasury would have a significant impact on the abilities of the commissioners to carry out their functions and to create both lasting, shared prosperity for the nation and jobs in Wales. Although this Bill is ostensibly attractive, without any amendments it would be economically disadvantageous to Wales; that is my main driver.
For those reasons, I speak to the amendments in my name. I do not have time to cover the last one; suffice it to say that I think that, if we pass this Bill, there would be real benefit in having after one year a review not just of what has happened in Wales but, potentially, of what has happened in Scotland as well.
Lord Harper (Con)
My Lords, I will speak briefly. I strongly support what my noble friend Lord Moynihan said about the complexity of the economic opportunities here. I was involved in some of those negotiations when I was the Secretary of State for Transport. They are complex and overlap on both English and Welsh interests. If you were to split them, that would make it harder to land those economic opportunities.
I want to touch briefly on what the noble Baroness, Lady Bennett of Manor Castle, said about the 20 mph speed limits in Wales, in order to present a balanced picture. I will not dwell on them, because they are not the subject of this Bill, but I think that she should also have mentioned that the original proposals by the Welsh Government carried a cost to the Welsh economy of £4.5 billion; that is in the Welsh Government’s own impact assessment. You have to balance that against the lives saved and decide whether that balance is correct and whether that cost of £4.5 billion, if used in a different way, would achieve a better outcome. I just want to put that on the record to balance out the argument. The noble Baroness is pulling a face at me, but the impact assessment of the Welsh Government costed that policy at £4.5 billion; that is their figure, if she wants to take it up with them.
The final point I want to make picks up the point made by the noble Baroness, Lady Harris of Richmond, about where the revenues go. It is worth pointing out, I think, that, through the Barnett formula, the Welsh people are net beneficiaries of the UK Exchequer. It is not clear from the Bill, as proposed by the noble Lord, Lord Wigley, what impact transferring revenues of the Crown Estate has on the Barnett formula—that is, whether it will be netted off and leave the same amount of money going to the Welsh Government, or whether it will be an increase—but the point is that more than all of the revenue that flows from the Welsh public into the Exchequer goes back because they are net beneficiaries. So there is no unfairness here to the people of Wales. I think that taxpayers in the rest of the United Kingdom would look unfavourably on more revenues being transferred to the Welsh Government and increasing that net benefit at a time when the public finances are, as my noble friend Lord Harlech said, so stretched. The picture is a little more complex than some noble Lords have said. For those reasons, I strongly support—
Baroness Bennett of Manor Castle (GP)
For clarification, would the noble Lord like to make it clear that the figure of £4 billion he gave was over three decades?
Lord Harper (Con)
Yes, I am very happy to make that point, but it is still a significant sum of money. If you do what is normally done in these circumstances, which is to look at the cost versus the benefit, I would argue that that is not a good return. Of course, that is one reason—alongside the enormous unpopularity of that policy—why the Welsh Government responded to the political pressure from both my party and the public by changing the policy significantly. They themselves are not, I think, persuaded by those arguments.
I was going to finish by saying that, for the reasons I set out, I strongly support the amendments tabled by my noble friends Lord Harlech and Lord Moynihan. I very much hope that, in due course, the House will get a chance to support them.
Lord Thomas of Cwmgiedd (CB)
I shall speak to the amendments in my name. By way of background, we have had the benefit of the noble Baroness, Lady Harris of Richmond, speaking about what makes this issue what I would describe ultimately as a hearts-and-minds issue. The acquisition of the Crown Estate in Wales by conquest and inheritance, the imposition of English laws, the exploitation, as it is perceived in Wales, of Wales’s resources of coal and water and the fact that Scotland has been allowed to control its own estate turn this into an important political and hearts-and-minds issue. I have tried, through the amendments I have put forward, to recognise that. In saying that it is an important hearts-and-minds issue, we must bear in mind the view of the Welsh Government, of the same complexion as the Government here in London, that they want devolution. The overwhelming majority of Welsh authorities want devolution. The very strong feeling is, for the reasons that I have tried briefly to summarise, that there ought to be devolution of the Crown Estate to Wales.
What has bedevilled this problem is a failure to understand and give effect to the difference between ownership and benefit from an asset and management of an asset. Those of us who may be fortunate to have the odd spare penny or two know the difference. Allowing someone else who is better qualified to manage assets while ensuring that the policy towards those assets and the ultimate benefit appertain to the owner is an important distinction that I have sought to make.
The first step is to try to identify what is the Crown Estate in Wales. Is it valuable? Does it have any assets? Does it have any revenue? Noble Lords may recall that in the Second Reading debate I spent a little time—I am not going to do that today because it is unnecessary—going through the accounts of the Crown Estate Commissioners in respect of Wales. The revenue and asset values for the year ending March 2021 were clear, but there was nothing in the accounts thereafter.
I challenged the Minister, the noble Lord, Lord Livermore, the Financial Secretary to the Treasury, about how an accountant could possibly not be able to identify the assets and income. I am immensely grateful to him and the chief executive of the Crown Estate Commissioners and to one of the commissioners for a meeting I had with him. Having checked with him, and I am happy to say he agrees that I can say this, I was told by him that in the financial statements for next year—that is, for the year ending March 2026—it is the commissioners’ intention to provide a separate breakdown for Wales of the assets and revenue. That shows that you can identify what is Welsh and what is English, and you can show the resultant revenue streams and capital expenditure, so an awful lot of the obfuscation that has occurred can be got rid of. I do not want to comment any further. Let us wait for those accounts to be produced. It brings to an end the argument that you cannot really say what is Welsh and what is English and what is the benefit from it. We will know. It is a great pity that this was not done before.
Therefore, I think that what is before us now is, if this hearts-and-minds issue is to be addressed and dealt with, how do we take this forward? It would be very helpful for us to hear from the Minister about the discussions that have been taking place between his colleagues—I assume that they are his colleagues—in Cardiff and his colleagues here in London about dealing with this hearts-and-minds issue and, as the noble Lord, Lord Moynihan, has been very careful to stress, obtaining economic benefits for Wales. The distinction that I try to draw is between ownership of and benefit from the assets and the management of the assets, and that is why I put forward Amendments 4 and 7.
First, Amendment 4 is primarily to set a timetable. It is no use having a Bill, it seems to me, that transfers the assets on its passing without some clear preparatory work and a timetable to reassure investors and others that the transfer is orderly. Therefore, Amendments 4 and 7 put forward a timetable. I have put dates forward as indicative only: obviously, the timetable is a matter for detailed discussion between the Governments in London and Cardiff, providing that, during that period, the Crown Estate commissioners remain completely in control—they ought to take account of the views of Welsh Ministers but not be bound by them—and that the income thereof in the meantime is properly identified. This really provides a bridging period, dealing with the issue of the transfer of the assets but allowing their management to continue, and therefore really tries to address the problem that, as I understand it, some Government Ministers have put forward, that all this would wreak havoc with investment and jobs in Wales. I regard that as a fallacy. When one really looks at what we are talking about, it is accepting that the Crown Estate in Wales is a national asset of the Welsh people, but accepting that there needs to be an orderly transfer.
As to the future, I have put down a separate amendment, Amendment 5, which I will address in due course, in the second group of amendments, because it addresses this fundamental misunderstanding that is used to try to justify the preparation of an injustice which does such damage to the union.
Lord Sandhurst (Con)
My Lords, the amendments in this group relate to the operation of the Crown Estate in Wales under the newly devolved approach. I should say at the outset that on this side of the House, we are opposed to the Bill in principle. I know that the noble Lord, Lord Wigley, tabled amendments to the Crown Estate Act during its passage through your Lordships’ House. The Official Opposition were clear at that point that the Government should resist those amendments. As my noble friend Lady Vere of Norbiton said then, we have set the Crown Estate on a very different path as a result of that legislation, and now is not the time to frustrate that process with a very different proposal on the direction of the Welsh part of the Crown Estate. That argument was right then; it is right now.
Amendments 1 and 6 in the name of my noble friend Lord Harlech would require the revenues of the Welsh part of the Crown Estate to be paid to the Exchequer after the devolution and transfer of functions to a new body. This would ensure that the existing revenues go to the Exchequer, which, as we all know from the rumours about the spending review next week, is already in great need of income. If control of the functions of the Welsh Crown Estate were to be devolved but the revenues continued to be paid to the Exchequer, that would at least achieve part of the aim of the noble Lord, Lord Wigley, without depriving the Exchequer of much-needed revenue. Perhaps the noble Lord is open to that.
My noble friend Lord Harper raised interesting and cautionary points about the Barnett formula more generally. Amendments 2 and 8 in the name of my noble friend Lord Moynihan seek to ensure that the Welsh Crown Estate is bound by the same borrowing limits as the Crown Estate itself. As noble Lords will recall from the passage of the previous Bill, my noble friends Lady Vere of Norbiton and Lord Howard of Rising spoke at length and pressed Ministers to secure that borrowing limit. We were pleased that Ministers accepted those calls and implemented a borrowing limit, even though this was placed on a statutory footing. The amendment which my noble friend Lord Moynihan has sensibly tabled seeks to ensure that the Welsh Crown Estate is similarly bound by an appropriate limit on its borrowing. Here I should mention, of course, the important points that he made about the impact that this transfer would have on the future of energy, in this country as a whole and in Wales in particular, and the difficulties in apportioning that.
Amendment 3, in the name of my noble friend Lord Moynihan, seeks to establish a backstop to prevent mismanagement of the Welsh Crown Estate. We know how poorly Wales is served by her current devolved Government. Whether it is education, healthcare or economic outcomes, Wales consistently underperforms, so much of this is the responsibility of the Welsh Government. Given that backdrop, it is understandable that noble Lords are a little more than reticent about proposals to take another step down that road, with a body as important as the Crown Estate and with such big assets. We on these Benches share the concern that motivates my noble friend in his amendment, and we would be interested to hear from the Minister whether the Government might consider some form of backstop such as that proposed by this amendment.
Amendments 4 and 7, in the name of the noble and learned Lord, Lord Thomas of Cwmgiedd, reflect legitimate concerns about the untimely transfer of these powers in the event that the Bill is passed. Clearly, a sudden change so soon after we passed the Crown Estate Act, which sets a very different direction of travel for the Crown Estate, would be very disruptive to that new direction. Perhaps the noble Lord, Lord Wigley, would respond to that point in his remarks at the conclusion of this group.
In summary, we have serious concerns about the transfer of the Welsh parts of the Crown Estate to a devolved framework. There are many important issues that must be addressed before this proposal could go forward. We look forward to hearing from the noble Lord, Lord Wigley.
Lord in Waiting/Government Whip (Lord Wilson of Sedgefield) (Lab)
My Lords, before I start my speech, I pay tribute to our Armed Forces who participated in D-Day 81 years ago today. I will mention the 2nd Battalion of the South Wales Borderers and the Durham Light Infantry, who fought side by side on the beaches that day. We will never forget their sacrifices.
While the Government’s position was made clear on debates on this topic during the passage of the recent Crown Estate Bill, it continues to be a pleasure to speak in Committee on this Bill. We should all recognise the passion that the noble Lord, Lord Wigley, has shown on this issue. I prewarn noble Lords that there will be a time during my speech when the Durham accent comes into contact with the Welsh language—so just beware of that.
I thank the noble and learned Lord, Lord Thomas, and the noble Lords, Lord Harlech and Lord Moynihan, for their thoughtful contributions and accompanying amendments relating to the operational framework of any devolved Welsh Crown Estate entity. I also welcome the contributions from the noble Baronesses, Lady Harris and Lady Bennett, and the noble Lord, Lord Harper.
Amendments 1 and 6 would ensure that the revenues from the Welsh Crown Estate would still be paid into the Exchequer. Amendments 2 and 8 would place parameters on borrowing. Amendment 3 would allow the Treasury to impose whatever conditions it sees fit under the scheme for ensuring the expeditious exercise of the functions of the Crown Estate in Wales. Amendment 9 would require the Secretary of State to produce a report on the effectiveness of devolving the management of the Crown Estate.
Amendments 4 and 7 would delay the transfer of the functions in respect of the Crown Estate in Wales for a period of three to seven years after the passing of this Bill, while establishing interim arrangements including requiring the Crown Estate commissioners to engage with Welsh Ministers when exercising their powers in relation to property, rights or interests in land in Wales, and rights in relation to the Welsh zone, in order to enable an orderly and planned transfer, to publish financial information about the Crown Estate in Wales and to pay the proportion of the consolidated revenue account distributable to the Consolidated Fund, which is attributable to the Welsh Crown Estate and to the Welsh Consolidated Fund.
As the House has heard previously, the Government believe that the Crown Estate as it currently operates across England, Wales and Northern Ireland provides the best outcome for Wales and the wider United Kingdom. Devolution of the Crown Estate would risk fragmenting the energy market and delay our progress towards net zero. The Crown Estate has played a critical role in positioning the United Kingdom as one of the most significant global markets for offshore wind over the past 20 years. It has also helped to position Wales at the forefront of clean energy technology and growth, with North Hoyle offshore wind farm becoming Wales’s and the United Kingdom’s first major offshore renewable energy project in 2003 during leasing round 1. Subsequent leasing rounds, including round 4, are delivering offshore wind benefits to Wales.
More recently—in fact, last month—in a boost to the United Kingdom’s clean energy transition, the Crown Estate announced that through its capacity increase programme, seven fixed-bottom offshore wind farms will increase the amount of power produced by offshore wind by adding turbines to projects already at sea. This includes Awel y Mor in north Wales. In addition, the ongoing offshore wind leasing round 5 for floating offshore wind in the Celtic Sea is expected to deliver significant jobs and supply chain benefits to local communities in Wales and the south-west.
The benefits of these projects are felt in the local communities and supply chains across Wales. For instance, the Crown Estate recently invested £1.2 million in Welsh tidal stream energy through the Morlais demonstration zone. Owned and managed by Ynys Môn social enterprise Menter Môn, the Morlais tidal scheme is set to become the largest consented tidal energy project in Europe.
The recently passed Crown Estate Act, which has broadened the scope of the Crown Estate’s investment and borrowing powers, means that it is uniquely placed to drive forward growth-generating projects in Wales. But this is not all that the new Act achieves. As noble Lords will remember, the Government were pleased to support the amendment of the noble Lord, Lord Hain. This was a thoughtful and positive step that will see the appointment of two additional Crown Estate commissioners, each with an additional responsibility to advise on conditions in Wales and Northern Ireland respectively. This will ensure that the board continues to work in the best interests of Wales while delivering its statutory duties as set out in legislation.
It takes time to set up new processes for such appointments. However, I would like to reassure noble Lords that the Treasury is working on plans for these appointments to ensure that they fit the public appointments recruitment process and comply with the governance code. An important feature of those appointments is that the devolved Governments reserve the right to be consulted on them.
Some noble Lords have argued that Wales would benefit financially from devolution of the Crown Estate. Let me set out why the Government do not believe this to be the case. The funds generated by the Crown Estate’s activities across the UK—more than £4 billion over the last decade—already benefit Wales in two ways. First, those Crown Estate revenues support UK Government spending on vital public services in Wales in reserved areas. Secondly, in areas which are devolved to Wales, when the UK Government fund spending in England, the Welsh Government receive funding through the Barnett formula.
Even if devolution could be achieved without risking the revenues generated in Wales, this would not automatically lead to an increase in available funding to the Wales Government. For example, in the case of Scotland, where the Crown Estate is devolved, the Scottish Government receive a block grant reduction to reflect the profits they retain from Crown Estate Scotland following its devolution.
To answer the point made by the noble Baroness, Lady Harris, in previous debates noble Lords questioned why the Crown Estate does not report on income generated in Wales. The noble and learned Lord, Lord Thomas, spoke particularly passionately—I thank him for his contributions—including today on the third amendment. Following the case put forward at Second Reading, the Crown Estate met with the noble and learned Lord to explain in more detail the challenges involved in reporting separate capital and revenue accounts according to administrative and geographical boundaries. However, the Crown Estate recognises the desire for greater understanding through a Wales lens and has committed to review reporting for Wales in its 2025-26 annual report and accounts. I thank the noble Lords from across the House for their engagement on this matter.
Finally, in response to the noble and learned Lord, Lord Thomas, and just to make the position clear, the Government will continue to discuss these issues with the First Minister and the Welsh Government to ensure that Wales sees the full benefits of the Crown Estate.
Lord Wigley (PC)
My Lords, I am very grateful to all colleagues who have participated in this debate. We are in Committee and therefore I am not going to be tempted towards the general arguments that have arisen from several directions over the past hour or so. I thank the noble Baroness, Lady Harris, for coming in from a distance, the noble Baroness, Lady Bennett, for her contribution, the noble Lord, Lord Harlech, for moving the amendment, and the noble Lords, Lord Moynihan, Lord Harper, Lord Sandhurst and Lord Wilson. and the noble and learned Lord, Lord Thomas, for speaking to his amendment, and from whom we may hear more in a moment. Have I covered everybody? I hope so. I am very grateful to everyone who has participated.
It might assist colleagues, particularly those who do not live in Wales and may not keep up with every twist and turn in Welsh politics, to know that, by now, of the 22 Welsh local authorities, of a whole range of political allegiance—and some have no overall political control—21, all but one, have passed resolutions calling for the devolution of the Crown Estate to Wales. This has been supported by Plaid Cymru, Labour and the Liberal Democrats, and I believe even accepted by some Conservative members and Reform UK councillors, who are only too aware of the current feeling of injustice in Wales in this regard.
Mention has been made of the windmills in the sea to the north of north Wales. Noble Lords who watched “Question Time” last night will have noted that the largest round of applause in the programme came when the suggestion was made that Wales should benefit from all those windmills that take up the horizon to the north of Llandudno, along the coast by Colwyn Bay, Prestatyn and Rhyl. There is very strong feeling about them, and that is why 21 out of 22 councils have passed resolutions in support—and I have little doubt that there is sympathy also in the 22nd, which has not.
In considering the amendments before us today, I hope we will bear these background points in mind. By all means, let us improve the Bill by debating amendments and, if appropriate, passing them on Report. But I urge that the Bill be approved by this Chamber and it would then be a matter for those in the other place to come to a resolution on it in due course, if they are prepared to make the time available, so that they can at least address the strong feelings of an overwhelming majority of Welsh councils.
I have noted the comments made by the Delegated Powers and Regulatory Reform Committee in its report last January, that the powers conferred by new Section 52A of the Wales Act 2017 should be subject to scrutiny solely by both Houses of Parliament. While I understand the logic of that viewpoint, I personally would have preferred to have an even-handed approach that enabled the Senedd to voice an opinion. However, I note that the Scottish Parliament were not afforded such an opportunity, and if that were the only issue at stake, I would of course accept an amendment to that end, to facilitate the progress of the Bill.
I will now address the first group of amendments, starting with Amendment 1, which was moved by the noble Lord, Lord Harlech. Amendment 1 seeks, in the words of the presenters of this amendment, to direct the moneys raised by the Crown Estate in Wales to the coffers of the Treasury, and not to the Government of Wales. This is nothing less than undermining the fundamental objective of the Bill, of course, and as such does not improve the Bill, but in effect works out as if the Bill had been refused a Second Reading.
This seems to me to be a back-door way of blocking the Bill and I would be grateful to know whether those who tabled this amendment have secured the agreement of the leader of the Welsh Conservative Party on this matter. If indeed Darren Millar MS has agreed to such a ploy, it is an issue about which the voters in Wales in various Senedd elections will certainly be aware. Let every voter be aware that the Tory party wants the resources of Wales to be put into the control of faceless Treasury mandarins rather than the elected representatives of Wales. My political friends in Wales have experienced this in both the Senedd and the National Assembly, to the dismay of elected Members of all parties.
I will give a specific example of that experience, which Wales suffered at the sticky hands of the Treasury in Whitehall. Between 2007 and 2011, the Labour-led Welsh Government, to their huge credit, attempted to avoid the fiasco of a year-end stampede to spend revenue moneys before the end of the financial year on any scheme that may be at hand, irrespective of whether such expenditure represented the best value for money. Everyone knows that this still happens the length and breadth of these islands. Despite a tightening of the rules, the Treasury has not sorted that out. So, 20 years ago, the Welsh Government devised a scheme whereby they accumulated all the year-end revenue underspends into a capital fund, which was allocated to worthwhile projects such as building schools and hospitals. Between 2007 and 2011, they accumulated some £400 million—a process that the then Labour Government at Westminster accepted.
Lord Thomas of Cwmgiedd
“(c) confer on the Welsh Ministers or the body that may be nominated as the transferee power to enter into an agreement with the Crown Estate Commissioners for the performance of specified matters in relation to management or investments of the Welsh Crown Estate on behalf of Welsh Ministers or the body nominated as the transferee.”Member’s explanatory statement
This amendment permits agreements to be entered into for the Crown Estates Commissioners to exercise specified management and investment functions on behalf of Welsh Ministers.
Lord Thomas of Cwmgiedd (CB)
My Lords, I will be brief. I separated out this amendment because it deals with an issue we too often neglect when we speak about devolution: the working of the union. It seems to me that the debate on the previous amendments brought into clear focus a failure to distinguish the positives of devolution—that is, giving to nations what they aspire to and what they feel they ought to have, as a matter of hearts and minds. As the noble Lord, Lord Wigley, has said, there is enormous support for the devolution of these powers. But it is also important to remember that we are part of a union, and the Crown Estate shows and exemplifies that you can give powers to be devolved in certain areas, but then you should work together.
I suggested in the amendment that the Crown Estate commissioners should have this power to take the management of the Crown Estate in Wales from the Welsh Government—in accordance with the investment policy of the Welsh Government, and being consulted about it—so that it could be a model of the way in which the union operates to benefit economically.
Spending a great deal of my time in Wales, I hope that the Government understand that there is an enormous feeling of hostility to the way in which the Government have run the Welsh economy—a feeling that they have not sufficiently acceded to what happens in Wales. I have no views on whether that is right or wrong—I express none—but it seems to me important that we do two things: that we recognise national aspirations and accept, as the noble Lord, Lord Wigley, said, that what you give to Scotland you ought to give to Wales, because you recognise it as having the same national aspirations. However, we also need openly and transparently to work together where it is in the common interest. As the remarks of the noble Lord, Lord Moynihan, showed, working together in the energy sector is essential.
I therefore wished this particular point to be debated separately to bring home, I hope, to His Majesty’s loyal Opposition—who were not very good at this when they were in government—and to this Government, before it is too late, the absolute essentials of making it clear that you respect nationhood and what has been done by way of devolution but also that you will work together to benefit each of the nations, by co-operation and joint policies, where it is in the overwhelming national interest.
The Crown Estate epitomises the recognition of national aspirations—but where it compels working together. That is a lesson much broader than this particular Bill, but, as a strong believer in the union, I think we in London too often forget it. We do not recognise the pluses that devolution has brought, the fact that we cannot row back on it and how much more effort needs to be put into working together. This provides the perfect model. I beg to move.
Lord Sandhurst (Con)
My Lords, I will speak briefly to Amendment 5 in the name of the noble and learned Lord, Lord Thomas of Cwmgiedd. He has made thoughtful and powerful contributions to our debate today, not least—as he has said—as a strong supporter of the union.
Amendment 5 would create a framework for powers to be granted to enter into agreement with the Crown Estate commissioners for the performance of specified matters in relation to the management or investments of the Welsh Crown Estate by Order in Council. I have listened carefully to the noble Lord’s arguments, and he has made a powerful case for his amendment. However, as I said in my more general remarks to the previous group, we have serious concerns about the direction set by this Bill. Now is not the time to take forward proposals for devolution of the Welsh Crown Estate.
That said, if this Bill is to go forward, we hope the noble Lord, Lord Wigley, will listen carefully to constructive remarks made by the noble and learned Lord, Lord Thomas of Cwmgiedd, and my noble friends Lord Harlech, Lord Moynihan and Lord Harper.
Lord Wigley (PC)
My Lords, as I indicated when I spoke previously, I would be minded to accept this amendment if it was moved on Report.
Lord Wilson of Sedgefield (Lab)
My Lords, as I have already set out, the Government believe that the Crown Estate, as it currently operates across England, Wales and Northern Ireland, provides the best outcomes for Wales and the wider United Kingdom. I will not repeat the arguments I set out earlier in this debate.
I thank the noble and learned Lord, Lord Thomas, again for his considered contributions to this debate. The amendment we are debating now—Amendment 5 —would permit the Crown Estate commissioners to exercise specified management and investment functions on behalf of Welsh Ministers.
I remind the House that existing statute provides the Crown Estate with independence and autonomy to set and achieve its goals. The Government believe that the Crown Estate should continue to operate in this way—as a commercial business independent from government—because it has shown itself to be a trusted and successful organisation with a proven track record in effective management. Even if the proposal in this amendment was being suggested for the Crown Estate in its current form, it would be important to ensure that independence was preserved in respect of any functions it took on behalf of Ministers.
More broadly, as I previously set out, the Government will continue to discuss these issues with the First Minister and the Welsh Government to ensure that Wales sees the full benefits of the Crown Estate.
Lord Moynihan (Con)
Before the noble and learned Lord, Lord Thomas, winds up, I completely endorse and agree with his views about co-operation. There is no doubt whatever that it is vital in the relationship between Wales and the United Kingdom in this context.
My arguments have not been principally political at any stage during Committee. My argument is that the lion’s share of the Crown Estate’s assets in Wales requires to be maximised in terms of economic value to Wales, and that there should be the overarching control and involvement of the Crown Estate as is currently set up. I believe that would be the most efficient and efficacious way of maximising the value of those assets in the Celtic Sea, and that was the reason that I pushed this argument so strongly, and not because of future political arrangements. After that project comes to fruition and benefits all concerned, there may well be an opportunity to look at the political realities that have been put forward by the noble Lord, Lord Wigley, and the noble and learned Lord, Lord Thomas.
I think that is the reason that the Government have taken the position they have, and I endorse it strongly: it is a cross-party view, but it is one that is driven—from my perspective—on the economic realities of those assets in Wales at this time. We should still make sure there is maximum co-operation between all interested parties, the Crown Estate and the locally interested parties in Wales, so that the projects we have been discussing in the context of this Bill are brought to fruition to the maximum economic benefit of both the United Kingdom as a whole and indeed Wales.
Lord Thomas of Cwmgiedd (CB)
I will briefly reply. There is a difference between what I have put forward and what the noble Lord, Lord Moynihan, suggests.
I thank everyone for listening patiently to what I had to say. I believe that, at the end of the day, as one sees across the world, we must recognise the importance of what is stirred up by nationhood. It is important to try to analyse the way in which economic benefits can be conferred. I have listened to all the arguments, and it still seems to me that the compromise which I put forward—namely, to recognise nationhood and national aspiration but to co-operate to provide economic benefit—is something for now and not for some distant time in the future. Having listened to all the arguments and hearing the views of the Committee, I beg leave to withdraw my amendment.