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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.