Preterm Birth Committee Report

Baroness Blackstone Excerpts

Friday 6th June 2025 Lords Chamber

[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.

Women’s Health Strategy

Baroness Blackstone Excerpts

Tuesday 4th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree with the noble Baroness. It is a disgrace that there is such a huge inequality in maternity care. Maternal mortality rates are some 2.3 times higher for black women and 1.4 times higher for Asian women, while those living in the most deprived areas have a maternal mortality rate nearly twice as high as that for those who live in the least deprived areas. That cannot be acceptable in 2025. I am glad that we have taken a number of actions to ensure that trusts who fail on maternity care are robustly supported. We will set an explicit target to close black and Asian maternal mortality gaps. Trusts are also required to publish a suitable plan to tackle this and to put it into action. It is a challenge, but not one that we shy away from.

[Baroness Blackstone (Lab)]

My Lords, I declare my interest as set out in the register. What is the Government’s timetable for a revised or updated version of the women’s health strategy? Can the Minister also assure the House that there will be adequate funding for its implementation when it is brought in?

[Baroness Merron (Lab)]

Let me assure my noble friend and other noble Lords that there are no plans to cancel the women’s health strategy. I know my noble friend did not say that, but it is very important to put that on record. We continue to implement it; for example, since I have been in post, through measures such as supporting pregnancy loss through a full rollout of baby loss certificates, introducing menopause support in the workplace, and boosting women’s participation in research and clinical trials. As I said, our priorities for delivering the strategy will be through the 10-year plan. Funding decisions will be announced in due course.

Musculoskeletal Health

Baroness Blackstone Excerpts

Thursday 30th January 2025 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords—

[Baroness Blackstone (Lab)]

My Lords—

[Lord Pannick (CB)]

My Lords—

Black, Asian and Minority-Ethnic Women: Maternal Mortality Rates

Baroness Blackstone Excerpts

Monday 29th July 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for his kind remarks; I am very pleased to see him again across the Dispatch Box. The duty of candour is extremely important in all this. Racism in this area is not just towards mothers and families; as the noble Lord said, it is also towards staff. Clearly, we need to tackle this for both patients and staff. The patient’s voice is key. Even at this early stage, it is quite clear to me that women, and people of black, Asian and minority-ethnic heritage, are not being listened to. We will bring forward plans to put this right. As part of the report to which I referred earlier, I will be glad to update the House in this regard.

[Baroness Blackstone (Lab)]

My Lords, I declare my interest as set out in the register. Given the complexity of the causes of these unacceptable mortality rates, what is the Minister’s department doing to ensure that there is a cross-government approach to ending the maternal mortality gap?

[Baroness Merron (Lab)]

My noble friend is quite right: this is a cross-government matter. There are complex reasons why black, Asian or minority-ethnic people are suffering far worse than those who are white. They include socio-economic factors such as deprivation and health inequalities being felt across the whole range. It is not going to be possible to solve this without cross-government co-operation. I look forward to working with my ministerial colleagues to put it right.

Smoking

Baroness Blackstone Excerpts

Thursday 25th January 2024 Lords Chamber

[Lord Patel (CB)]

My Lords—

[Baroness Blackstone (Lab)]

My Lords, I refer to my interests as set out in the register. Would the Minister agree that smoking in pregnancy has enormously damaging effects, leading to much poorer birth outcomes than for mothers who do not smoke? Would he also agree that incentives to pregnant women not to smoke have been very effective? In the light of this, could he give a guarantee that the existing scheme, which comes to an end this year, will be continued with adequate resources, so that it is not in any way disrupted?

[Lord Markham (Con)]

I totally agree with the noble Baroness on the importance of stopping smoking—always, but especially during pregnancy. In fact, we have a maternity debate coming straight after this, where this will be one of the things that we discuss. I hope, from showing that we are putting all this spend in place, that we are backing everything that works. As long as the anti-smoking in pregnancy measure continues to work, that will be one of the major features to make sure that we are continuing to stop all activity, but especially in pregnant ladies.

Osteoporosis: Early Detection

Baroness Blackstone Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord refers to the fracture liaison services. It is the responsibility of all ICBs to roll out those services or their equivalent. Regarding the numbers that he cited, I should say that 51% of ICBs have a fracture liaison service in that shape or form and the others have different versions of it, and they are all responsible for rolling those out. At the same time, they are also responsible for musculoskeletal services, to make sure that we have nationwide provision for it.

[Baroness Blackstone (Lab)]

My Lords, the Minister said that prevention is better than cure. That is obviously the case, yet we have severely failed to prevent the horrible development of this crippling disease, which mainly affects women, as has been said. He has talked about a 95% target. What is he going to do, as the Minister with some responsibility in this area, to ensure that the target is met, given the failures in the past? Will he find a way of reporting back to the House on progress in reaching that target?

[Lord Markham (Con)]

One of the many things for which I am responsible is NHS performance, as I think the House is aware, and these are exactly the sorts of issues that I am interested in, so I am happy to undertake to give an update on that. We all know that effective spend, which we need to make sure is always put to best use, involves identifying where these problems are, and 3 million people are affected every year. As I said earlier, a fractured femur is the second biggest reason for intake into hospitals, in terms of beds. That is something that I am happy to be measured by and report back on.

Maternity and Neonatal Services

Baroness Blackstone Excerpts

Tuesday 25th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. I agree. This was captured in recommendation 1 by Dr Kirkup about having early warning indicators in place. That is what we have set up in the maternity quality surveillance framework, which has the oversight in this area and can escalate concerns and effectively report to the national maternity safety surveillance and concerns group, which can then put the trust into special measures.

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of the trustees of the Royal College of Obstetricians and Gynaecologists. I am aware that the Government have allocated an extra £200 million for maternity services over the last couple of years, but according to the Health and Social Care Select Committee this is not nearly enough. It recommends up to £350 million for staffing alone. Do the Government accept that, above all, more funding is needed now for multi-professional training and to support programmes to improve clinical practice? If so, can the Minister say how much funding the Government are prepared to allocate and when?

[Lord Markham (Con)]

I agree. We are putting the money into the training programmes. We have actually put £95 million on top of the £127 million investment into this area. As ever though, what is most important is outcomes not investment. Alongside the tragic instances we have seen, we have seen a reduction in stillbirth of 19% since 2010, a reduction in neonatal mortality over 24 weeks of 36%, and a reduction in maternal mortality of 17%. Alongside these tragic findings of individual trusts, we have an improving picture of maternity care overall.

Medical Abortion Pills

Baroness Blackstone Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

One of the reasons, as my noble friend would acknowledge, is that we had lockdown and then we were let out, and then we had more restrictions. We did not want to announce something and then have to go back on it. All I would say is that it was always intended to be a temporary measure. We have looked at the responses to the consultation in order to reach a decision, and we will be issuing our considerations later.

[Baroness Blackstone (Ind Lab)]

My Lords, I wish to declare my interest as chair of the trustees of the Royal College of Obstetricians and Gynaecologists. Following up on the question from the noble Baroness, Lady Sugg, I find it very strange that the Government are taking so long to make this decision. The temporary service that was provided for early medical abortions comes to an end at the end of next month. The evidence is clear. According to a survey of 50,000 women published in a leading medical journal, telemedical abortion is

“effective, safe, acceptable and improves access to care.”

In these circumstances, what is holding up the Government’s decision? It seems obvious that it would be welcomed by doctors involved in the treatment of such women, and by the women who need this care.

[Lord Kamall (Con)]

As I am sure noble Lords will acknowledge, this is a very sensitive area. Initially, it was meant to be a temporary-only service. If we do decide to respect its temporariness, an extension will probably be made to ensure that the clinics and other medical services have time to adapt before returning to the position before the pandemic.

Vaccination Strategy

Baroness Blackstone Excerpts

Thursday 13th January 2022 Lords Chamber

[Lord Kamall (Con)]

One of the wonderful things about your Lordships’ House is its range of expertise. I thank the noble Lord for enlightening us on the earlier question. However, as I committed to the noble Baroness, I will check the department’s reply and hope it corresponds with the noble Lord’s response; otherwise, I am sure we will have more discussions.

On young women, the noble Lord is absolutely right that we should be encouraging as many people as possible to take the vaccine, even—I know this is being broadcast publicly—those who have not had their first or second vaccine. It is not too late. We urge everyone to have their first and second vaccine, but also to have the booster. It is the best protection, even for those who have previously had Covid. We know that almost all pregnant women who are hospitalised or admitted to intensive care with Covid-19 are unvaccinated. The latest data from the UK Health Security Agency shows that Covid-19 vaccinations provide strong protection for pregnant women against the virus. It shows that the vaccines are safe for pregnant women, with similar birth outcomes for those who have had the vaccine and those who have not. We have launched a new campaign that urges pregnant women not to wait to take the vaccine; it highlights the risks of Covid-19 to mother and baby and the benefits of vaccination.

[Baroness Blackstone (Ind Lab)]

My Lords, I declare my interests as set out in the register. Following on from the question of the noble Lord, Lord Patel, I want to pick up the issue of pregnant women. The Government have belatedly—very belatedly—announced a campaign to persuade pregnant women to get vaccinated. Had they done it earlier, some deaths would have been avoided. Is the Minister aware of the particularly low levels of vaccination among pregnant women from ethnic minorities? What are the Government doing to reach out to them in particular, to persuade them to get vaccinated and save their own lives and those of their unborn children?

[Lord Kamall (Con)]

The noble Baroness makes an incredibly important point that I am sure we all agree with. This is a combination of two issues. One is reaching those communities that generally, pregnant or otherwise, are not being vaccinated. The other is making sure that pregnant women are receiving the message that it is safe to have the vaccine. We are doing this through a number of channels, including through medical staff and the NHS, but we also have a number of targeted campaigns, looking at those communities to make sure we build trust, break those gaps down and give them the confidence to come forward and be vaccinated.

Covid-19: Vaccines and Pregnancy

Baroness Blackstone Excerpts

Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend made a clear case for the importance of improving the way in which patient data is collected and analysed in this country. It is something that we are working on at the moment. She highlights a very difficult situation. A third of women do not know that they are pregnant, of course, and, when they are pregnant, their data is first caught at the hospital where they decide to have their birth. Those databases are not easily linked. We do not have a countersignal for pregnancy at the moment; it is therefore not an acute priority. However, I take my noble friend’s point and will look into it further.

[Baroness Blackstone (Ind Lab)]

My Lords, I declare an interest as chair of the trustees of the Royal College of Obstetricians and Gynaecologists. The RCOG survey found that more than half of those who declined the vaccine did so because they were waiting for more information about the safety of the Covid-19 vaccination during pregnancy. Will the Government, as a matter of urgency, issue guidance to all pregnant mothers explaining that the vaccination will not harm their unborn babies? Will they also provide facilities for pregnant women to be vaccinated at antenatal clinics as a mechanism to increase the take-up of vaccinations by pregnant women?

[Lord Bethell (Con)]

I am extremely grateful for those constructive suggestions from the noble Baroness. We have a very large amount of materials specifically for pregnant women, including guidance for pregnant women and a guide for women who are of childbearing age, pregnant or breastfeeding; those are widely distributed by GPs. However, as I said, a lot of pregnant women do not know that they are pregnant, so it is not possible to reach all of them all the time. At the moment, our priority is to ensure that those aged over 50 take their second jab. We will sweep up other demographics, and we will make that a priority when we reach it.