Preterm Birth Committee Report

Baroness Merron Excerpts

Friday 6th June 2025 Lords Chamber

[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.