Baby Loss Awareness Week

Caroline Dinenage Excerpts

Tuesday 8th October 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I beg to move,

That this House has considered baby loss awareness week.

This is the fourth Baby Loss Awareness Week debate, and it is incredibly heartening to see how this has become an annual event in the House. It helps to send a clear signal outside this place about the importance of this subject in the Chamber, in the Department of Health and Social Care and in the national health service.

Over the years, many Members of Parliament have been brave enough to share their personal and painful accounts of baby loss, which, while heartbreaking to hear, have done so much to raise the profile of this important issue and to start vital conversations about it. It is absolutely right and fundamentally important that we continue to raise awareness of both the devastating impact of baby loss and the support that bereaved parents need through the grieving process to help them adjust to their loss. I do not think people ever fully heal or get over the loss of a much loved and much wanted child, but with the right care and support they might be able slowly to move forward with their lives.

[Mr Jim Cunningham (Coventry South) (Lab)]

I identify with everything the Minister has said so far. One point about these debates for members of the public who have not experienced baby loss, and for some Members here, is what we learn about the heartbreak and, in some instances, the lack of support. In general terms, it has been very good to have these debates—even if we do have them annually—because they educate the public about an issue that has too often been shoved under the carpet, for want of a better term. It is better that people now understand what other people go through in life, so I do appreciate the Minister’s opening remarks.

[Caroline Dinenage]

I thank the hon. Gentleman so much for that intervention. He is absolutely right. In this place, we have a unique opportunity to raise subjects that people find it difficult to talk about out there. In doing so, we shine a light on those subjects, and we are able to really begin to move the dial and to change practice.

With that in mind, I would like to pay tribute to the hon. Member for Eddisbury (Antoinette Sandbach) and my hon. Friend the Member for Colchester (Will Quince), who is desperate to speak, although, being a Minister, he is prevented from doing so, so we will have to restrain him. However, in a late-night Adjournment debate back in 2015, they began to raise awareness of the variation in care for families bereaved by baby loss. It was an incredibly moving debate—I remember listening to it at the time—and it really made such a magnificent difference. It was followed by the Baby Loss Awareness Week 2016 debate, which was about bringing the subject to light and challenging the idea that baby loss is an uncomfortable topic that we do not like to talk about. I am grateful to the Members from across this House who shared their personal experiences on that day back in 2016 and have done since.

International Baby Loss Awareness Week begins tomorrow and finishes next Tuesday. This year, the focus is on the need for specialist psychological support for bereaved parents who need it. The Baby Loss Awareness Alliance group of charities will be publishing a report highlighting that some parents need that kind of support as part of their bereavement care.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I wholeheartedly support the thrust of this debate and what the Minister is saying. I am not going to make a speech today—I did that last year—but when a child is lost, which as Members know has affected my family, counselling and gynaecological advice are hugely important. However, my constituents are over 100 miles from the nearest hospital where someone can give birth. I just want to put it on the record that a 200-mile round trip from Caithness to Inverness makes getting the counselling and gynaecological advice so difficult. My constituents are losing out on that front, and I wish that Caithness general hospital in Wick could be used for such purposes.

[Caroline Dinenage]

I am grateful to the hon. Gentleman for raising that. The situation is particularly difficult in rural communities where people live a very long way from services. As we set out in the NHS long-term plan, maternity outreach clinics are going to start to integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties arising from or related to maternity experience, and we must keep in mind those living in very remote communities when we talk about those outreach facilities.

[Andrew Percy (Brigg and Goole) (Con)]

This is such an important topic. While the Minister is on the subject of outreach clinics, may I also emphasise to her the need for maternity bereavement suites within maternity suites? I am proud to have helped secure £22,500 for the new facility at Scunthorpe hospital that opened over the summer, and I pay tribute to the Health Tree Foundation for securing that £175,000 project. It took years but we now have a bereavement suite where parents who have had a stillbirth can spend time with their other children and with their baby on the ward in that maternity suite, just as other young mums and dads do. It is a really important part of the healing process. Frankly, that should be the norm throughout all our maternity suites. As we mark Baby Loss Awareness Week, perhaps the Government could consider such a system for the country as a whole.

[Caroline Dinenage]

I am grateful to my hon. Friend for raising that point. He is absolutely right that we need to give that area a lot more attention. Having that ability to spend time together will be an incredibly valuable and important part of the process of grieving and coming to terms with the unbelievably tragic death of a baby.

[Tim Loughton (East Worthing and Shoreham) (Con)]

On the question of raising awareness, a job that was so ably started by my hon. Friends, the Minister will be aware of my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, which became law in May, two parts of which relate to stillbirth. One gives the Secretary of State the power to have coroners investigate stillbirths and the other sets up a review by the Secretary of State to look into the registration of pre-24-week stillbirths. That review body has not met for over a year, so can the Minister update us on when the legislation will be laid so that, for the first time, coroners will have the power and ability to investigate stillbirths where they see fit to do so?

[Caroline Dinenage]

I am grateful to my hon. Friend for raising that matter, because he brought forward a really important private Member’s Bill. The consultation concluded on 18 June after receiving over 350 responses. Officials are currently analysing all those responses and will report as soon as possible.

Much has been achieved since 2015 to improve the quality of bereavement care for parents, and I put on record the efforts of the all-party parliamentary group on baby loss, ably led by my hon. Friend the Member for Eddisbury with support from Members on both sides of the House. I will speak more about developments in bereavement care in a moment, but first I would like to talk about some of the progress made by the NHS on improving safety and reducing baby loss in maternity and neonatal services.

I cannot continue any further without putting on record my enormous thanks and gratitude to my right hon. Friend the Member for South West Surrey (Mr Hunt), who has done more than anybody to further the cause of patient safety and to investigate the untimely deaths of babies, and across the NHS. I thank him from all of us for his incredible work in that space.

Members will be aware of the Government’s ambition to halve the rates of stillbirths and neonatal deaths by 2025, with an interim ambition to achieve a 20% reduction in those rates by 2020. The ambition includes similar reductions in maternal mortality and serious brain injuries in babies during or soon after birth, and a 25% reduction in the pre-term birth rate from the current 8% to 6% by 2025.

This ambition was set in November 2015, when the Lancet stillbirth series ranked the UK 33rd out of 35 high-income countries for stillbirths. Case reviews of stillbirths and neonatal deaths suggest that many such deaths might have been prevented by better clinical care, and the Morecambe Bay investigation report made 44 recommendations for improving the safety of maternity services.

In 2016-17, the Department of Health launched a range of initiatives that are being delivered by the NHS under the auspices of the maternity transformation programme, and I would like to mention a few of those achievements. Every NHS trust with maternity services now has a board that includes obstetric and midwifery safety champions to lead the development of an organisational safety culture. Every trust has received a share of the £8.1 million maternity safety training fund, and 30,945 training places for multidisciplinary teams were delivered in 2018-19, with courses focusing on training for childbirth emergencies in labour wards and in the community, as well as on leadership, communication and resilience.

Evaluation of the “Saving Babies’ Lives” care bundle found that clinical improvements such as better monitoring of a baby’s growth and movement in pregnancy, as well as better monitoring in labour, mean that maternity staff have helped to save more than 160 babies’ lives across 19 maternity units. An estimated 600 stillbirths could be prevented annually if all maternity units adopted national best practice. A revised version of the care bundle is currently being rolled out across England, and it includes elements to reduce the number of pre-term births and to optimise care where pre-term delivery cannot be prevented.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

I associate myself with the Minister’s positive words about my right hon. Friend the Member for South West Surrey (Mr Hunt) and all he did to improve patient safety in the NHS. It was a fantastic piece of work.

Mr and Mrs Pickup of Knaresborough have suffered significant personal loss but are seeking to drive change to ensure that no other family have to face the same tragedy. The issue is with the automatic sharing of medical records between trusts. The process used within the NHS to ensure that that happens has not always worked very smoothly, so will my hon. Friend please consider this matter as she works to improve patient safety across the NHS?

[Caroline Dinenage]

My hon. Friend is right to raise that matter. When a tragedy could have been avoided by something as simple as sharing patient records, there is no option but to embrace the technology we need to make that a reality. Both the previous and the current Secretary of State for Health and Social Care are in favour of that.

Every trust is now using the perinatal mortality review tool to review stillbirths and neonatal deaths to make sure lessons are learned so that other families do not have to suffer in the same way. The first annual PMRT report is due for publication later this week, and it will provide an analysis of the first 1,500 cases. Overall, a review has been completed on 96% of stillbirths and 86% of neonatal deaths since the tool was launched.

[Jamie Stone]

The Minister talks about safety advice and safety good practice, so may I ask her and the UK Government to share that advice with NHS Highland and indeed the Scottish Government, who have never in my two years or so here given me a straight answer on the safety of pregnant women? Some of those women, who might be in labour, are being transported more than 100 miles from Caithness to Raigmore Hospital in Inverness, in the middle of winter, when the A9 can be blocked. I think lives are in danger.

[Caroline Dinenage]

The hon. Gentleman has put his thoughts clearly on the record, and if there is anything we can ever do to share best practice with colleagues across the devolved nations and around the rest of the world, we are always happy to do that.

The Healthcare Safety Investigation Branch is another remarkable innovation. It commenced investigations in April 2018 and has been operational in the 130 trusts providing maternity services since the end of March 2019. By the end of August, the HSIB had completed 88 investigations, with 169 draft reports looking into maternity and neonatal deaths currently with trusts and families.

NHS Resolution recently published a report on the first year of its early notification scheme for potential birth brain injuries. The scheme requires all births at NHS trusts in England from 1 April 2017 meeting qualifying criteria to be reported to NHS Resolution within 30 days for investigation, so families with a baby affected by a severe brain injury attributable to substandard care can receive significantly earlier answers to their questions. This approach means that they do not have to resort to full court proceedings and can receive financial support with their care and other needs at a much earlier stage. In the first year, 746 incidents were eligible for the scheme. There have been early admissions of liability for 24 families, who have been provided with detailed explanations, admissions of liability and, very importantly, an apology. Families have been provided with financial support for early access to additional care, respite and, where needed, psychological support and counselling.

I am happy to report that this summer the Office for National Statistics reported that the stillbirth rate in England had decreased from 5.1 stillbirths per 1,000 births in 2010 to four stillbirths per 1,000 births in 2018. That represents a 21% reduction in stillbirths two years ahead of our ambitious plan.

[Neil Parish (Tiverton and Honiton) (Con)]

I thank the Minister for Baby Loss Awareness Week and for her statement. Let me reiterate that many mothers want to have a natural childbirth, and it is essential that they can do so if possible, but we also need to make sure that the facilities are there in all of our maternity units to be able to act if a natural birth does not take place, so that we can deliver the baby without any brain injury.

[Caroline Dinenage]

My hon. Friend is right, and so much of what the Government have been working on in recent years is about making sure we have the right facilities, skills and knowledge right across our NHS estate.

Let me reiterate what I mentioned a moment ago, which is that we have seen a 21% reduction in stillbirths two years ahead of our ambitious plans. Of course every stillbirth is a tragedy, but I am sure the House will want to join me in paying tribute to midwives, obstetricians and other members of multi-disciplinary maternity and neonatal teams across the NHS for embracing the maternity safety ambition that we set, and for their incredible hard work in achieving this milestone two years ahead of target—that is remarkable. However, there is no room for any complacency, because there is so much more to do.

Many Members will be aware that the neonatal mortality rate in 2017 was only 4.6% lower than it was in 2010, and that headline figure hides the fact that the ONS data show that the number of live births at very low gestational ages, most of whom die soon after birth, increased significantly between 2014 and 2017. In fact, the neonatal mortality rate in babies born at term—that is, after at least 37 weeks’ gestation—decreased by 19% and the stillbirth rate in term babies decreased by 31.6% between 2010 and 2018. The pre-term birth rate remains 8%. Clearly, the achievement of our ambition depends significantly on reducing those pre-term births.

[Gareth Thomas (Harrow West) (Lab/Co-op)]

I apologise to the Minister and to the House for missing the early part of her remarks. On the statistics she has just commented on, is it not the case that we are going backwards in our progress on neonatal deaths? Is it not also true that there is a marked difference in more socially deprived areas since 2014? Does that not suggest that significantly more investment in this policy area is needed urgently, particularly in those areas where social deprivation is most stark?

[Caroline Dinenage]

The hon. Gentleman is right. We are still going forwards, although nowhere near as quickly as we would want to be going, but there have been some backward steps along the way. A lot of the changes that we have introduced have not yet had the opportunity to take full effect, and I am hopeful that as we move forward we will begin to see neonatal death rates reduce. As I just mentioned, when babies are born at or close to full term, the rate has dropped significantly. It is pre-term births that are causing a lot of concern for us, which is why we are putting continued effort into this issue.

In the long-term plan that was published in January, the NHS committed to accelerate action to achieve the national maternity safety ambition. Maternity services will be supported to implement fully an expanded “Saving Babies’ Lives” care bundle across every maternity unit in England by 2020. The development of specialist pre-term birth clinics will be encouraged in England, which should help very much.

NHS England and NHS Improvement will continue to work with midwives, mothers and families to implement the continuity of carer model, so that by March 2021 most women will have a named individual caring for them during pregnancy and birth and postnatally. That will help to reduce pre-term births, hospital admissions and the need for intervention during labour. It will also improve women’s experience of care.

Let me return to bereavement care. Members will be aware that for three years the Department of Health and Social Care has provided funding to the charity Sands for it to work collaboratively with other baby loss charities and the NHS to develop and pilot the roll-out of a standardised national bereavement care pathway for parents who have experienced baby loss, whether through miscarriage, termination after receiving a diagnosis of foetal abnormality, stillbirth, neonatal death or, indeed, sudden infant death. The pathway sets out nine standards for good bereavement care and has so far been adopted by 40 trusts. I hope that many more will follow.

[Sarah Champion (Rotherham) (Lab)]

I was contacted by one of my constituents, whose baby died in July at 26 days. She still, now, has been unable to get counselling support. Will the Minister look into giving clear guidance to clinical commissioning groups to make sure that the National Institute for Health and Care Excellence guidance on bereavement is there for everyone?

[Caroline Dinenage]

Yes. That guidance is there. My heart goes out to the hon. Lady’s constituent. If she wants to get in touch with us about any lack of access to care and support, we will almost certainly be able to help and look into it for her.

Bereaved parents need time to grieve. I take this opportunity to congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake)—I do not think he is present—who last year had a fantastic private Member’s Bill. As a result, from 2020 the Parental Bereavement (Leave and Pay) Act 2018 will give all employed parents a day-one right to two weeks’ leave if they lose a child who is under the age of 18 or suffer a stillbirth from 24 weeks of pregnancy.

Finally, the NHS commits in the long-term plan to improve access to and the quality of perinatal mental healthcare for mothers, their partners and children, by increasing access to evidence-based care for women with moderate to severe perinatal mental health difficulties and personality disorder diagnosis. We also want to increase access to evidence-based psychological support and therapy, including digital options in a maternity setting; the development of maternity outreach clinics, as I have already mentioned, that will integrate maternity and reproductive health; and psychological therapy for women experiencing mental health difficulties directly arising from or related to their maternity experience.

In conclusion, the Government and NHS are fully committed to reducing the number of babies who die during pregnancy or in the neonatal period, and to providing that absolutely fundamental and much-needed support for bereaved families.