Stillbirth

Justin Madders Excerpts

Thursday 9th June 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is an honour to serve under your chairmanship, Sir David. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this extremely important debate and the compelling way that she introduced it. She is right that she is not alone in having gone through such a terrible experience, and she is certainly not alone in wanting to move this issue up the political agenda. I pay tribute to her for the courage that she has shown in retelling her experience. I do not think that any Member could fail to have been moved by her speech, and I am sure that many of those watching her contribution will, sadly, have recognised the personal tragedy, which was made more difficult by the defensive attitude of the health service. Many people have had such experiences—not just in this area but through many other failings in care in the health service. She made a compelling case for the extension of coroners’ powers to holding inquests on stillbirths. As we know from recent high-profile inquests, there is a need for a comprehensive review of that whole system.

Hon. Members from both sides have made excellent and sometimes very moving contributions. I draw particular attention to the contribution of the hon. Member for Henley (John Howell), who rightly raised the impact on parents’ mental health of such experiences and the loss that the whole family feels. Not only the mother and father, but little brothers or sisters and the wider family are impacted by such tragic events.

The hon. Member for East Renfrewshire (Kirsten Oswald) was right to highlight the need for prevention and how many parents experience a stillbirth and never get an adequate explanation of how that happened. I agree that only through continued targeted action will we drive the necessary progress. The hon. Member for Colchester (Will Quince) summed up the challenge very well when he said that we do not like talking about death in this country. I pay tribute to him for the great strength that he showed in talking about his experience. I am sure that he will be able to get many more Members to talk about this subject through his work on the APPG. The hon. Member for Livingston (Hannah Bardell) spoke with great sincerity about her constituents’ experience and the twin to twin transfusion syndrome process, and conveyed the incredible range of emotions that parents must go through in such situations, which are rare but none the less extremely difficult for those involved.

I welcome the debate, which, as we have heard, coincides with Sands awareness month. I add my voice to those of others who have already paid tribute to the enormously important work that that charity does. Sands awareness month gives us the opportunity to increase awareness of stillbirth and neonatal death and the devastating impact experienced when a baby dies before, during or after birth, which hon. Members have conveyed with great sincerity and courage.

In November, I was privileged to have the opportunity to respond for the Opposition in a debate marking World Prematurity Day. That debate was also difficult, and what we heard then from Members about stillbirths and neonatal deaths was equally compelling and challenging. We still face those challenges, and this is an opportunity to explore in further detail some of the issues that were raised in November and have been raised today and to scrutinise the progress that the Government have made in the six months since that debate.

As has been said already, although there has been enormous progress in the past century in tackling stillbirth and infant mortality rates, progress has more or less stalled in the past two decades, and the UK continues to perform significantly worse than many comparable nations on infant mortality rates and remains one of the poorest performing countries in the developed world for stillbirths. That is a clear sign that we are not doing well enough in providing neonatal care or tackling the underlying public health issues that contribute to premature births and stillbirth.

Research into babies stillborn from 28 weeks indicates that the UK has a stillbirth rate of 2.9 per 1,000 births —higher than Germany at 2.4; Poland at 2.3; the Netherlands at 1.8; and Denmark at 1.7. Members have said that this issue is not just about statistics, and it is about far more than that, but those statistics need to be laid out, because it is clear that we are not doing as well as we should be and progress is not as swift as in some other places in Europe. I think that all Members want to see that situation addressed. We welcome the Secretary of State’s ambition to reduce stillbirths and neonatal deaths by 50% by 2030, but 14 years is a long way off, so will the Minister give us some indication of what progress he expects to be made before that date? Will he also set out where he expects us to be by around 2020, by which time the Secretary of State has indicated that he expects there to have been a measurable reduction?

We welcome the announcement from 13 November of a £4 million investment in equipment and training and the establishment of a new system enabling staff to review and learn from every stillbirth and neonatal death. The Government have signalled their intention to review every one of those tragedies, and I would appreciate it if the Minister could update us on how close we are to reaching that target, and when he expects it to be met.

One of the key themes that has emerged today and in the debate we had last year is that we have some of the finest neonatal care in the world in this country, but that there is simply far too much variability between hospitals and regions. In my role as an Opposition spokesperson I have had the pleasure of visiting some excellent facilities, most recently those at Barnsley general hospital, where the commitment and attention to detail of the staff, based on listening to and valuing patients’ views, was particularly impressive. At this point, I think it is worth paying tribute to NHS staff who are tasked with helping families at their most difficult time for the sensitivity, understanding and professionalism that they show.

The hon. Member for Colchester raised the issue of bereavement suites being available in every maternity unit in this country. If we had the same quality of care that I saw in Barnsley throughout the country, that would be a real achievement. We need to see those units that currently offer the very best care spreading their expertise across the country, so that everyone can have the very best throughout their pregnancy. Attempts to achieve that have begun. In March, NHS England published new guidance, building on existing clinical guidance and best practice. It identified four key interventions, with the aim of meeting the Secretary of State’s ambition to halve the rate of stillbirths by 2020. Those key interventions are reducing smoking in pregnancy, enhancing detection of foetal growth restriction, improving awareness of foetal movement and improving foetal monitoring during labour.

It has been estimated that if no women smoked during pregnancy, 7.1% of stillbirths could be avoided, which would equate to around 230 additional babies surviving each year. Smoking and passive smoking increase the risk of infant mortality by an estimated 40%. However, despite those startling statistics, we have seen a significant cut in public health funding, leading to around 40% of local authorities cutting budgets for smoking cessation services. Only last week I saw two pregnant women smoking on the same day. While I appreciate that that is anecdotal, it nevertheless brought home to me that we are certainly not making the inroads that we should be into cutting smoking during pregnancy. As the hon. Member for Colchester said, one in 10 women still smoke during pregnancy, which is startling, given the huge amount of evidence about the risks of doing so. We clearly need to do more to get that message across. If the key interventions are to be effective, cuts to public health budgets will not help in achieving that aim.

I have no doubt that the other suggested interventions will also help us to drive down rates of infant mortality. However, as the Royal College of Nursing has pointed out, England remains 2,600 full-time midwives short of the number it needs. We simply must have the correct level of staffing if we are to successfully implement that guidance. There are also serious issues in the levels of other clinical staff in neonatal units. The report published last year by Bliss, “Hanging in the balance”, argues that neonatal services are “stretched to breaking point”. It also states that two thirds of neonatal intensive care units do not have enough doctors and nurses, with around 2,000 more nurses needed to fill that gap. A report by the Royal College of Midwives also stated that more than 40% of wards became so busy last year that they were forced to close their doors. The average unit closed its doors on five occasions, with some closing more than 20 times.

Worrying reports this week also suggest that staff shortages and increasing demands are impacting on the ability of midwives and maternity staff to provide care. A survey by the Royal College of Midwives found that 62% of midwives and maternity support workers felt dehydrated at work because they did not have time to have a drink; 79% did not take the breaks to which they were entitled; and 52% had witnessed an error, near miss or other incident in the past month. Given the impact of current staff shortages, I question the proposal to replace bursaries for nurses and midwives with student loans, as I believe that is a risk we cannot afford to take at this stage.

The Universities Minister has confirmed that, since the tripling of tuition fees in 2012, the number of student nurses over the age of 25 has plummeted. Given that the average age of nurses and midwives in training is over 25, I have serious concerns that, for all the good intentions we have at the moment, we will not have the resources and staff to deliver the improved outcomes we all want to see. Areas such as neonatal care, which are already stretched, need more support, and I therefore invite the Minister to reconsider the current policy.

I conclude by focusing on the families who experience bereavement when their baby dies during or after birth. It is difficult to contemplate what they go through when what should be a time of joy and celebration becomes a period of tragedy beyond measure. Again, I pay tribute to the compelling way hon. Members have expressed their experiences. They have certainly given us all an awful lot to consider. What has made many people’s experiences even more difficult is that speaking about the loss of a baby has, as many Members have said, traditionally been considered taboo. Families have often felt they have nowhere to turn for help, or even to talk about it. The fact that Members have had the courage to talk about it today will help us challenge that taboo, and along with Sands awareness month, we will be able to make progress in making sure that we can talk about these issues openly and give a voice to those who have experienced the personal tragedy of the death of a baby.

I hope the great sincerity and passion with which Members have spoken will lead to a redoubling of efforts, not only in terms of neonatal care and tackling public health issues but in ensuring that we listen to the experiences of people who have gone through this, so that families get the support they need at the point of such a personal tragedy. They deserve the best possible bereavement support from highly trained professionals, and we should do everything in our power to ensure they are offered nothing less than the very best.