I beg to move,
That this House has considered stillbirth.
I am grateful that I was able to secure this debate today. I know that I am not alone in this place in having direct or indirect experience of the very important issue of stillbirth. I will not attempt to put into words what going through this experience does to those who are left to pick up the pieces. There are no words to describe the pain and, normally, I am a pretty private person. However, I realised that, if I am going to campaign to help to improve this situation, I must speak out and use my experience to make things better, if I can.
Too many people suffer horrendously through stillbirth, but they suffer in silence. I am an MP and I believe that I have a duty to speak up for all those people who feel that they have no voice and that no one cares or understands. I want to work with others to make things better.
Stillbirth is not inevitable; it is not something that just happens. In my case, after five years of IVF treatment and one miscarriage, I experienced what all the medical professionals with whom I came into contact called a “textbook pregnancy”. I was glowing, in rude health and despite my small frame I was carrying a huge baby by the time my pregnancy came to an end. However, what I did not know, and what the medical professionals failed to pick up, was that I was suffering from HELLP syndrome, a form of pre-eclampsia. Apparently, it had been showing up in my blood tests for some time but that was repeatedly missed.
I was returned home, after I arrived at hospital on my due date, as previously arranged, with my hospital bag and ready to be admitted. The great discomfort that I felt—pronounced pain through my whole body—was dismissed as the usual discomfort that comes with late pregnancy. Having returned home, almost immediately, I had to go back to the hospital, where I was kept waiting for over an hour and a half and told that I was being a nuisance. Again, I was told to return home, but my husband refused to allow that to happen. It transpired that, if I had indeed returned home, I would most certainly have died.
As it was, I was sent to a bed with extremely bad grace and administered with high doses of morphine. My baby died overnight. No blood was checked, no monitoring took place and no doctor examined me. The next morning, after my baby was found to have died, doctors wondered why my body would not co-operate as they tried to induce labour. While they waited 48 hours to discuss this, my liver ruptured and I started having fits. My husband was told that I was unlikely to survive.
The reason I tell this story is that the failings in my care are far more common than they should be. Unfortunately, my case is very far from unique, particularly in one significant way. Work undertaken by Sands, the stillbirth and neonatal death charity, showed the importance of listening to mothers’ concerns about their babies. Forty-five per cent. of parents who experienced a stillbirth felt that something was wrong before the medical problem was diagnosed. Too many women are told that their concerns are unfounded and sent home, only for their baby to die soon afterwards. One simple change is for antenatal care to become more collaborative. Listen to mothers’ concerns; women know their own bodies.
To this day, Greater Glasgow and Clyde health board has not admitted that anything went wrong with my care. There has been no apology; apparently, it just happened. When I was discharged from hospital, it was agreed that an investigation into my care would take place and that any lessons that could be learned would be learned. At that point, I—like so many others before me—naively thought that that would happen. How else could the system improve?
Eighteen months later, after repeated phone calls, I received a one-page summary telling me, in language so vague and non-committal that I barely understood it, that the case had been looked at and lessons had been learned. At that point, and with extreme reluctance, I sought medical advice.
From that moment, Greater Glasgow and Clyde health board fought like a caged lion to cover its back to abdicate responsibility, which I realised it had, in fact, been doing all along. However, unlike so many other women, I was in a position to commission two independent reports from experts: Dr Shaxted, a consultant obstetrician and gynaecologist; and Dr Benjamin Stenson, a consultant neonatologist from Edinburgh. Quite frankly, they were astonished at the extraordinary, repeated and glaring errors in the care I received.
Many people would have walked away, and I know many people indeed have walked away, crushed by a system that compounds the huge loss suffered by refusing to accept when mistakes have been made, much less learn from them. I fought on because it was the only way I had of showing that my little boy mattered. I could not allow the loss of my son to be swept aside, ignored and dismissed, as though it were an incident of no importance.
People come to their MPs when they feel powerless, when their own efforts to solve a difficult situation in which they find themselves have failed. People often come to their MP when they cannot make themselves heard when dealing with an institution or organisation that refuses to listen to them, and crushes them beneath its weight. I know how that feels. That is why today I feel privileged to be in a position to offer help to some of my constituents when they feel that sense of powerlessness.
After I was elected as an MP, it seemed to me that the Greater Glasgow and Clyde health board became more interested in settling this case, which had dragged on for more than six years and with no apparent end in sight. I was offered a nominal sum, which I instinctively wanted to refuse. What I wanted was what I had wanted on the day I walked out of the hospital. I wanted an apology and I wanted to see some kind of evidence that work had been done to help to ensure that such mistakes would be much less likely to reoccur.
However, my choice was to take the sum offered, or face the real possibility of a judge awarding me the same amount or less, which in practice would have meant that I would be liable for all costs incurred by both parties. Bankruptcy beckoned, and the Greater Glasgow and Clyde health board was allowed to sweep the entire matter under the carpet, at a time of its choosing and without a backward glance after dragging out the entire process for more than six years. No liability was admitted, and as far as the Greater Glasgow and Clyde health board is concerned there is no case to answer. How is that justice? How can others who have suffered similarly have confidence in a system such as this, and confidence that similar mistakes will not be repeated? Since I have spoken out, many people have contacted me to tell me their own shockingly similar stories.
We know that many stillbirths are avoidable, although it is also true that in some cases we do not even know why such a death has occurred, and I applaud Sands for the work it does to raise funds for research in this area. Governments across the UK must commit the necessary funding to help us to understand more about unexplained stillbirths.
It is thought that around 50% of stillbirths cannot be explained by medical professionals. However, let us be clear—not knowing why around 50% of stillbirths occur does not mean that they are inevitable. The fact is that the majority of unexplained stillbirths occur in low-risk pregnancies. That suggests that routine antenatal monitoring is failing to identify babies at risk, even though such monitoring could save their lives. Around 50% of stillbirths can be explained and much can be done to raise awareness and increase monitoring to help to mitigate risk factors.
First, may I congratulate my hon. Friend on securing the debate and on the courageous way that she has raised this important issue? [Hon. Members: “Hear, hear.”]
Does my hon. Friend agree that sometimes there is a case for a coroner’s inquiry into babies who are said to be stillborn? My sister lost her son, Hamish Kinghorn, and because he was said to be stillborn there could not be a coroner’s inquiry, despite the fact that there were NHS failings during the labour process. It is a difficult job, but that could be one way that can bring succour to the mother, in this case, my sister. This is obviously one of many cases that my hon. Friend is hearing about.
I thank my hon. Friend for those comments. I will talk about the intervention of coroners in a little more detail but, in principle, I agree: there must be a role for coroners in the process.
With greater awareness, parents will be able to make more informed choices about their health and pregnancy care. As with most health issues, social inequalities are a factor. The truth is we are failing to properly identify many babies who are at risk. We lack knowledge, data and research into why babies die.
To put the figures into context, every year around 6,500 babies die before or shortly after birth. That is one baby every hour and a half—the equivalent of 16 jumbo jets crashing every year. Some 4,000 are stillborn and another 2,500 die within a month of birth. Although some work has been done, it is not unfair to say that there has been no significant reduction in the death rates in the past 10 years. There is still a taboo around stillbirth. Folk don’t like to mention it. They don’t know how. It creates discomfort and awkwardness. It is not like other deaths, is it? You cannot talk about shared memories of the lost baby. That leads to those suffering the loss feeling abandoned and isolated. Life must continue behind what is very often a fragile mask of normality.
Thinking of our own lives, almost all of us will know someone who has had a stillbirth or whose baby has died shortly after birth. However, the tragedies are too often hidden. Road traffic accidents kill around 3,000 people each year. Twice as many babies as that die, and still it barely appears on the agenda. Sands research showed that 75% of the public were very surprised by the numbers of stillbirths. There was more concern about cot death and Down’s syndrome, yet stillbirth is much more common. I think that it is not a political priority because it is considered unfashionable. It is not talked about generally and it is even more difficult for people to talk about when they have experienced it.
Will the Minister give assurances that the practice of trusts investigating themselves when things go wrong will be reconsidered? I have formally written to the Scottish Government’s Cabinet Secretary for Health, Shona Robison MSP, to ask for similar consideration to be given to that issue in terms of health boards in Scotland. Ideally, an independent body should complete investigations into alleged failings in care within a specified timeframe. That would prevent long-drawn out investigations or, worse still, legal processes. In my case, those lasted more than six years.
Experts in the field are unequivocal when they tell us with one voice that for otherwise healthy babies to die undelivered near term is an easily avoidable event. In answer to the point made by my hon. Friend the Member for North East Fife (Stephen Gethins), I find myself persuaded by the case put forward by the Campaign for Safer Births that coroners should have the power to hold an inquest for babies who die during labour or are stillborn at full term, which is from 37 weeks on. Coroners currently have no jurisdiction to hold inquests into such deaths.
In my case, Dr Stenson noted “with disappointment” that there was a record in my notes that I did not want a post-mortem performed on my son. He went on to point out that there was no record to indicate who spoke to me or what information I was given. I may or may not have had such a conversation. Quite frankly, I cannot remember, as much of my time in hospital was spent under extremely heavy sedation in a critical care unit and then a high dependency unit. Why was the conversation not had with me when I was more alert? Why was it not properly recorded? I cannot say what my response would have been, but I had no opportunity to make a measured assessment of the relative merits or otherwise of such an important decision. Is that not odd? Is it likely to be unusual? I doubt it very much.
That is what has helped persuade me that coroners should be involved in such decisions. It would mean that particular trends could be noted, informing training needs and highlighting serious failings. It would ultimately help the NHS to deliver what we all want: higher-quality maternity care. Coroners would be in a position to issue a prevention of future deaths report that hospitals must follow to prevent similar mistakes occurring.
In Scotland, 34% of all stillbirths occur at 37 weeks and beyond. The figure for England and Wales stands at 33%. Those figures are truly dreadful and are a national disgrace. The North Ayrshire and Arran health board has a higher rate of stillbirth than the UK average. It comes second in a list of 21 health boards across the UK given red light warnings for high stillbirth and newborn death rates. That causes me alarm, as I know it does for my constituents. Scotland ranks 31st out of 33 high-income countries in the world on this issue. Although international comparisons are difficult—definitions of stillbirth can vary—it is still an appalling statistic.
It is too late to save my little boy. There will be other little boys and girls as eagerly awaited as my baby who are yet to be born. We can do much more in Scotland and across the UK to take action to ensure they have the safest possible care. I urge the Minister to reflect seriously on the suggestions I have put forward. I will also be urging Scotland’s own Cabinet Secretary for Health to continue to work to improve maternity care. We cannot go on allowing 100 babies to die each and every week. It is time that the issue was put firmly on the political agenda. Tears and hand-wringing will not save our babies. Action and political will can. I urge the Minister to take action.
I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing the debate. She has spoken with great passion from a personal perspective. We have all been moved by what she has said. It was very powerful.
I want to make a short contribution on behalf of a constituent and a member of my family. My constituent wrote to me to tell me about how she lost her first child to stillbirth:
“This life altering event has led to us being placed into a world we never knew existed. Sadly, the baby loss taboo leaves many unsupported and prevention affected.”
She has been trying to get information from her clinical commissioning group on what is happening to ensure that such things do not happen again and that more women can be protected. What she has got back from the CCG so far has been a general statement of Government policy, which includes the four principal activities that CCGs are asked to concentrate on: reducing smoking in pregnancy; monitoring foetal growth; raising awareness of foetal movements; and improving foetal monitoring.
That is all very well—I put great emphasis on the improvement of foetal monitoring, so that the information is provided and is fed back to the individual concerned—but my constituent also wants detailed information about what the CCG is doing to ensure that the issue is addressed. The CCG operates across two obstetric units and four midwife-led units and has a small number of babies delivered at home each year. She has not been able to get detail about what that CCG will do to address the situation for the future. I hope we can send a strong message to CCGs around the country that concentrating merely on the Government’s four key objectives is not good enough. What we need is the detailed information on how they are going to go about dealing with this issue through their sustainability and transformation plans to provide reassurance for women who are in this situation.
I appreciate the effect that stillbirth has on women, but it is not exclusively a woman’s problem. The fact that stillbirth occurs is a problem that affects the whole family, and it affects men as well. I know that, to my own cost, through a family incident. It is essential to bear in mind the impact on the mental health of men who are involved in cases of stillbirth and simply do not know where to turn in what is a completely traumatic experience. I urge the Minister to concentrate on providing information about what the Government are doing for the whole family and for the wider community.
My next point is that essentially we are talking about an artificial distinction here. We are talking about the distinction between miscarriage and stillbirth and about a particular period, which comes at around 24 weeks. That is totally unfair. Before the 24 weeks, parents are given no chance to grieve for the baby who has been lost, or to go through the process of putting their lives back together again. We ought to look at that to see whether that distinction is still relevant.
Does the hon. Gentleman agree that counselling should be available for the whole family on request? We should be seeking to take that forward across the whole UK.
I pay tribute to my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) for introducing the debate and to the hon. Gentleman for his point about the effect that stillbirth has on the family. To add to that—I know I am not alone; there are women with whom I am sitting here who have suffered miscarriages, too—after you have suffered a miscarriage or a stillbirth, it is extremely difficult to enjoy any subsequent pregnancy. Every minute of every day is spent wondering whether you are going to lose the next child too. It is worth while bringing that point to bear in this debate to ensure that support is available for women after their loss.
The hon. Lady makes a valid point. It is not just about the individual stillbirth, traumatic though that is; it is about the future and ensuring that individuals can go through another pregnancy in the full knowledge that they are more likely to be safe than not. Anything that we can do to help that, we should. We should take any opportunity to take things forward. That is all I wanted to contribute to the debate, and I am grateful to have had the chance to speak.
It is a pleasure to serve under your chairship, Sir David. I commend my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) for securing this debate and for her heartfelt, considered and important contribution. It will have made a difference to many families, and I believe it will truly help to drive improvements.
We have heard about Sands. Sands awareness month should be a matter of concern to every Member of this House. Stillbirth can affect any family, and it is vital that we give it proper consideration and have ample time to discuss the varied and complex issues that surround it. I understand that stillbirth is a topic that is so hard to think of, let alone to debate here, but if we do not, we miss the opportunity to confront issues facing children and families who have been affected throughout Scotland and the UK. They deserve our attention and consideration.
I know that many people have their own personal experiences to draw on; I am very fortunate that this is not an experience I have had directly. I cannot say how thankful I am for that, and for the excellent care that I was fortunate to receive during my two pregnancies. But, like many here today, I know that not everyone has had experiences like mine. Far too many people watching today will have experienced the heartbreak of stillbirth. I will never forget a little girl who would have been the very same age as my eldest son, but who was stillborn. That is one of the memories that will stay with me forever. It is important that we remember all these children and acknowledge them.
We are fortunate to have access to excellent House of Commons Library briefings for debates. I was struck by the introduction to a briefing relating to this debate, which said:
“When a baby dies the impact on a family can be profound, with many parents reporting symptoms of anxiety and depression for years after their baby has died.”
I appreciate that that statement was included in that briefing because, although it seems obvious to all of us here today, it needed to be written down and put in black in white to be absolutely clear. There can be few things that anyone will ever have to deal with that are more difficult than the loss of their baby. It will have a terrible impact on family members, and for a long time. It is not something parents or families will ever forget about.
It is also vital that we continue to take steps to look at why stillbirth happens and what we can do to minimise the instances and increase awareness among medical professionals and parents of anything that might cause concern and be worth looking at.
I am grateful to my hon. Friend for giving way, and congratulate my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) on her very moving speech. Some Members may be aware that before I came to the House I specialised in medical negligence law, mainly acting for pursuers, or plaintiffs as they are known south of the border. Drawing on what our hon. Friend the Member for North Ayrshire and Arran said, does my hon. Friend agree that what is most important in cases where there has been medical mismanagement is a prompt investigation, a prompt apology and an undertaking to ensure that whatever lessons are required to be learned are learned?
I agree entirely with my hon. and learned Friend.
Stillbirth rates remained largely unchanged from the late 1990s to 2011. More recent figures have shown a decline, and the rate is now at its lowest level since 1992. Of course, that is positive, and there is undoubtedly a desire from both the UK and Scottish Governments to progress towards improving those figures further, but, as my hon. Friend the Member for North Ayrshire and Arran said, a desire is not enough: real action is needed. Maureen Watt, the then Scottish Public Health Minister, noted that
“The Scottish Government responded to a parliamentary petition in 2010…by forming a stillbirth working group and setting an aim in 2012 to reduce stillbirths by 15 per cent by 2015”.
She also noted a subsequent reduction of 18% in stillbirth rates, which
“shows that a combination of approaches”
can make an impact. Importantly, she stated that
“ministers were determined to reduce rates further.”
As my hon. Friend said at the beginning of her speech, this is not an issue of party politics, as I am confident that everyone present agrees; it is about finding ways to improve prospects for babies and preventing heartbreak and loss for families. We can all agree that this issue should have our support.
I am pleased that Scotland has made progress on reducing the stillbirth rate in recent years and similarly that the UK has made progress, but there is much work to be done and we must commit to focusing on that. It is also important that mothers who go through this traumatic and heartbreaking experience are offered the appropriate support and care, and have access, as my hon. Friends have said, to a complaints process that is open and transparent and offers opportunity for redress.
The comments made about the importance of investigation and the role of coroners are worth considering. It was interesting to see the Royal College of Midwives in The Lancet stating:
“Attention to preventing stillbirths in approach to term and 36 weeks plus must be improved”,
and that more must be done, just as we heard from my hon. Friend the Member for North Ayrshire and Arran. We need to focus our minds on the stark statistics that she has told us about. One third of stillbirths happen at term—37 weeks’ gestation or beyond—and in the vast majority of all stillbirths we never know what has befallen the baby. These areas need to be addressed with as much energy and urgency as we address important messages regarding maternal health and wellbeing.
Researchers for the Campaign for Safer Births have estimated that approximately 500 babies die every year because of avoidable factors during birth. Many are left permanently brain-damaged or disabled. They believe that all these tragic deaths and injuries could be avoided with better care. They aim to raise awareness of the issue, which my hon. Friend has surely helped to do by securing this debate today. They want to see safety improvements in maternity units and the provision of information to those who have experienced poor care or negligence.
I believe that a combination of approaches, such as those adopted by the Scottish Government, can make a material difference, but it is clear that we must be committed to driving change if we want to continue to reduce stillbirth rates. That will not happen without continued targeted action. The stillbirth group established by the Scottish Government has provided evidence that the stillbirth rate has fallen in Scotland since it commenced its work. There are 15 maternity units in Scotland taking part in a UK-wide study looking at foetal movements, which we have heard are a vital indicator, and, in particular, at how units respond to women who report decreased foetal movement. I am hopeful that there will be further progress in Scotland and the UK in this very important area.
In March 2015, the Scottish Government appointed Catherine Calderwood, an obstetrician and gynaecologist who was the national clinical director for maternity and women’s health for NHS England, as chief medical officer. That is important. Her work on reducing stillbirths and neonatal deaths in Scotland and avoidable harm in maternity services will be influential as we continue to push for vital further reductions in the number of stillborn babies. Those stillborn children are our children—they are our families’, our friends’ and our neighbours’ children—and we can best respect that by supporting continuing research, encouraging open conversations about stillbirth and helping to break down the taboos that are still all too prevalent. As politicians, we must push for new research and new ways of working, and encourage real dialogue among medical professionals about stillbirth, particularly where things have gone wrong with the care provided.
I express again my admiration for my hon. Friend the Member for North Ayrshire and Arran for securing this most important debate, and to the other speakers who have contributed.
I echo the comments about the hon. Member for North Ayrshire and Arran (Patricia Gibson) and congratulate her on securing this very important debate. She is incredibly brave to talk about her experience—I know that from my personal experience of doing the same thing. I also pay tribute to her colleagues who have come to support her, because that is hugely comforting. What she has done is incredibly brave, and I thank her very much for that.
The hon. Lady spoke about the importance of talking about stillbirth and neonatal death. She hit the nail on the head: we do not like talking about death in this country—even more, we do not like talking about the death of children and, in particular, babies—but it is only by talking about not just stillbirth but neonatal death and the death of babies that we can understand the scale of the issue. As she rightly said, a lot of people in this country do not understand how poor we are at tackling this issue. We are somewhere in the region of 23rd in the western world. Given that we have one of the best health services in the world, that is totally unacceptable.
I do not particularly like talking about statistics when it comes to babies. The hon. Lady rightly said that somewhere in the region of 3,500 babies a year are stillborn. If half of those deaths are avoidable, that is approximately 1,500 to 2,000 babies and 2,000 to 4,000 parents who would not have had to go through this experience. It is not just the parents who feel the effects of stillbirth and neonatal death, but the grandparents, the friends and the wider family.
I will talk about my own experience very briefly. I have three beautiful children, but only two of them are currently with us. We lost our son. He was diagnosed at 22 weeks with a very rare chromosomal disorder called Edwards syndrome, which meant that there was a relatively high likelihood that he would not make it. As was said earlier, it meant living every day with the prospect of a stillbirth—it was too late for a miscarriage at that stage. He went full term—he was a fighter—so we went through the experience of stillbirth at full term. I have said in the Chamber previously that there is no word to describe the experience other than numbness—in fact, I will not describe it because it is going to make me upset. The point I want to make is that every single stillbirth is an absolute personal tragedy. We as a Government and as politicians have a duty to do all we can to ensure that as few people as possible go through that personal experience.
That happened in 2014. On entering this place, I was committed to doing something about this issue. I teamed up with a number of other MPs and we set up an all-party parliamentary group on baby loss, which the hon. Lady kindly joined, to do something about this on a cross-party basis. The Government have the responsibility and the power to do a lot of the work, but the all-party group can act as a conduit between the fantastic charities that work in the sector and the Government, who I know are committed to tackling the issue.
My hon. Friend the Member for Henley (John Howell) made an important point about mums and dads. We thought it very important that I co-chair the APPG; it is intentional that we have a man and a woman co-chairing the group. It is important that we address the issue from both sides, because it affects men as much as it affects women.
As the hon. Lady said, Baby Loss Awareness Week is coming up in October. In Parliament, we will be marking that occasion for the very first time. Mr Speaker has kindly allowed us the use of his state rooms for a function. We will be sending around ribbons and encouraging as many right hon. and hon. Members as possible to wear them proudly, and to talk about and raise the issue as much as possible in that week and also throughout the year.
I spoke earlier about the amazing work of charities in this sector. I will name just two—Sands and Bliss—but there are so many more that do incredible work, from charities carrying out research to very small organisations that knit hats, mittens, scarves and all sorts of other things, which can be hugely comforting to parents who have gone through this experience.
The Government have a very important role to play in tackling this issue. As the hon. Lady said, research is a huge part of that, whether it is on social inequality—which, as she rightly said, is a known factor in stillbirth—maternal age or ethnicity. We still do not really understand why ethnicity is so important. There is another awkward subject that we do not like to talk about in this country: we do not encourage parents who have gone through this terrible experience to have post-mortems. Often, medical professionals do not want to ask the question, but if they phrase it correctly and say, “By offering your baby for a post-mortem, it would help us immensely in understanding, in research terms, why this happens,” it will help to prevent more in the future. We have to do far more to encourage post-mortems.
My hon. Friend the Member for Henley talked about education for parents-to-be, whether about drugs, smoking, diet or obesity—the two are somewhat different. There is a huge amount of work to do in that area.
The hon. Lady is absolutely right to suggest that this is not a party political issue—it crosses the divide—but I am hugely proud that the Government recognise that it is serious and have taken steps to address it. They are not just talking but putting money in, and they have set a target. Targets are thrown around all the time, but they are meaningless unless the money and resources are behind them, so I am proud that the Government have done that.
There are some important elements to the Government’s new care bundle. I fully agree with my hon. Friend that it is important that we ensure that clinical commissioning groups and hospital trusts are doing what the Government are mandating them to do. The smoking cessation work is really important. Still now, more than one in 10 mums smoke during pregnancy. We know that that is such a high-risk factor when it comes to stillbirth. On foetal growth monitoring, we are one of the few countries that do not scan in the late stages of pregnancy. We scan at about 20 weeks and then do not do anything until the mother goes into hospital, but lots of other countries scan at 36 weeks. We are also looking at foetal growth, which is really important. The bump is measured from naval to the pelvic bone, and if there are any issues with its size, the mother is sent to hospital for a scan with a consultant. That is very important. We need to do far more foetal growth scanning in the later stages of pregnancy.
The hon. Lady also made a hugely important point about the awareness of foetal movement and the importance of foetal monitoring. We absolutely have to empower more women when they get that feeling. In so many cases of stillbirth, the mums say with hindsight, “I knew there was something wrong, but I didn’t want to bother health professionals,” or, “I phoned my doctor or the NHS helpline, and they said don’t worry.” The reality is that, if there is an issue, mums often know. It is important to empower women, so that if they feel something is not right, they go and get it checked out. We would much rather they got a diagnosis to say, “There’s nothing wrong. You’re okay. Go home”, than they ignored it, but worried about it, only for horrendous consequences to ensue.
The new Government care bundle is important and good, with £4 million being put in. In my local hospital, Colchester general hospital, we have already seen the start of that money trickling down. New monitors have been installed, and they are going in all across the country, which will help with the monitoring element in the later stages of pregnancy. Another hugely important bit is the training of midwives and nurses, and more than £1 million has been put into that. Finally, a £500,000 investment has been made in the review process, to ensure that we document and learn from every single stillbirth, while treating each as a personal tragedy. Those records should be kept and shared, so that we can look at best practice across hospitals. Some of our hospitals in the United Kingdom are fantastic and world-class, but, sadly, some are not. We need to bring all hospitals and maternity units in the country up to the very best standard.
I am pushing the time limit, but I will touch briefly on two more points. Sadly, even if we meet the Government’s target on stillbirth, which is to reduce it by 15% by 2020 and half by 2030—an incredible aim, and I would love it if we got to that position—1,500 to 2,000 babies would be stillborn every single year, so it is still important to deal with some of the bereavement issues in hospitals across our country.
The first priority should be bereavement suites; it is imperative to get one attached to every maternity unit in the country, because it is totally unacceptable that any mum or dad, having gone through the experience of a stillbirth, should have to go on to a general maternity ward, surrounded by happy families with balloons and teddies and the sound of crying babies. That is not acceptable. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has absolutely recognised the issue, and is working hard on it; he is doing a study of exactly what provision we have in our hospitals. I would love it if, by the end of this Parliament, we could have a bereavement suite attached to every maternity unit in the country.
Finally, although the bereavement suite is one part of that jigsaw, the second part is having enough bereavement-trained midwives and gynaecological counsellors in those units who are able to give the support to parents, not only at the time, but afterwards and—as the hon. Member for North Ayrshire and Arran said—with future pregnancies.
In conclusion, the hon. Lady is hugely brave. She raises a hugely important issue, and one that I know the Government recognise and are taking action to address. We, as cross-party politicians, can keep pressure on the Government to ensure that they meet that target of a 15% reduction by the end of the Parliament and—what an aim!—to halve stillbirth by 2030.
Thank you, Sir David, for the opportunity to speak in this debate, the subject of which is of such huge importance. I pay tribute to my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) for bringing this issue, and her own tragic experience, to the attention of the House, an act of true bravery. I cannot imagine how hugely difficult it is for her and others who have contributed to the debate to speak so openly about losing their children. Equally, I cannot imagine how difficult it is for any parent or family to lose a child, but today is about raising awareness of stillbirth, and I will highlight to the House the case of dear friends of mine who had twin girls last year, but, tragically, lost one of them, Sophia Faith Fraser, who was born sleeping as a result of a little-known complication called twin-to-twin transfusion syndrome.
My friends were delighted and instantly felt hugely privileged and special to discover that they were to have twins. However, at their 20-week scan they were referred to the foetal medicine unit at the Queen Elizabeth university hospital in Glasgow, as their identical twin girls looked to be suffering from severe complications. The doctor confirmed their fears; their girls were suffering from stage 2 twin-to-twin transfusion syndrome. TTTS is a rare disorder, which can happen in identical-twin pregnancies and, simply put, is an unequal flow of blood between the twins across the shared placenta. One baby donates blood across the placenta to their twin, becoming dangerously anaemic, and the recipient twin becomes so overloaded with blood that they are at risk of heart failure. It is a critical condition, which can be fatal to both babies.
My friends’ doctor explained that laser surgery would be the best option, to try and correct the blood flow by closing some of the vessels the girls were sharing, but the procedure carries major risks, and the parents were advised that they could lose one or both of their girls. If left untreated, however, there was only a 10% chance that both girls would survive, and they would be very likely to suffer brain damage. As we can imagine, the parents wanted to help their girls in any way they could, so they decided to go ahead with the laser surgery.
The case carried a high risk of complications so, two days later, Sophia’s mum was taken to Birmingham, where their doctor could perform the surgery with the support of a specialist team. The laser surgery went well, closing some of the shared vessels through a small incision in Sophia’s mum’s abdomen. Two litres of fluid were drained from her womb, a dangerous side effect of the TTTS, and her parents were told that a scan would be performed an hour later, to tell if there were still two heartbeats. That was the longest hour of their lives, but they were overjoyed when the scan showed that both girls had survived the procedure, and had already begun to make improvements. However, the parents were warned that the next few days were critical and, a week later, during a check-up, it became apparent that although the laser surgery had corrected some of the flow, it had not solved the problem completely.
Sophia, the donor twin, was in grave danger and required a blood transfusion, which was given directly into her stomach through her mother’s stomach with a fine needle. That procedure carried great risk not only for Sophia but for her sister, Eloise. Without it, however, Sophia could not survive, and the parents wanted to do everything possible. Their aim was for the girls to make it to 28 weeks’ gestation, when they could be delivered and given a higher chance of survival. The blood transfusion brought some success, and the procedure was repeated to try and build up Sophia’s blood supply. However, heartbreakingly, when her mother was 25 weeks pregnant, Sophia passed away. The parents were devastated; she had fought so hard and for so long. They felt they were living in a nightmare, and—as they described it to me—one they could still not wake up from.
My friends were grieving for Sophia while fighting hard for Eloise, who was still in danger and had to be scanned every two to three days. Sophia and Eloise’s mum bravely carried both girls until she was 34 weeks pregnant when, after a check-up, she was given an emergency caesarean section due to a bleed in her womb. Eloise Hope Fraser was born at 6.46 pm, weighing 4 lbs 7.5 oz, and her little sister, Sophia Faith Fraser, was born sleeping shortly afterwards.
Both girls had been very poorly during the pregnancy, with the uneven blood flow endangering their lives and putting them at risk of severe long-term health problems or brain damage. The girls’ parents believe that Sophia knew how ill she was and let go, giving her big sister a special gift, the gift of life. For that, they think she is a brave and amazing little girl, who will always be an important part of their family. I know they could not put into words how much they love her and her sister, Eloise. Eloise is now thriving, and making her little sister proud every day.
My friends’ case is rare, but not unique. They have often said to me that the care they received during their pregnancy from the foetal medicine unit was absolutely outstanding. They described Dr Janice Gibson as the most dedicated and skilled medical professional they had ever met. She held their hands and cried with them, and she gave them hope and sound advice. They can never repay her for what she did for their family. Dr Gibson is the only person in Scotland trained to carry out the laser procedure, and funding is needed to support ongoing training and families going through similar experiences. The couple now hope to raise money for this important cause, which they have been doing through the Sophia Fraser Foundation. The money they raise will support foetal medicine through the Yorkhill Children’s Charity.
I tell Sophia’s story today, with her parents’ permission, to highlight some of the unknown complications and rare disorders that can occur during childbirth, such as the twin transfusion syndrome. Aftercare and bereavement support for parents, as has been said, is so important, and I pay tribute to Sands, which does work in my West Lothian constituency and across our countries to support families who have lost children to stillbirth or neonatal complications. We have come a long way in medical developments, and although Sophia’s mum had the best care she felt she could have had, we must continue to raise awareness and work to improve services and care so that lives can be saved, and so that parents do not have to go through what Patricia or Sophia’s parents have gone through.
It is very hard to sum up this debate. We have heard some extraordinary contributions from my very brave colleague, my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson), and from the hon. Members for Henley (John Howell) and for Colchester (Will Quince) and my hon. Friends the Members for East Renfrewshire (Kirsten Oswald) and for Livingston (Hannah Bardell). While listening to all those wonderful contributions, I reflected on my own story, which is not of a stillbirth but of a bad miscarriage, which I have never mentioned to my children who are alive now. This debate is so important, because it puts into the public domain the pain, grief and horror of stillbirth. As parliamentarians, we must make this a subject that we are able to discuss so that we can improve the life chances of children yet to be born.
My hon. Friend the Member for North Ayrshire and Arran asked the Minister to take steps to improve the statistics. The hon. Member for Colchester said that we do not want to talk about statistics; we are talking about babies. We want to improve the life chances of babies yet to be born. This is a time that I feel proud to be a Member of Parliament, because we can do that. The Sands month for remembering and mentioning stillbirths is important, as is the work of the other charities that have been mentioned. One charity that has not yet been mentioned is Kicks Count, whose work leads directly to women listening to their bodies and ensures that if there is not foetal movement, they can report that. I hope that as a result of this debate, women will be listened to. I know, since I have been there, that women know their bodies. They know when something is not right. If only we could get health professionals to take on board what women are telling them, that could make a huge difference.
Other changes could be made. As my hon. Friend said, health trusts—CCGs in England—should not be investigating themselves. There should be independent investigations into deaths, and those investigations should be time-limited and not allowed to drag on. That is important. Coroners should be able to hold inquests and post-mortems should be carried out to help our understanding of why babies die just before, during and just after birth. It is important that we take that work forward. I understand that men are also affected by stillbirth. We sometimes concentrate on mothers, but we must recognise that it is families who suffer.
As has already been said, there is nothing but consensus among the parties in this debate, both north and south of the border, and that is very important. We all want the best for babies. We all want them to be born. We all want to improve our standing in global statistics. Actually, we all just want more babies to be born safely, and when they cannot be, for their deaths to be investigated so that the fight to help this really difficult situation moves forward.
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.
I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this debate and on sharing her experiences so personally and powerfully with the House. I thank colleagues from all sides of the House for doing likewise. Sometimes this House, when it speaks with a personal voice on non-partisan issues, can strike a blow for democracy. I think anyone listening today will have seen their representatives doing their jobs and sharing here in Parliament that which is so often not well expressed in the land.
It is a great pleasure for me to stand in for the Minister for Care Quality, the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer). He is unable to be here today, ironically because his wife, who is pregnant, is having a check-up. I hope it will not be anything serious, and I am sure we all wish him well. I know how much he wanted to be here today, and a number of Members on all sides have paid tribute to his leadership and commitment to this issue, which is very personal. I know he would like to be nowhere more than here, other than beside his wife.
Being here is a particular pleasure for me, partly because I am the Minister responsible for research in the NHS, genetics and unleashing the power of our health system to use its daily footprint of treatment and diagnoses to help to prevent suffering for future generations. This is an area in which, as hon. Members have touched on, good research and intelligent use of data from our health system can help to support future care and improve standards of care and prevention.
On a personal note, I was a child of parents who lost a child. I was due to have a baby sister. She was stillborn very late, and it was a tragedy for the whole family, as hon. Members have talked about, and devastating for my mother. It created huge pressure on my mother and her then husband’s marriage, which did not survive, and led to a complex raft of mental health and domestic family issues, which, as a number of colleagues have said, is all too common. People suffer in silence, and I think all of us talking about this today will in itself help to give people courage to recognise that this is an important issue that people should feel free and able to talk about.
Before I address the specific points made by the hon. Member for North Ayrshire and Arran and other colleagues, I want to set the scene on the Government’s approach to stillbirths in England. I and the Minister for Care Quality, and the Department of Health and its officials, very much welcome the hon. Lady raising these issues today and her support for Sands awareness month, which is this month.
As a number of colleagues have mentioned, stillbirth is often a taboo subject that many people find difficult to talk about and, because of that, many people do not know the statistics. Stillbirth is a personal tragedy, but the statistics matter. Around 15 babies every day are stillborn or die in the first weeks after birth. Today, perhaps 15 families who are expecting a joyous life event will instead experience one of the biggest tragedies of their lives, with another 15 tomorrow and another 15 the day after, and so on. If there were 15 fatal car crashes every day, I dare say the country would be in uproar, but stillbirths remain an uncomfortable subject for people to discuss. It is important that here in Parliament we raise the issue and raise awareness of it.
I want to commend the all-party parliamentary group on baby loss, which is co-chaired by my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince). The APPG was established following one of the most moving Adjournment debates held in Parliament, last November, on bereavement support for families who have experienced the loss of a baby. Reducing the number of stillbirths is an absolute priority for the Department of Health, and we will continue to work closely with Sands and the health system to raise awareness of the risk factors and the clinical practices that can improve outcomes for families.
In fact, England is a very safe country in which to have a baby and it is encouraging that the stillbirth rate in England has fallen from 5.2 deaths per 1,000 births in 2011, to 4.7 in 2013; but we all know that there is much more work to be done. Compared with other similar countries, our stillbirth rates are frankly unacceptable. The Lancet stillbirth series was published in January and showed that the UK was ranked 24th out of 49 high-income countries. The same publication showed that the UK’s rate of progress in reducing stillbirths has been slower than that of most other high-income countries. The annual rate of stillbirth reduction in the UK was 1.4%, compared with 6.8% in the Netherlands. To be frank, that places us in the bottom third of the table—in 114th place out of 164 countries around the world—for progress on stillbirths.
We are aware, however, of the impressive work being done through the Scottish Maternity and Children Quality Improvement Collaborative that has resulted in a 15% decrease in the stillbirth rate in Scotland in just three years. That is another area where the devolution of responsibility allows healthy competition between the devolved Administrations and the best can inspire the rest. We want NHS maternity services to be an exemplar of the results that we can achieve when we focus on improving safety and the patient experience. We believe that, with a concerted effort, we can make England one of the safest places in the world to have a baby.
The Government are wholeheartedly committed to improving outcomes for mothers and babies. In November last year, the Secretary of State launched the national ambition to reduce the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 50% by 2030, with the short-term aim of achieving a 20% reduction during this Parliament by 2020. We were delighted that the royal colleges and maternity and neonatal professionals, as well as key third sector organisations, including Sands, have come together in this area and have welcomed that important yet stretching ambition; we know that to achieve it the health system, the Government, charities and the public all have to take action and work collaboratively.
We know from experience in some maternity services in England that making safety a priority can have an impact very quickly. Strong leadership in the service, good communication, implementation of evidence-based practices, learning from other services about what works and what does not, multidisciplinary team working and training can all have a real impact quickly.
To support the NHS in achieving that stretching ambition, the Government have also announced additional investment: £2.24 million to support trusts in buying monitoring and training equipment to improve safety. That fund was run at the beginning of this year and has now been completed. Over 90 trusts have been successful and received a share of funding, allowing them to buy the latest equipment. We are also putting £1 million into rolling out training programmes to ensure that staff have the skills and confidence they need to deliver world-leading standards of care.
We have also committed to fund the development of a new system—the standardised perinatal mortality review tool. Once that is complete it will be used consistently across the NHS to enable staff to review and learn from every stillbirth and neonatal death. We are developing the tool as many national reports have referenced—as colleagues have here this afternoon—the fact that the same mistakes are being made repeatedly, which is unacceptable. What is missing in these cases is a systematic approach to improving services. We must view individual failings as important and recognise the need for accountability, while balancing that with the need to establish standard processes that will prevent mistakes and avoidable incidents from reoccurring.
In November we also committed to work with Sign up to Safety—the national patient safety campaign launched by the Government in 2014—to support all organisations and to ensure that they can contribute to the national ambition and share best practice. In March we launched the Sign up to Safety sub-brand, “Spotlight on Maternity”. The new guidance asked all organisations with maternity services to commit publicly to placing a spotlight on maternity, to contribute towards achieving the Government’s national ambition and to improve maternity outcomes. It set out five high-level themes for services to focus on that are known to make care safer: building stronger leadership; building capacity and skills for all staff; sharing progress and lessons learned across the system; crucially, improving data capture and knowledge; and focusing on perinatal mental illness.
I want to deal, in particular, with a number of points that have been raised, starting with the investigation of stillbirths and neonatal deaths. The hon. Member for North Ayrshire and Arran raised two points about the investigation of stillbirths. The first was the suggestion that coroners’ powers should be looked at and could be expanded, so that they have jurisdiction to investigate the death of a child who is stillborn after 37 weeks’ gestation to try to understand why the death occurred and to inform best practice. The second point was about independent investigations about clinical care when concerns are raised about a stillbirth or neonatal death.
By law, coroners can only investigate the death of a child when the child has lived independently of their mother, and there are no current plans for the Ministry of Justice to change that. The points about the importance of parents being able to volunteer to have a coroner look at such cases have been well made this afternoon, and I am sure that Ministers at the Ministry of Justice will be watching this debate. If there is doubt as to whether a death was a stillbirth, it should be reported to the coroner to consider whether an investigation should be carried out. Expanding the remit of coroners would require a change in the law and would be an issue for the Ministry of Justice—I will make sure that this debate is brought to its attention.
The Royal College of Obstetricians and Gynaecologists’ guidelines on late intrauterine foetal death and stillbirth state that the right approach is for stillbirths to be reviewed in a multi-professional meeting, using a standardised approach to analysis for substandard care and future prevention. We believe that we should be pursuing that focus, led by clinicians. We are looking at all options to improve reviews into stillbirths and neonatal deaths, including investing half a million pounds to create a system to look at them more consistently across the country, so that staff can understand and learn from each incident.
In April we established a new independent healthcare safety investigation branch—HSIB—to carry out investigations and share its findings. It will operate independently of Government and the healthcare system, be transparent and support continuous improvement by using the very best investigative techniques from around the world, as well as fostering learning from staff, patients and stakeholders. We want that branch to act—in the same way as in the airline industry—as an exemplar to the system as a whole, so that investigations improve and clinicians are increasingly confident that when they speak up after a mistake the result will be learning and not blame.
I want to tackle the point the hon. Member for North Ayrshire and Arran made about collaborative care between clinicians—midwives and doctors—and mothers. She called for maternity care that is more collaborative and responsive to women. She is right. She mentioned the statistic from Sands that 45% of women who raised a concern with a health professional during pregnancy were not listened to and then went on to have a stillbirth. That is completely unacceptable. All women should receive safe, personalised maternity care that is responsive to their individual needs and choices. That is why the Minister for Care Quality has taken such a strong lead on this issue.
In February the report of the independent National Maternity Review chaired by Baroness Cumberlege, “Better Births”, was published. It set out the vision for maternity services across England to become safer, more personalised, kinder, professional and more family-friendly. As we work towards achieving the national ambition, the Department will continue to work closely with NHS England to ensure that this work is embedded in the maternity transformation programme that is delivering the “Better Births” programme.
Women and their partners and families also have a role to play. Evidence shows that this stretching ambition cannot be achieved just through improvements to NHS maternity services. The public health contribution will be crucial. In fact, The Lancet stillbirth series concluded that 90% of stillbirths in high-income countries occur antenatally and not during labour.
When starting pregnancy, not all women will have the same risk of something going wrong and women’s health before and during pregnancy is one of the factors that most influence rates of stillbirth, neonatal death and maternal death. We know that a body mass index of over 40 doubles the risk of stillbirth. A quarter of stillbirths are associated with smoking, and alcohol consumption is associated with an estimated 40%. In addition, the report, “Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the UK” published in June 2015 showed that the risk for women living in poverty is 57% higher, for babies from black and minority ethnic groups it is 50% higher and for teenage mothers and mothers over 40 it is 39% higher. Those striking statistics show why the Department of Health will continue to work closely with Public Health England and voluntary sector organisations to help women to have a healthy pregnancy and families to have the best start in life wherever they are and whoever they are.
As part of the national ambition, the Department is already developing a public-facing communications campaign with Sands and Best Beginnings to highlight the avoidable risk factors. It is vital that women and their families understand these risks and the impact they can have on outcomes for them and their babies, and the lifestyle changes they can make to increase their likelihood of a positive outcome. This campaign will be launched imminently and I encourage all hon. Members to support it during the launch period.
I want to touch on research as the Minister for research in the Department. Some hon. Members have asked that we support research into the causes of stillbirth and neonatal death so we can better understand how to identify babies at risk. Unless we invest in research, we simply cannot understand how to improve services. I welcome the fact that just this week Sands announced the launch of its 2016 research fund. In recent years, the Government have invested significant sums in support of research into important questions regarding stillbirths and neonatal deaths.
The National Institute for Health Research, for which I am responsible and on which we spend over £1 billion a year as the NHS research laboratory around the country, supports biomedical research centres at Cambridge and Imperial College, where it has invested over £6 million in research on women’s health, including research to increase understanding of stillbirths and neonatal deaths. Other NIHR funding pots are available for bids from researchers and charities. It is vital that we continue to encourage bids for studies on the causes of stillbirth and neonatal deaths and the identification of babies at risk, so we can learn how to improve services.
I want to touch on the importance of bereavement care, which has been raised. The death of a baby, whether during pregnancy or following birth, is a trauma and a tragedy for those involved. I can only begin to appreciate just how devastating it must be for the parents who experience that loss. It is important that we provide them with appropriate care and support at that time. It is our duty to them. The recent MBRRACE report stated that 60% of parents currently receive a high standard of bereavement care, but that means that 40% do not.
Since 2010, we have already invested £35 million in the NHS to improve birthing environments, including better bereavement rooms and quiet area spaces at nearly 40 hospitals. We have also conducted a survey to map the bereavement provision in England, which will allow us to build up a picture of current provision and identify where the gaps are. The qualitative data we have collected is also crucial in both highlighting areas of good practice and understanding the challenges that services face. My officials are considering all that information and working on setting out the next steps imminently.
In the time available, I want to try to deal with the other points that have been raised, including third trimester scans. The UK National Screening Committee is currently carrying out a call for new screening proposals. I can send hon. Members details of how to submit a proposal to that funding pot.
On routine antenatal care, the “Better Births” report by the National Maternity Review calls for safer care based on a relationship of mutual trust and respect in line with the woman’s decisions. The vision is for women from the antenatal period to receive care from a small team of midwives who work closely with an identified obstetrician. The relationship developed between the woman and the clinicians needs to ensure that the woman receives personalised and safe care that is responsive to their individual needs.
My hon. Friend the Member for Henley (John Howell) asked about ensuring that clinical commissioning groups are properly aware of their obligations. The “Saving Babies’ Lives” care bundle published in late March by NHS England brings together elements of maternity care that are recognised as evidence-based and/or essential for best practice. It is designed to tackle stillbirth and early neonatal death, and focuses on those four key areas. I am happy to take this opportunity to highlight the fact that CCGs should be aware of it and to make sure that NHS England ensures that CCGs are aware of their responsibilities and what is expected of them.
The hon. Member for Ellesmere Port and Neston (Justin Madders) asked about our commitment to report on the progress of our ambition of a 20% reduction by 2020. I am delighted to confirm that the standardised perinatal mortality review tool will be available to all trusts by 2017 and we will provide annual progress reports following the launch of the strategy. The annual progress report will include expert advice from all the royal colleges and we plan to publish the first this autumn.
Some hon. Members asked about counselling for families. We are committed and believe that good bereavement care should consider the needs of the whole family: mother, father and children. The Government are absolutely committed to improving bereavement care. We are working actively on setting out the next steps in due course.
In conclusion, I thank the hon. Member for North Ayrshire and Arran for securing the debate and hon. Members from all sides for sharing often personal and traumatic stories. It has allowed us to highlight some very difficult issues and to acknowledge the silent suffering of so many of our constituents—this condition does not respect party or geographical boundaries—and to stress the importance of tangible progress from all the agencies involved. I hope that I have reassured hon. Members that the Government are taking the matter seriously. We are putting in both investment and, importantly, leadership, which I think all hon. Members agree the Minister for Care Quality is showing. I look forward to seeing the progress of all this work and reporting on it later this year.
I reiterate my gratitude to the House for allowing me to have this debate. I want to make a brief point to the hon. Member for Henley (John Howell), which other hon. Members have made: of course this is an issue not just for women; it is an issue for mums, dads, fathers-in-law, mothers-in-law, sisters and brothers. It affects entire families and we must recognise the impact of that.
I thank all those who turned up today to participate in the debate or simply to observe it. Their presence helps to reinforce the importance of the issue. I thank the Minister for responding to the debate. I was hopeful when he mentioned that the Ministry of Justice might be interested in extending coroners’ powers. I will watch that carefully. I am heartened to see that there may be some movement towards independent reviews of care and deaths. I am also heartened to hear about the commitment to fund research to better understand the issue. I am very pleased to hear the Minister’s emphasis on and understanding of the need for more collaborative care that is more responsive to women, as well as his commitment to and faith in the “Better Births” programme. I thank him for that and I thank everyone who attended.
Question put and agreed to.
That this House has considered stillbirth.