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Maternity and Neonatal Services

Volume 824: debated on Tuesday 25 October 2022


Asked by

To ask His Majesty’s Government what steps they intend to take to implement the recommendations of the report by Dr Bill Kirkup Maternity and neonatal services in East Kent: “Reading the signals”, published on 19 October.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in so doing, I declare that I am remunerated for chairing the independent maternity review.

I am grateful to Dr Kirkup for this report. Our intention is to review the recommendations alongside existing work to improve maternity outcomes, including the recommendations from Donna Ockenden’s final report. With NHS England, we have established an independent working group chaired by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists that we will use to support our considerations.

My Lords, I thank my noble friend for that reply. Does he agree that as this has been a series of maternity tragedies across England, we must do all we can to prevent further disasters? Will he, with NHS England, introduce a maternity signalling system that identifies units providing poor care before they cause widespread harm?

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

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

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

My Lords, in yesterday’s Statement on Dr Kirkup’s report, the Minister told us that 23 hospitals are in maternity safety support programmes—special measures—and that, while four are coming out, another 10 are due to go in. Can he assure the House that extra resources, including extra supervision, will be there to ensure that mothers and babies in those hospitals are absolutely safe?

Yes. Resourcing the special measures programme—for want of a better name—is vital to all of us. I am pleased to see in the case of East Kent that, of the 67 special measures recommended, it has now passed 65 and the two remaining ones will be completed by the end of November.

My Lords, this is the most recent of several reports identifying failures of maternity units in England. The CQC identified 40 maternity units that had failing safety standards. Bill Kirkup has not only produced a brilliant report but identified the way forward, by developing a matrix of standards of safety and outcomes that would apply to all maternity units to make them all high calibre, high standard and safe. Will the Minister agree that, by meeting Bill Kirkup, Ministers could ask him to identify the areas to draw up these standards? Because time is short, if the Minister agrees I will be happy to meet him to enlarge further.

I agree about wanting to implement the recommendations. My colleague Dr Johnson, the Minister in the other House, already met with Dr Kirkup this week. We also undertook to come back in the next four to six months with where we are on each of the recommendations. I will bring that back to the House then.

My noble friend referred to the first recommendation for the prompt establishment of a taskforce to develop maternity and neonatal outcome measures. It is over a decade since we introduced the NHS outcomes framework but, far too often, it is not used as the basis for accountability inside the National Health Service. Will he say whether that first recommendation will be acted on immediately?

As I mentioned before, we have already put this in place with the maternity quality surveillance framework. At the same time, if we feel that more needs to be done, it will be included in my review of the recommendations and report back to the House in four to six months.

My Lords, one of the significant things about this devastating report is that it does not deal with a list of one-off recommendations, as previous reports have. It deals with systemic issues that mean that the whole service is challenged. One of those, as we have already heard, is the difficulty in identifying risks. The other is why we do not hear what families are saying, which is clearly an issue in preventable deaths. One of the specific recommendations is that the Government should now bring forward a Bill that would place a duty on public bodies not to deny or deflect or conceal information from families. That should be a priority. Will the noble Lord take that back to his senior Ministers and get them to acknowledge it?

We all acknowledge a duty of candour. That should be fundamental to the leadership and to everyone in every trust. In this case, I was pleased to see the trust completely accept the findings and its failings and apologise unreservedly. That is something we need to make sure that all trusts do. We have the framework in place to do that but, if we do not, we will not hesitate to act further to ensure that it is.

My Lords, this alarmingly clear report flags up flawed teamworking as a major failing throughout. That also reflects previous reports. It also points out the unintended adverse consequences of using the phrase “normal births”, which should perhaps be replaced by “safe births”. Will the Government consider the problem of teamworking? Although there already is a joint group between the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, there also needs to be commissioning guidance to make sure that services are commissioned only when there is joint education and training, audit, and co-production of guidance with parents who have experience of the unit.

Again, we agree with Dr Kirkup’s third recommendation that teamwork is vital in all this. Some £26 million has been invested in maternity teamwork training, and a core curriculum has been set up for professionals in this area. Strong leadership has been established, with two national maternity safety champions and a number of regional and local maternity safety champions. We believe that we have the framework in place for these independent working groups but, as we review these recommendations, if we find they are inadequate we will not hesitate to act further. We will bring this back to you in the four-to-six-month timeframe when we report on the recommendations.

My Lords, the duty of candour has been in place for some years now, but there still seems an ingrained culture of denial and blame deep-rooted within these services. This is the third such report since 2015 and one of its central tenets is that women are just not listened to and are ignored, resulting in terrible deaths and disabilities for so many children. Can the Minister give us his assurance that the duty of candour and listening to women will be at the heart of the Government’s response?

My Lords, Dr Kirkup’s extraordinary report cites a lack of junior staff and, critically, a shortage of midwifery leadership as contributing to the tragedies at East Kent. In the absence of a comprehensive workforce strategy from the Government, and more midwives leaving than joining, what is being done right now to tackle the considerable number of midwifery vacancies that the NHS is suffering? It currently stands at well over 2,000.

The number of midwives has been stable over the last four years. We have seen a slight decline over the last year, which is why we have a training and recruitment programme to recruit 1,200 more midwives. In my main point, I echo the comments that Dr Kirkup made: working under pressure is no excuse for staff being rude and aggressive. While we want to recruit the extra numbers, I think that the whole House agrees that there is no excuse for what happened at East Kent.