Babies: Intensive Care (Hansard, 29 June 1993)

§ The Parliamentary Under-Secretary of State (Department of Health) Baroness Cumberlege
My Lords, I believe that the noble Lord, Lord Molloy, is referring to a recent report by the voluntary organisation, Baby Life Support Systems (BLISS). That contains a reference to the British Association of Perinatal Medicine. Although the Government respect the work which BLISS does in supporting parents whose babies have experienced intensive care, they do not accept the conclusions of the report.

§ Lord Molloy
My Lords, I thank the Minister for that reply. However, is she aware that in addition to the voluntary organisation BLISS, the British Association of Perinatal Medicine also undertook a survey of 80 per cent. of neonatal units? It claims that one-third of baby deaths are avoidable, and that 1,000 of the babies who are born and subsequently die, would not die if basic requirements and more trained staff were provided.

§ Baroness Cumberlege
My Lords, the National Health Service has an insatiable appetite and it will continue to consume resources. However, in this field the record speaks for itself: the survival of babies weighing less than 1,000 grammes has improved threefold over the past 15 years. Moreover, 96 per cent. of babies weighing under 2,500 grammes (about 5.5 lb.) survive the crucial first four weeks of life.

§ Lord Mackay of Ardbrecknish
My Lords, has my noble friend seen the report in the British Medical Journal of a study by the National Perinatal Epidemiology Unit at the Radcliffe Infirmary in Oxford which has discovered that two-thirds of babies born very prematurely suffer mental and physical disability, and that one-quarter of them suffer severe disability? Does that not give rise to the difficult question about the wisdom of resuscitating very premature babies? A fall in the death rate of premature babies may in fact give rise to an increase in disability in childhood; and, if they reach adult age, in adulthood. Is it not one of those difficult questions where one has to balance the outcomes against the expenditure, the effort and the mental trauma involved in saving extremely premature babies?

§ Baroness Cumberlege
My Lords, my noble friend is absolutely right; it is up to purchasing authorities—that is, district health authorities—to assess the outcomes of treatment. It is also an issue that the Government are most anxious should require medical audit. However, the recent research that I have seen suggests that 75 per cent. of very low birthweight babies (that is, under 2 lb. in weight) are free from significant handicap.

§ Lord Ennals
My Lords, does the Minister share the anxiety recently expressed by the Chief Medical Officer that some of the targets in The Health of the Nation may not be met? As it is nearly a year since its publication date, will she soon make a statement on the matter?

§ Baroness Cumberlege
My Lords, in setting the targets contained in The Health of the Nation, the Government were anxious that they should be challenging targets. Indeed, we are making good progress on most of them. However, I should not like to anticipate that we shall meet all the target dates in the first year or indeed in the time set for them.

§ Lord McColl of Dulwich
My Lords, does the Minister agree that the trouble with such a Question is that it contains a statement which is simply not true? There is no evidence to suggest that 1,000 individual babies died from these particular causes. Is it really the sort of Question that should be tabled in the first place?

§ Baroness Cumberlege
My Lords, I believe that there is freedom in your Lordships' House for noble Lords to ask any Question that they may choose to put. However, I agree with my noble friend. It is extremely difficult to find any evidence as that suggested in the Question.

§ Baroness Jay of Paddington
My Lords, following the Minister's answer to an earlier question about the facts in which she referred to the growing number of low birthweight babies born in the country, I should like to ask this question. Does she agree that that number is increased by the general application and treatment with fertility drugs? What is the Government's attitude and policy on such treatment?

§ Baroness Cumberlege
My Lords, the Government's policy on fertility drugs was well set out in the debate that took place in your Lordships' House when I answered a Starred Question. It is up to clinicians to decide, taking into account various, criteria, whether they think it appropriate for that drug to be given to the couple concerned.

§ Lord Dean of Beswiclk
My Lords, is the Minister aware that, by any statistics, the inner areas of Manchester have the highest record of child deaths at birth and of those taking place before 12 months of age? Bearing those terrible statistics in mind, and recognising the fact that there has been a slight improvement, will the Minister turn her attention to the problem and see whether any further help can be given?

§ Baroness Cumberlege
My Lords, I recently visited that area. People in the North Western Regional Health Authority are aware of the poor mortality rates. They are setting out courageously to meet the targets set out in The Health of the Nation.

§ Baroness Robson of Kiddington
My Lords, can the Minister tell the House how many special care baby cots exist in this country, and what percentage of those have been donated by individuals or by voluntary organisations through charitable donations?

§ Baroness Cumberlege
My Lords, I do not have those figures with me; but I shall certainly write to the noble Baroness in due course.

§ Lord Harmar-Nicholls
My Lords, the accuracy of the statement in the Question has been questioned. Is my noble friend's department in a position to say whether or not the British Association of Perinatal Medicine has stated that more than 1,000 newborn babies have died because of this lack of attention? Is that true or not?

§ Baroness Cumberlege
My Lords, the statement is taken from a quotation by the president of the association that we are discussing. I am happy to let my noble friend see the source of that statement. However, this is not a simple question. We believe the survey undertaken by BLISS which quoted the President of the British Association of Perinatal Medicine is based on inaccurate information. We do not believe that the survey was carried out with the normal rigorous research protocols that we would expect from an organisation that receives so much publicity.

§ Lord Richard
My Lords, in view of the attack that was made upon my noble friend by her noble friend, will the Minister assure us that the president of the association which we are discussing made the allegation that is contained in my noble friend's Question, and that my noble friend is perfectly entitled to table that Question?

§ Baroness Cumberlege
My Lords, the reference to this comes from the Daily Telegraph dated 4th December 1992. The newspaper quotes Professor Richard Cooke, President of the British Association of Perinatal Medicine. The matter is still open to interpretation and that is why the department has some misgivings about the use of that quotation in the report we are discussing.

§ Lord Parry
My Lords, does the Minister accept that there is a massive credit side in the balance here; namely, that because of advances made in medicine, the perinatal period is becoming less threatening to life? That results in a great saving to the National Health Service. Each healthy child that survives that period makes an additional contribution. Research carried out in France proves that it would be niggardly to cut back on this service when great advances are being made.

§ Baroness Cumberlege
My Lords, there is no question of cutting back on the service. As regards the resources that have been spent, one can see that the 710 number of paediatricians has increased by 27 per cent. since 1987. Nurses and midwives employed in neo-natal units have increased by 13 per cent. over the same period. But, as I said at the beginning of this debate, it really is up to health authorities to decide where they wish to spend their resources. Indeed, I can cite a region that has good perinatal and infant mortality rates but has the lowest rate of input in terms of resources into neo-natal intensive care. That says a lot for the population, as was mentioned by the noble Lord, Lord Dean of Beswick, in connection with Manchester.

§ Lord Molloy
My Lords, I thank the noble Baroness for her defence of the principles of this House in the face of some people who would like to destroy those principles. The 4,000 families who have lost babies would not consider this an unnecessary Question. I thank the Minister for her assistance, and I hope there can now be some co-operation between our great voluntary organisations and the department.

§ Baroness Cumberlege
My Lords, I am aware of the gratitude this nation has for the National Health Service. That applies to parents, patients and other people who use the service.