Infant Mortality (Hansard, 15 April 2003)

§ Jacqui Smith

We welcome the latest report of the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI). It is not usual Government practice to publish a formal response to reports of confidential inquiries but we examine the findings of all reports very carefully and take action as appropriate. We note particularly that the report published on 24 March underlines the significant improvements that have taken place in care leading to twice as many premature babies being saved than was the case 15 years ago. CESDI rightly pays tribute to the work and dedication of the antenatal and neonatal intensive care staff who continue to improve outcomes for these smallest and most vulnerable of babies.

However, it is right that efforts continue to improve the level of care further in this area. Clinical guidelines have now been issued by the National Institute for Clinical Excellence (NICE) on the use of electronic fetal monitoring, the induction of labour and the routine use of Anti-D prophylaxis for rhesus negative pregnant women. Additional guidelines are due to be published later this year on antenatal care, including antenatal screening, and the use of caesarean section. We have recently commissioned NICE to develop further guidelines on intrapartum care (delivery), and postnatal care. NICE'S work will enhance and support the national service framework for children, young people and maternity services, which will set national standards of care for antenatal, intrapartum and post natal services.

CESDI advises the introduction of national standards to ensure appropriate referral and transfer arrangements in neonatal intensive care. The Department established an expert working group to advise on the most effective ways of caring for very sick and premature newborn babies and the delivery of these services. The group's conclusions were published on 10 April 2003 for wider consultation and are available on www.doh.gov.uk/nsf/neonatal.htm. In order to help implement the outcome of the review and consultation, we are making available £20 million capital funding this year, and additional revenue funding of £12 million this year, £19.8 million next year, increasing to £20 million in 2005–06.

We have also established the National Patient Safety Agency to improve the safety of national health service patient care, by promoting an open and fair culture and by introducing a national reporting and learning system for adverse events, including those involving mothers and their babies. The system will be rolled out across the NHS from summer 2003. Using data from the reporting system and other sources, the Agency will identify priorities to address areas of known risk to patients and develop solutions to prevent errors being repeated. The Agency plans to develop a patient safety programme in obstetrics and gynaecology and is in the process of appointing a specialist clinical adviser, jointly with the Royal College of Obstetricians and Gynaecologists, to develop this work.

The CESDI report pointed to a shortfall in specialist pathology services. We fully accept that specialist paediatric pathologists are best placed to perform all post mortem examinations on preterm infants, where resources allow—and we are very aware of the challenges facing NHS pathology services, including 91W specific subspecialties such as paediatric pathology. There is no quick and easy solution: it takes time to train new doctors and for them to gain the relevant experience. However, the Department is committed to addressing these staffing difficulties and is taking action to increase the number of pathologists overall, to fund specific projects to support paediatric pathology in the short-term, including funding Conversion Fellowships in paediatric pathology, and to ensure the long-term sustainability of the service.