To ask His Majesty’s Government what plans they have to improve miscarriage care and support.

My Lords, miscarriage can have a devastating impact on women and their families, and we are determined that they receive the support they need. We committed in the women’s health strategy to improve care for women, including carefully considering the graded model of care for repeated miscarriage. The National Maternity and Neonatal Taskforce will develop the national action plan to improve maternity and neonatal safety and experiences, and it will follow the pending recommendations of the independent investigation by the noble Baroness, Lady Amos.

There are around 250,000 miscarriages in the UK every year. Following the recent Tommy’s Graded Model of Miscarriage Care report, will the Government now review the specific requirement for women to experience three miscarriages before being able to access the support that could help prevent another loss?

This is an extremely important area, and I acknowledge very much that the current situation is not working for women or their families. To emphasise, we very much welcome the report from Tommy’s miscarriage centre at Birmingham Women’s and Children’s Hospital, which is about the effectiveness of its piloted model of sporadic or recurrent miscarriage care. I visited them when I first took office and was very taken by their work. I am glad they have reported, and, as confirmed in the women’s health strategy, we shall be looking very closely at this. It will deal with and refer to the point the noble Baroness makes.

My Lords, one of the issues that is going to come out this week, through a welcome report on Wednesday, is the effect of heat on pregnancies—on miscarriage and on very small babies being born. It used to be thought that this affected only women in very hot countries, but it now is realised that it affects women subjected to heat they are not accustomed to. In other words, it is just as important here as it could be in the tropics. Given that a lot of science now says that we are entering an El Niño period, which could mean tremendous heat towards the end of this year, what are the Government doing to address this and give women advice about hydration, shade, et cetera?

There are a number of causes of miscarriage, as I am sure the noble Baroness is aware, and it is helpful that she brings this point to our attention. In all areas it is very important that we give advice to women about how to manage their pregnancy to—I can only put it this way—minimise the possibility of miscarriage. There is another factor regarding pre-conception healthcare. Of course, many pregnancies are not planned, and our challenge is to ensure good health for women more broadly, in the ways I have described a number of times. But we will be looking at the point the noble Baroness raises.

My Lords, given continued reports from women that they are discharged from services following miscarriage with little psychological support or follow-up care, what assessment have the Government made of whether current NHS pathways are meeting the commitments set out in the women’s health strategy? How will the improvements that these women are really looking forward to be measured in the future?

In terms of the renewed women’s health strategy, we are going further than just mental health, important though it is, and taking a new and better whole-life course approach, right from the availability of contraception all the way through to and including menopause, because this is all part of life’s reproduction journey. That will greatly assist. On miscarriage and mental health, we have established mental health services in all areas of the country, which are available for those with pre-existing mental health needs. Bereavement counselling is also widely available for those who experience baby loss. We have also set up maternal mental health services to provide care for those who have moderate, severe or complex mental health difficulties arising from loss or birth trauma.

My Lords, baby loss can be one of the most difficult experiences for any person, but especially for NHS staff who work in or around maternity and neonatal care settings. Can the Minister outline for us what specific support is in place in the NHS for staff who experience baby loss that recognises this additional need?

The most reverend Primate makes a very sensitive point, which is of course correct. That is why NHS England has published a new policy to support NHS employees who are affected by baby loss, including paid leave. Our development through the Employment Rights Act will apply to NHS workers, including giving leave from work. We are currently consulting on the detail of this. It is about acknowledging the extreme effect on individuals of losing a baby, no matter at what stage.

My Lords, I welcome the Government’s commitment to review the graded models of care so that women can be helped, regardless of the number of miscarriages. How will the Government make sure that the needed services, particularly for support as well as investigations, are equitable throughout the country and not subject to a postcode lottery?

The 10-year women’s health strategy is absolutely focused on ensuring that services and support are available equally, no matter where people live. They are variable, and that is not where we want them to be. I have just spoken about the bereavement services, for example. As of January this year, all ICB areas are expected to provide a seven-day-a-week bereavement service across maternity settings. That was not in place earlier, and it gives a sense of the trajectory.

My Lords, in an era of more personalised medicine, it is important to note that the care of women who have miscarried is dependent on several factors: the gestation age when miscarriage occurs, the age of the mother, and any existing diseases. It is not just about the number of miscarriages the mother has had when the investigation starts. There should be more personalised aftercare for every mother who loses a baby.

I hesitate to say “of course”, but the noble Lord is of course right. As I mentioned earlier, there is a range of reasons why miscarriage may be taking place. It therefore requires that whole-system approach, but also the life-course approach that I spoke of. I am also glad that through our research arm, the NIHR, we are funding research through Tommy’s, which we have spoken about already, on the beneficial effects of progesterone, to give one example. It is important that we continue, as we are doing, to invest in this research.

I am sure the Minister is aware that Northern Ireland now provides up to two weeks of statutory leave for those who endure miscarriage before 24 weeks. Are she and her colleagues in government looking at that across the UK?

That is exactly why there is provision in the Employment Rights Act. We are consulting on the detail of how we can most effectively make it work, but it is quite right to do that, and I am glad we are following this example.

My Lords, it is widely reported that maternity services are in crisis—in fact, an inquiry is ongoing. Could it be that women suffering from miscarriage get less priority when maternity services are overstretched and as busy as they could possibly be, as we have read? Would it not be better if maternity services were improved once we get the result of the inquiry? Then there would be time and more patience to deal with the women suffering miscarriages, who are probably in the same area of the hospital as the maternity wards.

The noble Baroness, Lady Amos, will report next month, and we are grateful to her for conducting an independent investigation. The National Maternity and Neonatal Taskforce and all its expert reference groups—a number of noble Lords are kindly taking part in that, alongside those with lived experience and clinicians—are getting on with the work of how we improve maternity and neonatal services. We will not have to wait long for the noble Baroness’s report. We will look not just at her recommendations but at where there are gaps and, should reference to miscarriage be one, we will of course seek to fill that gap.