To ask the Minister of Health to detail the (i) actions he has taken to better support parents who have lost a child to stillbirth or neonatal death; and (ii) work undertaken to better understand the causes of stillbirth and neonatal death.

(i) All Trusts recognise the importance of supporting parents who have lost a child to stillbirth or experienced a neonatal death. In these sad circumstances, a wide range of support services for bereaved parents are available across each Health and Social Care (HSC) Trust and delivered in partnership between clinicians, bereavement coordinators and the community and voluntary sector.

In cases of stillbirth or early neonatal death, all Trusts in Northern Ireland have a Bereavement Midwife who provides support and guidance for bereaved women, partners and their families. This support and guidance will be tailored to meet the needs of the individual woman, her partner and family as appropriate. The Bereavement Midwife also works to ensure that all staff within the relevant healthcare settings are supported and enabled to provide compassionate and respectful care for families who experience such a loss.

Each Trust has also had a Trust Bereavement Coordinator in place since 2006, when the HSC Bereavement Network was established to provide information, guidance and resources for those who care for and support people around the time of death and bereavement, as well as a Bereavement Forum which meets regularly with a wide membership comprising staff and service users.

In addition, the Department has commissioned a Palliative and Life Limited Service (PALLS) from the NI Children’s Hospice. With the support of a dedicated specialist nurse and access to a bed in the Children’s Hospice (or the child’s own home), there is wrap around support for those families where the baby is expected to die shortly after birth. PALLS allows the parents to spend time together as a family in a supportive environment with time for memory making before the baby passes away. Follow up bereavement care and support is also provided to help the family in these difficult circumstances.

(ii) Reducing stillbirth and neonatal death is a priority for the HSC system. A number of work streams are in place across the region with the aim of reducing perinatal mortality:

Implementation of the Department of Health England’s Saving Babies’ Lives Care Bundle which first issued in 2016 with an updated version published in 2019 is underway in Northern Ireland. The focus is on reducing the incidence of stillbirth and neonatal death. Saving Babies Lives 2 saw the addition of work on preventing premature births where possible. The Public Health Agency (PHA) was asked by the Department to complete an assessment of the extent to which work to reduce stillbirth is embedded across the HSC. A regional action plan to reduce stillbirths has been put in place and a regional group, led by the PHA with representation from the five Trusts, has been tasked with overseeing and co-ordinating this important work.

UK Perinatal surveillance has been in place since 1992 and a consortium called MBRRACE-UK (Mothers and Babies: Reducing risk though audit and confidential enquiries) led by the National Perinatal Unit in Oxford has been running the Maternal, Newborn and Infant CORP since 2012. A yearly national report on perinatal mortality surveillance is published by MBRRACE in Autumn each year. A pattern of generally higher rates of neonatal morality in Northern Ireland has been demonstrated over the past seven years of reporting with peaks noted in 2015 and 2019. The NI data includes deaths associated with congenital anomaly. The Department and PHA are leading on coordinated regional action to consider and address recommendations of both the MBRRACE-UK Perinatal Mortality Surveillance Report for perinatal deaths of births in 2019 (published 14 October 2021) and the 3rd annual report on Learning from Standardised Reviews when babies die, National Perinatal Mortality Review Tool (published 13 October 2021).

Equally important in preventing stillbirths and neonatal deaths is the priority given to reviewing and learning from these events when they do sadly occur. Perinatal mortality reviews have a dual aim; primarily they support objective, robust and standardised review of stillbirths and deaths in the newborn period to provide answers for bereaved parents and families as to why their baby may have died, and secondarily to support local and national learning and inform further action to improve the safety and quality of services. All stillbirths and neonatal deaths are subject to a perinatal mortality review and the requirement to undertake a multidisciplinary review of all perinatal deaths is a corporate Trust responsibility. Using the Perinatal Mortality Review Tool (PMRT), each Trust will work through an objective, structured and detailed multidisciplinary review of each perinatal death. The review process aims to identify any contributory factors to sub-standard care and suggest potential issues which may be developed into action plans for learning and service improvement. Trusts are required to report progress on the use of PMRT to the Department of Health and the Public Health Agency on an ongoing basis and audits are in place to ensure adherence to the review process across all Trusts.