BRIEFING PAPER Number 08167 1 February 2018 The investigation of By Catherine Fairbairn Alex Bate stillbirth Oliver Hawkins Contents: 1. Stillbirth 2. Current investigation of stillbirth in England and Wales 3. Coroners and stillbirth 4. Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill 2017-19 www.parliament.uk/commons-library | intranet.parliament.uk/commons-library | [email protected] | @commonslibrary 2 The investigation of stillbirth Contents Summary 3 1. Stillbirth 5 1.1 Definition of “stillborn child” 5 1.2 Number of stillbirths 5 2. Current investigation of stillbirth in England and Wales 8 2.1 England 8 2.2 Wales 10 3. Coroners and stillbirth 12 3.1 Current position 12 Coroner’s duty to investigate certain deaths 12 No power for coroner to investigate stillbirth 12 Cases where there is doubt as to whether child was stillborn 13 Possibility of inquest in some cases 13 3.2 Court of Appeal consideration of coroner’s duty 14 3.3 Chief Coroner’s Development Plan 15 3.4 Calls for coroners to have power to investigate stillbirths 16 Sands 16 Baby Loss Awareness Week debate 16 3.5 Coroners’ investigation of stillbirth in Northern Ireland 17 3.6 Government looking at enabling coroners to investigate stillbirths 18 Responses to Secretary of State’s statement 19 4. Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill 2017-19 20 Contributing Authors: Catherine Fairbairn Alex Bate Oliver Hawkins, Statistics, Sections 1.2 and 3.1 Cover page image copyright Attribution: Flower and hands – no copyright required / image cropped 3 Commons Library Briefing, 1 February 2018 Summary This briefing paper deals with the position in England and Wales. Current investigation of stillbirth in England and Wales All unexpected or avoidable deaths, including those of mothers or babies, which may have been the result of healthcare failings should currently be investigated as serious incidents, under NHS England and NHS Wales national frameworks. The Department of Health and the Welsh and Scottish Governments have also jointly commissioned a standard Perinatal Mortality Review Tool, to assist maternity and neonatal units in investigating all stillbirths and perinatal deaths. A pilot was launched in summer 2017, with full rollout planned for the end of the year. Coroners and stillbirth At present coroners do not have power to investigate a stillbirth. There has to have been an independent life before the coroner has jurisdiction to investigate a subsequent death. The definition of stillbirth is based on there not having been an independent life, meaning that the coroner does not have jurisdiction to investigate. There have been a number of calls for the law to be changed, including by Sands, the stillbirth and neonatal death charity, and in Parliamentary debate. In Northern Ireland, which has its own legislation, the position is now different. In 2013, in a landmark decision, the Northern Ireland Court of Appeal held that coroners do have jurisdiction to carry out an inquest on a child that had been capable of being born alive. Government announcement about independent investigations in future On 28 November 2017, Health Secretary, Jeremy Hunt, made a statement to the House on the Government’s new strategy to improve safety in NHS maternity services. As part of this strategy, from April 2018, the Healthcare Safety Investigation Branch (HSIB) will investigate every case of a stillbirth, neonatal death, suspected brain injury or maternal death notified to the Royal College of Obstetricians and Gynaecologists (RCOG) Every Baby Counts programme, amounting to around 1,000 incidents per year. Jeremy Hunt also said that he would work with the Ministry of Justice “to look closely into enabling, for the first time, full-term stillbirths to be covered by coronial law, giving due consideration to the impact on the devolved Administration in Wales”. Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill 2017-19 In July 2017, having come fifth in the Private Members’ Bill ballot which took place in June 2017, Tim Loughton (Conservative) introduced the Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill 2017-19 (the Bill). Explanatory Notes have been prepared by the Home Office with the consent of Tim Loughton. The Bill is due to have its second reading on 2 February 2018. The Bill would require the Secretary of State to “make arrangements for the preparation of a report on whether, and if so how, the law ought to be changed to enable or require coroners to investigate still-births”. The Secretary of State would be required to publish the report. Following publication, the Lord Chancellor would have power to make “investigation regulations” which could amend Part 1 of the Coroners and Justice Act 2009. 4 The investigation of stillbirth The Bill would also deal with a number of other matters. Another Library briefing paper provides further information: Commons Library analysis: Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill (CPB 08217, 1 February 2018). 5 Commons Library Briefing, 1 February 2018 1. Stillbirth 1.1 Definition of “stillborn child” The definition of “stillborn child” in England and Wales is contained in the Births and Deaths Registration Act 1953 section 41, as amended by the Stillbirth (Definition) Act 1992 section 1(1) and is as follows: “a child which has issued forth from its mother after the 24th week of pregnancy and which did not at any time breathe or show any other signs of life”.1 A term often used in relation to stillbirths is ‘perinatal mortality’, which refers to a child who has died between the 24th week of pregnancy and the first week of life. 1.2 Number of stillbirths The charts below show the number of stillbirths, and the rate of stillbirths, in England and Wales in each year from 1993 to 2015. NUMBER AND RATE OF STILLBIRTHS England and Wales, 1993-2015 4 6 3 4 2 2 1 Number (000s) Rate (per 1,000 live births) 0 0 1993 1997 2001 2005 2009 2013 1993 1997 2001 2005 2009 2013 Notes: Since October 1992, stillbirths are defined as late fetal deaths after 24 weeks of gestation. Source: ONS, Childhood mortality in England and Wales, 2015 Between 1993 and 2015, both the number and rate of stillbirths fell in England and Wales. The number of stillbirths fell from 3,855 in 1993 to 3,147 in 2015, which was a fall of 18%; while the number of stillbirths per 1,000 live births fell from 5.7 to 4.5, which was a fall of 21%. There has been a fairly consistent fall in the rate of stillbirths since 2003. 1 Previously the threshold had been 28 weeks 6 The investigation of stillbirth NUMBER AND RATE OF STILLBIRTHS BY COUNTRY AND REGION United Kingdom, 2015 Number per 1,000 live births United Kingdom 3,434 4.4 England 2,952 4.4 Wales 158 4.7 Scotland 211 3.8 Northern Ireland 76 3.1 London 646 5.0 East Midlands 252 4.7 West Midlands 330 4.7 North West 392 4.5 Yorkshire and The Humber 287 4.5 East of England 306 4.2 South East 428 4.2 North East 103 3.6 South West 208 3.6 Notes: Since October 1992, stillbirths are defined as late fetal deaths after 24 weeks of gestation. Source: ONS, Childhood mortality in England and Wales, 2015 The table above compares the number and rate of stillbirths in the countries and regions of the UK. In 2015, the rate of stillbirths across the UK as a whole was 4.4 stillbirths per 1,000 live births. Among the different countries of the UK the rate was highest in Wales (4.7) and lowest in Northern Ireland (3.1). Comparing both countries and regions of the UK, London had the highest rate of stillbirths (5.0), followed by the East and West Midlands, and Wales (4.7). The North East and South West had the lowest rate of stillbirths in England (3.6). Every other region of England had a higher rate of stillbirths than Scotland (3.8), while Northern Ireland had the lowest rate of any country and region of the UK (3.1). In January 2016, researchers based at the London School of Tropical Hygiene and Tropical Medicine published estimates of stillbirth rates in different parts of the world in both 2000 and 2015, in order to quantify changes in stillbirth rates over time. 7 Commons Library Briefing, 1 February 2018 ESTIMATED STILLBIRTH RATE BY MILLENIUM DEVELOPMENT GOAL REGION Stillbirth rate per 1,000 total births MDG region 2000 2015 Developed region 4.5 3.4 Southern Asia 35.5 25.5 Caucasus and Central Asia 16.8 11.9 Eastern Asia 14.3 7.2 Latin America 11.3 8.2 North Africa and Middle East 19.9 14.5 Southeastern Asia 17.0 12.2 Sub-Saharan Africa 35.6 28.7 Worldwide 24.7 18.4 Source: National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis; Blencowe, Hannah et al. The Lancet Global Health , Volume 4 , Issue 2 , e98 - e108 The table above shows the overall estimated stillbirth rate in Millennium Development Goal regions of the world in 2000 and 2015. Between these years the overall global stillbirth rate per 1,000 total births fell from 24.7 to 18.4. The region with the largest percentage reduction was Eastern Asia, where the stillbirth rate almost halved, falling from 14.3 in 2000 to 7.2 in 2015. 8 The investigation of stillbirth 2. Current investigation of stillbirth in England and Wales 2.1 England In response to failings in maternity and neonatal services at the University Hospitals of Morecambe Bay NHS Foundation Trust between 2004 and 2013, which led to the death of 11 babies and one mother, the Government launched an independent investigation led by Dr Bill Kirkup.