Recommendation 25

HM Government Not Addressed

106. The Government accepts this recommendation in part. 107. The NHS Mandate7 sets out an aim of year on year reductions in the difference in the stillbirth and neonatal mortality rate per 1,000 births between that for black, Asian and Minority Ethnic women and the national average. 108. The Committee rightly states, the underlying causes of health disparities relate to a range of issues beyond the remit of the Department. The root causes of disparities in health are a complex interaction between personal, social, economic and environmental factors. The Marmot Review “FairSociety, Healthy Lives” states that to take action on health inequalities, action must be taken across all social determinants of health (PHE, 20178). 109. Pregnancy lasts around 40 weeks, but a lifetime approach is needed to address issues which contribute to maternal and neonatal deaths and to help women prepare for pregnancy. 110. The life course approach to disparities in health indicates that there are opportunities for intervention at many points throughout life. Reducing health disparities through the life course requires a whole-of-society approach dealing comprehensively with all health determinants9. 111. The health of women as they enter pregnancy remains a major challenge to maternity services, and two-thirds of maternal deaths in the UK are now in women with pre-existing medical conditions. Preconception health describes the health of women and men during their reproductive years. Good preconception health encompasses two main concepts: • Planning a pregnancy: Enabling women and their partners to choose if and when to start or grow their families • Fit for pregnancy: Recognizing that many pre-pregnancy health behaviours and risk factors are amenable to change 112. Improving preconception health represents an opportunity to reduce maternal and infant mortality and morbidity, prevent non-communicable disease in parents and their children and improve intergenerational health. 113. In the UK, preconception health is frequently affected by excess maternal weight, dietary deficiencies, smoking, excessive alcohol consumption, mental health issues, and recreational drug use, all of which are associated with poorer pregnancy outcomes and frequently rooted in social and economic deprivation. 114. The Department and its ALBs are undertaking a range of work in relation to public health to help women, including those in the preconception period, to be as healthy as possible. This includes work on smoking cessation, promoting a healthy lifestyle and healthy eating. 115. The new Office for Health Improvement and Disparities (OHID) will be established on 1 October 2021. The OHID will target health disparities, including racial and ethnic disparities in health, focusing on research, communications and expertise to reduce health disparities across all groups. The OHID is committed to improving preconception health from a universal and targeted perspective. 116. For the past three years NHSEI have been working to address the findings of the MBRRACE-UK reports10 about maternal and perinatal mortality, which show worse outcomes for mothers and babies from black, Asian and Mixed ethnic groups and those living in the most deprived areas. 117. Professor Jacqueline Dunkley-Bent OBE, Chief Midwifery Officer and Misha Moore, the National Specialty Advisor for Obstetrics - Public Health, are leading this work. The work aims to understand why mortality rates are higher, consider evidence about what will reduce mortality rates and take action to improve equity in outcomes for mothers and their babies. 118. During 2021-22, NHSEI will launch the ‘Core20PLUS5’ (Most deprived 20% of our population plus other population groups as identified by local population health data e.g. ethnic minority communities) initiative to drive targeted health inequalities improvements in key areas including Continuity of Carer. Further, through the Innovation and Technology Payment (ITP) programme, NHSEI is supporting the NHS to adopt Placental growth factor (PIGF) based tests to help rule out pre-eclampsia quickly so that pregnant women receive the most appropriate care. Pre-eclampsia is more prevalent in black women. 119. The Maternity Transformation Programme is a priority programme in terms of addressing health disparities. Interventions to tackle health disparities feature in the NHS Long Term Plan, Phase 3 planning guidance and the 2021/22 planning guidance (implementation guidance) 11which commits to the publication of equity and equality guidance and asks LMS’s to coproduce Equity Action Plans by 28 February 2022. 120. Further information is set out in ‘the Government’s response to the Health and Social Care Committee’s Expert Panel’s Evaluation of the Government’s progress against its policy commitments in the area of maternity services in England’. 121. Given that the social determinants of health are beyond the control of health services - requiring sustained and sign