Charlotte Warkcup

Derek Winter DL  
Senior Coroner for the City of Sunderland  
Sunderland City Hall  
Plater Way  
Sunderland   
SR1 3AA  

Dear Mr Winter,   

06 July 2023  

Thank you for your letter of 29 September 2022 to the then Secretary of State for Health and 
Social Care Thérèse Coffey about the death of Charlotte Warkcup.  I am replying as Minister 
with responsibility for Mental Health and Women’s Health Strategy.      

Firstly,  I  would  like  to  say  how  deeply  saddened  I  was  to  read  of  the  circumstances  of 
Charlotte’s death.  I can appreciate how distressing  her death must be for her parents and 
those who knew and loved Charlotte, and I offer my heartfelt condolences.  It is vital that we 
take the learnings from what happened to Charlotte to prevent future deaths.     

In preparing this response, Departmental officials have made enquiries with NHS England and 
the Care Quality Commission.  

Whether standalone midwife led birthing centres are a safe environment for delivery as 
opposed to those with immediate onsite access to a maternity unit within a hospital  

You may wish to note that although Freestanding Midwifery Units (FMU’s) are ‘freestanding’ 
in the sense that they are not physically based in an acute hospital with an obstetric unit, they 
remain  a  fully  integrated  part  of  the  whole  maternity  service;  they  are  staffed  by  midwives 
employed  by  the  maternity  service  and  served  by  local  ambulance  services.   FMU  quality, 
safety  and outcomes are governed by maternity  service  protocols  written by midwives and 
doctors, and women who labour in FMUs can be safely transferred into hospital should the 
need arise.   

The  National  Institute  for  Health  and  Care  Excellence  guidance,  on  ‘Intrapartum  care  for 
healthy  women  and  babies’1  states  that  both  Low-risk  multiparous  women  and  Low-risk 
nulliparous women are advised that planning to give birth in a midwifery-led unit (freestanding 
or alongside) is particularly suitable for them because the rate of interventions is lower and 
the outcome for the baby is no different compared with an obstetric unit.   

You may also wish to note that a multi-disciplinary research progamme2, jointly funded by the 
National Institute for Health Research (NIHR) Service Delivery and Organisation programme 
and the Department of Health Policy Research Programme has explored whether standalone 
midwife  led  birthing  centres  are  a  safe  environment  for  delivery  as  opposed  to  those  with 
immediate onsite access to a maternity unit within a hospital.  

 
  
  
  
  
  
  
  
  
  
  
  
  
  
 The  Birthplace  national  cohort  study  was  designed  as  part  of  the  Birthplace  in  England 
Research  Programme  to  answer  questions  about  the  risks  and  benefits  of  giving  birth  in 
different settings and included differences in adverse perinatal outcomes for planned births in 
freestanding midwifery units and alongside midwifery units compared with planned births in 
an obstetric unit.   

Data was collected on care in labour, delivery and birth outcomes for the mother and baby for 
over 64,000 'low risk' births in England including nearly 17,000 planned 'low risk' home births, 
28,000 planned 'low risk' midwifery unit births (AMUs and FMUs) and nearly 20,000 planned 
'low risk' obstetric unit births.   

The study found that for 'low risk' women, the incidence of adverse perinatal outcomes was 
low  (4.3  events  per  1000  births).   For  planned  births  in  freestanding  midwifery  units  and 
alongside  midwifery  there  were  no  significant  differences  in  adverse  perinatal  outcomes 
compared with planned birth in an obstetric unit.  Women who planned birth in a midwifery 
unit  (AMU  or  FMU)  had  significantly  fewer  interventions,  including  substantially  fewer 
intrapartum caesarean sections, and more 'normal births' than women who planned birth in an 
obstetric unit  

The  study  also  found  that  for  multiparous  women,  there  were  no  significant  differences  in 
adverse perinatal outcomes between planned home births or midwifery unit births and planned 
births  in  obstetric  units.   Furthermore,  for  multiparous  women,  birth  in  a  non-obstetric  unit 
setting significantly and substantially reduced the odds of having an intrapartum caesarean 
section, instrumental delivery or episiotomy.  

The recruitment and retention of midwives to ensure continuity of care  

The Department recognises that professional staff is the NHS’s most valuable asset, and the 
importance of ensuring that maternity units have the appropriate number and mix of staff to 
deliver high quality care for all women.   

That is why, we have invested £165m of funding since 2021 to grow and support the maternity 
workforce and improve neonatal care.  

The Government has also committed to expanding midwifery training places by 3,650 over a 
four-year  period  with  an  increase  of  650  in  September  2019  and  1,000  in  each  of  the 
subsequent years.   

And as part of the biggest nursing, midwifery and Allied Health Professional recruitment drive 
in decades, since September 2020, the Government has made available:    

A new, non-repayable training grant of at least £5,000 per academic year for 

• 
eligible students; and  
• 
example to cover childcare costs or for specialisms struggling to recruit.   

Further  funding  of  up  to  £3,000  per  academic  year  for  eligible  students,  for 

To improve working conditions to deter people from leaving the profession, the NHS People 
Plan has been developed to focus on improving the retention of NHS staff by prioritising staff 
health  and  wellbeing.   This  includes  a  wellbeing  guardian  role,  a focus  on  healthy  working 
environments,  empowering  line  managers  to  hold  meaningful  conversations  with  staff  to 
discuss  their  wellbeing,  and  a  comprehensive  emotional  and  psychological  health  and 
wellbeing support package.   

The  People  Plan  is  also  focused  on  improving  working  conditions  for  staff  through  flexible 
working and supporting an inclusive & compassionate workplace culture. £45 million has been 
invested in 2022/23 to support the continuation of 40 mental health hubs across the country, 

  
  
  
  
  
  
  
  
  
  
 the Professional Nurse Advocates programme, and expanding the NHS Practitioner Health 
service.  

The improved detection of babies who are of small gestational age  

The Government’s Maternity Safety Ambition is to halve the 2010 rates of stillbirths, neonatal 
and maternal deaths and brain injuries in babies occurring during or soon after birth by 2025.  
The ambition also includes reducing the rate of pre-term births from 8% to 6% by 2025.   

The Saving Babies’ Lives Care Bundle (SBLCB) is a set of guidance that was developed to 
support progress of the stillbirth element of the ambition, and brings together four key elements 
of  care  based  on  best  available  evidence  and  practice  in  order  to  help  reduce  stillbirth 
rates.   This  supports  commissioners,  providers  and  professionals  in  making  care  safer  for 
women  and  babies.   The  elements  of  care  bought  together  by  the  SBLCB  include:  Risk 
assessment and surveillance for fetal growth restriction; Raising awareness of reduced fetal 
movement; and Effective fetal monitoring during labour.   

Version 3 of the Care Bundle is being developed for publication in 2023, and is expected to 
introduce a more nuanced risk assessment, aiming to reduce intervention whilst maintaining 
the focus on the birth of babies at risk. The plan is to clarify this further so that all members of 
staff caring for women have clear, practical guidance.  

Since 2010, the stillbirth rate has reduced 19.3%, the neonatal mortality rate for babies born 
over the 24-week gestational age of viability has reduced by 36%, and the proportion of babies 
born preterm has reduced from 8% in 2017 to 7.5% in 2020. Whilst good progress has been 
made against some elements of the ambition, the Government is committed to continuing its 
work to improve outcomes for mothers and babies   

I  hope  this  response  is  helpful,  and  I  thank  you  again  for  bringing  these  concerns  to  my 
attention.   

MARIA CAULFIELD MP