NHS England Update
Baroness Thornton Excerpts(6 days, 4 hours ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Thornton (Lab)
My Lords, I apologise again for my wonky voice. My noble friend the Minister and I are veterans of running the NHS, when we were both Ministers in the last Labour Government. I am a veteran of leading the Opposition against the Lansley reforms when they came to the House; I spent two years of my life on them.
It is worth reminding the Liberal Democrats that they were party to putting that legislation on the statute book, so we hope they will help to remove it in a positive fashion. This was a huge piece of legislation—as somebody said, it was so big it could be seen from space —and over the years wasted billions that could have been spent on front-line services.
As a veteran of my local CCG and a non-executive director of my local NHS hospital, I value this announcement. I hope that the people who help to run the hospital of which I am non-executive director—the Whittington—who are brilliant managers in difficult circumstances, will be freed up to do their jobs better and more freely.
I ask my noble friend the Minister: what is the timescale—
Noble Lords
Baroness Thornton (Lab)
I am just asking the question. What is the likely timescale for when investment might be released? I am thinking particularly about technology and investment in infrastructure, as a non-executive director of a hospital, a large part of which is still a Victorian build.
Baroness Merron (Lab)
I thank my noble friend for her reflections on what has gone before and her welcome that the opposition parties can work with us to put this into a better place now. With respect to change and productivity, and a further extension to the point raised by the noble Lord, Lord Kamall, about culture, I can say straightaway that the Government have a 2% productivity growth target in 2025-26. That is immediate. We are not waiting to make this change, because if we do not improve NHS productivity and efficiency, we will not be able to deliver the three shifts needed to future-proof the NHS and support the Government’s growth mission.
We have already invested more than £2 billion in NHS technology and digital in 2025-26, which will help with essential services and drive productivity in hospitals, such as the one that I know my noble friend serves very well. That will free up staff time, ensure that all trusts have electronic patient records, improve cybersecurity and enhance patient access through the NHS app. That is before we even make this change.
We have already achieved a lot in the past eight months, but that is why we have to continue with this reform. We have delivered the 2 million extra appointments that we promised, months ahead of schedule, we have cut waiting lists by 193,000, and, as I said earlier, we have committed to 700,000 extra urgent dental appointments, just to name some. We know about the importance of change, which the noble Lord, Lord Scriven, asked me about, and that my noble friend calls for. That is why we will always continue to take bold steps where we have to, and not shy away.
NHS: Single-sex Provision for Staff and Patients
Baroness Thornton Excerpts(2 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Hayter of Kentish Town (Lab)
My Lords, NHS England wrote to me on the—
Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)
I think we will hear from the noble Baroness, Lady Thornton, first.
Baroness Thornton (Lab)
My Lords, would the Minister agree that once again we must reinforce the need to treat everyone with compassion, dignity and respect, especially in media reports that discuss protected characteristics and cases of alleged discrimination?
Baroness Merron (Lab)
I would indeed agree with the comments of my noble friend.
NHS: Independent Investigation
Baroness Thornton Excerpts(5 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
I begin by agreeing with the noble Lord, Lord Patel, in his assessment of the noble Earl, Lord Howe, as I am sure your Lordships’ House does. On the issue of capital, the total maintenance backlog stands at £11.6 billion, an increase of nearly 14% on the previous year. As I mentioned in my opening comments, this is holding back the productivity, ability and capacity of the National Health Service. Our financial situation is well documented, but we have asked the department and NHS England to review the health service’s capital requirements, and that includes NHS England’s assessment of long-term estate needs across a range of areas. We will have to establish the position and where we are to go from there, but I assure the noble Lord of the importance of this matter.
Baroness Thornton (Lab)
My Lords, I should declare an interest as a non-executive member of Whittington Hospital, and indeed as its maternity safeguarding champion. I have huge admiration and regard for the noble Lord, Lord Darzi, with whom I worked when he graced these Benches as a very successful and effective Minister. I agree with his analysis of the Health and Social Care Act 2012; I was opposite the noble Earl, Lord Howe, when we were debating that legislation—for what felt like many years—before it reached the statute book, and I agree that despite the challenges to the NHS, the vital signs remain strong.
Page 38 of the report addresses the question of inequality in maternity and neo-natal mortality, which is described. Does the Minister agree that after East Kent, Morecambe Bay and Shrewsbury, we do not need further research into understanding the challenges in our maternity services? What we need is leadership, attention and focus, so that our maternity services can benefit from the proposals in this report and the 10-year plan.
Baroness Merron (Lab)
I agree with my noble friend. I am pleased to inform the House that just this week I announced a number of pilot programmes, through which maternity staff will be taught and supported to better identify the signs of a baby in distress in labour, so that action can be taken more quickly, and which will help staff deal with obstetric emergencies during caesarean sections. Such actions help to avoid preventable brain injuries and are right for the baby and the mother. We also need to tackle the issue of the more than £4 billion cost of the lawsuits that have been brought over a number of years.
I have seen good examples of teamwork in Bristol and Surrey, to name just two, and there are many things that can be learned. We know what strategies work—one of which is listening to women—but the challenge is, how do we roll out what is successful, including from the pilot programmes? Following the recent report, which showed a devastating situation in maternity and neo-natal care, that is a high priority for this Government.
HIV Care: Access
Baroness Thornton Excerpts(6 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
The noble Lord’s campaign in this area is very well regarded, and for good reason; I certainly agree with him. The fact is that engagement in care is strongly affected by a number of factors, including a person’s well-being and quality of life, discrimination and, as the noble Lord says, stigma. That, alongside accessibility of service, will define how successful we are. I am keen that our new plan will absolutely take account of stigma.
Baroness Thornton (Lab)
My Lords, the crisis of people lost to HIV care is of course underpinned by serious health inequalities. Are the Government taking account of the pilot work by the Elton John AIDS Foundation in south London, which has successfully returned people to care through case-finding, focus follow-up and wraparound support for people when they return to clinics, thus saving the local NHS millions in the care that would be necessary if they were not receiving it?
Baroness Merron (Lab)
I can confirm to my noble friend that we are, and say how grateful we are to a number of charities, including the Terrence Higgins Trust and the Elton John AIDS Foundation. As she says, there have been pilots for emergency department HIV opt-out testing since 2018. A pilot that began in April has expanded that to 47 additional sites, and we will be looking closely at the impact of that.
Covid-19 Inquiry
Baroness Thornton Excerpts(6 months, 3 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Thornton (Lab)
My Lords, I was keen to participate in this debate today because I was the shadow Health Minister in your Lordships’ House during the pandemic and for many of the years leading up to it. I thank my noble friend Lady Merron for the opportunity for this debate and for her brilliant introduction to it. I would just like to point out this this is the first module of many—we are at the beginning of a process, not at the end of it.
I have been following the work of the commission of the noble and learned Baroness, Lady Hallett, since it started because I believe that this level and depth of inquiry is essential. As my noble friend said, not least we owe this to the tens of thousands who died, the thousands who suffer still the effects of long Covid and those who have yet to recover from the trauma that they experienced either while working in our emergency services in the NHS or in witnessing deaths and illness in their families or, indeed, their patients.
As Sir David Spiegelhalter said:
“The 2017 National Risk Register did include an ‘emerging infectious disease’ such as SARS and MERS, but the ‘reasonable worst case scenario’ was only ‘several thousand people experiencing symptoms, potentially leading to up to 100 fatalities’. This was the underestimate of the century – by the end of 2023, over 230,000 people in the UK had died with ‘Covid-19’ on their death certificate”.
I want to make two reflections today about this report, but I particularly welcome recommendation 10 in this module, which calls for:
“A UK-wide independent statutory body for whole-system civil emergency preparedness and resilience”
to be set up within 12 months, which would consult with the
“voluntary, community and social enterprise sector”.
As patron of Social Enterprise UK and founder of its all-party group and having worked and supported the voluntary sector for most of my working life, I think this is very important. With particular reference to the questions raised by the RNIB in its very helpful briefing, I ask my noble friend the Minister to provide us with an update on the Government’s plans for setting up such a body and the ways in which disabled people and other groups could be represented. A letter would certainly suffice to answer that question.
The first issue I particularly want to mention and to perhaps explore is how to avoid groupthink, as the noble Lord, Lord Evans, said. If I might interject a moment of political dissent into this, I was waiting for him to say that they got it wrong with that at some point in his remarks. I will just leave it at that, because his Government were in charge of what happened next. The report says that:
“The provision of advice … could be improved. Advisers and advisory groups did not have sufficient freedom and autonomy to express dissenting views and suffered from a lack of significant external oversight and challenge. The advice was often undermined by ‘groupthink’”,
which, of course, added to the lack of preparedness. Vital “what if?” questions were not asked, either in the flawed pandemic preparations prior to the pandemic or during the engagement in dealing with the pandemic in those vital early days.
That means that questions of the preparedness did not take account of health inequalities, or of on-the-ground issues such as care homes and local preparedness. I saw this in action myself, because I was a member of a local clinical commissioning group in my borough that was about to be abolished at the beginning of 2020. At our last meeting that March, our local GPs assumed that they would have a vital role to play with the public health teams in our area in dealing with what was clearly shaping up to be a serious infectious disease. However, there was no information flowing from the centre about step-down facilities for those who needed to be moved out of hospitals—because everybody recognised that people needed to be moved out of them—and all those present knew that they should not be placed in care homes immediately. No questions were being asked, and our public health experts were not being listened to. There was no collecting of data locally and no flow of information, so a serious lack of leadership happened at that time.
The background to this was that the committee that might have led on these matters—the threats, hazards, resilience and contingencies sub-committee—had last met in February 2017. In July 2019, the sub-committee was formally taken out of the committee structure, with the suggestion that it could be “reconvened if needed” but an acceptance that in fact it was abolished. As a result, immediately prior to the pandemic, there was no cross-government ministerial oversight of the matters that were previously within that sub-committee’s remit. I say to my noble friend that the need to challenge groupthink means that there have to be external voices and expertise in our pandemic preparedness. Can I be assured that that will happen and that there will be a commitment to partnership working with scientists, researchers and vaccine manufacturers to ensure future pandemic resilience?
My second reflection is about parliamentary and constitutional readiness for national emergencies. In many ways, this is covered in the first recommendation of the report, which is a
“radical simplification of the civil emergency preparedness and resilience systems”
and
“rationalising and streamlining the current bureaucracy and providing better and simpler Ministerial and official structures and leadership”.
Since the report was commissioned, there has in fact been an Independent Commission on UK Public Health Emergency Powers, chaired by the right honourable Sir Jack Beatson. The commission reviewed the UK’s public health legislative framework and institutional arrangements. Several Members of your Lordships’ House, including myself, gave evidence to that commission about what actually happened on the ground in terms of parliamentary accountability and governance. How do we build into our resilience structure our need for accountability, transparency and parliamentary control of executive action? That was what the independent commission was talking about; I am sure that its evidence has gone into the public commission, but it explored those issues.
When we build our new resilience framework, it has to take account of the role of Parliament and what happened. I think the then Minister and I were in agreement, along with lots of other noble Lords, that it was completely unacceptable that we were having to deal with decisions two or three weeks after they had been taken, or even longer. This Parliament found itself in a ridiculous situation, so we need to build into our new plans that that should not happen. One way might be that if we are faced with a national emergency, there should be a national political response that the Government have to lead and that takes account of all the different political voices that should be heard in that process.
I have been dismayed that some parts of the press and others have denigrated the inquiry as a waste of time and money, or as some form of petty personality dispute. We have lived through the worst disaster of our recent history, with upward of 230,000 deaths, as I have said, making us one of the most badly affected western nations. In terms of responsible governance, if we had lost that number of people in, say, a tsunami, we would have a huge inquiry to investigate all the nuts and bolts of future mitigation and best practice. Why would we not do the same in the event of the likelihood of another viral pandemic? Such events, stress-testing the machinery of our democracies to the maximum, seem to be part of this process.
I again congratulate my noble friend Lady Merron and look forward to many more discussions about future modules.
Baroness Brinton (LD)
My Lords, I declare my interest as a vice president of the Local Government Association. The report by the noble and learned Baroness, Lady Hallett, UK Covid-19 Inquiry Module 1: The Resilience and Preparedness of the United Kingdom, is an effective and thorough distillation of the difficulties, and of the failures by Ministers, officials and perhaps even by wider society as well. She and the Minister remind us that we must always remember the bereaved, those who lost their lives, survivors and those on the front line who dedicated their lives, sometimes literally, to dealing with the crisis that we perhaps failed to deal well with. From these Benches, I start by remembering the hundreds of thousands who died, including some Members of your Lordships’ House, families and friends, those who survived and those whose lives changed for ever as a result. This inquiry and its reports must be the action we need to take to ensure that we do not make the same mistakes again.
My noble friend Lady Tyler reminded us of the scandal of hospitals releasing patients into care homes, bringing Covid with them. I remember the “do not resuscitate” orders placed on disabled patients’ files without their or their family’s knowledge, until that was stopped. I thank Ministers for dealing with that as soon as it appeared to be an issue. We also want to thank the many NHS front-line staff as well as the people in public health, local government, transport and food chains, who, in those earliest and darkest days in March and April 2020—often without PPE, and, for many, with enormous sacrifice—ensured that everything could be done to keep the country going. These people were selfless and are our heroes. I thank the noble Baroness, Lady Fraser, for her focus on those with cerebral palsy and other disabilities. She is right that they are still living with the consequences.
This inquiry has got the measure of those issues. Recommendations must be accepted and acted on as soon as possible. As others have said, who knows when the next pandemic will arrive? The noble and learned Baroness, Lady Hallett, is clear, from the evidence, that it will.
Politicians, civil servants and public officials got it wrong. The noble and learned Baroness, Lady Hallett, says in the report that
“the UK was ill prepared for dealing with a catastrophic emergency, let alone the coronavirus … pandemic”,
assuming that it would be like flu, as in the 2011 strategy and later: the wrong pandemic. Worse, Ministers instructed civil servants and officials to focus all their efforts on preparations for a no-deal Brexit, so pandemic exercises did not happen at the highest levels and those that did happen were ignored in Whitehall.
The report talks about the lack of leadership, appropriate challenge and oversight. I shall contrast our experience with what happened in Taiwan. I use this as an example to the noble Lord, Lord Frost, of how it is possible to have not just a learning Government but a learning society. That country learned from its previous experience of SARS and other national emergencies, and its pandemic system moved swiftly into action. The key was reminding citizens of what was expected every day and taking them with them. The spread was so low that Taiwan did not have to lock down. Every single day, there was a Minister and an official on TV not doing press conferences, but taking questions live from the public until all the questions were finished every day. Taiwan had six deaths in the first year.
I want also to raise a point on Sweden. Although I have heard the noble Lord, Lord Hannan, make many points about Sweden in the past, the one thing he never mentions is that Sweden’s culture is very like that of the Taiwanese in that the relationship between the governors and the governed is much more trustworthy than we have in this country. I am sure that is one of the main reasons that things worked.
The Taiwanese version of test, trace and isolate, including universal masking being totally accepted and digital technology helping people to isolate, was operated locally. If people were asked to isolate, they had a call every day from someone in their local council or nearby to ask what they needed from the shops or the chemist, and it was brought to their door. People knew they were supported—no civil emergency but a nation working together—and the key to their success was learning from SARS.
So I ask: have we learned from Covid? The noble Lord, Lord Bilimoria, recounted the Premier League arrangements made possible by regular testing. He is absolutely right; that is an example of where we did get it right in this country, but we needed to get it right for everyone.
I believe that the recommendations must be accepted and acted on as soon as possible; that is one of the reasons why we need a module now that reports so that work can proceed, advising government, Civil Service, the NHS and other public bodies.
I am so pleased to see the noble Baroness, Lady Thornton, in her place. She and I were the two Opposition Front-Benchers in January 2020 and, between us, we saw Covid through with the support of our colleagues. We covered over 580 pieces of legislation in Parliament, and well over 300 of those were on health. I give way to the noble Baroness.
Baroness Thornton (Lab)
I think that, possibly, I saw the noble Baroness and the Minister more than I saw my husband for several months.
Baroness Brinton (LD)
I confess that I was probably in the same position. The noble Baroness, Lady Thornton, and I were always commentating on the regulations, but it was always post-event. One issue we need to look at is emergency legislation being enacted with us being able to see it only after it has happened. I understand that that was the case at the start, but we were still seeing emergency legislation only two years on. That is unacceptable.
My noble friend Lady Tyler talked about vulnerable people at risk because of poverty. The noble Baroness, Lady Coussins, rightly made the point, as she always does, about language support being so vital. Your Lordships will not be surprised to hear me say that clinically vulnerable people have expressed concern that the modules outlined at the start of the inquiry seem to ignore their plight. The noble and learned Baroness, Lady Hallett, said that the experience of vulnerable people would be threaded through her inquiry and its reports. I want to thank her for her clear recommendations in relation to clinically vulnerable people as well as those who are vulnerable for other reasons. Six of the 10 recommendations specifically mention them. I may mention them again later.
Can the Minister assure the House that the recommendations will be implemented at pace throughout all levels of national, state and local government and public agencies? Nobody has mentioned that the inquiry reprinted the extraordinary spidergrams that constituted the departmental and structural response to the emergencies. The report also noted that many with civil emergency pandemic preparedness responsibilities had full-time roles in their departments, meaning that planning and review were easy to push into the future. Will key staff with this responsibility now have time to read, think and do the regular reviews and exercises to ensure that, as and when an emergency occurs, a smoothly run system will kick into place as it did in Taiwan and Sweden?
It was also egregious that preparing for Brexit knocked everything else out of the way in Whitehall, including postponing those regular pandemic exercises. As other noble Lords have asked, how will this new Government remove groupthink from their and officials’ behaviour? As the noble Lord, Lord Harris, pointed out, we may need a change in system thinking too.
Interestingly, groupthink has also come up in the Horizon Post Office inquiry and the Infected Blood Inquiry; I am sure it will also come up in the Grenfell Tower inquiry tomorrow. This is a massive undertaking for government. The comments from the noble Baroness, Lady Thornton, about the role of Parliament were important as well: about how important our role of scrutinising government becomes at times like this. Can the Minister tell us what success will look like to the Government about how things have really changed, because groupthink about success is also sometimes part of the problem? I am very pleased that the Government are proposing a duty of candour. I think such a duty will help change the practice of Ministers being told what civil servants think Ministers want to hear.
The report is clear that the local directors of public health were not utilised effectively. They and their teams of local government environmental health officers were often ignored and dictated to, and they were ignored in their roles in local areas. The Association of Directors of Public Health continued to do all that they could throughout. I remember a conversation with one of them about 10 days after the February half term in 2020. It was evident to him at that point that a number of families had picked up Covid in northern Italy, and it was spreading swiftly into his local schools. They could not get this taken seriously further up the line despite needing powers to be able to close down independent schools—they could close down state schools but not independent schools. As a result, independent schools and the families of those attending them had a faster spread than elsewhere.
The noble Lord, Lord Lansley talked about the 2011 plan thinking only about schools in high-impact areas. Our early experience post that February 2020 half term may have guided people to say, “If we can’t control spread in schools, we’re going to have to do something else”. There was no test, trace and isolate at that point, and spread was just not contained.
The Minister talked about flexible systems, but will they also be local? Directors of public health and their teams in local councils and local NHS are well placed to help. Please can we guarantee that they will be involved?
The noble Lord, Lord Frost, was unhappy with module reporting. I disagree with him because the major changes that have to happen, and which are recognised by many past Ministers and the new Government, are major and will and should take time to get right. We do not know when the next pandemic will happen; perhaps it is brewing already. There is not just anti- microbial resistance, as outlined by the noble Lord, Lord Lansley, but the person-to-person transmission of avian flu, now happening in parts of the US, Texas in particular. Time is not on our side.
The Minister said in the previous Statement in late July, following the publication of this report, that the previous Government had changed the way they accessed, analysed and shared data. It is essential to get that right but the last Government and UKHSA have cancelled wastewater testing for Covid, which is essential for early detection and monitoring. It continues in Scotland, which is one of the differences there, and in the USA and other countries. This makes it difficult for officials to spot early signs of increased cases and outbreaks.
The cancellation of Covid testing unless you are in hospital or in a care setting means that it is very difficult to gauge the level in the community. The ONS and ZOE data were helpful. Will the Government reconsider that background data? The noble Lord, Lord Hannan, said that Covid is endemic. It is not endemic yet. I hope we are out of a pandemic but Covid is not everywhere and safe for everybody. It is not endemic.
Knowing what is happening becomes important. We have hospitals telling clinical staff not to wear masks, even though there is Covid in their hospital. One academy school is saying this week that it is fine for symptomatic Covid children to return to school immediately, and we have schools still refusing to provide ventilation in classrooms that would allow clinically vulnerable children to return to school.
In July, the Minister said in the Statement that the Government’s first responsibility is to keep the public safe, so can the Minister assure your Lordships’ House on the urgent and outstanding issue of PPE, masks and ventilation being provided and encouraged where necessary to help reduce spread. I am not talking about everywhere, but where necessary.
I am also glad that the noble Lord, Lord Reid, referred to mpox. I am pleased that the noble Baroness, Lady Chakrabarti, raised TRIPS waivers and Gavi as well. They are really important. I know somebody who is going to the DRC next week. They will be working in the refugee camps and their doctor went to UKHSA to ask whether they could have a vaccination. They were told that the UK is not issuing any vaccines. Unfortunately, there are no vaccines in Goma in the DRC at all. This is not on. Perhaps the Minister could find out what is happening and why this Government are not taking this report seriously.
I wanted to talk about other things such as the longer-term effect of long Covid. I want to mention very briefly that the NHS has fired many of its front-line clinical staff who got severe long Covid because they could not prove they got the Covid in the hospitals. That is a disgrace and I think it will come back to bite the NHS in the future.
I want to end by referring to Pale Rider by Laura Spinney, published in 2016, on the Spanish flu. In the final chapter, on memory, she says:
“Memory is an active process. Details have to be rehearsed … But who wants to rehearse the details of a pandemic? … Instead, there was silence and a loss of memory”.
Are we sure that we will not have a loss of memory in the next three to five years? Will the recommendations from the noble and learned Baroness, Lady Hallett, make us become that new learning for government and society so that next time we can respond like Taiwan and Sweden?
Foetal Sentience Committee Bill [HL]
Baroness Thornton ExcerptsFriday 22nd March 2024
(1 year ago)
Lords ChamberRead Full debate Foetal Sentience Committee Bill [HL] 2023-24 View all Foetal Sentience Committee Bill [HL] 2023-24 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Jackson of Peterborough (Con)
I think that is a fatuous conspiracy theory again, but, if the noble Baroness satisfactorily answers my question about the involvement of Marie Stopes International and BPAS in the RCOG, I will gladly debate with her on the issues that she raises.
If I can continue—
Baroness Thornton (Lab)
I am not addressing the noble Lord. I am speaking to my colleagues on his Front Bench. I am very sorry, but shouting “you” and pointing is not the conduct that we expect in this House. It is in our guidance, so I ask the Government Whip to please remonstrate with his colleague not to behave like that.
Lord Jackson of Peterborough (Con)
I say to noble Lords that the noble Baroness, Lady Kennedy of The Shaws, had ample opportunity to make her points. She intervened on me and I put a very reasonable question back to her. Perhaps I can now continue.
Noble Lords may be aware of a fascinating peer-reviewed academic study published in 2010 of twins in the womb at 14 weeks of gestation. The study found that the twins’ self-directed hand movements were more calibrated than movements to the uterine wall, while movements towards the co-twin exhibited even greater care. The study determined that such deliberate actions could not be the result simply of spontaneous reflexes. The team behind the study concluded that these findings force us to predate the emergence of social behaviour. Another study published by a team of child psychologists and neuroscientists in 2006 found “surprisingly advanced motor planning” in foetuses at 22 weeks’ gestation, again pointing towards a sentience of the foetus during the second trimester of pregnancy.
These are precisely the kinds of studies that ought to be informing government policy, yet neither was cited in the RCOG reports on foetal sentience to which my noble friend alluded earlier. Some will no doubt argue that a committee is not required when we have the Royal College of Obstetricians and Gynaecologists to guide us, but, on the contrary, I would suggest that RCOG reports on foetal sentience highlight the need for objectivity in this area and there are a number of good reasons to be cautious about accepting the conclusions. The RCOG itself has now distanced itself from some of the conclusions in its 2010 report. For example, its updated 2022 report no longer asserts, as the earlier one did, that a foetus is in “continuous sleep-like unconsciousness or sedation”. The 2022 report also removed a section on responding to common questions that included answering the question, “Will the baby feel or suffer pain?” with “No, the foetus does not experience pain”. Seemingly, it is no longer sure.
Since the RCOG has rejected sections of its own report, it would seem wise not to assume that its 2022 update is wholly reliable either. In a letter published in the European Journal of Pain, Italian neonatologist and bioethicist Carlo Bellini, who has written extensively on foetal pain, has questioned the conclusions of the 2022 report, arguing that they were based on misrepresentations and incorrect extrapolations of research cited in their support. As a layman of course it is difficult for me to comment objectively on differing research, but what is clear is that government policy would be assisted by a committee that can provide objectivity in this debate and consider all relevant findings. In fact, this is something that ought to be supported by the RCOG.
Let me finish with a final reflection on why this matters beyond simply informing the abortion debate. A 2007 academic journal cited in Neurodevelopment Changes of Foetal Pain asserted:
“Exposure of the foetus and premature newborn to pain has been associated with long-term alterations in pain response thresholds as well as changes in behavioural responses relating to the painful stimuli”.
In other words, if a baby experiences pain before birth, it may impact its development and behaviour in later life. It is therefore imperative that we understand foetal sentience adequately so that any treatment of unborn babies is performed in a way that will not lead to long-term damage. I therefore strongly support my noble friend’s Bill.
Baroness Thornton (Lab)
My Lords, I refer noble Lords across the House to the Companion at 4.18, where it states clearly that we address each other as “noble Lord”. We do not use the word “you”, and there is a good reason for that, which is that that actually makes us a politer House. Standing up, even in impassioned debates on subjects about which people feel strongly, and saying “you” will lead to people pointing, which is not acceptable, and there is a reason for this. I have been in this House for 26 years, and there are some things that are wise, and this is one of those.
Lord Moylan (Con)
My Lords, I heartily endorse what the noble Baroness has just said about how we address each other. Does she think that stating quite clearly that those who disagree with you are either in receipt of “dark money” or are “innocent dupes” meets the standards of the House?
Baroness Thornton (Lab)
The noble Lord will note that my noble friend made all her remarks within the guidelines of the House on how we address each other. He may not enjoy what she had to say, and he may disagree with her—some of us do agree with her—however, she did it within the rules of the House.
First, I would like to congratulate—
Lord Alton of Liverpool (CB)
I am sorry to interrupt the noble Baroness. I do not think I have ever misused the procedures of the House and I do not intend to start now. I respect the noble Baroness and we have made common cause on my occasions. Does she think it is within the rules of the House to talk about other noble Lords as if they are dupes or as if they are in receipt of money from outside that has been undeclared?
Baroness Thornton (Lab)
If the noble Lord reads Hansard, I am not sure that that is actually what my noble friend said. However, she is perfectly capable of defending herself.
I want to start my remarks by congratulating the noble Lord, Lord Moylan, on introducing the Bill with such clarity. He called it “modest”, but I beg to differ: this is not a modest Bill. It is short, which definitely helps, but it is not modest. I also need to start by stating that Labour’s policy is that abortion is an essential part of healthcare. We support a woman’s right to choose and we believe that access to safe, legal abortion should be available throughout the UK.
We need to be clear about the true intentions of this proposal: it seeks to chip away at the Abortion Act and change how we govern abortion law. The noble Lord, Lord Moylan, may have said that this is not about abortion or the Abortion Act, but the fact that so many of his supporters have said exactly the opposite—that this is indeed about abortion—shows that that is what the Bill is actually about. We can be clear that that is the intention behind the Bill.
The topic of foetal sentience is under constant review by the Royal College of Obstetricians and Gynaecologists, and its last review found no evidence of a foetus experiencing pain before 24 weeks. It is best that we trust expert medical bodies and scientists, not a Government-appointed committee, to say what is the case and how we should proceed. We need to be clear that the Bill seeks to circumvent expert clinical guidance because it has an ideological disagreement with its conclusions. I was looking at the list of participants on the committee of the royal college, and I suggest that noble Lords do the same because it is a truly impressive medical and scientific body that takes its job very seriously. One noble Lord said they had changed their view between 2010 and 2022. In a way, that proves the point: the point of that committee is to do that review.
Has there ever been a time when a Bill has been brought to this House asking the Government to set up a committee to analyse the medical evidence for, for example, coronary heart disease or endometriosis? No, because we trust the relevant expert medical bodies to do that job for us. We believe the Bill represents a dangerous move to politicise the way that we make decisions about healthcare, and for that reason I will not be supporting it if it moves forward.
The review of foetal awareness of pain reception undertaken by the Royal College of Obstetricians and Gynaecologists found in 2010 that the cerebral cortex is necessary for pain perception, and that connections from the periphery to the cortex are not intact before 28 weeks. It was therefore concluded that a foetus cannot experience pain in any sense before that stage. In the light of that, I ask noble Lords to ask why we would vote to set up a committee on that issue, unless that evidence is not considered robust.
I note that, if the Bill were to pass, the remit of this government committee would not extend to the health and well-being of pregnant women, as the noble Baroness said. The comments about sentience in fish, animals and so on make one question where the supporters of the Bill place women’s health, well-being and reproductive rights on the scale of animals, fish and so on. One has to question where that is coming from.
No other area of healthcare is subjected to a dedicated government committee designed to limit access to its treatment. The Bill would leave a woman’s right to access to care at the whim of a committee focused solely on the foetus, with no remit to consider women’s experience, needs or rights. I will certainly not support the Bill as it progresses.
Maternity Services
Baroness Thornton Excerpts(1 year, 2 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Thornton (Lab)
My Lords, it is a great pleasure to be taking part in this debate, and I thank my noble friend for her balanced introduction. I declare an interests as the maternity safeguarding non-executive member of the Whittington Hospital board and, of course, my day job as the shadow Women and Equalities Minister, both of which will inform my contribution today.
My life and possibly my son’s life might have been lost without maternity services when he was born 37 years ago at the Homerton University Hospital. I think he was the fifth baby born there—it was a brand new hospital—and the midwife and I were wandering around trying to work out where the light switches were. There is no doubt that they saved our lives; 100 years ago, we would both have died. We must recognise the great progress that has been made in antenatal and natal care in our NHS. I was particularly moved by the contribution of the noble Lord, Lord Patel, the importance of which is reflected in the Ockenden review and the need for multidisciplinary teams in our maternity units. We are talking about not just midwives but the role of people such as the noble Lord and our gynaecologists.
I meet amazing and dedicated midwives in the course of my work as a non-executive member of the Whittington Hospital board, and they are all too aware of the challenges they face, because there is a desperate need for more resources and better staffing. The Whittington is an old hospital. Some bits were built in Victorian times, including the entrance to our maternity unit, which might still have “lying-in” signposted on it. The noble Baroness, Lady Cumberlege, graciously opened a new birthing suite for us about a year ago and will bear testament to our having to adapt our facilities all the time.
One thing I am sure of is that a change in culture is still required in the NHS if it is to place the value on maternity services that it places on other medical services. I was conscious that maternity did not feature as often or as highly as it should have in our governance arrangements. It does now, but that is probably writ large in our hospitals right across England. As my noble friend Lady Taylor said, the core of the challenges outlined by the Ockenden and CQC reports is staffing. In its briefing, the Royal College of Midwives notes all the relevant points: 2,500 midwives are missing, we need to improve retention of experienced midwifery staff and increase the number of newly qualified midwives, and we need to place real value on our existing maternity services. There is no doubt that some maternity services have failed women and families. It is important that those lessons are learned and that we ensure that those mistakes do not happen again.
We must eliminate the stark, persistent, unacceptable disparities in the maternity death rates suffered by black women, Asian women and women from some of our most deprived areas, as eloquently described by the noble Baroness, Lady Gohir. I agree with her about the need for collecting data. Having been involved in equalities work for a very long time—some 40 years—I know that if you do not monitor and do not have the data, you cannot know where discrimination is taking place or show where deeply rooted discrimination is embedded in our systems. You have to collect that data. This Government have not always done that, and occasionally they have stopped funding. They need to collect that data.
The Commons report on black maternal health was vital to this debate. I raised this with the then Minister, and we had an exchange about the root causes of black and ethnic minority mothers dying at a starkly higher rate than white women. We both agreed that it was partly embedded racism in our maternity delivery services, and partly socioeconomic reasons and deprivation in some of those communities. That does not mean that we do not need to address this. A report by the Muslim Women Network said that black Muslim women, especially black African women, were most likely to receive poorer standards of care, followed by south Asian women, particularly Bangladeshi women. The Commons report noted that the themes included—as the noble Baroness, Lady Gohir, said—a gap in data and information collection on the needs, experiences and outcomes of minority ethnic women; women not being listened to; and women receiving care that was neglectful and lacked dignity and respect. Those are some of the challenges we need to address in tackling the difference in mortality rates in our maternity services.
We also need to recognise that we must take urgent action to tackle what is acknowledged as systemic racism in UK maternity services. It is always hard to say that when you have worked in public life on equalities for as long as I have, but the noble Baroness, Lady Gohir, absolutely illustrated it. I am shocked. I did not know that we were not collecting data on the claims and financial implications of maternal and infant death.
I turn to a more positive story concerning working with a general integrated hospital at a local level, like my noble friend Lady Taylor. We are both from Yorkshire, and Bradford and Huddersfield are the hospitals with which I am familiar at home. We know that it is important that those hospitals respond to the needs of the populations they serve. As an adopted Londoner and a non-exec at the Whittington Hospital, I can tell the House that we have tried to address these issues in various ways. I want to mention some of them because they are important. We are a local general hospital slap-bang in the middle of the inner city, serving mostly the very mixed population of Islington and Haringey. By the way, I am particularly proud of the fact that during Covid, all our births were attended. We did not stop fathers and relatives being present at the birth of babies in our hospital.
The specialist services that our midwives offer have to reflect the needs of our local population. I am impressed—and I hope this will be a generalist remark—that, for the varying conditions presented by pregnant women, whether epilepsy, diabetes, bipolar or sickle cell, we have midwives who are specialists in those areas. They need to be, because these conditions would have been barriers to giving birth in the past or would have made it a very dangerous procedure. In our part of London, we have a sickle cell unit in our hospital—it is a generalist unit of which we are very proud, and it has this very specialist unit—and, of course, it works right across into our maternity unit. That is very important, because we have mums coming in who have sickle cell, with all the problems that that presents.
As mentioned by the noble Baroness, Lady Watkins, for instance, combining midwifery with other expertise and experience, particularly mental health services, is very important. A woman who has a serious mental health condition and is having medication for that will need to be carefully monitored right through her pregnancy. Those specialities are very important indeed, to say nothing of the fact that mental health problems can sometimes assert themselves anyway as a result of a pregnancy.
The second thing I want to talk about is female genital mutilation. As a local hospital, in 2000, we had to respond to the fact that we had a growing number of pregnant women presenting who had suffered female genital mutilation. So the Whittington Hospital now has a female genital mutilation clinic, which used to be known as the African Well Woman Clinic. It was established in 2000 by a woman called Joy Clarke. Today, that clinic provides services on FGM: counselling, antenatal care, assessment, de-infibulation—reversal of FGM—and post-surgery and postnatal follow-up. It provides that service not only in Islington and Haringey but to the whole of London, and women from all over the country come to avail themselves of those important services. The midwife who leads it is called Huda Mohamed. She trained as a midwife at the hospital, joined the FGM service in 2012 and became our FGM lead in 2016. It is such a highly regarded service nationally, and she has played such a crucial role in providing a comprehensive and holistic approach to managing and raising awareness of FGM and the significantly positive outcomes and benefits for women who have undergone this procedure. She was given an MBE in the New Year Honours List, and we are very proud of that.
Black and Minority Ethnic Babies: Mortality Rates
Baroness Thornton Excerpts(1 year, 4 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Thornton
To ask His Majesty’s Government what steps they are taking to reduce the mortality rates of black and minority ethnic babies, following the publication of research from the National Child Mortality Database.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government are committed to tackling disparities for parents and babies. We are addressing this through the National Health Service three-year delivery plan for maternity and neonatal services, which sets out how care will be made more equitable for women, babies and families. Support is also provided through the universal public health programmes and programmes that target vulnerable families.
Baroness Thornton (Lab)
My Lords, what is very worrying in a rich country such as the UK, with a universal, mature healthcare system, is that this figure of infant mortality rates for babies and children from black and minority ethnic backgrounds is going up and not down. What does the Minister believe the drivers of this data show and how will the Government reverse it? For example, the Apgar score for testing the health of babies, which is a skin tone test, does not work for black and brown babies.
Lord Markham (Con)
I thank the noble Baroness for her Question and for her work in this space. I have tried to delve into the numbers. It seems that roughly half the reasons why black and ethnic minority people have higher death rates are to do with socioeconomic and lifestyle factors: where they live, levels of obesity, drinking, smoking and those sorts of factors. Clearly, behind that there is a lot that needs to be done in terms of education and support, folic acid in bread and folic acid generally. The other half is more to do with racial factors. English as a second language is a key thing behind that. I hate to make generalisations, but the fact that black and ethnic minority mothers can often be less assertive means that clearly there you need training of staff to take more time, listen more, make sure that they are understanding and asking the questions to find out whether the issues are there.
Suicide Prevention Strategy
Baroness Thornton Excerpts(1 year, 4 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Thornton
To ask His Majesty’s Government why claimants of out-of-work disability benefits are not included as a high-risk group in their latest suicide prevention strategy.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The actions in the new suicide prevention strategy for England are informed by the existing and emerging evidence, by engagement with people with expertise in suicide prevention, including people with lived experience, and by the mental health call for evidence. This strategy is population-wide and the actions within it aim to support as many people as possible, including those on out-of-work disability benefits.
Baroness Thornton (Lab)
I thank the Minister for that Answer, but I am not sure that clarifies this issue. This issue concerns one bit of government not heeding the research of another bit. NHS Digital’s Adult Psychiatric Morbidity Survey clearly shows that more than 43% of ESA claimants—that is employment and support allowance out-of-work disability benefit claimants—have considered suicide, compared with 7% of non-ESA claimants. The argument that this group should be included in the NHS suicide prevention strategy was made five years ago, and it was not included with no explanation. We now have the new suicide prevention strategy, and they are omitted again. I would like the Minister to clarify whether this group will be included in the Government’s—actually rather good—suicide prevention strategy or not, and if not, why not?
Lord Markham (Con)
What the strategy is trying to do is to look at those high risk groups and the risk factors behind them. One of the biggest risk factors causing suicidal thoughts are financial difficulties, which of course out-of-work disability benefits come into. One of the highest groups in terms of priority are middle-aged men, who are often the people suffering in this space. There are other groups as well, such as children and young people, pregnant women, new mothers and autistic people. There is a range, and what we are trying to do in this strategy is hit those areas of highest risk. To put this into context, those people on all DWP benefits in the reviews done on suicide make up less than 1% of the population of suicides. What we are trying to do is hit the major risk groups.
Childbirth: Black Women
Baroness Thornton Excerpts(1 year, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Thornton
To ask His Majesty’s Government what steps they are taking to address the fact that Black women are almost four times more likely to die in childbirth than White women.
Baroness Thornton (Lab)
My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I draw the House’s attention to my interests in the register.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
While births in England are among the safest globally, we must do more to tackle maternal disparities. Local maternity and neonatal systems have begun to publish action plans to tackle disparities in outcomes and experiences in maternity care at a local level. The Maternity Disparities Taskforce, which held a meeting on 18 April, brings together experts from across the health system, government departments and the voluntary sector to explore and consider evidence-based interventions to tackle maternal disparities.
Baroness Thornton (Lab)
I thank the Minister for that Answer. On 17 April I asked the Government about discrimination in the UK experienced by people of African descent—the Minister for Equalities pooh-poohed this report and strongly rejected most of the findings of discrimination. The following day the House of Commons Women and Equalities Committee published a report which said that black women are four times more likely to die in childbirth than white women in the UK. Does the Minister now accept that there was a point to my Question, and that research conducted on behalf of the Government since 2000 has shown that black women as a group have consistently remained at the highest maternity risk?
I would also like to ask the Minister about continuity of carer, which means having the same midwife throughout your pregnancy. It is a cornerstone of the Government’s and the NHS’s commitment to deliver safer maternity services, and indeed the report itself says that it is one of the ways to overcome barriers and improve communication and understanding throughout a pregnancy. When will the Government invest in the recruitment of midwives, bringing up their strength by 2,500, which the Royal College of Midwives says is essential to deliver this personalised care?
Lord Markham (Con)
I thank the noble Baroness; there were a number of questions there. I accept that there is a disparity, which is why the Maternity Disparities Taskforce was set up. I was speaking to Minister Caulfield just this morning, and I assure noble Lords that this is very high on her agenda. That is why, in providing continuity of maternity care, the focus is on making sure that people from ethnic minorities, particularly black women, get priority.