Support for Infants and Parents etc (Information) Bill [HL]

Baroness Uddin Excerpts

2nd reading
Friday 6th September 2024 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords, it is a privilege to follow the noble Baroness, Lady Finlay, and all the other powerful contributions to this debate. I welcome the Bill and I thank the noble Lord, Lord Farmer, for introducing it and for so eloquently describing the complex nature of services required to support parents. I take this opportunity to commend Dame Andrea Leadsom for her continuous commitment to women’s services.

Parents and mothers require a wide range of care and support during pregnancy. I should know: I gave birth to five children. I love the idea of the noble Lord, Lord Hannan, coming along as a fathers’ champion and bringing Cate Blanchett; I think she might still attract many fathers from different quarters. Ideally, there should be a seamless structural system of care in place as the child navigates their new world. The discourse surrounding parental support and infant care may have gained some momentum, not least from these debates; however, a holistic framework tailored to the needs of parents and children remains inconsistent and erratic, and absent in some communities. Parents’ and families’ voices need to be heard and reflected in the diversity of our communities. We do not need to reinvent services or programmes; there are countless pockets of best practice for us to reference and to inform national standards of care.

I want to highlight the work of one such organisation, which has lasted for 40 years. In the early 1980s, a group of women of Bangladeshi, Somali and Vietnamese heritage set up an advocacy scheme as a response to a lack of adequate prenatal and postnatal maternity care. At the time, urgent attention was required to prevent postnatal deaths and trauma. Research was conducted by Jean Taylor, a Tower Hamlets midwife who highlighted the immense deficit in maternity care for a significant group of black and Asian women, which led to establishing the first women-led advocacy scheme in the country. It was enthusiastically supported by visionary leaders in the NHS and local government, with funds, who recognised that structural discrimination was a harmful factor that significantly impacted the physical and mental well-being and health outcomes for the mother, the family and the child.

Through the advocacy service, at the point of entry, each woman would receive a comprehensive and detailed plan for the family for the duration of their pregnancy and up to the age of two years, with a holistic plan for postnatal support taking on board the physical and mental health needs of mothers. Each woman received a detailed package of information on how to access health visitors, postnatal check-ups, mental health screening, support for breastfeeding, such as breastfeeding buddies, and infant care.

The evidence demonstrated that early intervention was conclusive with regards to empowering parents. This was possible due to the statutory role of health visitors and the associated community health services in place at the time. In addition, there was a broad range of NGOs that provided a wraparound system of support for families, including advice on housing, finances, social care, training, language and leisure facilities. All of these, incidentally, address the first 1,001 days of children’s lives, providing a vital foundation for both the emotional and physical well-being of mother and child and for the early indication of any vulnerabilities and complex needs of mother and child in their family setting.

Overall, there was regular co-operation and co-ordination with statutory and voluntary organisations, with an agreed referral system to flag up any concerns, as well as successes, which evidently resulted in confidence and trust among parents and professionals alike. There were no smartphones or emails for communication, and I can still remember the many handwritten posters and leaflets, in many languages. We were all willing to do it, whether as volunteers or paid workers.

We have to accept that many such organisations that took decades to develop have suffered from neglect and deep cuts; this, along with essential community centres shutting down, has had huge long-term negative consequences on parents’ and children’s welfare and health. It must be said that most women of affluent backgrounds or from affluent areas may not experience similar challenges, unless, of course, they have a black or Asian heritage, when their education or social economic advantage may still be overshadowed by discrimination in the services. Even now, many women I have spoken to are not sufficiently aware of the information they are entitled to and, more so, are not given it with consistency. Many women are simply instructed to find information on Google or on a website, when advice and guidance from properly trained and skilled staff who are present for the duration of new parents’ and children’s lives is more impactful.

In addressing support for all parents and children, it is imperative to consider the detrimental effect of continuous and persistent inequalities and discrimination experienced by a substantial number of women in the maternity care services. It is nothing short of a crisis. The facts have been well-recorded, again and again, in countless research, that black and Asian women in our statutory system are four times more likely to die during childbirth than their counterparts. The status quo continues unabated. As the mother of a son who suffered injury during birth 46 years ago, I am shocked at how many parents still say that they did not have sufficient support or information about birth trauma and its prolonged consequences.

Incidentally, I spoke to the mother of Tafida Raqeeb, who is currently residing in Italy; she is waiting for her daughter to return to the UK to be supported in our system. She referred to other parents who feel unsupported by hospital administration and staff during critical care crises. Many women are grief-stricken, in their own words, due to systemic racism and failures which profoundly impacted their maternity care and mental well-being.

We seem to be living in the dark ages when it comes to the treatment of certain groups of women, who feel dismissed by healthcare professionals, their concerns ignored and their pain undertreated. We know that the result is often delayed diagnoses and treatment, resulting in complications that could easily have been avoided. It is a tragic outcome that should be unthinkable in a modern healthcare system. If we are speaking here about proper information, there has to be clear messaging about a safe route for parents to raise their concerns in confidence and safety. I did not see that in the Bill.

The transition into parenthood can be emotionally and physically overwhelming. Postnatal care remains woefully inadequate in the UK, particularly for women of my colour and faith. Women’s voices and participation in shaping services is fundamental to best practice. It is about their right to dignity in care. Also fundamental is investment in the workforce for midwives, health visitors and advocacy staff, without which we will not tackle persistent social determinants of poor health as it disproportionately affects women and their families. All parents are entitled to the highest quality of services and information. That is the mark of a just and civilised society. Given the pressures on the NHS and all other public services, does the Minister agree that holistic statutory provision will safeguard parents and their children’s well-being and be cost-effective in the long term?

Black, Asian and Minority-Ethnic Women: Maternal Mortality Rates

Baroness Uddin Excerpts

Monday 29th July 2024 Lords Chamber

[Baroness Merron (Lab)]

I certainly agree with the noble Baroness that the maternity landscape is extremely crowded; there have been a number of reports and inquiries, along with investigations. I shall look very closely with officials at the recommendations from those reports as well as those that are forthcoming. With regard to an independent commissioner, I feel that there is general agreement about what the issues are, and the most important priority is to take action. Of course, in reviewing what is going on, as I am now in this post, I will consider all suggestions, and that includes the one from the noble Baroness.

[Baroness Uddin (Non-Afl)]

My Lords, I also thank my noble friend Lady Gohir for her continuous campaign. I declare an interest having been involved in these matters in Tower Hamlets for some 40 years. I congratulate the Minister on her ministerial role. When she seeks to consolidate these matters and take the best course of action, will she ensure that she looks at the reports that have been on the shelves at the Royal London Hospital trust for the best part of 40 years?

[Baroness Merron (Lab)]

I thank the noble Baroness for her kind remarks and good wishes. Certainly, all reports will be considered because we will look for what works.

Sodium Valproate and Pelvic Mesh

Baroness Uddin Excerpts

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

My Lords, I thank my noble friend for her tireless work in this area. It is something which, in the Chancellor’s very own words—because it was the Chancellor who, as Health Secretary, first commissioned the report—remains a top priority to both him and the Government. That remains the case. I spoke to Minister Caulfield about it just this morning, and it is a complicated area, but it is something that we are very keen to redress in the next few months.

[Baroness Uddin (Non-Afl)]

My Lords, I am really grateful to the noble Baroness, Lady Cumberlege, for raising this issue. On previous occasions, I have raised my ongoing concerns about the use of sodium valproate, especially for patients with mental health issues incarcerated in hospital. Do the Government collect information on how many people have been prescribed this terrible medication in some cases, and whether it is being disproportionally applied, particularly to young men from minority communities in the mental health institutions?

[Lord Markham (Con)]

I thank the noble Baroness. I will provide the precise figures, but the incidence has gone down by 34% in terms of the amount that has been prescribed. At the same time—and this is particularly fitting, as tomorrow is National Epilepsy Awareness Day—for some people, this is the only treatment for epilepsy that will work for them. It is therefore important to make sure that protocols are in place for prospective mothers and prospective fathers to make sure that, in those cases, they are not being prescribed sodium valproate, because in other cases it is often the only medicine that works.

Mental Health Patients: Discharge

Baroness Uddin Excerpts

Tuesday 5th March 2024 Lords Chamber

[Lord Markham (Con)]

There is, quite rightly, a balance to be struck. For people with learning difficulties and autism, which noble Lords have debated before, we set a 50% target for that reduction—not 100% because, as has been mentioned, it is not always appropriate as a number of people in those situations need additional support. However, as a general sense of direction I think we all agree that, where we can put support into communities, that is the right thing to do. That is what the £1 billion extra investment is about.

[Baroness Uddin (Non-Afl)]

My Lords, I declare my interest as a former practitioner. I have spoken before about the disproportionate numbers of black and Asian men in the system using mental health services. There is a gross disconnect between the amount of funding available and the services that they receive, particularly regarding carers’ involvement. We must admit that the amount of medication that they are given is not often monitored successfully after discharge. Maybe that is one of the reasons why there is a high suicide rate. How can the Minister ensure that, when patients are discharged to the services of social workers, they are not put in extremely expensive mental health provision or private healthcare housing, which is often not needed? The services are wasting huge amounts of money. Will the Minister look at the disconnect between social services and the healthcare system to ensure that the money is used effectively?

Mental Health In-patient Services: Improving Safety

Baroness Uddin Excerpts

Monday 3rd July 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for her tireless work in this space. We believe that a number of constructive points were made in the committee report, which I know Maria Caulfield is working on and looking to get a timely response to. Maybe that is something on which we can meet up and discuss later.

[Baroness Uddin (Non-Afl)]

My Lords, I raise the issue of the mental well-being of men from black and Asian backgrounds. I particularly raise the issue of the care they are receiving at the hands of very poorly qualified, untrained, unsympathetic people, who do not adequately understand the complexity not just of mental health and well-being but the way that they should be operating. They are not working in tandem with the families, which is one of the requirements. There have been suggestions from a number of community organisations that black and Asian men are four times more likely to be detained, and sometimes it is more than likely that there has not been any consultation with their families, which is one of the prerequisites. Can the Minister assure this House that any formal forward-thinking and examination of these issues is looking at the disproportionality of the effects and the causes of very poor services, particularly for men from black and Asian minority backgrounds?

[Lord Markham (Con)]

Yes, we are very aware of the points made very well by the noble Baroness, including some of the stats on the community treatment orders and the fact, I believe, that if you are a black male, you are eight times more likely to be detained. I know that that led to some of the recommendations from the pre-legislative scrutiny committee. I can give an undertaking that that will be fundamental to what we are trying to do here.

Health Promotion Bill [HL]

Baroness Uddin Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords, it is a pleasure to follow the noble Lords, Lord Crisp and Lord Lansley. I applaud and thank the noble Lord, Lord Addington, for his leadership in pursuing this debate.

Like many noble Lords, I have spent a lifetime trying to improve health and social care in my backyard, alongside the work we do in this House. It would be remiss of me to not acknowledge the immense results we achieved back in the early and mid-1980s, which saw great improvements, particularly in perinatal and postnatal mortality rates, immunisation and breastfeeding. Most of those changes are under much stress now, adding to the improvements required in maternity services, which need urgent attention, and to the gross disparities we have talked about in this place and elsewhere on health and well-being, as well as air pollution, mental health and long Covid, particularly for those people living with disabilities and from minority communities.

Alongside this, the dissatisfaction rate among the general population for our GPs and much-beloved NHS and A&E services suggests that services have become inadequate. There is a lack of good quality maternity services, with women unable to receive adequate care during pregnancy, childbirth and postnatal care; one can see the trajectory of the health and well-being deficit in the family being set very early on. This is worsened if there are disabilities, mental health and care needs, in addition to the bullying, racism and discrimination within the system and which staff experience. If this is embedded in the services, is it any wonder we are facing this crisis? If noble Lords are minded to underestimating the effect of racism within institutional structures, I ask the Government to speak with Dr Chaand Nagpaul prior to setting up the new office proposed in the Bill to ensure that we do not just consult but involve those who have a track record of achieving changes within communities, even with restricted and constrained resources.

The Health Promotion Bill contains potential and important milestones to achieve better services. However, I would like us to pay the requisite attention to ensure that the issues of workforce balance, leadership in commissioning and senior management, and board representation are given equal attention and support. I welcome this Bill and agree that the national plan must be integrated, as has been said. What it does not explain is how we will set and benchmark standards, how implementation will be monitored, or how this will be embedded within the equality framework. This must be based on an absolute commitment from the Government to address workforce balance and leadership in commissioning and senior management. This must be a perquisite to the changes that are required.

This new office can flourish only with the determination of better collaboration which integrates sufficient resources and a commitment to achieving this, and by placing at the heart of any changes the service users and leadership which reflects all the communities in which these services are based.

Abuse and Deaths in Secure Mental Health Units

Baroness Uddin Excerpts

Wednesday 9th November 2022 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords, I declare my interest as a registered social worker. Last year, I had the opportunity to look at mental health services in east London, where the overrepresentation of black and Muslim men is absolutely horrific. Their experiences are vastly different, and there is no recognition of the fact that they are suffering not just bullying but racism and Islamophobia. As the Minister will be aware, the problem is that, as well as cases of bullying, these services are understaffed. More importantly, the staff who are supposed to be supporting these individuals who are very unwell are underqualified and severely underpaid. There is a great deal for us to be concerned about, including underresourcing and staff training. What is the Minister’s department doing about this? Having just announced one set of funds after another, which had no effect at all on the ground in those wards, can the Minister say what the reality is on the ground?

[Lord Markham (Con)]

We are investing, and I understand and agree with the point that training is key to this. We have committed to spend £2.3 billion more in 2023-24 in the mental health arena, exactly around this space. It is something that we are working on, and we understand that we need to ensure that the mental health of all our citizens, whatever their race or colour, is well served and looked after.

Disabled People: Personal Assistants

Baroness Uddin Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

On the face of it, that sounds a very sensible suggestion, so let me take it back to the department, and if I am still here, I will respond.

[Baroness Uddin (Non-Afl)]

My Lords, I very much welcome this Question, at a time when my family has just started experiencing the hard stuff of social care. It is completely absent from many people’s lives because they are stuck in hospitals and not able to leave. People who are already in employment will be suffering exactly the same problems and issues with personal assistance. The Minister has been in his post for a long time, and we have all been requesting that he listen to what many of us with long-standing experience have said. What will he do now?

[Lord Kamall (Con)]

I first pay tribute to the long-standing experience of the noble Baroness and to the many conversations we have had on this. That this Question has been asked will raise and highlight the issue. It also allows me to go back to the department, kick a few desks, as it were—without being accused of harassment or violence—and make sure that government can look at this in a joined-up way.

Polio

Baroness Uddin Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

I am aware that there are still some countries that use the oral polio vaccine, as opposed to the IPV we use in this country. I do not have the exact numbers with me. If the noble Baroness with allow me, I will go back to the department, see if that information is available and then write to her.

[Baroness Uddin (Non-Afl)]

My Lords, water quality in east London is appalling enough without this scare. I spoke with three of my neighbours yesterday, all with very young children, and not one was aware of this campaign. What steps are being taken to ensure sufficient and urgent awareness is created among East End multilingual communities, who are already struggling with a daunting array of health and well=being information?

[Lord Kamall (Con)]

As it happens, I was at an event yesterday at which a GP from east London was present; we were talking about the whole range of issues, not just this specific issue. Let us be clear: no one has got polio and no cases have been identified. We have found it in the sewage, and it probably came from someone who had the oral vaccine overseas, came to the UK and excreted it into the system. there are no cases of polio at the moment—we should be absolutely clear about that—but we are saying that this is a warning that people should ensure that they get vaccinated and check their records.

The noble Baroness makes a really important point about health disparities and there are lots of issues we must tackle. I have said many times that we must see how we can work on a community-led solution, rather than having someone in Westminster or Whitehall who thinks they have all the answers. To be honest, we have to show due humility and say that people sitting in this House can sometimes be out of touch with those communities.

Social Care: Adults

Baroness Uddin Excerpts

Wednesday 22nd June 2022 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords, 500,000 is a staggering number, but the number experiencing the deepest emotional and physical impact on families may be in the millions. Is the noble Lord and his department aware of the costs associated with neglecting these people and how many may have lost their lives while waiting for these services?

[Lord Kamall (Con)]

When we look at the 500,000 number, we are talking about an assessment of any kind. These are not people who are outside the system; sometimes they may be in the system but waiting for another assessment within the system. For example, they could be waiting for Care Act deprivation of liberty safeguards, occupational therapy assessments, the beginning of direct payments or a review of their care. It means they are in the system but just waiting for another part of the system to work. The other thing about the report was that there was a 61% response rate, and it was extrapolated from that. Anyone who has read behavioural economists Daniel Ariely or Daniel Kahneman will know that people are more likely to focus on losses rather than gains and, similarly, in surveys people are more likely to report bad things than things that are going well.