Mental Health Act: CQC Report

Caroline Johnson Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

The hon. Lady raises an issue that is close to my heart. In my opening statement I highlighted the discrimination faced by black people in detention, but I could just as easily highlight the discrimination faced by women. As she says, if they become victims of domestic abuse or coercive relationships, they often face mental health challenges as a result, and they are more likely to be detained in those circumstances. I co-chair the women’s mental health taskforce with Katharine Sacks-Jones from Agenda, and towards the end of the year we are looking to bring forward concrete actions to tackle exactly this kind of discrimination and make mental health services more responsive for women.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

As a doctor, I know how carefully doctors and other health professionals consider individuals before resorting to detention under the Mental Health Act. Does the increase in detentions under the Act reflect a general increase in mental health problems in the population, or can it be better explained by a greater proportion of people becoming so unwell that they need to be detained in order to support their care? What research is the Minister doing to determine which is the better explanation, and to ensure that we identify those people who are going to become severely ill in time to treat them?

[Jackie Doyle-Price]

Clearly, if we can determine the causes of the increase in mental health detention, that will become part of the toolkit that we use to tackle the issue. This is one of the things that we are asking Sir Simon Wessely to look at. There are anecdotal examples of why this might be happening, but the fact that we are seeing higher rates of detention among the black community and among women raises some interesting questions that will bear further examination. I recognise my hon. Friend’s point completely. Good medical practitioners will use detention under the Mental Health Act only as a last resort, and we must ensure that that good practice is spread as far as possible.

East Midlands Ambulance Service

Caroline Johnson Excerpts

Wednesday 21st February 2018 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Demographically, patients attending A&E, which treats accidents and emergencies, not anything and everything, are the very sickest patients, or those patients requiring treatment such as X-rays that cannot be delivered in centres such as a general practice. The review into the walk-in centre, as I understand it, and as it has been explained to me, was actually done by clinicians rather than politicians. The clinicians are telling us that it will not have an effect because, demographically, the patients going to the walk-in centre are those who are relatively well. If the walk-in centre was closed, they would be making their own way to the hospital, a general practice or a pharmacy, rather than calling 999.

[Ruth George]

The fact is that walk-in centres are open late in the evenings and at weekends, and in most GP practices it is not possible to get an urgent appointment without phoning at 8 am exactly. In my constituency, people have to wait at least two weeks to get an appointment.

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for High Peak (Ruth George) for securing this debate, on an issue that is incredibly important to her, to me, and to all of our constituents. As a children’s doctor, I have been required to deliver full intensive care to children, particularly babies, who are being transferred in East Midlands ambulance service ambulances through the night, through the day, hurtling along in the back of the ambulance as it travels on our rural country roads, round corners and down the hard shoulders of motorways at great speed, so I understand some of what they do. It has given me a deep appreciation of the work of ambulance crews and has also highlighted to me the unique challenges and pressures that they face, particularly in our rural areas.

My constituency of Sleaford and North Hykeham in north Lincolnshire has a dispersed population, a rural road network and some NHS staffing challenges, all of which have contributed to the ambulance service failing to meet its national targets. As the overnight closure of Grantham A&E, which is just adjacent to my constituency, requires ambulances to now travel greater distances to Boston, Nottingham and Lincoln, every few weeks I receive a letter from a constituent who has waited an unacceptable amount of time for an ambulance. Indeed, I myself, as a member of the public, have been at the side of the road trying my best to treat casualties, waiting a long time for an ambulance. One gentleman died, although it is likely that that would have been the case anyway.

There is no quick fix to improving ambulance response times in rural areas. It is easy to identify and talk about the problem, but we also need to talk about potential solutions. One example would be the effective cohorting of patients when they arrive in A&E to allow ambulance crews to get back on the road sooner.

We have heard about the problems faced by ambulance crews waiting a long time to hand over in A&E, and it is right and proper that the care of patients is properly handed over before the ambulance crew leave, but it is worth noting that when a crew is with a patient, that patient is effectively receiving two-to-one care. I appreciate that paramedics and nurses have different skills, but that is higher than the dependency level provided for intensive care, where there is a one nurse to one patient ratio. Many of those patients, since they are waiting in corridors—unacceptably, I would say—are at the lower level of dependency as compared with the patient that has been taken straight into resus and received immediate treatment. So when three consecutive ambulance crews come in with three patients, there are six members of staff caring for them, and that is not necessary. One crew could care for them while the other two crews go out and see patients.

It is also worth noting that the patient who is at home is at a greater level of risk than the patient in the hospital. In the circumstance I have described, we have six ambulance crew looking after three patients in a hospital. The patients are of moderate ill health—they need to be in hospital and need to be seen, but they do not need to go into resus right at this moment. Equally, they are at a lower level of risk than the person sat in their home in a rural area of my constituency, say in Nocton, waiting for an ambulance to come, who has no access to medical care at all. If the person at home deteriorates, they cannot be wheeled round the corner immediately into resus, while being continually observed by a paramedic in the meantime.

Following my work in A&E over the Christmas period—I still practice as a paediatrician—I met the Secretary of State for Health and Social Care to discuss that point. I understand he and the civil service are looking at it, and I would be grateful for an update from the Minister on how that work is progressing. I believe that it would improve not just patient care but also the ambulance response times in the community.

The second issue I want to talk about is the type of ambulance crew. Many people are of the view that when an ambulance crew arrives, it contains the same level of skill mix, regardless of which ambulance comes, but that is actually not the case. There are highly trained specialist technicians and there are paramedics, who have additional levels of skill. There can be situations where, because we need to direct the correct crew to the correct problem—for example a particularly ill patient might need a paramedic and another patient might need a technician—there might be two crews near two patients going in opposite directions, taking longer to get to somebody. That is because they are not all paramedic crew. Although that probably makes little or no difference to response times in a city centre, in a rural area, where response times will always be longer because of the geography involved, we should increase the number of paramedics, perhaps having all paramedic crews. If we were in a position where all crews were paramedic crews, an ambulance would always go to the nearest casualty and not necessarily the matched one, which would improve response times. In addition, we can increase the number of patients who receive care en route.

We hear a lot about the golden hour—patients that need treatment within that first hour of care. If they get treatment in that first hour, we know they get better outcomes in the long term. If we are sending a technician crew who are perhaps not able to provide some of the treatments that a paramedic crew can, the patient is not getting that. Again, in a city centre where the transfer time might be five minutes, perhaps that does not matter as much as it does in a rural area, where once the ambulance has got to the patient, simple geography may mean that it takes 40 or 30 minutes to get back to the hospital.

In summary, we hear a lot about the problems that the ambulance service has. I agree with my hon. Friend the Member for Gainsborough (Sir Edward Leigh) that a Lincolnshire service would provide a better solution than one that covers such a wide geographical area as the east midlands, but I would be grateful if the Minister could look at the other potential solutions.

Medicines and Medical Devices Safety Review

Caroline Johnson Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

As the right hon. Gentleman knows—we have had these discussions at the Health Select Committee—this country makes an enormous contribution to medicines regulation across Europe, because of our extensive scientific base, and we very much hope that those links continue.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I welcome the review of the yellow card process. The first responsibility of the doctor is always to do no harm, and every doctor, when making any prescribing decision, always balances the potential improvement in patient care with the known risks. Sometimes, as more drugs are given to more people, rarer side effects will come through, and the improvements in the yellow card system will mean that those are identified earlier.

My other point is about Roaccutane. It is a drug given to treat acne but is known to be exceptionally toxic in pregnancy. I remember from my time working in dermatology that to get a prescription women had to attend monthly and have a negative pregnancy test before the next prescription was issued. I wonder whether that approach could be more widespread in the prescription of some of these drugs, which do provide some benefit but are known to be harmful.

[Mr Hunt]

My hon. Friend’s question demonstrates how useful it is to have people with medical experience in the House. To be honest, I am slightly overwhelmed by the detail in her question, but her broad point is absolutely right. The difficulty with the issues today is how much they affect women, particularly pregnant women. Through the review, we want to establish whether we are doing less well than we should on women’s health issues. Given that Baroness Cumberlege has done more campaigning on women’s health issues than pretty much anyone else in either House, I think she is the right person to take the review forward. My hon. Friend is absolutely right about strengthening the protections for pregnant women.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 6th February 2018 Commons Chamber

[Jackie Doyle-Price]

The hon. Gentleman is right to highlight that, and we are always keen to respond to any representations made on this very important issue. We are also very keen to learn from the other nations about this area, because it is clear that the more we can do with early intervention in childhood, the better we protect people’s long-term health. I will look more specifically into that.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

As a children’s doctor, children’s health is very important to me, and the case of children’s doctor, Dr Bawa-Garba, worries me and doctors up and down the country. In NHS practice, I have seen the adverse effect on reflective practice and the impact that it has on staff morale. Ultimately, that will impact on patient safety. I know that the Secretary of State shares my concerns, and I ask him to tell the House what he is going to do about it.

[Jackie Doyle-Price]

My right hon. Friend the Secretary of State will be addressing that in a little while. The whole issue of reflective learning is important. We should not, through this case, prevent people from being honest about the experiences that they have had.

NHS Winter Crisis

Caroline Johnson Excerpts

Wednesday 10th January 2018 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

May I begin by disagreeing profoundly with the hon. Member for Wirral West (Margaret Greenwood)? As a health professional and as a doctor who has worked in the health service for 15 to 20 years, spending more than two hours listening to Opposition Members putting negative after negative on the NHS has been profoundly taxing, and it has been hard for me to remain in my seat.

I worked in the NHS in A&E in the Christmas and new year period. Yes, I saw people waiting much longer than we would like. I also saw a seriously injured child who came in and received the very best treatment. People and equipment were available, and all the necessary hospital staff were available for his treatment. At times there were a dozen people around his bed, and I am pleased that we could give him the treatment that he needed to survive. We need to get away from always picking out the negative points. We must remember that more people are being treated and survive, and that they are real, genuine people who go on to live long, healthy lives and are really pleased with the NHS treatment that they receive from people such as me and the millions of NHS staff working over Christmas and on new year’s day.

We have heard a lot of negatives from the Opposition, but we should look at what we can do to improve. I did not hear anything from the shadow Secretary of State about what he was going to do to make things better if he was in charge.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I will not take much time, but I have some suggestions. It is the over-75s who are mainly going to A&E. They are more unwell than they used to be. Why do we not get volunteers with medical experience to phone up people on every GP list and make sure that the over-75s are okay? They could urge them to turn up at the GP as soon as they become unwell, and not to wait until they reach a state in which they need intravenous drugs and have to go to A&E.

[Dr Johnson]

I thank the hon. Lady for her intervention, but I fear that she is mistaken because the people most likely to attend A&E are the under-19s. The over-65s represent about 20% of attendances at A&E but, following their attendance, the vast majority require admission to hospital, so they are in a slightly different category.

Those who are awaiting admission after they have been seen are the group who are waiting on the trolleys in A&E. People are waiting for those patients to be moved on to the wards so that the ambulances can be freed up and those patients treated. I have a solution to suggest, about which I met the Secretary of State earlier this week following my work in A&E over the winter period, when I observed ambulance crew waiting next to trolleys with their patients. They could not leave until they had properly handed over their patients.

It is really important that patients’ care is handed over properly, but equally we need those ambulances back out on the streets to collect the patients who are waiting at home. We could do much better if we cohorted the patients. For example, if three ambulances came in with six ambulance crew members on board, one ambulance crew could look after the patients while the other two went back out to see more patients. It is not all about money; some of it is about the inventive use of staff to create safe and efficient protocols.

I want finally to talk about the postponement of operations, which is very upsetting when someone has waited a long time for an operation and psyched themselves up for the pain and distress they know they will experience, and they may be nervous and fearful.

We have several choices. We could run hospitals at a very low capacity all summer—which is hugely expensive—so that there is a lot of free capacity ready for the winter; we could say that we will not do as much elective work over the winter, but then we might cancel operations that do not need to be cancelled—we may be giving more notice, but patients might have been able to have their operation; or we tell people that we will plan their operation but there is a possibility that if the winter is acutely busy, it will need to be postponed. None of those choices is ideal; all have pros and cons. We need an adult, cross-party discussion about the best way; otherwise, whichever option is chosen by the Government of whichever party is in power, the other side will criticise.

As many hon. Members on both sides of the House have suggested, we need to take the politics out of the health service, recognise that the vast majority of patients receive excellent care from the health service, which is doing more than ever, and consider together how we improve the areas that need improvement.

Maternity Safety Strategy

Caroline Johnson Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

We must give doctors, nurses and midwives our full support, because they do an extraordinary job. Sometimes there are difficult issues and the centralisation of certain maternity services can improve patient safety if it means that there is round-the-clock consultant cover and so on. In my experience, the most important thing is to spot the most risky births early in the process. I am not a doctor, but there is sometimes an assumption that it is all about what happens at the moment of labour when women go into hospital. Actually, a lot of this is about thinking earlier in the process about higher risk mums—mums who smoke and mums from lower socioeconomic backgrounds—and intervening earlier. That will be important for the hon. Gentleman’s constituents and for mine.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Pregnancy and childbirth are a time of joy for most families, but during my professional career, I sadly had to look after a number of babies who died. I therefore welcome the Secretary of State’s commitment to halving the number of neonatal deaths by 2025. In my professional experience, many babies who are stillborn were already dead or in serious trouble inside the mother before they arrived at hospital. Will the Secretary of State therefore confirm that the investigations will look at pre-hospital care, as well as hospital care, including things such as the measurement of babies’ growth? Will he also encourage expectant mothers to monitor foetal movements, as we know that a reduction in those can be a sign of distress?

NHS Continuing Care

Caroline Johnson Excerpts

Monday 27th November 2017 Commons Chamber

[Norman Lamb]

Depressingly, I have. Earlier this evening, when I was giving the Speaker’s lecture, I made the case that we need, ultimately, a pooled budget for both health and care to stop these awful arguments between the health and social care silos.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

In my experience, trying to define which is the social care part of an individual’s need and which is the medical part can be very challenging, as many people will have a combination of both. Does the right hon. Gentleman agree that the Government’s proposal for accountable care systems in which one group is responsible for meeting both needs is a great step forward?

[Norman Lamb]

If it were happening, I would. I totally agree that we need to bring health and social care together in localities, with a single budget and single commissioning. I think that we need to work across parties to come up with an ultimate long-term settlement for the NHS and the care system.

Families are also in the invidious position of being asked to provide, in effect, a top-up for care if they want their loved one to remain at home, rather than being forced into a care home. That is fine for those who can do it, but not good for those who cannot afford it. It is also completely contrary to any notion of personalisation —the concept of the person, what is important to them and their priorities being at the heart of decision making—which the Government accept. When I was working with the Conservative party in coalition, we passed the Care Act 2014. Its fundamental principle was the individual’s wellbeing, yet now are saying to people, “No, you’re going to go into a care home because it’s cheaper.” That is not acceptable, but it is happening around the country.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

With respect, I do not think it helps to reassure the brilliant NHS professionals from the EU who are working in the system when the right hon. Gentleman asks questions like that. The reality is that those people are staying in the NHS, and I take every opportunity to ensure that they feel welcome. I try to stress how important they are, and how the NHS would fall over without them. The Government continue to make every possible effort to secure a deal for their future, which we are very confident that we will achieve.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Grantham accident and emergency department is very important to my constituents and those of my neighbour, my hon. Friend the Member for Grantham and Stamford (Nick Boles). It is also very important to me, as it saved my husband’s life on two occasions. Last August it was closed overnight because there were not enough doctors to staff it safely. There are enough doctors now, but unfortunately NHS Improvement has interfered to stop its reopening, postponing it by at least a month. Does the Secretary of State agree that it should be reopened in December?

[Mr Hunt]

I think I have said to my hon. Friend in the House, and I have certainly said to my hon. Friend the Member for Grantham and Stamford (Nick Boles)—who I am delighted to see back in the Chamber after an incredibly brave battle against cancer—that this was a temporary closure based on difficulties in recruiting doctors, so I will certainly look into the issue very carefully.

Children’s Oral Health

Caroline Johnson Excerpts

Tuesday 31st October 2017 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing a debate to highlight this important issue.

We cannot overstate the fact that, as the hon. Gentleman said, oral health problems are the most common cause of admission to hospital for children aged five to nine. I am a children’s doctor—a consultant paediatrician—and I am responsible for the children on the children’s ward in Peterborough City Hospital. They often come in not because they are unwell but because they have had too much sugar and have not had their teeth brushed effectively; their teeth have become rotten, painful and uncomfortable and need to be removed.

As my hon. Friend the Member for Mole Valley (Sir Paul Beresford) said, behind the statistics there are children who are in pain and discomfort, and whose teeth are hurting. They may not want to eat—children who have tooth decay are lighter. There are other reasons for that, but in part it is because they do not want to eat because it hurts when they do. They cannot sleep, which affects their educational performance. As they get older, they do not want to smile because of the embarrassment and discomfort it causes, and that has an impact on their ability to socialise with other children. Perhaps most worryingly, more than 8,000 pre-school children are admitted to hospital each year to have teeth removed. Those children are not responsible for brushing their teeth and do not choose what they eat. Their parents or permanent care-givers are entirely responsible for all aspects of their dental health.

There are two ways to tackle this problem. First, we should address the issue of sugar. I welcome the Government’s proposed sugar tax, because it will encourage children to drink water, which in many areas is fluorinated and better for teeth, rather than sugary fizzy pop, which, as well as containing high levels of sugar, is strongly acidic and therefore detrimental for teeth. It would help if the tax were directed towards sugary drinks, and not spread out across the different drinks that the manufacturer makes.

Secondly, schools should educate children about what to eat. Last week, I went to Washingborough Academy in my constituency, which has an innovative programme for improving school meals for its primary school children. It has a vegetable patch and a fruit orchard in the school playing field, where the children grow their own food and learn about where their food comes from.

[Catherine West]

The hon. Lady is making some excellent points. When I was a council leader, I introduced free school meals for all children up to the age of 11 in all of our primary schools. That increased the take-up of free school meals to 90% across the borough and improved oral health.

[Dr Johnson]

That is an interesting point. The hon. Lady is right that it is important that our children’s school meals are high quality and as healthy as possible.

There are other issues relating to the mechanism by which children consume food. In my profession, I have seen pre-school children given Coca-Cola to drink not in a cup but in a sippy cup or even in a baby bottle with a teat. That is particularly harmful for children, and there should be more education about the fact that it damages teeth. Once children get past 12 months, they should be encouraged to move from bottles and sippy cups on to proper open cups, so that sugary drinks are in contact with their teeth for a shorter period.

If the child is of pre-school age and the parents do not take them to a dentist for whatever reason, health visitors can provide some of this education. It should be part of a health visitor’s role to encourage good oral hygiene in children.

I do not whether I am ageing myself here, but I remember being given disclosing tablets at school and rushing off into the school lavatories to brush my teeth to see what the horrible blue dye had done to the inside of my mouth. I was horrified because, although I thought I had done a great job of brushing my teeth, there was quite a lot of blue staining. That powerful tool should be available to all of our children. My children have recently come home with toothbrushes, toothpaste and some of those lovely tablets. Hopefully, they will have a good effect.

In my reading for this debate, I came across some research in health journals that suggests that the strep mutans and streptococcus sobrinus bacteria increase children’s likelihood of getting tooth decay. In families in which the diet and the amount of sugar consumed is the same and the amount of tooth-brushing is similar, some children get more tooth decay than others. Research suggests that that is due to those bacteria, so we should aim to reduce their presence in the mouth. I will be interested to hear the Minister’s thoughts on that point.

I am pleased that the hon. Member for Birmingham, Selly Oak secured this debate. I congratulate him on raising this issue.

Baby Loss Awareness Week

Caroline Johnson Excerpts

Tuesday 10th October 2017 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I pay tribute to the bravery of the many people who have described very personal and moving experiences in the Chamber this evening. I have experienced this issue from a different angle, in a professional capacity. As a consultant paediatrician, I have been privileged to see many hundreds of babies come into the world. I can honestly say that the joy and the miracle of that event, in whatever circumstances, is not diminished by having seen it on numerous occasions.

As a junior doctor, one is fortunate to see many happy occasions when babies are born in good health and at full-term. As a consultant, one is called only when either the mum or the baby is in significant trouble. That might be when the baby is very premature, when the baby or mum is very sick—for example, following a road traffic accident or with sepsis, which we have heard about here before—or when the baby is, sadly, born without a heart rate.

I can remember occasions from my professional experience when I have had to give parents the news that nobody—I speak as a parent of three—ever wants to hear, and no doctor ever wants to give: that a baby or child is, sadly, going to die. I remember holding one particular infant in my arms, because his parents were not able to do so, as he passed away. There is no doubt that we need to do everything we can—NHS professionals work very hard every day—to make sure that that does not happen, but unfortunately it does. I welcome the Government’s target to reduce the incidence of stillbirth by 50% by 2030.

I want to talk about some of the changes that have been made during my career. I graduated as a doctor in 2001, and I worked as a consultant paediatrician in the NHS, particularly in neonatal care. A number of changes in neonatal care have led to improvements over this time. There has been an increasing centralisation of neonatal care, so that the smallest and sickest infants are cared for in areas of significant expertise. This has helped to reduce mortality, particularly for the smallest and sickest babies. It has also led to a need for transportation. A baby who is born in a small district general hospital may need to be transferred many miles—sometimes hundreds of miles—to a hospital that has the expertise to care for their particular problem. When I was a junior doctor, that meant the doctor who was on shift, such as me, getting into the back of a 999-called ambulance and taking the baby in an incubator to wherever they needed to go.

Over the past few years, that has changed considerably. We now have clinical networks and areas of the country are divided up into patches in which there is a dedicated clinical team, led by a consultant neonatologist, with nurses and doctors who have specialised in this area. In many cases, there is a dedicated ambulance, as well as helicopter transport, to come and retrieve babies from whichever hospital they are born in and to take them to such a centre of expertise. That has been a big improvement in the care we offer children during the time that I have been a doctor.

As was mentioned earlier, another thing we have done is to focus much more on the lessons that we can learn. As a doctor, the first infant I saw who died was a young boy whose death was, sadly, entirely preventable. There was an investigation and lessons have been learned, but that does not take away from the horror of the occasion. It was an awful experience for the family, and it was traumatic for everybody involved. As an introduction to being a junior doctor—although I took no responsibility for it all medically—it was very traumatic, as it was for everybody.

We now have regular meetings to look at the cases of children or infants who have died, suffered significant injury or become more unwell than we anticipated, and where any type of adverse event has occurred. Such cases are looked at in detail by a multidisciplinary team, which goes stepwise through the process from the child being conceived or being referred to hospital and asks what has happened, why it has happened, what could have been done better and what would have changed the outcome. Although we would like to prevent every case, the reality is that, while we will get closer to doing so, we will never prevent every death, in my view. We should, however, prevent every one that can be prevented, and I very much welcome the Minister’s statement about improving the way in which cases are reviewed and about making that a statutory requirement.

I welcome the contribution of my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) in relation to child bereavement leave. He is right to say that most employers, like him, are very flexible in dealing with people whose infant may be very unwell in hospital for several months at a time, but some are not, and that places an enormous pressure on such people. I also welcome the national bereavement care pathway. All the hospitals in which I have worked have had bereavement rooms and I think they provided good care to bereaved parents and families, although I know that that is not accepted as a universal statement.

Will the Minister look in detail at the evidence on group B streptococcal infections, and at any evidence relating to whether women should be screened for that in pregnancy?

The centralisation of tertiary neonatal services has been a good thing in making the survival outcomes for babies better. We are now focusing not just on survival but on improving the quality of life, particularly for pre-term infants, such as by improving ventilator settings so that their vision is improved and their lung function is better as they grow up. However, centralisation also has an impact on families. For example, for a baby born in my constituency, the nearest tertiary neonatal centre is Nottingham, and if it does not have a bed, they might be sent further afield to Sheffield, Leicester or Norwich. For people looking after older children at home—having to take them to school, for instance—trying to manage having a baby several hours’ journey away will have a huge impact on the family. It also has significant cost implications, and I not infrequently see parents, particularly in working families on low incomes, who are struggling with the financial implications of travelling to visit their desperately sick baby who is several hours away.

Overall, I think there have been many welcome announcements in this field today.