Sepsis Awareness

Caroline Johnson Excerpts

Wednesday 9th October 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Ashfield (Lee Anderson) on securing a debate on this very important topic. I should also declare an interest as an NHS consultant paediatrician. I have cared for and continue in my work to care for people with this condition.

I would like to thank Abbi for coming today. It was an honour to meet earlier today and to hear her story from her MP, which highlighted both the difficulties she faced in getting good immediate care for sepsis and the consequences of that. I commend her for the bravery she has shown in coming today and for raising this issue for the benefit of other people. This debate will increase awareness, which is a very positive thing.

I remember sitting in the Chamber earlier this year when the former hon. Member for South Thanet re-entered Parliament to a standing ovation—an exceptionally rare occurrence in the House of Commons. It is truly humbling to reflect on the journey that he has been through in such a short space of time. Little over a year ago, he had no outward signs of sepsis at all. He has now become one of the most well-known advocates for people with it. His case brought renewed attention to this disease, which kills nearly 50,000 people in the UK every year. As the hon. Member for Ashfield said, that is around the same number of people who die from bowel, breast and prostate cancer combined.

The case of our former colleague speaks to not only a remarkable recovery but the suddenness with which sepsis can utterly change someone’s life. As many people have said today, early identification is vital. Under the previous Government, awareness of sepsis improved significantly, as did the clinical recognition of symptoms, screening rates and the administration of antibiotic treatment, but there is much more to do.

I want to commend the UK Sepsis Trust and other public campaigners who played a significant role in improving awareness among the general public. A recent YouGov survey showed that the UK has high levels of public awareness compared with other countries. Will the Minister say what steps the Government will take to work with NHS England and patient groups such as the UK Sepsis Trust to raise public awareness, so that people can more easily identify the signs of sepsis? I have also asked this of another Minister, but have not yet received an answer. The Chancellor said that she was cutting the communications budget—can the Minister confirm that those cuts will not affect the important public health messaging for campaigns like this? It is important that we do not cut budgets that will save people’s lives and, indeed, save the NHS money. It is also important to raise awareness not just across the general public, but among health professionals, including medical staff in both hospitals and communities.

The national early warning score has been introduced and is being rolled out, along with the sepsis six, which was developed with the UK Sepsis Trust. The six—oxygen, cultures, antibiotics, fluids, lactate management and urinary output monitoring—must all be carried out within the first hour. Has the Minister established how well those measures are being rolled out across the UK, and what is he doing to ensure that is being done effectively? The National Institute for Health and Care Excellence updated its guidance earlier this year. Will the Minister update the House on how effectively that guidance has been implemented across the UK? Martha’s rule was introduced before the election; the rule relates to the ability for people to get a second opinion from another health professional if they remain concerned about their loved one or themselves. Will the Minister update the House on the work the NHS is doing to roll that out, too?

Research is the cornerstone of transforming sepsis care, and the last Government invested more than £1 billion through the National Institute for Health and Care Research. It is important that we research the causes of and treatment for sepsis, but we must also research new antibiotics, because we are starting to see antibiotic resistance to infections. If we do not invest in antibiotic research, new antibiotics will not be developed—we are essentially asking people to develop a drug to be kept on the shelf for when we need it, and there is no money in that, so it will not get commercial take-up. It is therefore important that the Government invest in that.

The UK Sepsis Trust is calling on the Government to publish data on the sepsis care pathway so that we can see where it is performing well and where it is performing less well. I urge the Government to do that. It would be helpful if the Minister could confirm today that they will do so.

As we close the debate, let us remember what we are fighting for. Sepsis takes the lives of 50,000 people every year. It strikes suddenly and often without warning, as Lord Mackinlay’s case reminds us so powerfully. Early identification and rapid treatment are the keys to saving lives; we have made strides, and awareness is growing, but we must do more. We must continue to improve recognition, strengthen control and push forward with life-saving initiatives. I urge the Government today not just to maintain their commitment but to strengthen it by partnering with NHS England, publishing more data, researching the causes of sepsis and ensuring we can fight this disease together.

[Sir Christopher Chope (in the Chair)]

I thank the Front Benchers for sticking to their five minutes, which means the Minister now has 10 minutes; there will hopefully also be a couple of minutes for the proposer to reply.

Maternity Services: Gloucestershire

Caroline Johnson Excerpts

Wednesday 9th October 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher, and I congratulate the hon. Member for Cheltenham (Max Wilkinson) on securing this important debate. Childbirth is a really special event. It has been described today as the best moment of someone’s life, and that description is often used. It is a special moment in the lives of not just the parents and of course the child, but the wider family and friendship group—the birth of a baby is enjoyed by everybody.

I have been privileged to attend many births over my career as a doctor, although aside from the births of my own three children, they have generally been skewed towards where things have not been going to plan—it is not, I hasten to add, that that is a result of my presence, but more that my presence is a result of things not going to plan. The work of the NHS—its midwives, its obstetricians and the wider team that look after women and their babies—is by and large exceptional. However, we hear stories of where things go wrong and we need to minimise those as much as possible.

Essentially, the talk of whether Cheltenham needs a midwifery centre comes back to the pull and tug that I have seen throughout my career between the centralisation and the localisation of services in general. When services are centralised, it can be argued that there is an increase in expertise and an increased volume of cases, which makes people more familiar with emergencies because they happen more frequently. More specialist services can also be offered for those with high-complexity and low-volume problems. There can also be more support from staff, because there are more staff present in the unit. However, centralised services can feel more remote, they can be too far away for people living in rural areas and they can feel too impersonal, particularly for a procedure such as giving birth. In a local unit, people may feel more comfortable and know the staff, and there may be a close-knit team. However, as our veterinary colleague, the hon. Member for Winchester (Dr Chambers), so amply described, if things go wrong, people can be a long way from the help they need. So there is that balance and that push and tug.

As has been mentioned, choice is important to women who are making informed consent choices on where to give birth, based on the information they receive. The hon. Member for Cheltenham has made a good case for why the balance may not be as it ought to be in Gloucestershire; the Government should look carefully at that.

I was sorry to hear of the experience of the hon. Member for Gloucester (Alex McIntyre) with his new-born baby. As a paediatrician, I am familiar with the need to weigh all the factors in the balance: the fact that a baby has gone home and may have picked up a viral illness that has brought them back in again; the risk to the baby from going on a children’s ward where the impact of disease is more predominantly based in infection and infectious conditions than in older age groups and adult wards; and the risk of putting a baby on a neonatal unit and introducing the virus to that unit, which could make the babies already there so very unwell. We need to think carefully about a solution to that, so that people do not go round and round in circles, as the hon. Member for Gloucester described, being passed from pillar to post. I am sure that was a frightening experience for him and I am sorry that happened.

I now turn to other issues raised today. The hon. Member for Stroud (Dr Opher) talked about the importance of community midwives. Even though my eldest is now 17 and my youngest nine, I still remember my post-natal midwife Marie and the care she gave. Sometimes, maternity care focuses a little too much on what is going on in a hospital when what happens in the community is also very important.

The hon. Member for Thornbury and Yate (Claire Young) suggested that we could have a midwifery in-patient unit with mothers and babies and only one member of staff. I am afraid I do not agree with her on that. The hon. Member for Winchester raised the concept of two simultaneous emergencies. If there is only one member of staff, how do they go on a break, or what if they are in the bathroom when they are needed? If we have a unit, unless it is attached to a major centre with more staff, we need that second person.

As of December 2023, there were 2,361 full-time equivalent midwives working in the NHS’s trusts and other core organisations in England. That is an increase of 3,707—18.9%—since 2010. On the one hand, the birth rate is falling and the number of midwives is rising, but I recognise that the births that are taking place are more complex in some ways than they used to be. At the spring Budget, there was a further investment of £35 million to improve maternity safety over the next three years, including £9 million for brain injury.

I asked the Minister, at the previous debate on maternity safety on 4 September, whether she would commit to that money being spent and I have not received an answer. I asked her several questions during that debate, including whether she could confirm that the Government would proceed with the fortification of bread products with folic acid to protect babies from spina bifida. I asked her about the non-essential communications budget, which the Chancellor had said on 29 July would essentially be cut, and whether that was affecting public health budgets. Those budgets are very important, particularly around optimising public health messaging regarding chronic illness and conditions such as diabetes and obesity before conception. I have not received an answer to either of those questions.

I also raised the NHS saving babies’ lives care bundle, which was due to be updated on maternity early warning scores and tracking tools, to ask the Minister whether that was on track. Again, she has not written to me as promised with the answer to that question. I asked her whether she would be supporting the healthcare safety investigations branch and about the £35 million budget I have just described. I have not received answers to any of those questions more than a month later; none of my staff can find any correspondence from the Minister. Can she answer those questions today, or at least commit to doing so by the end of the week? We have waited quite a long time.

My final question last time was about the group overseeing maternity services nationwide, because following the East Kent report—I was the Minister when that was published—Dr Kirkup’s recommendations were accepted. Maria Caulfield, then Minister for Women’s Health, set up and chaired a working group to review the work being carried out by a whole range of programmes to improve maternity and neonatal care and implement those recommendations. I asked her who would go on to chair the group and whether she could guarantee that the work would continue, but I still have not received an answer. It would be helpful for the Minister to answer the questions raised in the last debate as well as in today’s.

NHS Performance: Darzi Investigation

Caroline Johnson Excerpts

Monday 7th October 2024 Commons Chamber

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

I am mindful of the need to be brief, but I wish to congratulate the hon. Members for South Norfolk (Ben Goldsborough), for South West Norfolk (Terry Jermy), for Esher and Walton (Monica Harding), for Gloucester (Alex McIntyre), for St Neots and Mid Cambridgeshire (Ian Sollom), for Mid Dunbartonshire (Susan Murray), and for Basingstoke (Luke Murphy) on excellent maiden speeches.

When I first heard that the Government had commissioned Lord Darzi to conduct a report on the NHS I wondered two things: why has this report been commissioned, and why has a former Labour Minister been asked to do it? The answer to the first question is still somewhat unclear after this debate. Much of the information is publicly available, and Labour had access to the civil service for six months before the general election, as is routine to help with planning. Before the election, in its manifesto Labour claimed to have a plan, and the Secretary of State said that he and the Government have a 10-year plan to reform and modernise the NHS. In the draft speech that I brought to this debate I was going to say that I assume that is the case, so where is that plan and when will it be published, but during the debate the Secretary of State said that he will soon meet to engage with patients and staff who will write the plan. Does it exist, or is it yet to be written? Given that Lord Darzi specifies that policy suggestions are outside the remit of his report, and notwithstanding the amount of time and dedication he has put into it, what primary purpose does it serve? Is it simply a political statement to cover the right hon. Gentleman’s plan and an increase in taxes in the Budget when it comes?

[Ben Coleman (Chelsea and Fulham) (Lab)]

Will the hon. Lady give way?

[Dr Johnson]

I will not because there is not much time. A potential answer to the second question of why a former Labour Minister has been asked to conduct the report is its silence on a number of issues, for example on increasing the number of medical students. I could not find any reference in the report to the five additional medical schools that were commissioned and opened by the former Conservative Government, and whose first new doctors have recently graduated. Indeed, I found no mention of the NHS workforce plan at all.

My constituency mailbag, no doubt much like that of Members across the House, is full of letters from elderly people who are frightened that their homes will be cold this winter, and that they will become ill, or perhaps even die, as a result. It is notable—again, perhaps this answers my second question—that despite being published two months after the Government’s announcement about the winter fuel allowance, the Darzi report appears to be silent on the subject. The chief medical officer said that,

“cold homes and fuel poverty are directly linked to excess winter deaths”

in his annual report from 2023. Is it remarkable that this report by a former Labour Minister does not mention cold homes? Perhaps it does not recognise the impact of such a decision because no impact assessment has been made.

On 29 July, I asked the Chancellor of the Exchequer what estimate she had made of the impact that her winter fuel payment changes would have on the NHS. Her answer implied to me that that was something that had not been given enough consideration. On 5 September I submitted a written question to the Secretary of State, asking whether he would make an assessment of the winter fuel payment changes on a range of factors relating to the NHS and the health of elderly people, including hospital admissions, deaths, GP appointments and so on. The answer to whether he will do something or not is clearly “yes”, “no”, or “I have already done it”, but it seems the Government struggled to answer that question and I would be grateful if the Minister could do so today: will the Secretary of State make an assessment of the various effects of the changes to the winter fuel allowance and the consequent cold homes on the NHS and the health of elderly people?

Earlier, the Secretary of State said that investment without reform would reduce productivity. He even said that it was “killing with kindness.” Actions, however, speak louder than words, so what substantial productivity gains come with the junior doctors’ 22% pay rise? None. What productivity benefits arise from a significant increase in the wages for train drivers? None. The NHS and the Government are now facing potential future industrial action from groups seeking similar pay deals. The Government’s willingness to take money from pensioners and give it to already well-paid train drivers suggests that such union demands will be successful, further creating a vicious cycle of industrial action that will ultimately be damaging to patients.

I fear that the Labour party sees the Darzi report as a political bludgeon rather than as a blueprint for any meaningful reform. There are undeniable challenges within the NHS—something that I as a doctor see—and we must be honest about them, but instead of a constructive conversation on policy, Labour brings partisan attacks to the table. We now need real leadership, specific reforms, and the courage to make the tough decisions that will keep the NHS suitable for generations to come.

Preventable Baby Loss

Caroline Johnson Excerpts

Wednesday 4th September 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Ashfield (Lee Anderson) on securing the debate; the stories he read were very emotive.

Many people witnessing birth for the first time describe the experience as the miracle of birth. It is indeed the most wonderous occasion. I have been honoured to be present at the birth of many hundreds of babies in my work as an NHS doctor. Unfortunately, birth is an unpredictable process, and the hon. Member for North Shropshire (Helen Morgan) is right that we should focus not on natural birth but on the outcome of a healthy mother and child.

Birth does not always go smoothly. Generally, and increasingly as I became a more senior doctor, I attended only the very high-risk deliveries—those when things go wrong. In a job focused on saving lives, the opportunity to do so at birth is perhaps the most rewarding, but sadly, despite the best efforts of the whole team—midwives, obstetricians, paediatricians and allied professionals—some babies die, and that leaves a hole in the families that, as others have said, does not go away.

I spoke in the baby loss debate in 2022 as the responsible Minister, and I am reminded today of the words of Hayley Storrs, which were read by the hon. Member for Leeds East (Richard Burgon):

“What people fail to understand when someone loses a child, it is that you have lost a lifetime. First days at school, first steps, graduations, what their favourite story would have been, birthdays, Christmases.”—[Official Report, 25 October 2022; Vol. 721, c. 65WH.]

That very moving account has stuck with me. It reminds us that this pain endures, so we must do all we can to prevent it.

I pay tribute to my NHS colleagues who strive every single day to ensure that pregnancy and birth lead to the happy, healthy outcome that we all want. Politicians and the Government must do all we can to support that. We must hold the NHS to account when it fails to uphold the very highest standards.

I also pay tribute to the many great charities, such as Sands, Tommy’s and Bliss, which have been mentioned by others, that do such great work in this area. I was proud to run the London marathon with a constituent earlier this year to raise money for Bliss, and I am grateful for the support it provided to him.

We must focus relentlessly and systematically—starting at pre-conception, as the hon. Member for Sheffield Hallam (Olivia Blake) said—on every single factor that can cause or increase the risk of baby death. That includes reducing teenage pregnancy, smoking and obesity; ensuring that there is chronic illness optimisation, so that if someone has diabetes, it is optimally managed before they conceive; making medication changes if needed, so that someone is not taking teratogenic drugs at the onset of pregnancy; and ensuring that women are aware that folic acid should be taken before and during the early parts of pregnancy. Before the general election, the Government consulted on the fortification of flour with folic acid to reduce the number of babies who suffer from a shortage of folic acid during pregnancy. Can the Minister confirm whether this Government will go ahead with the proposed legislation to fortify bread products?

Additionally, the Chancellor has said that she will stop all non-essential communications. Many of the messages we are talking about are public health messages that need public communication strategies. Can the Minister confirm that this essential form of communication is not affected by the Chancellor’s restrictions on communication costs?

NHS England introduced the saving babies’ lives care bundle, which currently focuses on six areas: smoking; the assessment of foetal growth during pregnancy; awareness among parents and families that a reduction in foetal movements can be a significant warning sign; expertise training for cardiotocography monitoring during labour and pregnancy; the reduction of premature birth; and the management of diabetes to ensure that people have optimal control. The NHS had a plan to update the bundle to introduce maternal early-warning schools and tracking tools. Can the Minister confirm whether it is on track to deliver that? Can she also confirm that the saving babies’ lives care bundle will be updated this year and at regular intervals, as evidence improves on how we can best reduce the number of baby deaths?

Two years ago, as Minister, I delivered a statement to the House on behalf of the Government regarding the outcome of Bill Kirkup’s independent review of maternity services in East Kent. His report was very sobering. Those tragic events revealed failings—failings seen previously elsewhere, which should and must not be repeated. In response to the review, the Government set up a group chaired by Maria Caulfield, then the Minister for Women’s Health, to oversee the work being done to improve maternity services nationwide, including by implementing the recommendations in Dr Kirkup’s report. Can the Minister confirm that the group’s work will continue under the new Government? If so, can she confirm who will lead it?

Can the Minister confirm that she will support the work of the healthcare safety investigations branch, which investigates all cases of stillbirth and life-changing injury, to see what lessons can be learned and how care can be improved?

Other have talked about the Sands and Tommy’s “Saving Babies’ Lives” report, and particularly about workforce issues. The previous Government invested heavily in increasing workforce numbers, building five new medical schools. That takes time, but it will ultimately increase the number of obstetricians and paediatricians. The number of midwives also increased. There were 23,361 full-time equivalent midwives in NHS trusts and other core organisations in 2023, which is an increase of 19% since 2010. Births fell in England and Wales during a similar period. In the spring Budget, the Government committed £35 million to improving babies’ care, £9 million of which was related to preventing brain injury. The remainder related mostly to funding 160 additional posts in midwifery and neonatal care. Can the Minister confirm that that investment will proceed in order to support the care of pregnant women and babies?

In summary, it is almost 10 years since the Government launched the maternity safety ambition. While that goal has not yet been achieved, from 2010 to 2022, the stillbirth rate fell by a fifth, the rate of maternal mortality fell by a fifth, and the rates of neonatal mortality for those babies born after 24 weeks fell by 36%. Those statistics are a good achievement, representing many hundreds of families who will now enjoy watching with love as their children grow, thrive and develop. We must build on that now to ensure that many more families—all families—have the same opportunity.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

I congratulate the right hon. Gentleman on his position. I should declare that I have been working in the NHS for 23 years, currently as an NHS consultant paediatrician. I look forward to using that experience in my new role as shadow Minister of State to scrutinise the Government constructively.

Under the new hospital programme, the previous Government had already opened six hospitals to patients, with two more due to open this financial year and 18 under construction. The Government are now putting that at risk by launching a review of that work, delaying those projects, which are vital to patients across the country. Could the right hon. Member please confirm when the review will be completed?

[Wes Streeting]

First, I welcome the hon. Lady to her new post. I must say I preferred her much more as a Back-Bench rebel than a Front-Bench spokesperson, but I have enormous respect for her years of contribution to the NHS and the experience that she brings to this House. I always take her seriously.

However, on this one, once again I say to the Opposition that they handed over an entirely fictional timetable and an unfunded programme. The hon. Lady might not know because she was not there immediately prior to the election, but the shadow Secretary of State, who is sitting right next to her, knows exactly where the bodies are buried in the Department, where the unexploded bombs are, and exactly the degree to which this timetable and the funding were not as set out by the previous Government.