Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 29th October 2019 Commons Chamber

[Matt Hancock]

I am very happy to meet my hon. Friend and colleagues from the MS Society. She is right to say that we need to ensure we get the evidence that the clinicians understandably want, and in fact we have committed public funds, through the National Institute for Health Research, to establish clinical trials to develop that evidence base.

[Fiona Bruce (Congleton) (Con)]

7. What steps he is taking to support end-of-life care.

[The Minister for Care (Caroline Dinenage)]

We are absolutely committed to supporting end-of-life care, not only through £4.5 billion-worth of investment in primary and community services but through providing an additional £25 million to palliative care and hospices in 2019-20. Today, I am in a position to announce how the geographical spending of that money will be allocated, and I will be putting the regional breakdown in the Libraries of both Houses this afternoon.

[Fiona Bruce]

What are the Government doing to better resource support for children’s palliative care, including addressing the shortage of specialist doctors and hospice nurses needed to care for children with life-limiting conditions?

[Caroline Dinenage]

We care passionately about the way in which children’s palliative care is delivered. That is why we have increased the children’s hospice grant from £12 million this year to £25 million in 2023-24. We have also seen a nearly 50% increase in doctors working in palliative care medicine since 2010, but the interim NHS people plan will set out actions to meet the challenges of workforce supply and demand.

National Marriage and Mental Health Awareness Weeks

Fiona Bruce Excerpts

Thursday 16th May 2019 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House has considered National Marriage and Mental Health Awareness Weeks.

It is a pleasure to serve under your chairmanship, Sir David. This year, National Marriage Week and Mental Health Awareness Week fall at the same time—this week. I am grateful to the Backbench Business Committee for allowing debate time to explore the connection between these two issues.

Increasingly, evidence is showing that mental health challenges are exacerbated when we experience relationship difficulties. There is a link between emotional health and wellbeing and mental health and wellbeing. As our most important and closest relationships are within our families, it is not surprising that when they are broken or dysfunctional, there is an increased likelihood of our mental health being affected. Evidence from a variety of sources, which I shall turn to shortly, increasingly demonstrates that.

However, the point of this debate is not just to draw the findings together, but to ask what the Government can do to address the matter through public policy decisions. We are suggesting not that the Government should tell people how to run their lives, but that a little bit of support—often it does not take much if it is provided early enough, whether that means early enough in life or early enough when relationship challenges occur—would help people to build stronger and more enduring relationships and, in turn, help to address the distressingly high level of mental health challenges in our country today, particularly among young people, reaping potentially lifelong benefits for them and benefits for wider society. That, of course, is a key thrust of “A Manifesto to Strengthen Families”, which was launched a year and a half ago here in the House of Commons and which has the support of more than 60 Conservative MPs as well as colleagues from other parties. Some are here today, and I thank them for attending.

At this point, I want to thank the Government, because they increasingly recognise the importance of addressing these issues. They are, for example, addressing poorly functioning relationships through the troubled families programme. The Department for Work and Pensions publication from a couple of years ago entitled “Improving Lives: Helping Workless Families” resulted in £39 million of funding for the reducing parental conflict programme, which focuses specifically on the couple relationship and on conflict that falls below the domestic violence and abuse threshold, but which means that parents need help to communicate and relate to each other. There is increasing recognition of the need to improve inter-parental relationships, as a primary influence on children’s long-term mental health and future life chances. I therefore welcome what is being done. Of course, it is geographically limited and, in terms of funding, will not reach all those who need the help and need it now.

It is also encouraging that the Government have committed some £90 million to addressing mental health problems in young people—probably, my right hon. Friend the Minister for School Standards tells me, with a particular view to providing mental health nurses in schools. However, the impact of that investment, as I have said to the Minister, will never be as it could be if those professionals worked not only with the children involved, but with their families. So often, the relationship issues within the home mean that families are the source of the mental health challenges that children bring into school. Unless the whole family are worked with, helping the child in school and then sending them back to the source of the challenges will never resolve the problem.

I want to divert for a few moments and commend a charity called Visyon, which it has been my privilege to be patron of for many years. A mental health charity based in my constituency of Congleton, it supports children and young people from the age of four when they have mental health challenges and it provides help right across Cheshire East and into north Staffordshire.

I am grateful to the chief executive for providing me with some pointers for today’s debate, which I shall summarise. The document states:

“The Government’s Green Paper, Transforming Children and Young People’s Mental Health Provision, recognises the important role that the voluntary and charities sector will play in the formation and delivery of support to schools and colleges. With an ever increasing demand for specialist NHS mental health services for children and young people, it will be vital that schools are able to identify the most appropriate interventions or services to prevent the escalation into costly specialist provision, where possible.”

I shall refer to one area of intervention where the charity works as a priority, which is with parents, but first I shall give a few statistics from Visyon. It says that three in four mental illnesses start in childhood, 75% of young people with a mental health problem are not receiving treatment, and the average wait for effective treatment is 10 years. It also says that UK funding for mental illness research equates to just £8 per person, compared with £178 for cancer and £110 for dementia.

The document that I have from the charity states:

“Visyon’s approach is to look at mental health holistically and provide interventions that involve and impact on all aspects of the…young person’s life…When a young person is struggling with their mental health it has a huge impact on the whole family. Parents are often desperate to support their children but…end up feeling lost, isolated and under skilled…At Visyon we approach our mission to improve a child’s mental health in a holistic way…parents can be a child’s biggest resource.”

Visyon runs a “Parent Empower Hour” programme and states that in a recent evaluation of it,

“parents were asked how family dynamics had changed since taking part in the group. Comments included ‘Our house is so much calmer. I feel less angry and overwhelmed’ and ‘I have found even ground now. I feel more in control and I know this is what my daughter needs’.

There is a conscious focus in Parent Empower Hour to encourage parents to look after their own wellbeing. This serves two purposes—it is important to model to children the importance of self-care and it recognises the emotional toil of caring for children who are struggling with their mental health. One parent commented ‘I have learned to look after myself more and not feel guilty about it. This makes it easier to cope when difficult situations arise.’”

It is encouraging that the Government recently launched their new relationships and sex education in schools curriculum, which requires an emphasis on building healthy relationships. The regulations recently passed by both Houses require that pupils learn about the nature of marriage and civil partnerships and their importance for family life and the bringing up of children; safety and forming and maintaining relationships; the characteristics of healthy relationships; and how relationships can affect physical and mental health and wellbeing.

I am delighted that my right hon. Friend the Secretary of State for Education has made the points for me in his foreword to the documentation that launched this. In his foreword to the guidance, he says:

“In primary schools, we want the subjects to put in place the key building blocks of healthy, respectful relationships, focusing on family and friendships, in all contexts, including online. This will sit alongside the essential understanding of how to be healthy. At secondary, teaching will build on the knowledge acquired at primary and develop further pupils’ understanding of health …Teaching about mental wellbeing is central to these subjects, especially as a priority for parents is their children’s happiness.”

I welcome all that the Government are doing, because that work is crucial, but much more needs to be done. We need to recognise that, just as fractured family relationships can affect the emotional wellbeing and, in turn, the mental health of us all, the impact on the mental health of children growing up and experiencing poor or broken family relationships from an early age can be lifelong.

How can Government help people in the earliest stages of life? I will review a number of recent studies on this issue, not all of which come from organisations that have what might be called a vested interest in the subject. Relate—the relationship people—cites the Early Intervention Foundation’s statement that the inter-parental relationship is a “primary influence” on children’s life chances. In particular, frequent and intense unresolved inter-parental conflict is highlighted as a key factor affecting children’s long-term health and wellbeing.

A 2017 Office for National Statistics survey, no less, showed that children aged between two and 16 who are living in families that struggle to function well are more likely to have mental health challenges than are children from healthy, functioning families.

Interestingly, just today The Times has published details of the latest 2019 ONS survey, under the headline:

“The key to happiness? Eat, drink—and be married”.

The article says that according to research published by the ONS just yesterday on relationships, married people gave the highest score when asked to rate their life satisfaction out of 10, as compared with those who are not married. Researchers looking at data from 2017-18 found that marital status has overtaken economic activity—for example, whether someone is in work—as the most important factor contributing to happiness after good health. That is good news in National Marriage Week, and from an unlikely source.

I will turn to other sources. The National Childbirth Trust says that new mothers may experience multiple mental health problems during pregnancy or after giving birth, including post-natal depression, as we know, as well as anxiety, eating disorders, obsessive compulsive disorder and post-traumatic stress disorder, with suicide the leading cause of direct maternal death after the first year following pregnancy. However, the NCT says that there is no requirement in the six-week maternal check, which mainly focuses on the baby, to include a check on the emotional health or wellbeing of the mother. NCT research shows that nearly half of new mothers’ mental health problems are not picked up by a health professional.

Also, as the National Society for the Prevention of Cruelty to Children says in “All Babies Count: The Dad project”, the role of fathers in supporting mothers can have a significant influence on improving the mental health outcomes of mothers after they give birth. Such early support is critical because parental mental health is a key factor in understanding the mental health of children.

Research by the Marriage Foundation found that family breakdown also has a major impact on teenagers’ mental health. Although its statistics showed that one in five 14-year-olds with a mental health problem live in an intact married family, just under double that number—two in five of teenagers with mental health problems—were the children of parents who live apart and had never married.

The Marriage Foundation also recently conducted an evaluation of factors affecting teen mental health, using data from the millennium cohort study of young people who are now aged about 14 or a little older, who were born around the millennium. The Marriage Foundation report suggests that family breakdown is the biggest factor behind the UK’s child mental health crisis. Its analysis of almost 11,000 families found that having parents who split up was the strongest influence on girls’ mental health in their teenage years, with strong links to emotional problems. It was also the joint strongest factor, alongside relationship happiness, in teenage boys’ mental health, with strong links to behavioural problems.

ChildLine’s latest annual review cites family relationships as the second leading reason why children contacted the service to talk. The Samaritans says that divorce increases the risk of suicide, because the individual becomes disconnected from their domestic relationships and social norms, and that those who divorce may experience a deep sense of “emotional hurt”.

The Mental Health Foundation kindly provided me with a briefing for this debate, entitled, “Relationships in the 21st century: the forgotten foundation of mental health and wellbeing”. The Mental Health Foundation says that people who are more socially connected to family, friends or community have fewer mental health problems than people who are less well connected. It also states that, as I have said, conflict within the family environment impacts negatively on the mental health of children within the family, and the negative effects can be felt across the whole of life’s course.

The Mental Health Foundation’s briefing says:

“The family relationship environment in pregnancy, infancy and childhood is of fundamental importance to future mental health. This is only now starting to be fully appreciated as the neuroscience of brain development is becoming known and being seen to support understanding gained through observational studies of human beings and their mental health.”

In this respect, I commend the Leader of the House, because she has set up a working party of Ministers to look at helping families with children in their very earliest years—the first 1,001 days of life. This subject needs to be focused on more closely by Government, so I am very pleased that my right hon. Friend has done that and I look forward to reading her report, which will come out soon, about what Government can do to support those early days, although of course there is a lot more that needs to be done in later childhood, and indeed in adulthood.

The Relationships Alliance concludes that relationships are a vital public health concern, stating:

“Evidence shows that the quality of our couple and family relationships is linked directly to specific areas of public health concern. Such areas include cardiovascular disease, child poverty, alcohol/substance misuse, depression and mental health, obesity/child obesity, children’s mental health/cognitive development, and infant attachment.”

Of course, the first attachment that we make with others is with our parents; that relationship is one of the most important in all our lives. Positive and secure attachment is important for positive emotional and social development, with children being able to adjust better to adversity and change; to use a favoured word now, they are more “resilient”. By contrast, insecure and disordered attachment relationships in early childhood are associated with depression, anxiety, self-harm, suicidal tendencies and post-traumatic stress disorder, among other mental health problems.

Living with parents who divorce before their child is 18 has now been assessed as an adverse childhood experience, or ACE, for that child. Having one or more ACE increases the risk of a child experiencing depression, poor academic achievement, time in prison or sexual violence, among other negative outcomes. As the Mental Health Foundation says, toxic relationships and negative experiences can have a serious impact on a young person’s mental health.

We should bear it in mind that our children are growing up in a country that has one of the highest levels of family breakdown in the world; indeed, the UK now has the highest divorce rate in Europe, such that nearly half of all our teenagers do not live with both their parents. This is a massive issue, as we also know from those who work in schools, colleges and universities, where supporting young people with mental health challenges is now a major concern.

Why am I referring to all this during National Marriage Week? Because it is not just the quality of the parents’ relationship that matters; it is also being increasingly recognised that the stability of the parents’ relationship matters, if that relationship endures through a child’s childhood. That is important not only for the children, but for the adults within that relationship. As the Centre for Social Justice says:

“Family environment is crucial to children’s outcomes. It is the instability and disruption caused by family breakdown, coupled with poor parenting, that is so damaging to their outcomes.”

Therefore, one of the factors that promotes wellbeing is stability in family relationships, and all the evidence shows— we cannot avoid it—that marriage, as opposed to cohabitation, is much more likely to endure and to promote stability. Just one married couple in 11 splits up before a child’s fifth birthday, compared with one unmarried couple in three.

The CSJ produced a substantial new report just last month, entitled “Why Family Matters—A comprehensive analysis of the consequences of family breakdown”. Before I give Members the statistics, and people reject the comments made in that report as the mere opinions of those who have an interest in promoting such arguments, I will clarify the methodology that has been used. These statistics have been calculated using a sophisticated methodology known as logistic regression. I know; I had never heard of it before, either. That means that the influence of other demographic attributes such as gender, age, socioeconomic grade and ethnicity, as well as experience of social issues, are controlled for. The result is that the statistics arrived at are a true reflection, in this case, of the impact that family breakdown has on the life of a young person.

Here are some of the statistics that the report has produced: those who experience family breakdown when aged 18 or younger are over twice as likely to experience homelessness; twice as likely to be in trouble with the police or spend time in prison; almost twice as likely to experience educational under-achievement, not being with the other parent of their children, alcoholism, teenage pregnancy or mental health issues; and more likely to experience debt and living on benefits. Surely those statistics alone should persuade us that Government should be doing much more to address family breakdown. The cost of not doing so is too great, not just in financial terms—although that cost is huge, far more than the £51 billion often quoted for tackling these issues, which are the consequences of family breakdown—but, tragically, in terms of the lost life potential of the millions involved.

The CSJ states that one adult in 10 who experiences mental health issues says that family breakdown was a contributing factor. Put simply, the CSJ says:

“Marriage leads to the better mental health of children. Children of married parents are more likely to achieve at school, less likely to use drink and drugs and less likely to get involved in offending behaviour.”

Marriage reduces the risk of violence and abuse, and the CSJ states that marriage is more enduring and stable than just living together:

“Marriage is directly linked to better mental and physical health amongst adults, the same benefits are not found amongst co-habiting couples. It is specifically a marriage effect.”

This is very much a social justice issue. Better-off people get this; they get married in far greater numbers than poorer people. Poorer people do not marry as much, and therefore are the ones who sadly experience the consequences of breakdown that I have described. That is not social justice, and it is a key reason that we need to address this issue.

Those tragic, heartrending consequences for millions of young people surely cry out for Government to prioritise supporting all of us to build healthy, close personal relationships, just as no one now blinks when Government recommend that we should eat healthier so that our physical wellbeing is maintained and improved. The steps that we can learn for improving our close personal relationships are not that complicated—I will mention a few shortly—but the benefits we can all glean are unquantifiable. If we can strengthen our emotional wellbeing, we can help to protect our mental health. Not just children in school who are learning through relationships and sex education, but all of us who are learning about relationships capability, would benefit.

The term “relationships capability” has been given to me, and very well promoted, by the organisation Soulmates Academy. About two weeks ago, its founders came to speak at a meeting of the all-party parliamentary group for strengthening couple relationships and reducing inter-parental conflict. That organisation says that we have ignored investing in relationships at our peril. It provides courses and helpful advice on relationships capability to individuals and groups, as well as corporate organisations, which increasingly understand the beneficial effect of relationships capacity on productivity. As Soul- mates Academy says, building a stronger relationship need not be complicated; its relationship tips can be summarised as follows:

“BE CURIOUS, not critical…BE CAREFUL, not crushing... ASK, don’t assume…CONNECT, before you correct”.

I recommend its website for more information.

The Mental Health Foundation also provides tips for building and maintaining stronger relationships, which again can be summarised. It says that there are five things we can do: make more time to connect with our family; try to be present with them, not always on our phone; actively listen in a non-judgmental way; concentrate on the needs others are expressing; and express our own feelings honestly. It says:

“As a society and as individuals, we must urgently prioritise investing in building and maintaining good relationships and tackling the barriers to forming them. Failing to do so is equivalent to turning a blind eye to the impact of smoking and obesity on our health and wellbeing.”

People are with us. In a recent YouGov poll carried out for Relate, the relationships charity, no fewer than 99% of people agreed that strong and healthy couple relationships are important to a person’s physical and mental wellbeing—I am sure that any colleague in the House would love a poll that was 99% in their favour. That is why Government need to invest much more in helping all of us to develop our relationship capability. Supporting organisations such as Soulmates Academy to do so would be a good start during National Marriage Week. As that organisation says:

“If we agree that our committed, long-term personal relationships & marriages are actually what anchor us in life and allow us to go on to achieve our potential, what are we doing to invest in them and build skills to develop them?”

We need a national strategic approach to strengthening families. We have a dedicated Minister for loneliness; why not one for relationships? A coherent strategy across Departments, led by a dedicated Minister at Cabinet level, would be very helpful in ensuring that relationships and families were supported at all stages and ages in life, not just when they run into trouble.

Such a Cabinet Minister could promote all the other policies in the manifesto to strengthen families, including the development of family hubs in local communities where that kind of relationship help could be made available. I am pleased to say that those hubs are springing up in different areas across the country, and the launch of the family hubs network to connect the growing number of hubs in local authorities will happen in Parliament’s Jubilee Room on 5 June. I hope the Minister, all colleagues and all those who have come to listen to today’s debate will attend.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Thank you, Sir David. I am sure you do not want to listen to me until 4.30 pm; in fact, I know very well that you do not. It is a pleasure to be here with you this afternoon.

I have really enjoyed listening to this debate. There have been some compelling arguments on a subject that we do not really discuss very often, yet it is the foundation of our society. This debate is a welcome opportunity to do that. Certainly, listening to all hon. Members’ remarks, I was given considerable food for thought, so I shall do my best to address the points that were made. I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing the debate and on having the imagination to bring together National Marriage and Mental Health Awareness Weeks.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about who might have responded to the debate were it not for the reference to mental health, which is an interesting question. Various Departments have an interest, including the Department for Work and Pensions, the Department for Education where the issue affects children, my Department where it impacts on mental health, the Ministry of Justice where it might lead to offending behaviour and the Ministry of Housing, Communities and Local Government in so far as it might lead to addiction.

This all comes back to the state delivery of services and how it tends to rely on a uniform process, yet we are dealing with human beings. If they require support, a one-size-fits-all, tick-box approach will not necessarily be effective in all cases. To be honest, when we see people whose adverse childhood experiences have led them to harm either themselves or others, I view that as a state failure. Perhaps we ought to look at the drivers of child poverty and see whether we can ensure a more effective Government response. When I sit on various cross-departmental working parties looking at domestic violence, mental health or knife crime, I often think they could all be brought together to look more holistically at the children who need early intervention. We need to get much better at that.

Obviously, how we raise our children and family relationships are crucial to how they turn out. We know that for some people, particularly those living in poverty or with an addiction or those who suffer stress, life can be hard. It ought to be available to us to give people extra help. My hon. Friend the Member for Congleton referred to the troubled families programme in her opening remarks. The ethos behind the programme was to support the families that needed extra help. We need to learn from that programme to see what works best so that we can do things better. That is very much in our thinking.

My hon. Friend also talked about some of the initiatives that we are already taking with respect to mental health and highlighted the new mental health teams that we are creating. She suggested that the teams need to work not only in schools but in families. Sir David, you heard me speak about the Charles Dickens primary school in Southwark in another meeting. I visited it as we were developing our thinking on the new support teams, and it had taken a very imaginative approach to embedding mental wellbeing throughout the school and the curriculum. Instead of having teaching assistants in the classroom assisting, the teaching assistants were doing one-to-one interventions with children. As well as one-to-one tuition, some of them were involved in reaching out and building relationships with the parents. Our school network is exactly where we ought to be able to identify the people who need a little more help.

[Fiona Bruce]

I am delighted to hear that. I do not know whether the Minister has heard of a similar approach taken by Middlewich High School in my constituency, but what is excellent about that is that the school is now reporting improved GCSE results because it works not only with the pupil, but with the whole family.

[Jackie Doyle-Price]

As my hon. Friend says, it is not rocket science. If someone is physically, mentally and socially fit, they will have a feeling of wellbeing overall. If any of those pillars falls down, it drags down the rest. If people have a happy environment at home, they will be happier in school and more disciplined and focused. If they live in a dysfunctional environment, they will want to escape, and that will not be good for their GCSEs or anything to do with their long-term development.

[Fiona Bruce]

Will the Minister allow me to intervene again? I do not want to interrupt too many times.

[Jackie Doyle-Price]

We have plenty of time.

[Fiona Bruce]

Yes, so we have heard from Sir David. Corporates are also realising how important this is to the bottom line: productivity. If people arrive at work having left a happier home, they will be more productive, which is an interesting factor to consider if we multiply it across the nation. It is fascinating that we have one of the highest levels of family breakdown in the world, but also low productivity compared with many of our competitor countries. The Minister touches on that when she talks about the flourishing of a human being in terms of relationships and productivity, which are not disconnected.

[Jackie Doyle-Price]

That is a very good point. We can expect employers to start doing things when they can see a return for themselves. It is interesting also that, as we reach higher levels of employment and as an appropriately skilled workforce is harder to come by, employers see the advantage of giving more help and support to their staff in order to retain them and keep them productive. We look forward to seeing more of that. Certainly our work through “Thriving at Work” with Mind, Paul Farmer and Lord Stevenson is designed to share best practice and encourage more.

My hon. Friend also talked about the long waits for children’s mental health services, which the hon. Member for Worsley and Eccles South (Barbara Keeley) also talked about. We have to concede that, historically, children’s mental health services have been very poorly funded and supplied, and we are dealing with the aftermath of that now. Everyone knows the extent of our ambition to deliver much improved mental health services to children and young people. However, we still have to properly address the situation that we have inherited. We are playing catch-up, but we will push forward and make sure that children have access to services. The mental health support teams are the first point of contact for children, helping them look after their own wellbeing.

--- Later in debate ---

[Fiona Bruce]

I am sure, Sir David, that colleagues were relieved and impressed by your astute wisdom in announcing after I had spoken that the debate could continue for longer. I thank all hon. Members who spoke, and I particularly thank the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for South West Bedfordshire (Andrew Selous) for their thoughtful contributions. I was very pleased to hear the Minister respond in such a constructive way. Her tone, as well as her words, said a lot when she recognised both the impact of family relationships on mental health and the fact that more needs to be done.

I thank the Minister for not sticking to her notes, but instead responding so thoughtfully to so many of the comments that were made. As we have heard—it is a matter of social justice—there is a real need to put strengthening relationships at the heart of Government policy, nationally and locally, to provide joined-up support for families. As the Minister said, the troubled families initiative has started to do that.

As the Minister also said, we need to better support the many excellent voluntary organisations engaged in this area. Crucially, today we have also recognised the importance of marriage in helping to address the country’s major mental health problem. As Members have said, that is not in any way to criticise or condemn those whose home circumstances are different—far from it. We are saying that building relationship capability is for all of us, because we all aspire to have beneficial and flourishing relationships in our lives. We know their benefits.

I was particularly interested to hear the Minister say that because these issues straddle so many Government Departments, and because of the processes and the way that Departments work in silos, addressing them is quite a challenge. That is exactly why the proposal of a Cabinet Minister for the family, to draw together the work on such issues across Departments and support people more effectively, is so important. I close by saying that after the authoritative and compassionate speech that he gave today—it represented the tip of the iceberg of many years’ work on this issue—I cannot think of any hon. Member who would better fill that role than my hon. Friend the Member for South West Bedfordshire; I hope the Minister will forgive me for saying so.

Question put and agreed to.

Resolved,

That this House has considered National Marriage and Mental Health Awareness Weeks.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 26th March 2019 Commons Chamber

[Caroline Dinenage]

The Government take this very seriously. The NHS long-term plan sets out priorities for the NHS, and deaths from respiratory disease is a key indicator and an absolute priority. However, it is only right that people who can afford to pay for their prescriptions, like me—I am an asthma sufferer and I can afford to do it—do so. Local areas have to decide those priorities. At the moment, 90% of prescriptions are free.

[Fiona Bruce (Congleton) (Con)]

Can Ministers outline the latest steps to support the children of alcohol-dependent parents? In the forthcoming alcohol strategies, will greater support be promoted for the families of alcoholics, who are often best placed to help to reduce alcohol harm in their loved ones?

[Matt Hancock]

Absolutely. My hon. Friend is right to stress the role of families in supporting the children of alcoholics. We made progress on that and were able to announce funding just last week. I pay tribute to my hon. Friend the Member for Winchester (Steve Brine) for all his work—I enjoyed doing it with him—to do everything we can to support the children of alcoholics.

Community Hospitals

Fiona Bruce Excerpts

Tuesday 12th March 2019 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I was pleased to note that on announcing his long-term plan for the NHS, the Secretary of State for Health and Social Care said he is a strong supporter of community hospitals, so I am today asking if Health Ministers will kindly look into how some of the additional resources announced with the long-term plan can be earmarked for the community care provided by community hospitals, such as the much loved Congleton War Memorial Hospital in my constituency.

Congleton Hospital needs sufficient resources to ensure that it can continue to provide the all-round services it has already provided for several generations of my constituents for generations to come. The hospital is much valued locally, providing a range of services, such as the minor injuries unit, which saves residents travelling some distance to hospitals further afield with A&E facilities. Minor injuries such as burns, cuts, splinters and sprains can be treated quickly and efficiently at Congleton. As one person, who sustained a hand injury, told me:

“I popped down to Congleton Hospital, the wound was treated straight away and I was back at work within the hour.”

That person would have lost at least half a day’s work travelling for treatment elsewhere.

In recent winters, the minor injuries unit has, on occasion, been closed temporarily by East Cheshire NHS Trust, with staff redeployed to Macclesfield’s A&E. Then, in September 2018, the trust stated that it expected closures to be in place throughout weekends and bank holidays, plus ad hoc weekdays, throughout this winter. As a result, the minor injuries unit is currently scheduled to open only between 9 am and 5 pm from Monday to Friday, but with additional ad hoc closures within these hours. It was not open, for example, when I visited last Friday afternoon.

It is therefore not surprising that some people in need of urgent treatment decide not to risk calling at a unit that may be closed unpredictably, with user numbers no doubt affected accordingly. It is also understandable that these closures are causing grave concern among local people. On their behalf, I am calling on Ministers to ensure, please, that resources are put in place so that valuable community hospital facilities such as Congleton Hospital’s minor injuries unit are not only stabilised but strengthened.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this issue to the Chamber. I spoke to her beforehand to ask what her thoughts were on this issue and how I might helpfully intervene. I spoke to the Minister, too. In the past few weeks, the national and provincial press have highlighted a number of incidents in hospitals. They report NHS staff referring to “war zone” conditions in A&Es. The community hospitals the hon. Lady refers to are vital for the treatment of patients, but it is also good for the mental health of NHS staff to have hospitals where they can do their job—their duty—without facing any injury or threat to their life.

--- Later in debate ---

[Fiona Bruce]

The hon. Gentleman is right, as he so often is. Where they are properly resourced, minor injuries units can help relieve A&E facilities and enable them to treat more serious injuries more efficiently.

More broadly, the wide range of local healthcare services at Congleton Hospital includes a 28-bed in-patient intermediate care ward called the Aston unit, which is particularly appreciated by local families visiting patients. As the hospital’s website states, that unit helps those who no longer need the more acute wards of Macclesfield District General Hospital, relieves services there and allows people to

“recover in a homely and relaxed environment”

in Congleton. The website adds that the hospital

“has a very ‘family’ feel about it.”

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

The hon. Lady is making a wonderful point about the value of community hospitals. In north Staffordshire, Bradwell Hospital, Haywood Hospital and Leek Hospital all provide excellent care, but my clinical commissioning group is consulting on closing those hospitals and reducing bed spaces. Does she agree that closing community hospitals is detrimental to the overall impact of our health economy? Exactly as she says, such hospitals free up more expensive acute beds in the big hospitals and allow people who are medically fit for discharge but are not ready to go home to get the care they need.

[Fiona Bruce]

I am sure the Minister will have heard what the hon. Gentleman has said. Indeed, that is why I entitled the debate “Community Hospitals” rather than simply “Congleton Community Hospital”.

As I have said, the hospital at Congleton has a family feel. I can testify to that following my most recent visit, just last week. I met kindly nursing staff who were clearly dedicated and committed to serving the community in and around Congleton, and who were proud to tell me that they had, through sound management, recently achieved an increase in the number of in-patients treated. About 350 are currently cared for each year in the Aston unit.

In addition to the minor injuries unit and in-patient care facilities, the hospital provides out-patient clinics, with approximately 9,000 out-patient attendances each year in a wide range of specialties. For instance, there are about 1,600 appointments a year for adult audiology treatment and about 1,000 for general surgery, and a similar number of gynaecology treatments. There are also about 2,000 trauma and orthopaedic appointments. Other services include blood tests, occupational therapy, a physiotherapy gym, district nursing, dementia services, and a highly popular GP out-of-hours service.

[James Heappey (Wells) (Con)]

In my constituency, Burnham On Sea War Memorial Hospital, West Mendip Community Hospital and Shepton Mallet Community Hospital do so much of the great work that my hon. Friend is describing. Does she agree that in areas where the main hospitals are somewhat distant—in my case, Bristol, Yeovil, Taunton or Bath—community hospitals are vital in filling that gap, and it is essential for them to remain a core part of our future NHS?

[Fiona Bruce]

My hon. Friend has made one of my points for me. None of the major hospitals in east Cheshire lie within my constituency, although it is reasonably large, so my constituents must travel some distance to use their services.

I have mentioned the four-hour GP appointments on Saturdays and Sundays. They are always full, and are meeting a very clear local need. The convenience of such services cannot be overstated. During my visit, an elderly gentleman, clearly frail, arrived asking for directions to the X-ray department. I watched as he was directed to it immediately. He was seen, and he departed. All that happened within what seemed to me to be about three minutes flat.

The value of such local services for a population like mine, which contains a higher than average number of older residents, cannot be overstated. They are particularly appreciated by those who are less mobile owing to age or infirmity, or for whom a lack of convenient public transport facilities would make travel to the larger hospitals outside my constituency very difficult, if not impossible. Moreover, 9,000 fewer out-patient appointments across east Cheshire must reduce congestion.

The trust informs me that the Congleton Hospital site also has space for use by other NHS organisations, including providers of mental health and health visiting services. As local health partners and providers increasingly work together in support of their local communities’ health and wellbeing, Congleton Hospital, located as it is almost in the centre of the town, is ideally placed to become an even more strategic community health hub for additional services.

[Karin Smyth (Bristol South) (Lab)]

The hon. Lady is making a powerful speech on behalf of community hospitals. South Bristol Community Hospital was opened only in 2012, after 60 years of campaigning by local people. As three providers run different services in it and as it is a LIFT building, no one is really responsible for making it work. Does the hon. Lady agree that the health service must bear in mind that such hospitals are developed and fundamentally loved by their communities, and that those communities should have the ultimate say in what goes into them?

[Fiona Bruce]

The hon. Lady is absolutely right. Indeed, members of the community in Congleton are speaking out about the importance to them of their community hospital. I shall say more about that shortly.

On behalf of my constituents, I am pressing Ministers to consider resourcing Congleton Hospital as a community hub going forward. It has a very special place in local people’s hearts, as I have said, not least because of the manner in which it was funded many decades ago by local people’s contributions from wage packet deductions. It was founded in 1924 by public subscription as a memorial to those locally who gave their lives in the first world war, hence its full name: Congleton War Memorial Hospital. I spoke at greater length about this here in this place in 2014, when I raised concerns about the future sustainability of the hospital, so this is by no means a new issue. Indeed, in 1962 when there was a suggestion that the hospital be closed, it resulted in a mass meeting in the town hall with an overflow of some 2,000 residents, presided over by the then mayor leading to a petition of 24,000 signatures. Plans were quickly dropped. More recently, the £20 billion additional funding announced by the Prime Minister for investment in the NHS surely offers an opportunity for the future of the hospital to be secured, or even augmented as a community hub for the long term.

I have been in continuing dialogue for some months now with—and have met, together with local councillors—John Wilbraham, chief executive of the local NHS trust responsible for the management of the hospital, the East Cheshire NHS Trust. I am grateful to Mr Wilbraham for that open dialogue. We spoke again recently when he confirmed that, in his words, the sustainability of the site is on the agenda for the transformation programme to be discussed by the trust shortly. So also on the agenda is the future of the minor injuries unit, which is, as I have mentioned, causing particular concern to residents, as the trust is aware from recent public demonstrations which involved people from right across the community and political divides, including me and Congleton town mayor Suzie Akers Smith, who was in full mayoral regalia and chain.

I am grateful that Mr. Wilbraham has agreed to meet a cross-party group in the town shortly to discuss the hospital’s future further and look forward to that meeting. In the meantime, for the record I note that in his most recent letter to me of late December 2018 he confirmed, and I welcome this, that

“the Trust has no plans to change the service provision at the Congleton Hospital site and this remains the case. I continue to discuss with health and social care partners about the service offer from the hospital site and I understand the desire of you and the local population to maintain the facility. We await the publication of the NHS 10-Year Plan in early 2019 which provides the basis for the local health partners, including the town’s GPs, to set out its plans for the next 5-10 years. I am certain this will provide the opportunity to be clear on future service provision across the local health economy including Congleton.”

I am optimistic that both Mr. Wilbraham, as its chief executive, and the trust itself have listening ears. We need only witness the furore that arose in Congleton three years ago when there was a suggestion that car-parking charges be introduced at the hospital. The trust clearly registered the indignation of local residents, not least through a petition I presented here in Parliament at that time. That they could be asked to pay to park at their own hospital—a hospital they and their forebears had paid for by both wage packet deduction and subsequent fundraising and donations over the decades—aroused considerable consternation. The trust subsequently discounted the suggestion of car park charges outright; it listened to local people’s concerns.

I was pleased to note the chief executive’s reconfirmation of this in his most recent letter to me, with the words:

“I note the suggestion of car parking charges being introduced to supplement the income for the hospital site but this is not something the Board will be considering.”

Now that the 10-year plan has been published, and in the light of the Secretary of State’s indication of his support for community hospitals, I am today asking the Minister what more can be done to ensure that vital services provided by community hospitals in the heart of our local communities, like Congleton, are not swallowed up by larger hospitals at a distance. What the Congleton community seeks is reassurance that the future of Congleton hospital is put on a firm, clear and sustainable footing going forward, so that the periodic recurring concerns over the years about its future can be fully and finally put to rest.

Mental Capacity (Amendment) Bill [Lords]

Fiona Bruce Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

There is still much to do to improve this deeply flawed Bill. I hope that the Minister and other hon. Members will take this opportunity today to improve the Bill by passing our amendments so that we can improve the safeguards for vulnerable people.

[Fiona Bruce (Congleton) (Con)]

I rise to support the Bill and, in particular, to speak in favour of Government amendments 24 and 33.

Before I do so, let me respond to some of the points that have already been made. First, with regard to the timescale in which the Bill is being taken forward, there has been plenty of opportunity for colleagues to look at its details. I draw Members’ attention to the fact that there have been not just one but two detailed reports on this issue by the Joint Committee on Human Rights, one in June 2018—our seventh report of this Session—and then, in October 2018, our 12th report, in which we considered the draft Bill in some considerable detail. At that point, we welcomed the recommendations of the Law Commission. Of course, the Law Commission had itself been some three years in preparing its recommendations, so the Bill can hardly be described as rushed.

[Steve McCabe]

Does the hon. Lady recognise that the Law Commission objects to the fact that its recommendations were not taken up by the Government when they constructed the Bill?

[Fiona Bruce]

I was about to say that the Joint Committee welcomed the Law Commission’s recommendations because they clearly highlighted the need for changes to be made.

As we pointed out in our seventh report, as far back as last June, the Cheshire West case that the Minister mentioned had resulted in a 10-fold increase in the number of DoLS applications. That is why there has been such a backlog. That case placed extreme pressure on local authority resources. Some 70% of the almost 220,000 applications for DoLS authorisations in the year up to our report were not authorised within the statutory timeframe. Consequently, many incapacitated people continued to be deprived of their liberty unlawfully. Those responsible for their care, or for obtaining authorisations, were having to work out how best to break the law. That is completely unacceptable, and it is why this Bill needs to brought forward in a timely way.

There also needs to be, as the Committee recommended in our 12th report, a definition in the Bill. I hear colleagues’ reservations about that definition, but, as we said—I am glad that the Government took up our recommendation—that it is important to give cared-for people and their families, and professionals, greater certainty about the parameters of any scheme so that we can ensure that scrutiny and necessary resources are directed where needed. We said:

“It is undeniable that any definition in statute may be refined by future case law”.

That remains that case. None the less, not to have endeavoured to provide a definition would, we believe, have been wrong.

Having made those preliminary comments, I will speak in more detail about amendment 24 and expand on the remarks made about the importance of family engagement and keeping the family informed. Information for the family and those who care deeply about the welfare of the person is the cared-for person’s greatest safeguard against exploitation and bad care. It is paramount that families have a role to play in their relatives’ care planning, wherever that is desired by the cared-for person, not least by giving them the option to stay fully informed and to object to proposed plans if they are not satisfied.

Families can play an important role in monitoring care if they are given sufficient information. The care itself is important. The quality of care will vary between and within care homes, but monitoring the care plan is essential to ensure that the cared-for person’s dignity is maintained. The cared-for person’s quality of life depends on how they are treated day in, day out and whether they receive care in a way that enhances their personal dignity or whether, sadly, they are treated less well.

Families are well equipped to monitor care, but only if they are kept informed. That is why I support amendment 24, which improves access to information for the cared-for person and their appropriate carers and supporters, which may well include their family. The requirement for information to be

“accessible to, and appropriate to the needs of, cared-for persons and appropriate persons”,

means that the cared-for person is placed at the heart of the liberty protection safeguards authorisation process. Not only that, but now that relatives can be informed about their loved one’s care plan, they will notice if the plan states something that is not happening and question why.

I am pleased to see that the amendment requires the publication of information on the cared-for person’s rights and the circumstances in which it might be appropriate to request a review or make an application to the court. People must know what their rights are and the legal procedures. This will not be costly. It will certainly be far less costly than the court cases that are likely to come if the requirement to provide information about all aspects of the process and the plan are not on the face of the Bill. It will save costs in the long term and ensure that the approved mental capacity professionals act always as they should.

The code of practice will play an important role. It would be helpful to see examples of family members working with the responsible bodies and the care teams to ensure that care plans are being delivered appropriately and are in the best interests of cared-for individuals. I am sure we all want to see that.

I turn to amendment 33. In the JCHR’s 12th report, we indicated that there has been concern as to

“whether care home managers have the necessary skills and knowledge to arrange or undertake the assessments and whether they are sufficiently independent to do so”

and whether care home managers are

“trained and resourced to take on these additional responsibilities.”

It is heartening to hear that the Government have listened and are clearly stating that care home managers and staff should not, and under these proposals will not, complete assessments. It is equally heartening that the Government, having listened to concerns expressed in Committee, are saying that all those doing such assessments must have the necessary skills, knowledge and qualifications—for example, as physicians, nurses or social workers—and that that will be specified in regulations. I want Ministers to put in place appropriate arrangements to assess whether implementation of this element of the Bill is working well—for example, to ensure that specifications of required qualifications and the experience of assessors are kept updated and that the revised system is working well and without difficulty in practice.

Ministers might consider taking up the recommendation in the JCHR’s 12th report that particular vigilance should be exercised by local authorities where care homes are rated by the CQC through an inspection as inadequate or requiring improvement, to ensure that those who are making referrals are properly competent to do so.

--- Later in debate ---

[Fiona Bruce]

The hon. Gentleman keeps talking about human rights, but what answer does he have for the fact that up to 125,000 people are currently being unlawfully deprived of their liberty, in breach of article 5 of the European convention on human rights? That is the problem that the Bill seeks to rectify.

[Mr Dhesi]

I thank the hon. Lady for her intervention, but in terms of human rights, this issue is being raised not just by me, but by more than 100 pre-eminent organisations in the field. The only way to solve that is through funding—that is the only way in which we can lay this matter to rest. The hon. Lady highlighted the 2017 Law Commission review of the deprivation of liberty safeguards, which stated that the current regime is

“in crisis and needs to be overhauled.”

I agree. There is a crisis and the current system cannot cope, but surely the answer is not to replace bad laws with yet more bad laws, and that is what we are in danger of doing.

Early Parenthood: Supporting Fathers

Fiona Bruce Excerpts

Wednesday 30th January 2019 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

Dads are good for lads—I know, because I have two boys—if only because they can share the interest of football. More seriously, it is true that fathers are good for sons in many ways. Anything we can do to support that relationship—and by we I mean the Government—we should do. I echo the respect expressed by others, which I share, for the Herculean task that single parents—most frequently, mums—do to bring up their children. Where we can, we need to look at how we can strengthen family relationships in a society where, today, over a quarter of children live with mum but not dad. More than one in seven are born into homes where there is no dad present.

The implications of that are serious; I will share a couple of sad statistics. The lack of a good male role model in young men’s lives is helping to lure them into substitute families: gangs. Apparently, most of the 50,000 or so young people caught up in county lines activities have come from homes where there has been no good male role model. Similarly, 60% of the sons of men in prison are likely to end up in prison, too. That statistic is even worse if both the father and a brother are in prison—it is then a 90% likelihood.

Those are staggering statistics that show why it is so important that we and the Government try to support families more. That support is positive for children and for the wider community.

[Eddie Hughes (Walsall North) (Con)]

I hope that later on in her speech my hon. Friend will refer to “A Manifesto to Strengthen Families”, which I believe has been endorsed by more than 60 MPs and has been available to Government for over a year now. It would be good to see some of its policies championed by Government.

[Fiona Bruce]

My hon. Friend makes an excellent point and I will indeed refer to it.

My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who introduced the debate so well, referred to a CSJ report from this year. Another CSJ report, “Every Family Matters”, which was produced as long ago as July 2009, said very similar things, such as the importance of strengthening families and of having a good, strong input into a child’s life. Yet I have here an interesting statistic: 43% of unmarried parents split up before a child’s fifth birthday, but only 8% of married parents do. That is an interesting factor for us to consider: if we are looking at strengthening family life, we should not forget that supporting marriage is part of that.

Sadly, the UK has one of the highest rates of family breakdown among the 30 OECD countries. Just two thirds of children aged nought to 14 live with both parents. In the OECD countries overall, 84% of children of those ages live with both parents. Very interesting work is being done on the link between those factors and British productivity, which is 18% below the OECD average.

[Tim Loughton]

I admire my hon. Friend’s determination to promote marriage, but I must give a plug for my private Member’s Bill on civil partnerships, which, if it passes through the Lords, will make civil partnerships available for opposite sex couples by the end of this year. They would be an additional incentive for those couples to stay together, as overseas statistics show, particularly for the good of the children.

[Fiona Bruce]

It is so important that we do what we can. In the very short time that I have left, I will touch on some of the practical policies in “A Manifesto to Strengthen Families”, which more than 60 Members of Parliament support, and express a degree of frustration that the Government have not taken them up more practically. I know that individual Cabinet Ministers are very interested, but in order to see some real progress we need a senior Cabinet-level Minister who is responsible for drawing together the manifesto’s several policies.

I will touch on some of the manifesto’s policies on fathers. Policies 8, 9 and 11 talk about promoting the importance of active fatherhood in a child’s life. Policy 8 says:

“Maternity services should maximise opportunities to draw fathers-to-be in early.”

Policy 9 proposes that, where appropriate,

“The Government should…require all fathers to be included on birth certificates.”

Policy 11 proposes that “high quality marriage preparation” should be available at a cost-effective rate for young people thinking of getting married.

Finally, one of our key policies is the promotion of family hubs. As we have heard, children’s centres are not always as effective as they need to be. Families need support bringing up children, not just aged nought to five, but nought to 19. In the teenage years particularly, the input by fathers into their sons’ lives is often critical. We believe that it would be really positive to have family hubs in each local community, to support families at every stage of a child’s development.

I am disappointed that the Government have not taken that up more strongly. We shall continue to persevere and to press them to do so. The good news is that many local authorities have taken up those ideas very strongly and family hubs are springing up across the country. I invite colleagues to a family hubs fair, which will take place on 14 February. It is convened by Westminster City Council, which is setting up its own family hubs. The fair will flagship best practice from local authorities across the country that have set up family hubs, specifically to show how we can best support families with children. I am sure that there will be many examples of how we can best support fathers to engage in their sons’ lives, which is such an important thing on which we need to focus.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I have enjoyed listening to everyone’s contributions this morning. It is often said that MPs do not live in the real world, but we have heard some frank accounts this morning that very much prove that we do; we do share those experiences. I am proud of my hon. Friends who have been raw in their accounts of fatherhood. I hope that my hon. Friend the Member for Moray (Douglas Ross) has not been put off by any of the things he has heard today.

The tone for the honest and frank accounts was set by the opening comments by my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who was characteristically honest in her expositions. I am grateful to her for obtaining this debate. It is time that we gave a big shout-out to dads.

The hon. Member for Ealing Central and Acton (Dr Huq), who is no longer in her place, mentioned the 400,000 single-parent families headed by dads. My partner was one of those 400,000; he raised his son alone for the first 10 years of his son’s life. It is often challenging for single dads, as things are focused on the mums. When he first started taking George to primary school, he was viewed as a bit of a curiosity by the mums and the teachers. A lot of low-level discrimination takes place towards dads in those circumstances, which we ought to be more alive to. That is probably symptomatic of discrimination towards dads. We have heard frankly today that it is all about the mum and the baby, and that the dad is a spare part. My hon. Friend the Member for East Renfrewshire (Paul Masterton) described driving home, having gone through the trauma of childbirth, and asking, “What happens now?”, then not being able to visit mum the next morning. Collectively, society needs to be a lot more understanding and welcoming of the father’s role in those early days, weeks and months, not least because it gives children the best possible start in life if dad is fully engaged.

We know that now, more than ever. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) is my conscience on these issues. He constantly emphasises to me that good-quality relationships are critical for every member of the family. He is absolutely right. Where society can bolster that, obviously we should take those steps. He has highlighted some things for me to look at, and I assure him that I will.

Childbirth and parenthood is life-changing and my hon. Friends have shared their experiences to illuminate that. Having support from a father as well as a mother is extremely important. We know that there are very real barriers to that involvement, including the pressures of work, which a number of colleagues have alluded to, particularly where employers in particular fields of employment are less than understanding about the fact that family is dad’s work as well as mum’s. That is something that we need to tackle. We have mentioned that services are not always tailored to dad’s needs as well as those of mums.

There is a general lack of information. A life-changing thing happens, and people are kind of expected just to suck it up and go along with it. It can be extremely challenging and scary, so we need to be more understanding of that. We also need to be cognisant of the fact that it is the time of most acute stress and strain on relationships. It is probably the riskiest time for relationship breakdown. We need to make sure that wraparound support is available to dads who need it.

I would like to say that I was satisfied with progress. It is true that progress is being made, but the debate, and the research that has been mentioned, show that we need to do more. Among the things that we are putting in place and expect to deliver, our first steps clearly need to be in maternity services. We believe that they should do more to maximise fathers’ involvement, at a time that clearly offers the most important opportunity to engage them in the care of their partner and the upbringing of their children. I can tell my hon. Friends who did not have that experience that we have invested £37 million to support the involvement of fathers in labour and post-natal units, including en suite rooms and double beds adjacent to maternity wards. Clearly, that would be a much better experience for new fathers, and we will make sure that that arrangement is rolled out more and more. National Institute for Health and Care Excellence guidance states that women, their partners and their families should always be treated with kindness, respect and dignity. We need to make sure that that is done properly. Scrutiny will be through Care Quality Commission inspections, which will be designed to ensure that maternity services deliver what we expect.

Interestingly, according to CQC’s survey of women’s experience of maternity care, 96% of women said that their partner was able to be involved as much as they wanted during labour and birth. Clearly that is not consistent with the figures that we heard today, but the explanation is probably that the question was asked of mums rather than dads. It illustrates what has been said about feeling like a spare part. My hon. Friends have been honest about their emotions at the time in question, and we know that men are not always frank in exposing their emotions. What the survey tells me is that a mum does not always know that the dad feels completely useless and like a spare part. That tells us that we have an issue to tackle. Seventy-one per cent. of women said that their partner or companion was able to stay in hospital with them as much as they wanted, but that is not borne out by the feedback today. My message going out to the health services is that in addition to inspections and standards there needs to be much more sensitivity and leadership, to make sure that dads are properly considered during such an important period.

I constantly challenge the instinctive prejudice within the system to spend the considerable amount of resource that the Government make available to the NHS on clinicians and clinical support, when we know that wraparound services, as often provided by the voluntary sector, are complementary to the services given by health professionals. When we are talking about supporting families and giving children the best start in life, the voluntary sector can obviously play a part. We have heard good examples of that today.

To move the subject on from birth to early parenthood, children clearly do better when both their parents are involved in their life. Where relationships are less strong, there is a risk of poorer outcomes in the long run, as we have heard today. The quality of fathers’ involvement matters more than the quantity of time they spend with their children and partner. We need to champion those who support their partners, which is facilitated by a father’s bonding with their baby or young child. When a father is an active parent, the secure attachment that is built as a consequence makes a big difference to the child as they develop their own relationships and resilience; it leads to better outcomes in life. For fathers it can be a positive experience, often helping them to re-engage with education, employment or training, and altering their outlook on life. My hon. Friend the Member for Chatham and Aylesford shared the experience of her partner’s doing exactly that.

How can we best support fathers in doing what I have described and exploring how to have the most satisfactory parenting experience? I see health visitors as our army in doing that. We have clear expectations about their work with new families. They keep an eye on them, with a view to getting the best outcomes for children and making sure that the family environment is secure. I see health visitors in that way because they often build a less formal and deferential, and more trusting, relationship with the new family. Often they are the only person who interacts with the dad. We shall be expecting health visitors to do much more to support fathers in the early months and years of a child’s life. We expect them to work to ensure that fathers are part of the holistic assessment of family fitness.

Where possible, both parents should be included in health reviews. I have heard the messages from various Members who said that that was not their experience, and we shall give a clear set of messages to the system about addressing that. Such an approach can only boost the chances of intervening early and getting proper support for the mother, the child and the father when it is needed. In doing my job I have been moved by health visitors’ accounts. We know that post-birth is a challenging time for mums, when they are most at risk of poor mental health. The feelings of isolation and helplessness on dads’ part in those circumstances are extremely difficult, and health visitors are incredibly well placed to provide support then, and steer them towards additional help.

[Fiona Bruce]

Will that encouragement of fathers include the time before the birth? As I understand matters—this is from CSJ—only about a third of fathers with a household income below £20,000 attend antenatal classes, compared with two thirds of those who are better off. One inhibiting factor is that if people cannot get a free antenatal class, a three-day course costs about £350. That is a lot of money for those who are already financially stretched.

[Jackie Doyle-Price]

The package of support that we are putting together, in terms of the continuity of carer, starts before birth and is designed to involve both parents. We are aware that there will be constraints on individuals’ ability to participate, and we need to make sure that the system is cognisant and respectful of that, and that it can make the relevant changes. My hon. Friend’s point is well made.

We need to promote initiatives such as Offload—a Warrington project for men aged 18 and over, in collaboration with rugby league. It helps men to learn the mental fitness techniques of professional sports players, to understand their own needs and help them cope. Such initiatives will enable new dads—because there is an issue with men facing up to mental health challenges—to reach out and get support from their peers.

The hon. Member for Ogmore (Chris Elmore), who is no longer in his place, raised the issue of loneliness, and my hon. Friend the Member for Chatham and Aylesford has done a great deal of work on that. Every father and family will have their own individual story. There is nothing like a life-changing experience to make one feel lonely, because all the familiar support networks are thrown in the air. We will expand social prescribing across healthcare services, so that all GPs can refer lonely patients to voluntary and community organisations. I reiterate that there is a role for the commissioning of the voluntary sector to do important work leading to better health outcomes. We will support spaces for community use, working with local groups to pilot ways to use space, to test how that can improve social connections. We need to make sure that we are keeping our eyes open for signs of loneliness, so that trusted support is given early.

In the short time I have left, I want to go further into the topic of mental health. Colleagues mentioned that 10% of fathers suffer mental ill health at the time of a child’s birth. We need to do more to support them. The “DadPack” used in Cornwall to help young fathers is a great development, and I want to champion all such models. I thank colleagues for the examples they have given.

We have had an excellent debate. It is only the start of our trying to do better at supporting dads and young families. I look forward to engaging with hon. Members on this important issue.

Question put and agreed to.

Resolved,

That this House has considered supporting fathers in early parenthood.

Children with Life-limiting Conditions

Fiona Bruce Excerpts

Tuesday 29th January 2019 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

It is humbling to follow the hon. Member for Swansea East (Carolyn Harris). I want to put on record my respect for her campaigning on this and other issues, and for my constituency neighbour and hon. Friend the Member for Eddisbury (Antoinette Sandbach).

I commend the work of the Donna Louise Children’s Hospice in Stoke-on-Trent, which provides children’s and young people’s hospice services across Staffordshire and south-east Cheshire. It has written to me this week—given that time is short, I will pass the Minister a copy of the letter after the debate. It talks about the quality of palliative care as patchy:

“The way in which NHS CCGs and local authorities plan, fund and monitor children’s palliative care in hospitals, children’s hospices and the community represents”—

as we have heard—

“a postcode lottery. Staffordshire has no coherent plan and this is reflected in the poor financial support the Hospice receives from local commissioners. Donna Louise receives 8.9% of its income from the NHS”.

The hospice calls on the Government and NHS England

“to consider appropriate mechanisms to bridge the children’s palliative care accountability gap.”

I want to spend most of my speech talking about an issue that I know is uncomfortable for some people to hear about. For that reason, I am delighted that you are in the Chair, Ms Dorries, because you have spoken about this issue on a number of occasions. Many families face a difficult decision when a child in the womb is diagnosed with a life-limiting or life-threatening condition. This is not a small issue: in 2017 there were a total of 3,314 ground E abortions on the grounds that the child was diagnosed with a substantial risk that, if born, they would suffer from physical or mental abnormalities, such as being seriously handicapped. Parents have to make really agonising decisions.

A few years ago, I held an inquiry in this place on the difficult situations that parents face when their child is diagnosed in this way and they have to consider an abortion. We took evidence from dozens of witnesses. Some had come under huge pressure to have an abortion, and the support they were given to consider keeping their baby was very limited. Many told us that they were steered towards an abortion, and they felt like the medical profession was irritated by them. Many felt like they were given no information on the support they might get; often the best information they got was through contacting charities, which could put them in touch with parents who were bringing up children—often very successfully. Those children brought great joy to their families, but the medical professionals did not give the families the information they needed to make a decision that was right for them. Some told us that all they received was a leaflet telling them how to have an abortion. The mothers who had kept their children, even if it was for a very short time, felt like they could grieve and care for their children in a way they had not been able to do otherwise. One mother had to have an abortion with her first baby and then decided she would keep the second, even though she knew the condition was life-limiting. She felt like there was a much better outcome for her and her family’s going through the grieving process.

The inquiry made a series of recommendations—I will pass a copy to the Minister because time is very short. I hope she will consider them and respond to me. Many people generally find this issue a very difficult one to address, as do—I am sorry to say—Ministers. Many of the recommendations in that report, which was published a few years ago, are still valid today. We recommended that guidelines for the medical profession should include training for obstetricians, foetal medicine specialists and midwives on the practical realities of the lives of children who have such conditions, so that they can better advise parents and give them better information when they make this difficult decision. One parent summarised what many others reported:

“Guidelines and standards need to be set in place”

so that all hospitals can meet a certain standard. Can the Minister assure me that she will look at our report and perhaps produce guidance to ensure that all mothers feel like they can make a genuinely informed decision when they are carrying a baby with a life-limiting condition? Does she agree that we ought to provide much better information, so that parents in such circumstances can make an informed choice?

[Ms Nadine Dorries (in the Chair)]

I am afraid that I will now have to put a formal time limit of four minutes on Back-Bench speeches.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 8th May 2018 Commons Chamber

[Jackie Doyle-Price]

The right hon. Gentleman rightly identifies problem gambling as another important contributory factor to mental ill health. When it gets out of hand, it can lead to considerable stress. We will of course work with the Department for Digital, Culture Media and Sport to ensure that we have the right regulatory processes in place, as well as ensuring that we are giving support to those who need it.

[Fiona Bruce (Congleton) (Con)]

Does the Minister agree that, when children and young people have mental health challenges, it is important wherever possible to engage with their families to help them to overcome them?

[Jackie Doyle-Price]

What my hon. Friend says is self-evidently true. We are putting in more help in schools through the Green Paper, but we also need to ensure that we are engaged with families much earlier than that. We have the health visitor programme, and those visits help to build relationships with parents. We have also taken action on specific issues, including the initiative relating to the children of alcoholics. We will continue to focus support where it is needed.

Breast Cancer Screening

Fiona Bruce Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

My hon. Friend may well be right that we need to do that, but what I would like to do first is to see the outcome of this review, what the lessons are and what precisely it says about the quality assurance that applied in this case, and then make a judgment about the implications for the rest of the NHS.

[Fiona Bruce (Congleton) (Con)]

I thank the Secretary of State for the genuine personal concern that he has shown today and for his determination to get to the bottom of the matter. Will he continue to keep the House and, more importantly, the public and any women affected informed as further information comes to light?

[Mr Hunt]

Yes, I am happy to give that assurance. The number of people affected is only an estimate at the moment, but there will obviously be great interest in the House and in the country in what the actual number ends up being.

Surgical Mesh

Fiona Bruce Excerpts

Thursday 19th April 2018 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I echo the comments of many hon. Members and express my deep concern for all women who have experienced debilitating and sometimes severe pain and discomfort following the use of vaginal mesh. In all our considerations of the use of such devices, their health, safety and wellbeing must be our first concern.

I welcome the Government’s recent announcements of Baroness Cumberlege’s review of the use of vaginal mesh and two other areas of medical safety—the use of valproate and Primodos. I was in the Chamber when the Secretary of State for Health announced that review on 21 February and I could tell from the tone of his announcement, not just the content, that he personally cares very greatly about the women affected by this issue. He wants to ensure that lessons are learned wherever possible, so that care can improve to ensure that each woman gets the treatment that is right for her—the best that can be provided for her as an individual. I am sure that the Minister shares that view.

The Secretary of State said:

“It is an essential principle of patient safety that the regulatory environment gives sufficient voice to legitimate concerns reported by patients, families and campaigners, works alongside them and responds in a rapid, open and compassionate way to resolve issues when these are raised.”—[Official Report, 21 February 2018; Vol. 636, c. 166.]

Ministers want to ensure that we do better in future where necessary, and to ensure that patient voices are brought to the table. I support the review and I want to ensure that justice is done for all women who have concerns about the use of vaginal mesh. We need to ensure that we maintain public confidence.

[Chris Elmore (Ogmore) (Lab)]

On the hon. Lady’s comments about justice being done, I have been approached by two constituents who have been greatly affected by vaginal mesh. One of them is unable to work. She has to be lifted up to walk as she cannot stand by herself, so she needs carers. Does the hon. Lady agree that in many cases it is not only justice that is needed, but compensation? As the Chair of the Health Committee said, we need to start looking at compensation for some women. My constituent is in her early 50s and can no longer work.

[Fiona Bruce]

That is something that I have said not only about this issue, but about the use of valproate. It is important that we pay close attention to the experiences and difficulties that patients have endured. We need to be more open to learning what we can from their experiences, making changes where necessary and—as the hon. Gentleman says—examining where compensation should be sought for them.

Baroness Cumberlege has been instructed to look comprehensively at the whole issue. The Government want to listen. We have all seen examples in which people have appeared to listen to concerns, nodded their heads and then gone away and done nothing. That is not what is happening here. I believe that the Secretary of State and Ministers not only want to listen carefully to concerns on this issue, but stand ready to act appropriately. For that reason, I think the proposal in the motion for a full public inquiry is inappropriate at this stage. We need to give time for Baroness Cumberlege to report. We need to urge that that be done urgently, and we need to ask Ministers questions.

I have some questions of my own for the Minister. What is the timescale for the review and what progress has been made already? Does the Minister agree that introducing an outright ban would be inappropriate before the review? Can she assure the House that the new NICE guidelines which recommend against first use of the surgical mesh to treat pelvic organ prolapse are being carefully followed throughout the NHS? Is it correct that in the vast majority of instances the use of surgical mesh has proven to be an effective intervention that has enabled many women to live happily and independently after surgery? I believe that some 1,500 women receive vaginal mesh implants each year and the majority respond well. If that is correct, it is important to balance that against the distressing individual cases that we have heard about today. I also understand that the high rate of success for the use of surgical mesh to treat hernias suggests that an outright ban would be rash at this stage, and certainly premature before the Cumberlege review reports.

What information can the Minister provide on the recent development of a new material for surgical mesh implants? What more information do we have about how that is expected to reduce discomfort because of its greater likeness to human tissue? Can the Minister update the House on what progress is being made to improve GPs’ awareness of SUI and POP and how best to treat those conditions, so that women are given the most appropriate treatment for their circumstances? Will the Cumberlege review take into account international research on this issue? We have heard some mention of it today, but I understand that no other jurisdiction has imposed an outright ban on the use of mesh.

In conclusion, the Secretary of State has made it clear that we are building on substantial work from over the past few years—the Cumberlege report comes on the back of a lot of other work, and I hope the Minister will confirm that that will all be taken into account. I ask Members to await that report before we make any final decision. Professor Keith Willett brought forward the 2017 Mesh Oversight Group report, which followed the Mesh Working Group interim report in 2015. He said that

“there has been significant progress since this work began. Information available to women and clinicians is now better and more consistent, data recording has been improved, including of complications, and women can now be referred to multi-disciplinary teams of health professionals with the experience necessary to advise women who are experiencing complications from mesh surgery on their treatment options.”

John Wilkinson, Director of Devices at the Medicines and Healthcare Products Regulatory Agency, stated:

“We continue to see that evidence supports the use of these devices in the UK for treatment of the distressing conditions of incontinence and organ prolapse in appropriate circumstances.”

We must ensure through this review that every circumstance in which these devices are used is appropriate, and that the women involved feel confident of that.