Ockenden Review

Debate between Jeremy Hunt and Nadine Dorries

Thursday 10th December 2020 Commons Chamber

[Ms Dorries]

I thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his, as always, constructive and reasonable tone in his response. Yes, I can assure him that the resources are in place, and have been guaranteed to be in place. As for the deadline, it is 2021. I cannot give an exact month. It was really important to me—I believe that Donna Ockenden has mentioned this in her report a number of times— that the first 250 cases were evaluated so that we could take the learning from those cases and introduce it as quickly as possible. In that way, we could identify what had gone wrong so that we could prevent it from happening again in the future. That is why we have produced the report in two stages. We know the findings of this interim report and the recommendations that have been identified by Donna and her team can be put in place. The second stage of the report will appear before the end of next year—certainly in 2021. I will, as the hon. Gentleman requests, and personally if he requires it, update the House on what is happening with the report.

With regard to the maternity safety training fund, we secured £9.4 million in the spending review. It cannot be underestimated, in this time of covid, what a huge achievement that was. The money will not go into the old format of the maternity safety training fund, because we do not believe that that worked as well as it should have done. Much of that money was used to backfill the staff, who then, unfortunately, did not attend training. We did not get the best results—the biggest bang for the buck.

What we, as a Department, are doing now is directing that £9.4 million to where it is needed most and to where it can be spent in the most effective manner to produce results in maternity safety. That work is ongoing now in the Department, and I hope to be able to update the House and the hon. Gentleman very soon on how that money is being spent and what results we expect to see in return for the expenditure.

I did not anticipate the hon. Gentleman’s question about midwives. I do not have the exact number, because the figure rises every day. None the less, we are recruiting new nurses—I think the figure was 12,000 when I last gave a statement to the House—some of whom will be recruited to become midwives. So, yes, work is under way on the workforce and on nurse recruitment.

[Jeremy Hunt (South West Surrey) (Con)]

Babies’ skulls were fractured and bones were broken in excruciatingly traumatic births that would never have happened if mothers’ wishes had been listened to. This is an utterly shocking report, and I think the whole House is immensely grateful to Donna Ockenden and her team for such a thorough report, and to the Minister for taking it so seriously, as she always does.

Although much has improved in maternity safety in recent years, does the Minister agree that it is time to stamp out the “normal births” ideology, which says that there can be a debate or compromise about the total importance of a baby’s safety? That should always be paramount, and decisions on it should always be taken in consultation with the mother. The report team said they had

“the clear impression that there was a culture within The Shrewsbury and Telford Hospital NHS Trust to keep caesarean section rates low”.

That needs to stop—not just at Shrewsbury and Telford, but everywhere throughout the NHS. The biggest mistake in interpreting this report would be to think that what happened at Shrewsbury and Telford is a one-off, as it may well not be and we must not assume that it is.

Secondly, the report talks about the “injudicious use of oxytocin” to facilitate vaginal births that perhaps should not have been happening. Will the Minister look into that issue? Finally, this report happened because Rhiannon Davies and Richard Stanton, who lost their daughter Kate in 2009, and Kayleigh and Colin Griffiths, who lost their daughter Pippa in 2016, persuaded me that something needed to happen. Is it not shameful that we make it so hard for doctors, nurses and midwives in the NHS to speak out about tragedies that they see and that all the burden for change is left on the shoulders of grieving relatives? Is it not time, once and for all, to end the blame culture that we still have in parts of the NHS?

[Ms Dorries]

My right hon. Friend asked a number of questions that deserve answers, so please bear with me. His first point was about the number of caesarean sections and the thought or belief in the hospital that it was a good thing not to have them, which the report identifies.

The report shows us that there were years when C-sections at Shrewsbury and Telford were running at 11% and the national average was 24%, and at 13% when the national average was 26%. That demonstrates a lack of collegiate working between midwives, doctors and consultants. Most of the report’s recommendations show that, fundamentally, that is the problem: a lack of communication and an unwillingness to work with people—the medics, doctors, obstetricians and midwives. My right hon. Friend is absolutely right about intervention. There is the old saying, “Mother knows best”, but every woman should own her birth plan and be in control of what is happening to her during her delivery.

I give all thanks to my right hon. Friend, because this report is fundamental in terms of how it is going to inform maternity services across the UK going forward, not least because the NHS is working on an early warning surveillance system. What happened at Shrewsbury and Telford was that it was an outlying trust. As with East Kent and others, including Morecambe Bay, where we have seen issues, there has been an issue culturally; they are outlying, without the same churn of doctors, nurses, training or expertise. The NHS is now developing a system where we can pick up this data and know quickly where failings are happening.

Oxytocin is a drug used in the induction of labour to control the length, quality and frequency of uterine contractions. There are strict National Institute for Health and Care Excellence guidelines on the use of that drug. My right hon. Friend is correct: every trust should follow the guidelines. By highlighting that in this report, we will ensure that trusts are aware of those guidelines and that they are followed in future.

Independent Medicines and Medical Devices Safety Review

Debate between Jeremy Hunt and Nadine Dorries

Thursday 9th July 2020 Commons Chamber

[Ms Dorries]

That was a long list of asks. I am sure the hon. Gentleman appreciates that we received the report yesterday, and it is a detailed, in-depth and complex report. He is pushing on an open door, with almost everything he asks—patients absolutely have to be at the heart of this. The report is titled, “First Do No Harm”. Our response has to be to do good. We are listening; I am in listening mode. I have listened to what he has said. I will listen to what everybody here has to say today, and to what all the groups have to say, to the details of the report. We will take it away.

The hon. Gentleman asks how long; I am sure he appreciates that work needs to be done to formulate a response. The response will come as soon as possible, as soon as the work has been done. He is quite right about the role of women, which he referred to at the start of his comments. Whether it is Shipman or Paterson or maternity issues or the Cumberlege report, more often than not women are at the heart of these—for want of a better word—scandals. He is absolutely right and I feel very passionately about making sure we come back with a really positive and robust response to this report as soon as possible.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Minister for the compassion and the anger in her response. She is a fantastic champion of patient safety. I also thank the many hon. Members, including my right hon. Friends the Members for Hemel Hempstead (Sir Mike Penning) and for Elmet and Rothwell (Alec Shelbrooke), who persuaded me to commission the report. I, too, would like to thank the brave campaigners who have not stopped until they got justice. I particularly thank Baroness Cumberlege, Sir Cyril Chantler and their team, who did a painstaking amount of work to get to where we are today.

I commissioned this report because I knew that many lives had been ruined because we did not act quickly enough to deal with problems in these three areas, but the results are far more shocking and disturbing than I ever imagined at the time. Thousands of lives have been blighted by what went wrong in the most terrible way. Does the Minister agree that the central issue is not about the three areas alone, but about all medicines and devices where there is no one for patients and people who are suffering to go to with the confidence that they will be listened to? That is why the suggestion of a patient safety commissioner is so important. It is not a tsar or a quango; they would be a person who would listen to people whose voices were not heard. I hope the Government take that recommendation seriously.

Will my hon. Friend give a commitment that the Government will come back to this House before the end of September with their recommendations? We completely understand her tremendous commitment to patient safety, but does she agree that the gravity of this issue is such that it should be the Health Secretary, who made a very important apology yesterday, who comes back before the end of September and tells the House what the Government are going to do?

[Ms Dorries]

I pay tribute to my right hon. Friend, who commissioned the review in 2018. Thank goodness he did, because without it, these voices would still be struggling to be heard.

On my right hon. Friend’s question about the patient safety commissioner, as that is a recommendation, it will be considered, as will every other recommendation. It is important to mention that we have Aiden Fowler, whom my right hon. Friend appointed to NHS Improvement to take on the head of patient safety role on behalf of NHS England. That does not mean that we will not consider the recommendation thoroughly; we will do so.

Obviously, I cannot speak for the Secretary of State, but I am sure he is aware of my right hon. Friend’s comments. I cannot commit to coming back by the end of September; what I can give the House is my absolute assurance that I will chase this daily. The work commenced when the report became available to us, and a huge amount of work has been done overnight on assessing the recommendations made in the report. I or the Secretary of State will be back here as soon as possible with our recommendations.

Maternity Services: East Kent

Debate between Jeremy Hunt and Nadine Dorries

Thursday 13th February 2020 Commons Chamber

[Ms Dorries]

I thank the hon. Gentleman for his collaborative tone on this issue. I think he may have missed my last comment, which was that NHS England and NHS Improvement will be commissioning an independent inquiry. That has been decided this morning, so that will happen.

On the hon. Gentleman’s first question about what is happening to support the trust now, NHS Improvement is in there. As I said, the chief midwife, Jacqueline Dunkley-Bent, has sent in some of the best midwives, obstetricians and neonatologists in the country from outstanding trusts to support the trust. They are having twice-daily huddles on the wards, which is where multi- disciplinary teams get together and discuss on an ongoing and regular basis what is happening on the wards, what disciplines are involved and what measures are being taken. We have fresh eyes looking at the cartography that measures foetal heart rates and contractions. We have a second pair of eyes reading those cartography read-outs, so it is not just down to one midwife.

A huge amount of support has gone into the trust. As I said, it is today a safe place for anyone to give birth. We are also asking HSIB to go in to do that deep dive to look at historical issues. Whether that will continue in light of the fact that NHS England is commissioning an independent inquiry is something I need to find out when I leave the Chamber. However, I want to reassure the hon. Gentleman and everybody that this is an issue that I take very, very seriously.

Babies bring joy and happiness when they arrive, and every family—every mother, every father and, indeed, every grandparent—is entitled to know that when they or their relative is in hospital, the delivery will happen in a safe environment, with the very best care. I can say that that is the case at East Kent now, and I—we all—will strive to make sure that it is the case at every hospital.

[Jeremy Hunt (South West Surrey) (Con)]

I thank my right hon. Friend the Member for North Thanet (Sir Roger Gale) for tabling this urgent question and for speaking so powerfully. I also thank the Minister for her work to respond to this. I, for one, hope that she continues in her role after the reshuffle because of her incredible commitment to patient safety.

What worries members of the public is that the NHS appears to be much better at transparency about care failures, but not always much better at learning from those failures. Does the Minister agree that that underlines the vital importance of the independent investigations that HSIB does into every Each Baby Counts incident, and the need for safe spaces so that doctors, nurses and midwives can talk openly and freely about what they think went wrong? Will she also consider publishing the report that CQC has already done into what is happening to reassure families that we are indeed confronting all these difficult issues?

[Ms Dorries]

My right hon. Friend is absolutely right. One of the issues in dealing with the ongoing problem—this is a bit like the airline industry—is that we need to generate a culture in which NHS staff feel able to speak up without fear of blame or litigation and we can take learning forward. Another issue is that when we have inquiries, we should take the recommendations and ensure that they are implemented. That piece of work is also going forward, along with HSIB and inquiries. We should look at implementing absolutely everything that we can to make sure that the safest possible environment exists.

Ockenden Review of Maternity Care: Shrewsbury and Telford

Debate between Jeremy Hunt and Nadine Dorries

Wednesday 15th January 2020 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

It is an absolute honour and a delight to be responding to this debate with you in the Chair, Mr Speaker—it is the first time I have done so—and congratulations.

I congratulate my hon. Friend the Member for Telford (Lucy Allan) on securing the debate. Before I respond to her specific comments, I turn to the wider points that she raised that addressed the UK as a whole.

To reassure people—mothers, particularly—I would like to make one or two points about the wider context of the debate: the safety of giving birth in the UK. The NHS in this country remains one of the safest places in the world to have a baby. The Government’s maternity ambition is to halve the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries in babies occurring during or soon after birth, by 2025. That ambition also includes reducing the rates of pre-term births from 8% to 6%. I reassure her that we have already achieved our ambition for a 20% decrease in stillbirths by 2020, so we are very much on track with those ambitions.

First and foremost, I express my heartfelt sympathies to every family who has been affected by previous failings in the trust’s maternity services. There can be no greater pain for a parent than to lose a child.

I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, who asked NHS Improvement to commission the independent review of maternity services at Shrewsbury and Telford in 2017, which is two years ago now—my hon. Friend was quite right about that. I take mild issue with one of her points, however, which was that NHS Improvement kept quiet about the failings. I find that slightly disappointing, because the raison d’être of NHS Improvement, which was also established by my right hon. Friend, is to investigate, expose and learn from failings, so I think she would agree it is not something that NHS Improvement would do. It is not in the culture of the organisation; the exact opposite is true.

The review being chaired by Donna Ockenden, a clinical expert in maternity and a registered midwife, was tasked with assessing the quality of previous investigations and the implementation of recommendations at the trust relating to new-born, infant and maternal harm. The original terms of reference covered the handling of 23 cases. The terms of reference have since been updated and were published in November to reflect the expanded scope of the review, and the review team will be in touch in the following weeks with the affected families to ensure that they are appropriately supported throughout the process. I am afraid I have to inform my hon. Friend and the House that the additional cases have now been identified and the total number relevant to the review now stands at 900, a small number of which go back 40 years.

The extra cases have been found by a number of means—from looking at previous incidents reported at the hospital to parents brave enough to come forward and talk about their own experiences. I am sure my hon. Friend will understand that, unlike with Morecambe Bay, which involved a small number of cases, it will take the review considerably longer to investigate 900 cases[Official Report, 20 January 2020, Vol. 670, c. 1MC.]. That is why there has been no report so far. The interim finding was not 600; the number is greater. It is appropriate that, while this important work is being done, we do not influence or comment on it and that we let Donna Ockenden get on with her vital work. It is our responsibility to let her do that and to provide the additional support needed given the additional cases identified. It is a huge increase on the original number of cases.

[Jeremy Hunt]

I thank the Minister for her personal commitment to patient safety, which I have seen on many occasions, but she will be aware that what she has just told the House is deeply shocking. She is saying that the scale of potential avoidable death at Shrewsbury and Telford may be no different from that at Mid Staffs. Could she reassure the House, given the huge resources devoted to the public inquiry into what happened at Mid Staffs, that the Department will make sure that Donna Ockenden has all the resources and support she needs, because getting to the bottom of this will be a huge job? Does the Minister also recognise that, while it will take more time, the families would also like it resolved as quickly as possible?

[Ms Dorries]

Absolutely, and I thank my right hon. Friend for his comments. Yes, the Department is liaising closely with Donna Ockenden about what support she needs to conclude her work as soon as possible, for the sake of the families. As he will understand, the review cannot be rushed; it has to be done properly and thoroughly. We have to get to the bottom of this matter, which is why Donna Ockenden is being supported in the way she is. Anything she needs in order to conclude this review successfully she will have. I thank my right hon. Friend for his personal comments. As he will know, and as he has said, I am utterly committed to patient safety, to eradicating avoidable harms and to making the NHS the safest place—not one of the safest—in the world to give birth. The review is important in the light of that.

As well as the families who came forward when the review was launched, media coverage has raised awareness of it, prompting further contacts with the trust and the review team. More recently, Donna Ockenden herself made a final appeal for any more families who believe that they have been affected to come forward. I am grateful to all the families who have voluntarily agreed to assist the review, although that may mean their having to revisit painful and distressing experiences. We expect it to conclude by the end of the year, at which point the Government will work closely with NHS England and NHS Improvement to consider the next steps.

As I have said, it is important for the review to be allowed to proceed unhindered, and without speculation about its conclusions or findings. However, I am very aware that current maternity patients at the trust may want reassurance that they will be safe and looked after. My hon. Friend the Member for Telford referred to “red lights”. I can reassure her that steps are being taken at the trust. It is completely understandable that people are asking questions, but I have asked for a meeting with the interim chief executive, because I want to see for myself that those steps are working. She has already made a public statement to reassure all families using the trust’s maternity services that much work has already been done to address issues raised by previous cases and to improve services, while acknowledging that the trust—obviously—had further to go.

During the November inspection of the trust’s maternity services, the Care Quality Commission found that the trust had taken action following the last inspection in April, so it was clearly listening and implementing the recommendations. As a result, there had been a number of improvements. Although more work was still needed, staffing had increased, and morale and governance had improved. However, I expect the CQC to keep a close eye on what is going on.

Let me end by restating the strength of our commitment to improving the quality and safety of maternity care. As I have said, the Government’s maternity ambition is to halve the 2010 rates of stillbirth, and we are on track to do that, which is incredibly important. Let me also say to my hon. Friend that, although I cannot reveal to her what is happening in the review—I cannot find out what is happening myself, because Donna Ockenden needs that autonomy—my door is always open. If my hon. Friend wants to discuss with me at any time what I have said tonight about the improvements that are being made at the trust, she need only pick up the phone. I am there to answer any questions that she may have on behalf of her constituents, and I ask her please not to hesitate to contact me if she needs further reassurances.

As I have said, the NHS remains one of the safest places, although we want to make it the safest place. What is most important is to ensure that the tragic cases that the Ockenden review is examining are not repeated anywhere else. That must be the objective. Women deserve a better maternity experience, and that is what we are determined to achieve.

Question put and agreed to.