Oral Answers to Questions

Jonathan Lord Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

As the hon. Gentleman will know, we are constantly reviewing all policies that could reduce tobacco use among young people. Smoking is the No. 1 killer, so dealing with it would be the best way of reducing this country’s premature mortality rates, which are far too high.

[Jonathan Lord (Woking) (Con)]

23. Does the Secretary of State agree that transparency is critical in improving hospital standards and that, following the Government’s latest measures in response to the Francis report, the health cover-ups by the previous Government will never be allowed to happen again?

[Mr Hunt]

The Labour party does not like to hear this, but the reality is that micro-managing the NHS through top-down targets failed to deal with the problems of compassionate care. My hon. Friend is absolutely right that the best way to deal with this is through total transparency, so that when we are sure there is a problem, the public find out about it quickly and it is dealt with quickly.

Stillbirth Certification

Jonathan Lord Excerpts

Wednesday 31st October 2012 Westminster Hall

[Chris Heaton-Harris]

That is my intention in raising this debate today. However, this is about not just the certification element, which I hope the Minister will answer, but the need for more awareness of all the issues around stillbirth and neo-natal care.

Having the flexibility for parents to be able to choose to have a birth and death certificate for babies born after 24 completed weeks of pregnancy but showing no signs of life, would massively help a large number of parents in their grief and show that the state recognises that they had a wonderful child. As some parents would be distressed at the possibility of having to go down that route, I wonder whether we could have a more flexible system whereby parents have the choice of a formal birth certificate, a stillbirth certificate issued by the hospital or—if they so choose—nothing. In modern society, we have the ability and sensibility to deal with the matter of certification, which is important to most of the parents to whom I have spoken because it is a simple process of formally naming their deceased baby.

Over the course of my time in this place, I have raised the matter of stillbirth certification a number of times. However, on each occasion I have received a similar reply from the Department of Health. One reply said:

“The registration of stillbirths and live births serve different purposes.”

It helps Departments collect statistical data and

“enables us to monitor the causes of stillbirth.”

Another reply said:

“Different state benefits are available to parents depending on whether a child was live-born or stillborn, so it is important to be able to distinguish one certificate from another.”

I completely understand the need for the state and the Department to be able to collect these important data for use in research. In fact, I am keen to encourage the Department to do more. However, I simply cannot understand why in 2012, with all the modern technology that we have at our disposal, we cannot, in a sophisticated way, collect all the data that are required and issue birth and death certificates when they are requested by parents.

[Jonathan Lord (Woking) (Con)]

I am grateful to my hon. Friend for giving way and I commend him for pursuing this issue in Westminster Hall when I know that there is another debate very close to his heart going on in the main Chamber. Does he have any information that he could share with us about how other countries do things, which might help to nudge the Department of Health in the right direction on this matter?

[Chris Heaton-Harris]

There is actually quite a lot of information out there. There is a very good charity called Sands, which has brought me lots of examples of best practice from across Europe, and indeed from different states in the USA. I am not saying that those methods would all work if they were brought into the NHS. However, by looking at the research that has been going on in Denmark and in Australia, and at the best practice in France and in some states in the US, we might be able to form much better practice in the UK to spread throughout the NHS. There are examples of good practice out there, and although I cannot cite them “fact for fact” off the top of my head right now, the charity Sands has all that information on its website. Sands is a very good resource for information.

I want to go back to the issue of what the state can do when it comes to stillbirth certification. I am quite sure that a sensible and easy solution can be found that allows these certificates to be issued and at the same time enables the state to have all the right information that it might require about any situation around each stillbirth.

Knowing that this debate was coming up, I asked some parents to try to help me to express why this new flexibility—if we are able to have it—would help them. A mum in my local area called Michelle told me this:

“My son was 9 days past his due date when he died at the end of my labour in May 2011; he weighed 7 pounds and 7 ounces, had wavy fair hair and was perfect. I can still feel the weight of him in my arms and how soft his skin felt. To be told your child has died is the worst pain a parent can feel but to be told they will not be recognised as a person in their own right but a statistic is heart-breaking. My son looked like any other baby, I went through a labour like any other mother but I didn’t have the happy ending. Going to the registry office to register his death was made harder knowing that the parents waiting with us would be registering their baby’s birth yet we would only be allowed to register our son’s death, not given the dignity of having a birth certificate. I feel I am being punished for not having a child that was lucky enough to take a first breath or to hear his first cry. A birth certificate is incredibly important to me and unless you have lost a child who has had the misfortune of being labelled as stillborn it is difficult to understand the need for this recognition. I have been lucky enough to go on to have a daughter, I love both my son and daughter equally yet they are not treated equally in the eyes of the law.”

She went on to say:

“This cruel law needs to be changed, what sense does it make to only register the death when the baby has to be born first regardless if he will take a first breath.”

I know from previous conversations that I have had with the Minister that he completely understands all the issues that I have raised here today, and I very much look forward to hearing his comments. All I ask is that he returns to his Department, reflects on today’s debate and considers whether it is actually not too difficult to build into the system the flexibility that I and a large number of parents from across the country would like to see. It would mean a great deal to a lot of people, Michelle included.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Thank you, Mr Owen, for calling me to speak. It is a great pleasure to serve under your chairmanship; like my hon. Friend the Member for Daventry (Chris Heaton-Harris), it is the first time that I have done so.

I pay particular tribute to my hon. Friend for raising this matter in Westminster Hall today. He and I have worked together in the past to raise awareness of the need to do more to support those families who have had the terrible experience of stillbirth. We have also worked together in the past to discuss the need for greater research in this area. He is absolutely right to highlight a number of the issues that he has raised today, and I will deal with the issues that he has raised in turn.

In my own medical career as a doctor, I have never seen anything more tragic than either a very badly injured or ill child, or a dead baby. The death of a baby is probably the worst situation that I came across, and losing a child is the worst experience for family and friends; it lives with people for ever. For some families, there is no coming to terms with the death of a child. It is a very difficult thing to live with and we must continue to do all we can to support those families, working with Sands and the other organisations that do a very good job in supporting those families; we must continue to do more.

My hon. Friend quite rightly highlighted the unacceptable regional variation in stillbirths. From the figures for 2011, we know that the strategic health authority for the north-east of England reported 5.8 stillbirths per 1,000 live births, whereas the SHAs for the east of England and the south-west of England reported 4.7 stillbirths per 1,000 live births. As I say, that is an unacceptable variation. There is an acknowledgment by the Royal College of Obstetricians and Gynaecologists, by the Royal College of Midwives and by Sands and many organisations that we need to do more to reduce the rate of stillbirths in this country. We must continue to do more to research the factors that cause stillbirth. As my hon. Friend said, in many cases the cause of a stillbirth is still unclear. We also need to continue to crack down on this unacceptable regional variation, and learn where there is good practice in combating and reducing stillbirth rates and where the NHS is doing things better, so that that good practice can be rolled out across the country.

As I said, the death of a baby, whether during pregnancy or following birth, is probably the worst tragedy that anybody can face, and that is true both from the point of view of a health care professional and from a family’s perspective. Stillbirth is not only the loss of a child, but the loss of all the hopes and dreams that the family would have had about what that baby would have become and what it would have meant to them in the years ahead. That is why it is particularly important that this is an area that we continue to focus on, to reduce stillbirth rates and so that both the Department of Health and medical professionals take this issue increasingly seriously. As my hon. Friend rightly highlighted, our stillbirth rates are 33rd out of 35 high-income nations and as a country we need to do better than that and improve on those rates.

[Jonathan Lord]

I am glad to hear my hon. Friend the Minister and my hon. Friend the Member for Daventry (Chris Heaton-Harris) talk about the work of Sands. I myself have had constituents come to me with the help of Sands, and my hon. Friend the Minister speaks very well about that organisation and about the real hurt of those families who have suffered a stillbirth.

However, could my hon. Friend the Minister just give us a little bit more information as to why he thinks the stillbirth rates in this country are higher than they should be, and why they are higher than the rates in many other western countries? What are the reasons behind that? That is the crucial thing—to stop this terrible tragedy happening to other families.

[Dr Poulter]

I thank my hon. Friend for that question, and he makes a very good point. As we have said today, we have high stillbirth rates in this country. One factor that the Royal College of Obstetricians and Gynaecologists has picked up on is the fact that there are sometimes variations in clinical practice, including in picking up on early warning signs that we know are associated with stillbirth, for example reduced foetal movements during pregnancy. That sort of thing always concerned me as a front-line professional and it concerns many midwives.

However, we need to have in place across the NHS better systems so that professionals can work with women to identify those early warning signs that something may be wrong in a pregnancy and to ensure that women come in quickly and seek help, or hopefully, rather than seeking help because something is going wrong, in many cases they can seek reassurance. However, where things are not right for a baby, we must ensure that the medical help is on hand to intervene quickly and to support the pregnant woman and hopefully mum-to-be.

There are parallels that can be drawn between where we are now with stillbirths and the situation with cot deaths a number of years ago. Back in the 1980s, the cot death rate was very high, peaking at 2.3 deaths per 1,000 live births in 1988. Following the launch of the “Back to Sleep” campaign in the early 1990s, the rate declined dramatically, falling to 0.6 deaths per 1,000 live births in 1995. This reduction has continued as awareness of the key messages on reducing the risk of cot death has increased. By 2010, the rate was 0.22 per 1,000 live births. To put that in real life rather than statistical terms, we are actually talking about a reduction from some 3,000 cot deaths a year to 300 or 400, which is not perfect, because we still have babies dying of cot death, but raising awareness and targeting cot death has proved to be an effective way of reducing rates. That is something we can learn from in the discussion we are having today about stillbirth.

The point that all hon. Members have made today is that the decline in stillbirths in the United Kingdom has not kept pace with that of comparable countries. According to The Lancet, we rank 33rd in the world for stillbirths. We need to ensure that we do better and take this issue seriously.

Both my hon. Friends have spoken about Sands. It is worth highlighting what that organisation has done. It provides tremendous support for families who find themselves in very difficult situations. It has highlighted the vital importance of the Government and the medical profession—midwives are taking this issue on board and are taking it more seriously—supporting families to make sure that in future pregnant women and families do not have to suffer the problems associated with stillbirth.

Sands has raised a number of issues, including research, which we have talked about and which I will come on to in a moment, and the fact that action is required to raise awareness, as we saw with cot death in the past, of the known risk factors for stillbirth so that prospective parents can make better choices and understand what could go wrong in pregnancy and what the warning signs may be—for example, reduced foetal movements. We need to ensure that parents are informed and that health care professionals know how to support parents and pregnant mums to help them to recognise the warning signs. They need to provide reassurance and care where appropriate and need to intervene when very serious concerns are raised.

We have said that it is not acceptable that the UK has one of the worst stillbirth rates in the developed world. We have developed a stillbirth prevention work programme, which my hon. Friend the Member for Daventry alluded to earlier. The Government are taking this piece of work very seriously, in conjunction with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, and the NHS to help to iron out the unacceptable variations in practice and the unacceptable regional variations that we have talked about.

The development of this work programme has been informed by a workshop jointly hosted by Sands and the Department of Health, which took place on 1 March this year. Discussions focused on key areas such as raising awareness and improving identification of babies at risk and improving perinatal reviews. We are continuing with this work to ensure that we can put that into practice throughout the NHS so that we provide pregnant mums with the support that they deserve.

My hon. Friend rightly raised the issue of research. It is important that we fully understand stillbirths. We do not always know what the cause of a stillbirth was. It is important that we do research and look into what the unknown causes and reasons might be. What are the factors that cause stillbirths? We know some of the causes; we do not know all of them. Continuing to research and focus on that is important.

The Government have funded a number of research programmes. Most recently, the Department has funded research through the National Institute for Health Research and the policy research programme. An estimated spend relating to maternal and foetal health has increased from £4.4 million in 2006-07 to £12.7 million in 2010-11. The issue of improving foetal health, babies’ health and maternal health is something that we take very seriously.

Working with Sands, the Department’s policy research programme has funded a policy research unit in maternal health and care at the national perinatal epidemiology unit at Oxford university. Research themes focus particularly on pregnancy loss, perinatal morbidity, maternal morbidity and maternal mortality.

The National Institute for Health Research in Cambridge has an ongoing programme of research on women’s health. A major focus of that research is understanding the determinants of stillbirth risk and using that understanding to improve clinical care of pregnant women. Indeed, last week I visited Manchester where there is a very high quality of care for pregnant women and for newborn babies. The university of Manchester’s maternal and foetal health research centre is currently leading projects in understanding the reasons for stillbirth. I know it will be looking to feed that in nationally so that we can continue to reduce stillbirth rates.

Research on its own is not enough. When we have the research, we have to ensure that we get it out there to the professionals, sharing it and the information from that with parents, to help them to make informed choices about their care and to be aware of the risks and the possible warning signs of stillbirth. Raising awareness is so important. It is an issue highlighted in particular by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. They have said that there is unacceptable variation, as we have accepted in this Chamber, in the rate of stillbirth and in how some health care professionals interact with families and pregnant women during pregnancy. Working up national guidelines that focus on professionals supporting families, as well as being aware of the other factors, is an important part of reducing stillbirth.

Another point made by my hon. Friend is that families who have suffered a stillbirth have not always received good bereavement support. We know that a lot of care and attention has been paid to ensure that more support and care is given to families—the royal colleges have taken that on board—and we are looking seriously at how we can provide more support. Many hospitals and trusts have invested in bereavement rooms and quiet areas for families when they have had early pregnancy loss or a stillbirth. That is right, because although maternity things generally go well and we have a good outcome, when things go badly we need to ensure that we are prepared and have a supportive environment to look after families in such circumstances.

Finally, it is important to focus on certification, an issue raised by my hon. Friend. I will look into the matter in more detail and get back to him in writing as well, rather than try to put together an answer in the two or three minutes available to me. He made the point that some mums who give birth have to go through the whole birthing process—they actually give birth to a dead baby—and that is an incredibly traumatic and difficult thing to do, because they know that their baby is not alive. Some mums, however, have to do that. In such situations, although the law, with such things as birth and death certificates, is there for good reason, the human reality is sometimes not recognised in the law as effectively as we might like. There will, though, sometimes be difficulties with law, however we have it. As best we can, we have tried to mitigate such situations by beginning to provide more supportive environments for parents after a stillbirth and by providing certificates recognising that there has been a stillbirth after 24 weeks. That goes some way towards recognising the difficult and tragic event—we recognise that a baby has been born, although the baby was not born alive. I will write to my hon. Friend in more detail in the next few weeks, because the issue deserves more than a few sentences at the end of the debate.

I thank my hon. Friend and pay tribute to his work on raising awareness of such an important issue. The Government are very much committed to taking forward our work with Sands and ensuring that we reduce stillbirth rates in this country, as well as providing more research to investigate the causes of stillbirth and better support for bereaved parents in what is perhaps the most difficult thing I have ever seen in my medical career.

Question put and agreed to.

Stafford Hospital

Jonathan Lord Excerpts

Tuesday 20th December 2011 Westminster Hall

[Anne Milton]

I agree entirely, and I am sure that my hon. Friends the Members for Stone (Mr Cash) and for Stafford are in touch with the local authorities, because it is extremely important, as my hon. Friend the Member for Stone rightly pointed out, that diversion signs are clear to people and that people do not turn up at an A and E department that is closed. It is actually quite extraordinary how resilient people are to those diversion signs. Information needs to be given to people in words of one syllable, so that they are quite clear that the A and E department is not open for business at the moment.

Stafford is taking, and it will continue to take, GP-referred maternity, paediatric and medical patients 24 hours a day, seven days a week, which will be of some reassurance to local people. I know that my hon. Friend the Member for Stafford has visited Stafford A and E department several times since the overnight closure came into effect, and I am pleased to hear that he is satisfied that the measures that have been put in place will ensure patient safety and good access to A and E services. I know that some of his constituents are concerned about the impact of increased demand on neighbouring A and E departments. The situation is being closely monitored and the local NHS is content that the arrangements are working well.

Of course at this time of year, the pressure on A and E departments gets greater. We have not suffered particularly severe weather in the south of the country, but some places have done so. Such weather always takes its toll on the NHS, and therefore the monitoring of how things go is very important.

As I have said, the closure took place on the advice of clinicians with the aim of ensuring patient safety. The trust continues in its efforts to recruit additional staff, and patients can be assured that it will not reopen its A and E department full time before it is safe to do so. The trust, the Staffordshire PCT cluster, emerging clinical commissioning groups and others are looking at a range of options to achieve a clinically safe and financially sustainable service, and will present their report on the way forward to the NHS Midlands and East strategic health authority cluster at the end of January next year.

I will say a word about emergency medicine nationally. The number of emergency medicine consultants has risen by more than half in the past five years, but we agree that it must continue to increase and we are working with the College of Emergency Medicine on how best to make that happen. In the short term, some trusts have been employing more GPs in A and E. GPs are primary care experts, so their presence in A and E allows emergency specialists to concentrate on the cases for which their skills are needed. We are, however, looking at a number of areas, because this matter is of national concern. We are considering revising the person specification for training in emergency medicine to make entry more accessible, and redirecting into emergency medicine some of the doctors who cannot secure other higher specialty training posts.

My hon. Friend the Member for Stafford pointed out the importance of specialist services, and what I have said about the national situation highlights exactly why they are so important. As my hon. Friend the Member for Stone mentioned, the particular needs of people in rural communities, for whom travelling long distances causes additional problems, must also be taken into account. It has long been the case that specialist services need to be provided in specialist centres, and during my own working life as a nurse we had regional neurosurgical centres for the specialties that required highly skilled and specific care. That is important, because we are always balancing patient safety with the accessibility of local services.

[Jonathan Lord (Woking) (Con)]

I join colleagues in commending the thoughtful leadership role that my hon. Friend the Member for Stafford (Jeremy Lefroy) has taken. May I ask the Minister two things? Can we be reassured that the awful lessons of Stafford have been learned nationally? If I may crave the indulgence of my Staffordshire colleagues, I have happy memories of fighting with the Minister during the previous Parliament, when I was chairman of her association, to save the A and E at the Royal Surrey, so perhaps she would care to extend her warm words to all the medical staff who will be working there over Christmas and the new year holiday, just as she did to those at the Stafford hospital and elsewhere in Staffordshire.

[Anne Milton]

I thank my hon. Friend for his imaginative use of this debate to point out that I joined with him to fight a long, hard battle to save our hospital in the Guildford constituency. It is important, of course, to extend our thanks and tributes to staff working not only in our own constituencies, but across the country. On the first question, there is no doubt that lessons need to be learned, and I think that we sometimes feel that the NHS is slow to learn the lessons it should.

Work is being carried out nationally to address the skills mix, by developing non-medical roles within A and E departments. Enhanced nursing roles have genuine potential, and in countries with very remote populations, such as Canada and the USA, they are an extremely important part of the general skills mix. Emergency nurse practitioners who can look at the minor injuries and illnesses that in most departments account for 40% of the work load can be a major contribution to ensuring that A and E services remain available for local people, and advanced clinical practitioners, such as nurses and paramedics, can therefore treat many more of the major conditions.

I thank my hon. Friend the Member for Stafford for securing this debate, and other hon. Members for attending on the last day before recess. A number of Staffordshire MPs have met with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), and I know that he will continue to keep in close touch, but should any new concerns arise I am sure that my hon. Friend the Member for Stafford will raise them with him. That leaves to me just to wish you, Mr Hollobone, and all the House of Commons staff a very happy Christmas and a prosperous and safe new year.

Oral Answers to Questions

Jonathan Lord Excerpts

Tuesday 7th December 2010 Commons Chamber

[Paul Burstow]

Perhaps a little humility might have been a necessary preface to that question, including, not least, an acknowledgment that the hon. Lady’s question is based on the failings of the previous Administration to deliver the necessary improvements in end-of-life care. On GP commissioning, there is undoubtedly an opportunity to integrate health and social care to deliver more timely and appropriate community-based end-of-life care, and we intend to deliver it.

[Jonathan Lord (Woking) (Con)]

9. What steps he is taking to improve the information provided to patients on their diagnosis and treatment.

[The Minister of State, Department of Health (Mr Simon Burns)]

As part of our White Paper reforms, a wide-ranging review of the information required to empower patients is in progress. Related current initiatives include the information standard scheme, information prescriptions and quality standards produced by the National Institute for Health and Clinical Excellence.

[Jonathan Lord]

I am grateful to the Minister for his reply. Currently good comparative data on the individual performance of doctors and surgeons are not readily available. How does he envisage compiling that data in a way that does not create too much bureaucracy or use up too much of doctors’ valuable clinical time?

[Mr Burns]

My hon. Friend is absolutely right: if we are to put patients at the heart of an NHS in which it is their care and views that are important and drive the provision of health care, we must empower them by giving them information that is consistently accurate, unbiased and easily understandable. We are currently consulting on our information revolution papers, and we await a chance to study the responses. However, we are determined to empower patients by giving them far more information, so that they can exercise their right of choice to get what they deserve, which is the very best health care.