Baby Loss

Justin Madders Excerpts

Thursday 13th October 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate the hon. Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince) on securing this debate, and I pay tribute to their courage in speaking so movingly about the incredibly difficult circumstances that they, sadly, have experienced personally. It is a great tribute to their character that they responded to such tragic experiences by seeking to do all they can to help others. We have heard from many Members how their constituents have done the same, following their own personal tragedies. I commend the work of the Members who comprise the all-party parliamentary group on baby loss, which has made an important and valuable contribution, addressing both the prevention of baby loss and the importance of offering the best possible care to parents when this happens.

This is the first time that we have discussed baby loss in the Chamber, but the third occasion on which I have responded to a debate on the subject over the past year. Each occasion has shown the House at its absolute best. I would like to take a few minutes to go through some of the compelling contributions.

The hon. Member for Eddisbury talked about the lack of recognition of how miscarriages can increase feelings of loneliness and isolation. I was sorry to hear about the lack of understanding that some people have faced when they have been contacted having suffered a miscarriage. I know from my own experience that there is a propensity to put miscarriage down as “just one of those things”, as we have heard several times today. The hon. Lady made very powerful comments that most parents just want to make sure that whatever has happened does not happen again. There is a recognition—a number of Members spoke about this—that parents sometimes do not feel that they get the answers they need.

It is disappointing to hear the statistic that the hon. Lady revealed that 25% of maternity hospitals do not have bereavement suites. Time and again today, we have heard Members welcome the provision of these suites in maternity units. I know from those I have visited up and down the country what a valuable contribution they make. They are often built following local fundraising and are often born from tragic circumstances. They always seem to receive significant input from parents who have suffered bereavements. I hope we are all agreed that we should aim to get a bereavement suite in every maternity unit.

As the hon. Lady said, one hour of bereavement training for midwives is clearly not enough, and the issue of training and support featured in several contributions. She is also right, however, that there is plenty of good practice out there, which we should disseminate across the country. Her comments about a bereavement pathway were important, and I am pleased to hear that Sands has been asked to look into it. I hope we will hear some good news about developments in that respect.

The hon. Member for Colchester spoke from personal experience with great passion and knowledge about what he believes needs to be done. He is absolutely right that no one who suffers a bereavement should have to go back on to a maternity ward. A number of Members made that point. He was right, too, to say that this is a far bigger issue than just ensuring that we have bereavement suites everywhere. We need to do much more work to understand why there are such disparities in occurrences across the regions and across different ethnic groups. His point that a mother can sense when something is not right was a powerful one. We should always stress how important it is to seek medical advice if there is any scintilla of doubt. The hon. Gentleman was right, too, that every stillbirth and every neonatal death is something that we should learn from. We need consistency right across the bereavement pathway and right across the NHS.

I wish the hon. Gentleman success with his private Member’s Bill, the Parental Bereavement Leave (Statutory Entitlement) Bill. We know that the odds of such legislation succeeding are not great, but perhaps today’s comments and the no doubt eloquent case he will make in support of the Bill will persuade the Government to bring forward legislation of their own.

My hon. Friend the Member for Heywood and Middleton (Liz McInnes) spoke with her customary experience of the health service. She gave examples of some of the best practice in her constituency, but also spoke of the struggle of one of her constituents, Jane, who had been trying to obtain answers following the death of her daughter Niamh, and referred to the gaps in support throughout the country.

The right hon. Member for Mid Sussex (Sir Nicholas Soames) talked about Group B Strep, which, he said, is one of the most common causes of infection. He told us that one baby a day develops it. That is a shocking statistic, given that, as we know, the infection is largely preventable. The right hon. Gentleman also mentioned childhood strokes and the courage of his constituent Emily. I look forward to hearing the Minister’s response to what he said.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) has her own personal experience. She very bravely told us about Kenneth, who would have been seven on Saturday. She rightly made the point that people often do not know what to say in such circumstances, and end up saying nothing at all. We hope that the more Members talk about these issues, the less often such situations will arise. The hon. Lady also said that the response that she had received that it was “just one of those things” was not good enough. She talked about the culture of secrecy and the pulling down of shutters, which cannot possibly help bereaved parents who are looking for answers.

My hon. Friend the Member for Kingston upon Hull North (Diana Johnson) raised an important issue about her constituent’s son William, whose ashes had been scattered without the constituent’s acknowledge. She talked about her campaign to get Hull council to conduct an independent inquiry into what is apparently a widespread practice in Hull. The campaign was initially successful, and my hon. Friend is right to be furious about the U-turn that has now taken place, with no consultation or warning. We certainly support her campaign to have the inquiry reinstated, and I hope that the Minister will agree to look into the matter and make representations to the Secretary of State for Justice.

The hon. Member for Banbury (Victoria Prentis) spoke, very bravely, about her personal experiences. She observed that we often hear that the nature of the public’s interaction with many public services means that people must tell their story again and again. She stressed the importance of relationship counselling, or, at the very least, an evaluation of how bereavement affects relationships. She also spoke with great knowledge about the importance of getting cremation right. I was pleased to hear that a working group is now looking into that.

The hon. Member for Gower (Byron Davies) said that awareness was the key to tackling this issue. He spoke with great sincerity about the fact that he and his wife had felt that they could not speak about their own loss, such was the stigma surrounding it. He rightly said that the medical advice that they were given at the time to “keep trying” was simply not acceptable.

The right hon. Member for Broxtowe (Anna Soubry) talked about her constituents’ daughter Emily, who was stillborn, and their subsequent discovery that there was no bereavement suite. She said that it was almost cruel for bereaved parents to have to be in close proximity to those who had experienced successful births, and I think we can all understand that sentiment.

The hon. Member for Congleton (Fiona Bruce) highlighted the experience of her constituents, and the lack of joined-up communication in dealings with bereaved parents. She gave some disturbing statistics from a miscarriage survey which found that four out of five women received no aftercare at all. I think it is clear to all of us, given what we have heard today, how important it is for that support to be provided as often as possible.

The hon. Member for East Worthing and Shoreham (Tim Loughton) spoke with great knowledge of this subject. He mentioned the shocking statistic that 68% of local authorities do not commission bereavement support, and presented a volley of other statistics revealing a lack of access to mental health support across the board. As he said, this is not something that just fades away; ongoing support is needed for parents. He paid tribute to the many charities that provide such support, but rightly said that people should not have to rely on charities to receive it. He also drew attention to his own private Member’s Bill, and to the legal absurdity of the classification of births before 24 weeks. He made, I think, a compelling case for a change in the law.

Finally, let me pay tribute to the outstanding contribution from my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft), who showed incredible courage in telling us about her daughter Veronica. We could all feel the pain that she must have felt every day for the last 23 years, and we all admire her bravery in talking about her experience. I am sure that Veronica would be as proud of her mum as we all are today.

As we have heard, this debate coincides with baby loss awareness week, which provides an opportunity for bereaved parents, their families and their friends across the world to unite and commemorate their babies’ lives. I echo the tributes that have been paid to the many charities that do so much to support families through what is possibly the most challenging time that they will ever face. I do not think that any Member can be in any doubt about how difficult it is, having heard the moving speeches that have been made today. I know that the hon. Member for Colchester did not want to single out particular charities, but I shall name four. Sands, Bliss, the Miscarriage Association and Antenatal Results and Choices all do excellent work.

It is a demonstration of the importance of this issue that in baby loss awareness week—as in every week—we know that more than 100 families will experience one of the biggest tragedies of their lives. An average of 15 stillbirths occur each and every day. We have heard from Members that stillbirth is often a taboo subject that many find difficult to discuss. I think we are beginning to change that, but we owe it to all those families to address the issue, and I know that today’s debate is a valuable part of the process. The loss of 100 lives a week in any circumstances is a tragedy, and if it were happening in a particular industry, there would no doubt be calls for action to be taken. That is why the words of the Members who have spoken today about their personal experiences are as important as they are brave.

I followed with great interest Monday’s baby loss debate on Twitter, and I commend the hon. Members for Eddisbury and Colchester for their innovation in facilitating it. The debate offered members of the public from all over the country an opportunity to share their views about this issue, and I want to put on record my thanks to everyone who took part. Twitter and social media generally have gained a bit of a reputation over the last few years for being unforgiving and cruel domains, but Monday's debate showed how that arena can be harnessed to bring about genuinely thoughtful and meaningful engagement with the public.

One of the key themes that emerged from the debate was the fact that this country offers some of the best neonatal care in the world, along with some exemplary psychological and bereavement support services. However, it also made clear that—as we have heard from many Members today and in the past—it does not offer that excellent care equally in every area. There is a great deal of variation across the country, which is why, much to our shame, our rates of stillbirth are unacceptable in comparison with those of similar countries. There has been an enormous amount of progress in reducing the rates of stillbirths and infant deaths in the last century, but it has sadly stalled in recent years. Indeed, according to The Lancet, the annual rate of stillbirth reduction in the UK has been slower than those in the vast majority of high-income countries. Our annual rate of reduction has been 1.4%, compared with 6.8% in the Netherlands. I think we would all agree that that is not an acceptable level of progress, and variability may well be one of the key reasons for it.

We welcome the Government’s commitment to reducing the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 20% by the end of this Parliament, and by 50% by 2030. During the debate that took place in June, the former Minister, the hon. Member for Mid Norfolk (George Freeman), confirmed that the first annual report on progress towards meeting those targets was due to be published this autumn. I should be grateful if the Minister would tell us whether that is still the Government’s intention, and when we can expect to see the report.

If we are to see a reduction in the number of avoidable deaths, another key priority, which is linked to the variability of care, is to ensure that there are safe staffing levels in neonatal units. According to the “Bliss baby report 2015: hanging in the balance”, 64% of neonatal units do not have enough nurses to meet national standards, and 70% of neonatal intensive care units regularly look after more babies than is considered safe. Given the strong evidence of a link between staffing levels and babies’ mortality, I ask the Minister to set out what steps the Government are taking to address that. We shall simply not be able to achieve the Government’s laudable ambitions if we cannot provide safe staffing levels in neonatal units.

Another issue that was raised during the debate in June was the investigation of stillbirths. At present, coroners do not have the jurisdiction to investigate the deaths of children who are stillborn to try to understand exactly why the deaths occurred and to inform best practice. As we have heard from many Members today, parents simply want to know what went wrong and whether it will happen again. Members of all parties were encouraged when the previous Minister undertook to discuss expanding the remit of coroners with his counterpart in the Ministry of Justice. I should be grateful if the Minister could tell us how those discussions have gone.

Let me end my speech by focusing on the families who so sadly experience bereavement, and the care and support that is offered to them afterwards. This is another area in which, sadly, there is a great deal of variability, with some families receiving the levels of support and care that we would expect while others have had shocking experiences such as those about which we have heard today. I should be grateful if the Minister could outline the steps that he will take to realise the Government’s commitments on parity of esteem for mental health in neonatal care. No one who has suffered the trauma of losing their baby should be left to suffer alone.

Members in all parts of the House have spoken very bravely and with great passion about their personal experiences. I hope that, following the debate, we shall be able to move forward, continue to break down the taboos, and ensure that every family to whom this happens receives the very best care, both medically and in terms of bereavement support. Families experiencing the very worst of times deserve a system that offers them the very best.

European Medicines Agency

Justin Madders Excerpts

Wednesday 12th October 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I congratulate my hon. Friend the Member for Cambridge (Daniel Zeichner) on securing this important debate and on the powerful and knowledgeable way that he made his case today. I share his disappointment that this matter is not being responded to by the Department for Exiting the European Union, but I understand that there are competing interests today. However, I hope that the Minister will undertake to raise the issues set out today with his colleagues in the Department and will answer some of the questions posed today.

I know that my hon. Friend the Member for Cambridge was and remains a passionate advocate for both the European Union and his constituency, and today he has channelled his disappointment at our impending departure from the EU into a well argued case to support key industries in his constituency. He spoke about the local interest that he has in this issue. The Cambridge biomedical campus is one of the most significant sites for medical research not only in this country, but anywhere in the world. Like him, I represent a constituency with an interest in the science and research sector, which could take on even more significance with the proposed Cheshire science corridor, which has the potential to create more than 15,000 new jobs by 2030, around a third of which could be in my constituency. Of course, I do not have to tell the Minister about that because the science corridor benefits Warrington as well as Ellesmere Port. Even before projects such as the Cheshire science corridor come to fruition, the north-west, as we have heard, is already one of the leading regions in the country for the pharmaceutical industry, employing about 18% of the total national workforce.

As my hon. Friend the Member for Cambridge said, the industry is a massive part of our country’s economy, with a turnover of more than £60 billion a year and exports worth around half of that. In 2014, it invested £4 billion in research and development: more than any other sector. It also employs some 220,000 people. I have set out those facts to paint a clearer picture of what is at stake in today’s debate and why it is so important that we begin to offer some clarity about what our plans are, not only for the future of the European Medicines Agency, but for pharmaceutical research, development and regulation more widely. I believe that the importance of the issue is reflected in the number of Members attending the debate, even though the bigger picture on our exit from the European Union is being debated in the main Chamber now.

I appreciate the tone that the hon. Member for Strangford (Jim Shannon) adopted. I think that he was saying that, wherever we came from pre-referendum, and whatever our views on the European Union, the vast majority of Members now want to ensure that our departure happens on the best possible terms. I regret the mischaracterisation of Members who request greater scrutiny and debate on the terms of exit as being involved in a Machiavellian plot to undo the referendum result. What Members are asking for is scrutiny, transparency and accountability on what is surely the most important issue that the country has faced in a generation.

My hon. Friend the Member for Heywood and Middleton (Liz McInnes) spoke from great personal experience. She was right to use the word “isolation”. We want to avoid becoming separate from the rest of the world in such an important area. She gave specific examples of the benefits of pan-European research on diseases such as cancer. The hon. Member for Linlithgow and East Falkirk (Martyn Day) raised important concerns about delays in approval, and the potential loss, on leaving the EU, of our involvement in pharmaceutical trials. He mentioned the concerns of the Japanese Government about the siting of their European bases in London. That echoes concerns that they have raised about other sectors.

The hon. Member for Central Ayrshire (Dr Whitford) clearly set out the fact that the EMA is not a body that tells us what we should do, which is how much of the European landscape is portrayed. It is part of a collaborative exercise across 28 nations, which have been making real progress. She also set out the financial benefits that this country has received from membership, and highlighted the important point about the difficulty that some smaller British companies may face in exporting their innovations, if we do not get the terms of exit right.

We all remember the famous promise, which several hon. Members have referred to, that the Brexit vote would mean £350 million a week being spent on the NHS. It is fair to say that it is accepted that that figure does not stand up and was misleading, but, as the hon. Member for Central Ayrshire eloquently pointed out, I suspect very few people who voted leave would have appreciated the threat that leaving means to jobs in the science and research sector and to speedy access to new medicines.

No one blames the Department of Health for those misleading claims. Indeed, I know from my own parliamentary questions that Ministers sought legal advice about the use of the NHS logo by the leave campaign. However, we are entitled to ask for more from Ministers on the near total absence of work to prepare for the possibility of a leave vote. For example, on 11 July, I asked the Secretary of State what assessment he had made

“of the potential effect on workforce numbers in the NHS of the UK withdrawing from the EU.”

I was told that no such assessment had taken place. On 6 September I asked what discussions the Secretary of State had had with the Home Secretary

“on the immigration status of NHS employees from other EU countries when the UK leaves the EU.”

I was told only that arrangements were being made for a meeting to take place at some point in the future. A similarly disappointing response from the Government on the issue was pointed out by my hon. Friend the Member for Cambridge, who noted that when asked about the future physical location of the EMA the Minister responded that it was “too early to speculate”.

We are not asking the Government to speculate; speculation is happening whether we like it or not. We are asking them to set out some concrete and substantive detail on what they plan to do. We have heard many times from the Prime Minister the words “Brexit means Brexit”, and that she is not prepared to give a running commentary. But investment decisions are being made right now, and if we cannot begin to provide some certainty we shall quickly find out that the UK and, in particular, places such as Cambridge and Cheshire will miss out on investment. It is about time we got some clarity on the Government’s position.

The first and most obvious point is the location of the EMA. We have already heard that countries from around the world are queueing up to offer it a new home. Having heard the benefits that it brings we can understand why they are forming an orderly queue. I know that the Minister does not want to speculate on what will happen, but will he at least set out whether, as part of the negotiations, he will take steps to try to retain the EMA headquarters in London, if that is possible? Will he also provide clarity about what steps the Government will take, if the EMA does relocate, to safeguard the headquarters of major international pharmaceutical and life sciences companies?

Beyond the future location of the EMA, there are wider issues about how medicines will be regulated in future, which could not only have an impact on investment but affect how quickly new medicines reach UK patients. Various hon. Members have mentioned that. Will we be able to safeguard the UK’s position as one of the leading locations for clinical trials in Europe? Clearly, a lot of Members feel passionately about that. Will the Government guarantee that the UK will continue to adhere to the EU regulatory framework on the authorisation and conduct of clinical trials? What assurances can the Minister give us that retaining access to the centralised marketing authorisation procedure will be a key part of our Brexit negotiations? Will the Government seek to negotiate continued access for UK research institutions to the innovative medicines initiative and other EU-funded research and collaboration programmes?

If the UK is left in the position of developing a separate regulatory framework from the EU, not only will that make it a much less attractive place in which to develop, manufacture and launch new products; it could also signify the end of accelerated access to treatments for patients in the UK, putting us to the back of the queue when new medicines are developed. Patients in Australia and Canada, where medicines are licensed nationally, have a comparative delay of six to 12 months before new medicines come to market. For people with rare conditions that could mean the difference between life and death.

European co-operation also provides some key benefits in terms of patient safety. One example is the European Centre for Disease Prevention and Control, which assists in our response to communicable diseases and pandemics. Another is the co-operation that reduces the risk of falsified medicines reaching UK patients. Can the Minister confirm that we will seek to continue to co-operate with our neighbours on those crucial issues?

What assessment has been made of the impact of the EMA’s leaving on the Medicines and Healthcare Products Regulatory Agency? As the hon. Member for Strangford said, work from the EMA is a substantial source of income for the MHRA, accounting for up to a third of its income. What provision has the Department made for the potential shortfall, particularly if the MHRA will have more responsibilities in future? As the hon. Member for Central Ayrshire said, in any scenario, it is likely that the MHRA will require further investment. What provision has been made for that?

This has been a wide-ranging and well informed debate. While we recognise that the issue does not begin and end with the physical location of the EMA and the 900 staff based there, there are at the heart of it, as my hon. Friend the Member for Heywood and Middleton said, 900 people—highly skilled and able to take their talents probably anywhere in the world—who face a future that is a vacuum. They will all have families and plans, and it is unrealistic to expect them to put their lives on hold for two or three years while things are sorted out.

I appreciate the Government’s reluctance to be drawn into making substantial commitments on the issues, but we run risks with respect to decisions about investment, future co-operation and, indeed, staff retention, if we do not begin to make our position clear. I hope that, when the Minister gets to his feet, we shall begin to get some certainty about the Government’s intentions as to seeking regulatory co-operation and, most importantly, safeguarding future investment in the sectors that we have heard about today.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

My right hon. Friend managed to include several questions in his impressive supplementary. I can confirm that much of the waste that took place in the years he cited—2002 to 2007—related to projects of the previous Labour Government that they themselves then cancelled, such as the IT project. I can also confirm that savings generated in the NHS are kept in the NHS. Lord Carter, whose report I referred to earlier, has identified £5 billion of efficiency savings, which we hope to deliver during this Parliament.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

There is a distinction to be drawn between realistic efficiency targets and systematic underfunding. Only last month, Simon Stevens told the Public Accounts Committee that for three of the next five years

“we did not get what we originally asked for”.

Chris Hopson, chief executive of NHS Providers, also said last month that

“we’ve got a huge gap coming… it’s the chairs and chief executives on the front line…who are saying they cannot make this add up any longer.”

On funding, the Government keep saying that the NHS is getting all that it has asked for; those actually running the NHS say something quite different. Who is right?

NHS Sustainability and Transformation Plans

Justin Madders Excerpts

Wednesday 14th September 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This has been a high-quality and interesting debate. I welcome the Minister of State, Department of Health, the hon. Member for Ludlow (Mr Dunne), to his new role. As he is new to the role, I will forgive him for not knowing precisely how many trusts ended last year in deficit—it is 80%, by the way. As my hon. Friend the Member for Lewisham East (Heidi Alexander) said, that is the context in which we are discussing the plans, which means that the public will rightly be cynical about them, particularly if they are presented with a final plan. The Minister underplayed their development a little when he said that they were simply ideas. If that is all they are, let us see them.

We have heard contributions from the hon. Members for Bosworth (David Tredinnick), for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston); my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown); my hon. Friend the Member for Dewsbury (Paula Sherriff); the hon. Members for Spelthorne (Kwasi Kwarteng), for Bedford (Richard Fuller) and for Faversham and Mid Kent (Helen Whately); my hon. Friend the Member for Bootle (Peter Dowd); the hon. Member for Lewes (Maria Caulfield); my hon. Friend the Member for Hammersmith (Andy Slaughter); the hon. Member for North Dorset (Simon Hoare); my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly); the hon. Member for Eddisbury (Antoinette Sandbach); my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury); the hon. Member for Stafford (Jeremy Lefroy); my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley); the hon. Member for Bath (Ben Howlett); and my hon. Friends the Members for Wirral West (Margaret Greenwood), for South Shields (Mrs Lewell-Buck) and for Heywood and Middleton (Liz McInnes). I am sorry that I am unable to refer more to hon. Members’ contributions because of the time pressures.

Let us get down to the brass tacks. This is another reorganisation of the NHS, only this time it is being done behind closed doors. It is not just a reorganisation but an admission, as if we did not already know it, that the Government got the last one wrong. The Opposition do not need persuading that there is a benefit to more localised strategic oversight of the NHS and the health sector. We know that because we opposed the Government’s decision to scrap strategic health authorities as part of the 2012 Act.Unlike the strategic health authorities they are now trying to replace, there is no statutory basis for STPs and there is no scrutiny or transparency at all. Despite this, they are being asked to go further than any body has ever had to in the entire history of the NHS in terms of the cuts they are being asked to make. These cuts are being cooked up behind closed doors. This is happening without the involvement of patients, carers, clinicians, trade unions and staff. Consultation with the public does not mean presenting them with a completed plan as a fait accompli and asking them whether they support it. It means involving them from day one. The bigger the change, the better it is to start early with that consultation.

In my area, what has been published about the Cheshire and Merseyside plan states that it

“will require our hospitals to be reconfigured, consolidated with less sites and clinicians and consultants.”

Yes, that means fewer hospitals, fewer doctors and fewer nurses. No wonder the Government do not want to talk about it. Many Members, including the Chair of the Health Committee, have talked about the importance of consultation. We know from history that if an attempt is made significantly to alter local health services without engaging with the public and establishing local support at an early stage, it will fail. That is not just my view. This is what the Secretary of State himself said:

“the success of STPs will depend on having an open, engaging, and iterative process that involves patients, carers, citizens, clinicians, local community partners, parliamentarians, the independent and voluntary sectors, and local government”.

That just has not happened so far.

Not only are the public locked out of contributing to this process, they cannot even find out what is happening. I submitted freedom of information requests to NHS England and the 44 STPs, asking for copies of the plans submitted in June. The deadline for replies is tomorrow and so far not one has been provided to me. Many have simply refused to provide me with the plans, using the exemption that they are “intended for future publication.” When I asked the Minister when the June plans would be made available, I was surprised to read in his response that

“The June submissions were a ‘checkpoint’ and will not be published.”

We have STPs saying one thing and Ministers saying something else about whether the plans will be even published. No wonder people are concerned about what is in them.

Is this not the nub of the matter? Plans about fundamental changes to local health services have been sitting on the Secretary of State’s desk since June, but he will not release them. Surely in the interests of transparency they should be made publicly available now. There is nothing wrong in principle with the idea of local partners working collaboratively to transform health services, but there is everything wrong with doing so without transparency, public involvement or clear lines of accountability.

I welcome the new Minister, the hon. Member for Warrington South (David Mowat), to the Government Front Bench. When he responds to the debate, will he commit to dropping the secrecy and listen to the concerns of clinicians and patients, and ask each area to make their plans publicly available immediately? Will he clarify his role in the plans? When responding to a point made by the right hon. Member for North Norfolk (Norman Lamb), he said that plans will not go ahead if they do not deliver for mental health. However, the Minister of State, in response to a written answer, said:

“The reconfiguration of services…is clinically led and a matter for the local National Health Service.”

So which is it? Who will get the final say? Will it be the Government or will it be the local STPs?

What we have seen so far is a process that has failed to engage with just about every stakeholder imaginable, but even those who have been invited to attend the meetings are beginning to lose faith in the process. Council leaders and officers are queueing up to express their concerns. We heard from my hon. Friend the Member for Bootle about how his council leader’s concerns were dismissed. The Conservative leader of Kent County Council, Paul Carter, said:

“In Kent and Medway, NHS England is doing everything it can to keep local government out of it.”

Izzi Seccombe, Conservative leader of Warwickshire County Council, said that local government was being

“left out in the cold and not involved in the integration agenda.”

If STPs are the answer, can the Minister tell us why even council leaders from his own party are finding themselves totally disengaged from this process?

Many Members, including my hon. Friend the Member for Lewisham East and the hon. Members for Central Ayrshire and for Totnes, made the point that much of the money set aside for transformation has been spent on deficits, so let us not pretend that STPs are a panacea. Do not take my word for it; listen to what NHS providers are warning:

“We must be realistic about what STPs can achieve…and what they can deliver in terms of the £23 billion efficiencies required. It should not be overestimated.”

Nigel Edwards, of the Nuffield Trust think-tank, says:

“I’ve been visiting a lot of STPs and nobody I’ve spoken to is confident they can reduce the financial gap.”

Given the warnings we have already heard, will the Government seriously engage with the health service on the challenges they face, or will they continue to insist on impossible targets and unrealistic timetables?

I am sure the response will be the same one that we hear time and again: that the Government are investing £10 billion more in the NHS. We know, however, that that is an illusion. The Health Committee has confirmed that they are in fact delivering less than half of that, while at the same time chronically underfunding social care. The NHS has just had its biggest deficit in history under the stewardship of this Government, but the Secretary of State is not simply trying to convince us that he will maintain services at their current level, he is telling us that he will somehow do more.

The Government are in denial. It seems that virtually every day somebody is warning us that the NHS is on the brink of collapse. Only this weekend, the chief executive of NHS Providers said that

“we face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate”.

The Society for Acute Medicine has warned us that the NHS could experience “pockets of meltdown”. In the real world, not one serious commentator or senior NHS manager—not one—believes the NHS can deliver the services that it currently does, function safely, improve quality, move to 24/7 working and be financially sustainable. Let us end this charade; let us open up the debate and get to the truth about the damage being caused to the NHS by this Government. I commend this motion to the House.

Capsticks Report and NHS Whistleblowing

Justin Madders Excerpts

Wednesday 13th July 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Main. I start by paying tribute to my hon. Friend the Member for West Lancashire (Rosie Cooper), who has ploughed what has at times been a very lonely furrow on this issue. She has shown incredible tenacity in pursuing the matter over a number of years. What makes this all the more remarkable is that, despite all of the inspection regimes and safeguards in place, the only reason we are debating this is because she had the courage and the determination to pursue these issues. She made a powerful and lengthy contribution today; I do not use that adjective in a critical way, but to highlight that there is so much that needs to be considered. The debate is certainly not going to be the end of the story. My contribution will perhaps not be as lengthy as on other occasions as I would like to give the Minister as much time as possible to set out how he intends to take matters forward.

At the heart of this is a random occurrence—my hon. Friend attending the trust in question as a result of her father being a patient there—and one can only wonder whether anything would have been done about the situation had she not attended, and had the brave staff on the ward not approached her after that. We heard from her about a whole catalogue of incidents, any of which in isolation ought to have raised alarm bells. When she spoke of the picture across the board, the number of grievances, some taking years to resolved, the suspensions that seem to be used as a punishment rather than the neutral act they are meant to be and the number of complaints of bullying and harassment it is clear that a wider pattern was there. In the words of the report:

“Non-Executive Directors took reassurance too easily and failed to provide sufficient scrutiny and challenge across a number of key areas. They collectively represented a series of missed opportunities to intervene.”

It should be said that there were also repeated failures by the executive directors to be open and transparent with the wider board, which included them not divulging details of a serious assault carried out on a staff member and keeping from the board the results of a staff survey that said 96% of respondents believed bullying was a problem to some degree within the trust. Will the Minister address whether he considers there needs to be more training or support for non-executive directors, so they at least know when they are not getting the whole picture? I also wonder whether there ought to be a requirement for at least one employee representative on each board so that, if there is a culture like this, there is a greater chance of it being revealed. What steps are being taken to prevent those non-executive directors who were involved in this from serving in a similar capacity in future?

The position of the executive directors deserves much sharper criticism, particularly when, as my hon. Friend pointed out, many of the senior people involved have found themselves in employment elsewhere in the NHS, and she quite rightly asked where the individual accountability is. Staff spending their last few days stood at a shredding machine is the sort of thing that goes on in multinational companies that have been cooking the books. It is not what should be happening in an open, transparent and accountable public body. It seems that the human resources team were used as a tool to enforce management’s will rather than to ensure the rules were applied fairly and consistently across the board. It is little wonder in those circumstances that staff did not feel confident that they could raise concerns freely.

I am sure we will talk about the duty of candour, but will the Minister give us assurances that this sort of situation will not happen again? Policies and good intentions can only take us so far, particularly when a culture develops that positively attacks those that raise concerns so that everyone is too frightened to raise those concerns in the first place. In my experience I have seen far too many times people who have legitimate concerns about a practice at their place of work but who do not have the confidence to raise those issues without fear of reprisal. A policy is only as good as the people entrusted to honour it and that is down to the people at the top. They set the tone and they have a duty to ensure that every person who raises a legitimate concern is protected. It only takes one bad experience or one failure to act in good faith on a concern raised and the entire system falls into disrepute.

I am sure that nobody goes into public service with the intention of creating such a culture of fear but it is clear that good intentions can be diverted by other influences and pressures. In this case, the central conclusion in the report, which needs more careful consideration, is that when the trust made the decision to go for foundation status what happened was an

“accompanying focus to reduce costs, which resulted in enormous pressures on many front line services and the emergence of a culture of bullying and harassment of staff at various levels within the organisation and the delivery to some patients of poor and in some cases sub-standard care.”

The report also said:

“For many of these concerns, it is hard to come to any other conclusion than that they were managed in the way they were in order to ensure the Trust application for NHS foundation trust status remained on track.”

That is pretty damning.

Aside from the financial pressures faced, we know that other pressures on staff are not going away, with significant numbers reporting work-related stress. We know that vacancy rates and rota gaps still remain unacceptably high and there are serious problems with staff morale across a whole range of services. I pay tribute to all NHS staff who are working hard in very trying circumstances, but we should also be realistic about the challenges they face. The staff at the trust have been key to delivering the improvements we have already seen, and the latest CQC report recognises that there have been improvements, which is not only a credit to those staff but also to the new leadership team.

It is fair to say that there is clearly still some way to go. For example, the performance of paediatric speech therapy service was worse than at the last inspection to the extent that the trust had to suspend the waiting list for a year. It was also noted that, despite some improvements, too many patients are developing serious pressure ulcers, which is something that ought to be eradicated altogether. Inspectors also highlighted “significant improvements” in the culture of the organisation and praised the trust for the measures it has introduced to keep staff safe, which is clearly one of the biggest and most important changes that was needed.

Whether that change in culture is permanent can only be tested by events, but we should reinforce at every opportunity the importance of speaking out with confidence. In that regard, it appears the future of the national whistleblowing helpline is still being considered. I would like to see the local guardians as complimentary to, rather than a replacement for, the national helpline. I would be grateful if the Minister will address whether any decision has yet been taken on the future of that national helpline.

In conclusion, I add my voice to the calls made by my hon. Friend the Member for West Lancashire for an independent clinical review into patient harm associated with the leadership failings at the trust. We also need an investigation into the adequacy of the actions taken at the same time by NHS Improvement, NHS England, the clinical commissioning groups and their predecessor organisations. Only then can we move into a position from which we can confidently say this is something that will never happen again.

NHS Spending

Justin Madders Excerpts

Wednesday 6th July 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

In what has been a hugely significant day in a monumentally significant fortnight, we have been discussing issues that are also of huge significance, but I fear that the contributions will be lost amid the historic nature of the events are currently engulfing this place and the whole country.

Let me turn now to the contributions to this debate. The hon. Member for Central Ayrshire (Dr Whitford) rightly highlighted the uncertainty now facing our staff who have come from the EU. There is also a very real fear that agency costs will go through the roof as a result of the decision that has been made.

My right hon. Friend the Member for Enfield North (Joan Ryan) spoke with graphic clarity about the problems that a lack of funding has caused the health services in her own constituency. She also pointed to the promises to protect local services that have not been honoured. She talked about the scandal of junior doctors left unsupervised in the North Middlesex hospital A&E. I know that she has a debate in Westminster Hall on that issue next week, and I am sure that some of the matters that have been raised today will get a further examination then.

My hon. Friend the Member for Copeland (Mr Reed), who, as my predecessor in this shadow role, has great knowledge of this area, spoke passionately about the challenges that his community faces in delivering an effective health economy. He is right to be concerned that the success regime could indeed turn out to be a Trojan horse.

My hon. Friend the Member for Burnley (Julie Cooper) gave a personal and troubling story about a recent case involving one of her constituents. I agree with the hon. Member for Aberdeen North (Kirsty Blackman) that all of us as politicians will have to work much harder to restore and retain trust in what we say. My hon. Friend the Member for Bristol South (Karin Smyth) spoke with the benefit of her own great experience of the NHS and her more recent experiences as a member of the Public Accounts Committee and the many critical reports it has written. I assure her that I have already considered many of them, so I trust I have her permission to watch the football later.

Finally, my hon. Friend the Member for Harrow West (Mr Thomas) spoke with great authority about the difficulties of his own local NHS trust. I think every Member who has spoken tonight has mentioned challenges in their own constituency, but more significant is the fact that every Member who has spoken tonight said that at least some of their constituents voted to leave the EU because they thought it would mean more money for the NHS.

Those are the Members who have spoken. Who have we not heard from? Where are the right hon. and hon. Members who have spent the last few months spearheading the campaign up and down the country claiming that there was £350 million a week just sitting there, ready to be spent on the NHS. Could it be that because it was a promise that could never be kept and should never have been made, we have seen a collective abrogation of responsibility by people who, frankly, should know better? Make no mistake: those who have associated themselves with such claims will be expected to account for their actions, but let us not allow those wild statements to distract us from the crisis in the NHS caused by this Government.

The challenges we already face in the finances, quality of care and the workforce put the NHS in a precarious position, but be in no doubt: those challenges were there before we voted to leave the EU. It has been clear for some time that the NHS does not have the resources needed to deliver the services that people expect. Only this week, we have heard where the Government’s priorities appear to be, with the Chancellor talking about reducing corporation tax yet again. Is it not interesting that we only hear such extra-parliamentary statements about tax cuts, and not about the extra investment that the NHS patently needs? Indeed, the Chancellor’s last big spending decision on the NHS was to cut £1.1 billion from this year’s capital budget, which came to light only after a study by the House of Commons Library—an approach about as far removed from parading impossible pledges on the side of a bus as I can imagine, but to my mind just as dishonourable.

As we know, the overall deficit in the NHS last year was a record £2.5 billion—a record deficit despite pledges from the Government that the investment needed would be front-loaded now to ensure that the NHS could implement the service transformation needed before the middle years of this Parliament, when the funding increases already announced for the NHS are microscopic. What will the NHS look like a few years down the line if the money that is supposed to be preparing us for the rocky road ahead will in fact be used to plug the black hole in finances left over from the last year? Surely, whatever the implications of the referendum result, the Government must recognise that their existing financial plan for the NHS needs comprehensive re-evaluation.

Only yesterday, we had a report from the Healthcare Financial Management Association that revealed that 22% of the NHS finance directors in hospitals and CCGs surveyed said that quality of care will worsen during this financial year. It does not end there: one in three finance directors fear that care will deteriorate in the next financial year. They warn that waiting times, access to services and the range of services offered are all likely to suffer because of the inadequate funding settlement. I know the Minister will try to reassure us that plans are in place to put the NHS back on an even keel, but I suggest that he listen to the 67% of CCG finance officers and 48% of trust finance directors who have said that there is a “high degree of risk” associated with achieving their organisation’s financial plans for this year.

In addition, only 16% of finance directors have expressed confidence that NHS organisations in their area will be able to deliver the changes required by their local sustainability and transformation plans. Along with the challenges they anticipate in delivering planned efficiencies, finance directors say that continued high spending on agency staff and inadequate funding of social care are pressures that are not going away. As my hon. Friend the Member for Bristol South mentioned, the Minister will be aware of what the Public Accounts Committee said: that the 4% annual efficiency targets imposed are

“unrealistic and have caused long-term damage”.

None of that will be news to the Minister. It is high time the Government acknowledged that within the current parameters, hard-working NHS staff are being set up to fail.

Across a whole range of indicators, the NHS is experiencing its worst performance since records began, but let me be clear: I do not for a second hold the people who work on the frontline in the NHS responsible for that. Indeed, it is only through their dedication that the health service keeps going, despite the best efforts of the Government to destroy staff morale. Be it the current generation of junior doctors alienated by botched contract discussions, the next generation of nurses deterred from entering the profession by tuition fees, or the thousands of EU nationals working in the NHS who fear for their future in this country, existing staff, who are at breaking point, see nothing from the Government that gives them confidence that the Government have a clue how to fix this mess.

Let us once and for all nail the myth propounded by Government Members that this Government have been generous in their funding for the NHS. The King’s Fund and the Health Foundation looked into this claim. Despite the oft-repeated mantra that this year’s funding increase is the sixth largest in the NHS’s history, they said:

“We find that…this year it is in fact the 28th largest funding increase since 1975”.

That is the truth. That is the cruel deception at the heart of the Government’s NHS plans.

NHS Providers, the organisation that represents NHS trusts, had this to say about the size of the deficit:

“the combination of increasing demand and the longest and deepest financial squeeze in NHS history is maxing out the health service”.

The fact is that the NHS is halfway through its most austere decade ever. It is getting a smaller increase this year than it got in any single year of the last Labour Government. Since the health service’s creation in 1948, NHS demand and costs have risen by 3.5% to 4% a year, and on average funding has kept pace. Now funding will rise, on average, by only 0.9% a year between 2010 and 2020. That is a quarter of the historical average, and well below what is needed to provide the same quality of service to a growing, older population.

I return to my opening remarks. It has been a seismic few weeks for this country. Politicians have been exposed as cavalier with the facts, cynical in their actions and irresponsible about the future of this country. Let us not allow that approach to continue to pollute our politics. Let us have the courage to be honest about the challenges that lie ahead. Let us stop the pretence that the NHS can continue to be the service that most of us want it to be within current Government spending limits.

Let us also be clear that the answer is not to emblazon buses with cheap slogans and then run away from those slogans at the first opportunity. Instead, the challenge for all of us in this place who want the next generation to enjoy the same access to the NHS that my generation has taken for granted is to provide a coherent, credible set of policies and then actually deliver them. On that measure, this Government have fundamentally failed. I therefore commend the motion to the House.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 5th July 2016 Commons Chamber

[Ben Gummer]

I welcome the hon. Lady to her seat. She fought a courageous campaign, and it is good to see her in the Chamber. She brings expertise to the House, which is also very welcome.

I agree with the first part of the hon. Lady’s question—the deficit at her local hospital is indeed partly caused by the excessive costs of agency nurses, and we are trying to put a cap on those costs—but I am afraid I disagree with the second part. I believe that changes in nurse bursaries will enable us to get more nurses and healthcare professionals into the NHS. There has been a similar development in the rest of the higher education sector, and I want to replicate that success in the NHS so that we can provide it with the workers that it requires.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I, too, am delighted to welcome my hon. Friend the Member for Tooting (Dr Allin-Khan) to her seat. Her recent experience on the front line of the NHS will be of great value, and we in the Labour party pride ourselves on listening to NHS staff. Let me also put on record my thanks to my hon. Friend the Member for Lewisham East (Heidi Alexander) for the excellent job that she did as shadow Secretary of State.

I must challenge the Minister again about the impact of this policy on mature students. According to an answer given to me by his colleague the Minister for Universities and Science, in 2010-11 there were 740,000 enrolments in higher education among people aged 21 or over. Let me ask a simple question: in 2014-15, after tuition fees trebled, was the number of enrolments among mature students higher or lower?

[Ben Gummer]

I echo the hon. Gentleman’s remarks about the hon. Member for Lewisham East (Heidi Alexander). She gave the House admirable assistance in challenging the Government, and I regret her loss from the Opposition Front Bench.

The latest figure from UCAS, for 2015, shows that the number of mature student applications has risen since the introduction of £9,000 tuition fees, but the hon. Gentleman is right to identify that factor as a challenge in relation to our new plans. That is why we asked open questions during the consultation, and I hope that, now that it has closed, we shall be able to respond to those questions to ensure that we can give the best possible assistance to mature students who want to become nurses.

[Justin Madders]

According to the universities Minister, the number of mature students enrolling in universities has fallen by 22%. If that were repeated in the health sector, what is already a staffing crisis would become a catastrophe. The Minister has said that an extra 10,000 training places will be created during the current Parliament, but everything I have heard from the Government suggests that that figure was plucked out of thin air. What is the baseline figure for the Minister’s claim—10,000 more places compared to when?

[Ben Gummer]

There will be 10,000 additional places over the five years from when the policy was announced last year, and that will give NHS organisations throughout the country the assistance that will enable them to bring down their agency costs. It is only through such bold initiatives that we can reform the NHS for the betterment of patient care throughout the country.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is right to draw attention to that issue. We, too, are very proud of the progress we have made on mental health, with 1,400 more people accessing mental health services every day than six years ago, but there is a particular job to do with children and young people’s mental health, and we are putting £1.4 billion into that during the course of this Parliament—and there is a specific plan for the Manchester area, which I think will help my hon. Friend’s constituents.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It seems that almost every day there is another report about the deteriorating condition of NHS finances. Today we hear of a survey by the Healthcare Financial Management Association that said 67% of clinical commissioning group finance officers reported a high degree of risk in achieving their financial plan for the year, so does the Secretary of State now accept that the Government need to commit more funds to the NHS?

[Mr Hunt]

We have accepted that, which is why in our manifesto at the last election we were committed to putting £5.5 billion more into the NHS than was being promised by the hon. Gentleman’s party, but we have to live within the country’s financial envelope, because we know that without a strong economy we will not have a strong NHS. We will continue to make sure we get that balance right.

Stillbirth

Justin Madders Excerpts

Thursday 9th June 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is an honour to serve under your chairmanship, Sir David. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this extremely important debate and the compelling way that she introduced it. She is right that she is not alone in having gone through such a terrible experience, and she is certainly not alone in wanting to move this issue up the political agenda. I pay tribute to her for the courage that she has shown in retelling her experience. I do not think that any Member could fail to have been moved by her speech, and I am sure that many of those watching her contribution will, sadly, have recognised the personal tragedy, which was made more difficult by the defensive attitude of the health service. Many people have had such experiences—not just in this area but through many other failings in care in the health service. She made a compelling case for the extension of coroners’ powers to holding inquests on stillbirths. As we know from recent high-profile inquests, there is a need for a comprehensive review of that whole system.

Hon. Members from both sides have made excellent and sometimes very moving contributions. I draw particular attention to the contribution of the hon. Member for Henley (John Howell), who rightly raised the impact on parents’ mental health of such experiences and the loss that the whole family feels. Not only the mother and father, but little brothers or sisters and the wider family are impacted by such tragic events.

The hon. Member for East Renfrewshire (Kirsten Oswald) was right to highlight the need for prevention and how many parents experience a stillbirth and never get an adequate explanation of how that happened. I agree that only through continued targeted action will we drive the necessary progress. The hon. Member for Colchester (Will Quince) summed up the challenge very well when he said that we do not like talking about death in this country. I pay tribute to him for the great strength that he showed in talking about his experience. I am sure that he will be able to get many more Members to talk about this subject through his work on the APPG. The hon. Member for Livingston (Hannah Bardell) spoke with great sincerity about her constituents’ experience and the twin to twin transfusion syndrome process, and conveyed the incredible range of emotions that parents must go through in such situations, which are rare but none the less extremely difficult for those involved.

I welcome the debate, which, as we have heard, coincides with Sands awareness month. I add my voice to those of others who have already paid tribute to the enormously important work that that charity does. Sands awareness month gives us the opportunity to increase awareness of stillbirth and neonatal death and the devastating impact experienced when a baby dies before, during or after birth, which hon. Members have conveyed with great sincerity and courage.

In November, I was privileged to have the opportunity to respond for the Opposition in a debate marking World Prematurity Day. That debate was also difficult, and what we heard then from Members about stillbirths and neonatal deaths was equally compelling and challenging. We still face those challenges, and this is an opportunity to explore in further detail some of the issues that were raised in November and have been raised today and to scrutinise the progress that the Government have made in the six months since that debate.

As has been said already, although there has been enormous progress in the past century in tackling stillbirth and infant mortality rates, progress has more or less stalled in the past two decades, and the UK continues to perform significantly worse than many comparable nations on infant mortality rates and remains one of the poorest performing countries in the developed world for stillbirths. That is a clear sign that we are not doing well enough in providing neonatal care or tackling the underlying public health issues that contribute to premature births and stillbirth.

Research into babies stillborn from 28 weeks indicates that the UK has a stillbirth rate of 2.9 per 1,000 births —higher than Germany at 2.4; Poland at 2.3; the Netherlands at 1.8; and Denmark at 1.7. Members have said that this issue is not just about statistics, and it is about far more than that, but those statistics need to be laid out, because it is clear that we are not doing as well as we should be and progress is not as swift as in some other places in Europe. I think that all Members want to see that situation addressed. We welcome the Secretary of State’s ambition to reduce stillbirths and neonatal deaths by 50% by 2030, but 14 years is a long way off, so will the Minister give us some indication of what progress he expects to be made before that date? Will he also set out where he expects us to be by around 2020, by which time the Secretary of State has indicated that he expects there to have been a measurable reduction?

We welcome the announcement from 13 November of a £4 million investment in equipment and training and the establishment of a new system enabling staff to review and learn from every stillbirth and neonatal death. The Government have signalled their intention to review every one of those tragedies, and I would appreciate it if the Minister could update us on how close we are to reaching that target, and when he expects it to be met.

One of the key themes that has emerged today and in the debate we had last year is that we have some of the finest neonatal care in the world in this country, but that there is simply far too much variability between hospitals and regions. In my role as an Opposition spokesperson I have had the pleasure of visiting some excellent facilities, most recently those at Barnsley general hospital, where the commitment and attention to detail of the staff, based on listening to and valuing patients’ views, was particularly impressive. At this point, I think it is worth paying tribute to NHS staff who are tasked with helping families at their most difficult time for the sensitivity, understanding and professionalism that they show.

The hon. Member for Colchester raised the issue of bereavement suites being available in every maternity unit in this country. If we had the same quality of care that I saw in Barnsley throughout the country, that would be a real achievement. We need to see those units that currently offer the very best care spreading their expertise across the country, so that everyone can have the very best throughout their pregnancy. Attempts to achieve that have begun. In March, NHS England published new guidance, building on existing clinical guidance and best practice. It identified four key interventions, with the aim of meeting the Secretary of State’s ambition to halve the rate of stillbirths by 2020. Those key interventions are reducing smoking in pregnancy, enhancing detection of foetal growth restriction, improving awareness of foetal movement and improving foetal monitoring during labour.

It has been estimated that if no women smoked during pregnancy, 7.1% of stillbirths could be avoided, which would equate to around 230 additional babies surviving each year. Smoking and passive smoking increase the risk of infant mortality by an estimated 40%. However, despite those startling statistics, we have seen a significant cut in public health funding, leading to around 40% of local authorities cutting budgets for smoking cessation services. Only last week I saw two pregnant women smoking on the same day. While I appreciate that that is anecdotal, it nevertheless brought home to me that we are certainly not making the inroads that we should be into cutting smoking during pregnancy. As the hon. Member for Colchester said, one in 10 women still smoke during pregnancy, which is startling, given the huge amount of evidence about the risks of doing so. We clearly need to do more to get that message across. If the key interventions are to be effective, cuts to public health budgets will not help in achieving that aim.

I have no doubt that the other suggested interventions will also help us to drive down rates of infant mortality. However, as the Royal College of Nursing has pointed out, England remains 2,600 full-time midwives short of the number it needs. We simply must have the correct level of staffing if we are to successfully implement that guidance. There are also serious issues in the levels of other clinical staff in neonatal units. The report published last year by Bliss, “Hanging in the balance”, argues that neonatal services are “stretched to breaking point”. It also states that two thirds of neonatal intensive care units do not have enough doctors and nurses, with around 2,000 more nurses needed to fill that gap. A report by the Royal College of Midwives also stated that more than 40% of wards became so busy last year that they were forced to close their doors. The average unit closed its doors on five occasions, with some closing more than 20 times.

Worrying reports this week also suggest that staff shortages and increasing demands are impacting on the ability of midwives and maternity staff to provide care. A survey by the Royal College of Midwives found that 62% of midwives and maternity support workers felt dehydrated at work because they did not have time to have a drink; 79% did not take the breaks to which they were entitled; and 52% had witnessed an error, near miss or other incident in the past month. Given the impact of current staff shortages, I question the proposal to replace bursaries for nurses and midwives with student loans, as I believe that is a risk we cannot afford to take at this stage.

The Universities Minister has confirmed that, since the tripling of tuition fees in 2012, the number of student nurses over the age of 25 has plummeted. Given that the average age of nurses and midwives in training is over 25, I have serious concerns that, for all the good intentions we have at the moment, we will not have the resources and staff to deliver the improved outcomes we all want to see. Areas such as neonatal care, which are already stretched, need more support, and I therefore invite the Minister to reconsider the current policy.

I conclude by focusing on the families who experience bereavement when their baby dies during or after birth. It is difficult to contemplate what they go through when what should be a time of joy and celebration becomes a period of tragedy beyond measure. Again, I pay tribute to the compelling way hon. Members have expressed their experiences. They have certainly given us all an awful lot to consider. What has made many people’s experiences even more difficult is that speaking about the loss of a baby has, as many Members have said, traditionally been considered taboo. Families have often felt they have nowhere to turn for help, or even to talk about it. The fact that Members have had the courage to talk about it today will help us challenge that taboo, and along with Sands awareness month, we will be able to make progress in making sure that we can talk about these issues openly and give a voice to those who have experienced the personal tragedy of the death of a baby.

I hope the great sincerity and passion with which Members have spoken will lead to a redoubling of efforts, not only in terms of neonatal care and tackling public health issues but in ensuring that we listen to the experiences of people who have gone through this, so that families get the support they need at the point of such a personal tragedy. They deserve the best possible bereavement support from highly trained professionals, and we should do everything in our power to ensure they are offered nothing less than the very best.

Diabetes-related Complications

Justin Madders Excerpts

Tuesday 7th June 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate my hon. Friend the Member for Dewsbury (Paula Sherriff) on securing this important debate and on the eloquent and powerful way she set out the issues in her opening speech. Several hon. Members have echoed what she said, and I will no doubt repeat it to an extent. After just a year as an MP she has established herself as one of the most effective campaigners in this place, and she is a passionate advocate on a range of issues—particularly public health matters. She spoke of her visit to King’s College with my hon. Friend the Member for Heywood and Middleton (Liz McInnes), and described the excellent care there, as well as mentioning the fact that, sadly, that experience is not replicated throughout the country. She highlighted the cost of diabetes and described education as a missed opportunity to reduce complications. That is a theme that has come through in several of the contributions today.

I also want to mention the contribution from the hon. Member for St Ives (Derek Thomas), who made a powerful point about what kind of future the next generation is heading towards, if we do not put more focus on the issue now. He gave us constituency-specific figures on amputations. I wonder whether all hon. Members would be interested to find out the specific figures for their constituencies. They really bring the issue home. I agree with the hon. Gentleman that the matter should not just be left to CCGs, and that there is a need for more co-ordinated national support. He was also right to say that we should aim to reach the point where amputation is seen as a failure and an exception.

My hon. Friend the Member for Islwyn (Chris Evans)—I hope that is the right pronunciation of his constituency—

[Chris Evans]

Someone once said it as “insulin”.

[Justin Madders]

We could have been forgiven for making that error today, but we will talk more about pronunciation afterwards. My hon. Friend spoke with great sincerity about the benefits for children of taking part in sport, and about how once they get into it they can enjoy the physical activity. I know from experience that dragging kids off the Xbox can be a difficult challenge, but once they actually get out there they enjoy themselves, and that contributes to a healthier lifestyle. He also made a valuable point about the world of work, in that so many more jobs are now sedentary in their nature. Of course, a healthy workforce is a more productive one, and productivity is a challenge for the whole country.

My hon. Friend the Member for Heywood and Middleton spoke with great experience of health. It was great to hear that she had been inspired by her visit to King’s College. She spoke about the national diabetes audit, and the importance of using the data collected to drive improvements. Again, she highlighted the need for more education. It was interesting to hear that some of her constituents have difficulty attending some education courses because employers are not agreeing to give them the time off. It will be interesting to hear the Minister’s reflections on that and it comes back to the point about a healthy workforce being a more productive one. We really need to get that message across to employers.

The hon. Member for Inverclyde (Ronnie Cowan) spoke about his family’s experience and gave us a useful personal insight into the everyday challenges faced. We can all reel off the figures but hearing from someone who has had a close relationship with the condition for a considerable length of time brings home some of the practical challenges that people face.

There is a consensus, as the hon. Member for Linlithgow and East Falkirk (Martyn Day) said. All hon. Members acknowledge that diabetes is one of the most significant healthcare challenges, given the impact that it has on NHS resources and, more importantly, the impact it has on people. We heard very powerful details of that today.

To put the condition in perspective statistically, 45 people in the UK will have been diagnosed with diabetes in the time it takes to complete today’s debate. In that time, one person will have undergone a diabetes-related amputation and four people will have died prematurely due to diabetes-related complications. According to figures produced by Diabetes UK, there are currently 4 million people living with diabetes in the UK, of whom 549,000 are undiagnosed.

The number of people with diabetes is increasing, as various hon. Members have said, and it has more than doubled since 1996. More than doubling the number of people with any condition in 20 years is bound to lead to serious questions about how our society is operating. Indeed, several hon. Members have given some good examples of the challenges we face. Part of our role is to question and support, where possible, how the Government respond to those challenges, particularly when we are talking about something that can be preventable. The level of interest shown by hon. Members today shows that there is at least recognition and agreement that the issue demands significant attention.

The number of people with a diagnosis is huge, as is the cost to the health service. The NHS now spends about £10 billion on diabetes each year, which is equivalent to about 10% of its budget, and £8 billion of that is estimated to be spent on complications, which, as we have discussed, are largely avoidable. Diabetes is an important issue to tackle at any time but, when we have such financial pressures on the NHS, it becomes even more pressing to really get on top of trying to avoid the complications it can cause.

At the heart of the issue are the people involved. Although many are able to manage their diabetes effectively, it is still a life-changing condition that has an impact on those living with it on a daily basis. We heard from the hon. Member for Inverclyde about how it really has an impact not only on the individual, but on their family. For somebody with type 2 diabetes, managing their condition means learning how to treat it with diet and exercise, and possibility coming to terms with the need to take medication and insulin. For someone with type 1 diabetes, it means constant diet management and carefully working out the correct amount of insulin to take. However, for everyone living with diabetes, it means being aware of the potential complications that can occur, and keeping a careful watch not only on blood glucose levels, but on cholesterol, weight, blood pressure and the conditions of eyes and feet.

Put simply, living with diabetes means becoming an expert on the condition. Despite that, less than 2% of newly diagnosed individuals with type 1 diabetes, and just 5.9% of those newly diagnosed with type 2 diabetes, attend a diabetes education course, which is a theme that has been mentioned by various hon. Members. Those figures alone are disappointing, but they are even more so given that there is clear evidence that the courses reduce the risk of individuals developing complications, and given the fact that a worrying 69% of people say that they do not fully understand their diabetes. The very nature of the condition means that self-management is the only practical way to reduce the risk of complications.

We welcome the publication of the Government’s new improvement and assessment framework for CCGs, which will assess CCGs on the attendance of structured education schemes and on the NICE recommended treatment targets. Will the Minister tell us what steps the Government are taking to improve access to diabetes self-management education, what steps she envisages taking against CCGs that perform poorly in the improvement assessment framework, and what support will be available to those identified as poor performers in order to bring them up to what is considered best practice?

[Mr Jamie Reed]

Does the shadow Minister agree that some consideration ought to be given to the funding allocation for CCGs with particularly large concentrations of people with type 2 diabetes, which is, after all, linked to obesity and lifestyle, especially considering that obesity is increasingly statistically linked—there is a clear correlation—with the incidence of poverty and socioeconomic disadvantage? Does he agree that CCGs with those significant populations should have their funding allocation reviewed?

[Justin Madders]

I agree that that needs due consideration. In some written answers, the percentages of people with diabetes per constituency are shown, and there are some definite peaks and troughs. If we are to get the issue under control, we must think more strategically about where the resources are put.

At the moment, a third of CCGs do not commission specific courses, which is contrary to national guidance. I hope that the Minister will be able to tell us what she will do to try to end the current postcode lottery. One of the most convenient and effective sources of education for many people with diabetes is their local pharmacy. There is a need—possibly, a demand—for expanding the role that pharmacies play in supporting people with diabetes. What are the opportunities and possibilities for thinking again about the Government’s plans to slash the community pharmacy budget, which may lead to the closure of up to 3,000 sites?

More significant than the variation in education is the variation in the levels of care and support offered depending on location, the age of the patient and the type of diabetes. There is evidence of markedly different routine care throughout the country, which has a huge impact on the quality of life of diabetics, as well as being costly to the NHS. One in six people in hospital has diabetes, yet one in three hospitals has no diabetes specialist nurse. The national diabetes in-patient audit paints a worrying picture of the variations in the way in which the condition is managed by hospitals, and the unacceptable number of in-patients suffering avoidable complications.

Some of the most serious diabetes-related complications are avoidable amputations and foot ulcers. We have heard that £1 in every £150 that the NHS spends is in that area, and such action has a dramatic, life-changing impact on individuals and their families. As my hon. Friend the Member for Dewsbury said, in 2013 the Health Secretary committed to reducing the rate of amputations by 50% in five years. Will the Minister tell us what progress has been made towards achieving that goal, particularly given that Diabetes UK has said that no progress has really been made? Will she confirm that she still hopes to meet that target?

NICE recommends that all people with diabetes undergo an annual foot check but, in the worst performing CCGs, one in four people are not receiving a foot check at all. Part of the reason for that is the shortage in the number of podiatrists, particularly following a recent reduction in the number of students from 361 to 326. I am concerned that the plan to scrap bursaries for podiatry students and to push them into about £50,000 of debt will make the situation even worse. I ask the Minister to reconsider the direction of travel on this policy. Will she advise us what assessment has been made of the likely number of podiatrists who will be trained each year under the new funding regime?

I will close by making a few remarks about prevention. As I said at the beginning of my speech, the number of people suffering from diabetes continues to rise. The primary driver of that is, of course, lifestyle. Some 11.9 million people are currently at an increased risk of developing type 2 diabetes as a result of their waist circumference or weight. Two in every three people in the UK are now overweight or obese. As other Members have said, people might not necessarily feel that that relates to them, but we must reflect on those figures. Obesity accounts for 80% to 85% of the risk of developing type 2 diabetes, and therefore we need to focus on education and treating the condition. The main strategy to address the prevalence of type 2 diabetes has to be to address the rise in obesity, particularly at a young age, as the hon. Member for St Ives said.

We welcome the Government’s announcement of a sugar tax in the Budget, but that measure will only be effective as part of a wider strategy to address childhood obesity. I do not know whether the Minister will be able to tell us, but what is holding back the publication of the strategy? Is there disagreement on what will be in it? Is it at all possible for her to give us a date for when it will be published? [Interruption.] I suspect I have my answer from the grin on her face.

Both sides of the House are alert to, and supportive of, the need to get on top of this challenge but, as with all such matters, the Government will be judged by the results, on which we will keep a close eye in the coming years.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

It depends of course on the career progression of that particular nurse, but the repayment terms will be precisely those for students of other degrees. Newly qualified nurses will not pay any more than they do currently, and the exact rates at which they will pay back—9% above £21,000—are outlined carefully in the consultation document. I recommend that the hon. Lady looks at it and sees the benefits that will come from the reform that, were it to be adopted in Scotland, would provide an enormous benefit to the service north of the border.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I start by congratulating the Secretary of State on becoming the longest serving Health Secretary in history. It is an important-landmark, not least because it is the first target that he has managed to hit.

On NHS bursaries, last week the Minister said that

“more mature students are applying now than in 2010.”—[Official Report, 4 May 2016; Vol. 609, c. 197.]

However, a written answer given to me yesterday by the Minister for Universities and Science appears to contradict this. Indeed, it shows that numbers of mature students have fallen in the past five years by almost 200,000. Given that the average age of a student nurse is 28, and in the light of the clear evidence from his own Government, will the Minister correct the record and commit to looking again at the impact of these proposals on mature students, who form a significant part of the student nurse intake?

[Ben Gummer]

I, too, as I know will all my ministerial colleagues, congratulate my right hon. Friend the Secretary of State on a remarkable tenure in his post.

It is clear that mature student numbers dropped immediately after the higher education reforms, but they then started rising and have now exceeded the rate before the reforms. I am happy to give the hon. Gentleman the details of that. We are also clear that we need to nurture mature students, which is why the consultation asked the specific question that it did. We want to invite answers from the service about how best we can do that because we are clear that the current system is not working as well as it should.