Oral Answers to Questions
Lord Soames of Fletching Excerpts(5 years, 6 months ago)
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Mr Speaker
My ambition is to reach Question 17 so that the House, Mid Sussex, the nation, the European continent and the world can hear the right hon. Member for Mid Sussex (Sir Nicholas Soames).
Sir Nicholas Soames (Mid Sussex) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
Mr Speaker, I share your ambition in reaching Question 17 to be able to say that the long-term plan for the NHS sets out ambitious goals to embed a culture of quality improvement of which my right hon. Friend would be proud.
Sir Nicholas Soames
Thank you very much, Mr Speaker, for getting this far down the list of questions. I know that my right hon. Friend the Secretary of State has a serious ambition to try to drive this plan forward, but it is unacceptable that best practice is not better disseminated throughout the NHS. It is completely unacceptable that there are such wide divergences in standards between hospitals, and it requires the everyday attention of the Secretary of State himself to drive this change through.
Matt Hancock
I agree entirely and enthusiastically with my right hon. Friend. The need to improve services in the NHS just to bring them up to the best that is in the NHS is vital and urgent. We can lift the quality of care that all our constituents get simply by learning from the best. We have schemes such as the “getting it right first time” programme, which is brilliant at teaching hospitals how to do things the way the best hospitals do them, and we want to see more.
NHS Long-term Plan
Lord Soames of Fletching Excerpts(5 years, 10 months ago)
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Matt Hancock
When I answered a previous question on the timing of the social care Green Paper, I said it would be provided “soon.” I certainly intend that to happen before April. My previous commitment was to do it before Christmas, so it is well advanced. But the hon. Lady is right on the legislative proposals. There is a broad consensus on the need for more integration, as my hon. Friend the Chair of the Select Committee said. The proposals that are made by the NHS in the paper are what it thinks is needed in order to deliver this integration, which I very strongly support.
Sir Nicholas Soames (Mid Sussex) (Con)
No doubt my right hon. Friend is gratified, as would be the Churchill-led National Government of 1944, by how truly remarkable and amazing the national health service, the baby of that Government, has turned out to be. Will he assure me that this money does not come without strings and that he will enforce a much better system of lessons learned and, in particular, of disseminating best practice more widely through the NHS? Finally, will he please kick the work of the sustainability and transformation partnerships into some form of prompt result?
Matt Hancock
When I referenced Churchill, I did not realise that it would be in front of his family. My right hon. Friend is quite right about the need for a just culture—a need for understanding the lessons that are learned when things go wrong—in what is a high-risk business of providing medicine and medical care. Those lessons should be properly learned and there should be transparency and openness and a culture of constantly improving the way that things are done, whether that is medically, logistically or organisationally in hospitals. That is a critical part of the review that Baroness Dido Harding will take forward. It is something that she cares deeply about, making sure that we get the culture right within the workforce not only to tackle the high levels of bullying and harassment, which are completely unacceptable in the national health service, but to make sure that there is a spirit and a culture of continuous improvement and of learning from errors that everyone makes. All of us make errors, and we should learn from them and that culture should be inculcated right across the NHS.
Oral Answers to Questions
Lord Soames of Fletching Excerpts(6 years ago)
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Steve Brine
We will be taking evidence, including from the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, which is meeting as we speak, to look at the safe upper limit of folate levels. I am particularly keen to get that right, but I am convinced that the evidence shows overwhelmingly that this is something we should be doing.
Sir Nicholas Soames (Mid Sussex) (Con)
Matt Hancock
My right hon. Friend identifies a critical factor in improving the future of the NHS, which is to have stronger leadership at all levels, to be able to support innovation and to find out the best that is happening elsewhere and bring it to trusts. I know he has a particular interest in that, and I look forward to working with him on it.
NHS Outsourcing and Privatisation
Lord Soames of Fletching Excerpts(6 years, 5 months ago)
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Jonathan Ashworth
I do agree. May I reassure my hon. Friend that those Unite and Unison members who are taking industrial action at Wrightington, Wigan and Leigh have our support? We stand with them in solidarity. I congratulate her and my hon. Friends the Members for Leigh (Jo Platt) and for Wigan (Lisa Nandy) on the campaign that they have been running. These jobs should not be outsourced to wholly owned subsidiaries; they should be in-house.
Sir Nicholas Soames (Mid Sussex) (Con)
I am very grateful to the hon. Gentleman for giving way. I know him to be a good man. May I put this to him? None of these figures or statistics means anything to people wanting treatment on the NHS. May I assure him that my constituents, like his, are not over-concerned where their treatment comes from? What they are concerned about is that they should be competently, effectively and caringly treated under the national health service.
Jonathan Ashworth
I say to the right hon. Gentleman, of whom I am tremendously fond, as he knows, that I agree broadly with the point that he is making. If my memory serves me correctly, he sits for a Sussex constituency and, of course, in Sussex, we had the shambles of a patient transport contract that went to a firm, Coperforma, which did not even own any ambulances and which was leaving patients stranded on their doorstep waiting for transport to dialysis appointments and to chemotherapy appointments. It often could not then pick up the patients from the hospital and take them home. That contract had to come back in-house. It is these types of privatisation that we believe are doing great damage to the health service.
Oral Answers to Questions
Lord Soames of Fletching Excerpts(6 years, 9 months ago)
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Caroline Dinenage
Of course blanket bans on treatments are unacceptable, and decisions on treatments should always be made locally by doctors, based on clinical assessment. I understand that those patients will be offered an alternative, more rounded service and that the CCGs have arranged for each patient to meet their consultant to discuss their treatment. Where there is evidence of rationing, we expect NHS England to ensure that CCGs are not breaching their duties.
Sir Nicholas Soames (Mid Sussex) (Con)
Does my hon. Friend agree that the integration of health and social care is so important to the future success of the NHS that everything needs to be done to speed up the programme to integrate them better? Will she join me in encouraging a speedier approach to that method in Surrey, Sussex and Kent?
Caroline Dinenage
My right hon. Friend is absolutely right. The better care fund is already having a fantastic impact in the area. We are developing metrics for assessing progress on integration by local area, particularly at the interface of health and social care. We need to proceed with this as rapidly as possible, and I am sure that with his backing, that will happen in his local area.
Oral Answers to Questions
Lord Soames of Fletching Excerpts(6 years, 11 months ago)
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Mr Hunt
The hon. Gentleman is right to say that we need more midwives. We have 6,000 midwives in training, and we have 2,000 more midwives than we had in 2010. It is also important to recognise the progress that is being made. Stillbirth rates were down 14% between 2010 and 2015, and neonatal death rates are down 10%, so there is some really important progress happening.
Sir Nicholas Soames (Mid Sussex) (Con)
Will my right hon. Friend join me in congratulating my constituents in Group B Strep Support, and the Royal College of Obstetricians and Gynaecologists, on the September update to the green-top clinical guidelines on group B strep infection, which I am sure he will agree are a significant step forward in preventing that wicked and wholly unnecessary neonatal infection?
Mr Hunt
I am happy to offer my congratulations, because that is an incredibly important area. We have done really well on clostridium difficile and MRSA infections, but the rates of other infections such as group B strep and E. coli are higher than they need to be. In fact, I am speaking at a conference on infection prevention and control this afternoon.
Oral Answers to Questions
Lord Soames of Fletching Excerpts(7 years, 7 months ago)
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Nicola Blackwood
We have been clear that we are going to introduce the data regulation. We are working on exactly how we will do that in a balanced way that encourages data-sharing for the purposes of research in a sustainable NHS. We have set up a sub-group to examine the impact of the GDPR on research. It is hosted by the Wellcome Trust and includes members of the Health Research Authority’s confidentiality advisory group, the NHS Confederation, the Medical Research Council, the Department of Health, and the PHG Foundation. We will ensure that this works in an effective way to address the concerns that my hon. Friend has raised.
Sir Nicholas Soames (Mid Sussex) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
My right hon. Friend will be aware that Public Health England published a paper in June 2015 precisely on this subject, but it concluded that within the currently accepted clinical guidelines there are no clinical indicators for testing women using enriched culture medium methods. This test is not, therefore, recommended for routine use at present.
Sir Nicholas Soames
My hon. Friend will be aware from his reading of the British Paediatric Surveillance Unit report that the incidence of group B strep has increased by 30% over the last 15 years. Does he agree that this matter has gone on for far too long, and that the Government must come to a conclusion to prevent further tragedies?
Mr Dunne
As my right hon. Friend will be aware, the UK National Screening Committee is reviewing the evidence for antenatal screening, including the use of enriched culture medium tests for group B streptococcus, following a public consultation. I understand that its recommendation will be published very soon, and I assure him that I will consider the recommendation very carefully and write to him with my view.
NHS and Social Care Funding
Lord Soames of Fletching Excerpts(7 years, 9 months ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
I want to start by paying tribute to our hard-working staff in the NHS and those in the care sector. The best way to thank those staff would be by giving them the resources they need to do the job we want them to do.
I welcome the contributions made by hon. Members today, particularly the moving contribution from my hon. Friend the Member for Chesterfield (Toby Perkins), who bravely told us about the personal catastrophe for him and his family when his father was sent home from a pressured A&E, sadly to die from an aneurysm. My hon. Friend the Member for Workington (Sue Hayman) was able to tell us about the happy death her father had with the end-of-life care at the local community hospital.
The hon. Members for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston) both emphasised the complexity and frailty of patients needing care in the winter months. We should remember that in terms of the scale of pressures facing the NHS. Both those Members supported the four-hour target for A&E as a barometer of the wider system pressures in the NHS: a measure of how the system is managing to process those frail and complex patients. My right hon. Friend the Member for Doncaster Central (Dame Rosie Winterton), as a former Minister for emergency care, urged the Government not to give the NHS the impression of giving up on the four-hour target, as that sends the wrong message. At our NHS leaders’ summit yesterday, we heard a real concern that, for instance, parents might be discouraged from taking their children to A&E.
Conservative Members have cited both Simon Stevens and Chris Hopson in support of their claims on NHS funding, but I would like to update them, because in the House this afternoon Simon Stevens said that
“we got less than we asked for”
and that the Government are
“stretching it to say the NHS…got more”.
He also said that it does not help anybody to pretend there are not financial gaps. Chris Hopson, of NHS Providers, said:
“No, we don’t believe the NHS has got all the money it needs”
and that the NHS is not sustainable on current funding.
I turn now to the pressures on the NHS caused by social care. The crisis in our hospitals has been made much worse by the Government’s continued failure to fund social care properly. The care crisis is caused by insufficient funding in the face of growing demand, and Ministers have ignored warnings from a wide group of doctors and from leaders and professionals in the health and care sectors. The Government failed to produce a single penny of extra funding for social care in the autumn settlement. Then they told us that extra funding was being made available for social care in the local government funding settlement, but this was not the extra funding so desperately needed from central Government—what Ministers did was to shift the burden on to council tax payers. That was made worse by the fact that the £240 million adult social care grant was actually money recycled within local government budgets, from the new homes bonus. One third of councils will be worse off as a result of this settlement; my own local authority, Salford, will have £2.3 million less in its budgets. This is not a boost to social care.
What health and social care leaders had pleaded for was for Ministers to bring forward funding promised for 2019 to address the current crisis in social care, and that is what today’s motion proposes. That would provide some breathing space, which is needed because the lack of social care means that thousands of older people are stuck in hospital waiting for a care package in their own home. That was the most common cause of delayed discharges caused by social care. More than a third of the record 200,000 delayed days most recently reported were due to lack of social care. Being stuck in hospital not only affects patient morale and mobility; it increases the risk of the patient getting hospital-acquired infections. The major impact, though, is the knock-on effect on people in A&E who are waiting for a bed for an emergency admission.
Health Ministers like to blame local authorities for the lack of social care, but there are problems with that. When NHS chief executive, Simon Stevens, gave evidence to the Communities and Local Government Committee’s recent inquiry into social care, he was asked by the Chair, my hon. Friend the Member for Sheffield South East (Mr Betts), what extra resources would be needed if every local authority performed as well on delayed discharge as the best local authority. He said:
“Even having sorted that out, if we have a widening gap between the availability of social care and the rising number of frail old people, that is going to show up as extra pressure on them, their families, carers and of course the NHS.”
Of course we want to reach a position where the best practice in tackling delays is spread throughout the country, but Ministers have to start to reflect on what their Government have done through the cuts they have inflicted on local authority budgets. Figures from the Local Government Association show that the hardest hit local authority has had cuts to its budget of 53% over the past five years; the average cut is 39%.
The budget cut for Surrey was at the lower end of the scale, at 29%. Even so, the cabinet member for social care in Surrey, Councillor Mel Few, wrote a letter to The Guardian about the issues faced by his local authority. He said:
“The Care Quality Commission is not the only organisation with worries about inadequate adult social care funding and the impact on already clogged-up hospitals.”
He went on to say that although the social care precept was
“a welcome move, it falls many millions of pounds short of what is needed now—let alone in two decades.”
I suggest that the Health Secretary and the Chancellor talk to social care leaders such as Councillor Few to understand the needs that they see in local communities and the impact of the lack of social care on NHS hospitals. Ministers have been warned and warned about the impact of cuts on social care, but they have ignored those warnings. The Royal College of Emergency Medicine has said that emergency care is
“on its knees…mainly due to a lack of investment in both social and acute health care beds”.
Barbara Keeley
No, I will not.
The BBC has reported that last week there were 18,000 trolley waits—that is, people waiting on a trolley in a hospital corridor—of more than four hours, and there were 485 cases of patients waiting more than 12 hours. My hon. Friend the Member for Preston (Mr Hendrick) rightly said that we do not even know the figures for patients waiting in corridors, or being treated and waiting on a chair because of a lack of trolleys.
The figures do not tell us about the misery for patients and their family members waiting with them. Last night, a senior A&E consultant said on “ITV News” that patients can be left with absolutely no dignity during these waits. He said:
“We have got patients with severe illnesses on chairs receiving drips, antibiotics, medications, and patients with cardiac problems on chairs because there are no trolleys for them to go on to.”
The senior doctor talked about patients who were left unable to move off their trolleys or who were stuck on chairs and about a lack of shutters and blinds, meaning that patients can be left in full view of others while they are being treated. He also reported that some patients were incontinent in front of relatives and strangers because hospital staff could not reach them in time. He said:
“Patients have absolutely no dignity left.”
That is what the lack of social care and acute beds can lead to. How would any of us feel if that was our relative?
The situation may get worse with the expected cold weather, when more major incidents may be declared and more hospitals are put on black alert—the most severe warning level, which means that they cannot cope with the number of patients.
Downgrading the four-hour waiting time target for A&E misses the point that the problems in emergency departments are a symptom of a much wider problem. As has been discussed in the debate, that four-hour target is a proxy for patient safety. It is miserable for a sick patient to lose their dignity through being incontinent during a trolley wait in a hospital corridor. It is also miserable and frightening for a vulnerable patient to be discharged in the middle of the night to a cold home with no care package. That is why we repeat in the motion our call for the Government to bring forward £700 million of the funding promised to social care in 2019 to help the NHS and social care systems to cope with the extra pressures this winter. We are also calling for a new, improved settlement for the NHS and social care to be included in the Budget in March, so that we avoid this sort of crisis in future.
Staff in emergency departments are at the sharp end of saving lives. Many other NHS staff save lives, too, but A&E staff are so directly on the frontline. Whether they are working in people’s homes or in care or nursing homes, care staff make a huge difference to the lives of millions of older and vulnerable people, people with disabilities and people with mental health conditions. Those should be the best jobs in the UK, but without the right investment in the funding they need, the people doing them feel undervalued and overstretched. I urge Members to vote for the motion tonight.
Mental Health and NHS Performance
Lord Soames of Fletching Excerpts(7 years, 9 months ago)
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Sir Nicholas Soames (Mid Sussex) (Con)
As a frequent user and admirer of the Red Cross, I regard its claims as being grossly over the top. I join the Secretary of State in his tribute to the wonderful work of the frontline staff of the NHS at a very difficult time. Does he agree that the pressures are not going to go away, and that there must be a continuing drive for reform and to do these things better? What exactly are the impediments in the NHS to the sharing of best practice, and what steps is he taking to create a more experienced and better trained leadership who are more prepared for the exceptional medical and management challenges that the NHS now faces?
Mr Hunt
My right hon. Friend speaks extremely wisely. I, too, think that we have to be very careful about the language we use in these situations because many vulnerable people can be frightened if we get the tone wrong. The vast majority of NHS services are performing extremely well under a great deal of pressure. His point about leadership is extremely important and one to which I have given a lot of thought. At the heart of the problem is that we do not have enough hospitals being run by doctors and nurses. Around 56% of our managers have a clinical background, compared with 76% in Canada and 96% in Sweden. To put it bluntly, doctors like to be given instructions by other doctors. Exceptional people from a non-clinical background can do it, but it is hard because doctors have many years of training and are highly experienced people. I have put in place measures to try to make it easier for more clinicians to become our managers of the future.
Baby Loss
Lord Soames of Fletching Excerpts(8 years ago)
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Sir Nicholas Soames (Mid Sussex) (Con)
I hope that the whole House will read the speech of the hon. Member for Lewisham, Deptford (Vicky Foxcroft) and feel that she has done something incredibly brave and courageous today. To my hon. Friends who have proposed this debate, I say that nothing but the greatest respect is due. To my hon. Friend the Member for Eddisbury (Antoinette Sandbach), who talked about this with such courage and straightforwardness, I say that all our thoughts are with her and all the other parents who have suffered these terrible losses.
I do not think that it is possible—having heard the hon. Member for Lewisham, Deptford I know that it is not possible—for anyone who has not suffered the unbearable tragedy of the loss of a child truly to understand the grief, the pain and the hopeless feelings that it must involve. I therefore warmly congratulate my hon. Friends the Members for Eddisbury and for Colchester (Will Quince) on securing this very important debate.
I will, if the House will allow me, speak about two issues. For the past 15 years, I have worked with a wonderful charity in my constituency that is very close to my heart and I greatly admire. I am patron of Group B Strep Support. I first became aware of the work of the charity in 2003 when its founder and chief executive, Jane Plumb—a remarkable woman—came to see me to raise the issue of group B strep. Jane and her husband, Robert, lost their middle son, Theo, to a group B strep infection in 1996 less than a day after he was born.
I learned that group B strep is the UK’s most common cause of serious infection in newborn babies. It is the most common cause of meningitis in babies under three months, and also causes sepsis and pneumonia. It is truly shocking that on average in the United Kingdom one baby a day develops group B strep infection, one baby a week dies from group B strep infection, and one baby every two weeks survives with long-term disabilities. It is even more shocking that most group B strep infections in babies can and should be prevented. The parents of these precious babies and their wider family live with the consequences of their baby’s unnecessarily horrible illness for the rest of their lives.
Matthew Pennycook (Greenwich and Woolwich) (Lab)
The right hon. Gentleman will know of the case of my constituents Fiona Paddon and Scott Bramley, whose son Edward tragically died at just nine days old from a group B strep infection. As devastated as they were and still are, they have channelled their grief into campaigning work and on a petition that has reached almost 250,000 signatures. Does the right hon. Gentleman agree that there is an urgent need for more consistent and effective screening, and that the risk factor strategy by which we have assessed this infection to date has failed to reduce the number of instances and should be reviewed?
Sir Nicholas Soames
I certainly agree, and I am grateful to the hon. Gentleman for talking to me last night. I look forward to working with him on this terrible illness and to joining him to present the petition when it comes along.
I have to say to my hon. Friend the Minister of State—he is not only my hon. Friend, but a real friend—who will be responding to debate, that what I have to say is not meant in any disrespectful way to him, but I have what can only be described as “issues” with the Department of Health about this matter. I have made representations on the issue to Governments of both complexions, and it has been an uphill, pretty unrewarding and generally lowering experience. Since the time of an Adjournment debate introduced by the previous Prime Minister, the former Member for Witney, on 9 July 2003, I have dealt with five Ministers, all of whom have promised prompt action and progress, all of which has been unacceptably slow, for reasons that I, the charity, the families involved and mothers to be would find pretty hard to understand in any objective examination.
The campaign has been pushing since 2003 for the enriched culture medium test to be made available, and I would like my hon. Friend to note that the Government committed to making the ECM test available on the NHS from 1 January 2014, following a meeting we had with the then Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), and the chief medical officer in December 2012, only to make a complete U-turn on the decision in the final weeks of 2013. Despite these setbacks and the dismal pattern of indecision, I want to congratulate Group B Strep Support on all that it has achieved to raise awareness of this terrible, unnecessary infection since its founding in 1996, and to ensure that the issue is at least on the agenda among the key decision makers, even if they do nothing about it.
The charity has one overarching objective: to eradicate group B strep infection in newborn babies. To achieve that objective, which is frankly military in its clarity and precision, the charity informs and supports families affected by group B strep, educates the relevant health professionals and pushes for improvements. The charity has virtually single-handedly raised awareness of group B strep from virtually nothing to a position where one in 10 new and expectant mothers had heard of it in 2006, and five in 10 new and expectant mothers had heard of it in 2015. Amazingly, the NHS does not routinely provide information about group B strep as part of standard antenatal care, which makes that a significant achievement for a small charity. The charity has covered for an inexplicable shortcoming on the part of the NHS.
From the very start, Group B Strep Support has pushed for improvement to policy and practice, and it has done an extraordinarily good job. It is my view that the reason for the shortcoming is a fundamental disagreement between doctors, and we all know what that means. It is not clear to me why Ministers do not simply override this and order the test, which would save lives, and spare the tragedy and agony of those involved. I know that the Government say that they are committed to finding a way forward, but it is taking them a very long time to get there, and neither I nor the charity are one bit satisfied by the progress. When my hon. Friend the Minister winds up the debate, will he particularly mention group strep B and give us some hope that that cause will be considered?
The most wonderful young constituent of mine, an adorable girl aged 14 named Emily McStravik, came to see me at my surgery 10 days ago with her mother. Emily is a miracle child who survived two strokes at the age of 18 months. I shall be sending my hon. Friend the details of Emily’s case and the wider case for dealing with childhood stroke, which needs to achieve greater prominence and understanding. Stroke is one of the top 10 reasons why children die, and an alarming number of children who have had a stroke are misdiagnosed or sent home. There is no greater honour or privilege that Members of Parliament can have than to raise on the Floor of the House a child’s story and talk about her remarkable courage and survival. I would be grateful if my hon. Friend would examine carefully the information that I will be sending him from Emily and her family.
The Minister of State, Department of Health (Mr Philip Dunne)
I am humbled to be responding to this debate. It is undoubtedly the most moving debate that I have participated in during the 11 and a half years I have been in the House and I pay an enormous tribute to all those who have spoken, particularly those who spoke of their own personal experiences. I shall touch on that further in a few moments. I want to start by congratulating my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince) on initiating this debate during baby loss awareness week. I also commend them on the remarkable progress they have made in launching the all-party parliamentary group on baby loss and on securing cross-party support for it. The group has had an unusually large impact compared with the plethora of other groups, and it has managed to achieve a Commons Chamber debate within a few months of being set up. That is an unusual and impressive achievement by them and the other officers of the group on both sides of the House.
Yesterday, hon. Members from across the House showed tremendous support for the work of the group. This was evidenced by the support from Mr Speaker in hosting a reception in his state rooms which was attended by many of the 21 pregnancy and baby loss charities that are dedicated to arranging support and care for families that go through this terrible experience. Events such as those that have taken place throughout the week here in the House—and indeed on Twitter, as the hon. Member for Ellesmere Port and Neston (Justin Madders) mentioned earlier—help to raise awareness for the families who suffer this loss, often in silence. One of the things that has struck me most about this debate is the determination of those who have experienced such loss, either directly or through their families or constituents, not to allow the issue to remain in the closet.
I would like to address some of the comments that have been made and to applaud the contributions and interventions that we have had today from the more than 30 hon. Members who have spoken of their own personal experiences and those of their constituents. Interestingly, although we have had contributions from 17 Back-Bench women, we have also had contributions from 13 Back-Bench men, some of whom have had personal direct experience as well. Particularly moving have been the contributions from Members who have not raised their experience of this issue in public in this place before. They included the hon. Members for Lewisham, Deptford (Vicky Foxcroft) and for North Ayrshire and Arran (Patricia Gibson), my hon. Friend the Member for Banbury (Victoria Prentis)—she might have mentioned it before, but she made another moving contribution today—my hon. Friend the Member for Gower (Byron Davies) and the hon. Member for Glasgow North West (Carol Monaghan). Such personal testimony obviously touches the heartstrings of everyone who hears it, and there was barely a dry eye in the House when they were speaking. I pay tribute to their courage in making so clear the pain that they went through, either recently or some years ago. Foremost among those Members are my hon. Friends the Members for Eddisbury and for Colchester, who brought this matter so vividly to our attention with their speeches nearly 12 months ago.
I shall not go through every contribution that has been made today, but I shall try to refer to many of them in my remarks. In particular, I should like to pay tribute to the hon. Member for Ellesmere Port and Neston for his very thoughtful contribution and for the spirit in which he made it. I shall try to address most of his questions as I continue. Before I forget, I should like to address the question put by my right hon. Friend the Member for Crawley—
Mr Dunne
I am sorry. Have I got it wrong again?
My right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) asked about progress on screening for group B streptococcus, and I can reassure him that the UK national screening committee is reviewing its recommendation on antenatal screening for GBS carriage as part of its three-yearly review cycle. It will be taking new published evidence into account. We are anticipating that a public consultation will be held on this topic shortly, and I am sure that my right hon. Friend will want to participate in it. Once it has been concluded, we will review the recommendations that emerge.
The loss of a baby is clearly devastating for its parents and the family, regardless of when or how the death occurs. Those experiencing the heartbreak of miscarriage, stillbirth, the death of an infant or the decision to terminate a much-wanted pregnancy need our support and kindness, and the acknowledgement that their child was here for a short time and was loved. I have been deeply struck by the comments about the lack of sensitivity that can occur when such a loss takes place, and it is absolutely right that the Department of Health should encourage best practice across the NHS in order to minimise the distress caused by insensitive conduct on the part of those involved in supporting families at this time.
Such feelings of loss are real, but as has been said, in particular by my hon. Friend the Member for Gower, who explained this dispassionately and clearly, the issues are often not discussed. Many of us do not realise that on an average day in England around 32 women will be diagnosed with an ectopic pregnancy, 15 babies will be stillborn and eight babies born on that day will die before their first birthday. Most of those infants will probably be less than a month old. It is therefore important that we in Parliament discuss the issues around baby loss and the care for those families experiencing such tragedies.
I want to talk about the steps we are taking with the NHS to reduce stillbirths and other adverse maternity outcomes. I also want to talk about what we are doing to support families who experience this loss. England is a very safe country in which to have a baby, and it is encouraging that the stillbirth rate in England has fallen from 5.2 per 1,000 births in 2011 to 4.4 in 2015. In 2014, the neonatal mortality rate was 2.5 deaths per 1,000 births, and the rate of deaths in babies aged 28 days to one year was 1.1 per 1,000 births. Those rates have been steadily declining and are now at their lowest levels since 1986. There is, however, as we have clearly heard from every contribution today, more that we can do, and, as a Government, we are determined to do so.
It is important that we do not accept all miscarriages, stillbirths, pregnancy terminations or neonatal deaths as inevitable, or simply nature taking its course, as has been touched on by a couple of contributions today, because many of them might have been prevented.
When compared with similar countries, our stillbirth rates remain unacceptable. In the stillbirth series of The Lancet, which was published earlier this year, the UK was ranked 24th out of 49 high-income countries. The same publication showed that the UK’s rate of progress in reducing stillbirths has been slower than that of most other high-income countries. The annual rate of stillbirth reduction in the UK was 1.4% compared with 6.8% in the Netherlands. That places us, as we heard from my hon. Friend the Member for Eddisbury, in the bottom third of the table, in 114th place out of 164 countries around the world, for progress on stillbirths.
We also know that the rates of death in some higher risk groups are not coming down. Again, that was referred to by my hon. Friend the Member for Colchester. According to the Twins and Multiple Births Association, stillbirth rates for pregnancies involving twins, triplets or more increased by 13.6% between 2013 and 2014. Multiple births make up 1.5% of pregnancies in the UK—around 12,000 pregnancies each year—but a disproportionate 7% of stillbirths and 14% of neonatal deaths.
We want NHS maternity services to be an exemplar of the kinds of results we can achieve when we focus on improving safety. With a concerted effort, we can make England one of the safest places in the world in which to have a baby. That was why, last November, the Secretary of State launched a national ambition to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 2030, with a shorter-term aim of achieving a 20% reduction in each of these rates by 2020. I am glad that that was recognised by my hon. Friend the Member for Eddisbury and pleased that she will be keeping an eye on the progress that we make each year to achieve those targets.
To support the NHS in achieving this stretching ambition, the Government have announced plans for investment. There will be a £2.24 million fund to support trusts to buy monitoring or training equipment to improve safety. More than 90 trusts have been successful in receiving a share of the fund, enabling them to buy equipment such as training mannequins, and foetal or maternal monitoring equipment such as carbon monoxide monitors and portable ultrasound equipment.
As my hon. Friend the Member for Colchester acknowledged, we are also investing in the roll out of training programmes to support midwives, obstetricians and entire maternity teams to develop the skills and confidence they need together to deliver world-leading safe care. We hope to be able to say more about how maternity services can apply for this funding soon.
We are also providing funding via the Healthcare Quality Improvement Partnership for developing the new system—the standardised perinatal mortality review tool—which, once complete, should be used consistently across the NHS in Great Britain to enable maternity services to review and learn from every stillbirth and neonatal death. That was an important element of the APPG’s vision for the future. We need to develop proper learning and understanding from what goes wrong, and then the lessons learned should be spread to maternity services across the country. As my hon. Friend the Member for Grantham and Stamford (Nick Boles) emphasised, many reports have highlighted that we do not effectively learn from our mistakes. Indeed, the guidelines of the Royal College of Obstetricians and Gynaecologists state that all stillbirths should be reviewed in a multi-professional meeting using a standardised approach on analysis for substandard care and future prevention. That is something that we would like to see taken up.
We must view individual failings as important and recognise the need for accountability, but balance that with a need to establish standard processes that can prevent avoidable mistakes from happening again. In April we established a new independent healthcare safety investigation branch to carry out investigations and share findings. The HSIB will operate independently of Government and the healthcare system to support continuous improvement by using the very best investigative techniques from around the world, as well as fostering learning from staff, patients and other stakeholders.
An important improvement in maternity care is care that is more collaborative and responsive to the needs of women. Several Members referenced the investigations by Sands, the stillbirth and neonatal death charity, which has revealed that 45% of women who raised a concern with a health professional during pregnancy were not listened to and then went on to have a stillbirth. Clearly, that is not acceptable. All women should receive safe, personalised maternity care that is responsive to their individual needs and choices.
The hon. Member for Ellesmere Port and Neston asked where we are on supporting those with mental health conditions through pregnancy. I draw his attention to the announcement in January in which the Government set out that an additional £290 million will be made available over the next five years to 2020-21 to invest in perinatal mental health services. That is funded from within the Department of Health’s overall spending review settlement, and it will go a long way to providing support for women who are pregnant and need mental health counselling both before and after birth.
Last November we asked the national patient safety campaign Sign up to Safety, which was launched by the Government in 2014, to support all NHS trusts with maternity services to develop plans to improve safety and share best practice. In March this year we launched “Spotlight on Maternity”, with guidance for maternity services to improve maternity outcomes. This set out five high-level themes that are known to make maternity care safer that services could focus on: building strong clinical leadership; building capability and skills for all staff; sharing progress and lessons learned across the system; improving data capture and knowledge; and improving care for women with perinatal mental health problems.
In February this year, “Better Births”, the report of the independent national maternity review that was chaired by Baroness Cumberlege, was published, and hon. Members have touched on it today. It sets out that the vision is for maternity services across England to become safer, more personalised, kinder, more professional and more family-friendly. The Department of Health is leading the promoting good practice for safer care workstream of the maternity transformation programme that was launched last July to deliver the vision set out by the national maternity review, and we will set out our action plans shortly.
As my hon. Friend the Member for Eddisbury highlighted, it is vital that we support research into the causes of stillbirths and neonatal deaths so that we can better understand how to identify babies at risk and improve services. In recent years, the Government have invested in research, looking at important questions regarding stillbirths and neonatal deaths. From 2012, the National Institute for Health Research biomedical research centres at Cambridge and Imperial College will have invested £6 million over five years in research on women’s health, including research to increase understanding of the causes of still births and neonatal deaths. We continue to encourage research bids for new studies that will help us to identify babies at risk.
The evidence shows that this stretching ambition cannot be achieved through improvements to NHS maternity services alone. The public health contribution will be crucial. As The Lancet stillbirth series concluded, some 90% of stillbirths in high-income countries occur antenatally and not during labour.
We heard from a number of hon. Members about the need to do more to highlight risks during pregnancy so that women are aware of what they can do while they are pregnant to minimise the risks. When starting pregnancy, not all women will have the same risk of something going wrong, and women’s health before and during pregnancy is one of the factors that influence rates of stillbirths, neonatal deaths and maternal deaths. We know that a BMI of over 40 doubles the risk of stillbirth, that a quarter of stillbirths are associated with smoking, and that alcohol consumption is associated with an estimated 40% increase to stillbirth risk. In addition, the MBRRACE—Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries—report published in June last year showed that women living in poverty had a 57% higher risk, babies from BME groups have a 50% higher risk, and teenage mothers and mothers over 40 have a 39% higher risk.