Long-term Segregation in Hospital: Baroness Hollins’ Report

Maria Caulfield Excerpts

Wednesday 8th November 2023 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Today we have published our response to Baroness Hollins’ final report as chair of the Independent Care (Education) and Treatment Review (IC(E)TR) Oversight Panel. This follows the completion of the second phase of the IC(E)TR programme, which Baroness Hollins has overseen, in order to reduce the use of long-term segregation for people with a learning disability and autistic people. Baroness Hollins’ final report includes recommendations for Government. A copy of both the report and our response will be deposited in in the Libraries of both Houses.

We warmly welcome Baroness Hollins’ report and the work of the oversight panel. The report and the examples of poor care reported are sobering. I continue to be deeply concerned by the examples of unacceptable treatment of people with a learning disability and autistic people in long-term segregation in hospital. The use of long-term segregation must be significantly and urgently reduced. Where it is used, it should only ever be in a way that respects human rights, and all treatment plans should aim to end long-term segregation.

The recommendations made in the report are critical in informing our work to reduce the use of long-term segregation for people with a learning disability and autistic people. They are also aligned with our wider work to reduce the numbers of people with a learning disability and autistic people in mental health hospitals, with more people living ordinary lives in the community.

In our response, we highlight some of the work being undertaken now to reduce the use of long-term segregation in people with a learning disability and autistic people. In particular, I am pleased to be able to confirm that in the very near term IC(E)TRs will continue, now led by CQC, to preserve regulatory oversight and understanding of long-term segregation for people with a learning disability and autistic people and crucially to support people to less restrictive settings and discharge to the community. We will also seek changes to the CQC regulations (subject to parliamentary approval) to improve reporting and notifications by providers to CQC on use of restrictive practices. Once in place, this will provide a better flow of information, supporting CQC to convene an IC(E)TR as soon as possible where someone is moved into LTS to scrutinise the care provided and protect rights.

We will also use Baroness Hollins’ recommendations to inform our longer term work. For example, using the report and accompanying framework code of practice to inform updates to the “Mental Health Act 1983: Code of Practice” when it is next reviewed. Work is ongoing on a number of recommendations as outlined in the report.

I am extremely grateful to Baroness Hollins and the oversight panel for their expertise and commitment to this work over a number of years. Their report will play a critical role in tackling the unacceptably high levels of long-term segregation and in supporting people with a learning disability and autistic people to receive high quality care that is right for them. It is essential that Baroness Hollins’ report and recommendations drive that change.

[HCWS12]

Health and Social Care

Maria Caulfield Excerpts

Tuesday 7th November 2023 Ministerial Corrections

The following is an extract from the Backbench Business debate on Baby Loss Awareness Week on 19 October 2023.

[Maria Caulfield]

We announced in July that we would be rolling out baby loss certificates. They will be retrospective. There is no time limit on applying for them.

[Official Report, 19 October 2023, Vol. 738, c. 472.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield):

An error has been identified in my response to the debate on Baby Loss Awareness Week. The correct information is as follows:

[Maria Caulfield]

We announced in July that we would be rolling out baby loss certificates. They will be retrospective. Initially, only those who have experienced a loss since 1 September 2018 and are currently living in England will be eligible to apply for them.

Training of NHS Staff

The following is an extract from Health and Social Care questions on 17 October 2023.

[Theo Clarke]

What steps are the Government taking to increase the recruitment of midwives, given the closure of Stafford County Hospital’s freestanding midwifery birthing unit due to shortages, and how is the Secretary of State going to ensure that all midwives are trained to deal with birth injuries to reduce risk?

Menopause

Maria Caulfield Excerpts

Thursday 26th October 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I congratulate the hon. Member for Swansea East (Carolyn Harris) on securing this debate, and I am sad she is not here to join us this afternoon because we have held this debate on almost an annual basis and have made huge progress in achieving some of her asks. She is a tireless voice for women in this place, always raising awareness and inspiring action, and I am very proud to be working with her as co-chair of the menopause taskforce. One key piece of work by the Government has been to respond to one of her asks and reduce the cost of NHS prescriptions for HRT. Of course, there is much to be done. Our women’s health strategy has made the menopause a key priority area. For far too long, women’s health was a secondary consideration. This Government have put it top of the agenda—menopause, fertility, baby loss, dementia and osteoporosis are now priority areas for this Government—and we are the first Government to do so.

There has been a menopause revolution here this morning. I really thank the hon. Member for Bootle (Peter Dowd) for presenting the debate. We have heard from four male colleagues—the hon. Members for Merthyr Tydfil and Rhymney (Gerald Jones) and for Bootle, my hon. Friend the Member for Walsall North (Eddie Hughes) and the hon. Member for Strangford (Jim Shannon)—which is twice the number of women Back Benchers contributing. It is absolutely positive news that we have made so much progress that the menopause matters to men as much as it does to women. In my own Department, to mark World Menopause Day we organised a session during which officials tried on the world’s first menopause simulator, so that men could experience some of the side effects. It was a great success, and many male colleagues went away with an enhanced appreciation of women’s experience of the menopause. I also thank the all-party parliamentary group for its important work. It does a huge amount to shine a light on the issues, particularly with its manifesto for menopause.

I hope the House will give me some time to update it on the progress we have made since our last debate in the Chamber. First, a number of Members have mentioned the HRT prepayment certificate. It has been rolled out since April, and women can pay less than £20 a year for all their HRT prescriptions for 12 months. Many women are on multiple products—they are often on dual hormones—and each of those has a prescription cost. However, just to reassure colleagues, about 89% of all prescriptions are not paid for and there are no charges, and for HRT about 60% pay no prescription charges at all. For those who do, the £20 a year absolutely makes a difference, and it could save women hundreds of pounds on the cost of their HRT. In the spring, we launched a successful campaign to alert women to these changes, and I am really pleased to say that, as of the end of September, well over 400,000 women in England had purchased a HRT prescription prepayment certificate. For anyone who has not got one yet, they can be purchased online, but they can also be purchased in some pharmacies.

The shadow Minister, the hon. Member for Erith and Thamesmead (Abena Oppong-Asare), mentioned HRT supply, which has been an issue over recent months. We have seen a huge wave of women coming forward asking for HRT from their GP, and GPs have been much more comfortable in prescribing HRT, which did put pressure on supplies. There are over 70 products available in the United Kingdom, and in fact the majority of them remain in good supply. We have held six roundtables with suppliers, wholesalers and community pharmacists to discuss the challenges they were facing, and these have delivered results. Since April last year, there were 23 serious shortage protocols for HRT—relevant to 23 products—but as of today only one of those remains in place. That means that at the moment there is only one product for which there is a serious shortage protocol, meaning alternative dispensing or reduced dispensing occurs. We are holding a seventh roundtable later this month, and manufacturers are confident that, in producing and securing more, there will be supplies to be used. That is a real success story, and when women have their prescription, they can be confident that their prescription will be available at their pharmacy.

A key part of our menopause taskforce has been talking about research into the menopause and management of the menopause. The National Institute for Health and Care Research has conducted an exercise to identify research priorities, which concluded in January. I cannot remember which hon. Member mentioned testosterone, but research into how testosterone can alleviate menopausal symptoms has been identified as a gap. It is not licensed for use in the menopause because there is not currently the evidence base for the Medicines and Healthcare products Regulatory Agency to allow a licence. Having that research into testosterone and the improvements it could bring is a crucial step towards any licensing of that hormone. That is why it requested bids for organisations to come forward with research proposals in this area, and we expect an update in December. I am also pleased to update that between April last year and July this year, the NIHR has invested £53 million to support women’s health. On World Menopause Day, it funded the James Lind Alliance to launch its menopause priority-setting partnership. That is crucial in developing the evidence base for better management of the menopause.

I will just touch on a number of other points that were raised. First, on health checks, I have asked the NHS health check advisory group to review the case for including the menopause in the NHS health check alongside its broader future considerations on the health check, following the delivery of the digital check next spring. I will keep the House updated on that work, particularly the hon. Member for Swansea East, as co-chair of the menopause taskforce, because it is crucial that it is included.

We have started the process to set up women’s health hubs across every ICB in the country, because our ambition is for women and girls to access services for women’s health more generally in the places where they live. That is why we are investing £25 million to expand women’s health hubs across England. Hubs will deliver a range of healthcare experiences, but we would expect the menopause and advice on it to be covered by women’s health hubs. We are meeting ICBs shortly to get an update on progress.

One other point raised was about conducting a review into specialist menopause care. It is important to remember that specialist menopause care is not funded by central Government, but is commissioned by integrated care boards and implemented at a local level. They have a statutory responsibility to commission healthcare that meets the needs of whole populations, including for the menopause, but we know that is not always happening on the ground.

[Nick Smith]

I acknowledge that the Government are making good progress on this topic, and I thank the Minister for that. Having said that, my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) spoke from the Labour Front Bench about training and development for GPs on supporting women with menopause symptoms. Can I press the Minister to tell us more about the Government’s plans to boost training and development for clinicians to help women experiencing the menopause?

[Maria Caulfield]

The hon. Gentleman makes a valid point, and I will come on to that in a moment, because we are making huge progress there. If I may, I will touch on specialist support for the menopause. We will be working with ICBs, and when we meet shortly to ask for updates, we will be looking at the progress being made at the local level in providing that support. We have tried to ensure that information for women is as accessible as possible. We launched our dedicated women’s health area on the NHS website recently, where there is advice and support on the menopause, as well as for other health conditions. That will be updated regularly. Women now have a trusted source to go to for healthcare and advice. That includes a new HRT medicines hub, providing information about the different types of HRT and other options, because HRT does not work for every woman, and sometimes women have to try several types to get one that works for them.

Workplace support has also come up. As Employment Minister, my hon. Friend the Member for Mid Sussex (Mims Davies) has made huge progress. In March, we appointed Helen Tomlinson, who is the menopause employment champion. This month, she published a report with a four-point plan to improve menopause support in the workplace. Organisations such as Wellbeing of Women offer support to businesses, small and large, on how to improve their offer to women. Many of the suggestions that have been made in this place are being taken up, and they do make a difference. We hear from women all the time about the difference they make. This month we launched a new space for guidance on the helptogrow.campaign.gov.uk website. Large or small, businesses can get advice there about the difference they can make in the workplace not only in retaining women, but in having open conversations in the workplace. Flexible working is a key part of that.

To touch on the GP point, we are looking this year to consult on the future of the quality and outcomes framework, which is one of the measures used to look at health conditions, to see whether the menopause should be included. We fully recognise the importance of ensuring that GPs ask the right questions so that women get the right support. We intend to have those conversations with GPs about the QOF framework.

We are also, rightly, looking at staff training and developing education and training materials for healthcare professionals across the board, not just GPs, so that healthcare professionals have better awareness of the menopause. My hon. Friend the Member for Walsall North and the hon. Member for Strangford pointed out that women often go and ask for help, but their signs and symptoms are not recognised as being related to the menopause. Our women’s health ambassador, Professor Dame Lesley Regan, is doing crucial work on engagement in this place. We are also ensuring that GPs are assessed on menopause as a measure in their training. From next year, all medical students will have to complete a module that includes menopause so that doctors, whether GPs in primary care or in secondary care, have better awareness of the signs and symptoms and management of the menopause, so that when women approach for help, they will be better supported.

I thank all hon. Members for their contributions to the debate. We have taken great strides in the last 12 months in supply of HRT and reducing the cost, rolling out women’s health hubs, but I know that there is more work to be done. I know also that the hon. Member for Swansea East will be back to hold my feet to the fire, and I look forward to working with her as co-chair of the menopause taskforce.

IVF Provision

Maria Caulfield Excerpts

Tuesday 24th October 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Jarrow (Kate Osborne) for tabling this important debate, and all Members across the Chamber for their contributions. It has been a positive debate—a good example of putting politics aside and debating how to do the right thing. While I am not denying the challenges for the LGBT+ community raised by the hon. Member, I want to highlight that the Government have brought in major changes over the years with the introduction of same-sex marriage, and the transformation of the management of HIV with the roll-out of opt-out testing and PrEP treatment.

I am pleased to announce that, following the advice from the Advisory Committee on the Safety of Blood, Tissues and Organs, the Government will be introducing secondary legislation to allow the donation of gametes by people with HIV who have an undetectable viral load; we will be introducing that as soon as we can. We will also be addressing the current discriminatory definitions of partner donation, which result in additional screening costs for female same-sex couples undergoing reciprocal IVF; again, amendments through statutory instruments will be introduced as soon as possible.

Those are some of the measures that we have been working on, but I absolutely understand from what I have heard today that there are many issues still to be dealt with, and I welcome the hon. Member for Jarrow holding my feet to the fire to deliver change. Hopefully some of these updates will provide reassurance. This is a priority area, which is why IVF, fertility, and particularly same-sex access to IVF, were in the first year of the women’s health strategy, and it is why we are not going to wait for the 10 years of the strategy to introduce the changes.

To be clear, the Government are implementing a policy that no form of self-financed or self-arranged insemination is to be required for same-sex couples to access fertility treatment. I acknowledge that is taking a little while to be rolled out across the country. Hon. Members, especially the hon. Member for Pontypridd (Alex Davies-Jones), have spoken about infertility a lot. We absolutely recognise that it has a serious effect on individuals and couples, which is why it is a priority—particularly for the women’s health strategy.

As the hon. Members for Strangford (Jim Shannon) and for Livingston (Hannah Bardell) pointed out, I can only speak on the provision of IVF in England, but I am very happy to work with colleagues in the devolved nations of Scotland, Wales and Northern Ireland to achieve a consistent approach. Although we are dealing with the inconsistencies in England, if we are a United Kingdom, these matters need to be addressed across all four nations and I am not precious about stealing best practice from other parts of the UK.

In our call for evidence for the women’s health strategy, women told us time and again that fertility was a key issue and that they felt very frustrated about the provision of, and access to, fertility treatment. Colleagues have made a number of important points which I will respond to in turn, but it has been recognised that there has been unequal access to IVF in England since the treatment was introduced; that is why this is such an important issue. There is resistance in some parts of the country to the changes the Government want to make, but I think we will be able to make progress on them.

NICE is reviewing its fertility guidelines, taking account of the latest evidence of clinical effectiveness. These will be published next year and we will be working with NHS England to implement these guidelines in England quickly and fairly. I am told that they will end regional variation and create a compassionate and consistent fertility service across England, but that does not mean that we cannot improve services in the meantime.

As has been set out, integrated care boards are now responsible for delivering IVF services. They were previously determined by CCGs, but from July last year the 42 ICBs across England are now responsible. Since the ICBs were created, we have seen a levelling up of IVF provision in many. Where CCGs have come together, ICBs have often adopted the higher rate of provision, rather than the lowest level. That is to be welcomed, but by no means does it mean that the level of provision is where we want it to be. Some, but by no means all, ICBs, including in north-east London and Sussex—I declare an interest as a Sussex MP—are now fully compliant with the current NICE guidelines and the provision of three cycles. Others are improving their integrated offer, but some ICBs have kept their pre-existing local offer. That is not good enough, and we are aiming to tackle it.

[Abena Oppong-Asare]

What conversations has the Minister been having to make sure that ICBs are currently being updated to be as robust as possible?

[Maria Caulfield]

I will go through that. One of the first things we have done is to be transparent about what is being offered. We have asked every ICB—the whole 42—to detail their provision. We are now publishing that on gov.uk, so if ivf.gov.uk is entered, the table will come up. That illustrates the number of cycles offered by every ICB, the age provision, the previous children rule and what funding is offered for cryo-preservation. That is not just to say, “This is what’s on offer” so that women and couples can see what is available in their area; it is also the start of the process of holding ICBs’ feet to the fire—and for local MPs to be able to say, “Look, they’re offering free cycles in Sussex; why are we not offering that in our local area?”

[Abena Oppong-Asare]

The Minister may be about to get to this point, so I apologise if I have intervened too quickly. In terms of transparency, it is great that the Minister is publishing the data, but what are the Government doing to make sure that more work is being done by ICBs to provide a better—or adequate—service, given that publishing data does not require them to take any action?

[Maria Caulfield]

As the hon. Lady will know, it was only last year that we published the women’s health strategy. IVF was front and centre of that—the first year priority. Getting that information is the first step, and then we are able to look at the ICBs that are not offering the required level of service, have those conversations about why and have a step change to improve the offer. That is just one tool in our box to fulfil our ambition to end the postcode lottery for fertility treatment across England.

Colleagues have also raised the issue of lack of information about IVF, both for the public and healthcare professionals. We are working closely with NHS England to update the NHS website to make IVF more prominent, and also with the royal colleges to improve the awareness of IVF across healthcare professions. One area we are dealing with is that of add-ons, which the hon. Member for Pontypridd (Alex Davies-Jones) and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) addressed. As part of our discussions with the HFEA, it now has the add-on rating system, so that people can see what percentage difference an add-on would make and make an informed choice about whether they want to do that as part of their IVF treatment.

I have also just received the HFEA’s report about modernising the legislation, with particular regard to its regulatory powers. That will cover the provision of add-ons, and I hope to be able to respond to the report as quickly as possible. We are making really big changes to some of the issues that have been holding back IVF for a long time. I know that for many people this is not quick enough, but I reassure hon. Members that progress is being made.

For female same-sex couples and same-sex couples across the board, I know that this is a really important matter. I took the position that it was unacceptable for female same-sex couples to shoulder an additional financial burden to access NHS-funded fertility treatment. On the transparency toolkit now on the gov.uk website, we can easily see which parts of the country are asking for six cycles of self-funded insemination, for instance. In Cambridgeshire and Peterborough it is 12 cycles, in Bristol and north Somerset it is 10. As the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) said, that is exactly the information we need so that we can tackle the issue head-on and directly with the ICBs. Indeed, one of our key commitments in the women’s health strategy was to remove this injustice once and for all. We were hoping to do that completely in the first year; it will in fact take us a little longer, but it will not take us 10 years.

[Hannah Bardell]

It is certainly comforting to hear that, but I urge the Minister to supercharge that work, so that female same-sex couples and, indeed, the trans community can make sure they can access that. Will the Minister say something about surrogacy, because I know that across the UK—though, again, we have somewhat better standards and access in Scotland—there are still major challenges, legal and otherwise, for male same-sex couples accessing surrogacy?

[Maria Caulfield]

The Law Commission has recently produced a report on changes to surrogacy, which we are in the process of responding to. It will address some of the issues raised today. The Government’s position is to abolish the requirement for female same-sex couples to undergo six cycles of self-funded treatment before they can access NHS-funded treatment. We have been clear that the NHS-funded pathway should now offer six cycles of artificial insemination followed by IVF to female same-sex couples, giving everyone access to NHS-funded fertility services. Some ICBs are doing that already, but others have delayed implementation, and that is what we want to focus on now. We are clear that that needs to be urgently addressed, because same-sex couples’ expectations have rightly been raised and the service has not met them swiftly enough. I take that on board from the debate today and reassure colleagues that that is a priority.

To accelerate action, NHS England is developing advice to assist ICBs. I hope they will be able to share that soon. I will share that with the House as soon as it is available. When it is published, we expect ICBs to update their local policies. There should be no further delay and no waiting for NICE guidelines when they are published next year. ICBs must urgently address all local inequalities in access to fertility treatment. There is a reason that IVF was made a priority in the women’s health strategy and a reason it was a priority in the first year.

Our health service pioneered the use of IVF in the 1970s. It is a great British invention that should be available to every couple who want to start a family, because the Government back women and families and the accessibility of IVF to those who need it. I look forward to the hon. Member for Jarrow continuing to hold my feet to the fire until we have delivered the change—deliver it we must.

Trends in Excess Deaths

Maria Caulfield Excerpts

Friday 20th October 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I congratulate the hon. Member for North West Leicestershire (Andrew Bridgen) on securing this important debate. I only have five minutes of this 30-minute debate to respond. I will try to cover all the points if I can.

Can I start by acknowledging that the hon. Member is correct that we have seen an increase in excess deaths in the last year? However, I disagree with his analysis, because the causes that he refers to simply do not bear out the statistics that we have. There has been a combination of factors contributing to the increase in excess deaths, including, in the last year, high flu prevalence, the ongoing challenges of covid-19, a strep A outbreak and conditions such as heart disease, which he touched on, diabetes and cancer. Because we had had virtually a lockdown of routine health services over a two-year period, many people are now coming forward with increased morbidity and mortality as a result.

I will start with winter flu. The number of positive tests last year peaked at 31.8%, the highest figure seen in the last six years. Interim analysis from the UKHSA indicates that the number of deaths in England associated with flu was far higher than pre-pandemic levels, so the excess deaths due to flu last winter are, sadly, part of the answer.

The hon. Member touched on the independent body, the ONS. Its figures show that the leading cause of death in England is still dementia, which accounts for about 10% of all deaths. It also looks at the cause of excess deaths. If we look at the figures as of June this year, the top three causes of excess deaths are respiratory illnesses, dementia and ischaemic heart disease, which is often caused by an increase in cholesterol, smoking or not having a blood pressure check. There are a number of reasons, and they are often chronic conditions that people have had for years, or in some cases for decades; they are not acute illnesses.

In the three minutes I have left to respond, I will touch on some of the points that the hon. Member made. First, on the importance of vaccination, it is very easy to say that there is a prevalence of high rates of covid vaccination in people who have died. That is correct: when 93.6% of the population have had at least one dose of the vaccine, there will be a high rate of vaccination in excess deaths. That is different from causality. I completely agree with the hon. Member that there is a high prevalence rate, but that is not the same as saying that vaccination is the cause of those deaths.

The Office for National Statistics has looked at this, and those who have been vaccinated have generally had a lower all-cause mortality rate than unvaccinated people since the introduction of the booster in 2021. A recent study in Singapore looked at unvaccinated patients who had recovered from covid, and showed that those patients had a 56% higher risk of cardiac complications a year later than those who were vaccinated. There is conflicting data on this issue, and I am not necessarily disagreeing with the hon. Member, but I think we need to have a robust conversation about it, not to assume that one side necessarily has all the answers.

I will touch on a couple of points that the hon. Member made about vaccine safety. The regulator has been taking account of those who report adverse events, and I encourage anyone who has had a side effect from any of the vaccines to use the yellow card system and report it to their GP. When those side effects have been reported, the MHRA has taken action. In April 2021, the MHRA reacted to rare cases of concurrent thrombosis and thrombocytopenia following the AZ vaccine, which resulted in adults under 30 not being offered that vaccine. In May 2021, that was increased to adults under 40. With regard to the mRNA vaccine specifically, following reports of a link between covid vaccines and myocarditis, the Commission on Human Medicines conducted an independent review in June 2021, which found that the incidence of that side effect was rare: between one and two cases per 100,000. When there are concerns, we absolutely must investigate them. There is no doubt about that.

We had a debate earlier this afternoon about those who have experienced rare side effects from the vaccine. We do have the vaccine damage payment scheme, which offers a payment of £120,000 if that is shown to be—

Covid-19 Vaccine Damage Payments Bill

Maria Caulfield Excerpts

2nd reading
Friday 20th October 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I congratulate my hon. Friend the Member for Christchurch (Sir Christopher Chope) on securing the Second Reading of this Bill. This is an important issue, and I thank him for the tone in which he has conducted the debate and for his sentiments at the start, when he said that this is not about being anti-vaccination. As my right hon. Friend the Member for Tatton (Esther McVey) indicated, vaccination is a crucial part of our armour in dealing with disease across the world. The Bill is specifically about the covid vaccination and I advocate, as did the shadow Minister, that after clean water, vaccinations are the most effective public health intervention in the world in terms of saving lives and promoting good health.

The flu vaccination, which is being rolled out as we speak, will enable many people to be healthy over this winter and avoid hospital admission. The HPV vaccination for preventing cervical cancer, which is rolled out to young girls and boys in our schools, has the potential to eradicate cervical cancer in future, and we must remember that vaccination has a powerful role to play in the health of our nation. Globally, we have one of the best immunisation programmes around the world, and it is important to pay tribute to all those staff who take part in vaccinations programmes and make them such a success.

Let me turn to the covid vaccination. The UK was at the forefront of tackling covid-19 through the vaccination programme, and it was the first healthcare system in the world to deliver the covid vaccination outside clinical trials. We should be proud of that. As the shadow Minister said, it was one reason why we were one of the first countries to lift restrictions, because of our success in covid vaccination. On the point made by my hon. Friend the Member for Shipley (Philip Davies), I am happy to go on record and say that although covid vaccines have saved tens of thousands of lives, unfortunately there have been extremely rare circumstance where individuals have, very sadly, experienced harm and difficult circumstances, following a covid vaccination. Thankfully, such cases remain rare, but that does not reduce the impact on those individuals who experienced that and their families. I am sure the whole House will join me in expressing concern for those individuals who suffered such harm, and their families.

Vaccination remains the best way for individuals to protect themselves and others from the impact of covid-19. We have done the right thing by encouraging people to have the vaccine, to protect both themselves and other more vulnerable members of society.

[Philip Davies]

I am grateful for what the Minister has said, but I think that the people who, as she acknowledges, have suffered harm and damage from the vaccine—they were coerced into taking it in one form or another—would probably prefer more than just sympathy and concern from people in the House. What they really want is proper compensation. Will she therefore take on board what my hon. Friend the Member for Christchurch (Sir Christopher Chope) said and ensure that people are adequately and properly compensated for the damage done to them? Will she at the very least ensure that the maximum amount that can be paid out rises in line with inflation?

[Maria Caulfield]

I will come to those points shortly. All medicines have risks and side effects—even simple paracetamol, which is taken safely by the vast majority of people, can have serious side effects for some—and it is no different for the covid vaccine. That is true of all vaccinations, and that is why we set up the scheme specifically for vaccinations in the first place.

The Government cannot support the Bill’s proposals to make provision about financial assistance specifically for those who have had a covid vaccination. The scheme as a whole is to support anyone who has had side effects to a certain level of impairment from any vaccination, and it would be wrong to single out covid-19 for a separate scheme. The Government already provide long-standing mechanisms to offer financial assistance to individuals suffering disablement following vaccination in the form of the VDPS.

Just to clarify, the VDPS is not a compensation scheme. It was established in 1979 to provide a one-off tax-free payment to individuals who had been found on the balance of probability to have been harmed by a vaccine listed in the Vaccine Damage Payments Act 1979. In December 2020, covid-19 was added to the scheme to ensure that those who had severe disability found to be linked to the covid-19 vaccine would receive support through this tried and tested system.

The Government’s current focus is on scaling up the scheme’s operation by the NHS Business Services Authority, which took over its running in November 2021 from the Department for Work and Pensions, because we felt it was better placed to access patient notes and to improve timeliness. We have seen a significant improvement in trying to process claims, which I will come to.

The Bill also asks the Government to report on the merits of a no-fault compensation scheme for covid-19 vaccine damage. Establishing a dedicated stand-alone scheme would risk favouring those who, in extremely rare circumstances, have sadly experienced harm following a covid-19 vaccine above those harmed by other vaccines, which, again, does happen in rare circumstances. That would create inequality between vaccines, which could be damaging to other vaccination programmes.

Another element of the Bill is to question whether there should be an upper limit on the financial assistance available. It is important to reiterate that the VDPS offers a one-off lump sum payment. It is not intended to cover lifetime costs for those impacted. The amount has been revised periodically by statutory sums orders. The initial payment when the scheme was set up in 1978 was £10,000. It has been reviewed several times, with the current amount set at £120,000 as of July 2007. The award should be considered in addition to the Government’s support package for those with a disability or long-term health condition, which includes statutory sick pay, universal credit, employment and support allowance, attendance allowance and personal independence payments.

[Philip Davies]

The Minister says that the figure has been reviewed periodically and that we are now at £120,000. She just said that it was last reviewed in 2007, which was 16.5 years ago. Does she not think it is time for another periodic review?

[Maria Caulfield]

My hon. Friend makes a point. A review of the limit is not just down to the Department of Health and Social Care. I went to a meeting of the all-party parliamentary group chaired by my hon. Friend the Member for Christchurch, where that question was asked. Of course, we will look into that, but I cannot give a commitment at the Dispatch Box today. We will keep it under review as part of ongoing business and cross-Government discussions.

Finally, I turn our opposition to adjusting the criteria for disability. I recognise that some hon. Members who have spoken would prefer the level of disability for the scheme to be assessed on a sliding scale. However, assessing it on that basis would run counter to the intention behind it, namely to provide a one-off lump-sum payment.

The current scheme eligibility of 60% disablement is in line with the definition of severe disablement set out by the Department for Work and Pensions in “Industrial Injuries Disability Benefit”, which is a widely accepted test of disability and puts it in line with many other assessments across the board. Very few claims are rejected for not reaching the 60% disability threshold, and in the event that an application is turned down on that basis, there is also the option for claimants to appeal against the decision and provide additional evidence. We will continue to review the latest data on covid-19 to ensure that when decisions are reviewed, the reviewed decisions are based on up-to-date evidence. When I spoke to the APPG, concern was expressed about the time taken to appeal against decisions. I have given a commitment that if an appellant has been waiting for a significant time, I shall be happy to follow it up if the APPG contacts me about any individual case.

The Bill asks for an adjustment of the provisions on awarding payments to include all cases in which there is no other reasonable cause for death or disablement. Such an amendment to the scheme would not be beneficial at this time, because the payments are awarded on the basis of causation on the balance of probabilities. As the criterion for the scheme is already established and is being applied by medical assessors to conclude the remaining covid-related claims, any such amendment would risk further delaying outcomes for all claimants, including those most in need.

A number of questions have been asked this morning, and I have tried to answer as many as possible. My right hon. Friend the Member for Tatton (Esther McVey) asked about the MHRA. I hope I can reassure her by saying that following the Julia Cumberlege report “First Do No Harm”, there have been significant changes at the MHRA. I am pleased that it reviewed the AstraZeneca vaccine and made two changes based on evidence, but I can give reassurances about other medicines as well. The MHRA has had a significant influence on the recent statutory instrument concerning the use of sodium valproate, which is used mainly for epilepsy but can cause harm during pregnancy. There have been a number of such pregnancies. The MHRA met campaign groups such as In-FACT—the Independent Fetal Anticonvulsant Trust—and as a result of its influence, the SI provides that sodium valproate can be dispensed only in the manufacturer’s original packaging, so that women are aware of the risks. That is an example of the way in which the MHRA is changing. As Dr June Raine said, it is not just a regulator now; it is part and parcel of the patient safety framework around medicines. I hope that that provides some reassurance.

[Esther McVey]

Is my hon. Friend as concerned as I am that the head of the MHRA has said that the covid pandemic catalysed the transformation of that regulator from watchdog—which it should be—to enabler? It has shifted its purpose significantly.

[Maria Caulfield]

I cannot speak for Dr June Raine, but I can say that I take “enabler” to mean “enabler of patient safety”. The fact that, in a number of cases, the MHRA has stepped in means that it is advocating for patient safety and is not simply a body that processes applications for clinical trials or runs a yellow card system. It is willing to meet a range of groups, and indeed I suggested that the APPG invite it to one of its meetings.

Let me briefly touch on the issue of claims. As I said earlier, we have moved the scheme from the DWP to NHSBSA. The point of that was to speed up the claims, because the limiting factor in terms of turnaround time is obtaining clinical notes, and NHSBSA is much more able to gain access to them than the DWP. We have introduced the subject access request so that there is just one consent form to get notes from a variety of sources, from primary care through to secondary care.

To update Members on the latest figures, as of 6 October, 7,574 covid claims have been made to the vaccine damage payment scheme. Of those, 3,593 have been processed, with 149 having received a payment. On average, it is taking six months to investigate and process claims. Some will be outside that because of difficulties getting their clinical records, but the average is six months.

[Sir Christopher Chope]

Is my hon. Friend looking forward to the Government giving evidence to module 4 of the UK covid-19 inquiry? In particular, is she pleased that the inquiry will be looking into whether the VDPS is fit for purpose?

[Maria Caulfield]

The Government are always happy to give evidence to the inquiry. My hon. Friend makes a good point. I have had correspondence from constituents and from people around the country asking for the covid inquiry to cover vaccines, too. We have talked today about transparency and about being able to have an open and honest dialogue on vaccines. My right hon. Friend the Member for Tatton is right that to give confidence to vaccine programmes, people need to be able to raise concerns, to raise it when they have had an adverse event and to feel confident that those things will be investigated and not brushed under the carpet.

[Philip Davies]

I felt that the Minister was coming to a close. Before she does, I want to raise the point I made in my speech about the clinical trial involving children and a Bradford patient recruitment centre. I do not expect her to give a definitive answer now, given that I have just raised it, but will she give me a pledge that she will look into this matter, take on board the comments I have made and write back with her thoughts about what is happening with that trial?

[Maria Caulfield]

Absolutely. I will finish my points to my hon. Friend the Member for Christchurch and then come back to my hon. Friend the Member for Shipley. It is for the inquiry to decide what it investigates, but it would be helpful for vaccines to be discussed at the inquiry, so that people can put their concerns forward and so that we have a thorough look at the vaccine programme. That will enable us to learn lessons for the future, should we ever need to roll out a vaccine programme on that scale ever again.

To touch on the point made by my hon. Friend the Member for Shipley, I worked in clinical trials before I came into this place, and there are strict rules about posters advertising clinical trials, particularly for children. I do not know the details of the particular trial he is talking about, but if he has concerns about how it is being recruited to, that is a matter for the MHRA. I suggest that he contacts the MHRA, or I would be happy to discuss it with him after the debate.

[Esther McVey]

That point goes back to what I said about the MHRA moving from watchdog to enabler. I would like the role of that watchdog to be looked at.

[Maria Caulfield]

I hear that loud and clear from my right hon. Friend. I would just say that when advertising and recruiting for a clinical trial, any posters—I have not done this for a couple of years now—would usually have to be submitted to the MHRA for approval, and it is important to know whether that has happened in this case. We can certainly look at that after the debate.

To close, my hon. Friend the Member for Christchurch has made some good, valid points about the safety of vaccines and about encouraging people to come forward. We want people to come forward if they feel they have had side effects from the vaccine. It helps build up the profile and enables better decision-making for the future. He also made points about the vaccine damage payment scheme. We recognised that the process was taking too long, and that is why we moved it from the DWP to the NHS. We recognised that there were multiple requests for access to patient notes, which is why we brought in the subject access request forms. We want to ensure that those who have, on rare occasions, experienced side effects can access the scheme. Unfortunately, we cannot support the Bill at this time, because our focus must remain on improving the operation of the scheme and continuing to process claims as quickly as possible, but I very much welcome the debate today.

[Madam Deputy Speaker (Dame Eleanor Laing)]

With the leave of the House, I call Sir Christopher Chope.

[Sir Christopher Chope]

We have had a preview of the Government’s response to the UK covid-19 inquiry module 4, which will take place next July. All I can say is that I hope the Government improve their performance before then, because I do not think the arguments put forward today will be very well received. Basically, the Government are saying, “It’s all hunky-dory. There have been a few delays, but we are sorting that out. We are not going to change anything, whether in relation to the £120,000 limit, the eligibility criteria, the 60% disablement threshold or all the rest of it. And don’t worry, the vaccine damage payment scheme deals with other vaccines as well.” That was how the Minister started her response. She said there were other claims being made under the vaccine damage payment scheme, but I do not think she has really comprehended—or certainly did not give an indication that she comprehended—the gravity of the difference. She talked about the importance of flu vaccines. There have been, between 1 October 2021 and 1 September 2023, 35 claims under the vaccine damage payment scheme in respect of flu, nine claims in respect of HPV, and 6,809 claims in respect of covid-19. Surely the Minister can see there is a disparity between those figures.

[Maria Caulfield]

I did not address the point my hon. Friend made on that. The difference is that around 93% of the population received at least one dose of the covid-19 vaccine—tens of millions of people. HPV and flu vaccines are targeted at a much smaller group; they are not open to the whole population. That is why, naturally, we will see fewer claims coming forward.

[Sir Christopher Chope]

If that is the explanation, I am sure that also covers the fact that only 15 cases have been referred to the vaccine damage payment scheme in relation to MMR vaccines, compared with 6,809 in relation to covid-19. If the Minister thinks they are all equivalent then so be it, but all I can say is that the evidence suggests otherwise and there are serious questions now about whether the VDPS is fit for purpose. That is why it is great news the inquiry will be looking into that issue.

Worker Protection (Amendment of Equality Act 2010) Bill

Maria Caulfield Excerpts

Consideration of Lords amendments
Friday 20th October 2023 Commons Chamber

[Justin Madders]

Yes, that is absolutely right. The Equality Act is framed in such a way that it protects everyone from harassment on the basis of their sex. I think that we now have a Bill that, after the amendments, to our regret will not protect workers from third-party harassment. The duty to take all reasonable steps has now been reduced or watered down to taking reasonable steps. We are disappointed that the Bill returns in a form that looks very different from what was originally passed by this House. It seems that the original good intentions of the Bill have—to use the terms of the hon. Member for Devizes—been “gutted”, and I am sorry to say that seems to have been with the support of the Government. Let us not forget that, when the Bill passed through the Commons originally, it did have support from the Government and it also had cross-party support, which is a rarity these days. Therefore, it is extremely disappointing that the democratically elected House seems to have given in to the unelected Lords, seemingly with the endorsement of the Government.

I have to say that the Government’s decision to support the Lords amendments that have taken the guts out of the Bill is frustrating, given that the Bill was enacting pledges that the Government had made.

[The Minister for Women (Maria Caulfield)]

Does the hon. Gentleman not recognise that this is the Bill of the hon. Member for Bath (Wera Hobhouse) and it is up to her to decide which amendments she does or does not accept? The Government have fully supported the hon. Lady. This is not a Government decision; it is part of the parliamentary process.

[Justin Madders]

I thank the Minister for her comments. The Government have a majority, so if they wanted to keep the Bill in its original form they could have ensured that it passed. Let me quote what she said at Committee stage. She said that

“the Government committed to a package of new measures aimed at reducing incidences of workplace harassment. That includes the two legislative measures being brought forward in the Bill: explicit protections for employees from workplace harassment by third parties, such as customers and clients; and a duty on employers to take all reasonable steps to prevent their employees from experiencing sexual harassment.”––[Official Report, Worker Protection (Amendment of Equality Act 2010) Public Bill Committee, 23 November 2022; c. 10.]

--- Later in debate ---

[Justin Madders]

No, that is not what I want, which is why I have said that we will not oppose the amendment, but we are still entitled to express our disappointment about the capitulation. The Equality and Human Rights Commission’s 2018 report found

“a quarter of those reporting harassment saying the perpetrators were third parties”

and that third-party sexual harassment was dealt with poorly and considered

“a ‘normal’ part of the job”

by some employers. I do not think that is a situation that we should defend. Let us be clear: we would not have objected to the Bill if that had been in place—we certainly would have supported it—but we will support it as it stands because, as the hon. Member for Bath said, it is an important step in the right direction, albeit a much smaller step than originally intended.

The question remains: what is the Government’s plan to deal with third-party harassment? If they will not bring forward a legislative solution, what do they intend to do? If there were a repeat of the scenes at the Presidents Club tomorrow, what would be the consequences for the perpetrators? We need answers to those questions.

Despite the removal of the word “all” from the Bill, the duty to prevent sexual harassment is, as the hon. Member for Bath said, a new duty that represents a positive step forward. Establishing that preventive duty will shift the emphasis away from a reliance on individuals reporting harassment to employers and will encourage employers to take preventive steps. We are optimistic—we can be—and hope that the Bill will drive structural change by fundamentally shifting the responsibility from the individual to the institution, but what that will mean in reality and how much capacity the EHRC will have to investigate complaints remains to be seen. Its responsibility to create a statutory code of practice should mean that the focus will be more on working with employers. Does the Minister have any information on when she expects that statutory code of practice to be published, should the Bill be passed, and will it draw mainly from the non-statutory code of practice that has already been produced?

We believe that everyone should be able to go to work safe from sexual harassment, knowing that their employer has taken steps to create a safe working environment. That is why a Labour Government would go much further than the House has today.

[Maria Caulfield]

I congratulate the hon. Member for Bath (Wera Hobhouse) on progressing this Bill, which tackles the important issue of sexual harassment in the workplace. I thank her for the pragmatism she has shown to ensure that the Bill can progress with agreement from across the House. It is slightly disappointing to see the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), take such a partisan approach, because the Bill has had cross-party support throughout all its stages.

It is often very difficult for private Members’ Bills to pass through this place, but the Government have fully supported the Bill, because it is such an important issue to tackle. We have especially made time for an additional sitting Friday, to ensure that the Bill passes. We remain committed to tackling sexual harassment in the workplace by introducing the employer duty, to strengthen protections in the Equality Act 2010.

While I note the concerns from my hon. Friends the Members for Southend West (Anna Firth) and for Devizes (Danny Kruger), I am very pleased that consensus has been reached here and in the other place, and I hope Members will agree that this important Bill should now be on the statute book. I would like to particularly thank my hon. Friend the Member for Devizes, who has some genuine concerns about the Bill that he has expressed today and at previous stages.

This is a difficult subject. While there may be differences in views and opinions, I am really pleased that the hon. Member for Bath has been able to progress the Bill through both Houses, because we need to make our workplaces better and safer. That is particularly true for women. We have heard recently about some of the experiences of female surgeons in the healthcare system. With my other hat on as a Health Minister, I am particularly pleased that this legislation will hopefully prevent some of those experiences in future.

I turn to the Lords amendments. Lords amendment 1 leaves out clause 1, to remove the proposed liability of employers for third-party harassment in the workplace. I am glad to hear that the amendment to remove this third-party harassment liability eases concerns that it could have had a chilling effect on free speech in the workplace. I am pleased that that has been addressed. There are some—I know the hon. Member for Bath is one of them—who are disappointed that the amendment has removed the third-party harassment liability, for very valid reasons, but this is about getting a compromise, so that we get the majority of the measures in the Bill through this place.

The Government believe it is important that workers are protected against this form of harassment, and good employers are already taking steps to ensure that their employees are protected from harassment by third parties, regardless of the legal position. However, to progress the Bill, we have had to be pragmatic, acknowledge the complexities at play and find a suitable balance. While we want to strengthen protections, we also do not wish to infringe on individuals’ rights to freedom of speech. Everyone has the right to their views and to debate them just as we are doing today, respecting others’ views in the process. The aim of the Bill is to tackle workplace harassment and not limit people’s freedoms. It is important to remember that, despite the removal of the third-party harassment provision, the Bill will still introduce a new duty on employers to take reasonable steps to prevent sexual harassment.

The Government’s priority is to ensure that the legislation works effectively. We have consistently consulted with a wide range of stakeholders and have listened to all their views. As my hon. Friend the Member for Southend West has consulted with her chamber of commerce, the Government have done so more widely. When concerns regarding the potential chilling effect on free speech were first raised as the Bill progressed through the Commons, the Government took on board those issues. It was feared that employers may take unreasonable or drastic measures to avoid liability for harassment of their staff, particularly by third parties, to the extent that they would feel obliged to shut down conversations in the workplace. While employers will be expected to take action against workplace harassment, we recognise that those actions should fall short of prohibiting conversations. Free speech is crucial to our way of life, and it is important that we found a way forward.

With over 40 amendments tabled to the Bill in the other place following its Second Reading on 24 March, even after the Government tabled their amendment, it was clear that there remained concerns that the Bill would still have a chilling effect on free speech. The Government took those amendments very seriously, as they were fatal to the Bill. In our engagement with stakeholders and peers, we heard the strong concern, particularly about the third-party harassment issues, so we were eager to find a balance and a way forward for the Bill to reach the statute book with cross-party support. Therefore, the Government have been pragmatic and alive to the issues raised, and consensus was reached with peers by removing all but two of their amendments. The shadow Minister, the hon. Member for Ellesmere Port and Neston, did not comment on the other amendments—over 38 of them—that we managed to get removed.

Pregnancy Loss Review Recommendations: Implementation

Maria Caulfield Excerpts

Thursday 19th October 2023 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I wish to inform the House of our progress in implementing the recommendations of the pregnancy loss review following Baby Loss Awareness Week last week.

The sensitive handling and storage of pregnancy loss remains—We have begun a review of the guidance on the sensitive handling of pregnancy remains and the Human Tissue Authority will make any necessary updates by March 2024. The Department of Health and Social Care is working to develop specifications for a bespoke receptacle to ensure foetal remains can be collected and stored with dignity by February 2024. Scoping work is also under way to map the provision of cold storage facilities to avoid needing to temporarily store pregnancy remains at home.

Recurrent miscarriage—The Tommy’s Miscarriage Centre at Birmingham Women and Children’s Hospital will be launching a three-month pilot to assess the effectiveness of a graded model of sporadic or recurrent miscarriage that brings forward support to before a third miscarriage. The results of the pilot will be considered in due course.

Bereavement care—NHS England will commence a compliance survey of the estates, including early pregnancy facilities, starting by spring 2024. NHS England will also review the “Health Building Note” for maternity care facilities to update best practice guidance on the design of new and existing facilities, including access to appropriate facilities for women and families who suffer bereavement at any stage of pregnancy.

Education, training, and information—The Department of Health and Social Care is working with stakeholders to develop new information resources, based on best practice examples, for primary and secondary healthcare settings, including a poster on “what to do if you have pain or bleeding during pregnancy”.

Early Pregnancy Assessment Units—Work with commissioners of NHS 111, ambulance services and trusts will look at the direct booking of appointments with early pregnancy assessment units so that patients with complications can be sent direct. A review of the current directory of services, which allows women to find their closest service, will ensure that local information is kept up to date.

Baby loss certificates—In July, I announced that we would be rolling out the baby loss certificate service in October. Following testing phases with over 1,000 families who have experienced pregnancy loss, I have commissioned an enhanced service specification to improve the application process and ensure the proper protection of this sensitive service, including strengthening the method of second parent verification. We are working at pace to put in place additional verification and the certificates will be available as soon as possible.

In addition to the progress being made, we have established a pregnancy loss ministerial oversight group, and the first meeting will take place this month to ensure actions are on track to progress work on the priority recommendations.

I will continue to update on our work, including on the remaining medium and long-term recommendations, via written ministerial statements.

[HCWS1076]

Black History Month

Maria Caulfield Excerpts

Thursday 19th October 2023 Commons Chamber

[The Minister for Women (Maria Caulfield)]

I am grateful to be able to contribute to this Adjournment debate to mark Black History Month. I congratulate the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) on what has been a marathon afternoon for us both. It is lovely to finish the afternoon by responding to such an important debate.

As Minister for Women, I was pleased to see that one of this year’s themes for Black History Month is “celebrating sisters”. That gives us a chance to recognise the important contribution that black British women have made in the story of this nation. From individuals such as Mary Seacole, a trailblazing nurse who served during the Crimean war, to women from the Windrush generation who helped rebuild this country after the second world war, these pioneering women fought for civil rights and equality, playing an essential role in shaping the diverse and inclusive nation we are today.

As a Government, we are committed to ensuring that Black History Month is, as the hon. Lady said, not a once-a-year event and that schools are equipped to teach black history all year round. How our past is taught is crucial to ensuring that every pupil, regardless of their background, feels a sense of belonging to this country. We also want to celebrate the fact that our country is more diverse than ever before. According to the 2021 census, 18% of people in England and Wales are now from an ethnic minority group, compared with just 14% in 2011. Integration is also increasing, with the mixed- ethnicity population in England increasing by 40% in 10 years; 2.4 million households are now multi-ethnic.

[Abena Oppong-Asare]

According to some of the latest data, contained in a report produced recently by the newspaper the Voice in conjunction with Cambridge University, although we are seeing more diversity, especially in communities, there are concerns about the way people feel. May I urge the Minister to look at the report and think about what action can be taken in that regard?

[Maria Caulfield]

I have not seen the report, but I shall be happy to look at it, because the question of how people feel is important, in terms of both their experience and how it shapes their future.

It would of course be naive to say that tolerance and inclusion are the universal experiences of everyone who lives here, which is why, in July 2020, the then Prime Minister established the Commission on Race and Ethnic Disparities. We published our response to the Commission, “Inclusive Britain”, in March last year. That response sets out a groundbreaking action plan to level up the country, with three clear aims: to build a stronger sense of trust and fairness in our institutions—the hon. Lady touched on that, in relation to maternal health in particular —to promote equality of opportunity, encouraging aspiration and empowering individuals to reach their full potential; and to encourage and instil a sense of belonging to a multi-ethnic United Kingdom that celebrates its differences while embracing the values that unite us all.

The landmark “Inclusive Britain” strategy sets out 74 actions to tackle entrenched ethnic disparities in health, education, employment, policing and criminal justice. The strategy aims to increase trust and fairness, promote equality of opportunity, nurture agency, and foster a greater sense of belonging and inclusion. In April we published an update for Parliament, setting out the excellent progress we had made in delivering our ambitious strategy. This is a cross-Government approach, and we have delivered a number of changes already. There is new guidance from employers on how to use positive action in the workplace. We have published our ambitious schools White Paper, and provided targeted support for pupils who need it the most. We have established an Inclusion at Work panel to promote fairness in the workplace, and we are improving the stop and search process through new training for police officers. All of that will make a difference to the lives of black communities. Eighteen months on, we have already completed more than half those 74 actions, and we are proud to be delivering on our promises to all our citizens.

[Abena Oppong-Asare]

I appreciate that the Government are taking steps to try to address this issue, but given that this is the 75th year of the Windrush generation, I should like to hear more about what they are going to do for, in particular, those who have contributed so much to the NHS, have worked in Transport for London, and have helped our public sectors in general. They are being massively left behind, and the compensation scheme has not moved forward at all.

[Maria Caulfield]

The hon. Lady raised that point in her speech. We want to make sure that this is a fair scheme. The Home Office has reduced the time taken to allocate a claim for a substantive casework consideration from 18 months to less than five months. However, I fully understand the points that the hon. Lady has made, and I am happy to raise them with Home Office colleagues, because we fully understand the frustration and the upset that has been caused.

[Abena Oppong-Asare]

It is great that the case workload has been reduced, although it needs to be speeded up. However, I want to ask about the Wendy Williams review, which has been in place for some time. Is the Minister able to give us any firm commitments on its full implementation and any timescales applying to that?

[Maria Caulfield]

I am not able to give a firm commitment from the Dispatch Box this afternoon, but I can update the hon. Lady, and I shall be happy to write to her with some firm timelines after the debate.

I understand that Windrush is a particularly sensitive area, but I reassure the hon. Lady that we are making progress across the board, particularly on the school curriculum. Our model history curriculum will help pupils to understand the complex nature of British history and their place within it.

The hon. Lady touched on maternal health, and the evidence and statistics show that women from black, Asian and working-class backgrounds have poorer maternity outcomes, which is why I am so pleased that we set up the maternity disparities taskforce. My co-chair Wendy Olayiwola is a trailblazing black woman, and she follows the fantastic Professor Jacqueline Dunkley-Bent, who transformed how maternity services respond to black women in particular.

We established the taskforce in February 2022 to tackle disparities for mothers and babies, and our work is currently focused on pre-conception health and wellbeing because our understanding is that disparities are often bedded in by the time a woman is pregnant. The way to reduce those disparities is to ensure that women have help and support before getting pregnant, as that is the best way to ensure a safe outcome during pregnancy and birth.

The taskforce met in September, just a few weeks ago, and we are bringing together experts from across the health system, including some of the charities that the hon. Lady talked about, to explore and consider interventions. We are looking at setting up a pre-conception toolkit, and those charities, including Five X More, are feeding in what they think will make the greatest difference for women across the board. We know from their testimony that previous poor experience of healthcare services often prevents black women from engaging with healthcare services in future. It is important that we break down those barriers and change black women’s experience of NHS services.

Our Online Safety Bill will soon become law, allowing us to hold social media companies to account in clamping down on online racist abuse. This is just a taste of the work we have done and will continue to do to make sure the inclusive Britain commitments are implemented.

The hon. Lady touched on a meeting back in 2022. I was not the Minister at the time, but I am happy to follow up and let her know the outcomes. If it has not been actioned since that meeting, I will follow it up.

I am grateful for the points raised by the hon. Lady throughout this debate. I share some of her concerns, particularly on maternity services, and we are committed to trying to transform the statistics to make sure that black and Asian women in particular, have better maternity outcomes.

Across the board, the Government are committed to continuing to work towards a society in which every individual, regardless of their background, has the opportunity to succeed. We are not there yet, as the hon. Lady so eloquently pointed out, but I have every confidence that the decisive action we are taking as part of our inclusive Britain strategy will help us to achieve that goal.

Question put and agreed to.

Baby Loss Awareness Week

Maria Caulfield Excerpts

Thursday 19th October 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I start by thanking the hon. Members for North Shropshire (Helen Morgan) and for Sheffield, Hallam (Olivia Blake). I know the hon. Member for Sheffield, Hallam could not be here this afternoon, but she has done a huge amount of work over the last 12 months, since the last debate. I also thank my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), who is the co-chair. This is a fantastic example of cross-party working on such an important issue to women, but also to men, up and down the country. I pay tribute to the work that those on the all-party parliamentary group do. They are tireless campaigners for improving support for all families who go through the heartbreak of losing a baby.

This is the 21st Baby Loss Awareness Week and the eighth consecutive year that this House has held a debate to mark it. I am proud, once again, to be able to applaud all campaigners, charities and clinicians who mark Baby Loss Awareness Week. I will use my time this afternoon to provide an update on the progress we have made since the debate last year and on pregnancy loss in particular.

Before I do, I want to touch on the comments by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), who is my constituency neighbour as well. I want to apologise because, while we have delivered most of the changes in his Act, we still have not published the consultation on coronial investigations into stillbirths. I know from speaking to Bill Kirkup and Donna Ockenden that they are very supportive of coronial investigations into stillbirths. I have met many parents who have suffered the horrendous experience of losing a baby and who are very supportive of this change. I was hoping to come to the Dispatch Box and be able to make a positive announcement. Unfortunately, I cannot do so this afternoon, but I can assure him that I will personally follow this up after the debate. I hope that, in a very short period of time, we will be able to make a positive announcement for him.

The loss of a baby is, tragically, a common outcome. We are improving rates. Stillbirth rates have reduced by 23% and neonatal mortality rates for babies born over 24 weeks’ gestation have reduced by 30%, but that is no consolation to those parents who experience baby loss when it does happen. We know that, too often, when baby loss occurs, the experience of parents and families is not what it should be. That is why the independent pregnancy loss review published its report in July, and the Government are supporting the recommendations in that report to make sure that every trust offers a consistent, compassionate service. The review made it clear that baby loss is too often treated as a clinical event, with emotional support failing or falling short in a number of areas. That is why it is so important that we reintroduce compassion as an element throughout the experience.

Let me take one example that was shown in the pregnancy loss review. I was horrified to read stories of women miscarrying at home and storing their baby’s remains in their fridge in a Tupperware container because they were waiting days for their early pregnancy loss unit to reopen. The review put it down in black and white that major improvements are needed and that is why we are supporting the recommendations.

The review made 73 recommendations for change within the NHS and wider society, and we have already started action on many of those. The first was touched on by the SNP spokesperson, the hon. Member for North Ayrshire and Arran (Patricia Gibson): the use of baby loss certificates for babies who are born before 24 weeks, who currently cannot be registered. We announced in July that we would be rolling out baby loss certificates. They will be retrospective. There is no time limit on applying for them. They will be voluntary, so parents do not have to apply for one if they do not feel that they wish to. We are going through service user testing with families to ensure that the system we set up works for them. Following testing, there has been some service specification that we need to improve to ensure that the process runs smoothly. It will be run on the gov.uk website. Once we have those safeguards in place for both parents to be able to register on a certificate, we will announce the roll-out date formally to this place. It is important that parents who want to acknowledge the loss of their baby before 24 weeks are able to do so.

We also looked at the sensitive disposal of a baby after pregnancy loss, many instances of which happen at home rather than in hospital or clinical settings. It is important that women have access to proper collection facilities, so we have taken on board the recommendation on creating a bespoke receptacle to ensure that foetal remains can be collected and stored with due dignity. To do that we have been engaging with charities, women and healthcare professionals and we aim to finalise a specification by February. We are also working with the Human Tissue Authority to review and update its guidelines by March next year. NHS England is also consulting on a clear pathway to ensure that women can always have access to cold storage in NHS facilities, too.

We have also heard from women about the difficulty they often experience in getting help during a miscarriage. In partnership with NHS England, we are exploring how 111 and ambulance services can block-book appointments with early pregnancy assessment units, so that women in need can be directed straight to them if necessary; rather than going to A&E or other healthcare professionals, they can go straight to those units, where care can be provided with dignity and privacy. The review also proposes introducing graded care for women who suffer one, two or more miscarriages; the shadow Minister touched on that issue. We have taken on board those recommendations because currently, women have to suffer three miscarriages often before they get help.

Tommy’s miscarriage centre at the women’s hospital in Birmingham has launched a three-month pilot of that graded model, so that after one miscarriage assessments can be delivered. I have been to the unit to see the amazing work it does and I am looking forward to its results. It will look at that graded model and be able to present to us the difference that that will make to women experiencing baby loss. That will help to prevent further pregnancy losses in future.

Another recommendation made by the pregnancy loss review concerns the fact that families are often forced to grieve in public spaces. I want to be clear about this. Very often, the pregnancy facilities are inadequate. My hon. Friend the Member for Truro and Falmouth talked about the Daisy centre that is available in her area; it was not available when she tragically had to go through her experience. In many places, clinics, units and buildings are not able to meet women’s needs. Therefore, NHS England is surveying pregnancy facilities and will report back by the spring to ensure we can invest in those facilities to improve the outcome and experience for women and their families. We also need to improve bereavement support for both women and their families. That is another key area we are looking at.

Members touched on the number of midwives there are. I am pleased that in Cornwall there is a waiting list for training but across England there has been an increase in the number of midwives: there are 14.2% more than in 2010. We are engaging in a number of routes into midwifery. We have the degree apprenticeship now but we also have the nurse conversion course, which is popular with nurses who perhaps want to work in midwifery instead of nursing. Those routes are not just getting more midwives into practice but retaining them. That is a key element to be able to deliver all the asks in the pregnancy loss review.

We are also looking at how we support people in the workplace. It is important that women and families who experience baby loss are able to take the time off that they need. As a first step, the Department has signed the miscarriage association pregnancy loss pledge and we encourage other organisations to do so.

We could cover a number of issues that were raised in the debate. I just want to be clear with the House about all the issues that have been raised. With the ongoing maternity inquiries, we have set up a national oversight board so that we can pull together all the recommendations and findings, whether from Donna Ockenden, Bill Kirkup or other inquiries that have happened in the past, and make sure that every single maternity unit across England is responding to them, whether they are relevant to their units’ experience or not. We want consistent, good maternity care across the board, whether that is the Birthrate Plus model for making sure there are more midwives on units, making sure the capital framework of the unit is able to help support women who lose their babies, or ensuring that the culture of change that Bill Kirkup touched on so much in his review is rolled out, so that women have a compassionate experience when they go through the devastating loss of a baby.

It is our duty to support families who experience the devastating loss of a baby, and this Government remain committed to implementing all the independent pregnancy loss review’s recommendations. At the debate next year, I hope that my hon. Friend the Member for East Worthing and Shoreham will have a more positive comment to make and we will have addressed his concerns in detail, but also that we will have taken a step forward on many of the issues raised today and on some of the work we have started with the pregnancy loss review.