Birth Trauma

Maria Caulfield Excerpts

Thursday 19th October 2023 Commons Chamber

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

I, too, congratulate my hon. Friend the Member for Stafford (Theo Clarke) on her courageous speech, in which she described the birth of her daughter and the terrifying experience that she had. It is good to hear that she received such great support from her NHS team, but concerning to hear of her negative experiences—and as a former Minister for maternity services, I know that they were not isolated and that many others will have had similar experiences. My hon. Friend is a tireless advocate for women who have suffered birth trauma, and I pay tribute to her for the work that she has done and, I am sure, will continue to do.

I also congratulate Members on both sides of the House who have shared their personal experiences and those of their constituents, including my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), who does so much in the area of baby loss, and who I am sure will speak in the next debate. The hon. Member for North Shropshire (Helen Morgan) talked about her experience of a caesarean section, and I want to reassure her that we are trying to move away from terms such as “normal” and “natural” to the term “a safe birth”, whether that refers to a “natural” birth or a C-section. I have been working with the hon. Member for Canterbury (Rosie Duffield) on the East Kent inquiry and its recommendations, and have met many of her constituents who also shared their traumatic experiences about the care they had received.

I thank my hon. Friend the Member for Moray (Douglas Ross) for sharing his experience as a partner, and also for pointing out that many of these issues apply to all four nations of the United Kingdom. I respond as the Minister for services in England but, obviously, I work closely with devolved colleagues to try to ensure a consistent service across the country.

I have listened very carefully to the contributions and pay tribute to everyone for their courage in sharing their stories. Before this debate, I was pleased to meet my hon. Friend the Member for Stafford to talk about the issues she has raised and to share with her the many pieces of work that the Government are already starting, after they were shared by women across the call for evidence on the women’s health strategy and by meeting many women across the country to discuss maternity services. We clearly need to do much more in this space, but I will also share some of the progress we are making.

I salute the work of the newly established all-party parliamentary group on birth trauma, chaired by my hon. Friend, which is showcasing an issue that very few people like to talk about. She discussed breaking the taboo, because even women who have been through birth trauma are often very reluctant to talk about this difficult subject, but the issue affects thousands of women. We can see from the response in the Gallery how important it is that we break the taboo and talk about these issues, both to prevent birth trauma and to manage the consequences when it happens.

I commend the work of charities such as the Birth Trauma Association and the many campaigners who are here today. It is important that we highlight this issue, because many women going through pregnancy do not realise some of the choices that are available to try to prevent birth trauma in the first place.

Birth trauma and injury take a toll on women, both physically and mentally, and greater awareness from the public and healthcare professionals is crucial to preventing birth trauma and mitigating its impact on women’s lives. We have heard a number of examples of compassionate care, which is essential both in reducing and preventing injury and in helping women and their families to cope with the impact of injury when it happens.

[Hannah Bardell (Livingston) (SNP)]

I am sorry that I was not able to be here for the speeches, but will the Minister join me in commending health practitioners such as Stephanie Milne, who runs Physio Village in my Livingston constituency? She does mummy MOTs, and she talks a lot about birth trauma and how her work supports women who have been through birth trauma. Does the Minister agree that the NHS can do more to help women through such post-natal healthcare support?

[Maria Caulfield]

I absolutely pay tribute to them. We have heard some great examples of work happening around the country, but the point has also been made that it is not consistently available to everyone. Those examples show why compassionate care is a key part of the work we are taking forward, particularly in relation to Bill Kirkup’s report on maternity and neonatal services in east Kent, which was published last year. Dr Kirkup rightly emphasised the need for compassionate care and a change in culture as well as a change in practice for women throughout their pregnancy, labour and post-natal period.

Compassion, kindness and understanding all require women and their families to be treated as individuals and to be heard. That is something we heard strongly in our call for evidence on the women’s health strategy, to which we had over 100,000 responses. That is why birth trauma is mentioned in the strategy, and I will talk about that further.

As part of this, we have to recognise that the PTSD, psychological trauma or depression that a mother may experience also have to be supported. Just delivering a safe birth is not enough. Wearing my other hat as the mental health Minister, it is why new mums are a high-risk group in the suicide prevention strategy. It is a shocking statistic that the leading cause of death in new mums is suicide, but it is a very vulnerable time in a woman’s life. They are often isolated from work colleagues if they are on maternity leave and, if they are a first-time mum, they will not have a support network of other mums. We hear all over the place on social media what a wonderful time it should be in a mother’s life, that they should be blooming with a new child, but the reality can be very different. We have heard that today, whether it is issues around breastfeeding, not sleeping or just feeling isolated. On top of that, birth trauma can cause difficulties in not being able to drive and with being in pain—there is a whole raft of issues.

Through the work we are doing on maternity and focusing on new mums as a high-risk priority group in mental health, we are trying to drive forward changes to support women better.

I am pleased to have the opportunity to update the House on the wider progress we are making to improve outcomes in pregnancy. I fully understand the importance of preventing perineal trauma during childbirth. We have to be honest that we cannot always prevent it. I am not a midwife, but there are risk factors such as a larger baby, a smaller cervix or a long birth that mean trauma and injury will sometimes happen. There is no doubt that we need to do more to reduce the incidence of perineal trauma but, if it happens, we need to manage it in a much better way.

That is why I am pleased that NHS England has this week published a national service specification for perinatal pelvic health services, which it aims to roll out across England by March 2024 in order to end the postcode lottery of services. The specification states that the services will work with maternity units across England to implement the obstetric anal sphincter injury care bundle developed by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives.

As my hon. Friend the Member for Stafford said, getting the specification rolled out across the country is an early success for the APPG. I am confident that this new guidance, which will be implemented across maternity units, will reduce the rate of anal sphincter injuries resulting from labour and vaginal births and help to manage such injuries in a much better way when they happen.

The introduction of these services will broaden the core service offer of pelvic health beyond the existing NICE and RCOG guidelines on care for obstetric anal sphincter injuries. The services will make sure that all pregnant women get the advice and support they need to prevent and identify pelvic health problems, and that those who do have problems are offered conservative treatment options before surgery is considered, in line with NICE guidelines.

We all know the crucial role that midwives play in recognising women who are suffering perinatal mental illness, including by taking a trauma-informed approach to care. To support this, NHS England is refreshing its core competency framework for perinatal mental health. The shadow Minister touched on this, and I reassure her that, by the early part of next year, every integrated care system in England—I cannot comment on what is happening in Labour-run Wales—will have a fully working maternal mental health service to support mothers experiencing moderate, severe or complex mental health difficulties.

It is true that the number of women accessing perinatal mental health services has risen by almost 50% over two years, but that is good news because we want women to come forward. The challenge for the Government in England is being able to meet that demand. For too long, women have suffered in silence and isolation. When they come forward, we need to have the services to support them. This demonstrates that mental health services are more important than ever before.

A number of colleagues have identified the issue of inequalities in maternity care, and we know that some women, particularly Asian, black and working-class women, are experiencing poorer mental health and poorer outcomes in maternity across the board. That is why we continue to fight to introduce NHS equity and equality action plans across the country. I am proud of the progress we are making on developing resources, and I pay particular tribute to the maternity disparities taskforce, which is working with organisations to deliver this as quickly as possible.

A number of issues were raised in the debate and, touching on birth trauma in the women’s health strategy, we will fairly soon be updating our year 2 strategy and setting out our priorities. I will let Members know about that as soon as possible.

There is a lot we could talk about in this space, and I pay tribute once again to my hon. Friend the Member for Stafford and all colleagues who have shared their experience. I reiterate that this is a priority for the Government. We are seeing change, but more change needs to happen.

Clinical Negligence Claims

Maria Caulfield Excerpts

Monday 18th September 2023 Written Statements

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

On 15 September, the Government response to the consultation on fixed recoverable costs in lower damages clinical negligence claims was published on www.gov.uk.

The rising costs of clinical negligence claims are of great concern to the Government. Costs have more than quadrupled in the last 16 years, with legal costs comprising a notable proportion of this rise. Claimant legal costs have risen sharply in lower damages claims—claims valued up to and including £25,000—and are often disproportionate to the value of those claims. These costs are funded from the core NHS budget and use resources that could otherwise have been spent on patient care.

The length of the legal process can also be disproportionate given the relative straightforwardness of many claims at this level, meaning that people who have been harmed are waiting longer to receive compensation.

The consultation response sets out a way forward for these lower damages claims: a set of fixed legal costs and a new streamlined process. Our aim is to facilitate faster resolution for claimants and defendants at a lower, more proportionate cost than under the current system for these claims. The scheme would only affect the amount of legal costs that claimant lawyers can recover from defendants following a successful claim, not the compensation that a claimant could receive.

We also believe that these reforms will achieve significant cost savings and make an important contribution towards addressing the overall rise in clinical negligence costs. The Department’s modelling indicates that introducing these reforms could realise cashflow savings to the NHS in England of around £500 million over a decade. These reforms would apply to care provided by NHS, non-profit and private healthcare providers in England and Wales, but would not apply in Scotland or Northern Ireland.

The responses to our 2022 consultation on introducing fixed costs in ‘lower value’ clinical negligence claims have been vital in helping us shape these reforms and informed some changes to the original proposals, in particular around strengthening the safeguards we have in place to protect claimants’ access to justice.

Alongside the response, I have launched a further consultation focusing on the specific issue of disbursements under the fixed recoverable costs scheme, inviting views on a proposed way forward on disbursements for all claims in the scheme. That further consultation will run for six weeks, ending on 27 October 2023. I welcome views from all interested parties on those proposals.

We will work with the Civil Procedure Rule Committee to ensure the smooth delivery of these reforms. Subject to agreement, the Government expect that legislation will be in place to implement the reforms by April 2024.

[HCWS1031]

World Sepsis Day

Maria Caulfield Excerpts

Wednesday 13th September 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, Ms Fovargue. I start by thanking the hon. Member for Neath (Christina Rees) for introducing this important debate, which is taking place on World Sepsis Day; for her work as chair of the all-party parliamentary group; and especially for her tribute to Dame Cheryl Gillan, who did so much work in this space. I am sure that Dame Cheryl would have been delighted by the way the all-party parliamentary group has been taken forward under the leadership of the hon. Lady.

I was touched by how she shared her personal experience of sepsis because I think that will highlight to people listening or watching how difficult it sometimes is to diagnose sepsis and the very many circumstances in which sepsis can present. Sepsis is a devastating condition and, while many people who develop sepsis survive, every death is tragic. Patients rightly expect it to be recognised and treated promptly because very often they are feeling so poorly that they are not necessarily in a position to raise concerns themselves. Even as the hon. Member for Neath pointed out, just becoming unwell with sepsis has long-term consequences and it can take many months to recover from an episode. She put that extremely eloquently.

The many interventions have moved us all. Many of us will know people who have become worryingly ill or have died from sepsis. It is especially heartbreaking when the family of someone who has died from sepsis feel that more could have been done to save them. Those cases are hard to hear, but it is important for us to listen and learn at all levels of Government, from officials through to frontline clinical staff.

As has been mentioned, we have all been moved to hear about Martha Mills who was 13 when she tragically died from sepsis despite concerns being raised by her family about her care. On what would have been Martha’s 16th birthday last week, her mother spoke about her death and the need for patients and families to be listened to when they think that something is wrong. I echo the words of the hon. Member for Neath. We need to encourage more people to ask that question: could it be sepsis?

I am pleased to add my support to the announcement made by the Health Secretary that the NHS will be exploring the introduction of Martha’s rule in the United Kingdom. The Secretary of State is meeting Martha’s family later today and is looking at how this could be implemented. I am sure he will be updating the House and I am happy to update Members on the follow-up from that meeting and the work that is being done to look at this.

We anticipate that Martha’s rule will be similar to a system in Queensland, Australia, known as Ryan’s rule, which is a three-step process allowing patients and families to request a clinical review of a patient’s condition if they are deteriorating. Such a system would build on initiatives already being tested in the UK, including the Call 4 Concern scheme introduced in the Royal Berkshire Hospital. Evidence from the scheme suggests that patients and their families find it useful, and that it can make a real difference in outcomes for patient care.

[Rachael Maskell]

In the light of the fact that people suffering from sepsis can rapidly deteriorate, will the Minister ensure that a review of a patient could also be undertaken really quickly, without it becoming a bureaucratic process?

[Maria Caulfield]

Absolutely. That is the point: if families want a review, it needs to be done as quickly as possible. If we are going to look at Martha’s law, those processes will need to be looked at. It must not become bureaucratic to make a request. It must be a really practical process that makes a difference.

Sepsis is not a single disease and it cannot be diagnosed with a single test. It varies in presentation depending on the source of infection and the individual. I pay tribute to the UK Sepsis Trust, which today has reiterated the signs and symptoms for people to look out for, including: fatigue; not passing urine; breathlessness; skin being discoloured, which is particularly important for ethnically diverse communities, because the skin colour may be different in different communities; fits and shakes; confusion; and shivers. All those symptoms are signs of potential sepsis, so it is really important that people understand to look out for them. We will never fully eliminate the risk of sepsis or other forms of acute deterioration, but we must do everything we can to ensure that clinicians and other NHS staff working on the frontline can recognise a very sick patient.

As many Members know, 100% of ambulance trusts and 99% of acute trusts in England screen for sepsis using the national early warning score or NEW score, which is carried out in clinical care. Following recommendations from the Academy of Medical Royal Colleges and the National Institute of Health and Care Excellence, we are working to update national guidance on sepsis. I very much take the point made by the hon. Member for Neath about the importance of ensuring that that information is all in step and aligned with guidance across the board, so that there is one clear narrative about recognition of sepsis and the targeted use of appropriate treatment.

Research is key to improving outcomes the detection of sepsis and finding more effective treatments. We are committed to driving the evidence base to improve our understanding, and the Department is providing funding of over £1 billion a year through the National Institute of Health and Care Research to drive forward research studies in these areas. Since 2017, the national institute has funded 14 research projects on sepsis, with a combined total funding value of £27 million, but further applications will be welcomed, so if there people out there want to undertake research studies, please encourage them to come forward and put in applications.

It is important that I touch on antimicrobial resistance, as the issue is inextricably linked to sepsis. It is critical that we conserve our antibiotics so that if an infection occurs, they remain as effective as possible when they are really needed, including for sepsis. In line with the asks of the declaration, the Government are delivering a five-year national action plan and a 20-year vision to contain and control antimicrobial resistance by 2040.

I am pleased to say that we are working collectively, across the UK, with our counterparts in Northern Ireland, Scotland and Wales on that antimicrobial resistance national action plan. Hon. Members have touched on international collaboration, because no country or Government can tackle this issue alone. A study published last year by the Global Research on Antimicrobial Resistance Project shows that resistance was associated with the deaths of 4.95 million people worldwide, and many of those cases will be because of sepsis related to antimicrobial resistance. By working together with international partners, we can protect ourselves and help to treat sepsis more quickly and easily.

World Sepsis Day is an important reminder that there is more work to be done. In recognition of that and as a reminder of the importance of the issue, the Department is lit up in pink today. Once again, I thank the hon. Member for Neath. I am happy to meet her and anyone she wants to bring with her, because there is still work to be done. We have made great progress, and she is touched on work that is being done, including on Martha’s rule, but I am happy to meet her and the APPG to ensure that, by next World Sepsis Day, we have made further progress with this significant condition.

Question put and agreed to.

PANS and PANDAS

Maria Caulfield Excerpts

Tuesday 12th September 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 Dowd, and to respond to this debate. To be clear, I can respond only on healthcare services in England, and not on behalf of Ministers in Scotland, Wales and Northern Ireland, because health is a devolved issue. I can, however, give a commitment to hon. Members that I am happy to work with colleagues in the devolved nations on this very important issue.

I welcome the shadow Minister, the hon. Member for Erith and Thamesmead (Abena Oppong-Asare), to her place. It is slightly disappointing that she chose to be so political—I thought we had quite a good cross-party consensus in this debate. I thank the hon. Member for North East Fife (Wendy Chamberlain) for providing the opportunity to raise awareness of paediatric acute-onset neuropsychiatric syndrome, or PANS, and paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, known as PANDAS.

We have heard from Members how important the issue is. I thank them for describing the experiences of their constituents and the issues that they have faced. I recently met the chair of the all-party parliamentary group on PANS and PANDAS, my hon. Friend the Member for Aberconwy (Robin Millar), to discuss the lack of guidance on diagnosis, treatment and assessment for children who suffer from either of those conditions, and about the lack of awareness across the medical profession in all parts of the health service. I absolutely agree that we need more research and evidence to improve our understanding of the conditions and to better support the families affected.

[Sir Julian Lewis (New Forest East) (Con)]

The Minister will have heard the excellent speech made by my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about taking it on himself to send leaflets to his GPs to raise awareness. Does the Department have a mechanism for alerting all GPs to these conditions, which seem to be relatively unknown? If so, could GPs be encouraged by her Department to consider prescribing amoxicillin or a similar antibiotic at a very early stage, because that seems to be an almost risk-free option?

[Maria Caulfield]

The Department does not regularly write to GPs because the NHS is operationally independent, but NHS England does and we can certainly speak to NHS England colleagues. They send out regular bulletins on a range of issues to GPs, so I will speak to my primary care colleagues to see whether that is possible. We do not have enough information at the moment about how many children in the UK are affected by PANS and PANDAS. In the US, scientists have suggested that the prevalence there could be as high as one in 200 children.

We have specifically talked about the United Kingdom and England today. Although there is a classification now by the World Health Organisation, very few countries issue guidance on the diagnosis, treatment, assessment and management of PANS/PANDAS, because the scientific evidence is so sparse. When I met my hon. Friend the Member for Aberconwy, we talked about how we can get that evidence base so that we can issue guidance to primary and secondary care providers. We know that symptoms tend to come on suddenly.

We heard from my hon. Friend the Member for North Devon (Selaine Saxby) about the example of Jack and the difference that a diagnosis made. It is often following an infection that children who are healthy and developmentally on track suddenly start exhibiting OCD or other neuropsychiatric symptoms. The hon. Member for Brentford and Isleworth (Ruth Cadbury) is correct that very often a course of antibiotics can improve and tackle some of the symptoms that parents say can change a child overnight such that they can no longer attend school and are suddenly plagued by anxiety and other neurological symptoms.

PANS and PANDAS require a clinical diagnosis based on specific signs and symptoms observed by a clinician. There are currently no lab tests or biomarkers that specifically diagnose those conditions. There is also an element of excluding other diagnoses in the process of diagnosing PANS and PANDAS. That means other illnesses or diseases are considered first rather than assuming it could be PANS and PANDAS.

Although there are currently no national or European clinical guidelines on assessment, investigations or diagnosis, a multidisciplinary team referral often helps speed the process up. That is why we need our primary care colleagues to be aware that this could be the cause of symptoms and to get those referrals in as quickly as possible.

[Ruth Cadbury]

I thank the Minister for her response. She mentions the fact that there is no lab test that can diagnose PANS/PANDAS, but is that not true for other neurological conditions that I mentioned, such as ME and some of the ongoing conditions that people are experiencing from long covid? Sometimes a lab test does not exist because of the nature of what caused the symptoms. Perhaps the medical profession and NHS England need to think slightly outside the box in their search for answers.

[Maria Caulfield]

I absolutely agree with the hon. Lady. NHS England has been happy to work on such issues with the working group. It is embarking on work to roll out a nationwide surveillance study designed to identify the signs and symptoms because, again, it is probably unlikely that we will reach a definitive test that will ever give us a diagnosis, and it is about matching symptoms with a diagnostic criteria. NHS England has committed to doing that, and the Department is happy to support it in its work.

There is the issue about how quickly antibiotics should be prescribed and dispensed, but while one antibiotic may work for one child, it may not work for another, and it is sometimes a case of trial and error before the appropriate treatment is found. Although there is an evidence base for the treatment of symptoms, such as obsessions, compulsions and tics, it is recommended that children and families affected should be offered evidence-based treatments. That is why we absolutely need to build that research base to provide evidence-based guidance to clinicians, whether they are in primary or secondary care. At the moment, NICE says that it does not have the evidence base to put that guidance together, whether that relates to psychological treatments or to medications such as antibiotics. The commitment I can give today is to push and work with the working group, organisations and Members in this place to try to develop that research base.

[Robin Millar]

I have been struck by a couple of things in the debate—one is the cross-party consensus, but another is the uniform distress that Members have relayed. On the point the Minister just made about whether treatment is psychiatric or medical, one of the key points is that PANS/PANDAS is often confused as being psychiatric when it is an infection that has proven susceptible to treatment with antibiotics. That is the kind of basic step forward that we are hoping for today.

[Maria Caulfield]

I absolutely agree. I acknowledge that while the symptoms mimic a mental illness, there is very often a physical cause for those developments. That is why we need to build that evidence base with research to back the guidance that we can give to clinicians who, as colleagues have said, may not be aware of the condition or how to manage it.

Training on PANS is now included in the Royal College of Paediatrics and Child Health curriculum. In April 2021, the British Paediatric Neurology Association issued a consensus statement with the faculty of child and adolescent psychiatry at the Royal College of Psychiatrists. Following concerns about variation in how it was being interpreted across the UK, the new PANS PANDAS working group, as we have heard today, which is being supported by NHS England, issued a statement recommending the development of appropriate service models and pathways back in February. I am keen that we support the working group in its important work bringing the key organisations together so that we can get that consensus out to clinicians in the field.

The work that the working group has done highlights that all children presenting with acute onset neuropsychiatric symptoms should receive a full medical evaluation and signposts clinicians to existing international peer review treatment guidelines. As I have said, while NICE currently has no plans to issue guidance, should the evidence base develop further, and should there be an opportunity to do that, we would look to update clinical policy. NHS England would then consider the development of care pathways for those living with PANS/PANDAS. The key is building that evidence research base.

We have the evidence to sufficiently demonstrate that PANS and PANDAS are discrete disease entities. I hope that answers the question by the hon. Member for North East Fife on whether we recognise that. We absolutely do, but we do not have the evidence and research base on assessment, diagnosis, treatment and management. However, the Department is funding research into rare diseases through the National Institute for Health and Care Research, which is spending over £1 billion a year every year on research particularly into rarer conditions. It welcomes funding applications for research into any aspect of human health, which would include PANS and PANDAS. Applications are subject to peer review and judged in open competition, with awards made on the basis of importance to the topics of patients, health and care services.

The National Institute for Health and Care Research does not just provide funding; it will also provide guidance, whether for academics, clinicians, researchers, the working group, charities or any other organisation. I am happy to organise introductory meetings with the National Institute for Health and Care Research. It has met other groups to explore the types of research it would support and that would build an evidence base. I strongly encourage researchers with an interest in this area to come forward with proposals so that we can develop that evidence base and make real inroads.

Other countries are not necessarily leading the way. Not many countries have international guidance on the issue. I cannot remember which hon. Member referred to this, but the UK and the devolved nations have an opportunity to take a lead, build that evidence base and develop guidance on that basis.

I assure colleagues that I am committed to ensuring that those with PANS and PANDAS get the care they need. We need more high-quality research into these conditions. That is the only way we can get better outcomes for patients. I am happy to meet both the APPG and the working group to take this forwards, because there is an opportunity to develop our knowledge, increase awareness and ultimately to have better outcomes for those children affected.

Suicide Prevention Update

Maria Caulfield Excerpts

Monday 11th September 2023 Written Statements

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

Every suicide is a tragedy with devasting impacts on individuals, loved ones and communities. Today we are publishing a new National Suicide Prevention Strategy for England, which refreshes the national strategy for England that was published in 2012.

The strategy considers the latest evidence collected through our mental health call for evidence and discussions with experts, including those who have experienced the suicide of a loved one, academics, those who work within suicide prevention and the Government’s National Suicide Prevention Strategy Advisory Group.

I am incredibly grateful to everybody who took the time to provide feedback to ensure that the new strategy reflects the most pressing challenges and opportunities.

The result is a new cross-Government and cross-sector strategy for the next five years, with a core message that suicide prevention is everybody’s business. Over the next five years, we intend to reduce the suicide rate—with initial reductions in half this time. The strategy also sets out measures to improve support for people who have self-harmed and those bereaved by suicide.

Together, this strategy lays out over 100 concrete actions across national Government Departments, the NHS, local government, employers, the voluntary sector and many others. It includes new priority areas of action, such as improving online safety, addressing the links between suicide and factors such as gambling and domestic abuse, and combating different methods of suicide.

We have already provided funding to improve access to crisis support and support the voluntary sector to deliver suicide prevention activity including:

The £10 million from 2023 to 2025 to support non-profit organisations to meet the increased demand seen in recent years and support a range of diverse and innovative activity that can prevent suicides, including targeting groups of concern identified in this strategy.

Over £2.3 billion more a year for mental health services by March 2024 compared to 2018-19 , with £57 million specifically for suicide prevention and suicide bereavement services.

The £150 million capital investment made available to urgent and emergency care mental health pathways, including mental health ambulances, crisis cafes, children and young people’s places of safety and new mental health assessment spaces.

We will continue to review progress and update actions to prevent as many suicides as possible. I look forward to continuing to work with members of this House, the National Suicide Prevention Strategy Advisory group and colleagues across the NHS, local government and the voluntary sector to deliver on our ambition to reduce suicides.

I will deposit a copy of the strategy in the Libraries of both Houses.

[HCWS1012]

Hormone Pregnancy Tests

Maria Caulfield Excerpts

Thursday 7th September 2023 Commons Chamber

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

I thank the hon. Member for Bolton South East (Yasmin Qureshi) for securing the debate and all right hon. and hon. Members who have taken part in it. We cannot help but be moved by the many cases that have been brought forward this afternoon. This is the first time I have been able to speak either in this Chamber or in Westminster Hall on Primodos because, as many Members have said, there were legal proceedings that ended in May. The claimants had until 11 August to make an application for permission to appeal, which they did not do in that time, so today is my first opportunity since that legal action to speak on it. A second claim is being issued by those who believe that they were harmed by hormone pregnancy tests, against Bayer/Schering. That claim was stayed pending the outcome of the first case and, given that the first claim was struck out by the court, there are now discussions regarding the next steps with that claim. However, I am free to speak today on the issues that we have discussed in the debate.

I want to be clear, as a Minister who is responsible for patient safety, that the patient safety element is the most pressing and important part of my role. Baroness Cumberlege is also a constituent of mine, so hon. Members can be assured that she lobbies outside Parliament as well as inside.

Baroness Cumberlege conducted a review, and the Government have accepted and made progress on most of those recommendations. As has been said, an apology was issued by Government Ministers at the time when they responded to that report. We have appointed an independent Patient Safety Commissioner, and Henrietta Hughes is doing an outstanding job holding the Government to account.

I will touch on the issues around redress in just a moment. We have set up the mesh centres for those affected by pelvic mesh; I meet regularly with those female campaigners to hear their feedback on the effectiveness of those centres, and there is work going on to review that. The MHRA itself is revising its practice as a result of Baroness Cumberlege’s report.

[Dame Angela Eagle]

I think the Minister for her generosity in giving way, but this sounds like a typical civil service-drafted speech, if I may say so, mentioning everything but the issue we are talking about. We are not talking about mesh; we are talking about Primodos, and we want to hear about redress. Can she now please address those points?

[Maria Caulfield]

I can show the hon. Lady my remarks—they are on the back of this paper, and I have been writing them down during this debate. I am only two minutes into my speech and I am addressing some of the points that were made. I will of course come on to Primodos as well.

It is important to recognise that we did take those issues in Baroness Cumberlege’s review seriously. We could not look at the issue around Primodos at that time because of the legal case, which I have touched on, but there have been some reviews. My hon. Friend the Member for Mid Norfolk (George Freeman) was here just before this debate. In his time as Minister for Life Sciences, he took the campaigns and the evidence around Primodos so seriously that he set up the expert review in 2014 to look at the evidence that was in place. I hear very loudly this afternoon some concerns about that expert working group and that maybe evidence was either misinterpreted or not looked at, but that expert working group did look at the evidence at that time and also issued a public call for evidence.

[Sir Mike Penning]

The so-called expert group changed the remit that it was given, with no recourse, as I understand it, to any Minister for permission to do so. It changed the terms of what it was supposed to look at, which is not what it was asked to do in the first place.

[Maria Caulfield]

I hear my right hon. Friend and, as I said, I will come on to that specifically towards the end of my remarks.

There were further evidence reviews. Hon. Members have touched on the evidence from Heneghan et al., and from Brown et al. in 2018. Those were looked at, and again there was no evidence of causality found in those reviews.

[Hannah Bardell]

Will the Minister give way?

[Maria Caulfield]

I will, but I need to make some progress on addressing the points made.

[Hannah Bardell]

Causality is one of the key issues here, because it is very difficult to prove. The only way it can be proven is if those tests were done on pregnant women, and we all know that would be utterly ridiculous and absurd. However, we do know that there was association, and the bar has been set so high that it has become impossible for people to get justice. That responsibility lies at the door of the Government. Thalidomide campaigners were able to settle with the company. We need to look at how we can make that happen for Primodos campaigners, but the Government also need to look at lowering the bar.

[Maria Caulfield]

I take the hon. Lady’s point that causality is a high bar. I am just going through the fact that there have been a number of reviews of the evidence so far. Baroness Cumberlege, when she set out the remit for her review, also stated from the outset that she would not be able to touch on causality for many of those reasons. There have been a number of reviews of the evidence, but I hear from right hon. and hon. Members some concerns that those reviews still have not got to the bottom of the issues that the families and those affected by Primodos feel that they have faced.

On the next steps, I have heard hon. Members. I heard my right hon. Friend the Member for Chipping Barnet (Theresa Villiers), who was clear about the drug being taken even after evidence had emerged. I heard from my hon. Friend the Member for Stourbridge (Suzanne Webb) about the effect on her constituent Helen and her family. I heard from my right hon. Friend the Member for North East Somerset (Sir Jacob Rees-Mogg) about his experience in Government and why these things often take so long. And, of course, I heard my right hon. Friend the Member for Maidenhead (Mrs May), who set up the Cumberlege review in the first place. My hon. Friend the Member for Leigh (James Grundy) has lobbied me hard outside this place on behalf of his constituent Marie Lyon and the many others who have been affected.

Now that we are in between the first and—potentially—second court cases, I am keen to meet and get to the bottom of right hon. and hon. Members’ concerns.

[Mrs May]

I wonder whether the Minister might clarify one point about the second court case. The Government were a party to the first court case; that was the argument that they used for being unable to come to a decision. Are the Government a party to the second court case? If not, the second court case seems to me irrelevant.

[Maria Caulfield]

I will come to that in a minute. We are in between cases, and I want to make progress while we do not have a live case. Discussions are ongoing at the moment.

I am the Minister with responsibility for patient safety, and on this matter, I, rather than officials, wrote my speech. We all know that tragic events and accidents can happen, but I am weary of meeting families up and down the country who are victims of the injustice in the health service at the moment. I and the Secretary of State met the families at the Countess of Chester Hospital only last week. I met the families from Tees, Esk and Wear valleys, whose young children died by suicide. I met, as you will know, Mr Deputy Speaker, the families whose children died in east Kent, where there was an inquiry. I met Janet and Emma, the sodium valproate campaigners from In-FACT—the Independent Fetal Anti-convulsant Trust—and the women who lead the mesh campaign. I hear day in, day out about the injustice that many have to face, and about the fight to get answers to basic questions when things go wrong.

I am very happy to say from the Dispatch Box that I will meet the all-party parliamentary group, the hon. Member for Bolton South East, and other hon. Members who have taken part in the debate. I am very happy to commit to a meeting with my hon. Friend the Member for Leigh and with Marie Lyon, as well as with any other families who wish to meet, to discuss the Primodos case. If there are concerns that evidence was left out or not scrutinised, or that evidence in previous reviews is disputed, I am very happy to look again at that evidence and to leave no stone unturned until we absolutely get to the facts of the matter.

The right hon. Member for Kingston and Surbiton (Ed Davey) mentioned the letter that has gone out to those taking part in court cases. I do not want people to be in a position where they feel that they cannot get justice simply because they cannot afford to, so I commit to looking at that matter and addressing the points that he made as soon as I get to the Department.

I do not want to come back to the Dispatch Box to discuss the issues around Primodos on an ongoing basis. If patients feel that there has been an injustice, and that there is evidence to support that, I am very happy to look at it again. There may be future court cases, as my right hon. Friend the Member for Maidenhead said, but we are at a point where we can look at that now.

[Mrs May]

I am sorry; I did not say that there may be future court cases. The Minister herself referred to a second court case, and I asked a simple question about whether the Government would be a party to that case. I am grateful, and I am sure that the families will be grateful, that the Minister has opened the door to sitting down with and hearing directly from the families and campaigners. She says that she is prepared to look at any evidence that comes forward. The Cumberlege review is the evidence; it sets it out very clearly. That is all the Government need.

[Maria Caulfield]

To be specific on that point, the Government are involved in a second claim. We are not sure whether that claim will go forward—discussions about that are ongoing. As the appeal timed out on 11 August, I am happy to commit today to looking at the evidence and the Cumberlege review. Baroness Cumberlege is my constituent, and I am sure she will be pushing me for that.

[Ed Davey]

To follow on from the point made by the right hon. Member for Maidenhead (Mrs May), the Cumberlege review has concluded. There are recommendations. Is the Minister saying from the Dispatch Box that the Government are not accepting those recommendations? We want to hear that they are going to implement those recommendations, not hear more evidence—implement them!

[Maria Caulfield]

Finger pointing is not exactly effective. As I set out at the beginning of my remarks, we have accepted the majority of those recommendations. We could not accept the Primodos ones while there was an ongoing court case. I have given my commitment from the Dispatch Box to review the outstanding recommendations in relation to Primodos, because I want to get to the bottom of this once and for all and provide justice for the families. I have heard from Members across the House about their concerns and the outstanding recommendations of the Cumberlege review, and my commitment is to look at those now.

[Hannah Bardell]

It seems to me that we are caught up in a quagmire of bureaucracy. We have had the Cumberlege review. We know what the results are. The Government said incessantly that they would not address the Primodos matter because of the court case. We now know that the court case was, in some respects, flawed, because the complainants and victims were not able to take their case forward as their information was withheld by the legal firm. As the right hon. Member for Kingston and Surbiton (Ed Davey) said, they are now being treated in a hostile manner by the Government by being told that they will be sued for over £10 million if they take another case forward. That is an utterly preposterous situation. If the Minister really wants to get to the bottom of it, she needs to implement fully the Cumberlege review and ignore the nonsense that has gone on in the courts.

[Maria Caulfield]

I do not want to test your patience, Mr Deputy Speaker, because I know that I am over time, but I have made the commitment to review the Cumberlege recommendations for Primodos patients. For those who have been affected by sodium valproate and mesh, we are making huge progress. Only this week, we introduced a statutory instrument so that sodium valproate can only be dispensed in the manufacturer’s original packaging. We have the pregnancy prevention programme, which is drastically reducing the number of babies born to those taking sodium valproate. We are installing the registry, so that women on sodium valproate are better cared for and not taking that medication. Now that 11 August has passed and the claim was not followed up, I am looking at the Primodos recommendations as well. My commitment is to come back to the House and update Members on the progress on those matters.

--- Later in debate ---

[Maria Caulfield]

Will the hon. Lady give way?

[Yasmin Qureshi]

We want to sit down with the Minister, and we want her to say to us, “This is what we are going to do about the Primodos case.” We do not want the Minister to tell us the problems. We want a system of redress right now—that is what we want from the Minister—and I hope that when we have that meeting, she and her officials will present to us the practical action they are going to take so that all the people who have been suffering for decades and decades actually get justice. We want her to tell us not about what has happened before or about the court cases, but about the actions she will take based on what the Cumberlege review said. [Interruption.] The Minister is muttering, but in the past it has sometimes taken us months and months to get a meeting with Ministers. I am glad that she has reassured us, and I hope that we will get a meeting in the next couple of weeks and that her and her officials will present a concrete plan for how to get redress for the victims. [Interruption.]

[Yasmin Qureshi]

I am sorry; I did not realise the Minister was asking to intervene. I give way.

[Maria Caulfield]

I just wanted to reiterate that I have pledged to meet the APPG and all its members. I have also pledged to look at the recommendations specifically in relation to Primodos. I think it is important to meet the families and the APPG, so that we can make progress on this issue.

[Yasmin Qureshi]

I thank the Minister for that intervention. I look forward to meeting her and her officials, and to a great scheme that will help the victims of Primodos. I remind her that if we do not get our meeting, or if we do not get a satisfactory result, we will be back again—all of us. We have been fighting for the past 10 or 12 years, and we will continue to fight this campaign, because the whole House is united behind it. I hope we will get positive news at our next meeting.

Question put and agreed to.

Resolved,

That this House notes that children were born with serious deformities due to the hormone pregnancy test drug Primodos, which was taken by expectant mothers between 1953 and 1975; further notes that official warnings were not issued about Primodos until eight years after the first reports indicated possible dangers; observes that the report by the Commission on Human Medicines’ Expert Working Group on Hormone Pregnancy Tests in 2017 was inconsistent with other academic reports; notes that the Independent Medicines and Medical Devices Safety Review, First do no harm, found that Primodos caused avoidable harm; further notes that the Government has refused to acknowledge the recommendations by the Independent Medicines and Medical Devices Safety Review relating to Primodos families; and calls on the Government to fully implement the recommendations in the Independent Medicines and Medica al Devices Safety Review and to set up a redress fund for families affected by Primodos.

Draft Human Medicines (Amendment Relating to Original Pack Dispensing) (England and Wales and Scotland) Regulations 2023

Maria Caulfield Excerpts

Tuesday 5th September 2023 General Committees

[The Chair]

Before I call the Minister, I just want to confirm that if gentlemen wish to remove their jackets, they are free to do so.

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

I beg to move,

That the Committee has considered the draft Human Medicines (Amendment Relating to Original Pack Dispensing) (England and Wales and Scotland) Regulations 2023.

It is a pleasure to serve under your chairmanship, Ms Nokes. I will set out the purpose of the draft statutory instrument. The Human Medicines Regulations 2012 set out when medicines need to be prescription only and the requirements of pharmacists selling or supplying prescription-only medicines. This draft statutory instrument makes two amendments to the Human Medicines Regulations. First, it enables original pack dispensing of medicine when original packaging is required. Secondly, it requires whole-pack dispensing of medicines containing valproate.

The first amendment, under proposed new regulation 217B, will enable the pharmacist to dispense 10% more or less of the medicines compared with the quantity prescribed if they can dispense them with the manufacturer’s original packaging. Dispensing in the manufacturer’s original packaging brings a number of benefits. First, it improves patient safety because original packaging contains clear instructions and information about the medicines. Secondly, it frees up pharmacy time by reducing the amount of time spent splitting packs and counting packs and strips. However, the responsible pharmacist will need to make a judgment as to whether to use this 10% discretion. For example, the flexibility should not be applied to some medicines, such as courses of steroids or antibiotics, and the exact quantity prescribed should be the quantity supplied.

Original pack dispensing will not apply to controlled drugs, where the exact quantity prescribed will continue to need to be dispensed. Nor will it apply where a medicine is already dispensed in a full pack, for example because it is in a form that is not practical to dispense in the exact quantity ordered.

While the flexibility of 10% will not enable all prescriptions to be dispensed in the manufacturer’s original packs, it will deal with the issues of whether a month’s supply is for 28 or 30 days, and with multiples. For example, if a prescription is for 28 days but the pack has 30 tablets, currently the pharmacist has to remove those two extra tablets. The new flexibility will enable the full pack to be supplied and vice versa. The amendments for original pack dispensing will apply across Great Britain and they are enabling, so pharmacists can decide whether to utilise the original pack dispensing with the flexibility of plus or minus 10%.

A transitional provision has been included, so pharmaceutical services in England will need to further negotiate with Community Pharmacy England on pricing arrangements following the draft regulations. I understand that in Scotland, however, they are ready to move forward with this, so it will apply immediately.

[Valerie Vaz (Walsall South) (Lab)]

The Minister gave the example of 28 days or 30 days. Will pharmacists be able to explain to patients that they will not necessarily have to take them for 30 days?

[Maria Caulfield]

Absolutely, and pharmacists are very keen to do this. This will often be used for repeat medication. A GP may prescribe a month’s pack—which, depending on the supplier, will be for either 28 days or 30 days—but when dispensing the packs the pharmacist will be able to give advice to patients so that they are absolutely clear on the instructions, which will also be written on the pack.

That goes to my point that by ensuring that patients receive the necessary information that is included in the original manufacturer’s packaging, they will be supported in taking their medicines more safely and effectively. The amendments will lead to a reduction in the use of plain dispensing packaging—those little white boxes—so that patients can stop getting lots of small snips from blister strips. When they get full strips, that will make it easier for them to manage the supply and support compliance, because they will be able to identify more easily whether they have taken their tablet that day and how many they have left.

Original pack dispensing also helps pharmacists and their staff to become more efficient, as the number of times they have to snip blisters, repackage medicines and source extra patient information leaflets is reduced, freeing up time for other tasks such as providing clinical services to patients. The benefits of original pack dispensing will be synergistic with the benefits of expanding hub and spoke arrangements, which we are rolling out across the pharmacy sector. The use of hub and spoke dispensing arrangements has been consulted on, and we will publish that consultation in due course. Both today’s measures and the expansion of hub and spoke dispensing are a commitment to the community pharmacy contractual framework and are important foundations in transforming community pharmacy.

The second regulation, proposed new regulation 217C, is about the whole-pack dispensing of valproate. “Valproate” is a term for medicines containing sodium valproate, valproic acid and valproate semisodium; it includes various brands such as Epilim. Valproate is an effective medicine prescribed for the treatment of epilepsy and bipolar disorders, but it is associated with birth defects and neurological disabilities in babies exposed to it during pregnancy. The risk to children of mothers who have taken valproate during pregnancy of having neurodevelopmental disorders is estimated at 30% to 40%, in addition to an 11% risk of congenital abnormalities.

A number of measures are already in place to try to prevent pregnancies while women are taking valproate, such as the pregnancy prevention programme, which has already reduced the number of pregnancies exposed to valproate. But the latest data suggests that in England at least three pregnancies a month are still being exposed to medicines containing valproate. More needs to be done.

The regulations will require that patients receive only the manufacturer’s complete original packs, with limited exceptions in specific circumstances. The manufacturer’s original packs contain specific warnings and pictograms. There is a patient card along with statutory patient information leaflets, which outline the risks of taking the medicine. If patients are concerned about taking valproate, they should talk to their healthcare provider and should not stop taking their medicines without medical supervision.

The provision will be mandatory across Great Britain. There is no transition period and it will apply as soon as the regulations come into force. I hope I have set out the rationale for original pack dispensing for the majority of medicines and using the specific manufacturer’s complete original pack when dispensing valproate medicine. I commend the regulations to the Committee.

--- Later in debate ---

[Maria Caulfield]

I thank the Opposition for their support; it is very welcome and appreciated. I, too, pay tribute to Baroness Cumberlege for her work in this area, and to groups including In-FACT—the Independent Fetal Anti-convulsant Trust—which have been campaigning for a long time for better protection and support for women taking valproate.

Let me answer the hon. Lady’s questions. On greater flexibility, that is being looked at as a wider piece in community pharmacy by the pharmacy Minister, my hon. Friend the Member for Harborough (Neil O’Brien). There can be flexibility when there is a shortage of medicine; the hon. Lady brought up the example of HRT. When there is a shortage of a product, we issue a serious shortage protocol, which gives pharmacists flexibility when they have a pack on their shelf that is not quite what the prescription says. As she says, the prescription may be for 10 micrograms; if the pharmacist has two packs of 5 micrograms, or a different form of the medicine, there is flexibility under the SSP to dispense that, rather than sticking to the prescription. We are looking at whether that needs to be part of a wider piece of work on medicines overall.

The hon. Lady touched on Pharmacy First. The pharmacy Minister will update the House shortly on that; there is work going on around Pharmacy First and its roll-out. The hon. Lady touched on reimbursement. She is absolutely right: there are cost issues that community pharmacies will rightly want to iron out. That is why we have put a transitional arrangement in the SI: so that discussions with Community Pharmacy England on funding and reimbursement of costs can be hammered out before the SI is put into practice. That is the next stage. Once we have agreed to the SI, we will go into negotiations on pricing and reimbursement, so that the measures meet pharmacy’s needs when it comes to costs; the aim is not to put costs on pharmacy by introducing these measures.

I hope that I have reassured the hon. Lady that we are looking at the issues she mentioned. In particular, we issue serious shortage protocols quite regularly when we have a shortage of medicine, and that gives pharmacists a degree of flexibility in dispensing, without the need for further regulation. I thank Members on both sides of the Committee for their support today. I hope that I have reassured them that we are acting with urgency on valproate, and that original pack dispensing will give pharmacists flexibility, which will free up their time, so that they can focus more on clinical activity.

Question put and agreed to.

Autumn Vaccination Update

Maria Caulfield Excerpts

Monday 4th September 2023 Written Statements

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

On 8 August 2023, the independent Joint Committee on Vaccination and Immunisation (JCVI) published advice on who should be offered a covid-19 booster vaccine in autumn 2023. The Government accepted this advice.

Covid-19 Booster Vaccine Eligibility

Those eligible are:

Residents in a care home for older adults

All adults aged 65 years and over;

Persons aged six months to 64 years in a clinical risk group;

Frontline health and social care workers;

Persons aged 12 to 64 years who are household contacts of people with immunosuppression;

Persons aged 16 to 64 years who are carers and staff working in care homes for older adults.

More detail on eligibility criteria can be found in the UK Health Security Agency’s (UKHSA) Green book.

Autumn Vaccine Campaign Timings

On 30 August, the Government announced that this year’s autumn flu and covid-19 vaccine programmes will start earlier than planned as a precautionary measure following the identification of a new covid-19 variant, which was first announced in the UK on Friday 18 August.

While this variant is not currently classified as a variant of concern, advice from UKHSA suggests that speeding up the autumn vaccine programme will deliver greater protection, supporting those at greatest risk of severe illness and reducing the potential impact on the NHS. There is no change to the wider public health advice at this time.

The annual flu vaccine will be made available to these groups at the same time wherever possible, to ensure they are protected ahead of winter.

The vaccination campaign was previously due to commence in early October 2023. Vaccinations are now set to start on 11 September, with adult care home residents and those most at risk to receive vaccines first. NHS England has announced full details of the accelerated roll-out, and those who fall into higher-risk groups are being encouraged to take up the jab as soon as they are invited.

Vaccines to be Used as Part of Autumn Booster Vaccination Campaign

The JCVI advice on which vaccines should be used as part of this autumn’s booster vaccination campaign was also published on 30 August. The Government have accepted this advice, and I am informed that all four parts of the UK intend to follow the JCVI’s advice. The JCVI has advised the following products for use in the autumn campaign:

Pfizer-BioNTech mRNA bivalent BA.4-5 or monovalent XBB (subject to licensure)

Moderna mRNA bivalent BA.4-5 or monovalent XBB (subject to licensure)

Sanofi/GSK monovalent (beta variant)

The vaccine offered will depend on a person’s age and local supply considerations. Children under 12 years of age will be offered a paediatric (5-11 years) or infant (6 months to 4 years) formulation of the Pfizer-BioNTech mRNA monovalent XBB vaccine (subject to licensure).

Those eligible for vaccination are encouraged to take up the offer of the vaccine as soon as they are called to ensure they head into winter with the best protection.

Notification of liabilities

I am now updating the House on the liabilities the Government has taken on in relation to further vaccine deployment via this statement and accompanying departmental minute laid in Parliament containing a description of the liability undertaken. The agreement to provide indemnity with deployment of further doses increases the contingent liability of the covid-19 vaccination programme.

I will update the House in a similar manner, as appropriate, as and when any future deployment decisions impact the contingent liability of the covid-19 vaccination programme.

[HCWS997]

East Kent Hospitals University NHS Foundation Trust: Independent Review

Maria Caulfield Excerpts

Thursday 20th July 2023 Written Statements

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

I wish to inform the House of the Government’s full response to the report of the independent review into the maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust, which will be published today on gov.uk.

NHS England commissioned Dr Bill Kirkup CBE in February 2022 to undertake this review following concerns about the quality and outcomes of care. This inquiry was published in October 2022 with five recommendations for the healthcare system.

I want once again to express my thanks for the role the families have played in this review. I remain deeply sorry for the harm and pain that have been a result of the failings of the trust to provide safe care and treatment.

The Government informed the House of their interim response on 7 March 2023, and the fuller response published today sets out in detail how each recommendation is being implemented.

This response has been informed by extensive engagement with stakeholders from across the healthcare system and voluntary sector as well as by the insight and views from those families I met with in June, for which I am grateful.

While the issues set out by Dr Kirkup were a result of an investigation into one trust, many will resonate across the wider system. That is why our response sets out the existing work that is already underway to drive forward system-wide improvements, such as the implementation of the three-year delivery plan that was published in March 2023 by NHS England. This plan is clear on how maternity and neonatal care will be made safer, more personalised, and more equitable for women, babies and families. It will be an important supporting role in the implementation of the East Kent recommendations, and we recognise there is more that we can do.

Today, I want to draw the attention of the House to the key new action we are taking that will create the conditions needed in order for the improvements to be successful and sustainable.

I will chair the new national oversight group to bring together the key people from the NHS and other organisations to look across maternity and neonatal improvement programmes and the implementation of recommendations from this and other maternity reviews. At a local level in East Kent, I will convene a local forum bringing together the NHS, the Care Quality Commission and Members of Parliament whose constituents have been affected to share information and updates. I am also pleased to announce that Dr Kirkup has been appointed to support Government action in relation to recommendations 2 and 3.

It is with a firm determination that we must learn the lessons from this inquiry, as well as those before it, to implement meaningful change to prevent further inquiries into failings in maternity and neonatal services across England being needed.

[HCWS981]

Hyperemesis Gravidarum Awareness

Maria Caulfield Excerpts

Wednesday 19th July 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, Ms Nokes. I begin by thanking my hon. Friend the Member for Hyndburn (Sara Britcliffe) for a very moving speech. I express my condolences to Jess’s family and to Eddie, her partner, and let us also remember baby Elsie. My hon. Friend could not have expressed any better the impact on a whole family, a community and an individual, and I agree with every word she said. We met recently to discuss Jess’s case, and I am happy to continue to work with my hon. Friend on this issue.

Unfortunately, there are many women like Jess going through this. They are probably watching or listening to the debate, and will take comfort from the fact that they are not on their own, and that there are many others who feel like this. Every pregnant woman who is living or has lived with hyperemesis gravidarum or a difficult pregnancy—particularly those like Jess, who had such an active life before becoming pregnant—will recognise that isolation and loneliness. It is an all-encompassing feeling of not being physically well, which takes a toll on mental health as well.

To echo my hon. Friend’s words, hyperemesis gravidarum is a severe form of nausea and vomiting. She is right that we need to move away from the term “morning sickness” and to instead use the term “pregnancy sickness”, and we should also be aware that HG is very different from pregnancy sickness. Any woman who has experienced nausea or vomiting during the early stages of pregnancy knows how debilitating that is. However, when that continues week after week, and they see other pregnant mothers glowing and thriving in pregnancy, and sharing photos on Instagram and social media, it adds to the difficulty, and the feeling of isolation because they are not dealing with pregnancy in the same way as many others.

Hyperemesis gravidarum can affect between one and three in every 100 pregnancies, so it is not a small number. Thousands of women are affected. It can affect an individual’s mood and their ability to work. Many mums are keen to work for as long as they can, because they want to take as much maternity leave as possible after they have given birth. The effect of not being able to work, and the effect of HG on home life, particularly if mums have other children for whom they care, cannot be overestimated.

Although most women can be treated at home or as an out-patient, some need to be admitted to hospital. As my hon. Friend said, if they are not able to eat or keep fluids down, it is vital that medical care is there when they need it. Too many women are left feeling isolated and unsupported. There is stigma and a taboo; there is little understanding that this condition is very different from morning sickness, and that it affects women’s mental health, as well as their physical ability to cope with their pregnancy.

I absolutely agree that more needs to be done to address this issue. The National Institute for Health and Care Research is awarding funds for research on the causes of the condition, the way it can be managed and the nutritional impact on pregnancy. The women’s health ambassador, Professor Dame Lesley Regan, who is an obstetrician, is keen to look at hyperemesis gravidarum, because in her clinical practice she has seen its effect on women. She will host a webinar on hyperemesis gravidarum on 27 September in her role as chair of Wellbeing of Women, which is a leading women’s health charity. That public webinar, which is free for people to sign up to and attend, will explore the experience of patients with this condition and provide options for treatment, support and self-care. I encourage anyone who has been affected by it or has an interest in it to sign up. The details will be published on the Wellbeing of Women website. If the women’s health ambassador is championing improvements in this area, that is the start of the conversation. It will start Jess’s legacy, in terms of raising awareness for other women.

Mental health support is often not accessible. This is not the only case of women not being listened to when it comes to women’s health. Ahead of the women’s health strategy, we issued a call for evidence, to which we received more than 100,000 responses. Whether it was on endometriosis, the menopause or fertility issues, the overwhelming response was that women are often not listened to when they ask for help, either because healthcare professionals were not aware of the conditions that women were raising, or because the attitude of healthcare professionals, whether to pregnancy, the menopause or puberty, was, “This is part of a woman’s cycle, and you just have to get on with it.” We want to end that stigma.

There are so many interventions that can help women throughout their life course, regardless of their condition or the life change that they are going through. Through the women’s health strategy, we want to change that attitude, so that when women ask for help, they have a positive experience and feel supported.

We are looking at perinatal mental health. Tragically, the most common cause of death in new mums is suicide; that is absolutely extraordinary. It is tragic to hear that Jess died by suicide because she felt so isolated and helpless in dealing with her condition. We will hopefully publish the suicide prevention strategy very soon, and new mums—indeed, mums in general—will be a priority group in it. We recognise that there is not support for mums during and after pregnancy. We want to address the fact that suicide is the leading cause of death.

We are doing that already. Mental health services around England are expanding to include new mental health hubs for new, expectant or bereaved mums. We are opening up 33 of them, which will provide psychological therapy, maternity services and reproductive healthcare for women with mental health needs following trauma or loss, or directly related to their experience of pregnancy or birth. Those will be available in England from March 2024. I know that is no consolation to Jess’s family, but we are absolutely addressing that as quickly as we can.

We also recognise the importance of supporting women’s health in the workplace. My hon. Friend is quite right that there are laws in place to protect women when it comes to maternity leave and discrimination around pregnancy. I am happy to work with the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Mid Sussex (Mims Davies), on raising awareness of this condition, because employers are not aware that it is very different from early-stage morning sickness or pregnancy sickness, and that female employees will need help, support and understanding. They should not be afraid that the situation will eat into their maternity leave or, as my hon. Friend the Member for Hyndburn said, statutory sick pay. I am happy to have discussions with my hon. Friend the Under-Secretary of State for Work and Pensions. We have been working closely on the menopause in the workplace, so I am happy to take that up.

Hyperemesis gravidarum is not included in the women’s health strategy, which looks at the priority areas of women’s health, although pregnancy is. I would like to address that, because I have heard clearly from my hon. Friend, through what she said about Jess’s tragic experience and the outcome for her family, how difficult this issue is. I take on board that many healthcare professionals, particularly those whom a woman will see before she sees a midwife, will not have had training or support in understanding the extent of this condition. As my hon. Friend said, even midwives do not get specific training on HG.

I suggest that, following the webinar in September that the women’s health ambassador is leading, we organise a roundtable with her to discuss the findings, and see how we can take some of this forward. Through the National Institute for Health and Care Research, we have money for research, which could be on managing the condition; psychologically supporting women who are struggling with its devastating and debilitating effects; or the use of drugs such as Ondansetron. We need an evidence base, so that we can support primary care teams and midwives in giving medication safely to pregnant women. There could be research on hydration and nutrition support for those not able to keep down food and fluids; on the training and education of medical staff and midwives; on removing the stigma and taboo; or on raising awareness among healthcare professionals, the public and pregnant women. They may not realise that HG is a condition for which they should be able to get help and support, and that it is not just them being unable to cope with morning sickness. Some women do feel that, when they actually have a condition that makes their experience different from what many women go through.

The offer is on the table; I can meet my hon. Friend to see if we can draw some findings from Jess’s terrible experience, so that we can eliminate the chance of that happening to other women. In the minutes that I have left, I extend my thanks to my hon. Friend, and say to Jess’s family that I am so sorry to hear of their experience. I am happy to support Jess’s legacy, so that we change the experience for pregnant women who suffer with hyperemesis gravidarum, and never again hear such a tragic story.

Question put and agreed to.