GP Appointment Availability
Maria Caulfield Excerpts(3 years ago)
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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 Beaconsfield (Joy Morrissey) for bringing forward the debate. As we have heard from MPs from across the political parties, their postbags show that this is a big issue from the perspective both of constituents, who are trying to access appointments, and of GPs, who are reaching out to their local MPs to highlight the pressures and difficulties that they have faced recently.
I want to start off by thanking general practice teams and GPs in particular. It is disappointing to hear what the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), had to say. There is no war on GPs. We are all in this together, including GPs, reception staff and nurses. On 14 October the Secretary of State announced a GP support package precisely to support GPs in supporting their patients. We have been listening long and hard to the difficulties faced in primary care. The range of measures I will talk about are there to help GPs as much as patients. If we do not support GPs, the patients will struggle.
I wish to put on the record my thanks to all in general practice during the pandemic. They have gone above and beyond—and often under the radar—by continuing to see patients during the crisis. They have also helped support and in many cases run vaccination programmes in their local areas, and have been a key factor in supporting community teams to help patients be discharged from hospital more quickly and to prevent readmission. That was key during the crisis. Without their hard work and dedication, much of that would not have happened.
There is, however, an issue. We all know that there are problems with accessing GP appointments, but there is also some good news. My hon. Friend the Member for Barrow and Furness (Simon Fell) described the situation perfectly when he called it a perfect storm. So many patients did not come forward during the pandemic, as advised in the main, and many issues, symptoms, conditions and worries are now coming to the fore. The pent-up demand is such that GPs are overwhelmed by the number of people who now need to be seen, often with symptoms and conditions that are far worse than if they had been able to come forward at an earlier stage.
The physical set-up of many GP practices—infection control measures had to be put in place to protect GPs and their staff and patients—means that they have struggled to see patients. My hon. Friend the Member for Bracknell (James Sunderland) asked about those measures. They have been relaxed: social distancing has been reduced from 2 metres to 1 metre. Face masks are still required, but it is now safer for GPs to open their doors and get more patients into their waiting and consulting rooms. Some infection control measures have been relaxed and we should see an improvement.
Appointment numbers are returning to pre-pandemic levels. In August the average number of general practice appointments per working day was 1.14 million, which represented a 2.2% increase on August 2019. As GPs will tell us, they are seeing more patients. The proportion of face-to-face appointments is also increasing. Since August, nearly 60% of appointments have been face to face. That shows that things are starting to return to pre-pandemic levels, but the sheer scale of people who now need to be seen means that it often does not feel like that for patients.
I will give my hon. Friend the Member for Beaconsfield some specific figures for Buckinghamshire. In August, practices arranged a total of more than 200,000 appointments with patients, which is an increase of more than 3,000 from August 2019. In addition, practices in Buckinghamshire helped deliver more than 786,000 vaccines. I take her point that there are specific issues with certain practices that are struggling. My advice to her—and I am happy to meet her and discuss this more fully—is to try to broker a meeting between the GPs and the clinical commissioning group, because often additional support can be given locally to those practices that are really struggling. Sometimes GPs are so overwhelmed that they do not have the space to ask for help and support, even though that is what they need.
Many colleagues, including my hon. Friends the Members for Bolton West (Chris Green), for Beaconsfield and for Barrow and Furness, have raised the issue of telephone access. Much of the problem that patients face is that they cannot get through in the first place, whether that is to make a face-to-face appointment, have a telephone consultation or make a virtual appointment. That is an issue. GPs have historically devised their own telephone systems. They may have gone in with primary care networks or the CCG, and many have their own set-up. Given the sheer scale of the numbers, there is a real issue in having two or three receptionists tackle 300 or 400 calls on a Monday morning, most of which will be complex calls rather than quick, five-minute calls to book an appointment.
That is why part of the GP support package that the Secretary of State announced on 14 October will provide telephone support through a cloud-based system, which will do a number of things. First, it will increase capacity so that patients can get through much quicker. Secondly, it will provide an automated queuing system. I know from my own constituency that patients can be 29th in the queue and have to wait for a long time, so providing that extra capacity will take the pressure off GPs. It will also provide an insight into how much admin support GPs actually need. That valuable data will allow us to provide them with support for the long term.
There are a number of other measures in the GP support package and we are working hard on this matter. There is a £250 million winter access package, aimed at helping GPs open up their surgeries for more face-to-face appointments because this is not an either/or situation. Many Members, including the hon. Member for Batley and Spen (Kim Leadbeater), pointed out that many patients like telephone consultations and the virtual appointments, and we are not going back to pre-pandemic face-to-face-only appointments. We need to embrace the changes that technology has brought. It is far more beneficial for busy people who are working or juggling childcare to be able to speak to a GP rather than have to trundle down to the surgery, but there is a place for face-to-face appointments as well.
The access package of £250 million can be used in a number of ways by GP practices. It can be used to take on locum staff if they are available, to take on other healthcare professionals to see patients, to extend opening times, or even to change the layout of a surgery so that it can accommodate more patients. It is for local commissioners and GPs to decide how they would like to use that fund.
There are also significant moves to reduce bureaucracy for GPs. They are often the only people who can sign fit notes or Driver and Vehicle Licensing Agency requests. As has been said, there are other healthcare professionals who are equally qualified to do that. Some of it may need legislative changes, which we are working at pace to introduce, but we want to take that bureaucratic burden off GPs so that they are free to see patients when they need to.
There are also a number of other measures in terms of increasing the general practice workforce. As the hon. Member for Barrow and Furness said, communications is a crucial point because it is not always the GP that patients will see in face-to-face appointments. They might see a nurse, a pharmacist or a physio. We need to get that message out at a general practice level, but also at a national level.
Chris Green
On compulsory vaccinations in the care sector, I have concerns about compulsory vaccination on the NHS sector. Would the Minister do what she can to ensure that there is an impact assessment before this is done on the NHS, if it is done in the future?
Maria Caulfield
My hon. Friend is certainly persistent in his questioning on that issue. It is a decision for the Secretary of State, who is looking at such factors. The vast majority of NHS staff have been vaccinated, for their own protection as much as anything else. I want to highlight that we are increasing the number of primary healthcare professionals across the board, aiming to replicate the model used in hospitals, where a consultant leads a team of multi-disciplinary professionals who will help see a patient and are, sometimes, more expert in dealing with certain clinical situation than GPs themselves.
Margaret Greenwood
I have had GPs talk to me, somewhat frustratedly, about not having sufficient GPs in their surgery and having physician associates who do not have the same level of training. There is a concern that this is a backing-away from the Government’s commitment of 6,000 extra GPs. Could the Minister confirm whether the Government are still committed to 6,000 extra fully qualified, trained GPs?
Maria Caulfield
We are committed to increasing GP numbers, as in our manifesto commitment. However, that does not stop us increasing the numbers of other healthcare professionals. We need to get the message out to patients that seeing a nurse, physio or paramedic at the GP surgery is not second best. These are highly qualified, experienced and educated professionals who often are better placed—though I do not want to upset the shadow Minister—to see a patient than a doctor. They can make a considerable difference, but very often patients feel they are being fobbed off or seeing the second best. We need to do a lot of work to reassure patients on that.
We have already recruited 10,000 of the additional 26,000 staff we stated in our manifesto would be working in general practice by the end of 2023-24. We are strengthening our plans to increase the number of doctors in general practice. To reassure Members, so far we have filled a record number of GP speciality training places this year, with the latest data showing that there are already 1,200 more full-time equivalent doctors in general practice than two years ago. It is a challenge; I am not going to say it is not, but we are making progress.
I feel particularly passionate about the use of community pharmacists. In many other countries, the pharmacist is the first port of call for minor ailments. They are highly qualified professionals with over five years of clinical training who are able to assist patients. Over 800 practices have already signed up to participate in the community pharmacist consultation service, which enables patients to see a pharmacist, on the same day in many cases, to deal with minor conditions. That will not only help patients, but it will free GPs up to see the patients that really need to see them for clinical conditions.
Rachael Maskell
Will the Minister also ensure that the funding goes into community pharmacies in the right way if they are to be utilised? Likewise, with the voluntary sector involved in providing support for people through different forms of wider health support, will she ensure that it too gets proper funding?
Maria Caulfield
I thank the hon. Lady. The spending review tomorrow may have further updates on that, so I will not comment on the funding for now. NHS England and the Department of Health and Social Care have asked the Royal College of General Practitioners to provide GPs with more guidance on how to blend face-to-face with virtual appointments. We do need a mix of both going forward, and the comms, as has been said so much this afternoon, will make a difference, so that patients know where to go, what is available and who they can see for their particular condition.
The issue of abuse has featured heavily this afternoon. The hon. Members for Batley and Spen and for Linlithgow and East Falkirk (Martyn Day), my hon. Friend the Member for Bracknell and for Waveney (Peter Aldous) and others have mentioned the impact of abuse. When patients have been waiting a long time to see a GP, cannot get through on the phone and are feeling unwell in very distressing situations, they often take it out on practice staff. It is unacceptable, and we all have a role in this place to say that we have zero tolerance for that.
We know as MPs what it is like to face a torrent of abuse. If it is not acceptable for us, it is certainly not acceptable for them. My message to general practice staff is that we are four-square behind them on this and will support them. As part of the winter support package, there is £5 million to facilitate extra security, be that CCTV, extra screens or door entry systems—whatever practices feel will make their staff more secure, that funding is available to them. That is not the only solution, and they should not face abuse in the first place, but we are taking it extremely seriously.
In the few minutes that I have left, I want to say that there are two main issues here. There is the short-term covid issue, which has seen a tsunami of patients whom we need to support as we come out of the covid period. There is the £250 million winter package, and there is support around opening up community pharmacies and enabling other healthcare professionals to see patients, which will take some of the bureaucracy away from GPs while we support them to get through the period. However, there are some longer-term solutions as well. General practice and primary care were creaking before covid, and we need to ensure that they are supported in the long term going forward.
I thank my hon. Friend the Member for Beaconsfield for securing this afternoon’s debate. She has raised some really important points. On Thursday, I am holding a cross-party call for MPs to raise some of their constituency GP issues. I urge them to feed back to me as the Minister where it is working well, because there are some brilliant examples out there. Where it is not working so well, it is not the fault of GPs. There are some fundamental solutions that we can help them with, but it is important that we hear about the problems so that we can support them. If Members have specific issues from their constituencies, they should join the call. We are hoping to hold such calls on a regular basis, if that is needed by colleagues, and I am keen to work with everyone across the House to support general practice, because that is the only way we will support patients in the end.
World Menopause Month
Maria Caulfield Excerpts(3 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
How amazing it is that, at last, women’s issues and the menopause are finally getting the coverage they deserve. I want to start by paying tribute to Sir David Amess, who was such a long-standing campaigner on women’s health issues, particularly endometriosis. I feel sure he would have been with us here this afternoon, standing in solidarity on this very issue.
I want to thank the hon. Member for Swansea East (Carolyn Harris)—a woman not to be messed with, quite frankly—and my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for, and congratulate them on, securing this debate. I also thank them for their work on the all-party parliamentary group and on the Women and Equalities Committee, including for the launch of the inquiry that the Committee is about to undertake. For too long, the menopause has been a grubby little secret for women. It is often just called “the change” because women are just not confident enough even to call it the menopause.
I also want to thank all the Members across the House, and particularly the men, actually, for taking part—the hon. Member for Pontypridd (Alex Davies-Jones), my hon. Friend the Member for Hertford and Stortford (Julie Marson), the hon. Members for Newport East (Jessica Morden) and for Bradford South (Judith Cummins), my hon. Friends the Members for Cities of London and Westminster (Nickie Aiken) and for Stourbridge (Suzanne Webb), the hon. Member for Strangford (Jim Shannon) and the hon. Member for Motherwell and Wishaw (Marion Fellows). I completely agree with the hon. Member for Swansea East that this is not a political issue; this is something on which we need to be working cross-party, and I am confident we can make some serious progress on it.
It is so important that we raise awareness of these important issues and, in doing so, play our part in ending the taboo and stigma that surrounds the menopause. As a fellow member of the menopausal club, what frightens me is that most women are unaware that they are actually going through the menopause. We are talking about women in their 40s and 50s, which is a very busy time in their lives—they are often looking after children and have heavy work responsibilities, and maybe responsibilities for elderly parents—who suddenly feel that they cannot cope, are exhausted and are failing, but simply do not realise that they are going through a natural ageing process. A lot of women assume that the menopause is just hot flushes and their periods stop. They do not realise that it is about brain fog, low mood, weight gain, headaches, or not being able to sleep. It is a lightbulb moment when they realise that they are going through the menopause.
There are more than 30 symptoms of the menopause. Some women will experience some, some will experience all, and some will experience debilitating symptoms that completely transform their life. With around 400,000 women entering the menopause each year, access to high quality healthcare support is essential. All women going through the menopause should be able to have conversations with healthcare practitioners, whether that is a practice nurse, their GP, a councillor or a pharmacist. Guidelines from the National Institute for Health and Care Excellence on diagnosing and managing the menopause state that an individualised approach should be adopted at all stages, including diagnosis, investigation, and management of the menopause. I confirm to my hon. Friend the Member for Cities of London and Westminster that NICE guidelines state that after three months of taking HRT, it is recommended that GPs prescribe it for women annually, although we know that in practice, that does not always happen.
The guidelines outline the information that menopausal women should be given by clinicians to support the management of symptoms, and they include guidance on HRT, non-hormonal treatment and non-pharmaceutical approaches. They recommend that HRT is appropriate for most women, but unfortunately we find that levels of prescribing are relatively low, and only a minority of women currently get access to it. That is mainly based on flawed research from about a decade ago, which raised concerns for both women and healthcare practitioners, who are not necessarily confident in prescribing HRT. It is so important that work is undertaken with stakeholders to develop and implement optimal care pathways for women.
Let me touch on some of the issues raised in the debate, particularly about the workplace. I know that the Women and Equalities Committee will soon undertake its inquiry, and I am keen to work with it on that and see its findings. With one in four women in the workplace being either menopausal or post-menopausal, it is important that employers play their part. Companies such as Channel 4, Asos, Vodafone, HSBC and many others mentioned today are doing tremendous work. The NHS workforce is 77% female, and it is working to develop a menopause workplace support package, which will be pioneered in the NHS through local health systems. Some green shoots of progress are being made, but there is a huge amount more to be done and the Government are considering how we can influence that debate.
My right hon. Friend the Member for Romsey and Southampton North spoke about this issue, and I am keen to work with her and her Committee to make progress on that. We have mentioned the women’s healthcare strategy, and I am pleased that the Government launched a consultation on that in March this year. This is the establishment of England’s first ever women’s healthcare strategy, and the response was huge. In the call for evidence, more than 110,000 responses were given to the online survey, and more than 500 organisations provided written submissions. For women aged 40 to 49 and 50 to 59, the menopause was the No. 1 issue that they wanted the women’s health strategy to cover. I am pleased to announce today that the menopause will be a priority when we publish the women’s health strategy in the coming months.
The lesson from today is that we do not need just to talk about the menopause; we need to act and support women through it, whether in the workplace or by supporting them to get access to the treatment they need. This is about raising awareness among women themselves, so that they know they are going through the menopause, but also to get better recognition of it in society as a whole. We do not talk enough about how the menopause affects women. My hon. Friend the Member for Eastbourne (Caroline Ansell) contacted me to tell me that they are not just talking about the menopause in Eastbourne; they are singing about it, too, with the theatre running “Menopause the Musical”. It is up in lights down in Eastbourne if anyone wants to attend.
The hon. Member for Swansea East is completely right: we need to do much more than talk about this issue. We will have another opportunity to continue the debate next Friday, and I will talk to her between now and then to see what progress we can make. As we have heard today, the damaging taboos—the stigmas—that prevent women from speaking about their experience need to change. It is difficult to access support at the moment, and we need to do something about it.
As the Minister responsible for women’s health, I am committed to supporting women through the menopause to reach their potential and live healthier and happier lives, and I am convinced that we can make progress. Maybe a revolution is about to happen. I believe that we are about to see a seismic change in the way society and healthcare systems understand and support women experiencing the menopause.
NHS Dentistry: Lincolnshire
Maria Caulfield Excerpts(3 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I congratulate my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing this important debate. I am really pleased to hear dentistry getting some more parliamentary time and being put on the radar, because it is such an important issue. I am aware that there are long-standing concerns around dental access in parts of the east midlands. In my response I will consider the impact of covid on access to dentistry. We are aware of this, and I will focus on it initially. However, we have to acknowledge that there were problems in accessing NHS provision before covid. Even once we are through the recovery from the pandemic, we will need to address those issues once again. They will not disappear once the pandemic has passed.
As my hon. Friend highlighted, dentistry posed a significant risk during the pandemic because of the aerosol-generating procedures. I thank all the dental teams across the country who showed such resilience and dedication during this period, because they kept going and provided urgent care while facing considerable risk and anxiety. The steps we took during the pandemic ensured the safety of both dental patients and staff, but they have led to a reduction in the number of patients who can be seen.
We have worked closely with NHS England to consider the level of NHS dentistry that can be safely delivered in the environment of a pandemic. The thresholds that have been set for dental practices since the start of the year are based on what is achievable while maintaining infection control measures.
My hon. Friend will be pleased to know the UK Health Security Agency published new guidelines on 27 September that include three pragmatic changes to infection prevention and control measures, with a focus on elective care that allows providers to start making further safe changes to open up their services. I take her point, and I will consider what more support can be given for ventilation to help dentistry premises open up further still.
In the light of the reduction in activity, dental practices have now been asked to deliver as much care as possible, prioritising urgent care, care for vulnerable groups and children, and delayed planned care. Practices are now being asked to deliver 65% of their units of dental activity and 85% of contracted units of orthodontic activity from 1 October. Our figures suggest that we are starting to see a natural return to pre-covid levels of activity in dentistry, and I am pleased to see that in England urgent care has been back to pre-pandemic levels since December. We have made real progress there.
Sir John Hayes
It is widely acknowledged that the Minister brings both understanding and diligence to her role. Does she recognise that there are particular problems in rural areas such as Lincolnshire? We hear a lot in the place about urban deprivation and metropolitan needs, but we hear rather less about rural deprivation. In healthcare, public services and dentistry in particular, our county is peculiarly deprived. Will she take particular measures to help rural places such as Lincolnshire?
Maria Caulfield
My right hon. Friend makes an excellent point, which I was going to address. Officials tell me that the areas where we are seeing significant gaps are referred to as “sheep” and “seagulls,” with the sheep being rural areas and the seagulls being coastal stretches. They are the two areas of the country with a significant shortfall in NHS dentistry provision, and they are the two areas on which we will particularly focus.
Martin Vickers (Cleethorpes) (Con)
My constituency contains both sheep and seagulls. One of the problems, of course, is that rural villages and market towns are attracting increasing populations and we are seeing massive planning applications. I cite Barton-upon-Humber in my constituency as one example. What work is the Department doing with local authorities to make sure that, where there are major planning applications, public services and particularly dentistry are sufficient to meet the need?
Maria Caulfield
My hon. Friend makes a good point, and across Government Departments we are discussing the provision of both general practitioners and dentists for new developments. I am keen that dentistry is on a par with GP provision, because it is often an afterthought. I am keen that we push it up the agenda, and this debate helps.
Dr Caroline Johnson
Will dentists have a voice on care panels in the new integrated care systems?
Maria Caulfield
I thank my hon. Friend for that query. I am keen that dentistry has a louder voice than it does now.
As I was saying, part of this debate is about raising the profile of the issue. I reassure her that there are a number of things happening, particularly in her region. NHS England Midlands and East, which covers the east of England, is putting in place a number of initiatives, about which I wish to reassure her. Additional weekend dental sessions are going to be commissioned, to take place up to March next year. There will be additional clinical capacity to reduce waiting lists where a general anaesthetic is required, particularly for children. NHS England has also begun a procurement exercise to address the lack of orthodontic access across the region, particularly in Lincolnshire. To get us through the pandemic recovery phase, we will work closely with NHS England to ensure that that is happening as fast as possible.
In the short time available, I wish to turn to the long-term plan to address the shortfall that was there before the pandemic. We are taking up some of the suggestions that my hon. Friend has made so eloquently in this debate. The core of that is about ensuring that the NHS dental contract is renewed, because we are in a perverse situation where the contract sometimes acts as a disincentive. She made points about over-delivering or under-delivering; people can be penalised, and we can understand why dentists walk away from NHS contracts. This Government are focused on addressing that.
Lia Nici (Great Grimsby) (Con)
In my short time as a Member of Parliament for greater Lincolnshire, in Great Grimsby, I have been able to solve lots of constituents’ problems, but the one I have not been able to solve is dental care. A large dental practice went bust and I seem to be involved in some sort of dark art when I ask what is happening with those patients. Nothing has happened, nearly two years down the line. Will the Minister consider them as well, because I have constituents in terrible situations and I am unable to get anywhere to solve this?
Maria Caulfield
I am happy to meet my hon. Friend to discuss that issue with her. She represents a coastal constituency, and this emphasises the point about where there seem to be gaps in provision.
I am pleased that we are being able to take specific action, both nationally and locally, to improve recruitment and retention, because that is key. This includes widening access to dental careers and utilising the skill mix in dental practices. It is not always the dentists who need to be used and we need to upskill some of the dental workers in dentistry too, so that we can understand the oral health needs of patients in specific communities. As part of that work, Health Education England is looking to address regional shortages by ensuring that training place numbers are better aligned with the needs of local populations and that we are targeting provision. I take the point made by my hon. Friend the Member for Sleaford and North Hykeham about a dental school and I will look at that suggestion. She rightly says that students tend to stay where they train, and we need to look at where the gaps are. The number of dental school places is increasing and we are getting more students through, but I will look at her suggestion.
I feel that I have not specifically addressed the situation in Lincolnshire as a whole, which is the subject of the debate, so let me reassure my hon. Friend that a number of measures are in place to address the issues there. We have introduced additional face-to-face weekend dental sessions from August this year through to March next year; there are dedicated urgent dental slots for 111 patients; and we are trying to address some specific local gaps in Mablethorpe by commissioning urgent NHS dental care sessions on a temporary basis. We also want to improve recruitment and retention specifically in my hon. Friend’s area. Health Education England is working in Lincolnshire to recruit newly trained dentists but should perhaps look at a dental school to support that effort even further.
My hon. Friend raised orthodontic issues, which are very important for young people’s health. NHS England Midlands and East has begun a procurement exercise to address some of the backlog. Patients with a clinical need to start treatment quickly will be contacted. I reassure the House that any patient who was referred before they turned 18 but has not yet started treatment will still get free treatment, even after their 18th birthday, because the backlogs are not their fault.
I know that I have not answered all my hon. Friend’s questions, but I hope she knows that we take this issue extremely seriously. The provision of dentistry is a complex policy area for which there is no quick solution, so I shall not make promises tonight that we cannot deliver, but we are serious about trying to address the issues. I hope I have been able to provide some reassurance that, although this issue is challenging, as the new Minister responsible for dentistry I am committed to playing my part in not only supporting the covid recovery but driving forward long-term improvements. We want to see a contract that is attractive for professionals and that ensures equality of access for all, across rural regions and coastal regions.
Dr Caroline Johnson
Before the Minister sits down, may I ask her to meet me later this week, or perhaps next week, to discuss further the impact on military personnel in particular?
Maria Caulfield
Yes, absolutely. I have not been able to address that in my speech but I am keen to meet my hon. Friend and other colleagues who have particular shortages in their areas. I want to hear what is happening on the ground and make sure, as we go forward, that the problems are addressed and we start to see improvements. I would be happy to meet my hon. Friend and other colleagues.
Question put and agreed to.
Oral Answers to Questions
Maria Caulfield Excerpts(3 years, 1 month ago)
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Simon Fell (Barrow and Furness) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank my hon. Friend for raising a question on this rare but important condition. Public Health England’s national disease registration service contributed data to a European Dandy-Walker syndrome epidemiology study back in 2019. The results identified that the condition occurs in about 2.7 live births per 100,000. More work is currently being done to report on the number of people living with the condition in the United Kingdom.
Simon Fell
I thank my hon. Friend for doing the research on this question. One of my constituents, Steven Forster, came to see me during a surgery last summer. His granddaughter, Mia, is suffering with Dandy-Walker syndrome. As there is not the knowledge in the NHS about how best to treat the condition, like many families, when they do eventually find a doctor who has that knowledge, they have to travel a long way to see them and there is a huge cost attached to that. With that in mind, will my hon. Friend agree to meet some of the families across the UK who are trying to get together a support group on the issue, and consider putting together an NHS centre of excellence so that parents and carers know where to go for help?
Maria Caulfield
I thank my hon. Friend for raising his constituent’s granddaughter Mia’s case. With over 7,000 rare conditions, awareness among healthcare professionals can be difficult. That is why in January this year the Government set up the UK Rare Diseases Framework whereby officials are working with partners including Health Education England to raise awareness of rare conditions such as Dandy-Walker so that we provide training for staff and target education for healthcare professionals. I would be happy to meet him and his constituent to talk about this and listen to some of their concerns and experiences.
Damian Green (Ashford) (Con)
Sarah Olney (Richmond Park) (LD)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
The Department’s consultation on aligning the age for free prescriptions with the state pension age closed on 3 September. The responses to the consultation are being reviewed, and we will outline the next steps in due course.
Sarah Olney
We know that low incomes are associated with worse healthcare outcomes and also that average prescription use is higher among those in more deprived areas. Will the Minister accept that increasing healthcare costs for those on low incomes will mean that health inequalities will widen, increasing the pressure on low-income families and the NHS this winter?
Maria Caulfield
I thank the hon. Lady for her question. I reassure her that around 90% of prescription items in the community are provided free of charge. Those who are vulnerable and on low incomes, such as those on universal credit, income support and jobseeker’s allowance, already qualify for free prescriptions. It is really important that those over the threshold can also apply for the prescription prepayment certificate, where all their items will cost just about £2 a week. We are making sure that costs are low for those on low incomes.
Martyn Day (Linlithgow and East Falkirk) (SNP)
Record levels of funding by the Scottish Government for primary care will protect free eye examinations and free prescriptions for people in Scotland and will also enable the abolition of all NHS dentistry charges. Will the Minister follow Scotland’s lead and commit to a similar policy for England?
Maria Caulfield
I thank the hon. Gentleman for his question. Although the Scottish Government provide free prescriptions, the money comes out of existing budgets, which means it is taken from elsewhere in the health service. That may be why, at the moment, three health boards in Scotland need the armed forces’ support to deal with their winter crisis.
Sir Edward Leigh (Gainsborough) (Con)
Damian Green (Ashford) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank my right hon. Friend and I share his concerns completely. Just to reassure him, NHS England provided £1.6 million to East Kent Hospitals University NHS Foundation Trust to fund an additional 38 midwives, with 26 already in post. I would be happy to keep updated with him to see what the clinical experience is on the ground.
Ian Lavery (Wansbeck) (Lab)
Baby Loss Awareness Week
Maria Caulfield Excerpts(3 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank all Members of the House who have taken part in the debate this afternoon. The shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), is right to say that this is an issue that unites us all and puts politics aside. The loss of a baby is never easy to discuss, whether it is the loss of your own baby or a baby known to you, or the experience of a constituent, it is a hugely emotional and sensitive area, and time is often not the great healer it is made out to be. This debate has raised some difficult but important issues.
I also thank the co-chairs of the all-party parliamentary group on baby loss: my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), who spoke extremely bravely about her experience of losing baby Lily; and my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who also helped to secure this debate. The response and strength of feeling shows how many lives have been affected and touched by this issue. There have been so many moving contributions, and I cannot name them all, but they included those from the hon. Member for Pontypridd (Alex Davies-Jones), my hon. Friend the Member for Bracknell (James Sunderland) and the hon. Member for North Ayrshire and Arran (Patricia Gibson), who talked about baby Kenneth.
This is the sixth year that a debate has been held to mark Baby Loss Awareness Week, and I am honoured to take part as the new Minister for primary care and patient safety and to work with all hon. and right hon. Members across the House to make a difference in an area as vital and important as maternal and neonatal safety. It is perhaps fitting that the debate is happening so soon after I have taken on this role, as it has sharply focused my mind on the huge amount of work there is to do in improving the outcomes for families and babies.
The Government’s maternity ambition is to halve the 2010 rates of stillbirth, neonatal and maternal deaths and brain injuries in babies occurring during or soon after birth by 2025. The ambition also includes reducing the rate of pre-term births from 8% to 6%, and we are making progress on that. Since 2010, there has been a reduction of 25% in stillbirth rates and a 29% reduction in neonatal mortality rates for babies born after 24 weeks gestation. There is, however, progress to be made on reducing maternal mortality rates, brain injury rates and pre-term birth rates, because progress has been slower than any of us would have hoped. There are pilot schemes in place, however, including those introduced under the brain injury reduction programme, which saw £9.4 million-worth of investment during the spending review last year going towards reducing the incidence of birth-related brain injuries. The pilots will produce cutting-edge training and expert guidance, and I hope to report back to the House on their impact.
My hon. Friend the Member for Truro and Falmouth raised some incredibly important points, and I want to touch on a few of them. Financial investment can of course make a difference in improving maternity services. NHS England announced earlier this year an additional £95 million of recurrent funding for maternity services to support the recruitment of 1,200 midwives and 100 consultant obstetricians and the implementation of the actions arising from the Ockenden report. NHS England and NHS Improvement are also providing an additional £52 million to fast-track a long-term plan commitment for all women to be able to access their maternity notes and information via a smartphone or other device by 2024.
Money is not the only solution, however. One key way to improve outcomes is to look at what has gone wrong in the past, and the perinatal mortality review tool is important in that regard. The Health Departments in England, Wales and Scotland collectively fund the perinatal mortality review tool so that the deaths of all babies between 22 weeks gestation and four weeks old are reviewed to provide answers to bereaved parents about how their baby died and so that the NHS can learn lessons and improve care. All bereaved parents now have the option to be involved in a high-quality review of the death of their baby and, according to the last perinatal mortality review tool annual report last year, 84% of review cases in England, 86% of cases in Wales and 87% of cases in Scotland included parents in their final reports. It is by learning from parents and listening to their concerns that we will ultimately improve services for families and save lives.
The shadow Minister and my hon. Friend the Member for Truro and Falmouth raised the issue of tackling inequalities in perinatal outcomes for women from black, Asian and other minority ethnic groups. There are huge disparities in outcome across different communities. Earlier this month, NHS England and NHS Improvement published an equity and equality strategy, supported by a £6.8 million investment, to address the causes of inequalities in health outcomes, experience and access. It provides guidance for local maternity systems and focuses on black, Asian and minority ethnic groups, who currently experience poor maternal health outcomes. This is a priority area for me, and I take the point raised by my hon. Friend the Member for Truro and Falmouth about the importance of continuity of care.
In helping to support bereaved families following the tragic loss of a baby, I am delighted to hear that we have now reached the milestone of every NHS trust in England having expressed an interest with Sands in joining the national bereavement care pathway programme, and 65% of trusts are now members. We will continue to take a cross-Government approach to assessing what more needs to be done to support bereaved families.
I will discuss with my ministerial colleagues the point raised by the hon. Member for Lanark and Hamilton East (Angela Crawley), in particular, on leave for those who have experienced a miscarriage before 24 weeks.
Important points have been made about mandating a pathway and funding to ensure that every hospital has an appropriate bereavement suite and specialist staff and training. I will feed back to the House on our progress on that, as I recognise that we need to move swiftly.
My hon. Friend the Member for Truro and Falmouth, like many other hon. Members, commented on mental health support for bereaved fathers, parents, families and siblings. We heard from my right hon. Friend the Member for South West Surrey about the impact that the loss of baby Sarah had on his whole family. Losing a baby can have a massive impact on the whole family, and this Government are committed to expanding and transforming mental health services in England so that people, including those affected by the loss of a baby, get the help and support they need. My hon. Friend the Member for Guildford (Angela Richardson) could not have been more eloquent about the experience of not getting it right.
We have a long-term commitment that a further 24,000 women will be able to access specialist perinatal mental healthcare by 2023, building on the additional 30,000 women who can access such services this year.
Dame Andrea Leadsom
Does my hon. Friend agree that, along with all the things she is talking about, we need a joined-up set of start of life services, such as the Government are already working so hard to implement in their “Best start for life” work? If we could provide continuity of care and wraparound support for families, so many of the health disparities and terrible outcomes would be avoided.
Maria Caulfield
My right hon. Friend is right that there has to be a whole family, cross-departmental approach, which I hope we can take forward.
The partners of expectant new mothers also face the stigma that many hon. Members have mentioned this afternoon, and I hope we can improve the situation by offering a range of help, such as peer support, behavioural couples therapy sessions and other family and parental interventions. I will focus on that.
This year, unlike in our previous debates on Baby Loss Awareness Week, we have to consider covid. This year, more than most, has been particularly difficult for those facing the loss of a baby. The covid pandemic means measures have been put in place to protect healthcare workers, patients and the general public, and it has been particularly difficult for those who have suffered baby loss during this period.
Specifically on preventing maternal death and morbidity due to covid, recent findings from a national perinatal study show that of 742 women admitted to hospital since vaccination data has been collected, four had received a single vaccine dose and none had received both doses. This means that more than 99% of pregnant women admitted to hospital with symptomatic covid-19 are unvaccinated, and one message I want to get across today is that it is hugely important that mothers and their families are vaccinated to improve their safety.
Sarah Owen
We have been pushing the Joint Committee on Vaccination and Immunisation to make sure that pregnant women are a priority group. Will the Minister give a commitment today that pregnant women will be a priority group in any booster programme?
Maria Caulfield
I take the hon. Lady’s point. There was a lot of misinformation earlier in the year that made pregnant women reluctant to come forward, and there is a lot of work we can do to improve that communication.
Jess Phillips (Birmingham, Yardley) (Lab)
I wish to raise a specific point about covid that I learned of from an obstetric consultant: the number of preemie births dramatically dropped during covid because women were at home. It was a doctor from Reading who told me this. He had to be dispatched somewhere else in the NHS because his services in dealing with premature babies were no longer needed as the number had dropped so greatly because women were at home. Will that form part of the strategy, to make sure that in terms of baby loss we are looking after women throughout their pregnancies?
Maria Caulfield
The hon. Lady makes an excellent point. We need to be guided by clinical evidence and practice, and we will look back and reflect on some of the lessons that can be learned from the period of covid.
Many hon. Members mentioned the staff who look after women and families who have lost a baby. It is incredibly important that we support those staff, because the impact is huge. May I put on the record my thanks to every one of those maternity staff who look after women and families, because the toll on them is sometimes greatly underestimated? It is assumed that because they go into that speciality they can cope with this, but it is extremely difficult for them. Like my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken), may I too welcome Jane Scott and her colleague, one of the midwives from St Mary’s Hospital, who have set up the UK National Bereavement Midwife Forum? I would be delighted to visit them and learn from their experience, because we are committed to supporting staff and making sure that they are able to undertake the special work that they do.
In conclusion, there are multiple and complex issues associated with baby loss and we need to do more not only to support families through such a difficult experience, but to reduce the numbers of people experiencing baby loss in the first place. Crucially, as I said in my opening remarks, we have made some good progress on our national maternity safety plans. We have seen a 25% reduction in the stillbirth rate since 2010 and a 29% reduction in the neonatal mortality rate for babies over 24 weeks’ gestation. That means hundreds more mothers and families are going home with a live and healthy baby each year, but, as this debate has ably demonstrated, there is still much more to be done. I hope to return to the Chamber next year during Baby Loss Awareness Week to be able to show the further progress we have made on this important issue.