Acute and Community Health

Michelle Donelan Excerpts

Thursday 8th February 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend is right: although 37 trusts have gone into special measures, a significant number have not just moved out of special measures, but moved from “room for improvement” to “good”. That is relevant to a much wider challenge in the NHS, whether it involves procurement, workforce planning, or mentoring for junior doctors. I met the family of a junior doctor last week to discuss mentoring and support, particularly for those in their first year out of medical college. Trusts have shown leadership on a number of issues, and I think that the special measures regime has shown the scope to spread that best practice much more widely across the system.

[Michelle Donelan (Chippenham) (Con)]

I agree with the Minister that it is vital for us to expose and tackle failings in the NHS, especially when they put people at risk of harm. Does he agree with me that this case highlights the fact that money is not always the only answer? Effective leadership and responsible management are also important.

[Stephen Barclay]

My hon. Friend is right. I think that at the heart of Dr Kirkup’s findings was the conclusion that what drove these events was not money—and he made that point specifically in relation to the finance for the initial services—but the desire to seek foundation trust status, which led to a wholly unrealistic cost improvement plan and an unwillingness to address the issues that arose as a consequence.

Oral Answers to Questions

Michelle Donelan Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

I have a great deal of respect for the hon. Gentleman, but that is not the first time that he has presented a somewhat incomplete picture of what is actually happening. In the last five years, we have 15,700 more nurses, and the reason for those vacancies and for the pressure is that, as he knows very well, under the last Labour Government we had Mid Staffs, which was a crisis of short staffing that this Government are putting right. That is why we want to recruit those extra nurses.

[Michelle Donelan (Chippenham) (Con)]

5. What steps he is taking to improve mental health provision for children and young people.

[Edward Argar (Charnwood) (Con)]

8. What steps he is taking to improve mental health provision for children and young people.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

This week is Children’s Mental Health Week, and still too many children and young people wait too long for their mental health provision in the NHS. That is why, by the end of next year, we will have invested an extra £1.4 billion, meaning that 70,000 extra children and young people are seen every year.

[Michelle Donelan]

A constituent’s 14-year-old son suffers severe obsessive compulsive disorder, resulting in self-harm. Treatment options have failed and his doctor recommends an intensive residential programme, but as Ministers are aware, places are very limited. He has been waiting seven weeks and counting, with 24-hour parental support and supervision. What more can be done to ensure that that boy and other adolescents who are in desperate need of help get that help before it is too late?

[Mr Hunt]

I thank my hon. Friend for raising that issue, and I understand that in that particular case clinicians are meeting this week to resolve those issues. She is right: we need to expand the number of beds available for children and young people. They are at a record level—1,440, and that went up by another 81 last year—but more needs to be done, which is why we published our children and young people’s mental health Green Paper.

NHS Winter Crisis

Michelle Donelan Excerpts

Monday 5th February 2018 Commons Chamber

[Stephen Barclay]

I thank the hon. Gentleman for his more mature approach, in recognising the huge amount of work performed by NHS staff. Indeed, as I pointed out, 1,200 more people a day are being treated in A&E, which reflects how much more is being done in our NHS with more resource, more money, more doctors, more nurses and more paramedics.

In terms of the specifics on money, the Government have given £1.6 billion to support performance improvements, which will be used to treat a quarter of a million more patients in 2018-19. The NHS planning guidance also shows that it expects performance to improve in the face of growing demand. That shows how more is being done, and more needs to be done.

[Michelle Donelan (Chippenham) (Con)]

All over the world, every winter sees a spike in illness and pressures on healthcare. Does the Minister agree that this Government have been proactive? In fact, for the first time ever, care home staff can receive vaccinations for free.

[Stephen Barclay]

My hon. Friend is right to highlight the importance of vaccinations. This year we have seen 1 million more vaccinations than last year, which is part of addressing the demand on A&E. The number of 111 calls dealt with by clinicians has more than doubled, which has mitigated much of the demand from the flu virus.

Tobacco Control Plan

Michelle Donelan Excerpts

Thursday 19th October 2017 Commons Chamber

[Michelle Donelan (Chippenham) (Con)]

I am delighted to have the opportunity to speak in today’s debate on the Government’s tobacco control plan, which was unveiled in July 2017 and is supported by the British Heart Foundation. It is a co-ordinated effort to bring together the NHS, the Department of Health and local government to tackle smoking.

Although smoking in the UK is declining, the problem should not be underestimated. There are still 7.3 million adult smokers in the UK, and more than 200 smoking-related deaths a day in England, which costs the NHS millions every year. I welcome the plan and the £16 billion that has been ring-fenced by the Government for local public health services until 2021.

Those who use a local stop-smoking service are four times more likely to quit. The figures are astonishing. As the daughter of a smoker of more than 20 years, I have seen at first hand the journey that needs to be replicated to achieve the goal of a “smoke-free generation”.

The success of the 2011 to 2015 tobacco control plan reduced adult smoking rates from just over 20% to just over 15%. The aim now is to reduce rates to 12% and lower by 2022. That is not only right, but essential. We must work to save the 79,000 preventable deaths in England per year and the £11 billion that smoking is costing the economy.

Smoking is not a necessity. A cigarette is not a fashion accessory; it is the way towards lung and mouth cancer, strokes and heart disease and a host of other ailments and illnesses that kill. Let me be clear: I believe in choice and individual freedom, but I also believe that the Government have a role not only to guide, but to signpost and to promote the choices that will lead to healthier lifestyles. That is why I am so proud that the Government are prioritising the issue of smoking.

Some people have said to me: “Michelle if people want to smoke, let them.” I respond by saying that we must arm those people with all the information—the warnings and the facts. We must work together to deglamorise smoking. As has been pointed out, the smoking industry also has a responsibility to play its part. We must guide people and steer them to make informed choices. We must also discourage them, otherwise we will have to pay their NHS bills—money that could be spent in other sectors of the NHS. I often ask people, “If smoking were invented today and we knew all the risks and effects, would it be so freely available and popular?” Armed with the facts, we often make different choices in life.

My mother started smoking in an era when the health consequences were not known. I saw her struggle, desperately trying to give up. My Dad describes that time as a caricature, with my mother wearing anti-smoking patches and smoking cigarettes, while chewing anti-smoking gum and seeing a hypnotist, all at the same time. She simply tried everything. All the hypnotist did was to get her on to menthol cigarettes and give her a fear of hypnotists, so that did not go quite to plan. That taught me that, to break the cycle, it needs to be killed at the root, and people need to be prevented from smoking in the first place. I must add that my Mum has now not smoked a cigarette for seven years. [Hon. Members: “Hear, hear.”] Instead, she has e-cigarettes. Although that cannot be seen as the answer, it is very much part of the solution.

As part of the tobacco control plan, I want to touch on the support provided for pregnant workers, which aims significantly to reduce the likelihood of a person smoking while having a child. Currently, more than 10% of pregnant women smoke, and the plan is to get it down to 6%. Smoking during pregnancy increases the risk of stillbirth. Babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. It is important that we give those mothers all the support and information available. For example, within the plan, NHS England will work to reduce smoking in pregnancy through carbon monoxide testing at antenatal care facilities and referrals to stop smoking services through the Saving Babies’ Lives care bundle.

Support, advice and information are crucial. We must make sure that all mothers are aware of the dangers of smoking. I urge us to be bold—bold with our information and bold with our warnings.

[Alex Cunningham]

Information is key to this matter as well. ASH has told me that the Government no longer have the measure of the number of people with mental health conditions who smoke. Does the hon. Lady agree that the Government need to re-establish a national measure for smoking rates among people with mental health conditions, as that will aid planning and the provision of services?

--- Later in debate ---

[Michelle Donelan]

Indeed, we have problems among many categories in the country. By 2018, the target is to ensure that all mental health facilities are smoke free. We need to identify why people with mental health problems are turning to smoking and then target those issues.

I urge us to be bold with our information and warnings. We should not be afraid to shock in our marketing material, because we in this House have a duty to those who have yet to have a voice and the ability to choose for themselves.



As I mentioned before, perhaps the section of the plan that will prove the most successful is the backing of evidence-based research into e-cigarettes. As the right hon. Member for Rother Valley (Sir Kevin Barron) said, it is the first plan to reference e-cigarettes. In 2016, it was estimated that 2 million people had used e-cigarettes and completely stopped smoking, while a further 470,000 were using them as an aid to quit.

There has been a great deal of discussion on e-cigarettes—the pros and the cons—so what is needed now is more evidence to support them and enable their use positively. They are not risk free and they are addictive—it would be wrong not to mention that—but I agree with Public Health England, which recommends that e-cigarettes are used in areas not covered by the smoke-free legislation and that organisations do not include them in their smoking policies. It is true that we do not know the full extent of the medical effects, but we do know that, for the majority of people, they are the only way to stop smoking and they are by far a better alternative.

In addition, statistics show that people rarely start on e-cigarettes. They use them as a way of breaking their cigarette addictions. It is important to remember that, to tackle smoking effectively, we need a prevention strategy as well as a strategy to help people quit smoking. Dr Andy McEwen, executive director of the National Centre for Smoking Cessation and Training, stated that switching from tobacco to e-cigarettes substantially reduces the major health risk. I urge the Minister to push the case for a review by the National Institute for Health and Care Excellence, which currently is at odds with Public Health England on this topic.

As I said, we have seen many worried headlines about e-cigarettes, particularly for young people. However, the latest and largest study, based on five separate surveys, gathered data from 2015 to 2017 and was from a collaboration including experts from Public Health England. It showed that a tenth to a fifth of 11 to 16-year-olds had tried an e-cigarette. However, only 3% or fewer used them regularly, and they were already smoking tobacco-based products. Among young people who have never smoked, the use of e-cigarettes was completely negligible, despite the media headlines. It is also important to remember that they are restricted in terms of the minimum age sale and the tight restriction on marketing. Let us be clear: the best thing that a smoker can do is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco.

Another area that I want to mention is inequality in smoking. By 2022, the Government expect to reduce the inequality gap in smoking prevalence between those in lower paid or manual occupations and those in higher paid or professional occupations. For example, the plan includes promoting links to “stop smoking” services across health and care systems in the UK. However, it is important that we look at the causes, not just the symptoms, when we examine why those in lower economic circumstances smoke more, and why they struggle more to quit. That is why support to councils is so vital, so that they can identify local trends and solutions. I would be interested to hear more about the Government’s plans to invest in research into the causes. We do need to pay more attention to the challenges that are faced by the disadvantaged and those from lower socio-economic groups.

As someone who believes in low tax in general, it would be remiss of me not to point out that on this subject I passionately argue that we should maintain a high duty rate for tobacco products. It is a disincentive for people to start smoking, especially the young, and I urge the Government to go further in the upcoming Budget. Of course, enforcement is nothing without encouragement to give up. So, to conclude, I echo the sentiments that tackling smoking requires a plan—a plan that seeks to prevent smoking, but also assists those who currently want to give up smoking. This plan does that. Treating smoking-related illnesses is estimated to cost the NHS £2.5 billion a year, while the wider cost to society is a staggering £12.7 billion. But the real cost is the human lives—those that are cut short, and the families that suffer: families in Wiltshire, in my constituency, and up and down the country. I am delighted that in Wiltshire there are now 25% fewer hospital deaths from smoking-related illnesses, but that is still too many, and that is why creating a smoke-free generation is essential.

Baby Loss Awareness Week

Michelle Donelan Excerpts

Tuesday 10th October 2017 Commons Chamber

[Michelle Donelan (Chippenham) (Con)]

I feel extremely humbled to be able to speak in the debate. Let me start by paying tribute to my hon. Friends the Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach) and for Banbury (Victoria Prentis), as well as all members of the all-party group. They have shone a much-needed light on the issue of baby loss, its effect on parents, and the need for action. They have not only pushed for change, but helped to achieve it. On behalf of everyone who has ever suffered, I take this opportunity to say thank you.

We must also pay tribute to the medical professionals who work day in, day out to prevent baby loss and deal with it, and to organisations such as the Royal College of Obstetricians and Gynaecologists, as well as charities such as Sands. They play an important role in developing programmes and reviewing the care provided for expectant and bereaved parents.

Baby loss is not a regional or even a national problem, but an international one. It affects people in all our constituencies, and hurts and devastates families in Wiltshire and throughout the country. It has touched my own family. My grandma experienced the loss of her first-born in 1948 when the child was breached. Tragically, the ambulance reached her too late. The months after that were probably the hardest that she experienced in her life, and I heard about them when I was growing up. Like other women in the same situation, she struggled with the ordeal of having carried the baby and prepared for its birth, only to lose that child as soon as it arrived. Devastated and receiving no help, my grandmother suffered a period of depression.

That is the story of the strongest, most no-nonsense woman I have ever met in my life. She was a woman full of grit and strength, yet she had no help in her time of need, and even the strongest among us do need help. My grandma is long passed and now in heaven, but I think that she would want me to share her story, and to ask the question: why, after so many, many years, are the rates of baby loss still so high? The most recent review of stillbirths and neonatal deaths in the UK reports that of 782,720 births in 2015, 3,032 were stillbirths and 1,360 were neonatal deaths. Yes, there has been a reduction since 2013, but the number remains higher than those in comparable European countries.

I am proud that the Government have taken action to address maternity care and set an ambitious target, which I think is bold and moral, to halve stillbirth rates by 2030. Now we must all work together to ensure that we meet that target by keeping the subject on the agenda. I hope that debates such as today’s will help to serve that purpose so that 69 years from now, when another MP is standing here, they are not saying the same thing.

I think that my grandmother would also ask why, 69 years on, we have failed to improve our bereavement care to a satisfactory and appropriate level. Bereavement care, as has been pointed out, is the focus of this year’s Baby Loss Awareness Week. Bereavement care is vital, both for psychological and emotional support, and for advice and signposting. Since 2010 we have invested £35 million in the NHS to improve birthing environments, including better bereavement rooms in 40 hospitals. We need that for every hospital and facility. The current guidelines vary far too much between setting and service. In addition, most of the frameworks are guidelines, and they are not mandatory, or indeed monitored, in all areas. That is why the Government’s work to create a national bereavement care pathway is so important. That will reduce the variation in the quality of bereavement care provided by the NHS so that residents in Wiltshire get the same care as those in, say, London or Manchester. That is essential.

One can only imagine how harrowing and devastating the loss of a baby must be. I think that the courage that Members have displayed by sharing their experiences in this House is remarkable. Bereavement care must be of a high quality, consistent, individualised and available across the UK. It is time that we achieved that so that, as I have said already, we do not look back in 69 years’ time and again ask why we are not doing more for those in need.

It is estimated that today about 15 babies in the UK will die before, during or shortly after birth. Today let us not only remember those who have suffered and the babies they have lost, but pledge to work together, across parties, to support the Government’s work and ensure that nobody faces a postcode lottery when it comes to baby loss. We need to determine what should be the level of bereavement support and ensure that it is consistent across the country so that parents receive what they deserve if they tragically lose a child.