Maternal Mental Health

Nadine Dorries Excerpts

Wednesday 10th March 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I thank the hon. Member for Richmond Park (Sarah Olney) for bringing forward this important debate. We have had a number of debates about maternal health over the past year, but this is particularly important, given the timing.

Pregnancy and motherhood are a period of great change for everyone. It has been particularly difficult for new mothers during the past year, while they have been in the middle of lockdown. I want to pick up a couple of points that the hon. Lady made. She cited a case study, which I cannot respond to because it is from Scotland, and, as she knows, health is a devolved matter. She asked about the number of midwives that we have, and that was mentioned by a number of Members. There has been an increase of 14.6% in full-time equivalent midwives in trusts and clinical commissioning groups over the past 10 years.

Let me answer a few quick questions that came up. My right hon. Friend the Member for Basingstoke (Mrs Miller) brought up workplaces. We need a call for evidence to gather the data that we need about what is happening to women in the workplace, both when they are pregnant and to do with their health. On Monday, I mentioned issues such as endometriosis, menopause and the musculoskeletal issues that women suffer from more than men. We need data about all that, which is why we made the call for evidence, and I do so again. It is very easy to click on the link and for women to let us know what is happening to them in terms of their health, both in the workplace and in healthcare settings. The number of respondents was in the thousands within a few hours of it going live, and we hope that it will give us the data we need to develop policies for the workplace.

My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) mentioned my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom), whom I spoke to last week. We await with great excitement the early years review. It started at the first 1,001 days. This has been my right hon. Friend’s life’s work. I have known her since she first came here as an MP and before, and this is something that she is absolutely passionate about and committed to. The cross-party review will be illuminating, and we are excited to see it launched, which I think will be later this year.

Although the perinatal period can be a time of celebration and joy, for some it can be a time of considerable anxiety and worry. Indeed, like the hon. Member for Lewisham West and Penge (Ellie Reeves), when I became a mother for the first time I was actually alone, because when my baby was 14 days old my husband had to go and work abroad for six months. So I was completely alone, and I absolutely remember waking up in the middle of the night, having nobody with me and being entirely alone trying to breastfeed a baby, totally struggling and not being able to do it. So I remember how hard it is.

Actually, I think I am allowed to say that I am about to become a grandmother for the first time, and I really hope that I can be there for my daughter. I hope that we are over this pandemic and out of it by the time that my daughter gives birth, so that I can be there for her, to help her through what will be difficult times, because every new mother feels that difficulty.

I would like every new mother to know that support is there. Increasingly—indeed, at a rate of knots—we are expanding services, and there is no shame in seeking help, including through the pandemic. Specialist and in-patient perinatal mental health services have remained open during lockdown. There have been restrictions, but services have been providing digital and remote support. For those with severe needs or those who are in crisis, perinatal or otherwise, all mental health trusts have set up new 24/7 crisis helplines—I remember the call on 4 April last year when we decided that we would do this, and those helplines rolled out and were open. I have spoken to the chief executive officers of mental health trusts, and one told me yesterday that the volume of people using those 24/7 helplines has been tremendous. They have been set up and they have been used, including by new mothers.

In the 2020 spending review we also announced up to an additional £500 million for mental health services. That was on top of the £2.3 billion a year that we are investing to address waiting times for mental health services and to give more people the support that they need.

We have also taken action to ensure that mothers can continue to have broader support throughout the perinatal period, both from statutory services and from family support. Health visitors, who are ideally placed to support families, and the health visiting service continue to provide an opportunity to identify families who may need support. The health visiting service has remained in contact with families throughout the pandemic and it will continue to do so and to prioritise very young babies and vulnerable families.

Recognising the support that a father or the mother’s partner can bring, we published guidance in September to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services. We also launched a campaign to ensure that people continue to access services and get support early.

We have continued to deliver on the ambitions for maternity and mental health services that we had before the pandemic, to ensure that mothers get help earlier. From April 2020, we have invested an additional £12 million per year for every mother to be offered a six to eight-week post-natal check by her GP. I think that my hon. Friend the Member for East Worthing and Shoreham campaigned on this for some considerable time. Through the post-natal health check, every mother can now expect to have the opportunity and the time to discuss any concerns that she may have about her physical or mental health and wellbeing.

We remain committed to making perinatal mental health services a priority through the NHS long-term plan. There is now—this point is very important—a specialist community perinatal mental health service in every area of England, and we are further increasing access to perinatal services, so that at least 66,000 women will be able to access perinatal mental health services in 2023-24.

I went to see one of these perinatal services at the beginning of my time in post, 18 months ago; they had just begun to roll out. I have been to see one of these perinatal mental health teams working, and it was just tremendous. The nurses had only been in place and operating for a matter of weeks, but they had already had something like 120 referrals and mums they had seen. That demonstrated the need for such a service and almost endorsed the reasons why they were there, as well as highlighting the services that they were providing to those young mums.

Importantly, we are extending the length of time for which specialist perinatal mental health community services will be available, so those services, which currently run from preconception to 12 months after birth, will be available from preconception to 24 months after birth. We are also developing and implementing maternal mental health services or maternity outreach clinics, which bring together maternity and reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from or related to the maternity experience.

As the hon. Member for Richmond Park can see, we have put a huge amount of work into maternal mental health. She is quite right. I cannot remember who highlighted the fact—it may have been the hon. Member for Tooting (Dr Allin-Khan)—that suicide is still the biggest cause of death in the period from, I think, eight weeks post delivery to 12 months. It is still the biggest cause of maternal death. That is why this issue is so important to us. To reduce the figures and ensure that suicide is not the biggest cause of maternal death, we have to put the services in earlier. We need to ensure that both at an antenatal stage and at the time of the check with a qualified GP at six to eight weeks, those perinatal mental health services, which are now available in every area of the country, are in place. We have done that through the funding that there has been from the £2.3 billion that has been allocated to the long-term plan.

Many mothers who experience mental health problems in the perinatal period are treated in the community, but a very small number will need hospital admission for their mental health, as the hon. Member for Richmond Park will know. It is right that, where possible, we keep mother and child together. That is why—this is also an announcement; a fact that I am proud of—NHS England has expanded the capacity of mother and baby units in England, with additional four to eight-bed units now providing specialist care and support to mothers who are experiencing severe mental health problems during and after pregnancy. I checked just before I came into the room for this debate, and we are now up to 152 beds across England, which represents a tremendous increase in the number of those units. It is so important in those first days to keep mother and baby together as much as possible.

The units support women with serious mental health issues by keeping them together with their babies and with specialist staff who nurture and support the mother-infant relationship on the ward at the same time as the mother is treated for her mental illness. That is a huge step forward from how things used to be not so long ago. Mothers who are at that severe stage of mental illness post delivery can have that treatment in those beds; they can be treated by those specialists. Mother and baby are together, and there are psychiatric services at the same time. That is a huge leap forward.

We recognise that maternal ill health can also have an effect on the child’s father or the partner of the mother. We are therefore also offering partners of women accessing specialist perinatal mental health services and maternal mental health services evidence-based assessments for their mental health and signposting to support as required. In the future, partners of expectant and new mothers who are seriously unwell will be offered a range of help, such as peer support, behavioural couples therapy sessions and other family and parenting interventions.

We are also taking forward work to ensure that all babies and young children in England receive the best start in life. I will come on to the early years review. My right hon. Friends the Secretary of State for Health and Social Care and the Prime Minister jointly commissioned in the summer of 2020 the early years healthy development review. It is important, so I will say this again. The review looks across the first 1,001 critical days. The SNP spokesperson, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), also spoke about the importance of the first 1,001 days, from conception to the age of two. This is about ensuring that babies and young children in England can be given the best start in life. Phase 1 of the review is in its final stages, and the vision for brilliance, setting out policy actions for the Government, will be published shortly.

I hope that my response goes some way to assuring all hon. Members that this Government remain committed to supporting mothers throughout the perinatal stages and up to 24 months after giving birth and ensuring that we can reach out to mothers who may need help coming forward about their mental health.

I would like to end by talking about women’s health more broadly. Pregnancy, childbirth and motherhood are just some of the stages of life that many women can experience. Throughout the course of our lives, the physical milestones, the changes to our bodies and our experience of the world have an impact on our health. I reiterate that we are having our International Women’s Day debate tomorrow, and I hope that the call for evidence will be mentioned, so that we can better understand women’s experiences of the health and care system but also, as I said at the beginning, their experiences of health, including motherhood and maternity, in the workplace. Without that evidence from women, we do not have the data and the information that is necessary in order to adapt and develop policies moving forward.

I will finish by urging all women to share their experiences through the call for evidence. It will form the basis of a new women’s health strategy—the first of its kind. This is the first time any Government have called on women for evidence, so that we can set an ambitious and positive new agenda to improve health and wellbeing and to ensure that health services are meeting the needs of women everywhere, especially in perinatal mental health.

Women’s Health Strategy

Nadine Dorries Excerpts

Monday 8th March 2021 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

With permission, I would like to make a statement about the women’s health strategy. Today is International Women’s Day, and on this important day we must acknowledge that for generations women have lived with a healthcare system that is designed by men, for men. As a result, women have been underrepresented in research. Despite women making up 51% of the population, we still know little about some female-specific issues, and there is less evidence and data on how conditions affect women and men differently. Despite living longer than men, women spend a greater proportion of their lives in ill health and disability, and there are growing geographic inequalities in women’s life expectancy. That makes levelling up women’s health an imperative for us all, so we must meet our goal of extending healthy life expectancy by five years by 2035.

There is already a lot of excellent work under way to achieve that. The Government are working on the next strategy on tackling violence against women and girls, and we have announced plans for a new sexual and reproductive health strategy, led by the Minister responsible for prevention, public health and primary care—my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—which we plan to publish later this year.

Although this focused work is vital, it is also important that we take an end-to-end look at women’s health from adolescence to older age. I am thrilled to inform the House that today we are embarking on the first Government-led national women’s health strategy for England. It will set an ambitious and positive new agenda to improve the health and wellbeing of women across England. As we know, not all women have the same experience, so we want to hear from as many women as possible, from all ages and backgrounds, about what works well and what we need to change as today we launch our call for evidence.

The call for evidence, running until 30 May, seeks to examine women’s experiences of the whole health and care system, including mental health, disabilities and healthy ageing, as well as female-specific issues such as gynaecological conditions, pregnancy and post-natal support, and the menopause. The call for evidence is based around six core themes, which cut across different areas of women’s health, and I would like to set them out briefly in the House.

The first pillar is placing women’s voices at the centre of their health and care. We know that damaging taboos and stigmas remain around many areas of women’s health, which can prevent women from starting conversations about their health or seeking support for healthcare. When women do speak about their health, all too often they are not listened to. As the Minister for patient safety, I regularly hear from and meet people who have been affected by issues of patient safety. As independent reports and inquiries have found, not least the Cumberlege review and the Paterson inquiry, it is often women whom the healthcare system fails to keep safe and fails to listen to, and this has to change.

The second pillar is improving the quality and accessibility of information and education on women’s health. If we are to tackle taboos and ensure that women’s voices are heard, the provision of high-quality information and education is imperative. To give a timely example, March is Endometriosis Awareness Month. Endometriosis is a common condition affecting one in 10 women of reproductive age, yet the average diagnosis time is seven to eight years. It greatly saddens me to hear how so many women think, or worse, are told that the debilitating pain and symptoms that they are experiencing are normal or imagined and that they must live with it. We must ensure that women have access to high-quality information about health concerns. We must also ensure that health and care professionals can access the necessary information to meet the needs of the women they provide care for.

The third pillar is making sure that the health and care system understands and is responsive to women’s health and care needs across their life course. Women have changing health and care needs across their lives, and we know that specific life events, or stages of life, can influence future health. For example, we know that women who have high blood pressure or pre-eclampsia during pregnancy are at greater risk of heart attack and stroke in future. We also know that women can find it difficult to access services that meet their specific needs, or that meet their needs in a convenient place or time, and that there are significant inequalities between different groups of women in terms of access to services, experience of services and health outcomes. For example, women of black ethnicity are four times more likely than white women to die in pregnancy and childbirth. That is why I recently established the maternity inequalities oversight forum to bring together experts to consider and address the inequalities of women and babies from different ethnic backgrounds and socioeconomic groups. There is still more to do, so levelling up women’s health must be a priority for us all.

The fourth pillar is maximising women’s health in the workplace. The pandemic has brought home just how important this is. Some 77% of the NHS workforce and 82% of the social care workforce are women, and throughout the pandemic women have been on the frontline, making sure that people receive the health support and care that they need.

There is some evidence that female-specific health conditions—such as heavy menstrual bleeding, endo-metriosis, pregnancy-related issues and the menopause —can affect women’s workforce participation, productivity and outcomes. There is little evidence on other health conditions and disabilities, although we know that common conditions that can lead to sickness absence—for example, mental health conditions and musculoskeletal conditions—are more prevalent in women. Investment in women’s health in the workplace is therefore essential to women’s ability to reach their full potential and contribute to the communities in which they live, so that is a fundamental pillar of our strategy.

The fifth pillar is ensuring that research, evidence and data support improvements in women’s health. We have a world-class research and development system in the UK, but women—particularly women from ethnic minorities, older women, women of childbearing age, those with disabilities, and LGBT women—have been under-represented in research. This has implications for the health support and care that women receive, their options for and awareness of treatments, and the support that they can access afterwards. We must work to ensure that women and women’s health issues are included in research and data collection and so finally end the data gap that sadly exists. The better the evidence, the better we can understand the health and care needs of women and deliver the change that we need to see.

Our sixth and final pillar is understanding and responding to the impacts of covid-19 on women’s health. This pandemic has taught us so much about our society and our health and care system. As we build back better after this pandemic, we must make sure that we fully understand the impact of covid-19 on women’s health issues and what we can do to take that understanding forward.

The call for evidence is about making women’s voices heard. We want to hear from women from all backgrounds and will be inviting all organisations and researchers with expertise in women’s health to provide written evidence, too. We will respond to the call for evidence after the summer and we aim to publish the strategy later this year. I hope that the strategy will be welcomed across the House.

I thank the Members who have been working with us on this vital agenda. I thank my hon. Friend the Member for Thurrock (Jackie Doyle-Price) for breaking down taboos around women’s health through her advocacy in the House, and my hon. Friend the Member for Gosport (Caroline Dinenage) for her initial work on the strategy. I also thank the Members who lead the all-party parliamentary groups on women’s health, on endometriosis, on sexual and reproductive health and on women and work, and many more. We will keep working with Members in all parties as we take forward this essential work.

This strategy marks a turning point for women in this country. We are making women’s voices heard and putting them at the very centre of their own care, so that we can make sure that our nation’s health system truly works for the whole nation. I commend this statement to the House.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I thank the Minister for the advance copy of the statement. I wish every woman in the House and throughout the country a very happy International Women’s Day.

It is welcome that the Government want to understand the plight of women throughout the country, but although the Minister said that this strategy is the first of its kind, in reality it is not. We heard much that was in this announcement when the Government launched the women’s mental health taskforce in 2017. If the Government took this matter seriously, it would be a first. The Minister responsible for mental health at the time, the hon. Member for Thurrock (Jackie Doyle-Price), said:

“This report is a call to action for all providers, commissioners and practitioners across the health care system to drive forward the ethos of trauma- and gender-informed mental health care.”

That echoes what the Minister just said, so why are the Government asking the exact same questions four years later?

A multitude of health concerns are unique to women and are often overlooked. In hospital, I hold the hands of women in their darkest times: young women and girls presenting with eating disorders; trans women admitted after suicide attempts and substance abuse because they had been made to feel as though they do not belong; and women of colour presenting far too late with conditions that could have been easily treatable if they had found healthcare more accessible. I meet many women victims of domestic violence. They use healthcare services more than non-abused women, so I hope to see the Government’s upcoming violence against women and girls strategy address their needs.

The coronavirus crisis has had a disastrous impact on many women, and I have been honoured to listen to colleagues share their heartbreaking experiences of baby loss. My heart breaks for all those women who have had to go through that alone during the pandemic. What support will be offered to women who experience baby loss without their partners by their side? Within maternity services there are huge inequalities. The Minister is right to highlight the fact that black women are four times more likely to die in pregnancy or childbirth, and I welcome the launch of the forum, but the Government have known about these inequalities for years, so why has there not been action sooner? The Government are running a separate sexual and reproductive health strategy; would it not have made more sense to bring it, as part of that working, into this? A part of this which is widely stigmatised is the menopause. How will the Government be seeking to engage women who have to go through difficulties throughout the menopause?

The “Five Year Forward View for Mental Health” recommended that by 2020-21, in England, 30,000 more women each year would be able

“to access evidence-based specialist mental health care during the perinatal period”

and said that that was important. Can the Minister tell us whether that target has been met? Today, it is huge news that a woman of colour has spoken about her mental health struggles during pregnancy. Many women face difficulties but stay silent, afraid to seek help. With stigma attached to mental illness, the Government must ensure that evidence is collected from all of our ethnically diverse communities.

Women are still being misdiagnosed in 2021. With male bodies being seen as the default body, there is a huge historical data gap in understanding women’s health needs. It is shocking that women are 50% more likely to be misdiagnosed following a heart attack simply because our symptoms differ from those of men. What research will the Government commission to bridge that divide?

Finally, pay is a gendered issue. Women are 82% of the social care workforce and 90% of the nurses. Can the Minister justify the real-terms pay cut to our frontline NHS staff? Will she end poverty wages in social care? We need healthcare to work for every woman across the UK—young and old, white and women of colour, cisgender and transgender. We cannot wait any longer. Women’s health and wellbeing should not be an annual PR exercise. We need action and we need action now.

[Ms Dorries]

I join the hon. Lady in wishing every woman across the world a happy International Women’s Day. She opened by talking about the mental health taskforce and saying it is not the first of its kind, but it absolutely is. It was a five-year project that the NHS used to bring together women and organisations from across the healthcare sector to develop a mental health plan—a five-year view—which it did and reported on. As she knows, partly as a result of that, we now have the long-term plan in mental health.

The hon. Lady also spoke passionately, as she always does, about the patients she meets as part of her work and the women who are suffering from eating disorders—sadly, that has been a tragic cost of covid. We know that two groups have been affected by the past 12 months in the mental health sphere: people, including women, with pre-existing mental illness; and, in particular, young women aged 15 to 26, in whom we have seen an explosion in the number of referrals—I believe the figure is 22% for young women seeking help with eating disorders. We have committed funding during the spending review, when £500 million was announced, and I announced £79 million on Friday. Part of that is going to deal with the problems that we have as a result of the pandemic, and with young women and girls—and in some cases young men—who are suffering from eating disorders.

The hon. Lady talked about the stillbirth and neonatal target of halving the number of stillbirths by 2025. We are way ahead of our target on that. The Office for National Statistics published new data last week, and I believe we are looking towards a 30% figure already. We are way ahead of target, and that is a result of the measures that have been put in place in the maternity safety arena, including the saving babies’ lives care bundle and the early notification scheme.

I reiterate that what we are announcing today is a call for evidence from women everywhere in the UK: from every organisation and every friend, every partner, every family of every woman.[Official Report, 12 March 2021, Vol. 690, c. 5MC.] The link has been published today. I published it on the Government website and it is on the Department of Health and Social Care website and on my Twitter feed. It is a link that women can easily access using their phones or their laptops, and it takes a few minutes to complete. We want to develop the first ever women’s health strategy within the Department of Health and Social Care that will deal with all the issues—there are too many for me to talk about now—and all the ways in which women have been affected. These will include research funding and cohorts of trials not using women, using all the information that we have from Paterson and Cumberlege and from women stating clearly that women are not listened to in the healthcare sector. To address that, we need to hear not just from the Paterson women and the mesh women who spoke to Cumberlege; we need to hear from all women everywhere, and that is why we have launched this call for evidence today, to develop this strategy before the end of the year.

[Caroline Nokes (Romsey and Southampton North) (Con) [V]]

I really welcome this call for evidence and my hon. Friend’s clear commitment to hear from all women everywhere. Can she please reassure me that the consultation will not just be about reproductive health, important though that is, and that it will include all conditions and ensure that women have the ability to express freely what they want to see from their strategy? I welcome the timescale of the strategy coming forward in September.

[Ms Dorries]

My right hon. Friend is a huge champion for women’s rights and a Committee Chair. I would ask her, following the work that was undertaken by the all-party parliamentary group on women’s health, to contact anybody that she knows who can help to get this dealt with or who she has liaised with throughout her time as Chair of the Women and Equalities Committee, so that they can help to get this message out to the people who they know, to encourage women everywhere—and, as I said, not just women but families and anybody who wants to contribute.

Within the first minutes of the link going live this morning, we instantly had 300 responses. I have not checked what the figure is now. We need huge numbers of women and yes, absolutely, it is not just about the usual issues that get talked about, although they are an important part of this. Menopause, menstrual health, maternity and neonatal issues are the things we talk about frequently, but this will be about everything. For example, we know that drugs that are used on women are trialled and developed using all-male cohorts, and that doctors are taught in medical school to recognise symptoms that are taken from men and not applied to women. We know about the inequalities, and we need to know about any subject from disability to mental health; anything that a woman experiences in a healthcare setting, we need to know about it.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP) [V]]

I welcome the Minister’s statement, which is timely on International Women’s Day. I also refer the House to my entry in the Register of Members’ Financial Interests. A gender health gap has arisen during covid-19, and the Scottish Government are also developing a plan to address women’s health inequalities. Research indicates that young women in particular have been found to have increasing anxiety, depression, suicidal ideation and loneliness. With coping strategies and social support diminished, eating disorders are tragically on the rise with high levels of morbidity. Young women disproportionately struggle to be referred for treatment due to an antiquated medical model based on body mass index to identify eating disorders rather than on a psychological model, treating the whole person. Will the Minister work with the all-party group for eating disorders and cross-party parliamentarians who want urgently to address this matter via the funding announced, but also to ensure the timely access to treatments for those crying out for help and a diagnosis, saving the lives of young women, and, in many cases, those of young men, too.

[Ms Dorries]

I thank the hon. Lady for her question. In fact, we met recently to discuss this very subject, and I have also had meetings with a number of Members from across the House who have an interest in this area. I also thank her for the work that she does in this area. I think that, as a result of our private conversations, she understands both my commitment and that of the Government. I know that she is aware of the funding that we have allocated to assist with this surge of eating disorders that have presented of late and of our commitment in the long-term plan to assist young women with both mental health issues and eating disorders in particular. An eating disorder is the most deadly of all mental health illnesses and also one of the most difficult to treat. I am delighted to hear that this issue is being taken seriously in the devolved nations as well and that Scotland is also embarking on a similar path. I hope that, as we do on all issues related to health, we and the devolved nations will share data and the methods of collecting it, experience and the evidence to develop a women’s health strategy, which will one day be rolled out across the UK.[Official Report, 12 March 2021, Vol. 690, c. 5MC.]

[Julie Marson (Hertford and Stortford) (Con) [V]]

I really congratulate my hon. Friend on her statement today, particularly on International Women’s Day. Does she agree that the women’s health strategy, including the detailed pillars that she has outlined, is the first of its kind and will mark a real step change in approach in the way that it centres women, their voices, their lived experiences, and their evidence in making real change to the future of health policy in England?

[Ms Dorries]

I thank my hon. Friend for her encouragement. She is absolutely right. We are very excited about this strategy because it is the first of its kind. That is why we have put quite a tight timeframe on this to keep the momentum going. We will be collating all the information and data before the summer and we will be reporting when we come back after the summer recess. We will then be able to announce our women’s health strategy before the end of this year. I hope that everybody is as excited as I am about women getting involved and giving us their information, telling us what they feel, when we know that their voices are not heard. We have, I believe, provided the platform for women to have their voices heard. I thank my hon. Friend for her remarks and I hope that she will follow this process. I hope that she will download the link, provide evidence herself—I hope that every woman in this House does that—and be there when we announce the women’s health strategy later in the year.

[Dame Diana Johnson (Kingston upon Hull North) (Lab) [V]]

Last year, the all-party group on sexual and reproductive health, which I chair, produced a report called “Women’s Lives, Women’s Rights” on women’s access to contraception. I hope the Minister will shortly meet me to discuss this report, which showed that, over the past 10 years, with cuts to public health budgets and the fragmentation of NHS services, women’s access to contraception has reduced, most strikingly in access to long-acting reversible contraceptives; that Black, Asian and minority ethnic women, in particular, lose out; and that abortion rates have increased. What does the Minister say about how we can put this right and how the separate sexual and reproductive health and HIV strategy running alongside a woman’s health strategy will actually work and ensure that women are at the centre of NHS services?

[Ms Dorries]

The Government are committed to developing a sexual and reproductive health strategy, which we plan to publish in 2021. Development of the sexual and reproductive health strategy will be separate from the women’s health strategy. However, officials are working closely together to ensure coherence between the sexual and reproductive health strategy and the women’s health strategy. We hope that they will not contradict each other; we want them to work closely together. The sexual and reproductive health strategy is an incredibly important piece of work in its own right.

Abortion is not a part of the women’s health strategy because, as everyone in the House knows, abortion is a free vote issue—it is a conscience issue; it is something that Members decide as individuals, not as parties—and therefore it is more appropriate that that goes into a strategy on sexual and reproductive health and contraception than the women’s health strategy. That does not mean that those subjects are off limits when women respond to the call for evidence on the women’s health strategy. Nothing is off limits; women can talk about anything. We have not yet decided what will go into the women’s health strategy, because we want to hear what women have to say and what issues we are contacted about that we can develop in terms of policy. We will be working closely, and officials will be working side by side.

The right hon. Lady also mentioned LARC. Access to SRH services is being maintained during covid-19, with a scaling up of online services. In response to covid, Public Health England launched a national framework for e-sexual and reproductive healthcare, which allows local authorities and service providers to purchase an expanded range of online services, including emergency contraception and the contraceptive pill. Those services have continued during the pandemic.

I congratulate the right hon. Lady on the work that she does in her APPG. I hope that she will inform its members and those she knows who have an interest in women’s health issues to click on the link and provide their evidence to us.

[Siobhan Baillie (Stroud) (Con)]

On International Women’s Day, I would like the House to think about women with complex and multiple needs—addiction, trauma, abuse and eating disorders. Some lives are just too complicated for one service, and some experiences are just too awful for many of us to contemplate. These women can, however, turn their lives around safely with the right support; I think of organisations in my constituency such as the Nelson Trust, which does so much brilliant work. Will my hon. Friend confirm that women with complex and multiple needs will not be forgotten in this strategy?

[Ms Dorries]

I would like to reassure my hon. Friend, and I hope that she will do her utmost to make sure that those women she is aware of are aware of the link and will provide us with their evidence. It is the evidence that we need to develop the women’s health strategy, so we need to hear from exactly the women she is talking about. Complex needs are just that: they are very complex. We need to know about these women’s experiences in the healthcare sector—what acts as a barrier to them, where they think they are not heard, where they think their voices are drowned out and where they feel they are not listened to and do not get the services they should get. I will use endometriosis as an example. It can take women seven to eight years to be diagnosed, all the time being told that they may have a mental health condition, that it is something they have to live with and that that level of pain is normal for a woman to experience, when none of those things is true. We want to hear from those women.

I thank my hon. Friend for her question, which is really important. She is right: many women suffer from a number of complex health issues and have difficult lives. That is why we have made responding so simple, via a link on a phone and taking a few minutes. I really hope that those women hear this call and will respond.

[Wera Hobhouse (Bath) (LD) [V]]

I welcome the Minister’s statement on the women’s health strategy. It has already been mentioned this afternoon but, as the chair of the eating disorder all-party parliamentary group, it needs emphasising again: eating disorders have the highest mortality rate of all mental health disorders. While eating disorders do not discriminate, they affect women disproportionately. The longer they go untreated, the longer and more complicated it is to recover. Will the Minister look at the evidence—there is already plenty of it—showing that we urgently need waiting time targets for adult eating disorder services?

[Ms Dorries]

I thank the hon. Lady for her question; I was waiting for it as I knew she would be contributing today. We have had private conversations about this issue, and I want to reassure her. I hope she noticed that some of the £79 million I announced last week will be going towards dealing with eating disorders and the recent surge in referrals to mental health services. She is right to say that there is lots of evidence, and we are aware of what happens with eating disorders and how they develop, and we work with charities, as she well knows. We would still like those women to respond to this call to evidence.

Many women struggle to get anyone to listen or understand that they have an eating disorder. We struggle to identify them early enough or pick up such things. We still need to gather that evidence, because it is at certain points of contact that healthcare professionals do not recognise or realise that they are dealing with an eating disorder. That is the kind of thing that we think we could get fresh evidence about from women by them clicking on the link and letting us know, either via their phone or their laptop. The hon. Lady has a huge number of contacts, so I urge her to inform them and ask them to contribute to the call for evidence.

[Robbie Moore (Keighley) (Con)]

Keighley has fantastic women’s mental health charities such as Roshni Gar, which provides culturally appropriate responsive services for south Asian women experiencing mental health issues, and Wellbeing Women Talk & Thrive, which does an excellent job. Will my right hon. Friend confirm that the forthcoming women’s health strategy will contain measures to level up access to mental health services for women and girls across England, so that no matter where they come from, they can always access the mental health support that they need?

[Ms Dorries]

Parity between physical health and mental health is a priority in the Department for Health and Social Care. This is about breaking down taboos and stigmas. That is why we have invested £2.3 billion, year on year, into mental health and into the development of a long-term plan. That is why we had another £500 million allocated at the spending review a few weeks ago. That is why we allocated £79 million of that on Friday to dealing with the very issues my hon. Friend has just raised. When we talk about a call for evidence for a women’s health strategy, I hope it is understood that we are talking about both physical health and mental health. I thank my hon. Friend for his question; it is important that such issues are raised as often as possible.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC) [V]]

I, too, welcome the launch of this call for evidence today, on International Women’s Day. The consultation refers to evidence that female-specific health conditions can affect women’s workforce participation. However, the welfare system does not currently provide adequate support for many such conditions. For example, statutory sick pay is available to an employee only for a linked period of sickness for a maximum of three years, which penalises those people—women, of course—with chronic long-term conditions such as endometriosis. Will the Minister commit to the women who come forward with evidence that she will work with the Department for Work and Pensions to resolve those issues?

[Ms Dorries]

I thank the right hon. Lady for her question. If women are giving evidence that substantiates the points that she has just made, we will take it and provide it to the DWP. It is not the case that we would not do anything with that evidence; we absolutely will share it with other Departments.

[Selaine Saxby (North Devon) (Con) [V]]

This is a really positive announcement on International Women’s Day as the women’s health strategy will deliver a much-needed step forward to improve the health and wellbeing of women across the country. Does my hon. Friend share my concern that women’s experience of healthcare can vary across different geographies, and can she confirm that the forthcoming strategy will contain measures to address this?

[Ms Dorries]

I have no idea what the women’s health strategy is going to contain because we have not had the evidence yet. We do not want to decide in advance where we are going to go with it; we are going to wait to hear women’s voices before we do that. However, my hon. Friend is absolutely right. As I mentioned in my statement, there is a geographic disparity in many areas. I think that, as part of the evidence that we receive from women, that will become very apparent. I hope that she will be involved, click on the link herself and direct any women she knows who could be involved to do so.

[Tonia Antoniazzi (Gower) (Lab) [V]]

The pandemic has seen us make dramatic changes in how we live, and the impact of these changes has been especially sharply felt by women. The Institute for Fiscal Studies found that mothers are only able to do, on average, a third of the uninterrupted paid work hours of fathers, so is it any wonder that six out of 10 women are finding it harder to stay positive day to day compared with 47% of men? What are the Government going to do to ensure that there is support available for these women, whose labour is paid and unpaid, and who have been instrumental in getting the country through this pandemic? What will the Minister do?

[Ms Dorries]

That is not strictly a health question but, on the mental health issues that I think the hon. Lady was referring to—the stress and other issues that women are feeling—I hope she will encourage the women she knows to click the link and contribute to the call for evidence.

[Nickie Aiken (Cities of London and Westminster) (Con) [V]]

I thank my hon. Friend for her statement and welcome the launch today, on International Women’s Day, of the Government’s call for evidence to help to form the basis of a new women’s health strategy. Given that an estimated 13 million women in the UK are currently peri-menopausal or menopausal, including this woman, which equates to one third of the entire UK female population, will she assure me that menopause services will be at the heart of the strategy, and will she agree to meet me and a group of women experiencing the menopause to discuss how we can ensure that women are properly supported and do not have to deal with this major, life-changing experience on their own?

[Ms Dorries]

I answer this question as a post-menopausal woman. The online survey within the call for evidence seeks information on the menopause. It explores the menopause across various themes, including listening to women’s voices, access to information on women’s health across the life course and women’s health in the workplace. I encourage stakeholders and women with experience of this area to respond to the call so that we can identify future work. Women often face damaging taboos when starting a conversation about their health. It is really important that we start smashing those taboos here, as we have been doing for a number of years now, and that we talk about the menopause openly. Women can often face unsympathetic and stigmatised responses when speaking about the menopause, particularly in the workplace, which is clearly unacceptable. This Government are committed to breaking down those taboos, supporting women and working women at all stages of their life, and enabling them to reach their potential. This includes, of course, having more open conversations on the menopause, whether that be with healthcare professionals or employers, and assisting women through that stage in their life, so that they can remain full and active contributors during that stage of their life in their chosen careers or workplaces. I urge my hon. Friend to click on the link, to get involved and to make sure that women she knows do the same.

[Carla Lockhart (Upper Bann) (DUP) [V]]

I thank the Minister for outlining that women can discuss anything during this consultation. Can she therefore outline what efforts will be made to reach out and gather evidence from mums such as Rachel Mewes, who said on Twitter that she was pressured to consider having a late-term abortion at seven months pregnant, when she had previously stated repeatedly that she would never terminate for Down’s syndrome? As a result, she now has post-traumatic stress disorder and has said that being forced to imagine someone killing her little girl Betsy nearly destroyed her. Has the Minister considered the devastating impact that this kind of treatment is having on women’s health and wellbeing during pregnancy, and does she agree that disability discrimination in the womb should end?

[Ms Dorries]

I thank the hon. Member for highlighting her constituent’s concerns. Abortion as such will not be part of the women’s health strategy, because it is being discussed under the sexual and reproductive strategy, which is also ongoing, and is a conscience issue in this House. It is not decided on party lines, it is down to individual Members’ votes, so it will not form part of the women’s health strategy, which will be about policy. However, the hon. Member is absolutely right; we will take evidence, we will look at that evidence and, if it comes in via the portal, we will pass it on to the sexual and reproductive strategy. However, there are no taboos and nothing that cannot be discussed. We want to hear about all women’s health issues, and I urge her to urge everybody she knows to click on the link and get involved.

[Dehenna Davison (Bishop Auckland) (Con) [V]]

I am grateful to the Minister for her statement and fully welcome the call for evidence. One area that I have been contacted about is IVF, for which we know there is currently something of a postcode lottery. I was contacted by my constituent Klara Halpin, who was seeking to have a child through IVF but was rejected NHS treatment in County Durham because her partner has children from a past relationship. However, if Klara had lived under a different clinical commissioning group, she would be eligible for that IVF treatment. Will my hon. Friend encourage women undergoing IVF to share their experiences, either to this review or the sexual and reproductive health review, to try to ensure more equalised provision of services right across the country?

[Ms Dorries]

Absolutely, and I thank my hon. Friend for her question and for highlighting that case. I urge her constituent to contact us and share her experiences with us. Fertility clinics across England have remained open throughout the last lockdown. Clinics obviously have to meet robust criteria to assure the Human Fertilisation and Embryology Authority that safe and effective treatment can be offered. I am not sure of the geography that my hon. Friend was talking about, but I am disappointed to hear the difference between two care commissioning group areas and would ask her to ask her constituent to contact us and let us know more details about her experience.

[Mohammad Yasin (Bedford) (Lab) [V]]

In January, Bedford Hospital’s maternity services were downgraded to inadequate due to significant concerns on the part of the Care Quality Commission about staffing levels and insufficient training. Maternity staff are facing extreme burnout during this pandemic. The hospital has taken steps to improve services, but will the Minister tell me what her Government’s plan is to urgently train, recruit and retain more midwives so that all women can receive safe maternity care?

[Ms Dorries]

One of our objectives is to be the safest country in the world in which to give birth, and we have made tremendous progress by halving stillbirths and neonatal deaths. This is an area in which we are making huge progress, and I would ask the hon. Member to ask those with whom he is discussing these issues to respond to today’s call for evidence.

[Mary Robinson (Cheadle) (Con) [V]]

I congratulate my hon. Friend on her continued work ensuring that women have equal healthcare outcomes and experiences, and I look forward to taking part in this call for evidence. Consultations are most valuable when there is significant participation, allowing us to gather information from a wide range of people and experiences. Will she therefore say what conversations she is having with other Departments and organisations to ensure a broad reach, for instance, through participation from colleges, schools and universities, as well as charities and the workplace?

[Ms Dorries]

This call for evidence is going to last for 12 weeks, we are going to keep up the drumbeat consistently and it will be cross-departmental. I hope that other Ministers in other Departments will pick up part of the load along the way and use their contacts and access to charities and organisations. We are working strongly with journalists and other outlets to try to get the news over about what we are trying to achieve, our aims and objectives. My hon. Friend is absolutely right that working with charities, organisations, the third sector and all women, and their families and friends, across the UK is really important.[Official Report, 12 March 2021, Vol. 690, c. 6MC.] I ask her, as I have asked everybody else: if she knows of any particular organisations or charities that feel that they can contribute, she should encourage them to do so.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

For decades, women with epilepsy were prescribed sodium valproate and were told it was safe to take during pregnancy. It was not. Their babies were harmed, and women continued to be prescribed sodium valproate and babies continue to be harmed right to this day. The Minister in her statement paid lip service to the Cumberlege review, but this statement comes on the same day she has given me a written answer that I have here, where she said that she is not going to implement recommendation 3, which is about a redress agency for victims of sodium valproate. If this statement is meant to mean anything on International Women’s Day, can the Minister remember those women with epilepsy whose babies were harmed in the womb? Can we get a redress agency for the victims of sodium valproate?

[Ms Dorries]

Ever since sodium valproate was first licensed, the Medicines and Healthcare Products Regulatory Agency’s position has been clear: valproate should only be used in women of childbearing potential if no other medicine is effective or tolerated. The MHRA has kept sodium valproate under constant review. The national director for patient safety has recently set up a clinically led valproate safety implementation group to consider the range of issues relating to valproate and prescribing and to explore options to review and reduce prescribing. In terms of the redress agency, we have looked at that across the board as a result of the Cumberlege recommendations. A number of redress processes are available already, and we did not want to complicate the landscape any further. We feel that, with the MHRA and the national director for patient safety, we have a response to sodium valproate.

[Darren Henry (Broxtowe) (Con) [V]]

I absolutely applaud the statement from the Minister, especially as it comes on International Women’s Day. I speak on behalf of Broxtowe constituent Sarah Kolawole and her daughter Ariella Kolawole, who sadly passed away shortly after being born in February 2019. I welcome all the research that has been conducted to explore why negative birth outcomes and traumatic births for pregnant women of black, African and Caribbean descent are more frequent than other ethnicities. As we move forward with our NHS long-term plan, does my hon. Friend agree that we must use this call for evidence to ensure that equal outcomes are achieved for mothers of all ethnicities?

[Ms Dorries]

I thank my hon. Friend for raising such an important point. It is the very reason I established the maternal inequalities oversight forum, so that I could learn from experts and organisations such as MBRRACE —Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries—and Maternity Voices about the issues that affect black, Asian and minority ethnic women in particular and why the statistics are as they are. I thank him for raising the individual case of his constituent, and I ask him to ask her to provide us with her evidence of what her experience was. It is really important that BAME women understand that we want to hear their stories and birth experiences. BAME women are five times more likely to die in childbirth than white women. We need to know what those issues are, and it is important to get that message out to those women.[Official Report, 12 March 2021, Vol. 690, c. 6MC.]

[Kerry McCarthy (Bristol East) (Lab) [V]]

I was pleased to hear the Minister mention endometriosis and acknowledge the shocking fact that it currently takes eight years, on average, for a woman to get a diagnosis, and the underlying assumption that it is just something that women have to put up with if they have pain during their periods. As I am sure the Minister knows, it is National Endometriosis Awareness Month, and campaign groups are asking for a commitment to reduce average diagnosis times to four years or less by 2025, and a year or less by 2030. I am slightly concerned that if we wait for this strategy, it will delay action being taken. What reassurance can she give that the Government are acting to reduce waiting times now?

[Ms Dorries]

I thank the hon. Lady for raising the all-party parliamentary group on endometriosis, which I have spoken to. The report has raised a number of important issues, and we are grateful to the APPG for raising awareness and for contributing to our understanding of this very important issue. The report’s recommendations are to be considered as part of the work to help the women’s health strategy. I urge that APPG and others, and the stakeholders, to participate in the call for evidence. As this is an issue in the women’s health strategy, we cannot go any quicker than putting the call out now for 12 weeks, doing what we can before the summer recess to get the data and working on it over the summer recess, and then have a strategy before the end of the year. Our timetable is tight and quick, but that is what we want, because we do not want to lose momentum. We want to get this report out before the end of the year.

[Craig Whittaker (Calder Valley) (Con) [V]]

Happy International Women’s Day to all colleagues on both sides of the House.

Our successful vaccine programme has shone a light on concerns based on a lack of trust that make members of some communities more hesitant about coming forward to access services that could save their lives. Will my hon. Friend confirm that she is taking steps to ensure that a range of voices, from different communities, are consulted on this strategy, so that it leads to better outcomes for women and girls from ethnic minority backgrounds?

[Ms Dorries]

I refer my hon. Friend to my previous answer. The impacts on BAME women in the health sector are of the utmost importance. That is why, over a 12-week period, we are using all Departments and all Ministers to keep the drumbeat up and make sure that we reach all women across the sector. It is really important to us that as many women from as many backgrounds and as many geographical locations as possible across the UK respond to this call for evidence.[Official Report, 12 March 2021, Vol. 690, c. 6MC.]

[Mr Deputy Speaker (Mr Nigel Evans)]

I thank the Minister for her statement and for responding to all 20 questions on the call list. May I ask Members to be very careful as they leave the Chamber? We have Karen Buck on video link, which means that we can go straight on to the ten-minute rule motion. Perhaps during that period we could sanitise both Dispatch Boxes so that we can go straight on to the next business, if the principals have taken their places, and get at least one extra person in for the Budget debate.

Oral Answers to Questions

Nadine Dorries Excerpts

Tuesday 23rd February 2021 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

On 13 January, we published a White Paper on reforming the Mental Health Act 1983, setting out proposals to make the Act work better for people. We have launched a 14-week consultation, during which we are inviting views from the public, professionals, service users and carers to ensure that we get this once-in-a-generation opportunity right.

[John Howell [V]]

I am delighted that my hon. Friend is taking steps to bring mental health laws into the 21st century, not least because they are 40 years old. Can I take this opportunity to pay tribute to Sir Simon Wessely, who produced his independent review into the Mental Health Act in 2018? Can my hon. Friend confirm that the Government will be accepting many of his recommendations?

[Ms Dorries]

I wholeheartedly agree with my hon. Friend, and I would also like to pay tribute to Sir Simon and his co-chairs for their comprehensive work. The Secretary of State said in the House last year that

“the Wessely review is one of the finest pieces of work on the treatment of mental ill health that has been done anywhere in the world.”—[Official Report, 23 June 2020; Vol. 677, c. 1164.]

I know that the review was welcomed by hon. and right hon. Members across the House. We are taking forward the vast majority of Sir Simon’s 154 recommendations, either directly or by advancing the principles put forward by the review. The White Paper document contains the Government’s response to each of the recommendations.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

The overhaul of the Mental Health Act has been long awaited. It is people who have to be at the heart of the legislation, and that includes staff. The promises that the Secretary of State has made rely on a workforce: our fantastic frontline mental health staff, of which there are simply too few at present. I asked him last month to outline when we would get the workforce settlement and what reassurance he could give on filling the training places. We are still waiting for an answer. Would the Minister like to answer now?

[Ms Dorries]

Work is under way; Health Education England is looking at proposals, particularly for the training of mental health workers. I wish to highlight one area where we can see that happening rapidly: in the mental health support teams that are going into schools. People are coming out of universities with their degree and going through a year’s training so that we can get them into schools faster to work with children and young people. The hon. Lady is right; the mental health workforce is at the heart of these reforms. I assure her that we have seen an increase in the number of people applying to be mental health nurses—and nurses across the healthcare estate—and that will have a knock-on effect on the number of people we have working on the wards with people who have severe mental illness.

[Mr Richard Holden (North West Durham) (Con)]

What progress has been made on the covid-19 vaccination programme.

Health and Social Care

Nadine Dorries Excerpts

Monday 22nd February 2021 Ministerial Corrections

The following is an extract from the debate in the Second Delegated Legislation Committee on Monday 8 February 2021.

[Ms Dorries]

Fixed penalty notices for those caught attending illegal gatherings, such as house parties, of more than 15 people will double for each successive offence, up to a maximum of £6,400. There is one point on which I will not have to write to the hon. Member for Ellesmere Port and Neston. He asked, “Why 15? Why is that the number?” This will just take the number of questions to be answered down by one. This is the new fine for attending larger gatherings, where there is a higher risk of spreading the virus, which goes back to my point that we know how and where the virus travels and where it is most transmissible. It was the scientists who decided this: it was seen as the right level, balancing public health risk versus social impact—for example, the impact on larger households. There continues to be a fine for breaching covid regulations, including by attending a gathering of 15 or fewer.

[Official Report, Second Delegated Legislation Committee, 8 February 2021, c. 21.]

Letter of correction from the Minister for Patient Safety, Suicide Prevention and Mental Health:

An error has been identified in my response to the debate.

The correct response should have been:

[Ms Dorries]

Fixed penalty notices for those caught attending illegal gatherings, such as house parties, of more than 15 people will double for each successive offence, up to a maximum of £6,400. There is one point on which I will not have to write to the hon. Member for Ellesmere Port and Neston. He asked, “Why 15? Why is that the number?” This will just take the number of questions to be answered down by one. This is the new fine for attending larger gatherings, where there is a higher risk of spreading the virus, which goes back to my point that we know how and where the virus travels and where it is most transmissible: it was scientists who advised this. Fifteen was seen as the right level, balancing public health risk versus social impact—for example, the impact on larger households. There continues to be a fine for breaching covid regulations, including by attending a gathering of 15 or fewer.

HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (ALL TIERS) (ENGLAND) (AMENDMENT) REGULATIONS 2021 HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (ALL TIERS AND SELF-ISOLATION) (ENGLAND) (AMENDMENT) REGULATIONS 2021

Nadine Dorries Excerpts

Monday 8th February 2021 General Committees

[The Chair]

Mr Speaker has asked that Members wear masks in Committee unless they are speaking. I do not think it is an attempt to shut people up. Will Members kindly keep them on?

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I beg to move,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021 (S.I. 2021, No. 53).

[The Chair]

With this it will be convenient to discuss the Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021. (S.I. 2021, No. 97).

[Ms Dorries]

It is a great pleasure to serve under your chairmanship, Sir David. I hope that the Committee will approve the regulations, which are in the name of my right hon. Friend the Secretary of State for Health and Social Care. I will briefly explain each statutory instrument.

SI No. 2021/53 amends the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020 and came into force on 20 January 2021. The need for the changes in it was identified in the ongoing review of regulations. It provides for minor and technical clarifications, including of the fact that competitive sport can continue, that cafés and canteens in all post-16 education and training settings are able to remain open, and that marriages and conversions under the Marriage (Same Sex Couples) Act 2013 are permitted. These changes provide legal certainty that these activities are permitted.

SI No. 2021/97 amends the all tiers regulations and the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020, and came into force on 29 January 2021. It allows for additional data to be shared between NHS Test and Trace and the police for the purpose of effective enforcement of the self-isolation regulations. The statutory instrument also amends the all tiers regulations to introduce a new, higher fixed penalty notice to persons aged 18 or over participating in a gathering of more than 15 people in a private dwelling, in education accommodation, or at an indoor rave. The first penalty is £800, reduced to £400 with early repayment. Subsequent offences double the size of the fixed penalty, to a maximum of £6,400.

I will now outline in further detail the main changes made by SI No. 2021/97. As I noted, the main amendment it makes to the all tiers regulations is that it provides for FPNs that can be levied against individuals who participate in gatherings of more than 15 people in a range of settings. We have introduced a new fixed penalty notice, because although the majority of people follow covid regulations and guidance, it is important that the police have the right tools to take action against the small number of people who break the rules. We know that the virus is transmitted through close contact; as a result, larger gatherings of people who do not live together pose an increased risk of transmission. The existing regulations already penalise people who organise unlawful gatherings of 30 or more people, but there was no enhanced penalty for those attending, other than the £200 FPN for breaching social contact and gathering rules. This new, larger fixed penalty notice will support wider efforts to improve compliance with the regulations, thereby helping to bring transmission rates down.

I will now focus on changes to the self-isolation regulations, as I am aware that many Members are most interested in this. The self-isolation regulations came into force on 28 September 2020 and make self-isolation a legal requirement for individuals who have been notified by NHS Test and Trace that they have tested positive for covid-19 or are a close contact of such a person, subject to a number of exemptions. Non-adherence to the regulations can result in an FPN ranging from £1,000 to £10,000, and failure to pay the FPN can result in court action and conviction. The SIs being debated today do not change those levels of FPN.

In order for police to issue FPNs, they need sufficient information about the suspected breach, and evidence that the individual is supposed to be self-isolating and has received a notification from NHS Test and Trace to do so. This SI allows for the minimum necessary information to be shared with the police in order for them to enforce self-isolation. Four key changes have been made. The first is the addition of date of birth and email address, which will help strengthen the evidential base by enabling the police to verify the identity of someone who is suspected of a breach. Secondly, information on whether the individual is participating in coronavirus-related research will be used, where available, to determine whether the subject is permitted to leave their place of self-isolation under an exemption in the regulations. Thirdly, the SI permits the sharing of notification information, including the method of notification, the contact details—

[Mr Mark Harper (Forest of Dean) (Con)]

On the point of notification information, I understand that now, to improve the contact rates, if Test and Trace notifies someone that they have to self-isolate, and there are other members of the household, that person is asked to notify those members and confirm that they have been notified. For the purposes of the regulations, if someone has notified members of their household, does that count as a notification that makes those members legally have to self-isolate? Is the information that someone has passed on to them communicated to the police in some way, so that they can take action under the regulations?

[Ms Dorries]

The only time the police would contact a person would be if a breach had taken place. On the point about the relatives, household members or close contacts of somebody who has been notified by NHS Test and Trace that they are positive, my right hon. Friend asks whether the data of those people who the person has taken on the responsibility to notify will be transferred to the police. I will ensure that I get a swift response to that question.

[Mr Harper]

The first part of my question was about an individual who has had a positive test result. If they notify members of their household, does that count as a notification that gives those household members a legal duty to self-isolate?

[Ms Dorries]

I would say yes to the second half of my right hon. Friend’s question. Again, I will seek legal clarification on this issue, but if someone has been notified that they have been in close contact with somebody who has tested positive, they have a responsibility to self-isolate. On whether that person’s details are put on the NHS Test and Trace database, and on whether the police can therefore be notified if they breach the social contract that we have with Test and Trace, I will need to find out for my right hon. Friend.

[Mr Harper]

This will be the last question. I am pressing her because it was very clear that the initial self-isolation regulations, which, for the avoidance of doubt, I strongly support, applied only to people whom the Test and Trace service had notified. There was no legal requirement for a person to self-isolate if, for example, the app told them to. That is why I want to be clear. I completely agree that people should self-isolate, but there is a real difference between whether someone should, and whether there is a legal duty on them to do so or face criminal action from the police.

[Ms Dorries]

I take my right hon. Friend’s point entirely. It is a legal point, and I will get legal clarification for him swiftly, if not before the end of the debate. I will certainly make sure that question is answered, because there is a legal nuance on where the legal responsibility lies. I welcome his intervention—in fact, interventions from Members on both sides of the House—because they challenge us on how we deal with this new virus, and the world of covid regulations and social distancing. They challenge us all the time to think about these points and to do things better.

Thirdly, the SI permits the sharing of notification information, including the method of notification, the contact details, and a copy of the notification issued to the person informing them of their duty to self-isolate. As my right hon. Friend pointed out, that happens when someone is informed by NHS Test and Trace that they have to self-isolate. That is so that the police can confirm that the individual received a notification to self-isolate and was aware of their legal duty to do so. If required, the police can use that copy to remind the individual, as I have said.

Finally, the SI allows information to be shared on whether the suspected breach is a positive case or a close contact. The police require a distinction to be made between the two types of cases—I think I am answering my right hon. Friend’s question; perhaps I am not—and the relative circumstances may need to be evidenced by the police in criminal proceedings. It is crucial that the police know the precise circumstances and the chain of events that may need to be investigated and evidenced in each individual case.

That data will primarily be shared with the police where there is a reported breach of self-isolation regulations. This is for the purpose of access. The police do not have direct access to the NHS Test and Trace database and its details on all individuals who need to self-isolate, and that will remain the case. Sharing this additional information is both necessary and proportionate, as it gives the police the information that they need to effectively enforce the law. The police have a role in upholding and enforcing the regulations, and we must ensure that they have the tools necessary to carry out their job efficiently and speedily, so that we can deter people from breaching self-isolation at a time when adherence to self-isolation requirements is crucial.

Above all else, the self-isolation regulations are a safety measure designed to drive up compliance among those most at risk of spreading the virus. Any improvement to the way the regulations are upheld will have a positive impact on the public health of the country as a whole by bringing down rates of transmission, protecting the most vulnerable, reducing pressures on healthcare and aiding a return to normality for us all.

Both statutory instruments were introduced using emergency powers, so that we could respond quickly to the threat to public health posed by covid-19. The urgency of SI No. 2021/97 stems from the critical national situation, the need for the police to be able to conduct their duties efficiently in this context, and the crucial impact that it should have on improving compliance with self-isolation and bringing down the R number.

The SIs demonstrate our willingness to take tougher action against the most serious breaches of the rules. They are designed to protect us all. We keep wider regulations under ongoing review and clarify them as appropriate. We also understand that it is crucial to take steps to allow people to return to a more normal way of life. The most effective way of doing that is by reducing transmission of the virus while we continue to deliver our vaccination programme. The SIs set out to achieve that, and should therefore remain in force. We are committed to ensuring that the measures are in place only for as long as is necessary. I commend the regulations to the Committee.

[The Chair]

I apologise to Committee members for the room’s being so gloomy and desperately cold, but the views of Queen Victoria seem to have prevailed.

--- Later in debate ---

[Mr Harper]

It is a pleasure to serve under your chairmanship, Sir David. It is also a great pleasure to see the Minister in her place. I know that she is assiduous in her duties. I am pleased that she answered my earlier intervention in the right spirit, which is the spirit in which I am asking the questions. I genuinely believe that asking questions, which Ministers have to answer, means that you get better laws and regulations, and a good Minister should never be afraid of scrutiny. I am grateful to her for taking my intervention in that spirit.

By way of opening, I should say that I support the principle that people who test positive for coronavirus, or who are contacts of people who test positive, should self-isolate, to protect those around them and reduce the rate of infection. The real question that faces us and is at the heart of these enforcement powers is this: how do we more effectively get people to self-isolate? Is it with the stick or the carrot? That is why I have some concerns about the approach set out in this SI. I am particularly concerned that sharing information with law enforcement authorities does not lead to the best public health response.

I asked the Minister a question, and she kindly said that she would get back to me with a response. There is a second part to my question, which the hon. Member for Ellesmere Port and Neston touched on. I think I am right in saying—I am very happy to be corrected if I am not—that one of the qualification criteria for the isolation payment, which is very important for people on lower incomes, is that someone has been notified by Test and Trace that they have to self-isolate.

Part of the reason I was pressing the Minister on the legal position was not just from the point of view of enforcement and the police’s ability to enforce self-isolation. If someone is in a household where another person is notified that either they have tested positive or they have to self-isolate, they notify that person. If someone is on a low income and needs the isolation payment but has not been told to self-isolate by Test and Trace, I think I am right in saying that they do not qualify for the payment. One of things I am trying to test is whether the way that the test and trace system has changed the rules on how it notifies people has inadvertently led to more people not qualifying for the payment, which is therefore driving down the rates of self-isolation.

[Ms Dorries]

Just to save my right hon. Friend having to elongate that point, I have had information that I need to clarify the legal nuance—the point that he raised last time. Where a positive case undertakes to inform their household contacts of their duty to self-isolate, NHS Test and Trace takes details of those contacts and will separately SMS or email them, so that they are in the system and are notified. I do not know whether that makes it any clearer. I would imagine that applies to the points that my right hon. Friend raised about financial remuneration, but also in respect of the legalities about whom the SI applies to and what powers the police have to enforce the SI.

[Mr Harper]

I am grateful to the Minister for that clarification. I think she is saying that Test and Trace takes people’s contact information. Did she say that Test and Trace then texts or contacts them directly to officially notify them?

[Ms Dorries]

Yes.

[Mr Harper]

I am grateful. That should therefore deal with the payment issue.

My second point comes back to the point that the hon. Member for Ellesmere Port and Neston raised about my question in October about the memorandum of understanding. One of the issues that concerns people is the scope of the information that is to be shared and the basis on which it is shared by the Department. If the Department were to publish the memorandum of understanding—the Minister will obviously tell me if it has been published—I cannot see what the problem would be. It seems to be that if there is nothing to hide, if the rules for sharing information are as set out in the explanatory note in the regulations and as the Minister set out, and if there are good, clear reasons for doing these things, that would help allay people’s genuine concerns.

People also have concerns about things for the sake of having concerns about them, and publishing the information and being transparent allays those concerns. It also stops people being able to whip up scare stories. We know there are people who deliberately set out to spread anti-vaxx nonsense, and to scare people about taking the vaccine or getting tested. The more the Government are transparent and open, the more we reduce the opportunity for people to do that.

Can the Minister confirm that the memorandum of understanding has been published? If it has not been published, and given that the House will be asked to approve the regulations—I presume that once the Committee has considered them, they will be on the Order Paper tomorrow—it would be outrageous if the memorandum of understanding was not available to the House at the point at which it was asked to take a decision on the regulations. It seems to me that that would be less than satisfactory.

Can I probe a point that the hon. Member for Ellesmere Port and Neston raised about the necessity to use the emergency procedure to lay the regulations? I completely accept that both at the early stage of the pandemic and at certain stages throughout it, there have been times when it has been necessary for Ministers, even subsequent to their commitment to coming to the House in advance, to legislate using the emergency powers under section 45R of the Public Health (Control of Disease) Act 1984 and then get Parliament to sign them off afterwards.

An obvious example was when we saw the new variant spreading very quickly. It was, I think, after Parliament had risen for Christmas. I agree it was necessary for the Government to take steps and then get the House to sign them off. To be fair, the Government did so. They recalled Parliament and held a debate at the earliest opportunity, and that was absolutely right.

In the present case, I do not understand what the urgency was when the need for the regulations was identified. Why was it not possible, a few days later, simply to have them debated by the House? I ask that because paragraph 3.3 of the explanatory memorandum states that

“it has become clear that changes around data sharing are necessary to strengthen the effectiveness of the current system.”

However, no further details are given.

Later, under the heading of “Policy background”, paragraph 7.4 includes the words:

“Feedback from policing suggests additional data”.

I should welcome more clarity from the Minister about what exactly suggested to the Department that more data was needed. What information did the Department get from policing? The memorandum is a bit vague about what “policing” means. It does not say whether it means the National Police Chiefs’ Council, individual police forces, or what.

What information was received from the police to suggest that they needed more data? When did that take place? Why was it necessary for the regulations to be made by Ministers and to come into force a few hours after they were made, before Parliament was given the opportunity to debate them?

The issue is important because it is important that the regulations be proportionate. The Minister used that word several times, and the statutory instrument states that the Secretary of State considers them a “proportionate” response. We need to know what evidence there is of people not following their legal duty to self-isolate. How many people, for example, who were under a legal duty to self-isolate were not doing so, and what is the evidence from behavioural science—the hon. Member for Ellesmere Port and Neston quoted a member of SPI-M, part of the SAGE committee, about that—that the changes in the regulations will improve compliance and lead to more people self-isolating than the opposite?

The Secretary of State is said to be satisfied on the legal test that the provisions are a proportionate response, and in order to be satisfied about that he must have data about it available to him. It would be helpful if the Minister would furnish the Committee with that information. That would also enable us to judge whether it was appropriate for the measures to be made in advance and put into law before the House had a chance to consider them.

Having discussed the background, I have some specific questions about what information can be shared, and in what circumstances. Some of those would be answered if the memorandum of understanding were available. The Minister set out clearly that it would include information on the individual’s date of birth, the means by which they were notified—whether their postal address, telephone number or email address was used—and whether they are participating in coronavirus-related research. I would be grateful if she would confirm that that means just the fact of participation in the research, with no further details about what the research is. The final aspect was about whether someone had to self-isolate because of receiving a positive test, or being a contact. The reason why that is important, and why the regulations have caused some concern, is that if someone tests positive, that is health information. As the hon. Member for Ellesmere Port and Neston highlighted, under data protection regulations, health information is a specific category that is very sensitive.

Members of Parliament know that there is a general assumption, set out in law, that when we contact organisations on behalf of our constituents, those organisations are entitled to presume that we have the constituents’ consent, and that a specific document is not required as evidence of that in each case; however, quite often with health data, the NHS will insist on a specific piece of information, showing a constituent’s explicit consent, before it will disclose health information. That is, rightly, because the health information is very sensitive. I want to know why Ministers feel that disclosing health information to the police is essential to carrying out this law enforcement, and whether it is proportionate to the problem that was being encountered when the information could not be disclosed. That is the implicit assumption.

I am also concerned about the uses to which the police can put the information, and how they get it, which would again be covered by the memorandum of understanding. First, it is not clear what the mechanism is for the police to get the information. Does the NHS choose information to send to the police—such as information about people who have tested positive or have positive contacts—for the police to do proactive enforcement work, or do the police have to approach the Department of Health and Social Care if they receive information about an individual that leads them to believe that the individual has a duty to self-isolate but is not doing so? I assume that it is the Department, as opposed to individual NHS bodies; it is presumably the Department and NHS Test and Trace, which is part of the Department of Health.

Do the police have to ask for the information on that individual, and what information does the Department ask for to evidence the fact that the police have a reasonable basis for wanting that health information? In other words, can the police choose anybody they feel like, contact NHS Test and Trace and say, “Can I have information about whether this individual has tested positive for coronavirus?” or do they have to have some information that gives them reasonable grounds for thinking that a criminal offence is taking place?

That is really important, because it would put people’s minds at rest. If a large-scale piece of data was being transferred, that might not put their minds at rest, but it is something that Parliament should know about. Is the information proactively sent from Test and Trace to the police for enforcement, or do the police have to ask for it, and are they able to do so—and will the Department release it—only if there are good grounds for suspecting that a criminal offence is being committed?

The final area concerns contacts, and the extent to which the police can use the information to go enforcing down the chain of contacts. In other words, if they get information that someone has tested positive for coronavirus, can they then make inquiries about whether that person’s contacts have a legal duty to self-isolate, or does responsibility for that sit with Test and Trace?

I ask those questions because there is anecdotal information that some people are worried about the impact of the legal duty on their contacts, in terms of their not being able to work and not having enough income. Let us be frank: there are people who engage with the police on, as it were, a professional basis for reasons not to do with coronavirus who may well feel that they do not want to go anywhere near the police, and therefore will not do what they should under a public health remit. If they thought that the police could go fishing around their contacts and get information about who they meet and when they meet them, they would not disclose it to Test and Trace. They would not engage with any of the public health information at all, and by introducing these measures we would have made ourselves not safer, but less safe.

A very good example, which I support, is what the Government have announced today. As a former Immigration Minister, I welcome the fact that the Government have said that even people who are in the United Kingdom unlawfully should contact the NHS and get a vaccine, and no steps will be taken, as a result of their doing so, to deal with the fact that they are in the country unlawfully. It is in all our interests that that essential public health measure, rather than the legal need to deal with the fact that they are in the country unlawfully, comes first, so Ministers have made the right choice. That is why I want to understand whether there is the right balance in the regulations, and I want to know that we are focusing on public health and reducing the effective transmission of the virus rather than inadvertently putting sticks in place—to use the words of the hon. Member for Ellesmere Port and Neston—and making things worse rather than better. I would be grateful if the Minister could answer those few questions.

[Ms Dorries]

That was a large number of questions covering a number of points. I know that officials are furiously trying to group them at the moment. I will do my best to answer them as well as I can. If there are any that I do not answer, I give the hon. Member for Ellesmere Port and Neston and my right hon. Friend the Member for Forest of Dean absolute assurance that they will be written to quickly with more detailed answers.

The first point raised by the hon. Gentleman was about why the regulations have come in after the event. Public health underpins what we are doing today. My right hon. Friend’s last question was about this being a public health initiative, and not a stick or a means of taking away people’s freedoms for the sake of it. That is absolutely not what the regulations are about; they are very much a response to the South African variant. We need to do what we can to ensure that people self-isolate when they are supposed to, that they are deterred from gathering in groups and that we do as much as we possibly can, using the instrument of the law, to protect the health of the nation.

Coronavirus is a brand-new virus, and we knew nothing of its biology or pathology when it landed on our shores this time last year. One thing that I have learned since then as a Health Minister is that when the virus mutates—there have so far been more than 10,000 mutations—the figures go in only one direction when they start to rise. They do not rise to small numbers and then suddenly drop off and disappear without very restrictive action, such as that taken in China and other countries where there is a much stronger social contract with the population.

We move very quickly, but the virus moves faster. It would be wrong of us, as a Government, to see a variant such as the South African one and not look at what further public health measures we can put in place now to protect the health of the nation and stop the variant rising.

[Justin Madders]

I am grateful for the Minister’s answer. I only wish that such action had been extended to quarantining international arrivals for the South African variant. Does that explanation also apply to the question of gatherings? Does anything about that variant apply to large gatherings and explain why the regulations were brought in as they were?

--- Later in debate ---

[Ms Dorries]

As I said in my opening remarks, we know that the virus, in whatever mutation, transmits well indoors with groups of people who are not socially distancing and who are close to each other. That is true whether it is the South African variant or the current dominant variant in the UK. We know from experience, from weddings and other gatherings, that it transmits when people are together indoors in numbers. Our objective is to stop the virus transmitting and to keep the R number low.

The hon. Member for Ellesmere Port and Neston raised a number of points about the police. He asked what information we had about the police wanting the measures to be put in place. The National Police Chiefs’ Council fed back to us that police needed more information on someone to whom they may need to issue a fixed penalty notice. If they do not have the information to say, “Yes, this person has a legal responsibility to self-isolate,” it puts them in a very difficult position. This information is not used in the pursuit of any other crimes, or in any other way whatsoever. It is used for the purpose of a FPN, in order to deter others from breaking their legal responsibility to self-isolate when they have been identified as testing positive.

The hon. Gentleman asked whether there was additional funding for the police to carry out this work. We have given them over £30 million, again in consultation with the NPCC. We are responding to a request from the police. They do not want to issue fixed penalty notices to someone who is telling them, “No, this is a mistake; I don’t have a responsibility to self-isolate. No, I’m not covid positive. No, I haven’t been in contact.” They need the evidence. They need to be able to say, “We know that you are somebody who has been asked to self-isolate.”

[Mr Harper]

Will my hon. Friend give way?

[Ms Dorries]

I will just finish my point to the hon. Member for Ellesmere Port and Neston. On his comments about stick and carrot, the police have had a great deal of extra responsibility put on their shoulders. There have been times when they have exercised what they call the four Es. It is not about enforcement and a heavy hand.

As the hon. Gentleman knows, because we have discussed this before, it is about encouragement, explaining and helping people to understand their social responsibility, both towards the people that they are with and in terms of keeping the virus down. It is not a case of the police going in and handing out fixed penalty notices. It is about explaining to people what is expected of them once they have received a notification that they are a close contact or they have tested positive, and their responsibility is to self-isolate. This is about encouraging people to comply with the regulations more than it is about hitting people with a stick.

Both my right hon. Friend and the hon. Gentleman spoke about the memorandum of understanding. I understand that it is between the Department of Health and Social Care and the Home Office. I will make some further inquiries about how that stands. I am not fully aware of the details, and I will get back to my right hon. Friend and the hon. Gentleman about that.

I was asked if the police had to request information on an individual or if they had access to the database. My understanding is that the police do not have open access to the Test and Trace database. This is about information on a need to know basis, when the police have been given information or when they are aware, or they suspect, that people are breaking the law. The police do not just access the database and take the information from it. My right hon. Friend and I have been in this place for a long time together, so he should know that I would not be happy with such a situation, purely from the point of view of civil liberties; I know he would not be happy with it either. The police have access to data that they request. I will write to him with further information on that, because there are many legal points around it. I know how thorough he is, and he will want those questions answered.

[Mr Harper]

Can I press the Minister on that? I am not sure that her answer has helped, because she said that the memorandum of understanding was between the DHSC and the Home Office. I presume that individual police forces, not the Home Office, access the information, although I do not know that because we have not seen the memorandum. That is the whole point about publishing the MOU—it would reassure us.

I think the Minister has confirmed that the police would have to suspect an offence was being carried out in order to get information. We are still not clear about who asks for the information, who discloses it and who makes the decision about whether to disclose it, to whom and what other information is disclosed.

Those are the things that are worrying people; if we can all be reassured about them, I think a lot of people will then stop being worried about them. The Minister herself is an experienced medical practitioner—a trained and qualified nurse—so she will know how important it is that medical information is not disclosed beyond the needs for which it was ascertained in the first place, and also how sensitive such information is.

[Ms Dorries]

We are totally in tune on that. In terms of the present system of information, I misspoke: it is a memorandum of understanding between the Department of Health and Social Care and policing, not the Home Office—I should be quite clear on that. My apologies—I misspoke there.

The present system of information-sharing with the police is reactive; as I said, it is based on the police receiving information from Test and Trace following a report of a suspected breach of the regulations—I probably said that more clumsily in my previous answer. It is when somebody has contacted the police to say that they believe somebody is breaking the regulations, or when there is a gathering of people—I think we called it a “rave” in the regulations—and somebody has reported that a gathering is taking place, and some of those people should be isolating.

[Mr Harper]

Just to be clear—I hope this will be my last question for the Minister—if, say, somebody’s neighbour rings up the police and says, “I think Mrs Bloggins has tested positive for coronavirus and isn’t self-isolating,” is that sufficient grounds for the police then to be given confidential health information about Mrs Bloggins, or does there have to be a bit more to it than somebody just ringing up and telling them something? I ask that because I think this is the bit that people are worried about—the basis on which the police asked for this information and the basis on which the DHSC will then give it to them. Again, it may be that all these questions are answered in the memorandum of understanding, in which case I really do think that if the Minister published it everyone would probably let out a big sigh of relief and would not be very worried about this—I hope that that is what we would find.

[Ms Dorries]

Our police are very responsible individuals. If they receive a report that somebody is believed to be breaking regulations, or breaking isolation, they will not automatically ask Test and Trace for the individual’s information before they have carried out an assessment of the situation. They would need to clarify for themselves whether a breach was actually taking place, such as a breach of the numbers—for example, if it was not a single-household individual mixing within their bubble. They would have to assess the situation and see if the regulations were being broken. If they were being broken, the police would have the right to revert to Test and Trace to ask for clarification on the individual’s details.

Both my right hon. Friend and the hon. Gentleman are pursuing a definition—as my right hon. Friend knows well—in legal terms within the legislation. I will need to seek legal clarification and write to both of them with the details on that point.

[Justin Madders]

I appreciate the Minister’s valiant efforts to explain how this all works in practice. I think that the answer, as the right hon. Member for Forest of Dean said, is to publish the memorandum of understanding. That is the way that we will all gain clarity on how this all works—I hope.

I will just go back to what the Minister’s colleague, the Minister for Care, said on 19 October last year. When asked if the memorandum of understanding would be published, she said, “It will be.” The Minister seemed to be backtracking a little from that tonight. Can she confirm whether we will actually get sight of it?

[Ms Dorries]

I am aware that it exists as a working understanding, as I said, between DHSC and policing. Obviously I will consider both points about transparency and take them both on board. However, I need to seek further clarification—if, why, legally, and how?—around the memorandum of understanding. The hon. Gentleman’s points have been well made today and have been noted. I will take the process further and explore the options, then get back to him with an answer.

[Justin Madders]

I am sorry to press the point, but one of the Minister’s colleagues said on the record that it will be published and she is now saying that that is not, or might not be, the case. That is not acceptable. We must have things said by Ministers on the record adhered to.

[Ms Dorries]

I completely agree. I have just been informed, in the form of our old notes, that the memorandum of understanding is currently being updated to reflect feedback from the Information Commissioner’s Office and the recent changes made by this SI.

[Mr Harper]

This is my final point, and it is probably less for the Minister and more for her colleagues in the Whips’ Office. There are a number of complex legal questions, which the Minister says she will write to the Committee about. That is perfectly understandable, but may I ask for an assurance, either from her or from those who are listening, that the House will not be asked to take a decision on this statutory instrument until the memorandum of understanding has been published and she has furnished the Committee, and indeed the House, with answers to the questions that have been asked? It would not be acceptable for us to ask questions and for her reasonably to go off and make inquiries, and then for the House to be asked to make a decision tomorrow before Members have been furnished with that information. That would not be an appropriate way to behave, especially as the regulations have come into force before being debated by the House. If she cannot give that assurance, I hope that others are listening and will feed that request back through the usual channels.

[Ms Dorries]

I thank my right hon. Friend for his points. As a former Chief Whip, he knows that these conversations will be taking place through the usual channels. I am glad that his comment was not directed toward me, because, as he also knows, the decision does not rest with me.

My closing remarks will cover some of the points that have been raised, but if I do not have the answers to any of them now, I will, as always, respond in writing. I really do thank both my right hon. Friend and the hon. Gentleman for the important contributions they have made today. The hon. Gentleman did not go too far outside the scope of the SI this time, as he often does. He usually goes miles off-piste, but today he was very well behaved, and I thank him for that. I absolutely take on board the point made by my right hon. Friend. When we are fighting a virus, with the Department of Health, public health bodies, SAGE and everyone else involved, the probing questions asked here help to create better laws and a better process. Hopefully, we are all trying to do the same thing—to get back to normal as soon as it is safely possible to do so. Anyone’s efforts as part of this process are as valuable as everyone else’s, so I thank my right hon. Friend and the hon. Gentleman for their probing questions and for pushing me on certain points, because that will create better answers.

The Government have always been clear that the highest priority is managing this national crisis, protecting the public and saving lives. As I stated in my opening remarks, the amendments in the SIs are necessary and proportionate for legal coherence and clarification. [Interruption.] Don’t worry, I haven’t got covid; I coughed because I have been talking so long. The ability to enforce more effectively and issue enhanced FPNs will ensure that we limit the spread of the virus and increase compliance, protect the NHS and safeguard public health.

Coronavirus remains a serious threat. The current level of confirmed cases and the identification of new, more transmissible variants of covid-19 have reinforced existing patterns. As during the first peak, we are witnessing a high number of infections, hospital and intensive care unit admissions and, sadly, high mortality rates. Even when mortality rates are not high—there are dips—that does not mean that our ICU beds are not full of people being treated for covid. If we are managing to keep people alive, that is a good thing, but it does not mean that beds are not full or that we are not trying to protect our NHS and prevent it from falling over. We continue to mitigate the threat to our NHS before it becomes overwhelmed, and strive to give it the best ability to provide a safe and effective service for all. Protecting our NHS is about keeping beds available and enough staff on the wards to treat people when they come in and need that treatment in order to save their lives.

It has been necessary to make a number of minor technical amendments to the all tiers regulations to provide coherency and ensure that there is no confusion about these measures, all of which have been implemented to limit transmission and reduce the spread of the virus.

As set out previously, the intentions of the amendments to the all tiers and self-isolation regulations are threefold: to reduce contact between people who do not live together, to drive down transmission; to increase fixed penalty notices for those caught attending illegal gatherings, to increase compliance; and to enhance data-sharing with the police to improve the evidentiary chain, to support effective enforcement against those who breach their duty to self-isolate. To issue a fixed penalty notice, the police need to be satisfied that they are engaging with the right person—this comes back to the substantive point that was raised a number of times during this debate: they need to be sure that they are engaging with, and issuing the FPN to, the right person—that the person is aware of their duty to self-isolate, and that the person has indeed breached that legal requirement. These changes to the self-isolation regulations will support the police in taking effective enforcement action when that is appropriate.

Fixed penalty notices for those caught attending illegal gatherings, such as house parties, of more than 15 people will double for each successive offence, up to a maximum of £6,400. There is one point on which I will not have to write to the hon. Member for Ellesmere Port and Neston. He asked, “Why 15? Why is that the number?” This will just take the number of questions to be answered down by one. This is the new fine for attending larger gatherings, where there is a higher risk of spreading the virus, which goes back to my point that we know how and where the virus travels and where it is most transmissible. It was the scientists who decided this: it was seen as the right level, balancing public health risk versus social impact—for example, the impact on larger households. There continues to be a fine for breaching covid regulations, including by attending a gathering of 15 or fewer.[Official Report, 22 February 2021, Vol. 689, c. 4MC.]

[Justin Madders]

I am grateful for the Minister’s explanation. It seems that, as we would expect, this decision is based on scientific advice. Would the Minister be able to publish that, so that we can see it in full?

[Ms Dorries]

I am sure that the hon. Gentleman’s request has been listened to—he knows that publishing the advice from SAGE is above my pay grade.

As I said, fixed penalty notices for those caught attending illegal gatherings, such as house parties, of more than 15 people will double for each successive offence, up to a maximum of £6,400. These amendments to the all tiers and self-isolation regulations will provide the police with the enhanced powers that they need to tackle egregious breaches of the law.

Unfortunately, covid-19 has forced us to balance the increasing social contact restrictions with the protection of public health. These decisions are not easy ones to make, but with alarming epidemiological evidence suggesting that the new variant is much more transmissible, urgent action has become appropriate. We will continue to work alongside scientific and medical experts to ensure we have decision making appropriate to the circumstance at each stage of this crisis, and we will review the regulations regularly, assessing them in the light of the latest science and other data. I commend the regulations to the Committee.

[The Chair]

I reassure the Committee that all the exchanges have been perfectly in order and well within the scope of these two instruments.

Question put and agreed to.

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021 (S.I. 2021, No. 53).

Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021 (S.I. 2021, No. 97).—(Nadine Dorries.)

HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (ALL TIERS) (ENGLAND) (AMENDMENT) REGULATIONS 2021 HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (ALL TIERS AND SELF-ISOLATION) (ENGLAND) (AMENDMENT) REGULATIONS 2021

Nadine Dorries Excerpts

Monday 8th February 2021 General Committees

[The Chair]

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

[The Chair]

[Ms Dorries]

[Mr Mark Harper (Forest of Dean) (Con)]

[Ms Dorries]

[Mr Harper]

[Ms Dorries]

[Mr Harper]

[Ms Dorries]

[The Chair]

[Mr Harper]

[Ms Dorries]

[Mr Harper]

[Ms Dorries]

[Mr Harper]

[Ms Dorries]

[Justin Madders]

[Ms Dorries]

[Mr Harper]

[Ms Dorries]

[Mr Harper]

[Ms Dorries]

[Mr Harper]

[Ms Dorries]

[Justin Madders]

[Ms Dorries]

[Justin Madders]

[Ms Dorries]

[Mr Harper]

[Ms Dorries]

[Justin Madders]

[Ms Dorries]

[The Chair]

Mental Health In-patient Deaths in Essex: Independent Inquiry

Nadine Dorries Excerpts

Thursday 21st January 2021 Written Statements

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

The Parliamentary and Health Service Ombudsman (PHSO) published his report “Missed opportunities: What lessons can be learned from failings at the North Essex Partnership University NHS Foundation Trust” on 11 June 2019 which found that there were a series of significant failings in the care and treatment of two vulnerable young men who died shortly after being admitted to North Essex Partnership University NHS Foundation Trust. I have previously announced my commitment to an inquiry into these tragic events.

Today, I am announcing the establishment of a non-statutory, independent inquiry into the circumstances of mental health in-patient deaths at the former North Essex Partnership University NHS Foundation Trust, the former South Essex Partnership University Trust and the Essex Partnership University NHS Foundation Trust, which took over responsibility for mental health services in Essex from 2017. This will cover the period from 1 January 2000 to 31 December 2020.

In announcing this inquiry, I am mindful of the current, extraordinary demands on the NHS as it responds to the worst pandemic in living memory. The Essex Partnership University NHS Foundation Trust was one of the first to declare a major incident and the inquiry will schedule its work in a way that is sensitive to these pressures.

I have also listened carefully to the arguments proposing a more formal, statutory inquiry into these events. I share the desire for a robust and independent process that will get to the truth and deliver the necessary learning. I remain convinced that a non-statutory, independent inquiry is the best way to do this and identify the necessary improvements in the timeliest way.

I have asked the distinguished psychiatrist Dr Geraldine Strathdee CBE to chair the inquiry and am delighted that she has agreed to take on this important role. Dr Strathdee worked for many years as a consultant psychiatrist in the NHS. She brings a wealth of experience in mental health policy, regulation and clinical management and is a co-founder of the Zero Suicides Alliance. Dr Strathdee is a person of the utmost integrity and I will expect her to conduct this inquiry without fear or favour. In order to ensure her independence, she will step down from her current role as a national professional adviser at the Care Quality Commission when her term ends in March of this year.

The chair will be supported by expert advisers, including a legal adviser.

The inquiry will consider issues including:

the key factors that led to the deaths of individual patients, whether issues of omission or commission;

aspects of culture and governance that inhibited the trust(s)’ ability to learn and take action following any breaches of safety;

the quality of any previous investigations by the trust(s), the conclusions and recommendations of those investigations and the subsequent actions;

the response of the wider system to these events and the actions taken by the trust(s) in response to investigations or reviews conducted by any other body; and

the further lessons for the Essex Partnership University Foundation NHS Trust and what actions are necessary for the new trust chief executive and its board to ensure that current and future patients receive sustainable safe care; and

further lessons arising for the mental health services, the NHS and the wider system.

The inquiry will not reopen the investigation of fixed potential ligature points that has given rise to the prosecution of Essex Partnership University NHS Foundation Trust by the Health and Safety Executive but may consider the evidence in this area.

The inquiry will be able to interview witnesses to determine if there were failures in care, safety, governance or professional standards and will examine all relevant records to get to the truth. We owe the families nothing less.

My Department will co-operate fully with the inquiry’s investigation, including provision of any documents it might hold that are relevant to these issues and are requested by the inquiry.

Similarly, all NHS employees will be expected to give the inquiry their full co-operation.

I am moving forward with this important inquiry in order to shine a clear light on what happened at the trusts so that lessons can be learnt by the current trust and the NHS more widely. These lessons must be applied to the trust and the NHS to ensure that the provision of mental health services is improved and, critically, that lives are saved. This will require the investigation of some, possibly all, mental health in-patient deaths that occurred across the county between 2000 and 2020. Our focus must be on how we learn the lessons to improve services and prevent in-patient deaths in the future. The chair will want to consider what level of scrutiny of individual deaths is necessary to do this. However, there may be limits on the scrutiny that is possible of the earlier deaths that occurred during this period.



The chair will recommend a final terms of reference following consultation with the families and others affected by these events which I will communicate to Parliament in due course.



The inquiry will be formally established from April 2021 and will aim to report in the spring of 2023.

[HCWS729]

Long Covid

Nadine Dorries Excerpts

Thursday 14th January 2021 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I thank the hon. Members who tabled today’s debate on this very important topic. We know that long covid can have a significant impact on the people affected, and I am proud that this Government are committed to doing everything possible to support people who are still suffering with effects on their mental and physical health.

Covid-19 is still a new disease. Indeed, the hon. Member for Oxford West and Abingdon (Layla Moran) began by identifying that the disease pathway of covid is so new that we still do not have the evidence to understand fully what long covid is. It is not yet clear what the medical, psychological and rehabilitation needs will be for those experiencing long-term effects of the virus.

Typically, the time to recover from covid-19 is 10 to 14 days for mild and moderate cases; however, some people may experience lasting impacts on their health. Long covid describes a mix of mental and physical health effects. Research from the ONS has shown that one in 10 people has covid-19 symptoms for 12 weeks or longer, and it estimated in mid-November that around 186,000 people were experiencing symptoms between five and 12 weeks post infection.

I will start by giving an update on the important work that the Government and the NHS are leading into long covid. We continue to work closely with the NHS and other stakeholders to develop and deliver high-quality services for patients, to make rapid progress in terms of research, and to ensure effective communications and engagement with the public and the workforce. The NHS launched a five-point plan for dealing with long covid and providing support on 7 October 2020 and, just as it rapidly stood up specialist care for acutely ill covid-19 patients at the start of the pandemic, it is now responding sensitively and effectively to long covid.

The NICE guidelines for long covid, and how to manage it, were published on 18 December. For the first time, we have clinical definitions and terms for the initial illness and long covid at different stages. The guidelines describe the most commonly reported symptoms of acute covid-19 and long covid. Acute covid-19 covers the signs and symptoms for up to four weeks; long covid, or post-covid syndrome, is commonly used to describe the signs and symptoms that continue after acute covid-19. The guidelines also set out the support that long covid patients should receive.

The NHS announced the “Your COVID Recovery” online service on 5 July. That online tailored rehabilitation programme enables patients to be monitored by their local rehabilitation teams, and phase 2 was rolled out in November to provide further support for people with long covid. In October, NHS England announced £10 million to fund a network of assessment service centres in each part of England. Those new services bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments, and refer patients to the right pathway of treatment and rehabilitation.

The Secretary of State spoke to the House in October about his visit to the cutting-edge long covid clinic at University College hospital. There he met people in their 20s and 30s who are living with the long-term effects of the virus. It has completely changed their lives. There are now 69 centres operating across England, where hundreds of patients are already receiving treatment. Those centres are assessing and diagnosing people experiencing long-term health effects as a result of a covid-19 infection.

A further 12 sites are earmarked to launch in early 2021, and they will be in the east midlands, Lancashire, Cornwall and the Isle of Wight. The NHS and the wider scientific community are currently working to better understand the disease: the course of the covid-19 virus, including symptoms, severity and duration, long-term effects, and how best to support recovery. NICE and UK Research and Innovation have invested £8.4 million in a post-hospitalisation covid-19 study at the University of Leicester. This is one of the world’s largest comprehensive studies of the long-term health impacts of covid-19 on hospitalised patients. The study aims to better understand and improve long-term outcomes for survivors following hospitalisation with covid-19. The National Institute for Health Research and UKRI have also announced a joint research funding call for ambitious and comprehensive research into the long-term physical and mental effects of covid-19 in non-hospitalised patients. The panel is currently reviewing the bids and projects and this is expected to commence in early 2021.

The NHS has launched a long covid taskforce to help to lead the NHS response to long covid. It will produce information and support material for patients and healthcare professionals and develop a wider understanding of the condition. Led by the director of primary care at NHS England, Dr Nikita Kanani, the long covid taskforce brings together patients, charities, researchers, clinicians, policymakers and the royal colleges to provide an advisory function and to support the delivery of the NHS five-point plan. My colleague the noble Lord Bethell continues to hold monthly long covid roundtables to provide updates from NHS England, NHS Improvement and others working on various areas of long covid.

The covid-19 vaccine marks the start of a fightback against the pandemic. The NHS is deploying vaccines right across the UK and this has reached 3 million today in line with the founding mission to support people according to clinical need, not ability to pay.

Long covid is a new challenge for healthcare systems all over the world, not just in the UK. The UK is committed to listening to people with long covid and leading the way in excellent research, treatment and care. I pay tribute to the hard work and dedication of the NHS staff who set up these services to quickly meet sufferers’ medical needs all over England, to the researchers working hard to better understand this issue, and to the people living with long covid for sharing their insight and their experience with us. Combined with further research, the NHS England long covid taskforce, and the additional services and funding that we are providing, we hope to improve lives and aid in and fight against this global pandemic.

Independent Medicines and Medical Devices Safety Review

Nadine Dorries Excerpts

Monday 11th January 2021 Written Statements

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

The report of the Independent Medicines and Medical Devices Safety Review (IMMDS Review) was published on 8 July last year. I would like first to sincerely thank Baroness Cumberlege and her team for their work on the review. I also pay tribute to the women and their families who bravely shared their experiences and brought these issues to light. Without their tireless efforts to have their voices heard, this review would not have been possible.

The overriding question investigated by the review is how the health and care system listens and responds to patient concerns raised by patients, and women in particular. We must not forget that the Cumberlege review, alongside other independent inquiries including the Paterson inquiry, was commissioned because women did not feel listened to or their concerns acknowledged—today is another step towards righting this.

On the Paterson inquiry, I would also like to provide a very brief update. Work on the Government response was temporarily paused last spring due to the first wave of the covid-19 pandemic. Efforts have since resumed at pace, and I can confirm today that I will announce and publish the Government’s initial response in Parliament shortly.

Returning to the IMMDS review, many of the report’s recommendations have already been discussed in detail during the Committee stage of the Medicines and Medical Devices Bill, and this has helped us to determine our future direction. We are very grateful to Members from both Houses who have worked with us on this.

I am today updating the House on the Government’s response to the report of the IMMDS review, taking each recommendation in turn.

Recommendation 1: The Government should immediately issue a fulsome apology on behalf of the healthcare system to the families affected by Primodos, sodium valproate and pelvic mesh.

In July, when I introduced this report to the House, I made an unreserved apology on behalf of the health and care system to those women, their children and their families for the time the system took to listen and respond. I assure those affected that the Government have listened, and will continue to listen.

Recommendation 2: The appointment of a Patient Safety Commissioner who would be an independent public leader with a statutory responsibility. The Commissioner would champion the value of listening to patients and promoting users’ perspectives in seeking improvements to patient safety around the use of medicines and medical devices.

The central recommendation in the report is for the establishment of an independent Patient Safety Commissioner. This recommendation has rightly ignited much interest and debate in both Houses, and the Government have listened carefully to the arguments made for a Commissioner, and how this might sit within the wider patient safety landscape.

Patient safety is a key priority for the healthcare system. In my role as Minister of State for patient safety, I often hear from and meet with people who have been affected by issues of patient safety. Their stories have common themes—of suffering avoidable harm, of not being listened to—and of a system that is then difficult to navigate when things go wrong. We want to make the NHS as safe as anywhere in the world, and we must retain an absolute focus on achieving this goal.

I can therefore confirm that the Government tabled an amendment to the Medicines and Medical Devices Bill before the Christmas recess to establish the role of an independent Patient Safety Commissioner, in line with Baroness Cumberlege’s second recommendation.

The Commissioner will act as an independent advocate for patients, and strengthen the ability of our health services to listen to the voice of patients. The Commissioner will be established as a statutory office holder, appointed by the Secretary of State for Health and Social Care, and will act independently on behalf of patients.

The Commissioner’s core duties will be to promote the safety of patients and the importance of the views of patients in relation to medicines and medical devices. To help in carrying out these duties, the Commissioner will have a number of powers and functions, including the ability to make reports and recommendations to the NHS and independent sector, and to request and share information with these bodies.

The Government look forward to working with Members of both Houses to ensure this new post acts as a beacon for listening and reflecting the safety concerns of patients, so that we can drive positive culture change in our healthcare system.

Recommendation 3: A new independent Redress Agency for those harmed by medicines and medical devices should be created based on models operating effectively in other countries. The Redress Agency will administer decisions using a non-adversarial process with determinations based on avoidable harm looking at systemic failings, rather than blaming individuals.

The Government have no current plans to establish a redress agency as set out in recommendation 3. The Government and industry have previously established redress schemes without the need for an additional agency.

Recommendation 4: Separate schemes should be set up for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm and are eligible to claim.

Recommendation 4 on redress schemes for sodium valproate, mesh, and HPTs remains under consideration.

Recommendation 5: Networks of specialist centres should be set up to provide comprehensive treatment, care and advice for those affected by implanted mesh; and separately for those adversely affected by medications taken during pregnancy.

Good progress is being made on establishing specialist mesh services, which are the fifth recommendation in the report. NHS England is working with NHS hospitals to establish specialist mesh services which are currently planned to go live from the spring this year.

These services will bring together leading experts to provide multidisciplinary care and treatment for all women who have experienced complications due to vaginal or abdominal mesh procedures.

With a centre in every NHS region, these new services will ensure nationwide provision, and centres will work together to hone their expertise and share best practice.

We continue to consider the second part of recommendation 5, which is for specialist centres for those adversely affected by medicines in pregnancy.

Recommendation 6: The Medicines and Healthcare products Regulatory Agency (MHRA) needs substantial revision particularly in relation to adverse event reporting and medical device regulation. It needs to ensure that it engages more with patients and their outcomes. It needs to raise awareness of its public protection roles and to ensure that patients have an integral role in its work.

Patient safety is the MHRA’s top priority. The MHRA recognises that the major changes highlighted by the report, particularly recommendation 6, are very important.

The MHRA has already begun a substantial programme of work to improve how it involves patients in all aspects of its work, to reform systems for reporting adverse incidents with medicines and medical devices, and to strengthen the evidence base for its regulatory decisions.

Within the MHRA’s work to strengthen the evidence base, the safety of medicines in pregnancy is of utmost importance.

In the UK, three quarters of a million babies are born each year, and more than half of expectant mothers will need to take medicines when pregnant. We must ensure that women have high-quality, accessible information to be able to make informed decisions about their healthcare.

To that end, I would like to highlight two important developments of MHRA reform.

Firstly, the MHRA expert working group on optimising data on medicines used during pregnancy is today publishing its report which recommends ways in which healthcare data can be better collected and made available for analysis. This will enable the generation of better evidence on medicines used in pregnancy and will be vitally important when developing clear and consistent advice for women.

Second, the MHRA has established a safer medicines in pregnancy and breastfeeding consortium. This brings together 16 leading organisations from across the NHS, regulators, and key third sector and charitable organisations. Today, they are launching a strategy setting out how they will work to improve information on medicines for women who are thinking about becoming pregnant, are pregnant, or are breastfeeding.

Sodium Valproate

On sodium valproate, in response to concerns raised during the previous debate on the IMMDS review, I am pleased to announce that the National Director of Patient Safety has recently established a Valproate Safety Implementation Group.

This Valproate Safety Implementation Group will drive forward work to reduce harm from valproate through taking action to reduce the number of women prescribed valproate, and improving patient safety for women for whom there is no alternative medication, for example by increasing adherence to the Valproate Pregnancy Prevention Programme. The programme will ensure that every girl or woman knows about the risks of valproate in pregnancy, that where appropriate she is on effective contraception, and that she has a review by her specialist prescriber at a minimum once a year, when a risk acknowledgement form will be discussed and signed by both prescriber and woman herself. Importantly, the Valproate Safety Implementation Group will work with patients to understand how women can be supported to make informed decisions about their health care.

In addition, last week the MHRA published the conclusions of a safety review into antiepileptic drugs conducted by the Commission on Human Medicines. This will help clinicians identify safer alternatives to valproate for the treatment of epilepsy in women who may become pregnant.

I am also pleased to announce that the first data from the new Valproate Registry will become available later this month. The registry is being developed by the MHRA and NHS Digital, and will support work to monitor adherence to the Valproate Pregnancy Prevention Programme, and allow for long-term individual patient follow up.

Recommendation 7: A central patient-identifiable database should be created by collecting key details of the implantation of all devices at the time of the operation. This can then be linked to specifically created registers to research and audit the outcomes both in terms of the device safety and patient reported outcomes measures.

The seventh recommendation in Baroness Cumberlege’s report rightly reflects on the importance of collecting the right data for monitoring the safety of medical devices. We recognise the need for improved data collection and analysis for medical devices.

That is why the Government acted in June last year to amend the Medicines and Medical Devices Bill to create the power to establish a UK-wide medical device information system prior to the review report being published, as we recognised the need to deliver such an information system. This system will mean that in future, subject to regulations, we can routinely collect medical device, procedure and outcome data from all NHS and private provider organisations across the UK, ensuring that no patient in the UK falls through the gaps.

The Government are grateful to Members in both Houses, including Baroness Cumberlege, for their support for establishing a medical device information system.

Recommendation 8: Transparency of payments made to clinicians needs to improve. The register of the General Medical Council (GMC) should be expanded to include a list of financial and non-pecuniary interests for all doctors, as well as doctors’ particular clinical interests and their recognised and accredited specialisms. In addition, there should be mandatory reporting for the pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians.

The Government are considering recommendation 8, which is that doctors’ financial and non-pecuniary interests should be declared and publicly available.

Any publication of declarations of interest should cover all clinical decision-making staff, not just doctors: it would also need to be held where patients could most easily access and interpret the information, with appropriate governance arrangements. We will consider these issues in discussion with the GMC, other stakeholders and the patient reference group to ensure the views of patients are listened to and incorporated.

Recommendation 9: The Government should immediately set up a task force to implement this review’s recommendations. Its first task should be to set out a timeline for their implementation.

The Government have no plans to establish an independent taskforce to implement the report’s recommendations. A cross-system working group has already been set up, meeting regularly, to develop the Government’s detailed response to the report.

However, the Government recognise the need for effective patient engagement both to build trust, and ensure effective implementation. I am pleased to announce today that we are establishing a Patient Reference Group, which is part of Baroness Cumberlege’s ninth recommendation. The Patient Reference Group will ensure that patient voices are heard as we move forward towards a full response to the report.

Conclusion

The report of the IMMDS review powerfully demonstrates the importance of hearing the patient voice in patient safety matters. The actions outlined here demonstrate the Government’s commitment to learning from this report, and will support vital work already underway to hear the voice of the patient as part of the NHS Patient Safety Strategy. We currently plan to respond further to the report of the IMMDS review during 2021.

[HCWS692]

Ockenden Review

Nadine Dorries Excerpts

Thursday 10th December 2020 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

With permission, Madam Deputy Speaker, I would like to make a statement on the initial report from the Ockenden review, which was published this morning.

Before I update the House on the findings, I wish to remind the House of the tragic circumstances in which the review was established. It was requested by the Government following concerns raised in December 2016 by two bereaved families whose babies had sadly died shortly following their birth at the Shrewsbury and Telford Hospital NHS Trust. I am grateful to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who, as Secretary of State for Health and Social Care, asked NHS Improvement to commission the independent inquiry.

The inquiry is chaired by senior registered midwife Donna Ockenden, a clinical expert in maternity who was tasked with assessing the quality of previous investigations and how the trust had implemented recommendations relating to newborn, infant and maternal harm. As the report acknowledges, this year the country has rightly united in pride and admiration for our NHS, but we must accept that in the past not everyone has experienced the kindness and compassion from the NHS that they deserved.

The review team has met face to face with families who have suffered as a result of the loss of brothers and sisters, or who have, from a young age, been carers to profoundly disabled siblings. The team has also met parents in cases where there have been breakdowns in relationships as a result of the strain of caring for a severely disabled child or the grief after the death of a baby or resultant complications following childbirth.

The original terms of reference for the review covered the handling of 23 cases; however, since its launch more families have come forward and extra cases have been identified by the trust. As a result, the review now covers 1,862 cases, and this has led to an extension of its scope and delivery. An interim report has therefore been published today, and it contains a number of important themes that the review team believe must be shared across all maternity services as a matter of urgency. Indeed, I personally, and the Government, pushed to have this interim report at this point in time so that we could learn from the findings of the inquiry so far.

This is the first of two reports, based on a review of 250 cases between 2000 and 2018; the second, final report will follow next year. Today’s report makes it clear that there were serious failings in maternity services at the Shrewsbury and Telford Hospital NHS Trust. I would like to express my profound sympathies for what the families have gone through. There can be no greater pain for a parent than to lose a child. I am acutely aware that nothing I can say today will lessen the horrendous suffering that these families have been through and continue to suffer. Nevertheless, I would like to give my thanks to all the families who agreed to come forward and assist the inquiry.

The review team held conversations with more than 800 families who have raised serious concerns about the care they received. I know that it has not been easy for them to revisit painful and distressing experiences, but through sharing their stories we can ensure that no family has to suffer the same pain in the future. From the outset the inquiry wanted families to be central to the team’s work and for their voices to be heard, and I am pleased that the families were able to see the report first, this morning, shortly before it was presented to Parliament. I assure them, and Members of this House, that we are taking today’s report very seriously and that we expect the trust to act on the recommendations immediately.

I thank Donna Ockenden and her team for their diligent work. Their valuable work provides essential and immediate actions to improve patient safety and ensure that maternity services at the trust are safe. Four of those actions are for the trust and seven are for the wider maternity system. The report sets out clear recommendations for what the trust can do to improve safety relating to overall maternity care, maternal deaths, obstetric anaesthesia and neonatal services.

The report also sets out actions that can make a difference to the safe provision of maternity services everywhere. They include recommendations on enhancing patient safety and how we can best listen to women and families, developing more effective staff training and ways of working, managing complex pregnancies and risk assessments throughout pregnancies, monitoring foetal wellbeing, and ensuring that patients have enough information to give informed consent. I welcome those recommendations and the others in the report. We will be working closely with NHS England, NHS Improvement and Shrewsbury and Telford Hospital NHS Trust, which have accepted each of the recommendations and will take them forward. We learn from these tragic cases so that we can give patients the safe and high-quality care that they deserve.

Patient safety is a big priority for me and the Government. We want the NHS to be the safest place in the world to give birth, and this report makes an important contribution towards that goal. Our ambition is to halve the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries in babies occurring during or soon after birth by 2025. We have achieved early our ambition of a 20% decrease in stillbirths by 2020, but of course there is always more to do and we owe it to the families to get it right.

The Ockenden review is an important document that vividly shows the importance of patient safety. I assure the House that we will learn the lessons that must be learned so that the tragic stories found within these pages will never be repeated again. I commend this statement to the House.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I thank the Minister for advance sight of her statement and the personal commitment she has shown on this issue. I too thank Donna Ockenden and her team for their work to date.

Sadly, the report is not the first of its nature, and it is unlikely to be the last. We need to get ourselves into a place, sooner rather than later, where these systemic, almost cultural, failings become a thing of the past. The families have suffered unimaginable pain, and it must not be exacerbated by closed and defensive responses to the tragedies they have experienced.

Today’s statement comes only a fortnight after another damning report on maternity safety—Bill Kirkup’s report “The Life and Death of Elizabeth Dixon”. This is the latest in a long line of reports that show that, across large parts of the NHS, there is still a long way to go before we have the openness and transparency that patients deserve. That is not to do down the hundreds of thousands of staff who do a fantastic job day in, day out, but the report points to the wider problem—it is not a new problem—that when things go wrong, there is too little candour, too much defensiveness and a lack of leadership at the top of trusts; the leadership do not take personal responsibility and put right what has gone wrong.

Once again, we have got to this point only because of the persistence and resilience of the grieving families who have suffered such personal tragedy and refused to accept that what they were told was the end of the matter. I want to put on the record my appreciation of the courage and strength that they have shown throughout, but we really should not expect light to be shone on these issues only because individual families do not accept what they are told.

Senior leadership within trusts has to be much more candid and challenging with itself when faced with these concerns.  These families just want answers and an assurance that nobody else will have to go through what they did, but, too often, they do not get them. The fact that we are now looking at more than 800 cases over a 40-year period, when the original investigation was tasked to look at just 23, must surely tell us that, for a very long time, those grieving families were not being listened to and the necessary lessons were not being learned. That in itself is as much a failure as the individual incidents. With so many more families coming forward and having to relive some of the most difficult experiences in their lives, it is vital that support is offered to them to deal with the consequences of that, so can the Minister assure us that appropriate support is available to all those who need it?

So that we will all be clear now, the Ockenden review will be far larger and take far longer than was originally intended. Can the Minister assure the House that the review has the resources necessary to complete the final report as soon as possible? I understand that the trust has not waited until today to take action, but, inevitably, further recommendations will emerge from the final report. There are also actions for the whole NHS, and a number of specific actions that can be taken across the board now, which the Minister indicated are in fact urgent. I would be grateful if she indicated whether she intends to set a deadline for implementation of the system-wide recommendations and whether she will provide regular updates to the House on their progress.

Strong leadership, challenging poor workplace culture and ring-fencing maternity funding are all key to improving safety. On tackling the poor workplace culture that exists in some trusts, it is clear that there is still a long way to go. It is concerning to see a report this morning that the review into bullying at West Suffolk Hospital, which was originally due to be published last April, is now not due until next spring. It is also clear that there is a pressing need to reinstate the NHS maternity safety training fund. That money was vital for safety and makes a big difference to care, so can the Minister commit to reinstating that training fund?

Can the Minister also advise what action is being taken to ensure that we have enough staff in all maternity units, and will the Government commit to legislating for safe staffing levels? More widely, can she set out what is being done to tackle the estimated 3,000 midwife vacancies that we currently have? We cannot ignore the fact that some of the problems created by this culture will be exacerbated and will continue if we do not solve the staffing and resourcing crisis in the NHS, and these issues will continue to compromise patient safety.

Finally, it is understandable if families who are currently receiving care at the trust are anxious. Can the Minister provide them with some reassurance today that they will be safe and well looked after?

[Ms Dorries]

I thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his, as always, constructive and reasonable tone in his response. Yes, I can assure him that the resources are in place, and have been guaranteed to be in place. As for the deadline, it is 2021. I cannot give an exact month. It was really important to me—I believe that Donna Ockenden has mentioned this in her report a number of times— that the first 250 cases were evaluated so that we could take the learning from those cases and introduce it as quickly as possible. In that way, we could identify what had gone wrong so that we could prevent it from happening again in the future. That is why we have produced the report in two stages. We know the findings of this interim report and the recommendations that have been identified by Donna and her team can be put in place. The second stage of the report will appear before the end of next year—certainly in 2021. I will, as the hon. Gentleman requests, and personally if he requires it, update the House on what is happening with the report.

With regard to the maternity safety training fund, we secured £9.4 million in the spending review. It cannot be underestimated, in this time of covid, what a huge achievement that was. The money will not go into the old format of the maternity safety training fund, because we do not believe that that worked as well as it should have done. Much of that money was used to backfill the staff, who then, unfortunately, did not attend training. We did not get the best results—the biggest bang for the buck.

What we, as a Department, are doing now is directing that £9.4 million to where it is needed most and to where it can be spent in the most effective manner to produce results in maternity safety. That work is ongoing now in the Department, and I hope to be able to update the House and the hon. Gentleman very soon on how that money is being spent and what results we expect to see in return for the expenditure.

I did not anticipate the hon. Gentleman’s question about midwives. I do not have the exact number, because the figure rises every day. None the less, we are recruiting new nurses—I think the figure was 12,000 when I last gave a statement to the House—some of whom will be recruited to become midwives. So, yes, work is under way on the workforce and on nurse recruitment.

[Jeremy Hunt (South West Surrey) (Con)]

Babies’ skulls were fractured and bones were broken in excruciatingly traumatic births that would never have happened if mothers’ wishes had been listened to. This is an utterly shocking report, and I think the whole House is immensely grateful to Donna Ockenden and her team for such a thorough report, and to the Minister for taking it so seriously, as she always does.

Although much has improved in maternity safety in recent years, does the Minister agree that it is time to stamp out the “normal births” ideology, which says that there can be a debate or compromise about the total importance of a baby’s safety? That should always be paramount, and decisions on it should always be taken in consultation with the mother. The report team said they had

“the clear impression that there was a culture within The Shrewsbury and Telford Hospital NHS Trust to keep caesarean section rates low”.

That needs to stop—not just at Shrewsbury and Telford, but everywhere throughout the NHS. The biggest mistake in interpreting this report would be to think that what happened at Shrewsbury and Telford is a one-off, as it may well not be and we must not assume that it is.

Secondly, the report talks about the “injudicious use of oxytocin” to facilitate vaginal births that perhaps should not have been happening. Will the Minister look into that issue? Finally, this report happened because Rhiannon Davies and Richard Stanton, who lost their daughter Kate in 2009, and Kayleigh and Colin Griffiths, who lost their daughter Pippa in 2016, persuaded me that something needed to happen. Is it not shameful that we make it so hard for doctors, nurses and midwives in the NHS to speak out about tragedies that they see and that all the burden for change is left on the shoulders of grieving relatives? Is it not time, once and for all, to end the blame culture that we still have in parts of the NHS?

[Ms Dorries]

My right hon. Friend asked a number of questions that deserve answers, so please bear with me. His first point was about the number of caesarean sections and the thought or belief in the hospital that it was a good thing not to have them, which the report identifies.

The report shows us that there were years when C-sections at Shrewsbury and Telford were running at 11% and the national average was 24%, and at 13% when the national average was 26%. That demonstrates a lack of collegiate working between midwives, doctors and consultants. Most of the report’s recommendations show that, fundamentally, that is the problem: a lack of communication and an unwillingness to work with people—the medics, doctors, obstetricians and midwives. My right hon. Friend is absolutely right about intervention. There is the old saying, “Mother knows best”, but every woman should own her birth plan and be in control of what is happening to her during her delivery.

I give all thanks to my right hon. Friend, because this report is fundamental in terms of how it is going to inform maternity services across the UK going forward, not least because the NHS is working on an early warning surveillance system. What happened at Shrewsbury and Telford was that it was an outlying trust. As with East Kent and others, including Morecambe Bay, where we have seen issues, there has been an issue culturally; they are outlying, without the same churn of doctors, nurses, training or expertise. The NHS is now developing a system where we can pick up this data and know quickly where failings are happening.

Oxytocin is a drug used in the induction of labour to control the length, quality and frequency of uterine contractions. There are strict National Institute for Health and Care Excellence guidelines on the use of that drug. My right hon. Friend is correct: every trust should follow the guidelines. By highlighting that in this report, we will ensure that trusts are aware of those guidelines and that they are followed in future.

[Wera Hobhouse (Bath) (LD)]

Our heart goes out to all those who have suffered these tragic events and losses; those of us who are parents or grandparents suffer with these families. May I ask the hon. Lady a question as the Minister for Mental Health? The mental health of mothers during and after pregnancy is vital, not just in the tragic circumstance of baby loss or severe injuries during birth. Will she ensure that training in perinatal mental health becomes a strong focus for improving maternity services across the country?

[Ms Dorries]

I hope the hon. Lady will not mind my mentioning it, but I know that she is about to become a grandmother herself soon, so I understand the reason for her questioning. She raises a very important point. I know she is aware, because I believe we have had this conversation, that we are focusing on women in the Department at the moment, and of course the mental health of women is a big part of that. The post-natal depression services that have been rolled out across the UK in the past 18 months are a testament to the fact that we are focusing on mental health. I take her point on board, and she has made it before.

[Lucy Allan (Telford) (Con)]

I very much thank the Minister for coming to the House so promptly and making this statement, and for her commitment to patient safety. I also pay particular tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt) for initiating this very important review. Without that, we would not be here today.

The findings of the report are deeply harrowing. The scale of the deaths and injuries suffered are horrific, but so too was the response of the trust at the time. The report details this. Women at their most vulnerable could not get their voices heard. They were not listened to by those in positions of power, who normalised poor maternity care and also denied its existence. Instead of humility and empathy, what we saw was the harshness of bureaucratic defensiveness, with women at times “blamed for their loss”—that is in the report.

There is now a criminal investigation into this matter, but I would be grateful if the Minister would please ensure that nothing gets in the way of implementing the recommendations as soon as possible, so that families can see real change in maternity care, at this trust and also right across the country.

[Ms Dorries]

I thank my hon. Friend for her pursuance, her persistence and her dedication, both to her constituents and the hospital as a trust. I would also like to mention, as my right hon. Friend the Member for South West Surrey (Jeremy Hunt) did, the parents of Kate Stanton-Davies and Pippa Griffiths, who have been instrumental in getting us along the pathway to where we are today. Yes, my right hon. Friend commissioned the report, I pushed for it to happen now, and my hon. Friend has been pushing also, but it is down to those parents and their commitment. It should not have to be like this. Parents should not have to go through what they have gone through to get to where we are today.

As my hon. Friend is aware, I have visited the trust myself and have been round the midwifery unit and the consultant-led unit, and I think there is an anomaly there. Should we have a midwifery unit and a consultants’ unit? Is that not where the problem is, with two separate disciplines not working together? Should there not be just one delivery unit? Does the culture not start there, and should we not look at how it works?

However, my hon. Friend has my absolute 100% assurance that, for as long as I am in this post, I will be driving forward the recommendations and findings of this report.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her understanding and compassion on the findings of the Ockenden report. With other right hon. and hon. Members, I wish to express my deepest sympathy to those families who have been grievously damaged by the failings of the Shrewsbury and Telford Hospital NHS Trust.

But will the Minister underline that sympathy alone is not necessarily what is required? What is required is action, and an undertaking to review procedures not only in this trust, but UK-wide, to ensure that the Ockenden report recommendations are implemented in all maternity wards. Will she give a guarantee that that will be done?

[Ms Dorries]

I thank the hon. Gentleman for his question; he is absolutely right, of course. The findings will be put in place, and in many trusts they already are. I was just looking for my data on the Morecambe Bay investigation, which I believe my right hon. Friend the Member for South West Surrey (Jeremy Hunt) also commissioned. If we look at the Morecambe Bay trust investigation, the predecessor to this, it is quite commonplace to say—I hear it all the time—“Well, we had Morecambe Bay and nothing has happened: the recommendations haven’t been implemented there.”

Actually, the Morecambe Bay investigation made 44 recommendations, 18 of which have been completed within the Morecambe Bay trust. There were 26 wider NHS learnings and recommendations, of which 14 were accepted nationally and 11 are being worked on now in the Department, to be rolled out nationally. I use that as evidence that reports such as this have consequences: actions that are implemented and make a difference in maternity units.

[Philip Dunne (Ludlow) (Con) [V]]

I add my sympathy and condolences to all those who have suffered loss or damage to their baby or mother in childbirth under the care of the trust, and I also add my voice to thank Donna Ockenden and her large team for the important work that they have done to review so many cases over the past two decades and more. I hope this will help each and every family who have suffered to reach a better understanding of the tragedy of their own case. However, the principal motivation of my then constituents, the Stanton-Davies parents, in coming forward following the loss of their baby daughter Kate, which prompted this review, was to ensure that other parents could be spared the trauma that they went through.

I am grateful to the Minister for her response to this report. In addition to what she has already said, can she tell the House, and the thousands of expectant mums whose babies are delivered by the committed clinicians at Shrewsbury and Telford Hospital NHS Trust every year, about the improvements in safety and standards that prevail now in the women’s and children’s unit? That might reassure them that some lessons have already been learned, that more will continue to be learned on the back of this review in implementing its recommendations, and that the maternity service in Shropshire and Telford provides a safe place for babies to be born.

[Ms Dorries]

I thank my right hon. Friend for his question. As he is aware, I have visited the trust. We have a chief executive in place now who I personally, and the Department and NHS England, have been working closely with, as well as with the team in the hospital. The trust has accepted the findings of the report and will take each of the recommendations forward, so that we learn from these tragic cases of the past and can give patients the safe and high-quality care that they deserve. My right hon. Friend was a Minister himself, I think possibly in my role, in the Department when this report was commissioned, so he has been involved with it right from the beginning.

We want the NHS to be the safest place in the world to give birth—I know I say that often at the Dispatch Box—and this report makes a valuable and important contribution towards that goal. That starts in Shrewsbury and Telford, where as I stand here now the recommendations are being discussed within the trust, and ways found both to deliver and to implement the recommendations that have been made, so that from today onwards Shrewsbury and Telford will be a safe place—as it has been for some time, while it has been on our radar and in special measures—for women to give birth.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

We are discussing today the traumatic findings thus far of the Ockenden review about the Shrewsbury and Telford Hospital NHS Trust, and our hearts go out to the grieving parents and families. Until recently, the travesty of Morecambe Bay was considered the worst maternity scandal in the NHS, so why have there since been others, and what steps are the Government taking to implement findings of successive inquiries into maternity services across our country?

[Ms Dorries]

As I said, the vast majority of the recommendations on Morecambe Bay have been implemented. Of those that were for wider NHS consideration, 14 have been implemented and 11 have not. However, this is not a case of us overnight going out and saying, “Right, this is how you change”—it takes a vast amount of work in policy, process and delivery. Those 11 recommendations are being worked on and have been worked on since the report on Morecambe Bay happened. The hon. Gentleman is right to highlight the fact that we do not have consistency across the NHS in terms of care or delivery. That is what we are working towards. We are currently developing a core curriculum of training that will be multi-disciplinary and we hope will rolled out next year. It will be undertaken by midwives, doctors, obstetricians and everybody working in the maternity unit so that they are all at a certain point of skill in terms of consistency, they are all aware of the lessons to be learned from the past in terms of safety, and they implement the recommendations that go across the UK in maternity units. Most maternity units in the UK operate well and deliver babies safely. We have fantastic maternity services in the UK. However, we do have difficult trusts. As in all disciplines, they are not all the same. This is about the outliers—the hospitals that we are working to identify early. With the core curriculum, we are making sure that everybody working in maternity units across the UK has the same standard and level of training.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con) [V]]

I welcome the considered tone the Minister has taken today in responding to the difficult contents of this report and in promoting a clinically led response to the findings rather than allowing knee-jerk political reactions that often do not lead to the right results. Let me pick up on one thing. What we see throughout a number of reports, be it Mid Staffs, Morecambe Bay or now this one, is that management is often central to setting a culture that allows mistakes and deaths to occur. When a clinician is found to be negligent, they have a responsible body—the Nursing and Midwifery Council or the General Medical Council—that can take action against them, but what are we going to do to ensure that managers receive better training and that we stop the revolving door of bad managers who are responsible for poor care being employed elsewhere in the NHS?

[Ms Dorries]

I thank my hon. Friend, who, again, is a predecessor in my Department—a former Health Minister. He is absolutely right to talk about strong leadership. Strong leadership has been established across the system. In the context of maternity services, which is what we are talking about, we have the maternity safety champions who are being led by Dr Matthew Jolly, the national clinical director of maternity and women’s health, and Professor Jacqueline Dunkley-Bent OBE, the chief midwifery officer for England. There are lead clinicians who are leading clinically.

In terms of the management of the Shrewsbury and Telford trust, there have been eight chief executives in 10 years. That is not good. Good practice does not come from a revolving door of chief executives and board members who constantly rotate, because there is no continuation of learning, no loyalty, and no commitment to good outcomes at the hospital. We have to change this revolving door of boards and chief executives. The chief executive who is there now has our confidence, and we are assured that she will put in place the recommendations of the report, but my hon. Friend is right: it is crucial that we work on this revolving door of managers and those who are not clinically led, because that is part of the problem. He is right to identify that, and I want to reassure him that it is something we are aware of.

[Liz Twist (Blaydon) (Lab)]

First, our thoughts today must be with all the families who have been affected by this tragedy. The investigation found that an area of concern was having the right staffing levels and the right skills mix. Will the Government look to legislate for safe staffing levels in the NHS and, in particular, midwifery?

[Ms Dorries]

It is probably in the Secretary of State’s domain to make that kind of statement at the Dispatch Box, so I cannot give the hon. Lady that reassurance myself, but we are delighted about the huge number of new nurses and doctors that we have in training. Recruitment of our workforce in the NHS is going well, and I hope that that will be the ultimate goal.

[Dean Russell (Watford) (Con)]

Reading this report is utterly heartbreaking, and my heart goes out to the families who have been involved in this terrible situation. Leadership, workplace culture and patient safety clearly go hand in hand, so what steps is my hon. Friend taking to strengthen clinical leadership, in order to ensure that all maternity wards are the safest they can be?

[Ms Dorries]

I pay tribute to my hon. Friend for not only his work at Watford General Hospital—he is probably there more often some of the patients—but his commitment to mental health in his constituency. He has launched a programme of 1,000 mental health first aiders, which is a tremendous boost to his constituents. I am aware of his work, and I thank him for it.

My hon. Friend has hit the nail on the head. Midwifery leadership has been strengthened this year by the appointment of seven regional chief midwives, working with local maternity services to ensure the provision of safer and more personal care for women, babies and their families. I am sure that the hon. Member for Ellesmere Port and Neston (Justin Madders) had the same thoughts that I did on reading the report. There is a lack of collegiate working—“Let’s not let the doctors have this. Let’s keep this for the midwives”—and a lack of team working. The recommendations in the report put forward solutions to end that culture and to introduce one where doctors, nurses and midwifery champions work together, as a team, with the mother, who is in control of and owns her birth plan, because that is what it should be about.

[Rachael Maskell (York Central) (Lab/Co-op)]

It is devastating to read about the families involved in this. We have been here so many times. I think back to the publication of the Robert Francis report in 2013, which particularly talked about the duty of candour and the way that those issues are addressed. Clearly the system is quite passive; it is dependent on people raising concerns. What is the Minister doing to ensure that it is more interrogative of families and those involved in order to draw out people’s concerns at what is perhaps their most vulnerable time, as is the case for many women when giving birth?

[Ms Dorries]

The hon. Lady is right: there is a theme. Whether it is Paterson, the Cumberlege review or Morecambe Bay, central to all this is women, and so much of this report is familiar in that women are not listened to. The way some of those mothers were spoken to when they were delivering their babies or during the most tragic hours and days afterwards is just appalling. It is about women being downgraded almost, as though their complaints, their voices or their concerns, and the awful circumstances in which they find themselves are not worthy of the same consideration as patients in other hospitals in other situations.

The hon. Lady is absolutely right. We already have national guardians—they immediately spring to mind. We have 600 national guardians in hospitals. NHS workers wear lanyards and, when people want to highlight something that they have seen going wrong in terms of patient safety, they may speak to that person, who will assist them and raise their concerns. It is quite something when we need that, when patients need such assistance. It is also for staff to raise patient concerns. She is absolutely right—it is about listening and treating the complaints and issues of women seriously.

[Robert Halfon (Harlow) (Con) [V]]

My heart goes out to the families. I pay tribute to the Minister for her work on this. Although these tragic things go wrong in our national health service, does my hon. Friend note that many good things also happen across our hospitals? Our maternity ward in the Princess Alexandra Hospital in Harlow has been described as “outstanding” by the Care Quality Commission, and is one of the most successful and important parts of our hospital. Will she pay tribute to and thank staff across the NHS, as well as in Harlow, who do so much? Will she also look at best practice around the country, in places like the Princess Alexandra Hospital for maternity, to see what can be done to learn from that best practice to ensure that such tragedies never happen again?

[Ms Dorries]

My right hon. Friend adds such a hopeful note. I thank him. He is absolutely right. We stand here to talk about reports, patient safety issues and where things have gone wrong, and yet so much of the NHS so much of the time goes absolutely right. The Princess Alexandra Hospital in his constituency is a shining light and an example of the best practice in maternity services. Of course, we use examples such as Harlow to inform us of how things go right and how well maternity units work. He is absolutely right, and we will of course look at Harlow, as we do at other examples of good service across the NHS, which is—I thank him for reminding us all of this today—in most hospitals most of the time. Our job is to reassure women. The UK is among the safest countries in the world in which to give birth, and most of the time it goes right.

--- Later in debate ---

[Kerry McCarthy (Bristol East) (Lab)]

In that case, I thank the Minister for what is clearly a very genuine response to the concerns expressed today. What has been said about the culture within the NHS, revealed in this review, has echoes of the Bristol heart babies scandal, and it is tragic that parents must still fight to have their voices heard now. One of the things mentioned by families contributing to the Ockenden review is the desperate need for longer-term support following experience of baby loss. I know from my constituents that the NHS has struggled to provide that during the current pandemic. What more can we do to ensure not just that parents are listened to at the time of losing their baby, but that they are supported from then onwards, too?

[Ms Dorries]

I thank the hon. Lady for her comments, sincerely, and for her important question. Baby loss is something that we discuss in this House—rightly so—and we are discussing what happened at Shrewsbury and Telford, because many parents there lost their babies. The report makes a recommendation that the care and support that parents are given following a bereavement are strengthened, and that measures are put in place to ensure that the right package is there. Many charities work in this area across the UK—I will just mention Baby Lifeline, Sands and others—and have themselves put in place both practical and emotional measures to help parents at such a time. It is the worst time, in anyone’s life, to lose a child. We say that so many times in here, and it is our responsibility, both in the Department and in society as a whole, to hold those parents and to help them through those awful times. I thank the hon. Lady for her question—this is something we take very seriously in the DHSC.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the Minister for her statement and her full responses to all the issues that were raised by right hon. and hon. Members. We will now have a three-minute suspension for the safe entry and exit of right hon. and hon. Members.