Maternity Services: East Kent

Nadine Dorries Excerpts

Thursday 13th February 2020 Commons Chamber

[Sir Roger Gale (North Thanet) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the provision and safety of maternity services in East Kent.

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

I will set out the situation concerning East Kent Hospitals University NHS Foundation Trust in line with the written statement laid in Parliament this morning. In fact, I took steps to inform Parliament of this matter before the UQ was requested, and I hope that reflects the importance I place on this issue. Before I begin, I would like to express my deepest and most heartfelt sympathies for the patients and families who have been affected.

I made a statement on 28 January on concerns about maternity services in East Kent Hospitals University NHS Foundation Trust, and I would now like to update the House based on the reports from the independent Healthcare Safety Investigation Branch and the Care Quality Commission. I requested that both HSIB and the CQC report back to me within 14 days when I instructed them to go into East Kent trust two weeks ago, and they reported to me on Monday.

HSIB has already conducted a number of maternity investigations at the trust as part of its national maternity investigation programme. These identified a number of safety concerns, including the availability of skilled staff—particularly out of hours—access to neonatal resuscitation equipment and the speed with which patients’ concerns are escalated up to senior clinicians and obstetricians, along with failings in leadership and governance.

As requested, the CQC carried out an unannounced inspection of the trust’s maternity services between 22 January and 5 February. It has written to the trust with an oversight of its findings, and the full inspection report will be published in due course. The CQC received additional information from the trust this week, following its request for further assurances on triage, day care and medical staffing. The CQC is considering this information. It is important that everyone is aware that the CQC is in regular contact with the trust and will continue to be so for the foreseeable future.

From the findings provided to me by HSIB and the CQC, it is clear that the challenges at East Kent point to a range of issues, including having the right staff with the right skills in the right place, effective multidisciplinary working, clear collaborative working between midwives and doctors, good communication and effective leadership support, but it would be wrong to speculate that there is indeed one single cause.

NHS England and NHS Improvement are working closely with the trust and have taken some immediate actions. First, the regional director and regional chief nurse are providing support to the trust, and the medical director will address concerns surrounding appropriate senior medical oversight. Secondly, the regional chief nurse is providing support to the director of nursing and head of midwifery, to prioritise and focus their local maternity improvement plans and address identified safety concerns. They will also review the effectiveness of clinical governance and executive leadership support. That will include ensuring that the trust learns from all historical cases, and disseminates that learning throughout the trust.

The Chief Midwifery Officer, Jacqueline Dunkley-Bent, has sent an independent clinical support team to the trust to provide assurances that all possible measures are being taken. That expert team includes a director of midwifery services from an outstanding trust, two consultant obstetricians, and a consultant paediatrician and neonatologist. She has placed the very best at the heart of the trust, on the wards, and at the bedsides of patients, with fresh eyes to oversee the care currently being delivered. The independent team is working with trust staff to deliver immediate improvements to care, and to put in place robust and comprehensive processes to support improvements in standards over the long term. Jacqueline Dunkley-Bent has personally visited the trust to assess the changes being put in place, and to ensure that improvements are moving at pace.

Jenny Hughes, chief midwife for the south-east region, is working with the trust directly, and regional and national teams from NHS England and NHS Improvement will continue to work with the trust. The trust is taking the issue seriously and is working closely with NHS England and NHS Improvement. It has created and filled several specialist midwife posts. Safety huddles, where safety issues are regularly and frequently discussed, have been embedded on both sites to anticipate problems before they occur, and multidisciplinary teams are working collaboratively.

[Mr Speaker]

Order. The Minister is supposed to speak for three minutes, but we are now at five minutes plus. I realise that she has been given a lot of notes, and I think officials ought to take on board the time. I am not looking to you, but I am looking to others to help in the future. I am sure we will be coming to the end of the remarks, as there are lots of questions.

[Ms Dorries]

Thank you, Mr Speaker. I think in defence of my officials, because this is such a sensitive issue—

[Mr Speaker]

Order. I am not getting into a debate about this. I do not make the rules of the House. The House makes the rules, and it has decided that responses should be for three minutes, not me.

[Ms Dorries]

I will go straight to my closing statement, Mr Speaker. I reiterate my condolences, particular to the family of Harry Richford and all those affected. I also thank my right hon. Friend the Member for North Thanet (Sir Roger Gale) for raising this important issue. The Government are fully committed to reducing patient harm and improving the safety of maternity services.

[Sir Roger Gale]

I will try hard not to abuse your generosity, Mr Speaker, and on behalf of Tom and Sarah Richford I thank you for allowing me to ask this desperately sad and desperately urgent question. I also thank the Minister for her swift and robust action since the report landed on her desk on Monday night, which was based largely on her personal professional experience. I am deeply grateful, and I know that the families are too.

This morning, at an early hour, I spoke for half an hour with a husband and wife who now live in Australia. Two months after the death of Harry Richford, they lost their own child under similarly tragic circumstances, and it was the most harrowing call I have taken in 36 years in this House. Those parents deserve and need the opportunity to achieve closure and move forward, and they need to know that the failures in protocol, in clinical judgment, and in management, have been addressed.

Will my hon. Friend publish the Care Quality Commission report to which she referred as soon as possible? Will she seriously consider establishing an independent inquiry, so that at the very least, Harry Richford’s parents, Rosie’s parents, and others, will know that their children have not died in vain, and that this will never, ever, happen again?

[Ms Dorries]

I thank my right hon. Friend for his comments and suggestions. In response to his call for an independent inquiry, last night I asked my officials to look into sending the independent Healthcare Safety Investigation Branch back in to do a deep dive into historical and existing cases at the trust. I want to reiterate that the trust is a safe place for any woman who is pregnant or giving birth. We have some of the very best people and clinicians working in that trust right now.

I would just like to add that NHS England and NHS Improvement are themselves commissioning an independent review into East Kent maternity services, so my right hon. Friend’s question has been answered. That is the news I have just been given. We are taking this situation very seriously. We will publish the findings of the HSIB and CQC reports in due course, because we take this matter—I personally take this matter—very seriously.

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

Our thoughts go out to all the families, including the family of Harry Richford, who have endured unimaginable heartbreak because of avoidable and preventable failings at the trust. Harry Richford was aged just seven days when he died. His death was described by the coroner as “wholly avoidable”. This was a wholly avoidable tragedy and not, as the trust originally said, “expected”. After Harry died, the trust refused to refer the case to the coroner and it was only the persistence of the family that led to the inquiry.

The trust will now receive special support to help turn things around, but can the Minister outline exactly what that support will be, by whom and where the funding is coming from? Why has it taken us so long to get to this point? It was reported earlier this month that despite evidence in a report by the Royal College of Obstetricians and Gynaecologists back in February 2016, the same mistakes were made in subsequent years. We need an explanation for why those warnings four years ago were allowed to go unnoticed and unaddressed. I understand that the trust will not be put into special measures and it seems that the chief executive and the medical director will be staying in post. However, given the trust’s failure to deal with those identified failings at the first opportunity, there must surely be questions about the local leadership. Can the Minister outline whether anyone in the trust will be held personally accountable?

Once again, we are unfortunately hearing about another tragedy where the culture has exacerbated the pain suffered by the family: denial, obfuscation and a staggering lack of transparency. Why is it that these issues only come to light because of the persistence and bravery of the affected families? We need to create a culture within the NHS where safety concerns can be raised by trained staff at all levels, free from fear so that issues are dealt with quickly. Perhaps the biggest concern we have is that we do not know the true number of avoidable maternity deaths at the trust.

I would like to join Harry’s family and other Members in calling for a full independent inquiry. I understand that the HSIB deep dive will address matters to some extent, but I do not think it is the full transparent inquiry that the parents deserve and demand.

[Ms Dorries]

I thank the hon. Gentleman for his collaborative tone on this issue. I think he may have missed my last comment, which was that NHS England and NHS Improvement will be commissioning an independent inquiry. That has been decided this morning, so that will happen.

On the hon. Gentleman’s first question about what is happening to support the trust now, NHS Improvement is in there. As I said, the chief midwife, Jacqueline Dunkley-Bent, has sent in some of the best midwives, obstetricians and neonatologists in the country from outstanding trusts to support the trust. They are having twice-daily huddles on the wards, which is where multi- disciplinary teams get together and discuss on an ongoing and regular basis what is happening on the wards, what disciplines are involved and what measures are being taken. We have fresh eyes looking at the cartography that measures foetal heart rates and contractions. We have a second pair of eyes reading those cartography read-outs, so it is not just down to one midwife.

A huge amount of support has gone into the trust. As I said, it is today a safe place for anyone to give birth. We are also asking HSIB to go in to do that deep dive to look at historical issues. Whether that will continue in light of the fact that NHS England is commissioning an independent inquiry is something I need to find out when I leave the Chamber. However, I want to reassure the hon. Gentleman and everybody that this is an issue that I take very, very seriously.

Babies bring joy and happiness when they arrive, and every family—every mother, every father and, indeed, every grandparent—is entitled to know that when they or their relative is in hospital, the delivery will happen in a safe environment, with the very best care. I can say that that is the case at East Kent now, and I—we all—will strive to make sure that it is the case at every hospital.

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

I thank my right hon. Friend the Member for North Thanet (Sir Roger Gale) for tabling this urgent question and for speaking so powerfully. I also thank the Minister for her work to respond to this. I, for one, hope that she continues in her role after the reshuffle because of her incredible commitment to patient safety.

What worries members of the public is that the NHS appears to be much better at transparency about care failures, but not always much better at learning from those failures. Does the Minister agree that that underlines the vital importance of the independent investigations that HSIB does into every Each Baby Counts incident, and the need for safe spaces so that doctors, nurses and midwives can talk openly and freely about what they think went wrong? Will she also consider publishing the report that CQC has already done into what is happening to reassure families that we are indeed confronting all these difficult issues?

[Ms Dorries]

My right hon. Friend is absolutely right. One of the issues in dealing with the ongoing problem—this is a bit like the airline industry—is that we need to generate a culture in which NHS staff feel able to speak up without fear of blame or litigation and we can take learning forward. Another issue is that when we have inquiries, we should take the recommendations and ensure that they are implemented. That piece of work is also going forward, along with HSIB and inquiries. We should look at implementing absolutely everything that we can to make sure that the safest possible environment exists.

[Rosie Duffield (Canterbury) (Lab)]

I am extremely grateful to the Minister for addressing these urgent issues and to the right hon. Member for North Thanet (Sir Roger Gale) for securing the urgent question, as well as to the former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), who has shown a real interest in this case—especially now that he is Chair of the Health and Social Care Committee. I thank them very much.

I am grateful that we are talking about these inquiries and investigations. So many things have been brought up in the reports, and there are many questions from my constituents, dozens of whom are now really terrified about their future pregnancies and having babies in the area. Will the Minister think about committing to safe staffing levels, because there are so many issues in our trust, and that would be one way to reassure staff and patients?

[Ms Dorries]

I thank the hon. Lady for her commitment to working with her constituents, which is shared by my right hon. Friend the Member for North Thanet (Sir Roger Gale) and my hon. Friend the Member for Dover (Mrs Elphicke). I think that we should refrain from using words such as “terrified” because, as I said, the trust is a safe place for any woman to give birth. We have the best midwives, obstetricians and neonatologists from outstanding trusts working there now. She will know, as I do, that the trust’s location is slightly remote. Recruitment outside the major cities is a difficult issue, and we have to look at that for maternity services in trusts that are outlying in geographical terms. She is absolutely right to raise that issue, but I reiterate that it is very important that she lets her constituents know that the trust is a safe and welcoming place for women to go and give birth, because some of the very best staff in the country are working there right now and making sure that that is the case.

[Mrs Natalie Elphicke (Dover) (Con)]

I pay tribute to my right hon. Friend the Member for North Thanet (Sir Roger Gale) for his respect and diligence in securing answers for the family of baby Harry Richford, and also the hard work, commitment and compassion that has been shown by the Minister, particularly over the last two weeks, when she has worked night and day to make sure that there is a healthy and safe environment for our constituents—I thank her for that. Such strong and compassionate leadership in the handling of these tragic matters has not been shown by the trust, and I would like assurances that matters of culture, leadership and management will be addressed in the next stage, together with any update on whether inquests will be extended in relation to situations such as baby Tallulah-Rai, when there cannot currently be an inquest?

[Ms Dorries]

My hon. Friend was not in her usual place when I referred to her earlier, but now she is! I thank her for her kind comments.

I think that we now need to let the NHS and NHS Improvement go in and do their work, and to have the independent inquiry. As my hon. Friend knows, when an independent inquiry is taking place, these issues become more difficult to talk about, but I am sure that the inquiry will include a full assessment of the executive team and the board at the hospital, because those at the top must take full responsibility for whatever has happened in the trust. I hope that Simon Stevens of NHS England will not mind my saying that no stone will be left unturned. I will certainly be seeking reassurances that that is the case, and, from ward level to the chief executive’s office, this inquiry will be thorough and robust, because I will make sure that it is.

[Laura Trott (Sevenoaks) (Con)]

My right hon. Friend the Member for North Thanet (Sir Roger Gale) described powerfully the devastation and grief that these families are going through. Can the Minister reassure us that they are being given support to help them through this really difficult time?

[Ms Dorries]

I must congratulate Jacqueline Dunkley-Bent, the chief midwifery officer at NHS Improvement—we are very lucky to have her. Compassion drives her, along with the absolute pursuit of excellent maternity standards. I know that there will be support for those families, and that NHS Improvement will also be reaching out to women who are pregnant and are due to go into the trust.

Let me say this, because I did not mention it in my original response. A number of measures are being taken in relation to the trust, which I probably cannot specify, but a written ministerial statement, which is in the House of Commons Library, gives the full list. I want Members to be reassured that those measures are thorough and robust, and they are working.

[Lucy Allan (Telford) (Con)]

I thank the Minister for her excellent work and I hope that she does indeed continue in her present position.

Tragically, East Kent is not just a one-off; there seems to be a more widespread culture of denial throughout the NHS. We have seen that in the trust in my constituency. The management is saying, “It is historic, it is scare- mongering, it is just a few preventable deaths.” Does the Minister agree that if those in hospital management are to learn lessons, it is essential that that culture of denial is tackled and they recognise their shortcomings so that services improve?

[Ms Dorries]

As my hon. Friend knows, I have been to Shrewsbury and Telford Hospital NHS Trust to reassure myself—line by line—that every recommendation that was made by the Care Quality Commission has been implemented and is working. I thank her for raising this issue, but I also want to emphasise that Shrewsbury and Telford is a safe place for women to give birth, because the same robust approach is being taken there. It is a safe environment, and, as my hon. Friend will know, a new midwife-led unit will be opening shortly.

However, there is a culture that I know concerns the former Health Secretary, my right hon. Friend the Member for South West Surrey (Jeremy Hunt). In such circumstances, trusts do not feel able to put their arms around parents, to say sorry, to explain to them what has happened, and to show compassion or care. That culture must be broken, and I think that HSIB will go a long way towards contributing to the process.

[Victoria Prentis (Banbury) (Con)]

All too often when a baby dies, the shutters come down in a trust and we cannot get the answers that we need. Will the Minister—who is providing great leadership in this area—meet members of the all-party group on baby loss to discuss how best we can use MBRRACE-UK, HSIB and other investigators to get to the bottom of what happens? Will she also think about making maternal deaths a never event?

[Ms Dorries]

I fear that you will shout at me again, Mr Speaker, if I try to answer my hon. Friend’s question fully, because I agree with everything that she has said. Maternal deaths absolutely must become a never event, and we must focus on making pre-eclampsia and post-partum haemorrhage, which lead to such deaths, never events. I went to the first meeting of the APPG on baby loss and, as my hon. Friend knows, I am always happy to go and hear anything that anyone has to say about this issue that will help our work in trying to improve maternity standards[Official Report, 2 March 2020, Vol. 672, c. 4MC.].

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I should mention at the start of my question that I work as a consultant paediatrician, and that I look after babies and have attended a number of deliveries. I would like to thank the Minister for being so thorough, robust and dedicated in ensuring that this situation improves and that babies are safely delivered throughout the country. In my practice, I have noticed that all baby deaths and adverse outcomes are thoroughly investigated locally, but in my experience this tends to be done just locally. The lessons might be shared internally, but they are not being shared with other hospitals down the road, where the same mistake might be made. I welcome what she is doing, but can she reassure me that those lessons will be shared nationally, so that everyone can benefit from the lessons that are learned, and that such sharing will be widespread so that future tragedies are prevented? Can she also reassure me that, when she sets up the Healthcare Safety Investigation Branch process, its culture is such that doctors, nurses and midwives are able to give full and free answers, and that we get the balance between accountability and blame just right?

--- Later in debate ---

[Ms Dorries]

I thank my hon. Friend for her comments as a consultant paediatrician. She is a huge source of advice to me at times, including informally over a cup of tea. On her first question: yes, she is absolutely right to say that the investigations take place at local level and that that goes inwards into the local trust. I think that is something that we have to review. On her question about disseminating learning nationally, that comes through HSIB, but she is right to suggest that HSIB does not go into every investigation. One of the problems with a trust investigating itself and taking the learning inwards is the question of what reassurance we have that lessons are being learned and disseminated, and that improvements are taking place. I am going to ask officials to look at that, because we might have to work on developing a different model for maternity services, although we do have NHS Resolution and the HSIB, and a lot of work is going on in this area. However, we have seen too many cases in too short a space of time, and we now have to look at maternity services and patient safety with fresh eyes and decide how we make this the best for parents who have tragically lost a baby, from that moment onwards until they move forward.

Maternity Services: East Kent

Nadine Dorries Excerpts

Thursday 13th February 2020 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

I made a statement on 28 January about concerns regarding maternity services in East Kent Hospitals University NHS Foundation Trust. I explained that I had sought reports from both the health service investigation branch and the Care Quality Commission and asked them to report back in 14 days. I have now received those reports and an update from NHS Improvement and NHS England and would like to make a statement.

The most important thing when having a baby is that you expect to receive the safest possible care. When things go wrong that lead to harm, it is devastating for all concerned. Therefore, I would like to express my deepest and heartfelt sympathies for the patients and families of those affected.

System response

The key partners within the health system continue to work with the trust to identify the problems in maternity services and to ensure that swift remedial and appropriate action is taken. We all want and need to know that the care delivered is of the highest standard we would wish for ourselves and for our families.

Diagnosis (HSIB and CQC)

The healthcare safety investigation branch has conducted a number of maternity investigations at the trust as part of its national maternity investigation programme. It has started 25 maternity investigations at the trust since July 2018, of which 16 have been completed. These have identified a number of safety concerns, including the availability of skilled staff, particularly out of hours, access to neonatal resuscitation equipment, the speed with which patient concerns are escalated up to senior clinicians and obstetricians, along with failings in leadership and governance.

As requested, the Care Quality Commission carried out an unannounced inspection of East Kent Hospitals University NHS Foundation Trust’s maternity service between 22 January 2020 and 5 February 2020. The Care Quality Commission inspected the maternity provision at William Harvey Hospital, Ashford and the Queen Elizabeth the Queen Mother Hospital, Margate. These two sites provide the acute inpatient care and the vast majority of the trust’s maternity service.

The Care Quality Commission has written to the trust with an overview of its findings and the full inspection report will be published in due course. The CQC received additional information from the trust on Tuesday, following its request for further assurance on triage and day care and medical staffing. The CQC is considering this information and is in regular contact with the trust leadership to gain assurance of the required actions. The Care Quality Commission will continue to engage with the trust on all these issues and consider whether any further action is necessary.

It is important that everyone is aware that, the CQC is in regular contact with the trust and will continue to be so for the foreseeable future.

Robust actions in hand

From the findings provided to me it is clear that the challenges at East Kent point to a range of issues including having the right staff with the right skills in the right place, effective multidisciplinary working, clear collaborative working between midwives and doctors, good communication and effective leadership support. But it would be wrong to speculate that there is one single cause.

NHS England and Improvement are working very closely with the trust, and they have taken some immediate actions.

First, the regional medical director and regional chief nurse are providing support to the trust. The medical director will address concerns surrounding appropriate senior medical oversight.

Secondly, the regional chief nurse is providing support to the director of nursing and head of midwifery to prioritise and focus their local maternity improvement plans to address identified safety concerns. They will also review the effectiveness of clinical governance and executive leadership support, and this will include ensuring the trust is taking the learning from all historical cases and disseminating that learning throughout the trust.

England’s excellent chief midwifery officer, Jacqueline Dunkley-Bent, has sent an independent clinical support team into the trust to provide assurance that all measures possible are being taken. This expert team includes a director of midwifery services from a CQC-rated outstanding trust, two consultant obstetricians and consultant paediatrician and neonatologist. She has placed the very best at the heart of the trust, on the wards, at the bedside of patients with fresh eyes to oversee the care delivered.

The independent team is working with trust staff to deliver immediate improvements to care and to put in place robust and comprehensive processes to support improvement in standards over the long term. This input will also support East Kent to meet the 10 essential safety actions set by NHS Resolution’s maternity incentive scheme.

Along with the 14 day reports, I can offer further reassurance that Jacqueline Dunkley-Bent personally visited the trust two weeks ago to assess changes being put in place and that improvements are moving at pace.

Jenny Hughes, chief midwife for the south-east region, is also working with the trust directly.

NHS England and NHS Improvement regional and national teams will continue to work with the trust, with families where appropriate and with the intensive support team.

The trust’s board is taking the issues seriously and is working closely with NHS England and Improvement. The trust has already implemented a number of actions to improve safety. It has created and filled several specialist midwife posts. Safety huddles, where safety issues are regularly and frequently discussed, have been embedded on both sites to anticipate problems before they occur, and multi-disciplinary teams work collaboratively and effectively within these huddles. A protocol to ensure that CTGs—records of contractions and foetal heart rate—are subject to a “fresh eyes” check by another member of staff is working well.

The trust has also developed its approach to working with families in the sad case of a death, to ensure that it always provides a point of contact and that it includes and involves families in its investigations of these incidents, from the moment a serious incident occurs.

Sympathies and assurance

A dedicated quality surveillance meeting with the trust, Care Quality Commission and key health system partners is scheduled for 21 February 2020 to consider the trust’s actions to date and any further interventions required. I have asked for regular frequent updates plus a further update after this meeting.

We will never be complacent, and I can confirm to the House that I have had assurance from the Care Quality Commission that they are content that the trust is taking the issues identified seriously and has a genuine desire to make the necessary improvements. The Care Quality Commission also notes that the trust has a number of mitigations in place, including accepting NHS Improvement’s offer of maternity safety support, and the Care Quality Commission will be closely monitoring how the trust responds to the issues that it needs to address and I expect to be regularly updated.

It is critical that we continue to strive to make maternity care the safest it can be and to ensure that we build a learning culture in the NHS as set out in the NHS patient safety strategy. This requires leadership at all levels. This is why I have sought and had assurance from each part of the health and care system that they will continue to work with clinical and executive teams at East Kent Hospitals to make improvements to maternity and neonatal services across all sites operated by the trust.

Once more, I would like to express my deepest sympathies for the patients and families of those affected.

[HCWS114]

Health and Social Care

Nadine Dorries Excerpts

Wednesday 12th February 2020 Ministerial Corrections

The following are extracts from the Adjournment debate on Children’s Mental Health Week on 6 February 2020.

[Ms Dorries]

By next year, 70,000 more children and young people will be accessing specialist treatment each year, compared with 2014-15. That equates to 35% of children and young people with a mental health condition, and that is starting from zero.

[Official Report, 6 February 2020, Vol. 671, c. 555.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries):

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

The correct information should have been:

[Ms Dorries]

By next year, 70,000 more children and young people will be accessing specialist treatment each year, compared with 2014-15. That equates to 35% of children and young people with a mental health condition, and that is starting from around 25%.

[Ms Dorries]

We now have, in almost all A&Es across the country—I think it is 97%—a mental health liaison worker. When somebody—a child or an adult—presents at A&E with a mental health condition, they are now seen by an A&E mental health liaison officer.

[Official Report, 6 February 2020, Vol. 671, c. 557.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries):

A further error has been identified in my response to the debate.

The correct information should have been:

[Ms Dorries]

We now have, in almost all A&Es across the country—I think it is 97%—a mental health liaison worker. When an adult presents at A&E with a mental health condition, they are now seen by an A&E mental health liaison officer.

[Ms Dorries]

We want more mental health nurses. In fact, two weeks ago, I announced that the grant for those who want to work in mental health nursing will be £8,000—they will get the upper tier.

[Official Report, 6 February 2020, Vol. 671, c. 559.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries):

A further error has been identified in my response to the debate.

The correct information should have been:

[Ms Dorries]

We want more mental health nurses. In fact, two weeks ago, I announced that the grant for those who want to work in mental health nursing will be £6,000.

Paterson Inquiry

The following are extracts from questions following the statement on the Paterson Inquiry on 4 February 2020.

[Ms Dorries]

I will say it again: we want people to speak up, we want trusts and the private sector to listen, and then we want to act. It is the case that we can change this culture and let whistleblowers know that we will protect them. We also have a line at the Department for people to ring in on, because we want to hear from them.

[Ms Dorries]

As I say, Paterson practised between 1997 and 2011, and there was quite a long process of reporting and of concerns being raised about his behaviour and his practice. Eventually, somebody listened; I believe that it was a new chief executive at the Spire hospital trust at the time.

[Official Report, 4 February 2020, Vol. 671, c. 208.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries):

Errors have been identified in my responses to questions following my statement.

The correct information should have been:

[Ms Dorries]

I will say it again: we want people to speak up, we want trusts and the private sector to listen, and then we want to act. It is the case that we can change this culture and let whistleblowers know that we will protect them. We also have a dedicated National Guardian phone line for people to ring in on, because we want to hear from them.

[Ms Dorries]

As I say, Paterson practised between 1997 and 2011, and there was quite a long process of reporting and of concerns being raised about his behaviour and his practice. Eventually, somebody listened; I believe that it was a new chief executive at the Heart of England NHS Foundation Trust at the time.

Historical Stillbirth Burials and Cremations

Nadine Dorries Excerpts

Thursday 6th February 2020 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

I beg to move,

That this House has considered historical stillbirth burials and cremations.

Let me begin by congratulating the hon. Member for Swansea East (Carolyn Harris) on securing the debate, which was also supported by my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes).

It is a fact that anyone can be a Member of Parliament and anyone can be a Minister, but only someone who really cares can get things done, and it is without doubt that the hon. Lady has achieved much in the time she has been in the House because she cares. I have the utmost respect for her. She has done a fantastic job, and I think that her compassion has been demonstrated by the fact that she called for this debate.

Over the past few years, debates in this House have successfully raised awareness of the importance of supporting families bereaved through a stillbirth and other types of baby loss. By speaking openly and sharing their personal experiences, Members of this House have helped to stimulate improvements in bereavement care, including the development of the national bereavement care pathway for pregnancy and baby loss.

Unfortunately, in the not so distant past, people thought differently. Until the 1980s and 1990s, bereaved families of stillborn children were kept in the dark by doctors and midwives, ostensibly for their own protection. It was assumed that if a mother or father was allowed to see their stillborn baby and establish any kind of connection with it, this would only prolong and worsen their grief.

When I was preparing for this debate, I was reminded of my own experience as a nurse. In 1976, I was working on a gynae ward, and I was asked to take receipt of a cot that was coming up from the labour ward. In the cot was a baby that was still alive, which I was told was to be returned to “Rose Cottage” and put in the sluice room. The baby went there until it died a few hours later. Remembering that experience of years ago and the work I undertake now on maternity safety show just how far we have come in the way we treat maternity incidents, newborn safety and mothers.

Many parents were never consulted over funeral arrangements for babies lost through stillbirth, with individual hospitals having to set their own procedures and their own means of disposing of bodies. That makes this difficult, because it means that there is not just one answer across the country. There is not a clear picture as the situation is very piecemeal. Many parents were never told what happened to the body of their baby or the location of any burial or cremation. People thought they were doing the right thing for the parents by not inflicting more trauma on them.

That is a generous interpretation. There was a slight culture in those days in which women were not regarded with the esteem that they are today. It was almost as though this was not just about protecting them, and that they were not worthy of being given the information, either. There are question marks over the explanation, and that has a lot to do with the status of women at the time and again today.

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

The Minister is making an excellent point about the culture and about how women were treated. With families now coming forward wanting information about what happened, does she feel that those women and families are being treated better now? Are they, for example, being given the opportunity to find out where ashes have been strewn without their knowledge or permission?

[Ms Dorries]

I certainly hope so. In fact, those parents and women who are coming forward now are enabling us to move along the pathway to women being given the full, correct information about what happens when a maternity incident takes place. We still have a long way to go, but, as I said at the beginning, the hon. Member for Swansea East is part of that process. The debates that we have here about baby loss are also part of that process. There is not one answer, one sledgehammer, that comes from the Department of Health and Social Care. Everybody has a role to play, because this is an issue that is spread over decades. It is about culture, and it is about the culture in hospitals today. It is about the esteem in which women and mothers are held within society. It is a complex picture with many parts, and everybody has an opportunity to play their part, as do those women who are now coming forward to ask where their babies’ ashes are.

Some hospitals arranged for stillborn babies to be cremated and told the parents that, because the baby was small, it would not be possible to recover any ashes. Even if ashes were recovered, their parents were not told. The ashes might have been spread in a dedicated garden of remembrance, but in other cases they might simply have been disposed of or kept in storage at the crematorium.

Over the past 20 years, we have heard about the discovery of mass graves containing the remains of stillborn babies in, among other places, Lancashire, Devon, Middlesbrough and Huddersfield. The 2015 review of infant cremations at Emstrey commercial crematorium in Shrewsbury found that, by using appropriate equipment and cremation techniques, it is normally possible to preserve ashes from infant cremations.

We now recognise that parents are committed and connected to their children long before birth—I think we knew that back then—perhaps at the point of conception or even earlier, when women imagine themselves being mothers for the first time. I am happy to say that, nowadays, parents of stillborn babies are able to be as involved in decisions about what happens to their baby as they choose to be. New regulations were introduced in 2016 to ensure that parents’ wishes for the cremation of their children are respected. The regulations introduced include a new statutory definition of what constitutes ashes or remains and require cremation request forms to be amended so that family’s wishes are explicitly recorded prior to any cremation.

Thanks to tireless campaigning by the hon. Member for Swansea East, the Government launched the children’s funeral fund last July so that bereaved parents do not have to worry about meeting the cost of burying or cremating their child or stillborn baby. The fund is available regardless of a family’s income and also includes a contribution towards the cost of the coffin. We have received over 1,000 claims to date, and I am sure that the hon. Lady must be incredibly proud.

The hon. Member for Swansea East called for this debate to consider what we in Parliament can do to help bereaved parents who did not have the opportunity to bury their stillborn babies and now wish to trace their final resting places. We know that parents never forget their babies, no matter how long ago their death occurred. Unfortunately, tracing a baby’s grave or a record of cremation may not be easy, and it can be a difficult time for people, both mentally and emotionally.

Records containing information about the locations of the remains of stillborn babies are not held centrally. Parents therefore need to start their search by contacting the hospital where the baby was stillborn, as I am sure the hon. Lady knows. If records are still available, the hospital should be able to tell parents whether the baby was buried or cremated and the name of the funeral director who made the arrangements at the time—if, indeed, a funeral director was involved. Hospitals do not keep records indefinitely, and some records may not contain enough detail to be helpful. The hospital where the baby was stillborn may have closed or the funeral director involved—if one was—may no longer be in business.

Cemeteries and crematoriums, though, are legally obliged to keep permanent records. If neither the hospital nor the funeral director has a record of which cemetery or crematorium was used, parents can contact local cemeteries and crematoriums, starting with those nearest to the hospital where their baby was stillborn. As I mentioned, in many cases stillborn babies were and may still be buried in a shared grave with other babies. These graves are usually unmarked, although they do have a plot number and can be located on a cemetery plan. In many cases, several babies were cremated together. The crematorium should have a record of where the ashes are scattered or buried, but I am afraid the emphasis is on the word “should”.

My sympathies lie with families who have had to deal with the pain of not knowing what happened to their children’s remains for so many years. It is hard for many of us to imagine how long that pain must last. The Department of Health and Social Care expects all hospitals to provide as much information as they have available to any parents who inquire about what happened to their stillborn babies, no matter how long ago they died.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I echo the Minister’s tribute to the hon. Member for Swansea East (Carolyn Harris).

It is unimaginable to think that parents who lost their child through stillbirth were not even privy to the arrangements for the cremation or burial of that child’s body—it was a completely different world.

On the Minister’s last point about urging hospitals to co-operate as much as possible, there is a bigger issue in that some of these children may not have been stillborn. Where a child lived for a while, as in the case she cited from 1976. there are greater questions to be asked about the child’s birth in that hospital. As a result of my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, coroners will have the power, when the regulations are introduced, to look at such cases. Does she agree that there is a serious question not just on the whereabouts of a baby’s remains but on the circumstances of that baby’s birth?

[Ms Dorries]

That is an entirely different question but, yes, I completely agree with the substance of my hon. Friend’s point. I am sure he contributed to the Government’s consultation on the proposal for coroners to investigate stillbirths, which closed on 18 June 2019. The consultation attracted over 300 responses from a wide range of stakeholders. Officials in the Ministry of Justice and the Department of Health and Social Care have been working carefully to analyse the responses received. The question of babies who were not stillborn but who lived for a period of time before they died is possibly worth considering.

--- Later in debate ---

[Ms Dorries]

I would like to begin by paying tribute to everybody who has spoken in the debate. The hon. Member for Swansea East (Carolyn Harris) is right: there are issues we discuss in this Chamber that transcend party politics. Indeed, party politics has no place in this Chamber when issues like this are discussed, and I hope that that has been demonstrated today.

I would like to pick up on a point that the hon. Member for Swansea East made about a lady who has come to the Public Gallery to watch the debate. If she would like to leave the Gallery after I have finished and make her way downstairs, I will meet her at the back of the Chamber and have a word with her.

I will comment on Members’ individual contributions before going on to my substantive response. I thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for the compassion he has shown today. It is not always easy when we discuss issues that are so emotive, but I thank him for his understanding and the points he made. He asked about HSIB’s annual report, which was published in December 2019. As he probably knows, HSIB is a particular passion of mine, and we hope to have more news about it. The thematic maternity investigation report is expected to be published soon, and I am pushing for it to be published as soon as possible.

My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) said that love lasts longer. I think that love lasts forever. When Martin and other babies are mentioned, they have their voices here. It is love that brings them into the Chamber, and that is why we remember them; may we continue to do so.

My right hon. Friend asked whether I could do more with local authorities, as they are responsible for this. Actually, this issue is the responsibility of the Ministry of Justice. I will raise this matter with my colleagues in the MOJ. Perhaps my counterpart in the MOJ and I could send a joint letter to local authorities asking them to assist parents who are trying to trace the remains of their lost babies. That might be a way to push local authorities to be more co-operative.

I turn to the comments made by the hon. Member for Kingston upon Hull North (Dame Diana Johnson). I have the notes from the meeting that she attended last July with my predecessor my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the families, the chief executives of Hull University Teaching Hospitals NHS Trust, Hull City Council and Mrs Trowhill. I am informed that the trust and council agreed to give everyone affected as much information as they had available to them and that Mrs Trowhill agreed to share contact details. Following the promise that the trust made to set out exactly what processes are now in place to ensure that similar incidents cannot happen in the future, could the hon. Lady let me know whether Mrs Trowhill is happy with how far the trust has gone and the service she has had from it?

With regard to the independent local inquiry, I imagine that there may be a sensitivity around that, because some women or girls who had babies at the time may have done so without family members or other people knowing. That may be an issue that lawyers have considered. I have no idea why it costs so much, but that may be one way to help in a particular area where there has been a problem, such as the hon. Lady’s constituency.

[Dame Diana Johnson]

The issue raised with me as to why a local inquiry could not take place was that the local authority did not have jurisdiction over the NHS. Could the Minister say something about the co-operation that I am sure the NHS would want to extend to any local inquiry?

[Ms Dorries]

The hon. Lady is right; the NHS trust has the ability and the jurisdiction to conduct its own inquiry. I believe that NHS Improvement would have a similar responsibility. As a result of today’s debate, I am going to investigate a little more deeply within the Department how we can go about having an inquiry and what the terms of reference would be. It may be that such an inquiry is not possible, but I will certainly find out whether it is.

My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) asked for an update on the pregnancy loss review. I attended the APPG on baby loss a few weeks ago. We expect the report being done by Zoe Clark-Coates and Samantha Collinge to be published in spring/summer, and we expect to publish a Government response to the consultation in spring going into summer. Again, I will push and see how much longer that will take.

[Tim Loughton]

The problem is that nothing has been agreed, because the pregnancy loss review group has not met since 2018. If a report is imminent, it has not been approved by the panel members, including me and the hon. Member for Washington and Sunderland West (Mrs Hodgson). I do not know what will be presented to the Government before they can even respond. The Minister might want to investigate how the group came to conclusions of which we know little.

[Ms Dorries]

I will. If my hon. Friend drops me an email at my departmental address, we will look into that, and the officials will take it away. I am grateful to him for raising that, because I was not aware of it.

I do not think I have missed out anyone who made a speech. We have heard today how important it is to many parents to find the final resting place of their stillborn children’s remains. Unfortunately, that is not always easy or possible, and I have explained that such records are not currently held by the Government. Rather, they are held by local hospitals that arranged for burials or cremations with local funeral directors or crematoriums. In some cases, records no longer exist, or they may not contain enough detail to be helpful.

Nevertheless, I reiterate that the Department of Health and Social Care expects all hospitals to provide as much information as they have available to them to any parents who inquire about what happened to their stillborn babies, no matter how long ago they died. I would like to praise the 800 parents who have attempted to find out where their babies’ remains are, because they have helped to raise the profile of this issue. As the hon. Member for Swansea East said, only by raising the profile do we manage to get something done. We need to continue to do that, because that is how we will make progress.

We have also heard today about the new regulations and systems to ensure that parents are involved, as they want to be, in the burial or cremation arrangements for their stillborn children. Parents are required by law to register a stillbirth, and once registration has been completed the registrar provides parents with all the certification they need to organise their babies’ burial or cremation, and a funeral service if they so wish. The required burial and cremation forms ensure that the wishes of parents are recorded and respected. Many NHS hospitals still do make arrangements for funeral services and support parents to consider various options and to make the decisions that are right for them. Some parents may wish to arrange a private burial or cremation with a funeral director. Most funeral directors do not charge for their services for stillborn babies. Thanks to the hon. Lady’s efforts, the new children’s funeral fund supports parents, as I said in my opening speech.

A funeral can sometimes be a catalyst for people to begin processing a deeply profound loss. At such a time, parents mourning their stillborn baby need as much emotional support, compassion and understanding as possible. However, the quality of support can vary from one maternity service to another. This is why the Government have funded Sands, the stillbirth and neonatal death charity, to work with other baby loss charities and the royal colleges to produce a national bereavement care pathway. The pathway covers a range of circumstances of baby loss, including miscarriage, stillbirth, termination of a pregnancy for medical reasons, neonatal death and sudden infant death syndrome. The NBCP is now embedded in 43 sites, and a further 59 sites have formally expressed their interest in joining the programme.

I would like to talk a little bit about mental health support. The hon. Member for Kingston upon Hull North is a campaigner on this, and she raised mental health during her speech. A couple of weeks ago, I visited nurses who are delivering perinatal mental health care support. As part of the new approach to and new funding for mental health, there are now specialist perinatal mental health community services in all 44 local NHS areas in England, and further developments are planned. Just in 2018-19, this has enabled over 13,000 additional women to receive support from specialist perinatal mental health services, against a target of 9,000.

I spoke to the nurses about the perinatal services that are being delivered, and in that particular trust they have helped 700 women who previously had no assistance whatsoever. It was incredible to hear the stories of how that assistance—the mental health support—is now being given to women. As I have said, all trusts now have in place those perinatal support services, which were never there before. Again, that is a huge step on the path towards delivering services that are focused on women and their needs.

Via maternity outreach clinics, we are also providing targeted assessment and intervention for women identified with moderate or complex mental health needs arising from or related to their maternity experience who would benefit from specialist support, but where it may not be appropriate or helpful for them to accept specialist perinatal mental health services, so we are even thinking further than that. In those services we are also assisting partners and families, so it is not just for the women, but for their partners and families.

A huge amount of work is being done in this area. I am not saying that we have finished—there is more to be done—but we are making progress. This actually fits in very well with our women’s agenda in the Department of Health and Social Care. The women’s agenda is not just about periods and menopause; it is about so many things. The particular area we are discussing today is a huge part of that.

Hon. Members present for the Baby Loss Awareness Week debate last October may recall that I undertook to write to Professor Jacqueline Dunkley-Bent, the chief midwifery officer in England, to ask if those bereaved by baby death could be included in the NHS long-term plan commitment to develop maternity outreach clinics that will integrate maternity, reproductive health and psychological therapy support for women with mental health difficulties arising from or related to the maternity experience. I am delighted to tell the House that I recently received a letter from the chief midwifery officer confirming that access to these services is available to women and their partners who are experiencing moderate or complex/severe issues, so we have listened and we have addressed that need. At this point, I should pay tribute to Professor Jacqueline Dunkley-Bent for her understanding of and support for my role in helping to deliver better services to women.

As I have said, a funeral can often be a catalyst for helping people to deal with death and stillbirth death, and I believe that that is so important today. It used to be about protecting women or just not holding them in high enough esteem to inform them about what happened, but we now know that actually the opposite is true. As my hon. Friend the Member for East Worthing and Shoreham mentioned, it is important to be involved not just in the death, but in what happened before, during and just afterwards. The question parents have at a time like this is: why? That question needs to be answered, and it does not get answered in a sentence or in a minute. Parents need to know and women need to know. They can only feel as though they have fulfilled their own responsibility to their child when they have explored every avenue and know every detail of what happened.

[Jim Shannon (Strangford) (DUP)]

This debate has been specific to England, Scotland and Wales, and not necessarily about Northern Ireland. I congratulate everyone who has made a speech on their very valuable contributions. After this debate, could the decisions, conclusions and the way forward on the strategy be conveyed to Northern Ireland, where this is a devolved matter, so that we can all work together to help everyone?

[Ms Dorries]

The hon. Member is quite right that this is a devolved matter. However, this is an issue that affects all women in the United Kingdom. He is quite right, so I will ask my officials what discussions take place with the devolved Assemblies and come back to him.

The stillbirth rate in England is falling. As I am sure the hon. Member for Swansea East knows, it was our intention to reduce the 2010 rate of stillbirths by half by 2025. I am delighted to report that we are ahead of that target: in January 2020, we were already ahead of what we are trying to achieve. Since my appointment as the Minister with responsibility for both maternity and patient safety, I have seen for myself how NHS maternity services in England are working hard to ensure that the care they provide is safe and personalised to women’s individual needs.

Many measures have been introduced in maternity services that are achieving this reduction in the rate of stillbirths, and the issues raised in debates such as this on baby loss also make a contribution. We all know that applying pressure and raising the issue pushes the agenda further along.

The efforts have resulted in a 20% decrease in the stillbirth rate between 2010 and 2018. Between 2016 and 2018, there were 760 fewer stillbirths in England than in 2015. That is an enormous achievement, and something that we should be very proud of. There are 760 fewer families who have to go through the painful experience of planning a funeral for a much-loved and wanted child. I think we all know that there is nothing more painful for a woman or a couple than to go into hospital to have their baby and to leave with empty arms and broken hearts. The fact that 760 fewer families are doing that now, as a result of the measures that have been introduced, is a huge achievement.

In closing, I pay tribute to the initiatives that have been stimulated by Members of this House to improve support for families experiencing a stillbirth. These include the national bereavement care pathway, the children’s funeral fund and the Parental Bereavement (Leave and Pay) Act 2018, which provides for at least two weeks’ leave for employees following the loss of a child under the age of 18 or a stillbirth after 24 weeks of pregnancy.

I also pay tribute to the clinical professionals and support staff working in acute and community maternity services. They work incredibly hard. I visit these maternity units and meet amazing midwives who dedicate their lives to being in that room at that moment when a baby is born, to ensure a safe delivery. Through their efforts, many more women and babies are being supported to have a healthy pregnancy, labour and birth. They will be supported nationally by the maternity transformation programme, which will continue to oversee the implementation of maternity safety initiatives, including those published in the NHS long-term plan and the new NHS patient safety strategy, published last July.

I would like to conclude by thanking the hon. Member for Swansea East yet again—we are truly in her debt for the issues she raises in this place—and my right hon. Friend the Member for South Holland and The Deepings for supporting her, or for being her acolyte, as he described himself.

Question put and agreed to.

Resolved,

That this House has considered historical stillbirth burials and cremations.

Children’s Mental Health Week

Nadine Dorries Excerpts

Thursday 6th February 2020 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

It is a pleasure to respond to the excellent speech by the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), and I thank her for securing this important debate. I also thank the Members who made interventions, to which I will respond, with your permission, Mr Deputy Speaker.

I do not recognise some of the scenarios that the hon. Lady described. I have not read her article, but if she would like to give me a hard copy, I would be delighted to read it. She is obviously passionate about this subject. I have been in the House all morning, but I have had time to glance at the Children’s Society report that was published today. I was delighted to see that the Children’s Society highlights that the Government have made huge efforts to tackle mental health stigma through tireless work with schools and the Every Mind Matters campaign, which has reached 1.3 million people countrywide.

I am pleased that this debate is occurring during Children’s Mental Health Week. Today is also Time to Talk Day, which encourages everyone to be more open about their mental health in an effort to end mental health discrimination. It is going to be difficult to achieve parity of esteem between mental and physical health until we can completely eradicate the discrimination associated with mental health.

Our most recent data shows that one in eight five to 19-year-olds has a mental disorder. When it comes to young women and girls, the data is even more striking. Young women and girls are more at risk of self-harm, with about three times as many young women and girls aged 10 to 19 self-harming compared with men. The suicide rate for women and girls between the ages of 10 and 24 is at its highest on record, and it has nearly doubled since 2012. So I am with the hon. Lady on her concern about mental health and young people, and I am particularly concerned about the mental health of young women.

Those figures are heartbreaking. However, as the recent Children’s Commissioner’s report highlights, there have been major improvements to children and young people’s mental health care in recent years. I think it is important that we accept that. We need to get to that place so we can look forward to where we take these improvements.

I would like to mention Claire Murdoch, who is the clinical lead in NHS England responsible for the delivery of mental health programmes, as highlighted in the long-term plan. Claire described this to me yesterday as a bath that had been left empty for a very long time which suddenly had had the funding taps switched on—but we cannot fill the bath from empty to full immediately. The bath is filling, and it is filling with the £2.3 billion that this Government have committed to mental health. Just to put that into perspective, that is over half of the entire prisons estate budget. That is how serious our commitment is to addressing parity of esteem and mental health, particularly the mental health of children and young people. We will continue to drive forward this progress to ensure that every child can access the high-quality mental health care that they deserve.

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

I refer the House to my entry in the Register of Members’ Financial Interests.

Funding for mental health has increased right across the United Kingdom from when I first started in the field. However, we are really trying to raise awareness at the same time, and the more we raise awareness, the more we increase the demand. Increasing awareness and demand is a good thing, but we need many more psychologists to be working in the field alongside the psychiatrists to meet the demand.

--- Later in debate ---

[Ms Dorries]

The hon. Member is absolutely right, and I will come on to the workforce in a moment.

Making sure that people recognise this issue was part of the Every Mind Matters campaign. I do not know if everybody saw that, but we had the royals and celebrities such as Davina McCall promoting the Every Mind Matters campaign. We did that to reduce the stigma and to show that it was okay, because really successful people—hugely high achievers in society—have mental health issues and are concerned about mental health. Part of the project was to break down the stigma associated with mental health, which is a bit of a barrier to people accessing mental health care, and to get over that stigma to begin with.

We know that an increasing proportion of young people are seeking mental health help from the NHS, and we are responding by already ramping up capacity. We are on track to meet our commitment to improving access. By next year, 70,000 more children and young people will be accessing specialist treatment each year, compared with 2014-15. That equates to 35% of children and young people with a mental health condition, and that is starting from zero.[Official Report, 12 February 2020, Vol. 671, c. 9MC.]

[Preet Kaur Gill]

Can the Minister expand a little on how those young people are going to access that specialist support, because an early years counselling service in my constituency has a waiting list of 500 young people? It really does concern me, because the only way they are going to get any support is when there is actually a crisis. She keeps referring to the money, but can she give a bit more detail about what people can expect on the ground?

[Ms Dorries]

Indeed; I will go on to address access and waiting times. The money that has been given to CCGs to spend on children and young people’s mental health is ring-fenced, and the hon. Lady might want to go back to her CCG and ask to see how much money it has been given by the Government and how it is being spent so that she can assure herself that the money we are providing to her CCG is being spent on children and young people’s mental health and is not being siphoned off somewhere else. Claire Murdoch and her team at NHS England have been looking at CCGs across the country where they think there are problems and mental health services are not being commissioned adequately, but the hon. Lady may want to go away and do that with her own CCG, and check that it is spending the money that has been given on children and young people’s mental health.

[Preet Kaur Gill]

I think what my CCG will say is that the money is just not adequate. Birmingham is one of the youngest cities in the country; there are so many issues across the city in terms of trying to access care and there just are not the resources and the services, and we are not doing enough to engage our charity sector or support schools. I know that the Government have made an announcement about providing counsellors in secondary schools, but what about early intervention—what about primary schools given that we understand those issues are manifesting themselves very early on? Why are we allowing things just to continue and therefore having to spend much more money later on? That does not seem to make any sense.

--- Later in debate ---

[Ms Dorries]

One of our announcements has been to launch the trailblazer schemes, which we are hoping to have in 25% of schools by 2024. I do understand the problem in the hon. Lady’s area. I recently spoke to a headmaster at a school in Birmingham, and he told me that a third of the pupils in his school were receiving pastoral care or mental healthcare, and the reason was that a third of his children came from chaotic homes where either one or both parents were addicted to gambling, drugs or alcohol. As a consequence of having a third of the school roll in this situation, the school had serious problems with the children in the school.

So in some areas the challenges are very difficult. The hon. Lady said that we cannot just throw money at this, but the money has to fund the services—that is where it has to start, and then the workforce have to come.

The trailblazer schemes are doing incredibly well. I went to see one in Hounslow recently. We have committed to having 50,000 more nurses and are trying to train more mental health nurses, and we are having great success in getting people through universities and through the right courses and into schools. The school I visited in Hounslow, where the mental health workers were working for the children, was incredible to see. I spoke to a large group of the children who are receiving mental health support during the day, and they told me that they are being taught coping strategies. One young boy, whose name I will not mention, said to me that he suffers from anxiety—he gets anxious—and they have put an app on his phone so he has his time to be anxious and panic. His app time is at six o’clock, and he will go on to his phone and use his app.

There are so many aspects to the care being provided in school. There is early intervention, spotting mental health problems as they begin very early on. They could spot eating disorders almost as soon as they were arising in young girls. There are also issues such as anxiety and depression, and others that may not wholly be mental health-related but where the presentation of the problem was a mental health issue.

We are hoping to have 25% of schools across the UK covered by 2024, but, as I said, the bath was empty, so when we turn the tap it cannot fill straight away. The work has started. The people are being trained; they are being rolled out in schools right now, as we speak. I can say that early intervention, having seen it at work myself, is working. That was reassuring, because 18 months ago there were none of those teams in schools; there was no early intervention in any school anywhere. So the fact that we are watching these teams roll out into schools is incredibly reassuring.

On eating disorders—I will work my way through my speech, just to make sure I cover every aspect—more young people are getting the treatment they need. There has been a significant improvement in treating times in NHS care. An extra £30 million is being invested every year into children’s eating disorder services and there are 70 new or expanded community-based teams covering the whole country. Nationally, we are on track to meet the target of 95% of children and young people with an eating disorder accessing treatment, with a one-week referral for urgent cases and four weeks for routine cases.

I went to an eating disorder unit a week last Friday and met some of the young women there. It was fantastic to see the work being done. Once the young women go in, they have to stay in for quite some time. I am not sure that many people realise that an eating disorder is the deadliest mental health condition. One in four young women die from their eating disorder. It is the only mental health condition where the person suffering from it is scared of getting better. It therefore presents an incredible challenge to the mental health professionals who are working with those young girls. I saw the new eating disorder unit up and running, the work it was doing to turn the young women around and the investment that has gone in. The unit is managing to turn those young women around in a shorter time; it is just fantastic to see.

While recognising that we are still filling the bath and that there is more to do, what I really want to do is celebrate—I do not think that the hon. Lady will blame me for doing so—the good work being done by NHS professionals, including doctors, mental health nurses and those coming out of universities, to work on our trailblazer schemes in schools with young people. I want to celebrate their achievements. I am also very pleased that, after years of under-investment, NHS funding for children and young people’s mental health service is now rising and will continue to rise as we work towards the goals set out in the long-term plan. Funding for mental health services will grow faster overall in the NHS budget, in real terms worth at least £2.3 billion. The funding for children will grow faster than the funding for mental health care, which will grow faster than the overall NHS budget. This transformative investment will mean that by 2023-24 an extra—this is an important figure—345,000 children and young people from nought to 25 will receive mental health support every year.

Of course, some children will unfortunately experience a mental health crisis and will need rapid mental health support. I, like others across the House, am pleased with the strong focus on crisis care in the NHS long-term plan, which sets out investment of about £250 million in crisis care. I am not sure who mentioned A&E and hospitals; maybe it was the hon. Lady. We now have, in almost all A&Es across the country—I think it is 97%—a mental health liaison worker.[Official Report, 12 February 2020, Vol. 671, c. 9MC.] When somebody—a child or an adult—presents at A&E with a mental health condition, they are now seen by an A&E mental health liaison officer.

I am aware, however, that there is also a need to provide more support in the community, and to encourage early intervention and prevention. In fact, most of the £2.3 billion that has been allocated to mental health is for community services. Tim Kendall, NHS England’s national clinical director for mental health, says that no mental health service is ever better provided in a hospital than it can be provided in a community, except for the most serious cases. That is why we are delivering a new school and college-based service to help children and young people, staffed by a new workforce, through our children and young people’s Green Paper on mental health. It is about encouraging partnership working between services, and bringing together health and education to provide early intervention mental health support for children.

[Dr Cameron]

The Minister is being extremely generous in giving way. There is a lot of good work being done, as she has underlined, but one of the gaps—this is often raised by Members across the House—is autism diagnosis and intervention at an early stage, so that children get the support they need with the least detriment to their learning, development and education. She may not be able to respond today, but perhaps she could let me know about that at some point.

[Ms Dorries]

It would not be appropriate for me to respond to that because autism is not in my brief as a Minister. That comes under the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), but I will make sure that the hon. Member gets a response to that question.

To turn to the children and young people’s mental health Green Paper, every school will be encouraged to have a senior lead for mental health as well as access to mental health support teams, which are the trailblazer schemes.

[Preet Kaur Gill]

Does the Minister think that it is right that we will be expecting teachers to take on another role? They are already leads for safeguarding, FGM and Prevent—a huge array of things. Does she really think that that is right and that it will address the issues?

[Ms Dorries]

As I explained, we have the trailblazer schemes—we are putting fully qualified, dedicated mental health workers into schools. I imagine that some of the schools in the hon. Member’s constituency will be beneficiaries of that, so the responsibility will not be with the teachers; it will be with the mental health workers. I absolutely take her point: teachers have a huge amount to do. I will check with my officers which schools in the Birmingham area have trailblazer schemes and whether they are due to go in to help her. She described her area as having 500 young people waiting, so I am sure that it is very much on the list. I will also check with Claire Murdoch at NHS England, which is responsible for delivery. It is quite interesting that whenever I say to constituents in my surgery, “The Government provide the money and the policy but NHS England is responsible for delivery,” they say to me, “Who are NHS England? I don’t know who they are. You are the Government.” However, it is responsible for delivery so I will check with Claire Murdoch what is happening in the hon. Member’s area and where the trailblazer schemes are going.

Mental health support teams will be rolled out to a fifth of schools. I am sure that the hon. Member will be pleased to know that the new schools-based service is in addition to existing provision for children and young people with mental health needs. It is in addition to the additional funding that has been given to the care commissioning groups. I will also touch base with her commissioning group. One of my concerns has been that the money that is ring-fenced for children and young people’s mental health is perhaps not always being spent on what it should be spent on, so I will touch base with it. That would also give us a better picture of what the care commissioning group is dealing with. These new plans will significantly increase the availability of mental health support to children and young people and build on existing provision.

On the workforce, to deliver and spend the money, most of which will go on salaries, we need the people to spend it on to deliver the mental healthcare. We are not complacent about the scale of the workforce challenges associated with achieving the very ambitious plans for mental health services, and making transformation a reality will require significant shifts and innovation in the way in which we deliver our services.

We have seen promising results from NHS Improvement’s work to improve retention among mental health trusts. I spoke to a group of students recently who were considering healthcare as a future career; they were considering midwifery. We need more midwives. We have a lovely, glamourised image of the role of midwives from the television, from “Call the Midwife” and “One Born Every Minute”. People who are considering going into NHS caring professions are looking at the more glamourised areas of care, and I am struggling to persuade people that mental health is a fantastic, rewarding career. We want more mental health nurses. In fact, two weeks ago, I announced that the grant for those who want to work in mental health nursing will be £8,000—they will get the upper tier.[Official Report, 12 February 2020, Vol. 671, c. 10MC.] They will also get assistance with childcare costs. So I ask people who are considering nursing overall as a career please to consider mental health nursing. I know how difficult it is. When I was training to be a nurse, we were offered 12-week placements in maternity or psychiatry, and my entire cohort chose maternity, so I know the challenge that I am up against. We need to increase the workforce, but we need to attract more people to that area.

Social media was mentioned earlier. In that regard, the NHS holds only part of the answer. We must do more across Government to protect the mental health of our children, and that includes protecting young people against harmful online content. We now know more about the impact of social media platforms on the health and wellbeing of our young people, and the need to manage the detrimental impacts. The scale of the challenge that we face in protecting children online is vast. That is why the chief medical officer commissioned an independent review of the evidence, and gave advice about setting boundaries for children and young people online. The Government’s “Online Harms” White Paper sets out a range of legislative and non-legislative measures detailing how we will tackle online harms, and also sets clear expectations for tech companies to keep children safe.

My right hon. Friend the Member for New Forest East (Dr Lewis) mentioned online harms earlier, and he was absolutely right. We face many challenges in our modern society, such as poverty—which was mentioned—as well as online social media and addictions, and many of those challenges filter down and have an impact on young children.

I am extremely proud of what has been achieved so far in relation to children’s and young people’s mental health. As I said earlier, we have achieved more than any previous Government, including those of my own party. We are increasing funding massively, and we are introducing a whole new service through mental health support teams so that more children and young people than ever before—345,000—will be able to access mental health support. We have made huge progress on putting mental health on the same footing as physical health.

[Preet Kaur Gill]

We know that the Care Quality Commission has raised numerous concerns about mental health provision and instances in which young people are not receiving the care that they need. The Minister says that it is the responsibility of NHS England to deliver on that, but what more does she think she can do to put pressure on NHS England? What can we do? I do not understand how it is possible for a care provider that has been rated inadequate to continue to provide care for other people. Who should intervene if the necessary changes have not been made, and the CQC has allowed a young person to continue to receive inadequate care?

[Ms Dorries]

I am not sure which service the hon. Lady is talking about. If she is talking about an in-patient unit, perhaps she would like to speak to me afterwards so that I can obtain some more information for her, rather than just guessing. As for how we can ensure that NHS England delivers, I have regular meetings—in fact, I had a meeting yesterday afternoon—with both Claire Murdoch and Tim Kendall to get updates. Just a couple of weeks ago, Claire announced the launch of the first ever gambling clinic. They are working very hard at NHS England to deliver the long-term plan. As I have said, however, it is a long-term plan. The bath was empty, but the plug is now in, the taps are on, and it is filling up. Claire is working her socks off, as is everyone else, to deliver as rapidly as possible, but the other side of the coin is the workforce—getting the mental health nurses in and trained, recruiting them through universities, which has been more successful, and finding people who want to attract others to work in mental health. Claire is delivering those services as fast as she can, but they do not deliver themselves. They need people to deliver them, and that is what we are working so hard on.

In the context of NHS England, the hon. Lady asked what we could do. It is my job to hold it to account, and I can assure her that I am doing that every step of the way. Most people who work in mental health know Claire Murdoch and her 45-year reputation of working in mental health. She is a formidable force, and I do not think that anyone is going to prevent her from delivering as fast as she can. She has said to me that we have never had it so good and that we are going to motor ahead with this. That is exactly what is happening.

The Prime Minister has announced his absolute commitment to mental health, and I am confident that by continuing with record levels of investment, improving access and waiting times and focusing on prevention as well as treatment, we will provide a brighter and healthier future for all our young children.

Question put and agreed to.

Paterson Inquiry

Nadine Dorries Excerpts

Tuesday 4th February 2020 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

This morning the independent inquiry into the issues raised by the disgraced surgeon, Ian Paterson, published its report. The inquiry was tasked with reviewing the circumstances surrounding the jailed surgeon’s malpractice that affected so many patients in the most appalling way. As the report states, between 1997 and 2011, Paterson saw 6,617 patients, of whom 4,077 underwent a surgical procedure in the independent sector. Between 1998 and 2011, Paterson saw 4,424 patients at the Heart of England NHS Foundation Trust, of whom 1,207 underwent mastectomy.

The report contains a shocking and sobering analysis of the circumstances surrounding Ian Paterson’s malpractice. It sets out the failures in the NHS, the independent sector, and the regulatory and indemnity systems. As a result of these failures, patients suffered unnecessary harm. Their testimony in the report makes harrowing and appalling reading. As such, it is with deep regret that we acknowledge the failure of the entire healthcare system to protect patients from Ian Paterson’s malpractice and to remedy the harms.

Nothing I can say today can lessen the horrendous suffering that patients and their families experienced and continue to go through. I can only start to imagine the sense of violation and betrayal of patients who put their trust in Ian Paterson when they were at their most vulnerable. That the inquiry reports today—World Cancer Day—makes this all the more poignant. I apologise on behalf of the Government and the NHS for what happened, not least that Ian Paterson was able to practise unchecked for so long. I pay tribute to the bravery of all the former patients who came forward to tell their stories to the inquiry, and whose anonymised accounts have been recorded in the report. The report will make for difficult reading, as it highlights the human cost of our failure to detect and put a stop to Ian Paterson’s malpractice.

There was a catalogue of failings that resulted in harm to thousands of patients, causing devastation to countless lives. Some of these patients were let down several times, not least by the providers and the regulatory system that should have protected them, and by the failure of the medical indemnity system to provide any kind of redress at the first time of asking. From the outset, Bishop Graham wanted patients and their families to be central to the inquiry’s work and to be heard. It was right, therefore, that patients and their families saw the report first, early this morning, shortly before it was presented to Parliament.

Two aspects of the report are particularly striking to me: that the various regulatory bodies failed in their main tasks; and the absence of curiosity by those in positions of authority in the healthcare providers in the face of concerns voiced by other healthcare professionals. The report presents a tangled set of processes. Accountability was not exercised when it should have been. Some of the problems arose from not following through on established procedures, as opposed to insufficient procedures being in place.

We must take full responsibility for what happened in the past if we are to provide reassurance to patients about their protection in the future. I am therefore very grateful that the suite of recommendations, based on the patient journey, presents a route map for Government. The recommendations are extremely sensible and we will study them in detail. I can promise the House a full response in a few months’ time. That response will need to consider the answer to some very important questions that cut right across the healthcare sector. Unequivocally, regardless of where patients are treated and regardless of how their care is funded, all patients should be confident that the care they receive is safe, that it meets the highest standards with appropriate protections, and that they are supported by clinicians to make informed decisions about the most appropriate course of care.

I am very aware that this is not the first time that regulatory failure has been highlighted in an inquiry report. We have done much to make the NHS a safer system in recent years: revalidation, a reformed Care Quality Commission, and work by the Independent Healthcare Providers Network to establish the medical practitioners assurance framework to oversee medical practitioners in the independent acute sector. In the case of Ian Paterson, the system did not work for patients. Recent events at Spire Healthcare show that there are still serious problems to address. Patient safety is a continual process of vigilance and improvement. The inquiry does not jump to a demand for the NHS and the independent sector to invent multiple new processes; it says that they must get the basics right, implement existing processes, and ensure that all professional people behave better and take responsibility.

Last summer, NHS Improvement and I published a new patient safety strategy, led by the national patient safety director, Dr Aidan Fowler. It focused on better culture, systems and regulation—very sensible and familiar words, yet all things that this inquiry says were not delivered. What we need now is action across the NHS and its regulatory bodies, and the same determination to change in the independent sector.

We are absolutely committed to ensuring that lessons are learned and acted on from the findings of this shocking inquiry, in the interests of enhancing patient protection and safety both in the NHS and the independent sector. For today, I apologise again on behalf of the Government and the NHS, and send my heartfelt sympathy to the patients and their families for the suffering they have endured.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I thank the Minister for advance sight of her statement. I welcome her apology on behalf of the Government and the national health service. I agree that the issues raised in this report are, as she says, shocking, serious and harrowing. Our thoughts are naturally with all the innocent victims of Ian Paterson. As the Minister rightly acknowledged, today is indeed World Cancer Day. We all know that a cancer diagnosis is frightening. When we hand ourselves, or a loved one, over to the care of a medical professional, we are literally trusting them with our lives. For that trust to be callously betrayed for financial gain is unforgivable, and indeed, as it has been found, criminal. I associate myself with the Minister’s remarks in paying tribute to all the patients—all the victims—for their bravery in speaking out. I thank all those who have represented them, including the various legal firms such as Thompsons, and thank Bishop Graham for putting together this report.

The findings from the inquiry were published at 12 noon today, so the House will want time to fully digest and reflect on the recommendations. However, I think we all agree that while we cannot undo the awful harm that Paterson’s criminal action has caused to so many, lessons must be learned and changes made so that something so heinous does not happen again. This report must not remain on a shelf to be forgotten, because it is clear that this was not just the action of one rogue lone surgeon; systemic organisational failures were at fault as well.

Fundamentally, it is time that we addressed the question of safety in private healthcare providers and the way in which clinicians are able to operate in private providers with little oversight. Paterson worked under the so-called practising privileges model, effectively as a self-employed contractor whereby people get a fee on top of their NHS salary for each funded NHS operation carried out in the private sector. Moreover, private hospitals would often, and still often, incentivise referrals from consultants by giving them, for example, shares in those private hospitals. This model creates financial incentives to distort clinical decision making and can lead to over-treatment, as we saw in the Paterson case. Indeed, as the Minister said, earlier this month something similar happened at Spire Healthcare when it was forced to recall hundreds of patients amid concerns over operations carried out by another surgeon.

The inquiry makes a number of recommendations and it is right that we reflect on them, but what is clear is that we need full transparency and accountability. I hope the Government mandate health bodies to quickly implement many of these recommendations. The fight that patients had to go through for compensation is, quite frankly, shameful. Surely it is time that private hospitals employed surgeons directly and required them to be fully liable for their actions. In that way, we would resolve the liability loophole.

About a third of all private hospital income now comes from the NHS for hip replacements, hernia procedures, cataract procedures and so on. Yet safety standards in the private sector leave much to be desired. Unlike in an NHS hospital where there are multi-disciplinary teams on standby to deal with potential complications post-op, in the private sector, post-operative care for patients is often left in the hands of a single junior doctor—a resident medical officer often working many hours, 24/7. In private hospitals there are few critical care facilities available if something goes wrong. Indeed, many patients are often referred back to an NHS hospital when complications occur. In 2018, the previous Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), wrote to the private hospital sector telling it to get its house in order on patient safety.

Patient safety must always be a priority. If this demands legislation to change the regulation of private hospitals, I hope the Minister can bring such legislation forward. We would work with her constructively to ensure that it finds its way on to the statute book. It is time to take these issues in the private sector seriously, and we will be happy to work with the Government on that front.

[Ms Dorries]

The hon. Gentleman raises many issues that we can agree on. I am not here to defend the private sector, but I would like to reiterate that women were affected both in the national health service and in the private sector. It does not take into consideration the suffering of those women in the NHS if we just focus on one particular area.

The CQC has had a duty with regard to the private sector since 2015. These cases took place between 1997 and 2011. In 2012, the CQC introduced the revalidation system for doctors, with responsible officers attached to each organisation and an appraisal process that consultants and doctors go through to assess their performance. That happened in 2012 and was introduced by the General Medical Council.

In 2014, we instructed the CQC to appraise the private sector in the same way and hold the private sector to the same standards as the NHS. As I said, I am not here to defend the private sector, but in the CQC examination it came out as good, and I believe that Spire scored 85%.

The hon. Gentleman is right—this is about patient safety and all providers raising their game. As I said, healthcare providers and healthcare professionals have a responsibility to speak out. The time that it took from complaints being made about Paterson to action being taken was too long. We need people in the NHS and the private sector to speak up, to listen and to act more quickly. That is one issue we want to take forward. I will take all his points on board. There is much we agree on. As I said, I am not here to defend the private sector, but women in the NHS suffered as well.

[Julian Knight (Solihull) (Con)]

I thank the Minister and shadow Minister for the tone and content of their comments.

Scores of women and their families in Solihull have been dramatically affected by Paterson, who chose—for want of a better word—to experiment on his patients, seemingly for personal profit, ruining and shortening lives. They want to know that this can never happen again, with proper measures taken and recommendations followed. Does the Minister have confidence in the new whistleblowing procedure at Spire Healthcare? Is she, like me, disquieted to hear that the same hospital is currently reviewing 217 cases regarding another doctor, Habib Rahman, who is under suspension?

[Ms Dorries]

My hon. Friend is right; Rahman has been suspended. He is not practising at the Spire group. However, he is still in a non-patient facing role at the trust, and we are querying that.

My hon. Friend is right to say that this has been harrowing, and many women were affected. I do not think I can give him a guarantee that this would never happen again, because for that to happen we would have to have somebody reviewing every single appointment, operation and case that any doctor undertook. We have a process in place now that was not in place then. The CQC was not inspecting the private sector then, and it was not inspecting the NHS robustly enough. That has now changed. We also have the revalidation system, brought in by the General Medical Council in 2012 after Paterson. It is really important to point out that Paterson is in jail and has been for some time. This inquiry came after Paterson had gone to jail, and the purpose of the inquiry is learning, so that we can look at the recommendations and improve our service to patients in both the NHS and the private sector as a result.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Having been a breast cancer surgeon for 33 years, I find this case heartbreaking, and I can only apologise on behalf of the profession. The hon. Member for Leicester South (Jonathan Ashworth) highlighted that the way in which women were treated after the event and the fact that they had to fight for help and compensation added insult to injury.

As the Minister said, this was not a failure of processes not existing; it was a failure of processes that were not enforced. This scandal went on for 14 years, which highlights a failure to listen to people who raised concerns early on and the fact that there was a power differential between Paterson and people who were raising concerns. It should have been striking that his rate of surgery was so much higher among his private patients than his NHS patients. His practice was not being looked at within NHS quality audits, which might have shown that up. What will the Government do to ensure that all units are taking part in national audits, which faded away over the last decade, and in Getting it Right First Time, so that units cannot just opt out? Will that be rolled out to the independent sector, to ensure that units take part in national audits?

Breast cancer is a multidisciplinary team specialty, but we have to do a 360° appraisal only every five years. To me, that is the most telling and most important part of appraisal, and the Government should look at that part of appraisal being made more frequent and, again, being extended to private hospitals.

The Health Service Safety Investigations Body is currently envisaged as working only in NHS hospitals and for NHS patients treated in independent hospitals. Surely the Government recognise that the Bill legislating for that will need to be amended, to ensure that the HSSIB can investigate across the piece.

Once again, we come back to whistleblowers who have raised concerns, have not been listened to and have been suffering detriment, and an opportunity to stop Paterson many years earlier has been missed. What reforms are the Government planning genuinely to support whistleblowers? I am presenting a private Member’s Bill tomorrow, because we need a root-and-branch reform of how whistleblowers are treated.

[Ms Dorries]

The hon. Lady raises a wide range of issues, which I will try to go through. First, I reassure her that, at the time Paterson was practising, the CQC was not investigating or assessing the private sector; that was introduced in 2015. Whistleblowing was in an entirely different place from where it is now. We now have 500 lanyard-wearing national guardians across the NHS, and we encourage people to raise their concerns with those national guardians, the guardians to listen and the trust to act quickly on the concerns raised. I think it is fair to say, that since 2012, when the CQC introduced revalidation, a number of regulatory processes have been put in place. There was shockingly little at the time that Paterson was practising. The system is now much more robust—and yet, I completely take her point; much more still needs to be done.

We are learning the lessons from Getting it Right First Time. In fact, that is a subject of discussion within the Department. We are looking at how the lessons have been applied and what we can learn.

The hon. Lady is right about revalidation and 365° appraisal every five years. As she will know, the CQC is an independent body. It introduced revalidation and appraisal. Our job is now to ask the CQC to make that system more robust and look at how to improve it, because that is an important part of the equation, ensuring that something like this does not happen again. I say here and now at the Dispatch Box that I would like the CQC, as a matter of urgency, to look at how it can make that system more robust and effective, so that we can quickly identify doctors—not those like the hon. Lady—who are not up to standard, who are outliers and who should not be practising.

We will look at the hon. Lady’s point about the HSSIB. I do not think that there is a role for the HSSIB in the private sector. The private sector is a matter of personal choice. It is our job to ensure that healthcare reaches the same standard across the board, whether it is in the private sector or the NHS. The CQC does that, and that is how we hold the private sector to account. Then it is down to patients to make the choice about where they wish to be treated; that is their independent choice. That is a matter of consent, which is something else we need to look at—how do conversations about consent take place? Does the patient have the capacity to take in the information being given to them? Are they making an informed choice? Do they have enough information about the surgeon they are seeing to make the right choice? Those are the issues we need to focus on.

[Jeremy Wright (Kenilworth and Southam) (Con)]

If patients are to be kept safe, several things need to be true. First, as the hon. Member for Central Ayrshire (Dr Whitford) said, medical professionals who have concerns about the practice of other medical professionals need to have their concerns properly listened to. Is it not therefore a matter of serious concern that four of the six whistleblowers in this case—one of whom I have the privilege to represent in this place—found themselves subject to fitness-to-practise reviews after reporting their concerns?

Secondly, is it not right that medical organisations—public or private—need to act on those concerns? It is profoundly troubling that concerns were reported to the Heart of England NHS Foundation Trust in 2003, but it did not suspend Paterson until 2011.

Thirdly, is it not important that regulators do what they need to do? It is also profoundly troubling that concerns about Paterson’s malpractice were reported to the GMC in 2007, and his suspension by the GMC came only in 2012.

[Ms Dorries]

I would like to make an apology. I mentioned the CQC in response to the hon. Member for Central Ayrshire (Dr Whitford)—the acronyms!—but it was the GMC.

My right hon. and learned Friend is absolutely right. I reiterate that Paterson is in jail, and that the processes now in the regulatory framework did not exist at the time Paterson was practising. The culture towards whistleblowers is very different now from what it was then, as demonstrated by the roll-out of the national guardians scheme. The national guardians are there for whistleblowers to go to. We want—we absolutely want—people to report when they think somebody is acting inappropriately, or a surgeon or doctor is not practising to the standards they should be. We want to know that as soon as possible. There will be no investigations of whistleblowers’ fitness to practise; that will apply to the people they are reporting. I do not think the national guardians scheme has had enough press or that people are aware enough of it. It is about speaking up, listening and then the trust acting on the information it has. One of the outcomes of this report will be that we can reassure both healthcare professionals and the public that we want them to speak up. We actually want them to be a whistleblower because only by doing that can we guarantee patient safety.

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

I think all of us are shocked to hear that patients have been let down yet again over these events. I was surprised that the Minister did not refer in her opening comments to the Health Service Safety Investigations Bill. I want to back up what the hon. Member for Central Ayrshire (Dr Whitford), who speaks for the SNP, said. Along with her, I was involved in the draft scrutiny of the Bill in the previous Parliament, and it is very clear now that the Bill needs to be extended to include the private or independent sector. I very much hope that the Minister will be able to give us good news about when the Bill will be brought before the House.

[Ms Dorries]

I hope the Bill will be brought before the House in the autumn. As I have said, we got the report only this morning, and we need to look at the recommendations. I am sure her suggestion will be one of the recommendations that we will look at in detail. I got the report myself only a couple of hours ago, so we need to study the recommendations. We will report back to the House in three to four months’ time about the report itself.

[Saqib Bhatti (Meriden) (Con)]

Like my hon. Friend the Member for Solihull (Julian Knight), my constituency neighbour, I too have many constituents who suffered at the hands of Ian Paterson. On Saturday, I met survivors of this awful ordeal, and there are no easy words. I thank the Minister and the shadow Secretary of State for their sobering words. Will the Minister join me in commending the survivors for their bravery, and does she agree that there have been serious failings on the part of the Spire hospital? What assurances can we give the survivors that we will take heed of this report, and what more should we do to ensure that this is never allowed to happen again?

[Ms Dorries]

I thank my hon. Friend, and if I did not do so in my opening statement I would like to thank the patients, the survivors and the groups that have helped those survivors. I also thank Bishop Graham James, who has provided us with such a thorough and detailed report, with seriously robust and practical recommendations to take forward. Again, I can only give my assurance that we will read this report and study it carefully. If there is anything we can do as a result of the recommendations that will enhance and guarantee patient safety, we will, because patient safety is a paramount concern for us in the Department of Health and Social Care. It is absolutely at the top of our agenda, and we will be taking this forward.

[Wendy Chamberlain (North East Fife) (LD)]

In the Minister’s statement, she referred to two striking aspects of the report: the failures of a number of regulatory bodies, and the absence of general interest in the concerns raised by the very people in a position to take action. Sadly, the inquiry suggests that such a case could occur again. Given that the Government have promised to provide a full response to the inquiry in three to four months’ time—I believe that is what she said—how will the Government work with the devolved Administrations to ensure that all health services can take up the same safeguards?

[Ms Dorries]

I am sure we will work with the devolved Administrations in the normal way we do with all healthcare policy. Again, I give my assurances that we will be taking the recommendations and studying them seriously.

[Jackie Doyle-Price (Thurrock) (Con)]

Ultimately, this is all about behaviour—not just the criminal behaviour of Ian Paterson, but the behaviour of the professionals and the wider health establishment that came into contact with him. I associate myself with the comments of my right hon. and learned Friend the Member for Kenilworth and Southam (Jeremy Wright) about the behaviour towards the whistleblowers. Frankly, they faced intimidation, and we saw exactly the same thing at Gosport when whistleblowers reported to the Nursing & Midwifery Council. I would like to put it on record that it is high time this Government challenged the self-regulatory aspects of both the NMC and the GMC, if we are really to consider and improve patient safety.

[Ms Dorries]

I thank my predecessor in my post for her comments. She did an amazing job, and I am sure she will have been involved in this at the time. She is absolutely right: whistleblowers, we want you! We want them to speak up and to speak out; we want people to listen; and we want to act. However, she is also right that there is still a culture among staff within the NHS and the independent sector of reluctance to speak out, to listen and to act, and we need to change that culture. The culture now has to be that we want whistleblowers to speak out, and we want trusts to listen and to take their concerns seriously, because we want to act.

[Clive Efford (Eltham) (Lab)]

What has happened is horrific, and my heart goes out to all the people who have been affected, but surely this could not have happened without the collusion of others. It is not just a question of turning a blind eye; there must have been others involved. What has been done to investigate those individuals? Is the Minister clear that whistleblowers have a sufficient pathway to independent investigators outside an organisation? Quite often, it is very difficult within an organisation and it takes someone very brave to go to a senior manager and whistleblow. Is she confident that whistleblowers have access to independent ears to bring their concerns to light?

[Ms Dorries]

The national guardians scheme involves 500 healthcare professionals, who are identified by their lanyards alone to show that they are people to whom whistleblowers can speak both independently and in complete confidence. I think that is important because those people are in the NHS—the private sector has rolled out its own similar system—and people can see them, identify them and act immediately. Sometimes things are left for another time or place, but when people see somebody act inappropriately or in a way they should not, we want to know that they speak out about it immediately.

I will say it again: we want people to speak up, we want trusts and the private sector to listen, and then we want to act. It is the case that we can change this culture and let whistleblowers know that we will protect them. We also have a line at the Department for people to ring in on, because we want to hear from them.[Official Report, 12 February 2020, Vol. 671, c. 10MC.] There is only one way we can guarantee patient safety, and that is to know where inappropriate practice is taking place so that we can stop it. We absolutely open our door to whistle- blowers, and we want to hear what they have to say.

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

Can the Minister explain under what circumstances this criminal behaviour was finally exposed? Has anybody from the regulatory side been sacked as a result of their abject failure to discover it earlier?

[Ms Dorries]

There was actually quite a long process. As I say, Paterson practised between 1997 and 2011, and there was quite a long process of reporting and of concerns being raised about his behaviour and his practice. Eventually, somebody listened; I believe that it was a new chief executive at the Spire hospital trust at the time.[Official Report, 12 February 2020, Vol. 671, c. 10MC.] Somebody spoke out to him, he looked at the history of what had happened and he decided to take action. That is not good enough, however, because reports had been made on a number of occasions previously. In fact, there were two reports. One, by a consultant, looked at 100 of his cases in 2011, but no action was taken. Another report, by another NHS consultant, downplayed and focused on the wrong elements of Paterson’s care, and it took somebody to speak to a new chief executive for action to be taken. The process was all wrong, but that is how it was then, and it is very different now.

As I have said, the GMC has introduced revalidation and appraisal. We have been speaking to it, and we want it to make that process more robust so that we can assess doctors in a more appropriate and frequent way. The CQC is holding the private sector to account, as well as the NHS. Those of us who have been here for more than a few years know that a few years ago the CQC was not the organisation that it is today, and it is now much more robust and effective. We therefore hope that we can pick up cases such as this as they happen. However, the only way to crack patient safety in this country is if somebody who is practising alongside a surgeon, doctor or nurse speaks out, and for those to whom they speak to listen, so that we can act.

[Thangam Debbonaire (Bristol West) (Lab)]

I thank the Minister for her remarks. I welcome her mention of culture and cultural change, but I wish to push her a little further. She spoke about cultural change in relation to whistleblowers, but that is after something has gone wrong. I would like junior clinicians to feel able to challenge senior clinicians before something has gone wrong. Is anything happening to shift the culture, so that a culture of learning is encouraged among senior clinicians, and so that they welcome challenges and questioning from junior clinicians, in order to prevent something such as this from happening?

--- Later in debate ---

[Ms Dorries]

I am totally with the hon. Lady, and as a nurse myself, I know that that happens with senior nurses, not only senior doctors, because there is the same culture of fear, and of not wanting to challenge a superior who is more experienced in what they are doing. Such a change cannot happen overnight. It will take time, but I think it is already happening as a result of increased confidence. We have recently had a few inquiries, and I think patients now have more confidence to speak out. Under the national guardians scheme, whistleblowers have more confidence to speak out. I think that cultural change is happening, and last week I visited a hospital where I saw that in process.

Our job is to ensure that we introduce whatever needs to be put in place. No one is God. When I trained as a nurse, doctors were like God, but that is not true; that is not the case. This has been a long road, and we need to challenge that culture even further. Those who have been practising for some time are esteemed, and we value their experience. We value those people, but we must also break the culture that means they are not to be challenged. Making the revalidation and appraisal system more robust is one way to do that.

[Lucy Allan (Telford) (Con)]

I thank the Minister for her heartfelt apology for what has happened, and for her commitment to patient safety. Does she agree that there are clear commonalities between this case and other tragedies, such as those at Morecambe Bay and Shrewsbury and Telford Hospital NHS Trust? As the hon. Member for Central Ayrshire (Dr Whitford) said, there is an imbalance of power between male consultants, and in this case female patients, who often just accept what they are told by a more powerful figure.

[Ms Dorries]

This day is about the victims of Paterson and the women he treated, and I do not want to detract from that by going down another road and talking about another inquiry. My hon. Friend is right: often women are those most affected by these issues, which is why I spoke about the importance of consent. We as a Department must consider how such consent is gained, and I think the Cumberlege report, which we are expecting to come to Parliament soon, will help with that.

[Mike Wood (Dudley South) (Con)]

No amount of money can repair the suffering of Paterson’s patients and their families, but an inability to pay for treatment or support that might mitigate that suffering can make an already horrific situation even more difficult. Will the Minister look at the adequacy of medical indemnity cover for healthcare professionals, whether they work in the NHS or in the private sector?

[Ms Dorries]

The Government are currently undertaking a review of the clinical negligence indemnity cover market, to determine whether wider regulation is an appropriate means of addressing concerns in the market. As part of that they are consulting on the viability of introducing professional or financial regulation, or a combination of both.

Oral Answers to Questions

Nadine Dorries Excerpts

Tuesday 28th January 2020 Commons Chamber

[Ian Byrne (Liverpool, West Derby) (Lab)]

22. What recent assessment he has made of trends in the level of life expectancy.

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

Although life expectancy at birth remains the highest it has been, we want everyone to have the same opportunity to have a long, healthy life, whoever they are, wherever they live and whatever their background. We are committed to giving everyone five extra years of healthy life by 2035, and to addressing the needs of areas with the poorest health.

[Kate Osborne]

Life expectancy advances depend on good local service provision. Does the Minister agree with me and the people of Jarrow that, following the devastating closure of St Clare’s Hospice, we should take all possible steps to ensure that palliative care provision is put in place urgently in Jarrow constituency? Will she meet me to discuss this important issue?

[Ms Dorries]

I am unaware of the closure of that hospice, but my door is open to the hon. Lady. If she would like to see me at the back of the Speaker’s Chair after questions, we can arrange a suitable time to discuss the issue.

[Ian Byrne]

Today, a baby girl born in Liverpool can expect to live 13 fewer years in good health than a baby girl born in Richmond. A new study from University College London shows that being wealthy adds nine years to healthy life expectancy. Does the Minister agree that such health inequalities are an injustice in society that must urgently be addressed?

[Ms Dorries]

The best way to improve life expectancy is to prevent health problems from arising in the first place. Prevention is one of the top five priorities for the health service, and we are taking action to help people live longer and healthier lives. The Government have a proven track record of reducing the harms caused by obesity, tobacco and other substances. That is where we need to focus our efforts to ensure that life expectancy rises in all areas throughout the country.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The most shocking trend in life expectancy is that people with learning disabilities die so early—on average 25 years younger than the general population. We must see action to learn the lessons from each of those early deaths. The contract for the University of Bristol’s running of the learning disability mortality review ends in May, and there is now a growing backlog of cases, so will the Minister tell the House what the future of this important review is, and what staff resources are needed to continue the vital work of reviewing and reporting on early deaths?

[Ms Dorries]

We will introduce mandatory training for all health and social care practitioners. I hope that that will address the particular problem that the hon. Lady has brought up. It comes back to the substantial life expectancy issue, which is that regardless of the group, prevention is key.

[Damian Green (Ashford) (Con)]

In her initial response, the Minister rightly emphasised the importance of rising healthy life expectancy, as well as life expectancy more generally. Will she therefore join me in welcoming the forthcoming report from the all-party group on longevity—[Interruption.] If the Minister is listening, will she welcome the report, which will give the Government practical advice specifically on how to use prevention to raise the levels of healthy life expectancy?

[Ms Dorries]

I could not agree more with my right hon. Friend. We want everyone to have the same opportunity to have a long and healthy life, whoever they are, wherever they are and whatever their background. We will certainly look at that report.

[Paul Bristow (Peterborough) (Con)]

I welcome the fact that one theme underpinning the NHS long-term plan is prevention, to help enable people to live better lives for longer. Does my hon. Friend agree that supporting people to make healthier choices, combined with improved screening and diagnostic services, will help to increase life expectancy?

[Ms Dorries]

I very much agree, and that is where the Government are directing their efforts. My hon. Friend mentioned screening; we have put extra resources into screening and scanners, including in Peterborough. We are absolutely attacking on screening programmes and on obesity and tobacco—all those issues that we know affect life expectancy and cause harms. The Government have made those issues their top priority.

[Karl Turner (Kingston upon Hull East) (Lab)]

12. What steps he is taking to reduce health inequalities.

--- Later in debate ---

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

13. What recent representations he has received on people affected by the hormone pregnancy drug, Primodos.

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

Ministers have not received any recent representations. However, as we know, Baroness Cumberlege is leading the independent medicines and medical devices safety review, which includes an examination of what happened in the case of Primodos. Her review has had lengthy engagements with people who have been affected.

[Patricia Gibson]

As the Minister is aware, the hormone pregnancy drug test Primodos was taken by around 1.5 million women in the ‘60s and ‘70s, leading to birth defects, miscarriage and stillbirth, and, 50 years on, those affected still wait for justice. The review into this scandal, announced in 2018, was very welcome, but can the Minister confirm that, if it is merited, she is open to establishing a comprehensive public inquiry following the publication of the review to ensure justice for those affected?

[Ms Dorries]

Baroness Cumberlege’s review is examining what happened in the case of Primodos and will determine what further action is required. Ministers will consider any recommendations very carefully. We do not have a date for the publication of the review, but it will be very soon. Perhaps we can continue the conversation then.

[Mr Toby Perkins (Chesterfield) (Lab)]

14. What recent assessment he has made of the reasons for the increase in A&E waiting times.

--- Later in debate ---

[Rosie Duffield (Canterbury) (Lab)]

Following the desperately upsetting news headlines last week about preventable baby deaths at East Kent, including that of Harry Richford, aged just seven days old, whose death was described by the coroner as “wholly avoidable”, will the Secretary of State join me and Harry’s family in calling for a full, transparent public inquiry?

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

I thank the hon. Lady for raising this issue, and also my hon. Friend the Member for Dover (Mrs Elphicke), who made an excellent speech last night about this very issue at East Kent. I would like to reassure the hon. Lady that the Care Quality Commission conducted a further investigation of the whole trust last week and will take enforcement action if necessary. On Monday, I asked it to provide a summary report within 14 days. The Healthcare Safety Investigation Branch has examined 26 individual maternity cases at the trust, and it has already reported on 15. It was also asked on Monday to complete its work within 14 days and to send in a summary report to give us further information.

[Greg Hands (Chelsea and Fulham) (Con)]

The Secretary of State will know that my local Labour party has been running an outrageous campaign saying that the Parsons Green walk-in centre is set to close. The clinical commissioning group has confirmed that that is not the case, and the facility is both busy and popular. Will he join me in condemning this latest scare tactic from my local Labour party about local NHS facilities that are both popular and well used?

Health and Social Care

Nadine Dorries Excerpts

Monday 20th January 2020 Ministerial Corrections

The following is an extract from the Adjournment debate on 15 January 2020.

[Ms Dorries]

I am afraid I have to inform my hon. Friend and the House that the additional cases have now been identified and the total number relevant to the review now stands at 900, a small number of which go back 40 years.

The extra cases have been found by a number of means—from looking at previous incidents reported at the hospital to parents brave enough to come forward and talk about their own experiences. I am sure my hon. Friend will understand that, unlike with Morecambe Bay, which involved a small number of cases, it will take the review considerably longer to investigate 900 cases.

[Official Report, 15 January 2020, Vol. 669, c. 1126.]

Letter of correction from the Under-Secretary of State for Health and Social Care (Ms Nadine Dorries):

Errors have been identified in my response to my hon. Friend the Member for Telford (Lucy Allan).

The correct response should have been:

[Ms Dorries]

I am afraid I have to inform my hon. Friend and the House that the additional cases have now been identified and the total number that might be relevant to the review now stands at over 900, a small number of which go back 40 years.

The extra cases have been found by a number of means—from looking at previous incidents reported at the hospital to parents brave enough to come forward and talk about their own experiences. I am sure my hon. Friend will understand that, unlike with Morecambe Bay, which involved a small number of cases, it will take the review considerably longer to investigate over 900 cases.

Ockenden Review of Maternity Care: Shrewsbury and Telford

Nadine Dorries Excerpts

Wednesday 15th January 2020 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

It is an absolute honour and a delight to be responding to this debate with you in the Chair, Mr Speaker—it is the first time I have done so—and congratulations.

I congratulate my hon. Friend the Member for Telford (Lucy Allan) on securing the debate. Before I respond to her specific comments, I turn to the wider points that she raised that addressed the UK as a whole.

To reassure people—mothers, particularly—I would like to make one or two points about the wider context of the debate: the safety of giving birth in the UK. The NHS in this country remains one of the safest places in the world to have a baby. The Government’s maternity 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. That ambition also includes reducing the rates of pre-term births from 8% to 6%. I reassure her that we have already achieved our ambition for a 20% decrease in stillbirths by 2020, so we are very much on track with those ambitions.

First and foremost, I express my heartfelt sympathies to every family who has been affected by previous failings in the trust’s maternity services. There can be no greater pain for a parent than to lose a child.

I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, who asked NHS Improvement to commission the independent review of maternity services at Shrewsbury and Telford in 2017, which is two years ago now—my hon. Friend was quite right about that. I take mild issue with one of her points, however, which was that NHS Improvement kept quiet about the failings. I find that slightly disappointing, because the raison d’être of NHS Improvement, which was also established by my right hon. Friend, is to investigate, expose and learn from failings, so I think she would agree it is not something that NHS Improvement would do. It is not in the culture of the organisation; the exact opposite is true.

The review being chaired by Donna Ockenden, a clinical expert in maternity and a registered midwife, was tasked with assessing the quality of previous investigations and the implementation of recommendations at the trust relating to new-born, infant and maternal harm. The original terms of reference covered the handling of 23 cases. The terms of reference have since been updated and were published in November to reflect the expanded scope of the review, and the review team will be in touch in the following weeks with the affected families to ensure that they are appropriately supported throughout the process. I am afraid I have to inform my hon. Friend and the House that the additional cases have now been identified and the total number relevant to the review now stands at 900, a small number of which go back 40 years.

The extra cases have been found by a number of means—from looking at previous incidents reported at the hospital to parents brave enough to come forward and talk about their own experiences. I am sure my hon. Friend will understand that, unlike with Morecambe Bay, which involved a small number of cases, it will take the review considerably longer to investigate 900 cases[Official Report, 20 January 2020, Vol. 670, c. 1MC.]. That is why there has been no report so far. The interim finding was not 600; the number is greater. It is appropriate that, while this important work is being done, we do not influence or comment on it and that we let Donna Ockenden get on with her vital work. It is our responsibility to let her do that and to provide the additional support needed given the additional cases identified. It is a huge increase on the original number of cases.

[Jeremy Hunt]

I thank the Minister for her personal commitment to patient safety, which I have seen on many occasions, but she will be aware that what she has just told the House is deeply shocking. She is saying that the scale of potential avoidable death at Shrewsbury and Telford may be no different from that at Mid Staffs. Could she reassure the House, given the huge resources devoted to the public inquiry into what happened at Mid Staffs, that the Department will make sure that Donna Ockenden has all the resources and support she needs, because getting to the bottom of this will be a huge job? Does the Minister also recognise that, while it will take more time, the families would also like it resolved as quickly as possible?

[Ms Dorries]

Absolutely, and I thank my right hon. Friend for his comments. Yes, the Department is liaising closely with Donna Ockenden about what support she needs to conclude her work as soon as possible, for the sake of the families. As he will understand, the review cannot be rushed; it has to be done properly and thoroughly. We have to get to the bottom of this matter, which is why Donna Ockenden is being supported in the way she is. Anything she needs in order to conclude this review successfully she will have. I thank my right hon. Friend for his personal comments. As he will know, and as he has said, I am utterly committed to patient safety, to eradicating avoidable harms and to making the NHS the safest place—not one of the safest—in the world to give birth. The review is important in the light of that.

As well as the families who came forward when the review was launched, media coverage has raised awareness of it, prompting further contacts with the trust and the review team. More recently, Donna Ockenden herself made a final appeal for any more families who believe that they have been affected to come forward. I am grateful to all the families who have voluntarily agreed to assist the review, although that may mean their having to revisit painful and distressing experiences. We expect it to conclude by the end of the year, at which point the Government will work closely with NHS England and NHS Improvement to consider the next steps.

As I have said, it is important for the review to be allowed to proceed unhindered, and without speculation about its conclusions or findings. However, I am very aware that current maternity patients at the trust may want reassurance that they will be safe and looked after. My hon. Friend the Member for Telford referred to “red lights”. I can reassure her that steps are being taken at the trust. It is completely understandable that people are asking questions, but I have asked for a meeting with the interim chief executive, because I want to see for myself that those steps are working. She has already made a public statement to reassure all families using the trust’s maternity services that much work has already been done to address issues raised by previous cases and to improve services, while acknowledging that the trust—obviously—had further to go.

During the November inspection of the trust’s maternity services, the Care Quality Commission found that the trust had taken action following the last inspection in April, so it was clearly listening and implementing the recommendations. As a result, there had been a number of improvements. Although more work was still needed, staffing had increased, and morale and governance had improved. However, I expect the CQC to keep a close eye on what is going on.

Let me end by restating the strength of our commitment to improving the quality and safety of maternity care. As I have said, the Government’s maternity ambition is to halve the 2010 rates of stillbirth, and we are on track to do that, which is incredibly important. Let me also say to my hon. Friend that, although I cannot reveal to her what is happening in the review—I cannot find out what is happening myself, because Donna Ockenden needs that autonomy—my door is always open. If my hon. Friend wants to discuss with me at any time what I have said tonight about the improvements that are being made at the trust, she need only pick up the phone. I am there to answer any questions that she may have on behalf of her constituents, and I ask her please not to hesitate to contact me if she needs further reassurances.

As I have said, the NHS remains one of the safest places, although we want to make it the safest place. What is most important is to ensure that the tragic cases that the Ockenden review is examining are not repeated anywhere else. That must be the objective. Women deserve a better maternity experience, and that is what we are determined to achieve.

Question put and agreed to.