National Breastfeeding Week

Peter Bone Excerpts

Wednesday 24th June 2015 Westminster Hall

[Mr Peter Bone (in the Chair)]

It might help the hon. Lady to know that I will come back to her for a few minutes once the winding-up speeches are finished.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a pleasure to serve under your chairmanship, Mr Bone. I pay tribute to the hon. Member for Glasgow Central (Alison Thewliss) for initiating the debate and for her leadership of it. I particularly commend her for tweeting a picture of herself breastfeeding to help launch and publicise the Breastfeeding Network and the campaign this week.

I commend the hon. Members for Dulwich and West Norwood (Helen Hayes), for Aberdeen North (Kirsty Blackman) and for Washington and Sunderland West (Mrs Hodgson) for raising in a short time a number of very important issues. They include issues about the importance of breastfeeding and about women in the workplace; issues, which we had all hoped would become legacy issues, about prejudice and discrimination; and important issues about geographic variation and inequality, including the importance of cultural leadership in changing attitudes.

There were specific questions on policy, which I will try to come to in a moment. I just want to take this opportunity to celebrate and promote National Breastfeeding Week, which runs from 20 to 28 June. It is an excellent initiative and it is particularly good to see it so active on Twitter, which may be to the credit of the hon. Member for Glasgow Central, and to see the plethora of activities going on around the country and the sharing of good practice and experiences by women and health professionals in place-based and virtual networks. That is genuinely inspirational, and the Department and I look forward to seeing other activities organised by local groups around the country this week.

It will not have escaped your beady eye, Mr Bone, that I am, on a gender basis, the least qualified person in the room to be responding to the debate, but I am pleased that the shadow Minister, the hon. Member for Washington and Sunderland West, highlighted the fact that I am the Minister responsible for life and health sciences. This issue goes to the heart of our thinking more broadly about how we unleash the power of the NHS and our health system more generally to support and drive public health.

Before coming to the House, I worked in biomedical research. I had the great privilege of working at the Institute of Child Health, which is doing extraordinary work on the importance of pre and post-natal nutrition for long-term health outcomes. Extraordinary data are beginning to appear on the importance of early nutrition in determining our long-term health. As the Minister responsible for the National Institute for Health Research, as well as the whizzy high science of tomorrow’s technologies, I can say that we also have at the heart of the NHS a commitment to ensure, through the institute, that we are constantly using the power of our health system to drive public health and to promote best practice.

The Department of Health is working closely with our partners at UNICEF, the Royal College of Midwives, the Institute of Health Visiting, NHS England and Public Health England to co-ordinate our awareness messaging this week. This debate provides an invaluable opportunity for Members of Parliament to discuss these important issues.

It may help if I begin by setting out the Department’s view on breastfeeding in England, which is the only place for which I can speak. It is widely agreed that breastfeeding delivers significant health benefits for both the mother and her baby and is more cost-effective for mothers than other methods of infant feeding. A mother’s milk provides a perfect balance of nutrients and vitamins for the first six months of a child’s life. That is why the World Health Organisation and the Department of Health encourage exclusive breastfeeding for the first six months.

The Department is aware, however, that infant feeding choices are complex and personal, based as they are on individual and family circumstances. That is right. Not all mothers choose to or are able to breastfeed. In line with UNICEF’s Baby Friendly guidelines, all mothers should be supported to make informed decisions and to develop a close relationship with their babies soon after birth.

The evidence shows that, in addition to providing all the nutrients and vitamins that a baby needs, breast milk also protects him or her from infections and diseases. Breastfed babies are less likely to develop diarrhoea, vomiting and chest infections, leading to fewer hospital visits; and they are less likely to become obese both as children and in later life. Breastfeeding can also reduce the chances for some women of getting diseases such as breast or ovarian cancer later in life. The evidence and data also show that breastfeeding as soon as possible following birth helps to start the bonding process between a mother and her baby. We know that secure parent-child attachment results in better social and emotional wellbeing among children. Furthermore, evidence shows that that, in turn, has important implications in terms of life prospects for the infant.

I am pleased that the breastfeeding initiation rate in England has increased from about 62% in 2005-06 to 73.9% in the third quarter of 2014-15. The Office for National Statistics will publish the full-year figures in a couple of weeks. However, breastfeeding initiation rates vary widely across clinical commissioning group areas, from 43.9% in NHS South Sefton to 93.4% in NHS Lambeth.

While we understand that cultural differences exist in different areas, it is important that all new mothers receive the best quality of care no matter who they are or where they live. We encourage local commissioners and services to use their resources, and opportunities such as National Breastfeeding Week, to reduce such variations and increase overall breastfeeding rates.

Increased awareness of the health risks associated with not breastfeeding has brought about a drive in recent years to improve breastfeeding support and increase breastfeeding prevalence rates. Support and information is currently available to health professionals and parents through a range of channels such as the NHS Choices website under the Start4Life banner; the national breastfeeding helpline; the UNICEF UK Baby Friendly initiative; and local peer support programmes.

Parents-to-be and new mothers and fathers can also sign up to the Start4life information service for parents. Subscribers receive regular free emails, videos and text messages that offer high quality advice and information based on the stage of pregnancy and the age of the child. That service includes breastfeeding and signposts parents to other quality-assured information about parenting, relationship support and benefits advice.

In the past five years, I am delighted to say that we have recruited more than 2,100 more midwives into the NHS. We are training a further 6,400, who will provide women with the information, advice and support they need to breastfeed. In addition, appropriately trained and supervised maternity support workers play an important role in supporting women with breastfeeding and helping midwives to run parentcraft classes. In the past five years, 2,000 new health visitors have been recruited and we are on track to reach our target of 4,200 by the end of the year.

I will try to answer the important questions raised in the few minutes available; if I am beaten by the clock, perhaps I can write to hon. Members. The hon. Member for Glasgow Central mentioned the National Infant Feeding Network. In 2014, the Department of Health provided £30,000 to UNICEF UK to support the establishment of the network, which shares and promotes evidence-based practice on infant feeding and early childhood development to deliver optimum outcomes. It comprises 600 infant feeding specialists and supports 30,000 health professionals who, in turn, are responsible for caring for more than 650,000 mothers.

The network approached the Department for funding support in 2015. Unfortunately, its request could not be accommodated because it came in too late for the 2015-16 budget. However, we continue to work closely with the network co-ordinators on future funding.

The hon. Lady also raised the breastfeeding rights of women in the workplace. Specific health and safety requirements relating to new and expectant mothers at work are contained in regulations 16 to 18 of the Management of Health and Safety at Work Regulations 1999. A woman can ask her employer to provide a private, safe and healthy space to allow her to express milk and a fridge to store it in.

On the UNICEF UK Baby Friendly initiative, I repeat that we want to encourage more women to breastfeed. That is why we welcome the revised Baby Friendly standards that support feeding and relationship building. It is great to see that, across the UK, 91% of maternity services and 88% of health visiting services are working towards Baby Friendly accreditation. In the UK, 49% of maternity services, 51% of health visiting services, 37% of university midwifery courses and 9% of health visiting courses currently have full Baby Friendly accreditation.

On the infant feeding survey, I am happy to confirm that the Government’s policy is to improve outcomes for women and their babies. To do that, we need current information to inform policy and service delivery. The statistics that NHS England regularly gathers capture data from all women using NHS services, rather than from the periodic survey samples. From 2016, the maternity and children’s dataset will, for the first time, link a mother’s health and behaviours during pregnancy and post-natally to outcomes for herself. I will happily write with more details on that and on the issue of breast milk substitutes, since I am defeated by the clock.

[Mr Peter Bone (in the Chair)]

The Minister is certainly not defeated by the clock; it is at 5.44 pm that the debate will now finish.

[George Freeman]

Thank you, Mr Bone. I apologise; I was merely stretching my legs as I saw the clock hit the 5.30 button. I was not expecting the vote. I am delighted that I have more time to finish dealing with the two questions. There was an important question on breast milk substitutes.

For mothers who choose to use formula milk, it is important that measures are in place to protect babies’ health and that all the parents have the information they need to make the right choice. The Government provide advice for parents on maternal and infant nutrition via NHS Choices and the NHS Start4life information service.

The international code of marketing of breast milk substitutes is an international health policy framework to regulate the marketing of breast milk substitutes. In view of the vulnerability of babies in the early months of life and the risks involved in inappropriate feeding, the marketing of breast milk substitutes requires special treatment. Baby Friendly accreditation requires services to implement the requirements of the code, which goes further than UK law in regulating marketing activity. To meet the Baby Friendly standards, services must ensure that there is no promotion of breast milk substitutes, bottles, teats or dummies in any part of the facility or by any of the staff.

The Infant Formula and Follow-on Formula (England) Regulations 2007 are designed to ensure that all types of infant formulae meet the nutritional needs of babies, while ensuring that breastfeeding is not undermined by the advertising, marketing and promotion of such products. The regulations include strict controls on the promotion, labelling and composition of infant and follow-on formula and set out clear guidance for infant formula manufacturers on how the regulations should be implemented.

Finally, there was a question about the National Infant Feeding Network, which I think I have dealt with. If there are any other issues, I will happily respond by letter. I shall leave enough time for the hon. Member for Glasgow Central to close the debate.

[Alison Thewliss]

I thank the Minister and all the Members who have spoken today; the fact that they came along and participated is very much appreciated. I can see from Twitter that the debate has been getting a good and interesting response. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for her contribution and for her support for the organisations in her area that clearly need it at this time. Where we have instances of good practice in breastfeeding in this country, we must absolutely support services in every way we can. It is absolutely true that if we lose the expertise and the service, that will set breastfeeding back hugely and it will be difficult to re-establish.

My hon. Friend the Member for Aberdeen North (Kirsty Blackman) spoke passionately about the support required, about the importance of the consistency of a network and about the importance of having experienced midwife support. Experienced professional advice must be given, and it can be given only, whatever the circumstances, by seeing somebody physically. The answer cannot always be to do things online.

The Minister made the point about follow-on milk, commercialisation and the implementation of the code. I still think that we have issues. We can go further to implement the code; it is clear that the implication of some of the adverts for follow-on milk is that if women breastfeed for a year or two, their milk might not contain enough nutrients for their child. The opposite is true—it contains all the nutrients that are needed. That is exactly and specifically how nature has designed it for the healthy development of children.

I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson) for her contribution. She is hugely experienced and clearly very passionate about the subject, which is great. There are lots of obstacles in the way, not least women returning to work, and we need to be mindful of that and how best we can offer support. We need to make breastfeeding a normal process so that women do not feel embarrassed about asking to nip out to express milk or going to visit the nursery to feed their child.

I had a strange experience last summer as a volunteer at the Commonwealth games in Glasgow. It was the longest time I had been away from my baby at that point. I found it very difficult to explain to a room of strangers that I was nipping out for a couple of minutes to express milk and to ask whether I could hide it in the fridge somewhere. The situation is difficult and awkward; we need to be aware of that. Employers need to be aware of their obligations and how to make it easy for people, so that there is a private space where they will not be interrupted. People should not be offered a corner of a busy lunchroom and certainly never a toilet, because that is disgusting, frankly. We would not eat our lunch in the toilet, so we should not expect anyone else to.

The point about images and showing the world what breastfeeding looks like was interesting. The Minister commented that I had tweeted a picture at the weekend; someone came up to me yesterday and said, “That’s very daring of you!” and “That’s very brave of you!” To be honest, I did not think about it. I was holding a baby; there was nothing particularly to see in the picture other than me feeding my daughter. I thought, “What a strange reaction.” To me, it is completely natural; I do it almost without thinking.

I put the picture up to publicise the importance of the debate and National Breastfeeding Week. If we look at the hashtag, we will see women doing similar across the internet just now. It is a process of normalising the activity—perhaps making a breastfeeding selfie something that people do, rather than draw back from. The issue is about making breastfeeding part of everyday life that people see all the time. If people do not see women breastfeeding, do not know anyone who breastfeeds and all they see are women feeding children with bottles, they will think that breastfeeding is odd and may not feel brave enough—because it will feel brave—to attempt it themselves.

We need to think carefully about how we normalise breastfeeding and how families, extended families and friends can best support women when they are doing it. My neighbours in Glasgow were keen to help their daughters and daughters-in-law by taking their babies overnight when they were tiny to give the mother a break. Although that is a wonderful thing to do to help, it will not help breastfeeding at all and will make it all the more difficult. We all need to think about our roles as part of families, the things we say and the way in which we say them—not say, “You must be exhausted”, but rather, “Can I make you a wee cup of tea?” It is about finding ways to support people rather than passing comment or using phrases that almost feel undermining at every turn. We need to think about that as much as we can.

[Mr Peter Bone (in the Chair)]

Order. We are all finding our way with the new system that we have only just implemented in Westminster Hall. The wind-up speech should really be very brief—probably about two minutes. I think the hon. Lady has been going for more than five minutes, so she might want to bring her contribution to an end.

[Alison Thewliss]

Thank you, Mr Bone. I have found it difficult because the time is not what I expected it to be, so I was unsure about whether I was running out of time and how long I had. I thank the Minister for his contribution. I still think that there are lots of issues that we, as individual Members, ought to take up in this Parliament to support mothers in any way we can. I thank hon. Members again for attending.

Question put and agreed to.

Resolved,

That this House has considered National Breastfeeding Week.

A&E Services

Peter Bone Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

It is a matter of fact that we increased nursing numbers. The hon. Lady will be well aware that when we came into office in 1997, we were training 15,000 nurses a year, and when we left office in 2010, we were training 20,000 nurses a year.

On social care, under this Government, 300,000 fewer older people are getting the care they need, with more and more people being forced to stay in hospital. But that is only part of the story. When someone who needs care cannot get the help they need, it increases the risk that they will struggle or fall ill and have to go to accident and emergency. That is clearly demonstrated in the increasing number of older people arriving at A&E by ambulance. Almost 100,000 extra patients over the age of 90 were brought to accident and emergency by ambulance last year. That is an indictment of Government policy towards older people, and the problem is further exacerbated when the true scale of the damage to social care is revealed.

Before the election, the National Audit Office published its report on the impact of Government cuts on local council budgets. The report found that 40% of the total savings between 2013-14 and 2014-15 were made through reducing adult social care services.

The Association of Directors of Adult Social Services has calculated that a further £1.1 billion will be cut from adult social care over this financial year, and the president of the association said:

“Short-changing social care is short-sighted and short-term.”

The number of patients ending up in A&E because they cannot get the care they need to help them stay healthy outside hospital is clear evidence of this short-termism.

Cutting the social care budget is clearly a false economy, as thousands turn to A&E as a result. That is bad not only for the patient, but for the taxpayer. If a patient is not getting the care they need, their condition will deteriorate, which means that more complex interventions will be needed. A recent poll commissioned by the Care and Support Alliance found that nine out of 10 GPs believe that deep social care cuts are responsible for the overcrowding in our accident and emergency departments. The Government need to get a grip and address the crisis in social care in order to relieve the pressure on A&E departments and GP surgeries. Instead, they have chosen to risk putting more pressure on the heath system at all levels by announcing further cuts of £200 million to the public health budgets of local authorities without any idea of whether they can be made without harming vital services—services that potentially save money.

[Mr Peter Bone (Wellingborough) (Con)]

Will the shadow Minister recognise the initiative that is happening in north Northamptonshire? Kettering general hospital will have not only an A&E, but urgent care, social care and mental health facilities and GPs all on the same site. People can go to the hospital and be dealt with there and then, correctly. I will also have an urgent care centre in my constituency. Is that not the way forward?

[Mr Reed]

I am grateful to the hon. Gentleman for his intervention. I absolutely agree that models such as that and local best practice can exist in pockets all over the country. It is just a shame that so many health economies are getting cut to the bone, because that stops them developing such care models. He is right that it is precisely that kind of integration that points the way to the future. Have the effects of these public health budget cuts on primary care and accident and emergency been modelled by the Department, and will the Minister share that work with the House? If that work has not been done, will he explain why? Has the Department consulted on these latest cuts, and what was the response?

I now wish to turn to the situation in general practice. In the previous Parliament, we saw a marked increase in the number of people waiting longer for a GP appointment. By 2013-14, almost 6 million people could not get a GP appointment. If the trend continues, that figure could be around 10 million by the end of this Parliament. Those people are often left with little option but to turn to accident and emergency. The GP patient survey suggests that almost 1 million patients went to A&E last year because they could not get a convenient GP appointment. It is clear that the GP workforce crisis is a major driver of the issues under discussion today.

NHS Success Regime

Peter Bone Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I welcome the hon. Lady to her place. We are now repeating discussions we had in the previous Parliament, because I am afraid that the Labour party still does not understand that these decisions are not being directed from Whitehall. I know that is uncomfortable for them, because what they want to do is pull a lever and hope that something happens at the other end, but that does not work. The only way to get success is by having local clinicians, supported by national bodies, providing the solutions that local people deserve.

[Mr Peter Bone (Wellingborough) (Con)]

In North Northamptonshire we had a problem with the A&E at Kettering hospital. Local commissioners and three hon. Members—my hon. Friends the Members for Kettering (Mr Hollobone) and for Corby (Tom Pursglove) and I—all worked together to produce a plan, which the Minister has taken up. That is a precursor to the success regime, and it shows that local commissioners, local hospitals and MPs can solve problems by working together. Will the Minister continue to look on that favourably?

[Ben Gummer]

The care of my hon. Friend’s constituents, including Mrs Bone, is always a prime consideration. He has shown what Opposition Front Benchers should understand, which is that working across parties, as he did in his part of the world, can bring about co-ordination and success. I only wish that those on the Opposition Front Bench, on what should be a clean slate, would do the same.