Oral Answers to Questions

Tim Loughton Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Dunne]

I recognise that when the proposal was put forward back in 2012, it led to a process that we felt was wrong, and we therefore stopped it. This process, we hope, is being conducted in a more rigorous and fairer way, and will lead to outcomes driven, as I say, by improving patient experience.

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

13. What the estimated cost of private finance initiative liabilities to the NHS is in (a) 2016-17 and (b) the subsequent three financial years.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Labour’s legacy cost from the 103 hospital PFI schemes entered into between 1997 and 2010 was a public sector liability of £77 billion. The estimated total NHS PFI payments for the financial year ending at the end of this month is £1.97 billion, and the totals for the next three financial years are £2.04 billion, £2.11 billion and £2.16 billion.

[Tim Loughton]

Those are alarming figures, so what are the Government doing to support the trusts affected by those expensive and inflexible PFI and other deals reached under the previous Labour Government? What assessment has the Minister made of what the funds could be buying in the NHS now if it was not saddled by this Labour debt legacy?

[Mr Dunne]

My hon. Friend is right to point out that the Opposition constantly complain about the cost of the PFI programmes that they themselves initiated. The Government are making large efforts to support trusts in dealing with the PFI legacy. We are giving the seven trusts worst affected by PFI schemes access to a £1.5 billion support fund over a 25-year period. In 2014 alone, trusts negotiated savings worth over £250 million on their contracts.

Baby Loss (Public Health Guidelines)

Tim Loughton Excerpts

Tuesday 21st March 2017 Commons Chamber

[Will Quince (Colchester) (Con)]

As my wife will testify, I am rarely early for things, so to be more than three hours early for something is a rare treat indeed. I know that both you, Mr Deputy Speaker, and the Minister will be pleased to know that I intend to take only about two and a half hours of the just over three hours available to me.

As the House knows, I am a passionate campaigner in the area of baby loss. Having unfortunately experienced it myself, I have always been clear that I want to use my position in the House to bring about change so that as few people as possible have to go through this absolute personal tragedy. In the latest year for which figures are available, there were 3,254 stillbirths in England and Wales, with a further 1,762 neonatal deaths shortly after birth. Every single one of those is a personal tragedy, yet perhaps the most galling aspect is that so many of these deaths—reportedly about half—are actually preventable.

I strongly welcome the Government’s plans to cut the stillbirth and neonatal death rate by 20% by 2020 and, furthermore, to reduce it by 50% over the next 15 years, but those are just numbers unless we put in the resources necessary to deliver on this. Trusts have received £4 million to buy better equipment and boost training to cut stillbirth and neonatal death. More than £1 million is also being provided to help develop training packages so that more maternity unit staff have the confidence to deliver safe care. It is hugely positive that the Department of Health has recognised the scale of the challenge and set aside this funding, but we need to focus as much on reducing the risks of stillbirth.

One significant risk factor remains one of the toughest to eliminate and, as a result, carries the greatest reward if we can address it: smoking in pregnancy. Let me be clear that this debate is absolutely not about criticising or demonising women and their partners who smoke during pregnancy. We all know that tobacco is highly addictive and it can be difficult to stop smoking. However, smoking while pregnant is the No. 1 modifiable risk factor for stillbirth. If I may, I will run through a few statistics: one in five stillbirths is associated with smoking; women who smoke are 27% more likely to have a miscarriage; their risk of having a stillbirth is a third higher than that of non-smokers; and mothers who smoke are more likely to have pre-term births and babies are who are small for their gestational age.

Maternal exposure to second-hand smoke during pregnancy is an independent risk factor for premature birth and low birth weight, yet only one man in four makes any change to his smoking habits when his partner is expecting a baby. If, tomorrow, every pregnancy was smoke-free, we would see 5,000 fewer miscarriages, 300 fewer perinatal deaths, and 2,200 fewer premature births every year. Were children not exposed to second-hand smoke, the number of sudden infant deaths could be reduced by 30%.

The previous tobacco control plan set targets for reducing rates of smoking in pregnancy. In 2015-16, the number of women smoking at the time of delivery had fallen to 10.6%—below the Government’s target of 11%—yet the fact that the Government’s target has been met nationally masks geographical variations. Yes, we are seeing rates of 2% in Richmond, 2.2% in Wokingham and 2.4 % in Hammersmith and Fulham, but rates of smoking in pregnancy are 26.6% in Blackpool, 24.4% in South Tyneside and 24.1% in North East Lincolnshire.

Of the 209 clinical commissioning groups, 108 met the national ambition of 11% or less, but that means that 101 did not. It is even more worrying if we look for improvements in the rates of smoking in pregnancy in CCG areas. Yes, 14 CCGs have improved significantly over the past year, but 182 have rates that are about the same and, even more worryingly, 13 have significantly worse maternal smoking rates.

The Government have committed to renewing targets to reduce smoking in pregnancy. Reducing regional variation in smoking during pregnancy and among other population groups is a high priority for the Minister, and I know the Government are focusing on it as they finalise the tobacco control plan. I was pleased to see the recent news that NHS England granted £75,000 of funding to the 26 CCGs that are most challenged on maternal smoking.

How do we achieve the Government ambition for a 50% reduction in stillbirth and neonatal deaths by 2030? First, we need to publish a new tobacco control plan. The previous tobacco control plan for England expired at the end of 2015. The Government have promised that a new one will be published shortly. The publication of the strategy is now a matter of urgency, so will the Minister kindly advise on how shortly “shortly” is?

The strategy needs to include ambitious targets for reducing smoking in pregnancy. The Smoking in Pregnancy Challenge Group—a partnership of charities, royal colleges and academics—has called for a new national ambition to reduce the rate of smoking in pregnancy to less than 6% by 2020. I know the Department of Health is sympathetic to that aim and hope it will be included in the new tobacco control plan.

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

I congratulate my hon. Friend on securing a three hour and 53 minute debate on this important subject and thank him for all the work he does on baby loss. He may well address this issue later in his speech, but does he agree that the alarming figures for regional differentials also apply to stillbirth rates more generally? Another issue is cultural differences between different sections of our populations with very different outcomes. That, too, must be a priority for the Government, because wherever in the country someone is, surely they are entitled to the same level of support and the same health outcomes.

[Will Quince]

I thank my hon. Friend for that intervention. He, too, has done a huge amount of work in this area and is hugely supportive of the work of the all-party group on baby loss. He is quite right to highlight the regional variation that exists, and to which the Department is very much alive. I had not intended to focus on the specific demographics, in terms of race, but the figures do show that certain demographics have a higher propensity towards stillbirth. The honest answer is that we do not really know why, so there is a huge need for research in this area. I am not going to discuss that issue, but only because I want to focus specifically on smoking.

My hon. Friend is quite right about that particular demographic, and the reasons behind higher stillbirth and neonatal death rates may well be a public health issue. I hope that the Minister and the Department will look into that independently of this debate.

Secondly, communication to pregnant women must be sensitive and non-judgmental. Qualitative findings from the babyClear programme found that pregnant smokers found the interventions unsettling, but they were receptive to the messages if they were delivered sympathetically. To do that, healthcare professionals must feel able to have conversations about harm and have clear evidence-based resources and support for pregnant women.

Thirdly, the Government should ensure the implementation of guidance from the National Institute for Health and Care Excellence. NICE guidelines recommend that referral for help to stop smoking should be opt-out rather than opt-in. Research published by Nottingham University in April 2016 on opt-out and opt-in referral systems found that adding CO monitoring with opt-out referrals doubled the number of pregnant smokers setting quit dates and reporting smoking cessation.

Further, a recent evaluation of the babyClear programme in the north-east of England found that it delivered impressive results. BabyClear is an intervention to support implementing NICE guidance on reducing smoking in pregnancy. Let me give some background. BabyClear began in late 2012. Since then, smoking at the time of delivery has fallen by 4.0% in the north-east compared with 2.5% nationally. That equates to about 1,500 fewer women smoking during pregnancy in the north-east than in 2012. The cost of implementing the core babyClear package over five years is estimated at £30 per delivery.

Fourthly, we should embed smoking cessation across the maternity transformation plan. There are nine workstreams altogether and smoking cessation is central to achieving success in most of those. As an example, the workstream, “training the workforce”, should include training midwives on CO monitoring and referral, but there is a risk that smoking cessation is siloed into the workstream focused on improving prevention. It is vital that that does not happen.

Finally, the Nursing and Midwifery Council is updating its standards in relation to nurses and midwives. This training must be mandated and have smoking in pregnancy as a key part. These are all steps that can and should be taken by the Department of Health to help maintain the momentum on reducing smoking during pregnancy rates. However, there is one other suggestion that I would like the Minister to take away and discuss with his colleagues in other Departments. All alcohol bought in the UK carries a warning sign making it clear that pregnant women should not consume this product, yet only one packet of cigarettes in six carries a warning about the danger of smoking while pregnant. It is not unreasonable or unrealistic for all tobacco products to carry a similar warning to that seen on alcohol. I would be grateful to the Minister if he looked into the feasibility of introducing such a scheme. I understand that it falls under European law and European regulation, but that may, in the very near future, not be a problem.

This debate is absolutely not about criticising or demonising women and their partners who smoke during pregnancy. I fully appreciate that tobacco is highly addictive and that it is difficult to stop smoking. We also know that all parents want to give their baby the best possible start in life. We want a message to go out loudly and clearly that no matter what stage a woman is in her pregnancy, it is never too late to stop smoking. Yes, that can be difficult, but smoking is much more harmful to a baby than any stress that quitting may bring. Most importantly, we and the Department of Health will give parents all the support and tools to help them to quit.

--- Later in debate ---

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

I had not intended to speak in this debate—I just wanted to be part of it and perhaps to question the Minister—but you have tempted me, Mr Deputy Speaker, to add my three penn’orth. I, too, will not take up the remainder of the three hours and 50 minutes in making a few comments. I again congratulate my hon. Friend the Member for Colchester (Will Quince) on securing the debate.

The Government have made good progress on the smoking front, and that needs to be recognised, but 10.6% of people still smoke through pregnancy. That figure needs to be brought well down into single figures. My hon. Friend made a good point about the use of advertising messages with regard to alcohol. Of course, unlike alcohol, this issue affects only half the population. The graphic images on cigarette packets of diseased lungs, and those grisly television adverts with pus coming out of lungs and so on, really send home the message about the harm that any smoking can do. Making that clear to women who still take the risk of smoking during pregnancy would help to get the figure down further.

We still have a major problem in this country with high levels of baby loss through stillbirth as well as through the rather less quantifiable form of miscarriage, the true extent of which we do not really know. As I said earlier, it must be a priority for Government to work out why we have regional and cultural differences, and to extend and learn from best practice rather better than we do at the moment. Some of the pilots and experiments that have happened in Scotland are something for the rest of the country to look at and learn from.

Given the title of this debate, we could, strictly speaking, extend it well beyond just smoking, and I am going to take advantage of that. On drinking, there has been a very confused message for some time. I am an officer of the all-party foetal alcohol syndrome group. We produced a report that urged complete abstinence as the only safe way, and that must be the default position. For women who do choose to continue to drink in some form during pregnancy, there need to be very clear health messages, and perhaps lower-alcohol alternatives. If someone has to drink, there are ways of potentially doing less damage to their baby. The Government can be part of that through the differential pricing tax mechanism. We are rather bad at that in this area.

I remember going to Denmark some years ago and visiting a children’s home just outside Copenhagen that specialised in treating children who were the victims of foetal alcohol syndrome—particularly children of mothers from Greenland, where there is a particular problem with heavy drinking. Those children were born with all sorts of disabilities, some of which manifested themselves as the symptoms that we know of in ongoing conditions such as autism.

There may be an understating of the effects of foetal alcohol syndrome because it can appear somewhere on the autistic spectrum as well. We need to do more research into that. There is no more stark example than we see in Denmark of a direct correlation between excessive drinking and giving birth to a child who will bear the effects of that for his or her whole life, with the learning disabilities and other things that go with it. We have lessons to learn from that. We still need stronger messages to go out to women during pregnancy about the potential, and potentially lifelong, harm that can be done by inappropriate drinking.

[Gavin Robinson (Belfast East) (DUP)]

Although a strong message is important, the delivery of that message is crucial. There is a good argument for saying that the shock-and-awe messaging used in advertisements about driver safety or alcohol, and on cigarette packets, does not have the impact that we believe it should. Many mothers might take cavalier decisions about themselves, as many of us do. I certainly do when it comes to food and its health benefits; I do not follow the guidance. Does the hon. Gentleman agree, however, that a mother would never want to damage the future prospects of her child? The sensitivity of the message, however strong it is, is the most important element.

[Tim Loughton]

The hon. Gentleman makes a fair point. We, as grown-ups, can make a conscious decision to be gluttonous or to over-imbibe. That does damage to our bodies and our bodies alone, although there may be a cost to the taxpayer through the national health service. If anyone should be more sensitive and sensible about the damage that could be done to another individual, it is a pregnant woman. A pregnant woman, or a woman considering pregnancy, should be more amenable to good health messages.

It is a question of horses for courses, and I take the point that the hon. Gentleman makes about shock-and-awe tactics. The AIDS adverts in the ’80s could be described as shock and awe, and they were exceedingly effective at the time. We still remember those tombstones. One can go too far, however; members of the public are smart, and they recognise over-emphasis for effect. It hits them in the face, and they say, “I do not need to take any notice of that.” We need smart messaging, which is credible and honed appropriately for its target audience.

That is why when we in the all-party group on foetal alcohol syndrome produced our report, we had a big debate about whether we should recommend complete abstinence or whether that was just not realistic for some people, who were still going to drink. I take the view that the default position must be that drinking harms a woman’s baby, but if someone absolutely has to drink, for whatever reason, there are less harmful—but always harmful—ways of doing so. We need to nuance that message appropriately for different audiences. Of course, different cultures have different attitudes to drinking, foods and so on.

I move on to a subject that is completely different, but still within the scope of this Adjournment debate: perinatal mental health. I declare an interest as the chair of the all-party group for the 1,001 critical days, and as the chairman of Parent Infant Partnership UK, a charity that is all about promoting good attachment among parents and their children in the period between conception and age two. One of the biggest, most powerful and most effective public health messages that we can give is that effecting a strong attachment with one’s child, right from the earliest days, will have lifelong benefits for that child. That includes the time that the child is in the womb. A mother who is happy, settled and in a good place is much more likely to pass on those positive messages to a child than a mother who is stressed and suffering from perinatal mental illness or various other pressures.

At least one in six women in this country will suffer some form of perinatal illness. We know from the science, which is producing considerable data, that a child who is not securely attached—preferably to both parents but certainly to the mother, to start with—is much less likely to thrive at school and to be settled and sociable, and more likely to fall into drink and drug problems and to have difficulties with housing and employment. The first 1,001 days are absolutely critical, and we should be doing more. It is a false economy not to do so, and not to invest money early on.

The Government have quite rightly flagged up the importance of mental health. The Prime Minister absolutely gets the importance of mental health, and particularly of perinatal mental health. The additional money allocated is good, but it is still not enough. The problem, as we all know, is that that money is not making it through to the sharp end, so opportunities are still being missed to identify women who have some form of mental health problem—typically depression around the time of pregnancy—signpost them to the appropriate services and deliver quality and appropriate services in a timely fashion. That is why the charity I chair, PIP UK, has seven PIPs around the country, operating out of children’s centres, to which women can be referred, often with their partners, to get the support and confidence they need to effect the strong bond and attachment with their child.

The Maternal Mental Health Alliance has costed the problem of not forming such bonds at £8.1 billion each and every year. I repeat that, each year, the cost of getting it wrong is over £8 billion. The cost of getting it right is substantially less, yet too many clinical commissioning groups around the country still do not even have a plan for delivering perinatal mental health for women where and when they actually need it. On top of that, in our report “Building Great Britons”, the all-party group calculated that the cost of child neglect is over £15 billion a year in this country. By not getting it right for really young children and for babies, we are therefore wasting £23 billion financially, but far more importantly we are not giving those children the very best start in life socially, which we could do with a bit more, smarter and better targeted up-front investment.

I reiterate to the Minister and his colleague, the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood)—she very kindly saw a delegation from the all-party group on the 1,001 critical days recently, and I know she takes this subject very seriously and has convened a roundtable—that we absolutely must come up with such public health messages and talk in this place about the importance of getting it right early on, but what matters at the end of the day is actually delivering the service to those women where it is needed, at the appropriate time and place.

Finally, may I take the liberty of mentioning to the Minister, as I think I did in a previous Adjournment debate, the question of the registration of stillbirths? It is a subject on which I have campaigned for some years in this place, and on which I have had a private Member’s Bill. This falls within the remit of baby loss, which is in the title of this Adjournment debate; I know you are scrupulous, Mr Speaker, about our not straying beyond the remit of a debate.

Following some very helpful responses from predecessor Ministers and officials at the Department of Health and having convened various roundtables—with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and other key players, as well as various stillborn charities—I thought we had got to a place where the law could be changed to emulate what has been done in New South Wales in Australia. However, we still have a iniquitous and highly distressing situation: somebody who has gone through the trauma of carrying a child as far as 23 weeks and six days will find, if the child is, tragically, born prematurely and stillborn, that the child is not recognised in the eyes of the state, although a child born just after the 24-week threshold will be recognised as a stillborn child. I have previously raised the example of a woman who had twins either side of that threshold: sadly, they both died, but one was never recognised, while the other was recognised as a stillborn child, with a certificate being issued by the hospital.

For a woman who has given birth to a stillborn child, such a situation is one of the most sensitive and vulnerable of times. My hon. Friend the Member for Colchester knows this so well, and other hon. Members have given their own very emotional accounts of going through such traumas. The fact is that the state has still, so far, failed to take the straightforward and fairly cost-free step of coming up with a simple registration scheme for those for whom such a scheme would help to provide some form of closure.

For a stillborn child born at under 24 weeks—what I am talking about is different from miscarriage, although I am in no way trying to underplay the trauma caused by having a miscarriage—to be recognised as a human being, rather than as a child who, sadly, was born before an artificial threshold, seems to me to be a sensible but humane thing to do to help the too many women who still give birth to stillborn babies. We need to bring that figure down, and we are doing so. In the meantime, we can at least give some succour and comfort to parents who have to go through this situation by saying that we appreciate and recognise what has happened, and sympathise and empathise with what they have gone through.

May I ask the Minister again whether there is any way that we can get this campaign going again? The issue has featured in one of our national soaps: an actress who went through it in real life re-enacted it in “Coronation Street”. There has also been a lot about it in the press. I ask the Minister to ask his Department to look at this issue again to see whether something can be done, because I think there could be a solution.

Mr Speaker, I have more than abused my privilege in this three hour and 50 minute debate, but these are issues on which there is a good deal of sympathy and empathy in the House. Yet again, we are greatly indebted to my hon. Friend the Member for Colchester for bringing them back to the House, where we have the power to make a difference to our future constituents’ lives.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I congratulate my hon. Friend the Member for Colchester (Will Quince) on securing this debate on public health guidance and baby loss. I also congratulate you, Mr Speaker, on scheduling it on a day when the other business, inexplicably, was so curtailed, thereby enabling some very distinguished Members on both sides of the House who chair directly relevant all- party groups to make unusually—I would not say unprecedentedly, Mr Speaker, because you would be better placed than I to say whether it was unprecedented—long contributions in an Adjournment debate, and very welcome they were too.

We know from families who have experienced baby loss that the silence that often surrounds the loss can make the experience much harder. For that reason, I join the tributes from the right hon. Member for Rother Valley (Sir Kevin Barron) and my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) to my hon. Friend the Member for Colchester for the work that he does in leading the all-party parliamentary group on baby loss and for bringing the experiences that he has suffered to bear on this issue a number of times.

Before I address the specific points made by my hon. Friend the Member for Colchester—I counted six challenges that he laid down in his speech, and I will try to address each of them—as I have the luxury of a little time, I will set the scene on the work the Government are undertaking to reduce adverse outcomes during pregnancy and the neonatal period.

My hon. Friend referred to the maternity transformation programme in England, which began a year ago. It provides an opportunity to shape services for the future. Improving women’s health requires a collaborative approach across the entire health system, including commissioners, primary care, maternity services, public health and local authorities, to meet the needs of women and their partners. The result of all that work is that England is a very safe country in which to have a baby. Sadly, a small number of babies are stillborn or die soon after birth but, according to the latest figures, stillbirths and neonatal deaths occur in 0.5% and 0.3% of births respectively.

We are absolutely committed to improving maternity care and recognise that every loss is a personal tragedy for the family concerned. As a result, it is our national ambition to halve the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 50% by 2030. We are making considerable progress. The other day, I had the privilege of attending the Royal College of Midwives awards ceremony—one of the more enjoyable parts of my role in the Department of Health—where I was able to confirm that since 2010, the proportion of stillbirths is down by 10%, the proportion of neonatal deaths by 14% and the proportion of maternal deaths by 20%. Our plan is having some effect, which is very pleasing, but there is always more that we can do.

To support the NHS in achieving this ambition, we have a national package of measures with funding attached, including: an £8 million maternity safety training fund to support maternity services in developing and maintaining high standards of leadership, teamwork, communication, clinical skills and a culture of safety; a media campaign, “Our Chance”, comprising 25 animations and videos targeted towards pregnant women and their families to raise awareness of the symptoms that can lead to stillbirth; and a £250,000 maternity safety innovation fund to support local maternity services to create and pilot new ideas.

The fund was allocated in the past couple of weeks. One project that secured funding will develop a one-stop multidisciplinary care clinic for women with diabetes, hypertension, morbid obesity and epilepsy. Another project aims to develop a pathway whereby all women with high carbon monoxide breath test results—this was referred to by my hon. Friend—are referred for serial ultrasound measurements to provide them with more information about the potential impact of smoking on the child they are carrying. We are also investing £500,000 to develop a new tool to enable maternity and neonatal services to systematically review and learn from every stillbirth and neonatal death in a standardised way.

The Government are seeking to put in place infrastructure to improve maternal health, but clearly young mothers, partners and families have a role to play too. The evidence shows that the national maternity ambition cannot be achieved through improvements to NHS maternity services alone and the public health contribution will be crucial. It is vital that women and their families are made aware of and understand the lifestyle risk factors that can impact on the outcomes for them and their babies, and the changes they can make to increase their likelihood of positive outcomes. Hon. Members referred to a number of them.

As soon as a lady knows she is pregnant, she should be encouraged to contact her maternity service for a full assessment of health, risk factors and choices, so that a personalised plan of care can be prepared. Women with complex social factors, in particular teenagers and those from disadvantaged groups, do not always access maternity services early or attend regularly for antenatal care, and poorer outcomes are reported for both mother and baby. Maternity services need to be proactive in engaging all women.

Early in pregnancy, a midwife will provide a woman with information to support a healthy pregnancy. This will include information about nutrition and diet, including supplements such as folic acid and vitamin D as well as lifestyle advice, central to which is smoking cessation—on which my hon. Friend focused his remarks—the risks of recreational drug misuse and alcohol consumption, which my hon. Friend the Member for East Worthing and Shoreham focused on in his remarks.

When starting pregnancy, not all women will have the same risk of something going wrong, and women’s health before and during pregnancy are some of the factors that most influence rates of stillbirth, neonatal death and maternal death. We know that a body mass index of over 40 doubles the risk of stillbirth. A quarter of stillbirths are associated with smoking, and alcohol consumption is associated with an estimated 40% increase to stillbirth risk. In addition, the MBRRACE-UK perinatal mortality surveillance report, published in June last year, showed that women living in poverty have a 57% higher risk of having a stillbirth. Women from black and minority ethnic groups have a 50% higher risk, and teenage mothers and mothers over 40 have a 39% higher risk of having a stillbirth.

Those striking facts are why the Department of Health will continue to work closely with Public Health England and voluntary organisations to help women to have a healthy pregnancy and families to have the best start in life. Last year, NHS England published new guidance that aims to reduce the number of stillbirths in England. Building on existing clinical guidance and best practice, the guidance was developed by NHS England working with organisations including the Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, British Maternal and Fetal Medicine Society and Sands, the stillbirth and neonatal death charity. The Saving Babies’ Lives Care Bundle includes key elements intended to significantly impact on stillbirth rates through reducing smoking in pregnancy, detecting foetal growth restriction, raising awareness of reduced foetal movement and improving effective foetal monitoring during labour.

I now come specifically to the challenges posed by smoking in pregnancy. My hon. Friend the Member for Colchester stole most of my thunder by declaring many of the statistics on the impact of smoking, but I am particularly pleased that he focused on the fact that the plan, as set out in the tobacco control plan for England in 2011, which set a target to reduce the number of women smoking in pregnancy to 11% or fewer, has now been achieved at the national level, with a rate of 10.6% for England as a whole. As my hon. Friend also pointed out, this masks wide geographical variations across the country, ranging from 4.9% across London to 16.9% in Cumbria and the north-east. There was an even greater difference at the level of clinical commissioning groups, from which I believe my hon. Friend collected his statistics. These range from 1.5% at the low end to over 26% at the higher end, which is clearly a totally unacceptable variation.

Although we have made progress in recent years, about 70,000 babies continue to be born each year to mothers who smoke—and more if we include exposure to second-hand smoke. My hon. Friend made an interesting observation about the impact of partners continuing to smoke while their partners are pregnant. My hon. Friend mentioned the figure of 25%, so for one in four pregnant women their partners continue to smoke. That is an area on which we need to focus our attention and seek to raise the awareness of the impact of passive smoking. I am grateful to my hon. Friend for raising that issue.

Smoking during pregnancy is the main modifiable risk factor for a range of poor pregnancy outcomes. It is known to cause up to 2,200 premature births, as my hon. Friend said, 5,000 miscarriages and 300 perinatal deaths every year across the UK. It also increases the risk of developing a number of respiratory conditions, attention and hyperactivity difficulties, learning difficulties, problems with the ear, nose and throat, obesity and diabetes. Pregnant women under 20 are six times more likely to smoke than those aged 35 or over. Specialist stop smoking support, while available to pregnant women, clearly needs to be targeted on those higher-risk groups. That provides much of the challenge that my hon. Friend set for us in his remarks.

We are looking to take considerable action to advance the cause of reducing smoking. My hon. Friend asked in particular when we intend to publish the next iteration of the tobacco control plan. He asked me to define a well-used parliamentary term—“shortly”. I regret to say that it is way beyond my pay grade to provide closer definitions of that term. There are others, including someone who recently arrived in the Chamber, who might have some influence on the speed with which plans emerge from the Government. I very much hope that we will be able to progress with the next iteration of the tobacco control plan in the next few months.

My hon. Friend referred to the babyClear programme, which is about informing pregnant women about the risks they run from continuing to smoke. It is an important programme that has been evaluated by Newcastle University, which published some findings last month. We think that this is closely aligned with the NICE guidance, which is appropriate. It builds on the point made by my hon. Friend and by the hon. Member for Belfast East (Gavin Robinson) about the sensitivity involved in giving advice to pregnant women. My hon. Friend the Member for East Worthing and Shoreham referred to the mental health challenges that pregnancy can cause for some women. I think there is a sensitivity involved in the delivery of hard-hitting messages to women who find it impossible to shake their addiction to smoking. We must be aware, in conveying the message that persisting in smoking during pregnancy may lead to long-lasting damage to the baby, that there may be mental health implications to which we need to be alert.

My hon. Friend the Member for Colchester mentioned the possibility of introducing an opt-out, rather than an opt-in, for carbon monoxide testing of women who present as pregnant to their maternity services. That is an interesting idea, and I am certainly willing to discuss it with NHS England and the Department. If it is possible for such a test to identify pregnant women who are smoking, it would be foolish of us not to introduce it.

My hon. Friend referred to the maternity transformation plan. I will write to him giving a specific response to his ideas and explaining how they might be used to embed smoking cessation in the nine elements of that plan. I cannot give him a similar reassurance about the training programmes for midwives, because they are determined independently by the Nursing & Midwifery Council and it is not for me to prescribe what should be involved in such training, but the debate will doubtless be heard by the midwife trainers.

My hon. Friend’s final request was for a warning on cigarette packets that would specifically alert people to the risks of smoking during pregnancy. Again, I am afraid that that is not in my gift, but it is a very interesting idea. As was pointed out by the right hon. Member for Rother Valley, there are already some stark and shocking images on cigarette packaging. We have just engaged in a major consultation that has led to the introduction of plain packaging. I suggest that my hon. Friend send his proposals to those who are responsible for monitoring the impact of plain packaging across Government.

I hope that I have addressed my hon. Friend’s points. Let me now respond to the requests from the right hon. Member for Rother Valley, who is the vice-chair of the all-party parliamentary group on smoking and health, in relation to e-cigarettes. He suggested that, as a research priority, we should ask Public Health England to consider whether they are helpful or unhelpful in encouraging pregnant women to stop smoking, and also whether the nicotine contained in them could lead to foetal damage in the future. I think that that is potentially an interesting subject for research, and I should be happy to pose the question to Public Health England.

I am pleased that my hon. Friend the Member for East Worthing and Shoreham was able to contribute to the debate, because he is very knowledgeable about these issues. He welcomed the progress that is being made in reducing smoking, and I am glad he recognised that. However, he focused many of his remarks on another aspect of public health guidance, in his capacity as chair of the all-party parliamentary group for foetal alcohol spectrum disorder.

[Tim Loughton]

I am not the chair. I am an officer.

[Mr Dunne]

I stand corrected.

Significant health messages are being sent about the consequences of continuing to drink while pregnant, and, again, progress is being made. I do not have the figures in front of me relating to the level of alcohol that pregnant women continue to consume, but the Government share my hon. Friend’s ambition. We must continue to bear down on alcohol consumption, because it has the potential to cause lifelong harm to babies.

My hon. Friend finished with a request that we consider once more the registration date for stillbirths, and his example of the twins falling either side of the 24-week definition puts the points very concisely and starkly. Again, I am not in a position to give him comfort on that issue here and now, but I will write to him, having consulted colleagues in the Department of Health on where we stand on it.

On that basis, I am very grateful to my hon. Friend the Member for Colchester for securing this debate and giving us the opportunity to spend almost an hour, I think, discussing this subject, which is unusual and welcome.

Question put and agreed to.

Health and Social Care

Tim Loughton Excerpts

Monday 27th February 2017 Commons Chamber

[Anne Marie Morris]

My hon. Friend makes a fair point. I have one of those constituencies where communities are not very well off. Many of the facilities that are there to provide social care are failing because we do not have the more affluent individuals who can ensure that some of our care homes, particularly nursing care homes, are alive and well. I am now down to just three for a very large constituency, and that is completely inadequate.

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

My hon. Friend and I both have constituencies with a large proportion of elderly people. Indeed, Worthing has the highest proportion of over-85s in the whole country. This is a double whammy, because people who are over 85 tend to require a great deal more healthcare, stay in hospital for longer, and have multiple problems in hospital that cost more—we are looking after them well and need to look after them better—and the social care side when they do come out of hospital, too often delayed, is costly as well. Those are the growing pressures that the estimates appear not to take proper account of.

[Anne Marie Morris]

My hon. Friend makes an extremely good point. He is right that the cost of ageing is not adequately taken into account. The way the Government measure health outcomes is predicated on the number of births and looking at the lifespan of the population. Because people live longer in areas like my constituency in Devon, it is assumed that we therefore have better health outcomes, but that does not allow for the fact that we have a low number of live births. Many people move into our lovely area when they are much older, and so the level of improvement is small. There are some basic, fundamental flaws in the way the Government—not just this Government; it has gone on for years—estimate the need in an area. As my hon. Friend rightly says, one of the biggest challenges is age.

Integration is expected somehow to be the solution to all our problems, but there is no transition funding to allow for double running, and there are, as far as I am aware, not many pooled budgets. As we have heard, these plans make certain assumptions about the recruitment of individuals, but we cannot recruit at the level we need now, never mind what we will need for the future. There is also a lack of training in the specialisms that we are going to need. Specifically in some of our more rural areas—we have talked about the ageing population—we need more specialist generalists. That is agreed by most of the royal colleges, but it is not being put into practice. So many issues will impact on the effectiveness of integration that I doubt that it is really going to be a way forward in reducing costs. I am concerned that the integration model, while very welcome, has not been fully thought through. The barrier to its being successful is that there will be unbudgeted costs. There is no evidence for the assumption that demand will decrease, and so no evidence that integration will deliver savings. It therefore seems to me that these estimates cannot really be sound. Real cost estimates are needed.

We have failed to address the element of social care that is paid for privately. I refer here to the Dilnot report and the Care Act 2014. We are talking about how the Government’s money—the taxpayer’s money—is to be shared out between the two systems, but we should never forget that social care is means-tested as opposed to the NHS, which is free at the point of delivery. If we do not try to ensure that the necessary savings are made by individuals taking responsibility, with or without the Government stepping in, we will find that the demand on the NHS is simply too great for the system to succeed and for these estimates to be valid.

Defibrillators in Public Areas

Tim Loughton Excerpts

Monday 16th January 2017 Commons Chamber

[Maria Eagle]

The hon. Gentleman has had a frightening experience in his family, and also learnt the incredible importance of not only having defibrillators available, but having people who know how to use them. I could hardly better his family’s example of how important that is.

A study by the British Heart Foundation found that for every single minute without defibrillation, chances of survival fall by between 7% and 10%. The Care Quality Commission sets a response target of eight minutes for emergency ambulance services, but we know that ambulances cannot possibly arrive within that time in every case. Even if they did, the chances of survival without immediate defibrillation and CPR will have already plummeted to 20% or lower. Access to a defibrillator can therefore make a huge difference. If cardiac arrest is recognised, basic first aid is given, 999 is called and CPR is applied, in combination with rapid and effective defibrillation, the chances of survival can exceed 50%. In fact, in some cases it can be as high as 80%. However, immediate action is vital. A defibrillator must be at hand for those survival rates to be realised.

Three people who know that better than most are my constituents Mark, Joanne and Ben King. In 2011, Mark and Joanne King lost their son Oliver, and Ben lost his brother. Oliver tragically died following a sudden cardiac arrest while racing in, and winning, a school swimming competition. He was just 12 years old. He had a hidden heart condition, and without access to a defibrillator at school his chances of survival on that day were dramatically reduced. Had he lived, this Saturday would have been his 18th birthday.

I never met Oliver, but I have been struck by talking to those who knew him well. He was clearly a very happy and popular boy, judging by the tributes that poured in from those who knew him following the shock of that terrible day. He was known as a big character at King David High School. His teachers recall his “uncompromising zest for life” and how he was loved and respected by boys and girls and teachers alike. His best friend David recalls Oliver’s charm and how it was deployed on more than one occasion to get them out of a tricky situation. This year is particularly difficult for David, as he will be celebrating the milestone of turning 18 without his best friend.

Everyone mentions Oliver’s love of football—he was a staunch Evertonian. His family and friends all recall his great talent and potential on the pitch. One of his teachers describes him as

“a sportsman at heart and a natural at whatever he turned his hand to”.

Above all, Oliver was caring, loving and incredibly close to his family:

“family was everything to Oliver.”

It goes without saying that Oliver’s death left many who knew and loved him with a great sense of loss. His family and friends are sadly not alone in going through this terrible ordeal. As well as the thousands of people who die every year following sudden cardiac arrest, there are thousands more who are now faced with the agonising reality of living without their loved one.

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

I pay tribute to the hon. Lady for bringing this important subject to the House and for her good fortune in having, potentially, three and a half hours in which to debate it. She has given an emotional case of somebody for whom, for the sake of a relatively simple and inexpensive bit of kit, the outcome might have been different. Does she agree that public buildings—certainly places such as schools—should automatically be fitted with a defibrillator?

Will the hon. Lady pay tribute to Sompting Big Local in my constituency, which has a lottery grant for the enhancement of the village? Its first priority was to install four defibrillators in every corner of the village, including one outside the local pharmacy, because it saw it as a worthwhile thing to do. Many other people have imaginatively used things such as redundant telephone boxes by replacing them with defibrillators as an obvious help point for local people. Should not we just be doing those things automatically?

[Maria Eagle]

I agree very much with the hon. Gentleman. He has set out an example from his constituency. Around the country, there are many ways in which communities are starting to ensure that they have access to defibrillators so that, if needed, they are there. I welcome that. We should try to ensure that defibrillators are available throughout our land—up and down, north and south, and east and west. What happened to Oliver is not as rare as we might hope. In the UK, some 270 young people tragically die every year of sudden cardiac arrest while at school. That furthers the hon. Gentleman’s point that having defibrillators routinely available in schools seems to be a no-brainer.

In 2012, Oliver’s parents, Mark and Joanne, set up the Oliver King Foundation in memory of their son. It aims to raise awareness of the conditions that lead to sudden cardiac arrest, which is vital as the family did not know that Oliver had any condition that might have led to what happened. If they had known, probably with the diagnosis of a simple electrocardiogram test, they may well have been able to take steps that could have avoided what happened. Other aims of the foundation are to purchase and place defibrillators in schools and sports centres, to train staff how to use them and to hold screening events to enable simple, painless ECG testing to help diagnose such conditions and ensure that what happened to Oliver does not happen to the children of other families.

Mark and Joanne have done an incredible job. Their aim is simple: to ensure that no more families have to go through what they did, knowing that the death of a son, daughter, mother, father or friend may have been prevented. They campaign tirelessly and effectively to ensure that every school in the country is equipped with an automated external defibrillator. They have the support of more than 200 hon. and right hon. Members of this House, across parties.

Automated external defibrillators are specifically designed for use by non-medically trained people. They are remarkable, life-saving machines that are not difficult to use. The machine will apply an electrical pulse only when it detects an irregular heart rate and it talks the user through the process, step by step. However, at about £1,200, AEDs are not cheap and, even if provided, some people are often afraid of using them. As a result, many schools and high-risk public areas in the UK are still not equipped with them. As a direct result of the work of the Oliver King Foundation, more than 800 schools and public places now have this life-saving kit and people who are confident to use it. In Liverpool, Oliver’s home city, not a single school is now without one thanks to the work of the foundation and Liverpool City Council.

The foundation has also managed to train 15,000 people around the country in how to use an AED, thus making sure that in sudden difficult circumstances the confidence is there to use this life-saving kit. As a direct result, 11 lives have been saved that would otherwise have been lost, including an elderly gentleman who suffered a heart attack at his local gym. Thanks to the staff’s quick thinking and use of the gym’s defibrillator, he was sat up and talking by the time the emergency services arrived. In Woolton in my constituency, where Oliver used to live, an AED provided by the foundation was deployed three times this December alone. If the defibrillator is available and training is provided, people will use one: it is as simple as that.

However, we cannot and should not be reliant on charities to do all the heavy lifting and work in this policy area. In November, the hon. Member for Lewes (Maria Caulfield) introduced the Defibrillators (Availability) Bill under the 10-minute rule procedure, with the purpose being to

“increase the rates of survival rates from non-hospital cardiac arrests across the UK”.

Its objective is basically to do for the nation what the OK Foundation has done for Liverpool and is continuing to do in its work in other places: providing defibrillators in public places and training people to use them.

Young People’s Mental Health

Tim Loughton Excerpts

Thursday 27th October 2016 Commons Chamber

[Andrew Bingham (High Peak) (Con)]

Thank you for calling me to speak in this important debate, Madam Deputy Speaker. The report was brought to my attention by Lucy Broadman, my local member of the Youth Parliament, who has been in the Chamber for Youth Parliament debates. Lucy is in the Public Gallery to listen to the debate today and has even assisted me in formulating my remarks today—I will return to that later. As a result of the contact from Lucy, I made my own application for a Westminster Hall debate, but owing to an administrative error somewhere behind the Chair it was unable to be heard. I therefore congratulate and thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for bringing this debate to the Chamber today.

Before I address the subject directly, I would like to applaud not only the hon. Lady but the Backbench Business Committee for granting this debate, not just for the seriousness of the issue but for the legitimacy it confers on the Youth Parliament. As we all try to engage with young people more and more, it is imperative that the efforts of the Youth Parliament get acknowledged and debated in here. As Lucy, now a former member, tells me, when the Youth Parliament casts out for subjects, mental health is very often in the top five or six that concern young people, so it is important that it is considered. The report is excellent, but it is also important that we debate it today.

The report is thorough and makes several conclusions and recommendations, as highlighted by the hon. Lady, but I wanted to get a better understanding of the issues facing young people in the modern age that can lead to the mental health issues laid out in the report. It is a long time since I was a young person—[Hon. Members: “No!”]—thank you—so I thought the best way for me to understand the issue was to make use of the expertise of young people, as highlighted in recommendation 17 of the report. I decided to do that off my own bat, so I had a conversation not only with Lucy but with another 17-year-old young lady I know very well, Martha Banks Thompson. I asked them to tell me what their thoughts and experiences of life as a teenager were and about the pressures that they and their friends have to face in the modern-day world. Both girls are A-level politics students, but from different ends of the country. Lucy is from my constituency of High Peak and Martha lives in the constituency of my right hon. Friend the Member for Surrey Heath (Michael Gove). My remarks today are very much—although not completely—based on the conversations we have had.

Mental health issues in any person, of any age, are very often difficult to diagnose. As has been highlighted, they are not like a broken leg, which can be seen; they are not as tangible as that. Mental health issues can often be mistaken for a temporary emotional upheaval or distress, but in the young they can often be put down to other things: pure teenage angst, raging hormones or just plain old teenage moodiness—or, as some people say, the Kevin and Perry syndrome. Consequently, these issues go unspotted and unnoticed and therefore untreated. By the time it is realised that there is a problem, it has manifested itself to such a degree that it becomes even harder to treat.

Who would, should or could identify the problem? In all likelihood it would be an adult—a parent, a guardian or even a teacher. Because of that, there is a generational gap. I am sure anyone in the Chamber or listening today will have heard from a teenage the line, “You don’t understand”, and in this case I think that, as adults, we do not understand. So what should we look for and how does the problem manifest itself? There are various symptoms and they are all too easy to miss. As we have heard, there could be anxiety, depression, eating disorders, contemplation of suicide or maybe even self-harm. Self-harm can sometimes be seen as a cry for help or attention, but more often it is a symptom of a much deeper problem. When can it occur? In days gone by, the pinch points for stress among teenagers were usually exam times: January for their mock GCSEs—they were O-levels when I took them—or May for their final exams. However, in the modern world there are so many more pressures that can impact on young people and bring about problems.

How are things different from when we were young? What are the extra factors and circumstances that we did not have to contend with that the modern-day young person or teenager does? There are many, but it would be a derogation of our duty to consider this question without looking at the impact of social media, whether it is Facebook, Twitter, Instagram, WhatsApp or Snapchat, or the many more that those of us in the Chamber have probably not heard of. Only a few years ago, they were a figment of the imagination—in my day they were science fiction—but now not only are they part of everyday life, but for the modern teenager they are often the preferred method of communicating with each other.

These technologies have much to commend them and have many advantages, not just for the teenager but for all of us in the Chamber. I am sure many of us tweet and have Facebook pages, and I am sure we all have websites. Indeed, I would venture to say that most of our communication as Members of Parliament with our constituents comes via email, making us more accessible than we have ever been. It is good that we are, and so is communication between young people. Again, I am going to betray my age now, but the days of sending notes to the object of our affections across the classroom with “SWALK” written on the back of the envelope—

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

SWALK?

[Andrew Bingham]

Exactly. I mentioned this to Martha and Lucy and they did not know what SWALK was. I can tell my hon. Friend that it stands for “Sealed with a loving kiss”. Those days are long gone. Now everything is done via social media. It is out in the open for everyone to see and it is also there forever. The SWALK letter is read. If it is not reciprocated, it is thrown away; if it is reciprocated, it is replied to. On social media, it remains there forever.

That brings with it perils and pressures. Relationships, appearance, fashion, style—all are analysed in the public glare. Relationships, attitudes and opinions once shared privately between friends are now put out for the world to see, with every comment seemingly soliciting a further comment or response and the rhetoric growing from that. With, for example, chat groups on applications such as WhatsApp, it is very easy for what could be seen as a little verbal leg-pulling or teasing to take on a sinister complexion. We increasingly hear stories of cyber-bullying and the posting of revenge pictures. I am sure all of us in this House have at one time or another been on the receiving end of comments online that we would see as offensive or upsetting. However, for a teenager, maybe uncertain, vulnerable or lacking in confidence, such remarks can have a shattering effect on their self-confidence and in turn their mental state.

Let us look at the media in general. The modern media seem to present all young people in reality programmes such as “Made in Chelsea” as perfectly formed human beings, which puts pressure on so many young people to be absolutely perfect. The slightest imperfection, perceived or otherwise, can become a major issue. We hear a lot about body image, too, and young people’s attitude towards it. Again, the desire to be perfect crops up, so when a perceived imperfection is not only remarked on but ridiculed via social media, it can be amplified and re-tweeted, when “likes”, “unlikes” and “comments” can become very cruel, particularly to uncertain and vulnerable teenagers. This can severely damage the self-esteem and mental health of a young person.

Our consumer society is another issue. As we see with mobile phones, clothing and computers, everywhere we look there is a thirst for the latest, the best, the biggest, the fastest and the shiniest, while anything less than the optimum is seen as a problem. This is another issue that ratchets up the mental pressure on young people. I am not saying that a young person’s not having the latest iPhone will lead to mental health problems, but I am saying is that if someone is vulnerable and has low self-esteem, this sort of thing can work to enhance those insecurities and push someone into the territory that we are discussing today.

We need to remember, too, that all these pressures—I have mentioned only a few—are impacting on young people at a time when their minds, brains and characters are still growing and forming. As we get older, we form our minds and personalities, and we develop our own resilience to many of these outside pressures.

--- Later in debate ---

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

I declare my entry in the Register of Members’ Financial Interests. I apologise for missing the opening couple of minutes of the speech made by the hon. Member for Dulwich and West Norwood (Helen Hayes).

I am delighted that we are having this debate, and to be participating in it, for two main reasons, which I am sure you will share, Madam Deputy Speaker, because I know your interest in this matter. First, this is an important subject. It is something that we are failing on, so it is right, proper and beneficial that hon. Members talk about it openly, especially because, as we heard from my hon. Friend the Member for High Peak (Andrew Bingham), young people are much more prepared than ever to come forward with their own stories of their problems and issues, hopefully so that solutions can be found through them.

Secondly, I am delighted to participate in this debate because it is part of the UK Youth Parliament’s work. It is significant that we are giving up mainstream parliamentary time in the main Chamber of the House of Commons to discuss a report by the Youth Select Committee, an offshoot of the UK Youth Parliament. It is a shame that we have to do it in Backbench Business Committee time rather than Government time, but I pay tribute to the hon. Member for Dulwich and West Norwood for securing the debate and giving it such an excellent start—this will clearly be a high-quality debate. I take the view—I think that you share this view, Madam Deputy Speaker—that the Youth Select Committee has now taken on such status and stature, with its production of reports of such high quality involving such good research, that not only should the Government produce a formal response to the reports, as they have, but they should give up Government time in this Chamber on an annual basis—just once a year—so that we can formally debate the work of the Youth Select Committee. I have put that idea forward for some time, so I hope that the Whips and Government business managers are listening.

I am a big supporter of the UK Youth Parliament. It was founded during my time in Parliament, and I always try to attend its annual parliamentary sittings, which are a great spectacle. It is always exceedingly frustrating for Members when we return on the Monday and the Speaker inevitably says, “Why don’t you lot behave as well as the UK Youth Parliament members who were here on Friday; they are very smart, very concise, very well behaved, don’t heckle and set an example?” It is a shame that the media coverage of the Youth Parliament sitting is not more extensive because it is a great event for a great organisation, and it is great that we are discussing its work today.

When I was the Minister for children and young people, we produced the “Positive for Youth” document, which was all about promoting that sort of youth engagement. One of the things I most treasure having done is helping the transition of the UK Youth Parliament across to the British Youth Council to secure its future. I pay tribute to all its work over the past few years. It is a mainstream part of the youth voice in this country and in this Chamber.

I was the first witness ever to be called before the Youth Select Committee. It was an awesome and intimidating experience. I was called for its first inquiry back in 2012 along with the then Transport Minister, Norman Baker. We rather too nonchalantly rocked up before this group of young people in the Boothroyd Room. They were exceedingly well-rehearsed and well-researched, and were certainly not taking any BS from anybody. I have appeared in front of Select Committees—mostly the Education Committee—on many occasions, but I have to say that this was the most intimidating experience I ever had as a Minister in front of a Select Committee, and it was fantastic. That shows why the work of this Committee, and this, its fourth report, need to be taken seriously.

This Youth Select Committee report is difficult to distinguish, other than by its cover, from a House of Commons Select Committee report, and I congratulate Rhys Hart and his team on their work on it. They did all the things they should have done: they visited experts and sufferers of mental illness, and took no fewer than 148 submissions from expert witnesses and others—if only all the other Select Committees had as many well-informed and well-researched submissions as it did.

The Youth Parliament also has a substantial democratic endorsement. In 2014, when its priorities and the subject of the Youth Select Committee report were decided upon in the “Make Your Mark” ballot—which includes a debate in this House in the Youth Parliament’s annual sitting—no fewer than 875,000 young people from up and down the country bothered to turn out and vote. Of them, more than 90,000 voted specifically for the subject of mental health services, which is why we are debating this report in the Chamber today. That is a huge democratic mandate.

Every year I hold an event in the House of Commons to present democracy awards to schools in West Sussex, including my constituency, that have achieved a high turnout in the elections that are held every February. Each year the turnout gets higher, so more and more trophies have to be given out, and an ever bigger room has to be booked to accommodate everybody. Last year, one school had a 100% turnout—all its pupils turned out to vote for its UKYP members, which is absolutely fantastic.

This report is a chunky piece of evidence that needs to be appreciated, looked at and, importantly, acted upon. I am delighted that we are giving time to it today, and I am also pleased that the Government produced a formal response to it, whatever we may think about the shortcomings of what they said. That was produced jointly by the then Health Minister, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), and the then Education Minister, my hon. Friend the Member for East Surrey (Mr Gyimah). Neither of them are still in those ministerial posts, but I welcome the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), to her new position. I am sure she has learned the ropes quickly and that she will continue to do so. We need consistency in our approach to mental health, however, and a much more joined-up approach—and not just between education and health, because there are many other aspects as well.

This subject is clearly important to young people, as is this report, so it should be important to the House and the Government. There are many useful lessons that we can learn.

I am also very frustrated, however. I have been in the House for almost 20 years. I have been shadow Minister for mental health, and I was shadow Minister for children and young people for some nine years, as well as Minister for children and young people. I currently chair the all-party group on children and the 1001 group, which is all about perinatal mental health. I have seen mental health Bills come and go, too, and have been involved in them. I saw the 2011 mental health strategy “No health without mental health”, which was a very important statement about the parity of esteem we need to achieve, although we still have not. In 2014, I saw “Closing the gap: priorities for essential change in mental health”, with specific commitments to improve mental healthcare for children and young people. I saw the rolling out of talking therapies and the improving access to psychological therapies programme. In March 2015, as has been mentioned, we had the mental health taskforce, which produced “Future in mind”. I have seen lots of good work in the Department of Health, in particular, such as that done by my right hon. Friend the Member for North East Bedfordshire, and in February this year the mental health taskforce produced the “Five Year Forward View for Mental Health”. There has been a lot of talk about the importance of mental health and the necessity of achieving parity of esteem but, as the hon. Member for West Ham (Lyn Brown) rightly said, there is still a very big disparity. And here we are again: we are still here talking about this, and record numbers of children and young people still have mental health problems.

[Mr Kevan Jones]

Does the hon. Gentleman agree that we can have reports, taskforces and recommendations, but the real problem is that mental health is seen as a Department of Health issue, whereas what we actually need is a completely cross-Government approach so that mental health and wellbeing can be part of every single piece of policy development?

[Tim Loughton]

The hon. Gentleman is right; he pre-empts a couple of my comments. From my experience as a former Minister—and, I am sure, from his—the term “joined-up government” is a complete illusion. Joined-up government does not happen in practice. On becoming a Minister, one is cocooned in a Department, and instead of having a dialogue with colleagues in the Division Lobby or wherever, a huge wall suddenly comes between you. Trying to get interdepartmental action becomes really frustrating.

I remember setting up something called the youth action group, which consisted of Ministers from nine or 10 Departments and representatives of six major children’s charities. It was co-chaired by the Prince’s Trust and Barnardo’s. The charities came to us with problems—often complex ones—affecting young people. One example related to housing benefit and accommodation for children in care. I cannot remember what the specific problem was, but it involved housing, which was the remit of the Department for Communities and Local Government, and benefits, which were the remit of the Department for Work and Pensions, as well as children in care, who came under the remit of the Department for Education. Normally there was a vicious circle that involved people being pushed from pillar to post. Alas, that committee has not met for the past 15 months or so, but our meetings used to consist of at least six actual Ministers—not just civil servants—from the relevant Departments as well as their officials. We would get Ministers together and ask them to go away and solve the problem.

Mental illness falls into that category, in that it is not simply the remit of the Department of Health or the Department for Education. There are many other implications and knock-on effects that can relate to the underlying cause of somebody’s mental illness problems. The hon. Gentleman is absolutely right that the structure of government needs to be much better. We need taskforces that genuinely cut across Government Departments, but in my experience they will flourish only if they have the buy-in and direct engagement of Ministers at the top. One welcome initiative from the hon. Gentleman’s party was the appointment of a Cabinet-level Minister for mental health. I think that that appointment has slightly gone by the wayside now, but the principle behind it was absolutely right, in that it tried to join up all the relevant Departments at the top table.

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

May I remind the hon. Gentleman that I am the shadow Cabinet Minister for mental health? That post has not gone away on this side of the House.

[Tim Loughton]

I am delighted to hear that; I did not in any way mean to underestimate the hon. Lady’s contribution. However, when the hon. Member for Liverpool, Wavertree (Luciana Berger) held the position, she sat at the Cabinet table. I hope that that is still the case, and I would very much like to see my own party replicate that position in government, because this is such an important cross-cutting issue.

Mental health remains the Cinderella service of the NHS. Indeed, the report describes child and adolescent mental health services—CAMHS—as the Cinderella service of a Cinderella service. The whole question of parity of esteem and funding is important. We can have arguments about how much the NHS budget has increased and kept up with inflation, but in every year in which the funding for mental health remains static or, worse still, declines as a portion of the overall NHS budget, we are sending out a clear message that it is a secondary priority within the NHS, and therein lies part of the problem.

I do not want to be too negative, however. We are making progress, as are other countries. For example, when you go in through the main entrance of a hospital in Copenhagen, in Denmark, you turn left if you have diabetes and you turn right if you have a mental illness. And nobody cares whether you turn left or right; there is no stigma attached to mental illness. People are treated on exactly the same basis, and that is how we need to treat mental illness here. Despite the best intentions of many Ministers, that is just not happening in practice at the sharp end where our young constituents are trying to access the mental health support that they desperately need. It is certainly not happening in a uniform way across the whole country. As a result, at least one in four people in this country is still suffering from a mental health problem.

I have a particular interest in perinatal mental health, and I declare an interest in that I chair the all-party parliamentary group for conception to age two—the first 1,001 days. I am also chairman of the trustees of the Parent and Infant Partnership Projects charity. We now have seven parent infant partnerships—PIPs—across the country providing direct support and specialist perinatal psychological help to mums and dads with newborn babies. About half of all cases of perinatal depression and anxiety go undetected, and many of those that are detected fail to receive evidence-based forms of treatment. Alarmingly, at the time of the publication of the all-party group’s report, “Building Great Britons”, in February last year, just 3% of clinical commissioning groups in England had a strategy for commissioning perinatal mental health services. The upshot of all that, as the Maternal Mental Health Alliance has calculated, is a cost to the NHS of £8.1 billion for each one-year cohort of births in the United Kingdom. That is the equivalent of almost £10,000 for every single birth in this country, and it is a cost that the NHS can ill afford.

Why is this relevant to young people? Nearly three quarters of that cost relates to the adverse impacts on the child rather than the mother. Followers of attachment theory, which the hon. Member for West Ham (Lyn Brown) mentioned, will appreciate the strong link between achieving a strong attachment between the child and the primary carer and good nurturing from the earliest age—that is, from conception to the age of two, as our report puts it—when the synapses in the brain are developing at a rate of some 40,000 a second and the child’s brain, character and development are being formed. The earliest experiences shape a baby’s brain development and have a lifelong impact on that person’s mental and emotional health.

Research shows a direct link between what happens to a mum during the perinatal period and her child in later life. If a teenager aged 15 or 16 is suffering from some form of depression, there is something like a 90% chance that his or her mum suffered from perinatal depression. The link is that clear, so it is absolutely a false economy not to help mum out at that early stage. And let us not forget dad, who also plays a crucial role. Getting it right with parents and children early on is crucial to the good mental health of children and young people. This is not rocket science—technically it is neuroscience—and we should be doing it better, sooner.

Certain other factors have been flagged up in the report. My hon. Friend the Member for High Peak (Andrew Bingham) spoke about many of them, including the peer group pressure that our children and young people experience. In fact, I have no children any more. My youngest is now over the age of 18, but we went through the teenage years together and I have seen these things at first hand. No one can go out in the morning without the latest iPhone, without checking Facebook and without tweeting what they are having for breakfast and Instagramming a photograph of it. And that all happens just after they have got up. The pressure to succeed in school and the hothouse of exams and testing are not conducive to the best mental health, and young people need support to help them through the challenges. We never had those challenges in my day, which I guess was even earlier than that of my hon. Friend the Member for High Peak. Social media is a huge influence on young people, and it was just not around in my day. I would hazard a guess that it was not around in your day either, Madam Deputy Speaker.

[David Rutley (Macclesfield) (Con)]

Will my hon. Friend give way?

[Tim Loughton]

I will of course give way before I say something indiscreet.

[David Rutley]

I am sure that my hon. Friend would never saying anything indiscreet. He always makes important observations in such debates. He and I were at school together, and if bullying or similar was going on, children left their problems behind when they left school for the day. Does he agree that the challenge today is that such problems go home with the child beyond the school gates and during the holidays? Does he agree that digital service providers should take further steps to provide apps and protections that will help children in those difficult circumstances?

[Tim Loughton]

I do agree. Believe it or not, my hon. Friend is older than me and was in the year above me at school. He has aged rather better than me, but then he has not been in the House quite as long as I have. He is right about the dynamics of the stresses and strains in those days. How children communicate has also changed. For example, one of my daughters once put in her request for supper by text message from her bedroom to my wife and me in the kitchen—supper’s off! In an age when communicating has never been easier with email, social media, mobile device, tablet or whatever, the irony is that face-to-face communication between human beings has never been more rare or remote. Therein lies part of the problem. Communication between children and parents does not happen as regularly, and the fault lies with the parents as much as the children. Some people cannot talk frankly about the real pressures, strains and stresses on our children and about grooming, sex matters or drugs. In my hon. Friend’s day and my day, we perhaps talked more to our parents or other family members.

I will now pick out a few points from the report—I know that other hon. Members want to speak. We have reached a point at which one in 10 school-age children will have some form of mental disorder, and the age at which that happens is getting younger. Some 340,000 five to 10-year-olds have a form of mental disorder. If it is not detected early and acted on, it just festers and gets worse. Too often, the only immediate response if someone gets access to a clinician is the chemical cosh of drugs, which is in many cases inappropriate for younger children. Talking therapy, for example, might be more appropriate, but we increasingly find that when people have to wait weeks or months for them a call has to be made between waiting longer or giving some form of antidepressant.

The report flags up the big issue of the transition from childhood to adulthood. Nothing changes physically or mentally when someone receives an 18th birthday card from their Member of Parliament. The last thing that an 18-year-old needs if they are going through the stresses of mental health is to have a completely new process and system to deal with because they have suddenly become an adult even though their condition has not changed. There is a particular issue around children in care, who too often used to leave at the age of 16. Fortunately, we now have a new scheme, which I was proud to have piloted at the Department for Education, based on staying put, allowing for a longer lead-in time. Every child is different and different children will be ready to go into the big wide world at different ages. The report contains some good examples of best transition practice. Southampton general hospital has a 0 to 25 age range for its “Ready Steady Go” scheme, under which every person is treated differently—people have different “go” ages.

Turning to the report’s recommendation about GP training, it is right, certainly for younger children, that GPs will be the first port of call for clinical services. Training for GPs to deal with younger people’s mental health problems is not good. Young people may need a lot of confidence to go along to see a GP with a parent or whomever, and there must be a clear understanding of how to tease the best out of children, so we need better guidance. As the hon. Member for Dulwich and West Norwood mentioned earlier, young people should absolutely be in on the genesis of that guidance.

Another recommendation that we have heard a lot about relates to what happens in schools. The hon. Member for Dulwich and West Norwood quoted the National Association of Head Teachers briefing, which states:

“When children do not meet CAMHS thresholds, schools often become responsible for children’s mental health.”

In too many cases, they are ill-equipped to do so. We are dealing with potentially one in 10—three in a class of 30—children suffering from some diagnosable mental health disorder, and the chief medical officer says that three quarters of them will receive no treatment at all. That will obviously have an impact on the child, but there will be an impact on the class as well and it is very much in the school’s interest to do something about that.

We need better teacher training so that they are able to identify the signs that point towards a mental illness. They also need better awareness of where to signpost children to get the treatment that they require. They should also be able to talk about things more generally in class. We can argue whether PSHE should be compulsory—I have some sympathy with that—and whether mental health should be a formal part of it, but it must be done in an environment in which young people will feel engaged. It should not be just another lesson, but a place where they feel free to talk openly, to absorb and to learn.

[Helen Hayes]

The point about the proposal that mental health education should become compulsory is simply that its presence on the curriculum is too important to be left to chance. I entirely agree with the hon. Gentleman that it should be undertaken in a way that is engaging and effective at educating young people, but does he agree that whether it happens at all should not be left to chance?

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[Tim Loughton]

The hon. Lady and I have the same objective, but I am always sceptical about a solution that means making something another compulsory part of the curriculum. Sex and relationship education is an interesting case in point. Some of the best SRE that I have seen has been from outside youth workers and others who can empathise with young people and talk to them in a way that they will appreciate, respect and learn from. Making it another subject taught by Mrs Miggins the geography teacher, who happens to have a free period on a Thursday afternoon and so can be in charge that term, can cause problems. More schools should automatically want to have well-informed mental health education in whatever form is appropriate to engage their children. It is in their children’s best interests. I do not think that my objective differs from the hon. Lady’s, but we can have a debate about how we can most effectively achieve it.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

The hon. Gentleman makes a good point about the importance of having appropriate, properly trained, empathetic people—specialists—delivering mental health education to young people. He suggests that youth services could provide such education. The problem is that local authorities are cutting those services because they are non-statutory. Many schools that have been providing support and bringing in specialist experts to help young people and teachers in this curriculum area are also facing cuts. Headteachers are having to pare back services as they deal with reduced budgets.

[Tim Loughton]

I hear what the hon. Lady is saying and that is a subject for another debate. It is an issue on which I have campaigned for many years, and indeed I chaired a commission looking into the role of youth workers in schools. Some really good examples of best practice are available, often in academies, which have appreciated the value of youth workers, because they can empathise with young people better, and brought them into schools. That is missing in so many other places. I have been advocating giving other roles to youth workers, who, sadly, are no longer being employed, particularly in local authorities, because this is not a statutory requirement and therefore has fallen by the wayside. So I have a deal of sympathy with that view, but it is for another day and debate.

I wish briefly to deal with a couple more points, the first of which relates to the last one: the importance of resilience and character education in the well being agenda in schools. Recent Education Secretaries have begun to take that on board, and a lot of this subject lies within that area. Another issue to consider is how this is monitored, and another good recommendation in the report is that Ofsted should have a role in that. Ofsted now has a role in assessing behaviour in schools, but that should extend to how it copes with mental health problems among pupils—that should be on the checklist. We are really bad in this country at disseminating good practice, but I have seen many examples of it. I recall visiting a school in Stafford and sitting in on some of the sessions held by their full-time counsellor. The teachers had confidence in her, would refer to her children about whom they had some doubts, and the children would speak frankly to her. Such people can prevent a lot of problems from occurring later on in the schools that have them, but not enough schools do—again, there is a debate to be had about why that is.

We also have to address the issue of cyber-bullying and the role of social media. The report gives examples about websites that promote self-harm, which are a huge scourge. We need to be much more aggressive in tackling these sites, particularly where they relate to anorexia and self-harm. People are going to them to seek advice and find a solution because they have feelings about self-harm or problems with anorexia, but these bizarre websites are promoting those things. As the report suggests, we need some form of verification scheme and, as has been mentioned, a much more responsible and bigger role for our social media companies. They are huge companies employing many thousands of people, yet the numbers in their scrutiny and enforcement departments are woefully low. As Members of Parliament with Twitter accounts, most of us have blue ticks to show we are who we say we are. Can there not be some form of verification scheme, described in the report as a “kitemarking scheme”, so that young people, particularly those who are vulnerable and impressionable, have confidence that the sites they are accessing are there to give them support, not to encourage them to do harmful things to themselves? This applies to so many different areas, including in respect of radicalisation sites.

Body image has been mentioned, and Girlguiding, which regularly revisits the issue of body image and young girls’ perceptions, has recently produced a report on the subject. It is always so alarming and petrifying to see the number of young girls as young as 13 whose aspiration is to have plastic surgery. Despite the fact that their bodies are not even fully formed and that they are still growing up mentally, they are being conditioned to think that this is the ideal to which they must aspire. That is wrong, and these influences on our young people are at the root of so many of the weaknesses and vulnerabilities leading to mental illness and, in the most tragic cases, to suicide. In the old days, a note passed across a classroom with the words “Sealed with a loving kiss” might, at worst, end up on a playground floor. At the worst extremes, in the case of a form of sexting, the equivalent these days goes viral and ends up on social media in perpetuity, where it is open for millions of people to see. That is the difference between the note in our playground days and the casual, ill-advised text on social media these days.

Finally, the report makes recommendations about young people wanting to relate to people their own age, rather than old men in suits, which I guess takes in quite a few of the hon. Members here today. [Interruption.] Okay, I was talking about myself and my hon. Friend the Member for High Peak. They say that taking such an approach makes it easier to receive the right message, hence the recommendation that

“a consultation group of young people, both with and without a mental health history, be set up to work on and contribute to the anti-stigma campaign, and that someone is identified to ensure this happens.”

I completely agree with that.

My final point is that when I was a children’s Minister, I had four reference groups within the Department for Education, each of which came to me on a three-monthly basis: one comprised children who had been adopted; one comprised children in foster care; one comprised children in residential care homes; and one comprised children who had recently left care. They came to me in the Department without adults, we sat around the table and they told me exactly what was going on. They challenged some received wisdoms, and I got some of the best information that I ever got from any experts by speaking to those young people. This report has been produced by young people and by reference to many thousands of young people, many of whom have suffered and are suffering the sorts of problems that I and many other hon. Members have mentioned today. We need to listen to the voice of these young people, to act on their recommendations, and to include and involve them in the solutions. That is why this report is so important to them, but it needs to be equally as important to us, to this House and to this Government.

NHS Provision (Brighton and Hove)

Tim Loughton Excerpts

Monday 24th October 2016 Commons Chamber

[Caroline Lucas]

I am grateful to the hon. Gentleman, as he anticipates exactly what I am going to say. Of course we need new bricks and mortar, but we also need finances for the services inside them. We desperately need a central funding settlement that recognises the unique pressures on our hospital, so that the systems can be updated. For example, we need a computerised records system—this is not rocket science but we desperately need it. We need increased capacity, particularly for accident and emergency, because we are now serving a much wider region, as a result of being a central trauma centre. With debts currently of about £45 million, Brighton and Sussex University Hospitals NHS Trust is facing a situation that is simply unsustainable.

That is just one example, but there are plenty of other examples of what is going wrong in the health service in Brighton and Hove. Patients in the city have seen six GP practices close so far this year alone. When The Practice Group announced that it was walking away from its contract to run five surgeries in the city, the decision was largely a financial one. With almost 11,500 patients registered, the disruption and uncertainty was widely felt, and other nearby surgeries were simply expected somehow to manage increased patient numbers. NHS England was not required to step in to help because of the terms agreed with The Practice Group. The fact that this type of contract is no longer permissible was of little comfort to the patients forced to find a new GP with whom to register. I particularly recall the constituent who contacted me after a sixth surgery, Goodwood Court, was closed and who was unable to visit the emergency drop-in clinic at Brighton station for an urgent inhaler prescription because of a disability. That is just one individual, among many, who has experienced unnecessary, unhelpful anxiety and distress as a result of the Government’s NHS policies.

Our emergency ambulance service was placed in special measures on 29 September following a Care Quality Commission report that rated it as “inadequate”. The inspectors praised front-line staff, but identified unsafe levels of staffing, as well as poor procedures and leadership. The city’s mental health services, especially those serving children and young people, are overstretched and underfunded. Adult social care services in Brighton and Hove face ongoing cuts, despite the cost to individuals and the NHS. That means that over the next four years the city council is looking at potential cuts of £24 million and the complete privatisation of the remaining council adult social care, day centres, carers and so on.

I have lost track of the number of times that Ministers assert they are investing record amounts in the NHS, yet conveniently fail to mention the record amounts they are simultaneously cutting from local authority budgets that are supposed to cover essential care services for vulnerable people.

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

The hon. Lady is my near neighbour, and I refer back to some of the comments made earlier by my neighbour, the hon. Member for Hove (Peter Kyle). She is painting a gloomy picture, and I acknowledge the severe problems within Brighton and Hove. Does she also acknowledge that, next door, the Western Sussex Hospitals NHS Foundation Trust is one of only five hospital trusts in the whole country rated “outstanding”, yet we face the pressures of having one of the most elderly populations in the country and having increasing pressures placed on us because of people coming from Brighton and Hove to access NHS services across the county boundary? Why is Brighton and Hove in such a parlous state at the moment, yet a few miles down the round we are able to run a rather good hospital service?

[Caroline Lucas]

I thank the hon. Gentleman for his intervention and congratulate him on the performance of his local hospital trust. I recognise what he is saying about the extra pressures put on the surrounding area when there is a particular problem as there is in Brighton and Hove, but I contest the implication of what he is saying, which is that there is something particular to Brighton and Hove. If we look around the country, we see that, sadly, a great many hospital trusts are in severe difficulties. Only a few months ago, the Public Accounts Committee was absolutely saying the same thing, and I shall refer to that shortly. If I am asked specifically about Brighton and Hove, I would say that we face some issues—for example, the fact that we are working in the oldest building in the whole NHS. There are particular problems when that is combined with the demographics. There are particular challenges in Brighton and Hove that come from having a number of older people and people with lots of complex problems, such as mental health problems and homelessness problems. I do want to challenge the idea that, somehow, this might be a problem simply in Brighton and Hove, because it is not.

[Tim Loughton]

Fortunately, we have lots of time to debate this matter. The hon. Lady must acknowledge that, certainly recently, the average age of a patient in Worthing hospital—taking out maternity and paediatrics —is 85. That places considerable extra pressures on our hospital system. The average age in Brighton and Hove, the city, is considerably younger. The average age of people accessing health treatment in her city is considerably younger and therefore less demanding, so why is there such a contrast in the performances of our respective hospital trusts?

[Caroline Lucas]

That would be a very interesting issue to debate. The hon. Gentleman can get his own debate on Worthing hospital, but what I know about are the particular problems that are facing Brighton and Hove, and I will point again to the particular complex needs that come together when one has a city full of young people as well as very elderly people, a lot of people with mental health problems, homelessness problems, vulnerability problems and so on. If he will give me a little more time, I will set out for him what some of the problems are in Brighton and Hove and also, crucially, what some of the answers are.

I was talking about adult social care and about the fact that, unfortunately, the Government are cutting yet more money from local authority budgets that is supposed to cover those essential care services for vulnerable people.

The Government know that social care in places such as Brighton and Hove is on its knees, and that that has very direct knock-on effect on the NHS that no amount of financial smoke and mirrors can conceal. Brighton and Hove National Pensioners Convention has begun a valiant campaign to protect adult social care services from cuts, with unions such as the GMB fighting alongside it. I really hope that the Minister is listening, because this is a crisis that lets down everyone and there is no hiding from it. Where should responsibility for this catalogue of troubles lie?

What has happened to the city’s non-emergency patient transport service goes some way towards answering that question, and I wish to look at this in a bit more detail. It also demonstrates what can only be described as an utter dereliction of duty on the part of the Secretary of State for Health and I want to repeat my call for his Department to step in and for him personally to resolve an unacceptable and untenable situation.

I am referring to a service that takes people to essential non-emergency appointments—kidney patients going for dialysis, and cancer patients going to and from chemotherapy and radiotherapy. Since April, it has been run by a private company called Coperforma and a number of subcontractors. Coperforma faced intense criticism from the outset, with patients saying that they had experienced delays reaching appointments and subcontractors reporting that they had not been paid. Two of those subcontractors, Langfords and Docklands, went bust in September, leaving some ambulance drivers with up to six weeks’ worth of wages unpaid. In early October, drivers for another Coperforma subcontractor turned up for work only to be sent home again.

Last week, the Patient Transport Service was plunged into a fresh controversy after an investigation by our local paper, The Argus, revealed that one subcontractor may not even have been licensed to operate a fleet of 30 ambulances. I have the headline from the local paper, which Members can see very clearly. It says that ambulances are now in a total shambles—

--- Later in debate ---

[Caroline Lucas]

That is a good question. When I have asked the CCG that very question, the answer has not been clear. I have been told that the performance of the company was not such that the contract was breached, but one of the difficulties is that so much of the contract is not in the public domain. For example, if the CCG wants to see the sub-contracts between Coperforma and the various companies to which it is subcontracting, the CCG does not have access to those contracts so it cannot assure us what is in them. We have a very opaque system that makes it extremely difficult to say where accountability lies. That is why I say that this is a failed model.

I said earlier that the Coperforma example goes some way to illustrating some of the underlying causes of the NHS crisis that we are experiencing. Trying to get to the bottom of the contracts, sub-contracts and who is responsible for which bit of what is like grappling with a Gordian knot. The CCG admits that one of the biggest challenges is identifying responsibility when things go wrong. When, for example, people providing the service are not being paid, it is not clear where responsibility lies. Was it with Coperforma or with the sub-contracting companies?

That lack of transparency is deeply concerning. It is also a serious example of the problems and risks associated with this outsourcing of so many of our key NHS services.

As we know, the driving force behind all this is commercialisation—commercialisation made worse by the Health and Social Care Act 2012, which has not only exposed patients to unacceptable risks but engendered structures and terms and conditions that appear to protect profit-led companies at all costs. I do not think that is the NHS the public want or deserve; it is not even an NHS that is effective. The model is failing. Contracts such as the one with Coperforma do not work and need to be brought back in-house. I pay tribute to the hon. Member for Bexhill and Battle (Huw Merriman), who has done very good work on this issue, on which I think there is cross-party agreement. He has rightly asserted that, in this instance, private contracting has not worked and the local ambulance service would be better operated within the NHS family.

I would go further still, because it is not just our patient transport services that are in trouble. Coperforma is, as I say, just one example of the fragmentation and marketisation damaging the NHS. Fragmentation matters because the healthcare picture is made up of parts that ought to be interconnected, yet it is hard at the moment for one part to influence the other. For example, ambulance handover times at the Royal Sussex County hospital have apparently risen 16% this year, but that is largely because of the ongoing flow issue caused by a lack of places to discharge people to. The whole system gets blocked when there is no overview. A&E, especially in winter, is all too often the pinch point for failures elsewhere, most notably insufficient capacity in local community social care.

However, fragmentation is an inevitable part of a system that is designed to give private providers as many opportunities as possible to compete for services through a continuous cycle of bidding and contracting out, despite that being hugely inefficient and counterproductive. There are local fears that Brighton and Hove’s children and young people’s community nursing might be taken over by a private company such as Virgin Care. Sussex Community NHS Foundation Trust has preferred bidder status to continue delivering children’s services, but the city council is still forced to undertake a procurement process in the name of market competition. I would argue that that process is a waste of time, effort and money, and increases the risk of a private company stepping in and undercutting a highly valued, effective provider such as Sussex Community NHS Foundation Trust—a risk that is exacerbated by the Government’s mind-bogglingly short-sighted decision to cut public health spending by 3.9% each year until 2021. That equates to £1 million less for our city over the same three years, and it has resulted in some important services being decommissioned. Those include the Family Nurse Partnership, which provides regular visits for teenage mums during pregnancy and until their babies are two years old. That makes no sense, but it is what happens when we do not have a coherent, publicly planned and publicly provided NHS or a model that puts health needs before private profit—one that is based on co-operation, not competition.

That is the model that has been set out in the NHS reinstatement Bill, of which I am a sponsor. I tried to bring it to the House in the last legislative term as a private Member’s Bill, and it is currently before the House in the name of the hon. Member for Wirral West (Margaret Greenwood). That is the kind of NHS I think my constituents want, and it has to go hand in hand, crucially, with adequate levels of funding. According to the King’s Fund chief economist, the annual average real increase in UK NHS spending over the last Parliament was 0.84%. That is the smallest increase in spending for any political party’s period in office since the second world war.

From local ambulance drivers caught up in the Coperforma debacle to junior doctors, NHS staff are universally respected—except, it seems, by this Government. Our nurses should not have to fight for a measly 1% pay rise after years of pay freezes. That does not only have consequences for the individuals involved. Healthwatch Brighton and Hove points out that staff retention is a specific problem in the city, with poor morale and high housing costs as contributory factors. I am particularly worried about the impact of the EU referendum on NHS staffing.

Brighton and Hove is set to benefit hugely from a major new county hospital redevelopment thanks to capital investment secured as a result of a long-standing cross-party campaign, and I am grateful for that. However, I would like to extend the logic of public provision to the services that will be based in the new hospital. In the meantime, as Ministers know well, the big issue is running costs, with the NHS funding settlement during the last Parliament the most austere in its history—that is according to the House of Commons Library.

[Tim Loughton]

The hon. Lady is straying into the area of the ideology of NHS funding, but she might like to mention an example from her city. Brightpip—I declare an interest as the chairman of the trustees—works to promote the “1001 Critical Days” agenda to help children and their parents before the children are born and in the two years after they are born. That is an excellent example of the NHS working with the independent and charities sector to provide a much needed service, which I am sure the hon. Lady wants to promote in her constituency. So it is not all bad if it just happens to be outside the NHS.

[Caroline Lucas]

If the hon. Gentleman had been listening carefully, he would have noticed that I am talking about private companies that are taking over and cherry-picking key NHS services. He and I worked together on Brightpip, and I am incredibly proud of what it has achieved, but he will know that it does not work for profit. It ploughs money back into the services it provides. It is a wonderful example and there are many others, including the wonderful Martlets hospice in the constituency of the hon. Member for Hove (Peter Kyle). There are plenty of examples of the charitable sector doing amazing work, and the NHS reinstatement Bill absolutely made provision for them as well. What I am criticising is when the private sector comes in and cherry-picks services, which are then lost from the NHS and work for profit.

[Tim Loughton]

rose—

[Caroline Lucas]

I am going to make some progress, because I want to finish making my case about funding.

Last week the Prime Minister claimed that NHS funding was being increased by £10 billion. In doing so, she ignored a plea from the respected Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), for Ministers to stop using such a misleading figure, when the correct figure is less than half the amount claimed.

The chief economist of the Nuffield Trust argues that even that is overstating the case, highlighting King’s Fund research that found that NHS-specific inflation means that the real increase is about £1 billion—about a 10th of the figure that the Secretary of State and others repeatedly use. It is certainly not £350 million a week. I would be very surprised if any Ministers repeated that blatant lie again, but anyone who claims that the investment is £10 billion is playing hard and fast with the truth. Indeed, the NHS chief executive admitted to the Health Committee that the spending review settlement would actually deliver

“negative per person NHS funding growth”

in 2018-19, with “very modest” increases in the other years.

On top of that, Ministers expect the NHS to find £22 billion in efficiency savings by 2020-21. No one with expertise thinks that that is possible. In a scathing report in March, the Public Accounts Committee found that a significant number of acute hospital trusts are in

“serious and persistent financial distress”.

It said that there is a “spiralling” trend of increased deficits and that the current payment system is “not fit for purpose”. That is perhaps most starkly demonstrated by our beleaguered social care provision, the funding of which all three Care Quality Commission inspectorates agree is seriously affecting the NHS. The Committee goes on to warn that it must be funded sustainably as a priority.

Yes, we have the better care fund, intended to advance the integration of health and social care services, but the majority of that comes directly from the NHS budget, resulting in what the King’s Fund describes as

“a sharp and sudden reduction in hospital revenues.”

In other words, the Government are robbing Peter to pay Paul, while local authority social care budgets are slashed and people are having to sell their homes to pay for care or are not getting it.

Nor is the Government’s secretive sustainability and transformation programme the solution. Many constituents are worried that plans are being conducted behind closed doors and that vital NHS services could be cut as a result. We urgently need clarity on what STPs will mean in practice for both patients and staff. The Sussex and East Surrey STP area, which includes Brighton and Hove, faces a financial funding gap of literally hundreds of millions of pounds by 2021, and it is not at all clear how our STP will bridge that financial gap or whether acute services will be cut.

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[Mr Dunne]

On the first point, it is down to the CCG to undertake a contract that gives it visibility on subcontracts. If that failing has emerged, the CCG needs to be able to get to see them in subsequent contracts, and I am sure it will learn from that message. On the regulation of the provider, that is a matter for the CQC to look at. I undertake to inquire of the CQC what the status is of the current provider to ensure that it is properly regulated.

For much of her speech, the hon. Lady talked in rather familiar terms about her understanding of the impact of the so-called privatisation of the NHS. I gently remind her that the Health and Social Care Act 2012 did not introduce competition into the NHS. Previous Governments have used patient choice and competition as part of their reform programme. Independent sector providers have provided care and services to NHS patients under successive Governments ever since the NHS was founded. In particular, in the area of non-emergency patient transport, that has happened across many areas of the country. In the last year for which financial data are available, NHS commissioners purchased 7.6% of total healthcare from the independent sector. In 2010, that was about 5%. The rate of growth in the use of private providers under this Government is lower than it was under the previous Labour Government.

[Tim Loughton]

Will the Minister give way?

[Mr Dunne]

I will give way, for the final time, to my hon. Friend.

[Tim Loughton]

This is the first time I have intervened on the Minister, and we do have about an hour left in which to carry on this debate.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I may be able to help the hon. Gentleman. That is only if the Minister wishes to speak for an hour, because nobody else will be allowed to do so.

[Tim Loughton]

Perhaps you will therefore indulge me on this intervention, Mr Deputy Speaker.

[Mr Deputy Speaker]

As ever.

[Tim Loughton]

I have no problem with the principle of outsourcing. The Minister is absolutely right that the level of outsourcing may go up and may go down, because it should be based on the quality of an alternative provider that is able to provide a quality service at an affordable price and is best placed to do so at the time. Will he acknowledge the whole issue with Coperforma? It has been a major issue for all of our constituents. Vulnerable people relying on regular treatment have just been left at home or dumped elsewhere, and have not been able to access services. This has been going on for so long that, when we put a contract to such organisations, much better due diligence needs to be done. There also needs to be a fall-back plan, because given that the ambulance service, which declined to take on the contract in the first place, is now clearly not in a position to take it on anyway, there is little option for somebody else to take on the service urgently and provide the level of care that our constituents desperately need and that has just not happened in this case.

Baby Loss

Tim Loughton Excerpts

Thursday 13th October 2016 Commons Chamber

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

First, may I apologise? I very much hoped to be here at the beginning of the debate, but we had a three-and-a-half hour meeting of the Home Affairs Committee. Due to very poor chairmanship, it dragged on. I was chairing it at the time, so it is entirely my fault.

I pay tribute to the hard work of my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince). I was lucky to have caught many of the emotional speeches in this debate, which has been extraordinarily well informed by personal experience. It has shown the House at its best. It has also shown some quite extraordinary systemic insensitivities within the health system that can only make a tragic outcome even worse for parents experiencing the grief of baby loss. We must do so much better.

This is a big and partly hidden problem. The rates of prenatal, perinatal and post-natal mortality in this country are appalling and shameful. We rank for stillbirths 33 out of 35 developed nations in the world. One in every 200 babies dies as a result of stillbirth in the UK, which is 15 times the rate of mortality for cot deaths, an area on which we have made huge progress. We have heard many statistics so I will not quote many more, but there is a 25% variance between mortality rates in different parts of the country. That is a cause for great concern in itself. We need to be doing better as a nation, but certainly we need to be doing much better for certain parts of the country that do not deserve to be lagging so far behind in the progress that has been made elsewhere. We have heard that that is down to a whole host of reasons, including poor and patchy monitoring during pregnancy and a shortage of specialist midwives in some parts of the country, but at the end of the day 4.9 out of every 1,000 live births are stillborn. That figure must come down, because it has stayed stubbornly high for too many years.

I welcomed the Secretary of State’s pledge in March this year to seek to halve the number of maternal and baby deaths by 2030. If successful, that would save some 1,500 more lives every year. I welcome the progress made in giving out information and advice leaflets to all expectant mothers by week 24, but for reasons I will come on to in a moment, that is too late. We need to do better.

Smoking is a serious cause of baby loss. The self-induced poison of smoking during pregnancy, and in too many cases smoking excessively, has been attributed to 2,200 pre-term births, 5,000 miscarriages and 300 perinatal deaths. There has been progress and I pay tribute to the work done in this area. My hon. Friend the Member for Congleton (Fiona Bruce) mentioned the progress on foetal alcohol spectrum disorder. The all-party group, on which she and I serve as officers, produced a report on this recently. We have visited hospitals with the charity that promotes this subject to give clearer, better and more high-profile advice to women about what is acceptable and potentially harmful about the use of alcohol during pregnancy. Progress has been made, but we need a lot more. I contrast the lack of progress on baby loss with the great progress made on cot deaths. The very high-profile cot death campaign, some decades ago now, had a huge and very quick effect.

The brief we have received from Together for Short Lives mentions the appalling figures for bereavement support, which we have heard about—that 17% of clinical commissioning groups and 68% of local authorities do not commission bereavement support. This is not something that happens just in a medical environment; it happens when people are at home and maybe coming into contact with other council services, yet it does not happen in two thirds of local authorities. There is also the psychological and bereavement support in neonatal services, or rather the lack of it. The figures from Bliss show that 41% of neonatal units said that parents had no access to a trained mental health worker, while 30% of neonatal units said that parents have no access to any psychological support at all and one third of neonatal intensive care units, which look after the smallest and sickest babies, said that their parents had no access to a trained mental health worker.

This is not just about a bit of tea and sympathy from untrained bereavement support; it is about ongoing trauma. We have heard from my hon. Friend the Member for Colchester (Will Quince), for whom this tragedy happened some time ago, that it is still there. It is not something that leaves people, that they grow out of when they leave the hospital or that disappears when they are fortunate to have a healthy baby. It does not. People deal with it in different ways, with different levels of success or not, and those counselling services need to be available.

The figures for perinatal mental illness in this country are appalling. One in six women will suffer from some form of perinatal mental illness. Those are the women who are fortunate enough to give birth to a healthy baby, and we all know about the impact that attachment dysfunction can have on the child and the problems they may have growing up without a proper, good quality attachment with their primary carer. We know, too, from our report by the all-party group on the 1,001 critical days that the cost of not getting that right is £23 billion every year. It is therefore a hugely false economy financially, let alone socially, not to be doing more about this at those early stages.

There are many charities that step in and help on this front, particularly with after-support, and we have heard some good examples. As my right hon. Friend the Member for Broxtowe (Anna Soubry) mentioned earlier, this is not just down to the NHS. A very good charity approached me recently called Aching Arms, which provides free comfort bears to bereaved parents to support their mental health and healing after the loss of a baby during pregnancy, birth or soon after. Significantly, the bears it gives out are gifts from other families who have experienced the loss of a baby, so the parents receiving a bear will know that they are not alone. Each bear has a label attached with information about the charity and signposts to other charities from which bereaved families can seek support that is relevant to them. Thank goodness there are charities doing work like that, but frankly it should not be down to them to be relied on to provide what is some pretty basic, essential health and social welfare care to mums and dads at a point in their lives when they are particularly vulnerable.

What I want to major on—I thought my hon. Friend the Member for Congleton was going to upstage me earlier—is my private Member’s Bill, the Registration of Stillbirths Bill, which I launched in the House on 14 January 2014 with cross-party support. I want to resurrect my Bill and reheat its contents, because it has not come into law—surprise, surprise, for a private Member’s Bill—but it is just as essential now. Indeed, much of the evidence we have heard today shows why this is something we could do, without advances in medical science or huge costs, that could have a huge impact by giving some comfort and closure to the many thousands of our constituents who go through some of the experiences we have heard about today.

The private Member’s Bill I introduced in 2014 would have amended the Births and Death Registration Act 1953 to provide that parents may register the death of a child stillborn before the threshold of 24 weeks’ gestation. Twenty-four weeks is an arbitrary threshold. If someone happens to give birth to a stillborn child after 23 weeks, six days and 23 hours, that child never existed in the eyes of the state and is to all intents and purposes a miscarriage. If that child had clung on for another couple of hours and been stillborn beyond the 24-week threshold, it would be a child in the eyes of the state. That is an extraordinary anomaly in the law which we need to address.

As we have heard, some experience loss through miscarriage, often repeatedly, some give birth but routinely experience the pain of losing a child within days, weeks or months, and some go through all the trials and tribulations and the highs and lows of pregnancy, only to give birth to a stillborn child. The aim of my Bill was to help those parents. We have heard of the problems we still face, but the situation is made worse for parents who have stillborn children before 24 weeks because of the arbitrary nature of that figure. There are no central records of exactly how many babies are born in that way; they do not form part of the perinatal mortality figures; and therefore the position with stillbirths is actually even worse than we appreciate, because of those born before 24 weeks.

I do not wish in any way to downplay the importance and pain of a miscarriage, particularly for new parents struggling to have their first child, but those experiences are different. That was brought home to me most starkly by the story of a constituent of mine, Hayley, who came to see me back in 2013 to campaign for the change in the law that I then took up. Hayley was pregnant. For nearly 20 weeks, she carried the child of her and her partner Frazer. She felt the baby kicking. She went through all the other ups and downs of a first-time pregnancy, but sadly, after around 19 weeks, something went wrong, and Hayley and Frazer’s baby died unborn. It was not a miscarriage, and the following week Hayley had to go through the pain of giving birth to a baby that she knew was no longer alive. She had to take powerful drugs to induce the pregnancy. She experienced contractions. She went into Worthing hospital and had pain relief.

I pay tribute to Worthing hospital, which has the safest maternity department in the whole country. It has been rated as such by the Care Quality Commission and we are immensely proud of it. We are particularly relieved, given that many thousands of my constituents and I marched to save it back in 2008, when the idiot primary care trust thought we did not need a good maternity department at Worthing hospital. Despite having the oldest population in the country, if not the universe, in Worthing, we also have the best start-of-life facilities, and we are greatly thankful for that.

The day after Hayley went into hospital, she gave birth to her baby, Samuel—she gave him a name. She held Samuel in her arms. She and her partner took photographs, had his hand and footprints taken and said their goodbyes. Fortunately, Hayley was given good support by the clinical staff at Worthing hospital, as one would expect, and they had bereavement guidance. She has an understanding employer in West Sussex County Council and was also fortunate to find a sympathetic funeral director. The funeral took place two weeks later.

To all intents and purposes, Hayley, with her partner, went through all the experiences of pregnancy and the pain of childbirth endured by any other mother, but they were coupled in this case with the unimaginable grief of a parent who has lost a child before they could ever get to know him. She did not just go through a stillbirth: she had a still baby; she became a mum. The crucial difference is that Hayley and Frazer’s baby is not recognised in the eyes of the state because he was born before 24 weeks’ gestation. If he had been born after 24 weeks and one day, he would have been recognised and the death properly registered in a register of stillbirths, forming part of the statistics I referred to earlier. More than just adding to the statistics, though, that would have been the acknowledgment of an actual, individual life. To add further insult to injury, Hayley had to hand back her maternity exemption certificate straight after going through that experience.

When I launched that Bill, I got, as we all do, a wave of extraordinary, tragic experiences from mums and dads around the country, including one from a woman who had twins, one of whom was stillborn before 24 weeks. The other survived and was tragically born stillborn after 24 weeks, but in the eyes of the law she only had one baby. How absurd is that? That is why the law needs to be changed.

That stark difference surely cannot be right. It adds insult to the unimaginable pain that the parents have already had to suffer. Until the passing of the Still-Birth (Definition) Act 1992, which amended the Births and Deaths Registration Act 1953, the threshold was 28 weeks, so prior to that even more babies went unrecognised in official records. That change followed a clear consensus in the medical profession on the age at which a baby is considered viable. Since then, in fact, there have been cases of babies born well before 24 weeks who have, incredibly, survived.

It is true that there is an informal procedure for hospitals to issue so-called commemorative certificates for foetuses that are not classified as stillbirths. They provide parents with a certificate that records their pregnancy loss before 24 weeks; and Sands, that excellent charity of which we are all in awe, has produced a template for a certificate of births which it encourages all hospitals to adopt. However, it is unofficial and still counts for nothing in the eyes of the state. Since that Bill, there has been a happy ending, because Hayley and Frazer had a bonnie baby daughter called Bonnie, who I am delighted to say is well and healthy.

My Bill would provide for the official recognition and registration of stillborn babies of below 24 weeks’ gestation. It would be based not on a crude time threshold of what is deemed a viable foetus, but on the experience of giving birth. Hayley and Frazer’s baby would be recognised as having existed, and Samuel’s death would have been registered, which would go some way to providing some comfort to parents such as Hayley and Frazer at an unimaginably painful time.

[Antoinette Sandbach]

The issues around registration and the line between miscarriage and stillbirth were very much brought up by parents in the online digital debate that we had on Monday. The difficulty of parents having to go to a registry office to register a birth and death of a baby also came up, as it is hugely distressing when parents have to explain what happened to a registrar. The Liverpool Women’s hospital has the ability to carry out those registrations in the hospital; the Minister might want to look at that good practice. I very much support what my hon. Friend is saying.

[Tim Loughton]

I thank my hon. Friend for that. The solutions are, frankly, not rocket science; a bit more sensitivity and common sense would go a long way towards alleviating an awful lot of pain and trauma.

The suggestions in my Bill, or a variation on my Bill, would go some way to providing some comfort to parents such as Hayley and Frazer at this difficult time. It would also provide more data to aid the analysis of why stillbirths happen and hopefully suggest what can be done to jumpstart a resumption of falling numbers from last decade’s plateau. For those who say that the physical act of registering such a child alongside those registering a healthy birth could open up wounds and exacerbate the parents’ grief—we have just heard that—I am sure that a more discreet and empathetic procedure could easily be devised. We could even do it online, you never know.

The Bill had nothing to do with changing the law on abortion. It did not propose to change the status quo on the entitlement to maternity benefits or bereavement entitlement, although I think official recognition would make it easier to secure appropriate empathy and flexibility from employers. The Government have already rightly made changes to maternity allowance guidance to ensure that mothers whose babies are stillborn after 24 weeks receive the benefits to which they are legally entitled; the process has been made easier.

The wheels turn slowly. I was making some progress with my Bill. I am particularly grateful to the former Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who with his own clinical experience recognised the problems in this area. He worked with me, with various royal colleges and others, and we had a big stillbirth roundtable at Richmond House at the beginning of 2015, involving the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, Sands, NHS England, the Miscarriage Association and other relevant bodies. I think we found a way ahead in a hugely complex area that is not easy to solve.

A new law was introduced in New South Wales, Australia, whereby a formal recognition of loss certificate is issued in such circumstances, and it has official status. If we could investigate something like that, perhaps we could get back on track with this problem.

We are talking about something that should not happen and that medical technology and innovation are not required to solve. It is something that should not be subject to the restraints and constraints of funding that might apply within the national health service. We are talking about a bit of common-sense admin, but a really important bit of common-sense admin, for somebody who has had to go through this traumatic experience.

In paying tribute to the extraordinary testimonies we have heard today from people who are far more expert and who have had far more first-hand experience—mercifully—than me, may I gently ask the Minister to put this matter back on the agenda as part of improving the whole issue of baby loss? We could do an awful lot of good for an awful lot of our constituents if we could just get this one simple thing done properly.

--- Later in debate ---

[Mr Dunne]

I am sorry. Have I got it wrong again?

My right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) asked about progress on screening for group B streptococcus, and I can reassure him that the UK national screening committee is reviewing its recommendation on antenatal screening for GBS carriage as part of its three-yearly review cycle. It will be taking new published evidence into account. We are anticipating that a public consultation will be held on this topic shortly, and I am sure that my right hon. Friend will want to participate in it. Once it has been concluded, we will review the recommendations that emerge.

The loss of a baby is clearly devastating for its parents and the family, regardless of when or how the death occurs. Those experiencing the heartbreak of miscarriage, stillbirth, the death of an infant or the decision to terminate a much-wanted pregnancy need our support and kindness, and the acknowledgement that their child was here for a short time and was loved. I have been deeply struck by the comments about the lack of sensitivity that can occur when such a loss takes place, and it is absolutely right that the Department of Health should encourage best practice across the NHS in order to minimise the distress caused by insensitive conduct on the part of those involved in supporting families at this time.

Such feelings of loss are real, but as has been said, in particular by my hon. Friend the Member for Gower, who explained this dispassionately and clearly, the issues are often not discussed. Many of us do not realise that on an average day in England around 32 women will be diagnosed with an ectopic pregnancy, 15 babies will be stillborn and eight babies born on that day will die before their first birthday. Most of those infants will probably be less than a month old. It is therefore important that we in Parliament discuss the issues around baby loss and the care for those families experiencing such tragedies.

I want to talk about the steps we are taking with the NHS to reduce stillbirths and other adverse maternity outcomes. I also want to talk about what we are doing to support families who experience this loss. England is a very safe country in which to have a baby, and it is encouraging that the stillbirth rate in England has fallen from 5.2 per 1,000 births in 2011 to 4.4 in 2015. In 2014, the neonatal mortality rate was 2.5 deaths per 1,000 births, and the rate of deaths in babies aged 28 days to one year was 1.1 per 1,000 births. Those rates have been steadily declining and are now at their lowest levels since 1986. There is, however, as we have clearly heard from every contribution today, more that we can do, and, as a Government, we are determined to do so.

It is important that we do not accept all miscarriages, stillbirths, pregnancy terminations or neonatal deaths as inevitable, or simply nature taking its course, as has been touched on by a couple of contributions today, because many of them might have been prevented.

When compared with similar countries, our stillbirth rates remain unacceptable. In the stillbirth series of The Lancet, which was published earlier this year, the UK was ranked 24th out of 49 high-income countries. The same publication showed that the UK’s rate of progress in reducing stillbirths has been slower than that of most other high-income countries. The annual rate of stillbirth reduction in the UK was 1.4% compared with 6.8% in the Netherlands. That places us, as we heard from my hon. Friend the Member for Eddisbury, in the bottom third of the table, in 114th place out of 164 countries around the world, for progress on stillbirths.

We also know that the rates of death in some higher risk groups are not coming down. Again, that was referred to by my hon. Friend the Member for Colchester. According to the Twins and Multiple Births Association, stillbirth rates for pregnancies involving twins, triplets or more increased by 13.6% between 2013 and 2014. Multiple births make up 1.5% of pregnancies in the UK—around 12,000 pregnancies each year—but a disproportionate 7% of stillbirths and 14% of neonatal deaths.

We want NHS maternity services to be an exemplar of the kinds of results we can achieve when we focus on improving safety. With a concerted effort, we can make England one of the safest places in the world in which to have a baby. That was why, last November, the Secretary of State launched a national ambition to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 2030, with a shorter-term aim of achieving a 20% reduction in each of these rates by 2020. I am glad that that was recognised by my hon. Friend the Member for Eddisbury and pleased that she will be keeping an eye on the progress that we make each year to achieve those targets.

To support the NHS in achieving this stretching ambition, the Government have announced plans for investment. There will be a £2.24 million fund to support trusts to buy monitoring or training equipment to improve safety. More than 90 trusts have been successful in receiving a share of the fund, enabling them to buy equipment such as training mannequins, and foetal or maternal monitoring equipment such as carbon monoxide monitors and portable ultrasound equipment.

As my hon. Friend the Member for Colchester acknowledged, we are also investing in the roll out of training programmes to support midwives, obstetricians and entire maternity teams to develop the skills and confidence they need together to deliver world-leading safe care. We hope to be able to say more about how maternity services can apply for this funding soon.

We are also providing funding via the Healthcare Quality Improvement Partnership for developing the new system—the standardised perinatal mortality review tool—which, once complete, should be used consistently across the NHS in Great Britain to enable maternity services to review and learn from every stillbirth and neonatal death. That was an important element of the APPG’s vision for the future. We need to develop proper learning and understanding from what goes wrong, and then the lessons learned should be spread to maternity services across the country. As my hon. Friend the Member for Grantham and Stamford (Nick Boles) emphasised, many reports have highlighted that we do not effectively learn from our mistakes. Indeed, the guidelines of the Royal College of Obstetricians and Gynaecologists state that all stillbirths should be reviewed in a multi-professional meeting using a standardised approach on analysis for substandard care and future prevention. That is something that we would like to see taken up.

We must view individual failings as important and recognise the need for accountability, but balance that with a need to establish standard processes that can prevent avoidable mistakes from happening again. In April we established a new independent healthcare safety investigation branch to carry out investigations and share findings. The HSIB will operate independently of Government and the healthcare system to support continuous improvement by using the very best investigative techniques from around the world, as well as fostering learning from staff, patients and other stakeholders.

An important improvement in maternity care is care that is more collaborative and responsive to the needs of women. Several Members referenced the investigations by Sands, the stillbirth and neonatal death charity, which has revealed that 45% of women who raised a concern with a health professional during pregnancy were not listened to and then went on to have a stillbirth. Clearly, that is not acceptable. All women should receive safe, personalised maternity care that is responsive to their individual needs and choices.

The hon. Member for Ellesmere Port and Neston asked where we are on supporting those with mental health conditions through pregnancy. I draw his attention to the announcement in January in which the Government set out that an additional £290 million will be made available over the next five years to 2020-21 to invest in perinatal mental health services. That is funded from within the Department of Health’s overall spending review settlement, and it will go a long way to providing support for women who are pregnant and need mental health counselling both before and after birth.

Last November we asked the national patient safety campaign Sign up to Safety, which was launched by the Government in 2014, to support all NHS trusts with maternity services to develop plans to improve safety and share best practice. In March this year we launched “Spotlight on Maternity”, with guidance for maternity services to improve maternity outcomes. This set out five high-level themes that are known to make maternity care safer that services could focus on: building strong clinical leadership; building capability and skills for all staff; sharing progress and lessons learned across the system; improving data capture and knowledge; and improving care for women with perinatal mental health problems.

In February this year, “Better Births”, the report of the independent national maternity review that was chaired by Baroness Cumberlege, was published, and hon. Members have touched on it today. It sets out that the vision is for maternity services across England to become safer, more personalised, kinder, more professional and more family-friendly. The Department of Health is leading the promoting good practice for safer care workstream of the maternity transformation programme that was launched last July to deliver the vision set out by the national maternity review, and we will set out our action plans shortly.

As my hon. Friend the Member for Eddisbury highlighted, it is vital that we support research into the causes of stillbirths and neonatal deaths so that we can better understand how to identify babies at risk and improve services. In recent years, the Government have invested in research, looking at important questions regarding stillbirths and neonatal deaths. From 2012, the National Institute for Health Research biomedical research centres at Cambridge and Imperial College will have invested £6 million over five years in research on women’s health, including research to increase understanding of the causes of still births and neonatal deaths. We continue to encourage research bids for new studies that will help us to identify babies at risk.

The evidence shows that this stretching ambition cannot be achieved through improvements to NHS maternity services alone. The public health contribution will be crucial. As The Lancet stillbirth series concluded, some 90% of stillbirths in high-income countries occur antenatally and not during labour.

We heard from a number of hon. Members about the need to do more to highlight risks during pregnancy so that women are aware of what they can do while they are pregnant to minimise the risks. When starting pregnancy, not all women will have the same risk of something going wrong, and women’s health before and during pregnancy is one of the factors that influence rates of stillbirths, neonatal deaths and maternal deaths. We know that a BMI of over 40 doubles the risk of stillbirth, that a quarter of stillbirths are associated with smoking, and that alcohol consumption is associated with an estimated 40% increase to stillbirth risk. In addition, the MBRRACE—Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries—report published in June last year showed that women living in poverty had a 57% higher risk, babies from BME groups have a 50% higher risk, and teenage mothers and mothers over 40 have a 39% higher risk.

[Tim Loughton]

I sense that the Minister is coming to the end of his speech—if you have anything to do with it, Madam Deputy Speaker. Will he give me a guarantee that he will look into the registration of stillbirths? He has not mentioned that yet.

[Mr Dunne]

I will come back to my hon. Friend’s point just as I conclude.

These striking facts are why the Department of Health will continue to work closely with Public Health England and voluntary sector organisations to help women to have a healthy pregnancy and families to have the best start in life. A new information campaign will be launched shortly, and I encourage all hon. Members to support it during the launch period.

I would like to say a few words before I conclude about the importance of delivering good bereavement care for those families who have experienced baby loss, which was a topic raised by many hon. Members. Having not gone through the experience myself, I can scarcely comprehend how devastating it must be for parents to lose a baby. It is important that parents receive appropriate care and support as sensitively as possible when that occurs. The MBRRACE report that I referenced stated that 60% of parents currently receive a high standard of bereavement care, but that clearly leaves 40% who do not, which is not good enough.

Since 2010, we have invested £35 million in the NHS to improve birthing environments, including better bereavement suites and family rooms at some 40 hospitals, to support bereaved families. I have seen some of those rooms, including the superb suite opened last month in the Medway Maritime hospital, which I think was one of those that indicated that it did not have such a suite when my hon. Friend the Member for Eddisbury undertook her research. We have heard from my right hon. Friend the Member for Broxtowe (Anna Soubry) about the recent improvement in Nottingham.

We have been working with Sands, the Miscarriage Association, the Lullaby Trust and others to understand the challenges that maternity services face and to highlight areas of good practice. I am pleased that the all-party group’s report, which was published this week, recognises the work that we are supporting to develop an overarching bereavement care pathway to help to reduce the variation in the quality of bereavement care provided across the NHS.

In response to the comments made by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) in his intervention and elsewhere during the debate, I should like to say that I have been impressed by comments made about the distress caused by the registration of post-24 week baby loss, often in the same place where mothers with young babies are registering births. I can well imagine that that compounds the sense of grief. It is appropriate that we look at best practice and the common-sense delivery of registration to see whether it could be spread more widely, so I will ask officials to look at that, but I am not promising legislation.

I again thank again all hon. Members for participating in the debate and their deeply moving contributions. In particular, I thank those who secured the debate for their work in driving the all-party group and raising awareness across the nation. It is important that we as a Government try to drive an improvement in outcomes, and I reassure hon. Members that the Government are fully committed to reducing the number of babies who die during pregnancy or in the neonatal period, and to supporting those families who are bereaved. Although the Baby Loss Awareness Week events here in Westminster culminate with today’s important debate, other events are continuing to take place throughout the United Kingdom and internationally. I should like to encourage everyone to join in the global wave of light, which we heard about earlier this afternoon, by lighting a candle at 7 o’clock this Saturday 15 October and letting it burn for one hour in remembrance of all the babies who have died during pregnancy or at, during or after birth.

Conception to Age 2: The First 1001 Days

Tim Loughton Excerpts

Thursday 17th December 2015 Commons Chamber

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

Old Whip’s habits die hard, but we accept the overtures of the hon. Member for Nottingham North (Mr Allen).

I beg to move,

That this House calls on the Government to consider the adoption of the recommendations in the cross-party manifesto entitled The 1001 Critical Days, the importance of the conception to age two period.

In this my seventh contribution of the day, let me wish you a happy Christmas, Madam Deputy Speaker, when it eventually starts. I am grateful to the Backbench Business Committee for giving us this important debate, particularly as it is so close to the launch of this excellent manifesto, which I will also be promoting today. I know that every single Member in this Chamber and beyond has been sent a copy of it. I am also grateful to those Members who have stayed for the final debate on the last day before the Christmas recess.

It is perhaps appropriate that the final debate should be about babies and conception to age two just eight days before we celebrate the birth of one particular baby, albeit the subject of an immaculate conception and in which the confusion over paternity, a somewhat unprepared and astounded mother and inadequate birthing facilities could have given rise in normal circumstances to some attachment dysfunction problems.

It is good to see the Minister for Community and Social Care here. I know that his door is well and truly open to what we have been promoting. It is particularly good to see my old great friend the Minister of State in the Department of Energy and Climate Change, my hon. Friend the hon. Member for South Northamptonshire (Andrea Leadsom). I wish to pay tribute to her. Effectively, she conceived this whole manifesto, gestated it and gave birth to it, and has done so much to champion the cause of early years attachment and perinatal mental health in this House and for many years before she came to this House. She continues to combine her advocacy with her new day job in DECC. She championed “The 1001 Critical Days” manifesto, which is now three years old and which was relaunched this week with more support and recognition than ever before.

On Monday, no fewer than 200 people came to the House of Commons Terrace to support this manifesto. Those present included academics, senior practitioners in paediatric and mental health, commissioners, voluntary organisations and politicians of all parties. It is particularly gratifying that the manifesto has now been sponsored by Members from eight different parties across the House. There really is a genuine cross-party consensus to promote this manifesto.

There has been big progress since the manifesto was launched in 2012 and promoted in the party conferences in 2013. The manifesto is now becoming part of the mainstream. It was supported at its launch and continues to be supported by the WAVE Trust—I pay particular tribute to George Hosking and all the work that he has done well before our time in the House—the National Society for the Prevention of Cruelty to Children, and PIP, the parent and infant partnership charity. I declare an interest as the chairman of the trustees.

PIP is putting the “The 1001 Critical Days” manifesto into practical action through children’s centres around the country and changing the mindsets of commissioners. Our projects started in Oxford with OxPIP. We now have NorPIP in the constituency of my hon. Friend the Member for South Northamptonshire, projects in Enfield and Liverpool, and others in Brighton, Croydon and Newcastle coming online in the near future. We want to spread that network across the whole country.

It is crucial to change mindsets in relation to how we intervene early and reconfigure our health—particularly mental health—services, education and children’s social care services to intervene earlier to prevent the causes of poor mental health for mother and baby from leading to indisputable life disadvantages that become mired in a vicious cycle of intergenerational underachievement. The alternative is that we continue to firefight the symptoms at great cost to our society both financially and, more importantly, socially.

The Government have made good progress, largely through the troubled families programme, in acknowledging that if we recognise the problems of dysfunctional families early and intervene with intensive focus and joined-up support we can often get those families back on track and convert them to balanced, contributing members of society, rather than a huge challenge to it and drain on it. I am proud to have been involved with that work when it was started in the Department for Education in my time as a Minister there.

But we need to go further, with what I have termed a “pre-troubled families programme”. That is, in effect, what the “The 1001 Critical Days” manifesto is about, and this is why. Last year the Maternal Mental Health Alliance, so ably led by Dr Alain Gregoire, produced a report which estimated that the cost of perinatal mental illness at more than £8 billion for each one-year cohort of births in the United Kingdom. That is equivalent to a cost of almost £10,000 for every single British birth. Nearly three quarters of this cost relates to adverse impacts on the child, rather than the mother. Perinatal mental health problems are very common, affecting up to 20% of women at some point during and after pregnancy, yet about half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based forms of treatment.

As the Minister well knows, the current provision of services is patchy at best, with significant variations in coverage and quality around the country. Most alarmingly, just 3% of clinical commissioning groups in England have a strategy for commissioning perinatal mental health services and a large majority still have no plans to develop one. I am sure that with the new Minister’s laser-like focus and zeal, and the fact that NHS England has adopted perinatal mental health as a priority, this will start to change soon.

Why does this matter? Apart from the obvious major public health epidemic going largely under-appreciated at its extreme, the statistics are alarming. Just last week a report by the maternal research group MBRRACE, analysing maternal deaths between 2011 and 2013, found that one in four of those deaths between six weeks and one year after giving birth were linked to mental health issues, one in seven were a result of suicide, and mental health problems were instrumental in the deaths of one in 11 new mothers within the first six weeks after giving birth. At this extreme the figures are shocking, but they are also largely preventable with better and early detection and intervention, yet 40% of those women who committed suicide in that timescale would not have been able to access any specialist perinatal mental health care in their areas.

For those who lived through pregnancy and the early years of a baby with a mental illness, the impact on that child can be considerable. Another major negative impact might be substance abuse, poor parenting skills—often inherited as a result of a young mum being poorly parented herself—and being exposed to domestic violence. Incredibly, more than a third of domestic violence cases begin in pregnancy. This is a statistic that many of us would find hard to believe. Sadly, these negative influences are all too prevalent among new parents. Those is by no means a problem limited to those from poorer backgrounds. Parents unable to form a strong attachment with a new baby come from all parts of society, and we need a multifaceted approach for detection and intervention at all levels.

Children need nurturing from the earliest age. From birth to age 18 months, it has been calculated that connections in the brain are created at a rate of a million per second. The earliest experiences shape a baby’s brain development, literally, and have a lifelong impact on that baby’s mental and emotional health.

A pregnant mother suffering from stress can sometimes pass on to her unborn baby the message that the world will be dangerous, and the child might struggle with many social and emotional problems as a result; their responses to experiences of fear or tension have been set to danger and high alert. That will also occur at any time during the first 1001 days when a baby is exposed to overwhelming stress from any cause within the family, such as parental mental illness, maltreatment or exposure to domestic violence.

Attachment is the name given to the bond that a baby makes with his or her care givers or parents. There is long-standing evidence that a baby’s social and emotional development is affected by his or her attachment to his or her parents. As the chief medical officer, Sally Davies, puts it in her foreword endorsing “The 1001 Critical Days”:

“The early years of life are a crucial period of change; alongside adolescence this is a key moment for brain development. As our understanding of the science of development improves, it becomes clearer and clearer how the events that happen to children and babies lead to structural changes that have life-long ramifications. Science is helping us to understand how love and nurture by caring adults is hard wired into the brains of children.”

The all-party group for conception to age two—the first 1001 days, which I have the privilege of chairing, produced a report in February called “Building Great Britons”. That, too, was sent to every hon. Member and it complemented “The 1001 Critical Days”. The report calculated the cost of child neglect to be some £15 billion each and every year. When combined with perinatal mental illness, that makes a cost of more than £23 billion every year for getting it wrong for our youngest children and their parents. That is equivalent to two thirds of the annual defence budget.

In concentrating on perinatal mental illness in young mums, it is also important to stress how a child benefits most from forming strong and empathetic attachments with both parents. We should not forget that 39% of first-time fathers also experience high levels of distress during a child’s first year. We need a strong whole-family approach, and it is especially important to get that strong attachment with fathers in the second year of a child’s life as well.

Another big problem in this country is that it has been calculated that 1 million children suffer from the type of problems—attention deficit hyperactivity disorder, conduct disorder and so on—that are clearly increased by antenatal depression, anxiety and stress. Yet the cost of appropriate and timely intervention and support has been calculated at a fraction of the annual cost of failure. It equates to roughly £1.3 million per annum for an average clinical commissioning group with a budget of around £500 million.

The “Building Great Britons” report calculated that preventing these adverse childhood experiences could reduce hard drug use later in life by 59%, incarceration by 53%, violence by 51%, and unplanned teen pregnancies by 38%. It is not rocket science—technically, it is neuroscience. More and more people are coming to realise that this is an investment that we cannot afford not to make.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I congratulate the hon. Gentleman on securing this debate. He and I have worked on children’s issues for a very long time. This is a brilliant initiative. As we are listening to his brilliant analysis, we have to consider whether we have the right skills in the communities. Are we training people the right way? Are we depending too much on people with PhDs in educational psychology, rather than on trained people based in GP surgeries who can identify problems and support families at an early stage?

[Tim Loughton]

I am grateful to the hon. Gentleman for his support. He has been working on this stuff for even longer than I have and has great experience. We need to ensure that we are training the people who know about this stuff, appreciate its importance and know how to communicate with other professionals to have a joined-up approach. There is too much silo thinking going on. When Minister and shadow Minister, I saw families who seemed to be having all sorts of different professionals going in and out of the house but no joined-up approach to bring it all together and make the difference that the family needed.

We also need those professionals to be able to work with the parents, and to be able to communicate and empathise with them, because ultimately it is the parents who will have the biggest influence on the children. They need to be guided and supported. The state needs to take over only in extreme circumstances in which children might be at harm. We need to do more to ensure that parents know what good parenting looks like and are able to do it.

That is why “The 1001 Critical Days” manifesto is so important. It is not simply a political wish list; it has been endorsed by a very wide cross-section of children’s organisations, charities, practitioners, and academic and professional bodies, including the royal colleges of paediatrics and child health, midwives, psychiatrists, obstetricians and gynaecologists, and general practitioners; the NSPCC; Bliss; the Tavistock Centre for Couple Relationships; and the Centre for Social Justice. The Institute of Health Visiting said:

“As far as health visitors are concerned, the 1001 Critical Days Manifesto may yet prove to be one of the most important developments of the new millennium. It has created a long overdue focus on the essential first days of life when the blue print for an individual’s future health and wellbeing is laid down.”

I will not go into great detail about what the manifesto calls for, because every hon. Member has received a copy. In essence, it is about allowing vulnerable families to access specialist services; working closely together to share vital data between the different agencies I have spoken about; and making sure that every woman with past or present serious mental illness should have access to a consultant perinatal psychiatrist and specialist support in relation to mother-infant interaction, as required and in accordance with existing National Institute for Health and Care Excellence guidelines.

The manifesto has a truly holistic approach involving many Government Departments and agencies at a national level and a local level. In essence, it is about changing mindsets so that that should be the approach we ordinarily have and take for granted, because it is the right one. The aim is that “The 1001 Critical Days” becomes a recognised term with a recognised programme being delivered across every community, focused on children’s centres. I know that the Minister is already on board with this aim, and I urge him to promote and champion its adoption to his colleagues across Government. I commend the motion to the House.

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[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to follow the hon. Members for Congleton (Fiona Bruce) and for Sefton Central (Bill Esterson), and I completely endorse their points about foetal alcohol syndrome. It feels like we have not caught up with the evidence, and we need to do so urgently, given the awful carnage being done to babies by this dreadful condition, so I congratulate the all-party group on foetal alcohol spectrum disorder on its work.

I also congratulate the right hon. Member for East Worthing and Shoreham (Tim Loughton)—

[Tim Loughton]

Hon. Member.

[Norman Lamb]

Oh, I do apologise. To me, he is right honourable. He has shown great leadership, both as a Minister and in his work since, and I applaud him for that. I also join others in acknowledging the fantastic leadership shown by the hon. Members for South Northamptonshire (Andrea Leadsom) and for Nottingham North (Mr Allen).

Like the hon. Member for East Worthing and Shoreham, I had the one-to-one seminar with George Hosking from the WAVE Trust. I had it many years ago, but I remember it still very clearly: the evidence he showed me, from Australia and the United States, was compelling. He is rightly on a mission and has had a significant influence, which should be acknowledged, so I join the hon. Gentleman in thanking him for his amazing work.

I want to focus on perinatal mental health. Here, we are dealing with two lives: the mother’s and the baby’s. The impact of mental ill health in the first year after birth is profound. As the hon. Gentleman said, it affects up to 20% of women. We often think of it as post-natal depression, but it goes much wider than that. The London School of Economics’ personal social services research unit and the Centre for Mental Health have produced an important piece of work on the economics of this. They refer to anxiety, psychosis, post-traumatic stress disorder and other conditions, including obsessive compulsive disorder. The impact of these conditions on the mother, but also on the baby and the wider family, can be very profound.

The cost of failure, as the hon. Member for Nottingham North made clear, is enormous. The report by the LSE and the Centre for Mental Health estimates the cost of perinatal ill health as being £8.1 billion at the very minimum. The basis for calculation was the mothers who suffered depression, anxiety and psychosis, but they recognised that other conditions were relevant, too, which have not been costed, so the overall cost is bigger. We must understand that. As the hon. Member for East Worthing and Shoreham made clear, this amounts to £10,000 for every baby born in this country. The cost of failure is just enormous.

How have we responded to this extraordinary impact? Slowly but surely, things are changing, but if we look at the recently published map on the availability of services around the country—this relates to the UK’s specialist community perinatal mental health teams—we see that in 2015, the map is still horribly red. This does not indicate constituencies held by the Labour party—[Interruption.] Thank goodness! This indicates the parts of the country where no specialist team is available. Let us imagine for one moment that this was the case for stroke care or heart conditions: there would be a national outcry.

No party or Government is responsible for this situation. We are dealing with an emerging understanding, and it is about developing a new service. When I look at the whole of East Anglia, my own region, I see that not a single specialist team is available. That is truly shocking. As the hon. Member for East Worthing and Shoreham said, people are dying, and some even take their own lives, yet these are deaths that could be prevented by the application of specialist services around our country. None of us can be comfortable with the fact that so much of our country does not have the ready availability of support for mothers in this situation.

There is an urgency to ensuring that we act to get the whole country covered. I was pleased when in response to the cross-party campaign for equality for mental health, we had the basic simple principle that there should be equal access to care and support—irrespective of whether people have a mental or a physical health problem. At the moment, that does not exist, but the campaign that we launched in the run-up to the spending review secured a response from the Chancellor of an extra £600 million for mental health. In his statement to Parliament, the Chancellor specifically mentioned the importance of perinatal mental health services. That money must be used.

I end by urging the Minister to do everything in his power to instil a real sense of urgency, with a programme and a timetable to get every part of the country covered by specialist services. I find it unbelievable in this day and age that the CCGs mentioned by the hon. Gentleman have not even started to think about this yet. These are the people who hold responsibility in our NHS for commissioning services for our populations, but a significant number of them have not yet even started the process of thinking about the problem. The message needs to go out from the Minister, but also from NHS England nationally, that this situation is intolerable and cannot be sustained. We must ensure that this Parliament reaches the point by 2020 when the whole of that map of the United Kingdom is green, so that every mother, when she is in need, following birth, can get access to the specialist services that can help her to recover.

--- Later in debate ---

[Tim Loughton]

I am grateful to all hon. Members who have taken part in this debate. There have been some weighty contributions and I am grateful to those who have stayed for this last debate on the last parliamentary day of the year.

I am particularly grateful to the hon. Member for Nottingham North (Mr Allen) for his contribution. He spoke of the intergenerational problems we are inheriting, which he has done so much to address. He was also right in a later intervention to mention social finance and the possibility of social impact bonds, which we certainly want to develop.

At times the debate risked being hijacked by the report of the all-party group on foetal alcohol spectrum disorder, of which I am a member. I am delighted that we had an opportunity to give the group a voice, because it is a very important subject.

I am grateful to the right hon. Member for North Norfolk (Norman Lamb), who did so much on perinatal mental health when he was a Minister. The map he produced puts starkly, in graphic terms, the service provider gaps around the country. I was also grateful to hear from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who speaks on behalf of the Scottish National party, who spoke of the Scottish experience and her time as a clinical psychologist in the NHS.

I pay tribute to the Opposition spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders), not least for his optimism about the political fortunes of his party. I am grateful for the cross-party consensus, to which he contributed. He is absolutely right to say that it is a false economy not to be doing this. We need to impress on the Chancellor the fact that, just as we invest in roads and factories to aid the economy, we should invest in our youngest children as citizens who are going to contribute to society in the future.

This is an urgent matter for the whole Government and I urge the Minister to promote it as such. In doing so, I wish everybody a very happy and peaceful Christmas and an “attachment” new year.

Question put and agreed to.

Resolved,

That this House calls on the Government to consider the adoption of the recommendations in the cross-party manifesto entitled The 1001 Critical Days, the importance of the conception to age two period.

Health and Social Care

Tim Loughton Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Douglas Carswell (Clacton) (UKIP)]

It is an honour to follow the hon. Member for Eastbourne (Caroline Ansell). I remember sharing a platform with her when I campaigned for her in her constituency about a year ago. She was clearly a worthy candidate and she is a winner now, so I am delighted to see her here.

I may be my party’s only voice in the House of Commons, but I shall speak on behalf of not only my constituents, but the millions who voted for my party. I may have only one vote in the Division Lobby, but I shall use it to support Ministers when they do sensible things, to oppose the Government when they are being daft, and, when I think it is possible to improve things, to try to amend things to make them better.

There is, in short, much in the Queen’s Speech with which I agree. This is ostensibly a debate about health and social care, and I will direct most of my comments to that, but it would be remiss of me if I did not touch on one subject that is central to the long-term health and wellbeing of our nation in its broader sense, and that is the Europe question. I am absolutely thrilled and delighted that there is a European Union Referendum Bill in the Queen’s Speech. That is truly magnificent.

I remember 111 hon. Members from both sides of the House voting in October 2011 for an in/out referendum Bill. We were opposed on that occasion by Members on both Front Benches, all the Whips and, indeed, many of the pet pundits. It is wonderful that the Front Benchers, including Labour Members, have changed their minds and converted to the case for a referendum.

We should be generous to Ministers as they bring the Bill before the House. This is not a time for bickering or semantics. The Government have got it right on the big issues in this Bill. I think they are right about the franchise and more or less right about the wording, and I think they are even right on the timing, too. The campaign to leave the European Union begins with this Bill, and we are only going to win it if we are relentlessly upbeat, optimistic and generous. We should begin today by being generous to the Government.

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

I am interested in what the hon. Gentleman is saying. Does he therefore agree that the worst possible scenario would have been the policy articulated and advocated by UKIP, which was to hold a referendum now, without any reform of the European Union, when all the polls suggested that the result would be staying in an unreformed EU?

[Mr Carswell]

I am pleased that the hon. Gentleman is being generous, but he is also being a little unfair. My party’s position was to get the legislation on the statute book. Those of us who want to maximise the chances of the out campaign winning recognise that it would be helpful if the Prime Minister tried to negotiate a new deal and failed to bring back anything significantly different. If the Prime Minister wants to take his time to conjure up this fictitious new deal, let him do so. The more he is seen as being Harold Wilson mark 2, the greater the chances of the undecideds going into the no column.

During the referendum debate that will follow, we also need to be generous to those who will be pro-Brussels, including perhaps the hon. Gentleman. We must seek to convince them that Brussels is not a seat of high-minded internationalism, but a nexus of vested interests and a den of crony capitalism.

I hope also to be able to support the education and adoption Bill—something is wrong with some of the adoption process in this country—and I hope we will use it as a chance to look at what other countries do when it comes to adoption, particularly Scandinavian countries such as Denmark.

I want to support the childcare Bill and will study the small print. The issue of affordable childcare is very important in my constituency. I will look with interest at the detail of the housing Bill, too. It is a very good idea to support self-build and, indeed, a brownfield register.

The Health Secretary outlined ideas to change and improve our national health service, including the importance of putting more money into healthcare. Given the advances in medical technology, the ageing population and rising expectations, my party supports that. As nations become richer, it is natural that we should want to spend more on health. The Health Secretary seems to be talking about championing the patient’s interest, as opposed to that of the producer. He seems to be talking about seven-day surgeries and using innovation to allow people to access better care, and my instinct is very much to support that agenda.

The Health Secretary also touched on the challenges we face as a country when it comes to healthcare, including coping with dementia and social care and the need to do more for mental healthcare. There is clearly a shortage of GPs, there are clearly problems at A&E departments, and ambulance response times are not good enough. There needs to be a culture change in the health service. Those challenges and problems are very real, certainly at Colchester hospital, which serves many of my constituents, as Members on both sides of the House will recognise.

We should not forget, however, that we are living in an age of unprecedented progress. There will be 1 million more people over the age of 70 at the end of this Parliament, because we are living longer, healthier lives. Excessive alcohol consumption, particularly among younger people, is falling. Cigarette-related deaths are falling: e-cigarettes are providing a modern, cheap solution to the age-old tobacco problem. Diseases that were once terminal are in retreat. A whole new generation of tailor-made drugs are on the horizon. The public policy choices that any Minister will have to grapple with are difficult, yet they are choices borne of rising expectations, greater medical capability and greater scrutiny.

I imagine I will oppose much of what this Government do. I regret what is not in the Queen’s Speech as much as I support what is in it. There is a failure to introduce meaningful political reform. There is nothing in it that will make Government more properly accountable to Parliament and Parliament more properly answerable to the people. There is little in it to disperse power outward and downward, or to personalise public services in the way I think they need to be.

When I challenge the Government’s shortcomings, however, I will do so cheerfully and in the belief that, yes, things are not good enough, but that is because they could and should be better. I will be optimistic and cheerful in opposing the Government when I need to do so, and I will support them when I think they are doing the right thing.