Baby Loss (Public Health Guidelines)

Will Quince 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.

Primary Care: North Essex

Will Quince Excerpts

Tuesday 14th March 2017 Westminster Hall

[Mr Douglas Carswell (Clacton) (UKIP)]

I beg to move,

That this House has considered primary care in North Essex.

I am grateful for the opportunity to have this debate. We face a serious problem of primary care provision in our corner of Essex. To put it bluntly, there are not enough GPs. In my part of Essex, there are three local GP surgeries, which are not taking on any new patients at all. Those fortunate enough to be registered with a surgery often struggle to get an appointment.

Here are some of my constituents’ experiences, pulled out from my postbag in the past three weeks, to give a flavour of what they are having to put up with. An elderly lady from Little Clacton wrote to me a couple of weeks ago:

“On attending the practice, I realised that there was an average of three weeks waiting time to see a GP. … When I did finally get seen, the practice nurse said, and I quote, ‘You have to be at death’s door to get an urgent appointment on the NHS now.’”

This is a woman who has spent decades paying into the system, unable to see a doctor for three weeks.

Then there is a lovely lady from Kirby near Frinton who emailed me, saying:

“I’m writing to say how abysmal the doctor’s surgery is now. I waited two weeks for an appointment, only to be told to go to a different surgery if I wasn’t any better in two weeks.”

There is not much sign of customer service there, is there?

Finally, a man from Clacton wrote:

“I am my mother’s carer. I’m not a doctor. I just do my best and feel abandoned by my medical practice. I am having great trouble making appointments for my mother to see a doctor so that we can control her pain.”

Those are not isolated cases. My postbag is full of examples—it is fair to say that something is badly wrong with primary care in our part of Essex. What concerns me is that it was possible to see the problem coming. Back in September 2013, I led a delegation of GPs to see the Health Secretary to flag it up, precisely because GPs said the problems were going to happen.

To be fair to Ministers, we in this room all know—I hope people outside know it too—how disastrous the 2004 GP contracts were. They were certainly disastrous for those who are meant to be provided with primary care—but that is now more than a decade ago. We also recognise that a Minister cannot, as I think Nye Bevan put it, be held responsible for the “sound of every dropped bedpan” in every NHS surgery and waiting room. In fairness, I do not think we can blame Ministers for the failure of individual surgeries to get their appointment systems sorted out. But the question is, who does take responsibility? Who will answer to my constituents for these failings?

It is clear there has been a failure to provide the level of primary care that is needed in our part of Essex. What is less clear is who we hold to account. We have an alphabet soup of different agencies and quangos in charge, but none of them seem to be properly responsible. There is something called the CCG—the clinical commissioning group. It allocates the money and the patient is then expected to follow. The technocrats commission and the patient is expected to follow. Then there is the CQC—the Care Quality Commission. It inspects the GP surgeries. Would it not be better if surgeries had to satisfy customers and not simply comply with CQC assessments? Then, of course, there is NHS England, and in our part of Essex, something called ACE—Anglian Community Enterprise—which provides certain primary care services.

I have raised concerns with all those different branches of NHS officialdom on behalf of constituents and I have done so repeatedly. Promises are invariably made. I am told that we will get more GPs, that new contracts and a new kind of contract will be sorted out—always tomorrow. Not much ever actually seems to change on the ground.

Sometimes I am told, or it is implied—they do not dare tell me this any more because I react very strongly to it—that all of this is to be expected. There is, they say, an elderly population in our part of Essex. The profile of the patient group, I was once told, means that there is all this extra pressure.

Those sentiments are excuses for failure; they are not credible reasons. We should not be in the business of blaming people for being elderly. After all, if someone is elderly, it means they have paid more into the system. In what other walk of life or area of activity is a surfeit of customers regarded as a problem? In Clacton, it is possible—I speak as a father—to go shopping for the family 24 hours a day, seven days a week, so why is it not possible to see a GP on a Saturday if a child is ill?

At the root of the problem is a system of state rationing—it is probably one of the last vestiges of the mid-20th century system of state rationing—in which the patient is expected to stand in line and wait. The patient is made to follow the money. We need a system of primary care in which the money—for a taxpayer-funded service, free at the point of access—follows the patient.

Ministers are absolutely right to want to see surgeries open on a Saturday, at weekends and in the evenings. Heaven forbid, if we really had a system of primary care that responded to my constituents’ needs, there might even be GP surgeries in railway stations, where quite a large number of my constituents tend to congregate in the early morning and late evening. If we are to have a more accessible, customer-focused service, it means making the patient king. It is not something that can be done by top-down design or by ministerial decree. Good customer service comes from the need to please customers, not from on high.

GPs tell me that the burden they face could be alleviated in part if more people were willing to use and made better use of pharmacists. There is a lot of truth in that. Pharmacists are highly qualified and often very experienced, and we are right to look into that. I say this in the week when we have finally passed the legislation to get us out of the EU, but perhaps we could learn from some of our European neighbours who seem much better at making good use of pharmacists, particularly Italy and France. I gather that in Germany people do not have to depend on the equivalent of a GP acting as a gatekeeper in the way that we do in this country. I would be very grateful if the Minister could elaborate and talk about not just what we can do to alleviate the problems in our part of Essex but the far-reaching reform that is needed if we are to make sure that people who have spent all those years paying into the system can be seen by a doctor when they need to.

[Will Quince (Colchester) (Con)]

I recognise the issues that my hon. Friend rightly raises. Does he agree that a direct result is the considerable pressure placed on the general hospital in Colchester, which serves his constituents and mine, and that the foolhardy decision to consult on the closure of minor injuries units and the walk-in centre in Colchester should be dropped immediately, because it is such a ridiculous idea? It will just put additional pressure on Colchester general hospital.

[Mr Carswell]

My hon. Friend, as so often, is absolutely spot on. His judgment is impeccable. The failure to provide people with the primary care they need when they need it means that more people then tend to go to A&E departments. The people who run the ambulance service tell me that that then causes a bottleneck in A&E, which has a knock-on effect on ambulance response times. Many of the problems we are grappling with are a consequence of the failure to provide accessible, customer-focused primary care where it is needed.

The consultation on the minor injuries unit and walk-in centre is irresponsible. I share the view that it would clearly be absurd to shut that facility. A lot of angst and worry could be addressed if the option was ruled out now, and I hope it is.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Clacton (Mr Carswell) both on obtaining the debate and on the lucid way he put forward his case. I thank my hon. Friends the Members for Colchester (Will Quince) and for Harwich and North Essex (Mr Jenkin) for their points, which I will try to answer.

There is an issue with the number of GPs in the CCG in that part of north Essex. I will talk a little about why that is the case and what we can do about it. It is very hard to make progress on a number of the issues that were raised without fixing that problem. We are short of GPs across the country, but we are particularly short in the North East Essex CCG. Let me give some numbers for context. There are 40 GP practices and a little over 210 GPs within the CCG, which covers 330,000 people. The CCG estimates that it is 28 GPs short. I spoke to it this afternoon, and I was told that if any GP wants to get a job in Clacton, it will not be a difficult process. Indeed, the figures for Clacton and the coast are marginally worse than those I have just given.

That is somewhat mitigated by the fact that the CCG has more nurses than the UK average. That might well be to do with the walk-in centres and minor injury units, which are nurse-orientated. I will come on to talk about how we can work in a slightly different way—this was implied by the remarks of the hon. Member for Clacton—by making use of other disciplines, such as pharmacists, physios, allied health professionals of different sorts and mental health professionals. The CCG now has 10 full-time pharmacists, and there is a plan to increase that number considerably between now and 2020. Frankly, it is easier to recruit pharmacists than GPs, but we need GPs too.

I will spend a little time talking about the reasons for that. I spoke to the CCG about them in some detail today. As the hon. Gentleman mentioned, Clacton has an older population, which causes problems, and there may be contractual issues relating to that, although the GP contract allows extra money for areas of deprivation and those with ageing populations. There are no training GP practices in Clacton, which puts it at a disadvantage, as GPs are likely less to go there as part of their training and then stay. It is also true that Clacton has a higher than average age demographic of GPs, so there is a higher tendency for them to retire, which exacerbates the situation. I concede that there is a problem, and I will talk about some of the things being doing about it. The hon. Gentleman used the phrase “jam tomorrow”, and I am afraid that some of it might sound a bit like that.

I want to draw attention to some of the things that the CCG in north Essex does well. We often talk about issues to do with locations—bricks and mortar—whether minor injury units or hospitals, but all MPs, including me, should properly evaluate our CCGs on the full set of published metrics. We have done an awful lot on transparency. I will just mention some of the things that the CCG does well. The hon. Gentleman’s CCG is well above the national average for cancer diagnosis in stage 1, for dementia care planning, for organising health checks for patients with learning disabilities, and for organising care packages for people with mental health episodes. I say that to put its issues in context. It is clearly true that there are difficulties with access and, to a lesser extent, with getting on lists in the first place.

The hon. Gentleman rightly made the point that we should be following the patient. We do a lot of work across the NHS and with every CCG to poll patients to ascertain how satisfied they are with the level of service they have received. North East Essex CCG received something like 82% patient satisfaction—lower than the national average. It is thought that the figures for Clacton are likely to be lower than the CCG average as a whole, so I will not hide behind that number.

In terms of what we are going to do about it, I will start by talking about some national initiatives—the comment about STPs related to that—and the need to invest more in primary care. There are two national initiatives that I want to mention. First, there is the GP five-year forward view. I know it sounds like jargon, but it redresses the persistent underinvestment in primary care over the past decade or so. Between now and 2020, there will be a 14% real increase in primary care across the country, which will manifest itself in the workforce and in different ways of working. That is real money; it is accepted by the British Medical Association’s general practitioners committee. It is very welcome, and frankly it has been a long time coming.

If we were designing an NHS today, with the sort of patient environment we have now, we would not design it around acute hospitals, as was done in 1948. We would design it much more around long-term conditions—diabetes, dementia, heart disease and so forth—which account for 70% of the NHS’s total cost and mean that much more can be done in the community. That is our very clear direction of travel.

[Will Quince]

Although I very much welcome those plans and the steps the Minister is hoping to take in relation to primary care, there is still very serious pressure on Colchester general hospital. I welcome last week’s Budget announcement of £100 million for triage services in accident and emergency units. Will the Minister give serious consideration to making Colchester general hospital a pilot for that, which would help to alleviate some of that pressure?

[David Mowat]

My hon. Friend may be relieved to hear that Colchester general hospital is not in my portfolio, but I will speak to my ministerial colleagues about it being a pilot and write to him.

Baby Loss

Will Quince Excerpts

Thursday 13th October 2016 Commons Chamber

[Will Quince (Colchester) (Con)]

It is an honour to co-chair the all-party parliamentary group on baby loss and a privilege to follow the hon. Member for North Ayrshire and Arran (Patricia Gibson), who is an active member of the group.

I should like to share some statistics, some of which have already been shared with the House, but repetition is important in this case, so that we have a real understanding of the scale. One in four pregnancies end in miscarriage. One in 200 babies are stillborn in the UK. About 15 babies die each day either before, during or shortly after birth in the UK. There are about 3,500 stillbirths every year in the UK. Half of all stillbirths are said to be preventable. The rate of stillbirth in the UK is higher than in Poland, Croatia and Estonia. The lives of 2,000 babies could be saved every year if the UK matched the best survival rates in Europe.

It is a great honour to follow all those right hon. and hon. Members who have spoken so far and shared such harrowing accounts of what has happened to them. In particular, I should like to praise—I do not want to appear patronising in any way—and to say how proud I am of the hon. Member for Lewisham, Deptford (Vicky Foxcroft), who is a good friend of mine, for giving her account in such a powerful and emotional way. I want to make it absolutely clear that I genuinely believe that we are doing something very special in the Chamber today. We are breaking a silence; we are breaking a taboo; and we are showing parents up and down this country that it is okay to talk about the babies and children we have lost. In fact, it is more than okay; where we feel that we are able to, we should. I hope that people across this country have seen today that there is no subject that we will not debate and talk about in the mother of all Parliaments if doing so will improve the lives of others.

[Kevin Hollinrake]

I congratulate my hon. Friend on securing this debate. On his point about inspiring people to come forward, what he describes is exactly what happened to Luke and Ruthie Heron, constituents of mine. Their son Eli was born after 23 weeks and six days. He lived for two and a half days further. Had he not lived those two and a half days, he would have been considered a miscarriage, rather than a short life. Grief cannot be measured in hours, days or weeks. Does my hon. Friend agree that we should reconsider the time criteria that determine when a life is considered a life?

[Will Quince]

Yes. I thank my hon. Friend for that contribution. The all-party parliamentary group is very much looking at that. He is absolutely right to say how important this is. There are people who have suffered what is currently termed a miscarriage when—let us be clear—we are talking about a life, a baby. However, because of our abortion laws and all sorts of other rules and regulations, we are not allowed to register that life and give that baby a name. We are certainly looking at that.

[Mrs Hodgson]

Lucy, my daughter, was born at 23 and a half weeks. Sadly, she did not live; if she had, she would have been rushed straight to the special care baby unit at the Royal Victoria infirmary. I always class her as a stillbirth, but officially it was put down as a miscarriage, and I was not given a death certificate, which was another trauma on top of the trauma I had already gone through. On paper, it was a miscarriage, but she was blessed by the chaplain while I was still in hospital, and we went on to have a funeral, which I felt was right; I had held her in my arms, and she was a fully formed baby. There is an anomaly that has to be addressed.

[Will Quince]

Indeed. I absolutely agree with the hon. Lady. Moreover, I thank her for the huge role that she plays on the all-party group, and played in its formation.

To come back to the point that I was making about the importance of today’s debate, we are really lucky—I hope that all hon. Members agree—to have the best job in the world. We have a duty and responsibility to try to use our experiences—some great, some good, and some terrible—where we can to make the lives of others better. Through this debate, we would like to, in the fullness of time, reduce the stillbirth rate and neonatal death rate by 50% and save the lives of 2,000 babies. That is an incredible target to aim for.

[Hannah Bardell (Livingston) (SNP)]

I congratulate the hon. Gentleman and other Members on being so brave and speaking out in this debate. In the spirit of sharing experiences, friends of mine who were due to have twins sadly lost one due to twin-to-twin transfusion syndrome. Does he agree that it is important that, in the aftercare for parents who have lost babies, we consider the very different nature of, for example, multiple births, and ensure that care is tailored appropriately in all circumstances?

[Will Quince]

Absolutely; the hon. Lady makes a very good point. I will mention that a bit later. Charities such as the Twins and Multiple Births Association do incredible work in this field; one of my hon. Friends raised that issue earlier.

[Melanie Onn (Great Grimsby) (Lab)]

Following on from the point about mothers who experience late-term baby loss and the treatment that they receive in hospital, very often they are kept on maternity wards, which can be incredibly traumatic. The point was made about tailoring care and support for parents who lose their children. Is remaining on a maternity ward the most suitable option for them?

[Will Quince]

I thank the hon. Lady for that point, which I will come to in a moment.

Begging the indulgence of the House, I would like to share my experience, in the spirit of showing people outside the Chamber how important it is to talk about this, if we are able to. We found out at our 20-week scan that our son had a very rare chromosomal disorder called Edwards syndrome, a condition that is rather unhelpfully described as being “not compatible with life”. We knew throughout my wife’s pregnancy that the most likely outcome would be stillbirth, but our son was an incredible little fighter, and he went full term—over 40 weeks. He lost his life in the last few moments of labour at Colchester general hospital.

To pick up on the hon. Lady’s point, Colchester has a fantastic hospital that has a specialist bereavement suite called the Rosemary suite, where we got to spend that really special time—including before the birth, because we knew what outcome was, sadly, likely. I got to stay with my wife; we got to stay there overnight; we had a cold cot, so that we could have lots of cuddles. We could continue, the next morning, to spend time with our son. I completely agree with the hon. Lady, which is why my hon. Friend the Member for Eddisbury (Antoinette Sandbach) and I had a debate in November last year on bereavement care in maternity units. Bereavement suites are so important. In this country, in the NHS, there should never be any excuse for a mother and father, or a mother, who have lost a baby to go back on a maternity ward with crying babies, happy families and balloons; that is just not appropriate or acceptable. Having gone through that experience, I know that what people need is the peace and quiet to come to terms with the personal absolute tragedy that has just happened.

[Keith Vaz (Leicester East) (Lab)]

I congratulate the hon. Gentleman, the hon. Member for Eddisbury (Antoinette Sandbach) and all others who have been involved with the all-party group. When my child died at term, 23 years ago, we did not have a bereavement suite in Leicester, although we do now. The issue is not just parents’ ability to grieve and be with their child; it is also about getting expert help and counselling at that moment. My wife was told that she would never have children again after the stillbirth, but we had two children subsequently. It is so important to get that advice right at that time. Does he agree?

[Will Quince]

Yes, of course I agree. I will come to that point later. After the debate in November on bereavement care in maternity units, my hon. Friend the Member for Eddisbury and I were taken aback by the number of people across the country who got in touch and shared their stories with us. We sat down—this was during proceedings on a Finance Bill, so it was about 1.30 am —with the then Minister with responsibility for care quality, my right hon. Friend the Member for Ipswich (Ben Gummer), my hon. Friend the Member for Banbury (Victoria Prentis), who is not quite in her place, and the hon. Member for Washington and Sunderland West (Mrs Hodgson). We thought, “This is a far bigger issue than just bereavement suites. The whole subject of baby loss needs addressing.” We were pretty surprised that there was not already a group looking at the issue.

The all-party parliamentary group was formed in February, and I am very proud of the work that we have done so far, working with amazing charities across this country. I cannot name some of them, because I would have to name them all. From large charities that do the most amazing work and fundraising, through to the groups made up of just a handful of people who get together in a local pub or village hall and knit really small pieces of clothing for babies who are premature and sadly stillborn, it means so much that so many people across this country want to play their part and make a difference.

I cannot let this speech go by without referring to the support of Mr Speaker, who is not in the Chamber at the moment, not just for this campaign, but in kindly allowing us to use his apartments for the reception yesterday, and during baby loss awareness week. Yesterday, which would and should have been my son’s second birthday, he called me to ask a Prime Minister’s question on this subject, and so raise the issue in front of millions of people and the country’s media.

[Mr Kevan Jones]

I know that the hon. Gentleman does not want to name individual charities, but Sands does a great job. The point raised with me by Ashleigh Corker, a north-east co-ordinator who lives in my constituency, is that one of the most powerful things that Sands can do is put parents in touch with other parents—people who have gone through the same thing—so that they can share experiences. Does he agree that that is a very powerful thing to do? A lot of people can empathise with what parents are going through, but unless a person has gone through this themselves, it is very difficult to understand.

[Will Quince]

The hon. Gentleman raises an incredibly good point. In the run-up to birth, people can go to groups such as NCT and prenatal classes, so I totally agree. We have made friends who have gone through similar experiences. You feel that you can talk openly with them, because they have gone through very similar experiences and are feeling the same things as you. That is very powerful. There may be a role that charities and the NHS can play in putting parents—where they feel able—in touch with other parents who may want to talk about their experience.

I shall speak briefly about Government targets. I know that the Government sometimes get a hard time on the NHS, but they have accepted the premise of our argument. I remember first meeting my right hon. Friend the Member for Ipswich as Minister responsible for care quality—it was like pushing at an open door. We now have firm commitments to a reduction of 20% by the end of this Parliament and 50% by 2030. It is our job as an all-party parliamentary group to hold the Government’s feet to the fire and to make sure that they are working towards those targets and that we start to see results.

I could not let this debate go by without talking about some of the issues that charities have raised with me. I shall touch on prevention and then talk about bereavement. Research in this area is vital. As my hon. Friend the Member for Eddisbury said, around 50%—in fact, the figure is 46%—of stillbirths and 5% of neonatal deaths are unexplained. We need to look, for example, at ethnicity and ask why south Asian women are 60% more likely to have a stillbirth, and why black women are twice as likely to do so. Why is there a geographical disparity across the UK? I know that part of the answer is social inequality, but why is the figure 4.9% in some parts of the UK and 7.1% in others? That is around a 25% variation. It is not acceptable and we need to understand why it exists.

We need to look at multiple pregnancies, as the hon. Member for Livingston (Hannah Bardell) mentioned from the Scottish National party Front Bench, and at lower income families. We need to study our European counterparts and see why they are getting it so right and whether we can implement similar measures in the UK.

Some right hon. and hon. Members have mentioned public health and they are right to do so. Maternal age, nutrition and diet, drugs, alcohol and smoking are all relevant. We could achieve a 7% reduction if no woman smoked during pregnancy. That is a huge target to achieve and we could do a lot of work on smoking cessation, especially during pregnancy. Studies show that we could achieve a 12% reduction if no mothers were overweight or obese.

There is a huge piece of work that we could do on empowering women and mothers-to-be. Initiatives such as Count the Kicks are important. Nobody knows their body as well as a mother. If she feels that there is something wrong, there is a good chance that something is wrong. When she picks up the phone to the hospital or to her GP and her concern is dismissed with the words, “Don’t worry, it’s not important,” she needs to get it checked out. If there is nothing to worry about, great, but on the occasions when we do not get a concern checked out and then something terrible happens, we have to hold ourselves responsible.

There are various initiatives to empower women. Teddy’s Wish is currently sponsoring fantastic folders—as anybody who has had a baby will know, mothers-to-be get purple maternity notes which they carry around religiously just in case the baby comes early. The wonderful plastic folders that the maternity notes go in inform mothers—and fathers—what to look out for, what are the signs if something is not right, when to pick up the phone, when to go and see their GP and when to go to the hospital. Such innovation is exactly what is needed.

Investigation and reporting are important so that we learn the lessons of every stillbirth and neonatal death. Covering things up and dismissing them with comments such as, “That’s unexplained. These things happen. I’m terribly sorry,” are unacceptable. We have to learn from every case. I am pleased that the Government have put a significant amount of money into setting up a system of reporting to enable us to investigate and learn from every stillbirth and neonatal death.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) rightly mentioned post-mortems. So many parents are not offered a post-mortem. One might wonder what parent would want that opportunity, but parents who lose children often want to know why. They want to understand how and why it happened and how they can make sure that it does not happen again. Offered the opportunity, many parents opt for a post-mortem because they know that that research can help others, but clinicians may not be asking the question—often with good intentions, because it is not an easy question to ask. We must ask the question if we are to get post-mortem rates up, which will feed into the research that will allow us to cut our stillbirth rate.

An hon. Member—I apologise, I cannot remember who it was—mentioned late-stage pregnancy scanning. In this country we do not scan past 20 weeks. We scan at 12 weeks and we scan routinely at 20 weeks, but there is no routine scanning past that. I find it bizarre that the abnormality scan takes place halfway through the pregnancy, but after that the mother-to-be is not seen again for a scan until she arrives at the hospital when she is in labour. Other countries across the world and particularly our counterparts in Europe do scans at 36 weeks or Doppler scans. There are huge improvements that we could make in that area.

I want to clarify one point in relation to prevention. The NHS is brilliant, and where we get it right in this country, we really get it right. The problem is the inconsistency across the NHS. I know that the Secretary of State and the Minister of State will agree when I say that we have some of the best care in the world, but it is important that that is replicated in every hospital and every maternity unit in the country, so that whatever hospital a woman goes into and whatever GP she sees, she will get the same level of care and consistent advice.

Even if we manage to achieve our target, even if we match our European counterparts and reduce our stillbirth and neonatal death rates by 50%, that will still mean between 1,500 and 2,500 parents going through that personal tragedy every year. That is why it is important that the APPG puts an equal emphasis on bereavement. I have talked about consistency of care across the NHS, and there should also be consistency of bereavement pathway and bereavement care across the NHS. It is important that we consider aspects such as training for staff. I know that Ministers have put huge amounts of funding into training as part of the plan to achieve a significant reduction in the stillbirth rate.

[Victoria Atkins]

I am extremely grateful, as I said, to my hon. Friend for his part in securing this debate. I mentioned my constituents who had the nightmare of losing their baby boy. I asked the mother to write to me to set out precisely what had happened. Perhaps one of the most harrowing parts of an already harrowing story was when she told me that at the hospital she and her husband were not allowed to stay with the little boy for long. They were pressured to leave and when she was leaving the baby boy, she wanted to go back to say her last goodbye. She was refused. She collapsed to the floor and the officials around her said that if she did not get up, she would have to leave in a wheelchair or a stretcher, as it was time to go. Does my hon. Friend agree that kindness costs nothing, and that there is a duty on everyone, whether in the NHS or in the police, to make sure that when they are dealing with parents in such a situation, kindness is very much part of the way that they behave?

[Will Quince]

Yes, and my hon. Friend raises a good point. I only wish that the disgraceful behaviour and story that she has just related was unique, but sadly it is not. Reports from across the country and personal testimonies that I have read, sadly, echo such experiences. That is exactly what we need to address, and it is why training in this area is so important. Midwives and clinicians should be trained to deal with bereavement, including what language to use and what not to say. I will not repeat some of the things that I have heard said to parents who are grieving.

In our case, a stillbirth did not come as a huge shock, but let us not forget that many parents have no idea that such an experience, of stillbirth or neonatal death, is coming. It is one of the most emotionally sensitive periods of their lives and they are at their most fragile. My hon. Friend is right: it costs nothing to act with kindness, empathy and compassion. I would like to think that we can reach a point where those themes run through every maternity unit in the country. I know that that is the case in the vast majority of maternity units, but where we have instances such as my hon. Friend describes, they have to be ironed out.

I know that I am pushing your patience with regard to time, Mr Deputy Speaker, but I think that the bereavement point is so important. We must have bereavement suites and bereavement-trained midwives in every hospital in the country, and we need gynaecology-trained counsellors in every maternity unit. We also need ongoing mental health support, because the time a bereaved parent leaves the hospital is the not the end of their grief; for many it is just the start. Indeed, future pregnancies can be the most traumatic periods, because from the day they find out they are pregnant to the day they have a crying baby in their arms, they are thinking, “Is this going to happen again?” What mental health support is available? In some parts of the country it is fantastic, but in others it simply is not.

I want to make two final points. One relates to relationship support. We know that between 80% and 90% of relationships break down after the loss of a child, and that has a huge social cost. That is why mental health support is so important. I also think—this is one of the reasons I co-chair the APPG—that the voice of fathers must be heard. Fathers feel that they have to act as a rock, but in many cases we were there too. In my view, there is no worse experience than seeing your wife give birth to a lifeless baby. It is something that never leaves you. Every single day I think about my son. I think about what he would have been like yesterday, on what would have been his second birthday. I imagine a small boy running around our house, causing havoc and winding up his sisters. It is not to be, but every single day we live with that grief. Fathers need support too, as indeed do the wider family.

I want to end on a positive note. This is a hugely exciting time for us, because the opportunity for change is enormous. The APPG has made enormous progress since publishing our vision document, and I encourage those Members who have not yet seen it to find a copy—it is available online and in paper copy. What we have achieved since February, working with magnificent charities across the country, and with individuals feeding in their personal experiences, has been absolutely incredible. This is just the beginning of the journey, because we have just set out our aspirations and our vision of what we want to achieve. I know that we are pushing at an open door, because the Government want to achieve these targets too.

I want to send one final message to every parent who is bereaved up and down this country: we care; we are going to keep talking about it; and we are not going to stop talking about it until we reduce the stillbirth rate and, most importantly, we have the best quality bereavement care in the world.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 5th July 2016 Commons Chamber

[Alistair Burt]

There are no changes to the funding issues announced when the review of pharmacies started on 15 December. As my right hon. Friend the Secretary of State said, we are hoping to make an announcement on pharmacy when we can. I am aware that pharmacy is waiting for that.

[Will Quince (Colchester) (Con)]

7. What progress his Department has made on improving the safety of maternity care.

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

Since 2010, we have invested £37 million in improving the physical environment of over 140 maternity units and purchasing equipment to improve safety. We now have 2,103 more midwives in the NHS and 6,400 more in training than in 2010.

[Will Quince]

Expectant parents in Colchester are among the first in the UK to have hypnobirthing courses—I recently attended one myself. What consideration has the Secretary of State given to the effectiveness of hypnobirthing in improving maternity safety?

[Mr Hunt]

A variety of pioneering techniques, which could make a huge difference to women’s experience of birth, are emerging. I am delighted that we are seeing lots of experimentation and innovation. I would particularly like to pay tribute to my hon. Friend’s trust, which is in special measures and has been through a very difficult period. The fact that it is still managing to do this kind of innovation is wholly to be commended.

Land Registry

Will Quince Excerpts

Thursday 30th June 2016 Commons Chamber

[Will Quince (Colchester) (Con)]

I congratulate the right hon. Member for Tottenham (Mr Lammy) on securing this important debate. It is a pleasure to follow the hon. Member for Swansea East (Carolyn Harris). I am not sure that I can quite match her passion, but I will certainly set out where I stand.

I was elected last year on a mandate to balance the books. There is no question but that the Land Registry offers an opportunity to raise money for the Government—the amount is purported to be around £1.5 billion. I am not ideologically against privatisation. When the Government can raise capital by selling assets, without detriment to public services, it can make sense to do that in certain circumstances. I appreciate, however, that that is a point on which Opposition Members may not agree with me.

I was a practising property solicitor until the last election, so I spent my days buying and selling houses for people. As part of that role, I spent several hours a day and many hours on the telephone liaising with the Land Registry. I used to find the Land Registry very helpful, and I very much valued its expertise. However, on occasion, and sometimes more often, it was quite slow, particularly regarding non-urgent matters such as first registrations. To be fair, the Land Registry has done a great deal in recent years to innovate. It has largely moved away from paper and some of the online tools, especially the mapping tool, are really useful. Having said that, some of the tools it uses are very much outdated and in need of an upgrade.

On that basis, there is no question but that there is a strong case for privatisation, because that could lead to a cash injection that could be transformational and drive innovation. Having said that, I am not in favour of, and nor can I support, the privatisation of the Land Registry. To be clear, the Land Registry is not RBS or Royal Mail. To compare it with those organisations fundamentally misses what the Land Registry is and what the consequences would be if it were in private hands.

As hon. Members have said, the Land Registry continues to be an essential part of land and property ownership in England and Wales. The main statutory function of the Land Registry is to keep a register of title to freehold and leasehold land. That represents 24 million titles covering 87% of the land mass of England and Wales. On behalf of the Crown, the Land Registry guarantees title to registered estates and interests in land. For a very small fee—as little as £3—it also makes data available to the public and solicitors via searches.

My objections are simple. In proposing the move, the Government have misunderstood what the Land Registry is fundamentally about. It is more than just a data provider or an authority for recording title. It registers title, guarantees rights to land and provides guarantees pre and post completion searches. The reliability of the register is vital to the property market, and any loss of confidence in the register would significantly affect the property and mortgage markets and, therefore, the economy as a whole. While the Land Registry can, at times, feel clunky and hugely frustrating for property professionals, at its heart it is based on the principles of integrity and impartiality, and I fear it is that that we put at risk if we accept the proposals to privatise.

We are a nation of homeowners and a level of trust has been built into our system through the security that has been provided by the Land Registry since 1862. We have an established property market, which is why England and Wales is a highly trusted market in which to invest. I fear that privatising the Land Registry would put that trust at risk, particularly for foreign investors. Let us not forget that the Land Registry guarantees the titles to billions of pounds of residential and commercial property.

The Land Registry acts as a repository for huge amounts of important data as a monopoly, and rightly so. However, let us remember that it has no hidden agenda or motive other than to provide a public service and to ensure that the property market continues to function well. I share the concern of many that privatising the Land Registry would undermine impartiality, increase fees for customers and pose a considerable risk to the integrity of the organisation.

Let me be clear that I would not criticise any private company for acting in the way I have described; in fact, we should expect it. However, a profit motive would completely change the nature of the organisation and we should expect costs to be driven down, with prices for data and fees rising. With the monopoly that exists, I struggle to see how the move could not be seen as anti-competitive. Given the monopoly, it could be argued that if the Land Registry were in private hands, it could reduce innovation and the transformation agenda, as there would be no market forces forcing it to do otherwise.

Fees at the moment are reasonable and offer customers good value for money, but let us be clear that property transactions are expensive when we include legal fees, stamp duty, search fees and moving costs. The current scope of the Land Registry’s work is limited by its direct link to the property market, meaning that there are limited options for a private company to increase workload and therefore revenue and profit. I appreciate that there is potential for the Land Registry to start providing other searches. However, that would require primary legislation and would lead to opposition from local authorities and private companies that already provide such services. The most likely outcome, notwithstanding the commitment the Government have made to retain an element of control over fees, is that fees will rise.

I have not heard any stakeholders in the property industry calling for this change, let alone warmly welcoming it; in fact, they all criticise it. Solicitors, surveyors, estate agents and mortgage lenders are opposed to the plans. The Competition and Markets Authority has said that the proposals would give the new owner a monopoly on commercially valuable data with no incentive to improve access to it. The concerns raised are not unreasonable, nor do I consider those raising them to have a hidden agenda or motive; their worries are genuine and we should not ignore them. There is no need to do this. As the right hon. Member for Tottenham said, the Land Registry has returned money to the Treasury in 19 out of the past 20 years, while continuing to reduce the fees that it charges the public.

Selling the Land Registry—the sole record of land ownership information—is a privatisation too far. We would, rightly, not consider privatising HMRC or the General Register Office. Some things are just too important to take out of the hands of Government. We would not consider privatising the births and deaths registers, and we should not treat land ownership differently. The Land Registry works. It makes money. If all the concerns I have raised cannot be addressed, please just leave it alone.

Stillbirth

Will Quince Excerpts

Thursday 9th June 2016 Westminster Hall

[Will Quince (Colchester) (Con)]

I echo the comments about the hon. Member for North Ayrshire and Arran (Patricia Gibson) and congratulate her on securing this very important debate. She is incredibly brave to talk about her experience—I know that from my personal experience of doing the same thing. I also pay tribute to her colleagues who have come to support her, because that is hugely comforting. What she has done is incredibly brave, and I thank her very much for that.

The hon. Lady spoke about the importance of talking about stillbirth and neonatal death. She hit the nail on the head: we do not like talking about death in this country—even more, we do not like talking about the death of children and, in particular, babies—but it is only by talking about not just stillbirth but neonatal death and the death of babies that we can understand the scale of the issue. As she rightly said, a lot of people in this country do not understand how poor we are at tackling this issue. We are somewhere in the region of 23rd in the western world. Given that we have one of the best health services in the world, that is totally unacceptable.

I do not particularly like talking about statistics when it comes to babies. The hon. Lady rightly said that somewhere in the region of 3,500 babies a year are stillborn. If half of those deaths are avoidable, that is approximately 1,500 to 2,000 babies and 2,000 to 4,000 parents who would not have had to go through this experience. It is not just the parents who feel the effects of stillbirth and neonatal death, but the grandparents, the friends and the wider family.

I will talk about my own experience very briefly. I have three beautiful children, but only two of them are currently with us. We lost our son. He was diagnosed at 22 weeks with a very rare chromosomal disorder called Edwards syndrome, which meant that there was a relatively high likelihood that he would not make it. As was said earlier, it meant living every day with the prospect of a stillbirth—it was too late for a miscarriage at that stage. He went full term—he was a fighter—so we went through the experience of stillbirth at full term. I have said in the Chamber previously that there is no word to describe the experience other than numbness—in fact, I will not describe it because it is going to make me upset. The point I want to make is that every single stillbirth is an absolute personal tragedy. We as a Government and as politicians have a duty to do all we can to ensure that as few people as possible go through that personal experience.

That happened in 2014. On entering this place, I was committed to doing something about this issue. I teamed up with a number of other MPs and we set up an all-party parliamentary group on baby loss, which the hon. Lady kindly joined, to do something about this on a cross-party basis. The Government have the responsibility and the power to do a lot of the work, but the all-party group can act as a conduit between the fantastic charities that work in the sector and the Government, who I know are committed to tackling the issue.

My hon. Friend the Member for Henley (John Howell) made an important point about mums and dads. We thought it very important that I co-chair the APPG; it is intentional that we have a man and a woman co-chairing the group. It is important that we address the issue from both sides, because it affects men as much as it affects women.

As the hon. Lady said, Baby Loss Awareness Week is coming up in October. In Parliament, we will be marking that occasion for the very first time. Mr Speaker has kindly allowed us the use of his state rooms for a function. We will be sending around ribbons and encouraging as many right hon. and hon. Members as possible to wear them proudly, and to talk about and raise the issue as much as possible in that week and also throughout the year.

I spoke earlier about the amazing work of charities in this sector. I will name just two—Sands and Bliss—but there are so many more that do incredible work, from charities carrying out research to very small organisations that knit hats, mittens, scarves and all sorts of other things, which can be hugely comforting to parents who have gone through this experience.

The Government have a very important role to play in tackling this issue. As the hon. Lady said, research is a huge part of that, whether it is on social inequality—which, as she rightly said, is a known factor in stillbirth—maternal age or ethnicity. We still do not really understand why ethnicity is so important. There is another awkward subject that we do not like to talk about in this country: we do not encourage parents who have gone through this terrible experience to have post-mortems. Often, medical professionals do not want to ask the question, but if they phrase it correctly and say, “By offering your baby for a post-mortem, it would help us immensely in understanding, in research terms, why this happens,” it will help to prevent more in the future. We have to do far more to encourage post-mortems.

My hon. Friend the Member for Henley talked about education for parents-to-be, whether about drugs, smoking, diet or obesity—the two are somewhat different. There is a huge amount of work to do in that area.

The hon. Lady is absolutely right to suggest that this is not a party political issue—it crosses the divide—but I am hugely proud that the Government recognise that it is serious and have taken steps to address it. They are not just talking but putting money in, and they have set a target. Targets are thrown around all the time, but they are meaningless unless the money and resources are behind them, so I am proud that the Government have done that.

There are some important elements to the Government’s new care bundle. I fully agree with my hon. Friend that it is important that we ensure that clinical commissioning groups and hospital trusts are doing what the Government are mandating them to do. The smoking cessation work is really important. Still now, more than one in 10 mums smoke during pregnancy. We know that that is such a high-risk factor when it comes to stillbirth. On foetal growth monitoring, we are one of the few countries that do not scan in the late stages of pregnancy. We scan at about 20 weeks and then do not do anything until the mother goes into hospital, but lots of other countries scan at 36 weeks. We are also looking at foetal growth, which is really important. The bump is measured from naval to the pelvic bone, and if there are any issues with its size, the mother is sent to hospital for a scan with a consultant. That is very important. We need to do far more foetal growth scanning in the later stages of pregnancy.

The hon. Lady also made a hugely important point about the awareness of foetal movement and the importance of foetal monitoring. We absolutely have to empower more women when they get that feeling. In so many cases of stillbirth, the mums say with hindsight, “I knew there was something wrong, but I didn’t want to bother health professionals,” or, “I phoned my doctor or the NHS helpline, and they said don’t worry.” The reality is that, if there is an issue, mums often know. It is important to empower women, so that if they feel something is not right, they go and get it checked out. We would much rather they got a diagnosis to say, “There’s nothing wrong. You’re okay. Go home”, than they ignored it, but worried about it, only for horrendous consequences to ensue.

The new Government care bundle is important and good, with £4 million being put in. In my local hospital, Colchester general hospital, we have already seen the start of that money trickling down. New monitors have been installed, and they are going in all across the country, which will help with the monitoring element in the later stages of pregnancy. Another hugely important bit is the training of midwives and nurses, and more than £1 million has been put into that. Finally, a £500,000 investment has been made in the review process, to ensure that we document and learn from every single stillbirth, while treating each as a personal tragedy. Those records should be kept and shared, so that we can look at best practice across hospitals. Some of our hospitals in the United Kingdom are fantastic and world-class, but, sadly, some are not. We need to bring all hospitals and maternity units in the country up to the very best standard.

I am pushing the time limit, but I will touch briefly on two more points. Sadly, even if we meet the Government’s target on stillbirth, which is to reduce it by 15% by 2020 and half by 2030—an incredible aim, and I would love it if we got to that position—1,500 to 2,000 babies would be stillborn every single year, so it is still important to deal with some of the bereavement issues in hospitals across our country.

The first priority should be bereavement suites; it is imperative to get one attached to every maternity unit in the country, because it is totally unacceptable that any mum or dad, having gone through the experience of a stillbirth, should have to go on to a general maternity ward, surrounded by happy families with balloons and teddies and the sound of crying babies. That is not acceptable. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has absolutely recognised the issue, and is working hard on it; he is doing a study of exactly what provision we have in our hospitals. I would love it if, by the end of this Parliament, we could have a bereavement suite attached to every maternity unit in the country.

Finally, although the bereavement suite is one part of that jigsaw, the second part is having enough bereavement-trained midwives and gynaecological counsellors in those units who are able to give the support to parents, not only at the time, but afterwards and—as the hon. Member for North Ayrshire and Arran said—with future pregnancies.

In conclusion, the hon. Lady is hugely brave. She raises a hugely important issue, and one that I know the Government recognise and are taking action to address. We, as cross-party politicians, can keep pressure on the Government to ensure that they meet that target of a 15% reduction by the end of the Parliament and—what an aim!—to halve stillbirth by 2030.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Ben Gummer]

May I commend the hon. Lady for the brave stance that she has taken on this difficult issue? I will certainly take her concerns seriously. I want to read the report now that it has been delivered, and will speak to her at the earliest possible opportunity to establish how the Government and local commissioners can take things forward. It is imperative that the NHS has the best possible culture for how staff are treated and heard. I hope she will look at the announcement made by my right hon. Friend the Secretary of State about ensuring that people have the freedom to speak up and safe spaces in which to blow the whistle.

[Will Quince (Colchester) (Con)]

T6. At Colchester general hospital, insurance premiums under the clinical negligence scheme for trusts have more than doubled to £11.2 million in four years. What steps is the Department taking to reduce that figure?

NHS: Learning from Mistakes

Will Quince Excerpts

Wednesday 9th March 2016 Commons Chamber

[Will Quince (Colchester) (Con)]

My right hon. Friend is aware that we have one of the worst stillbirth rates in the developed world. Every stillbirth is a tragedy, and with more than 3,600 a year we must do all we can to avoid them, especially when half are preventable. I am co-chair of the new all-party group on baby loss. Does my right hon. Friend agree that it is only by looking at every single stillbirth and learning the lessons from them that we can get that number down by 20% by the end of this Parliament and by half by 2030?

[Mr Hunt]

My hon. Friend is absolutely right. I thank him for his work in this area. Maternity—stillbirths, neonatal deaths, neonatal injuries and maternal deaths—is the area where I hope we make the most rapid early progress in developing this new learning culture. There is so much to be gained. We can be the best in the world, but the truth is that we are a long way down international league tables in this area. None of us want that for the NHS. There is a real commitment to turn that around and I thank him for his support.

Childhood Obesity Strategy

Will Quince Excerpts

Thursday 21st January 2016 Commons Chamber

[Will Quince (Colchester) (Con)]

It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson). I thank my hon. Friend the Member for Totnes (Dr Wollaston) for calling this important debate. I am sure that Members can all see that I am a man who likes his food, and that I am not particularly in a position to lecture others on obesity. At the same time, I cannot ignore the fact that too many children in this country are obese, that poor children are more likely to be obese than rich children—boys and girls in the lowest quintile are three times more likely to be obese as those in the highest quintile—and that those living in towns are more likely to be obese than those living in rural areas. Those are unpalatable facts. It is right and proper that we investigate, and, where we have clear evidence, take the appropriate action.

However, the evidence does not suggest that childhood obesity is a problem that is getting significantly worse. The proportion of obese children in year 6 is higher than it was in 2006-07, but for reception children the proportion has fallen over the same period. Moreover, there has been a significant decrease in the proportion of British children, aged two to 10, who are obese.

[Dr Wollaston]

Will my hon. Friend go back and look at those figures in more detail? What he will see is that, although those figures are falling for the wealthiest children, they are rising for the most disadvantaged children. We are seeing a widening of the gap, which masks the underlying problem.

--- Later in debate ---

[Will Quince]

My hon. Friend makes a very good point, and I will come on to that in a bit more detail. The important element is that any approach we take must be evidence-based. I absolutely agree with her that we need to look at all the evidence.

I stated that the proportion of those aged two to 10 who were obese had gone from 17% in 2005 to 13% in 2013. The evidence suggests that childhood obesity rose quickly in the mid-2000s and has slightly fallen ever since. That is an important fact for two reasons. First, it suggests that our education programmes in our schools and the Government-backed campaigns on obesity within the last decade have had a positive impact in halting the increase in childhood obesity. Secondly, it undermines the scaremongering that suggests that childhood obesity is rocketing year on year. It simply is not; the reality is much more complex.

As my hon. Friend the Member for Totnes has already mentioned, there is a growing clamour for a sugar tax on soft drinks to combat childhood obesity. She has called in a recent article for a 20% tax on sugary drinks as part of that overall solution. Her calls have been echoed by the British Medical Association and other public health campaigners. I have huge respect for my hon. Friend, but I think that a sugar tax is completely the wrong answer. A sugar tax is illiberal and patronising —in my view, nanny statism at its worst.

Given how sugar tax campaigners argue, one might think that consumption of sugar in the UK is at a record high. It is not. Consumption of sugar per head in the UK is falling, from a high of more than 50 kg a year in the 1980s to less than 40 kg a year now. What is more, soft drink consumption in the UK is falling. The latest household food survey from the Department for Environment, Food and Rural Affairs shows that household soft drink consumption purchases have fallen by 5.2% since 2011 and by 19% for high-calorie soft drinks in the same period. Regular soft drink purchases are now at their lowest level since 1992.

[Geraint Davies]

Does not the hon. Gentleman agree, though, that a sugar tax would be eminently fiscally responsible? It would gather revenue, increase life chances, increase health and reduce health costs. From the point of view of the Exchequer, it would be very sensible. Can he not come up with other sensible ideas like that?

[Will Quince]

The hon. Gentleman makes an important point and, of course, that would make sense if the evidence suggested that a soft drink tax implemented anywhere else in the world had actually worked and had the effect that he suggests. He is right to suggest that there are a lot of other measures that we as a Government and that businesses and organisations can take to address this issue; I do not believe that the sugar tax is the right one.

Sugar tax advocates have pointed out the introduction of a sugar tax in Mexico and the corresponding 6% decline in soft drink sales since the tax was introduced. However, research in The BMJ does not show evidence of a link between the introduction of the tax and the small decline in soft drinks consumption. Further taxes on non-essential energy dense foods were also introduced at the same time as the sugar tax, and they accounted for a higher proportion of Mexicans’ daily calorific intake. As the authors of the research admitted,

“we cannot determine the independent role of each”

of the taxes. The research even acknowledges that there is a lack of information on nutritional data for packaged drinks in Mexico, which means that researchers cannot see what the fall in soft drink consumption meant for a decline in sugar intake.

As many Members may know, Mexico does not have safe drinking water. As a high-profile advocate of the sugar tax in Mexico, Alejandro Calvillo, stated:

“We know that there are people who drink a lot of sodas and they don’t have access to drinking water.”

How can we possibly compare the results in a developing country that has unclean, unsafe drinking water with how a tax might operate here in the United Kingdom? Instead, let us compare like with like. When sugar taxes have been tried in developed nations such as France, they have had a negligible effect on reducing consumption. Denmark scrapped its sugar tax on soft drinks in 2014 and labelled it an expensive failure. The Danish Ministry of Taxation labelled food and drink taxes as

“misguided at best and may be counter-productive at worst”.

They even described it as an expensive liability for business, and, as we all know, a sugar tax would be a very bitter pill for British businesses to swallow.

Study after study on soft drinks taxes in the USA also shows that they have a negligible impact on sugary drink intake and calorie consumption. What is more, the small decline in sugary drinks is almost entirely offset by consumption of other sugary products.

[Dr Wollaston]

My hon. Friend is very generous to give way again. I wonder whether he has had an opportunity to look again in detail at the article in The BMJ to which he refers. He is citing the figure of 6%, but the article makes it clear that by the end of the year the decline was 12% overall, and—more importantly, if we are to address the issue of health inequality—17% among the heaviest users. He might wish to update himself. I am happy to share the paper with him.

[Will Quince]

I thank my hon. Friend and I would be delighted to take another look at that piece of research.

My hon. Friend has made a case for the sugar tax to protect the poorest, and I think that that was the point that she was just making. As I have mentioned, and this is a good point, the poorest children are the most likely to be obese. However, the statistics show that, in low-income households in Britain, soft drink purchases dropped by 14% between 2007 and 2013. Perhaps a 20% sugar tax on soft drinks is not very much to celebrity chefs such as Jamie Oliver and some of those who are pushing the idea of a sugar tax, but for those on the lowest incomes—who we know, proportionally, buy these products—about 12p a can or 37p per 2 litre bottle is a massive amount of money.

[Maggie Throup]

I think that the point is that we are talking about a tax on sugary drinks and there are alternatives, such as drinks with artificial sweeteners. We are not making it so that these people do not have a choice. There are two different sides of the argument.

[Will Quince]

I thank my hon. Friend for that intervention. As someone who spent five years working in the soft drinks industry, I think she makes a valuable point. We need to question what we want our children—and adults —to drink. Do we want them drinking sugar or sodium benzoate, acesulfame and aspartame? That is a whole separate debate that we can have. I tend to choose to drink diet variants myself, but those options are there and the industry is driving people towards those lower calorie drinks. Let us take Britvic Soft Drinks as an example. Members will notice that they can buy a 600 ml bottle of diet Pepsi or Tango for the same price as a 500 ml full-sugar variant. The industry is already encouraging behavioural change.

To return to the Mexican experiment, 63% of sugar tax receipts have been collected from low-income households and 37.5% of receipts came from those in poverty. As I mentioned before, particularly with soft drinks but across the board, labelling has never been better, nor has the choice for consumers. The industry is doing a huge amount of work to encourage behavioural change and do the right thing.

I am conscious of the time and that lots of Members would like to speak, so I will conclude. I welcome a debate on childhood obesity and a clear strategy to reduce it. There are a huge number of measures that we as a Government could take ourselves and that we could encourage businesses and organisations to take, but let us ensure that the strategy is based on solid evidence. I strongly believe that a sugar tax is not the answer.

[Several hon. Members rose—]

--- Later in debate ---

[Will Quince]

I am interested to know why sugary soft drinks, in particular, are being targeted. Why are we not looking at cereals, biscuits and cakes as well? Why is it just sugary drinks?

[Jim Shannon]

I am happy to look at sugary drinks because we have to start somewhere, but I will happily look at cornflakes and other foods as well, so they should not think that we are going to let them off. The issue is that there are nine teaspoons of sugar in a can of fizzy drink, so we need to address the issue where it starts.

We cannot ignore the statistics, because they are very clear. The fact that by age 11 a quarter of children in Northern Ireland are not just overweight, but obese is an alarming statistic. I think that a comprehensive and robust approach will be required if we are to address that. One way to doing that is through education in schools. I think that we need to bring that education in at an early stage. I think that the Minister will probably respond along those lines.

I fully support having a tax on sugar, which I think would be a step in the right direction. If we do that, we can move things forward and address the issue of obesity and people being overweight very early. Without addressing this serious health issue at the earliest stage possible, it will lead to problems for the health of the person in question, and for public health and society as a whole. I found some statistics on obesity the other day. The obesity epidemic in Northern Ireland has led to a doubling in just three years in the number of callouts for firefighters to help obese people. Those are startling figures. We can sit and ignore those and say, “No, we’re not going to tax sugar,” or we can address the issue early on. I say that we should do it early on. Let us do it now.

Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health, has said that if the problem is not tackled now, it will rapidly get worse. She said:

“We should be worried because if we do not fix this problem now, we will see unhealthy kids turning into unhealthy adults with diabetes, heart disease and kidney problems.”

Why is it that it tends to be those on low incomes who are overweight or obese? It is quite clear to me, but perhaps it is not clear to others. I think that it is because their income dictates what they buy. If they do not have much money, they will buy the cheapest food they can, even if it is not the healthiest food, and more often than not cheap food contains levels of fat and sugar that are far too high. The issue of low incomes is therefore something we have to address as well, for those whose food choices are dictated by what is in their pockets.

We should be tackling these issues now not only because that is the right thing to do morally, but because it makes economic sense. The right hon. Member for Leicester East referred to the supermarket that had all the chocolate and sugary foods in one aisle in the middle of the shop. That is where they should be. They should not be at the checkout, where kids will see them and want their chocolate bar or their bottle of Coke. We have to address that issue as well.

Despite greater education on food and nutrition, there is still an obesity epidemic. Children are getting too many of their calories from sugars—on average, three times the Government’s recommended amount. That only contributes to an overall overconsumption of calories. One in three children are overweight or obese by the time they start secondary school, and that is a very clear problem that needs to be addressed. Childhood obesity is associated with conditions such as insulin resistance, hypertension, asthma, sleep problems, poor mental health—we cannot ignore that in children; we cannot think that they do not have it, because they do—early signs of heart disease, and an increased risk of developing cancer. The hon. Member for Colchester (Will Quince) referred to the need to have more physical activity in schools, and that issue could be addressed. Ministers mentioned it during this morning’s Culture, Media and Sport questions, so they recognise it as well. I have mentioned just a small number of the health costs of not acting to address this epidemic.

It is not just health that suffers because of inaction on this epidemic. Health problems associated with being overweight or obese cost the NHS more than £5 billion annually. Poor dental hygiene costs the NHS £3.4 billion a year, of which £30 million alone is spent on hospital-based extractions of children’s teeth. The total societal cost of obesity in the UK in 2012, including lost productivity, was £47 billion. The evidence is clear.

There can be no one solution to this complex issue. We need to enhance our nutritional education strategy, tackle poor diets through legislation, and encourage greater physical activity among our children. Given the shocking statistics that we have all spoken about, it is clear that despite health being a devolved issue, obesity, and obesity in our children, is truly a national problem. As such, it will require a national solution and a comprehensive approach.

--- Later in debate ---

[Andrew Gwynne]

That may well be the case, but we must of course ensure that any income raised by such a tax is reinvested in public health.

It is also important to increase levels of physical activity among adults and children throughout the United Kingdom. Inactivity is a key factor in ill health, and it is important that we encourage children to maintain active lifestyles from an early age. I believe that increasing the opportunities for young people to get involved in physical activity is just as important as improving diets. Treating obesity and its consequences alone currently costs the NHS £5.1 billion every year. Given that nearly 25% of adults, 10% of four to five-year-olds and 19% of 10 to 11-year-olds in England are classified as obese, the human and financial cost of inaction is significant. We must do much more to ingrain physical activity in our daily lives, whether that means walking instead of driving or taking the stairs instead of the lift. Every little helps.

A number of Members have touched on a point that is crucial to the debate. Many people have argued that the Government should introduce some form of tax on sugary products, particularly soft drinks, and the debate on that issue goes far beyond the Chamber. Public figures such as Jamie Oliver have come out in support of a sugar tax, and he has made a compelling case. However, the issue is complex, and I do not think that the answer is necessarily straightforward. Labour Members have always feared that a sugar tax, in itself, could be regressive, and that it would focus attention on consumers, many of whom are addicted to sugar, rather than manufacturers, who should be reducing the amount of sugar in their products. That said, however, I suggest to the Minister that it is right for us to look at the emerging evidence from other countries, which has shown that where similar taxes have been introduced they have had a positive effect, not least in changing behaviour.

[Will Quince]

Will the hon. Gentleman give way?

[Andrew Gwynne]

I am afraid not. I do not have time.

It has not escaped my attention that the Prime Minister has effectively gone from ruling out a sugar tax to not ruling out a sugar tax. I hope that the Minister will clarify the Government's position, but, in any event, it seems that the forthcoming strategy will mark a departure from the ineffective voluntary approach that they have favoured in recent years. The public health responsibility deal has seen firms making all sorts of promises and then hijacking the agenda to promote their own products, ultimately failing to fulfil their pledges. At the time of its introduction, organisations such as the Royal College of Physicians and Alcohol Concern complained that the pledges were not specific or measurable, and that the food and drink industry had simply dictated the Government’s policy.

I hope that the Government will take a much stronger line with industry than it has taken previously, because it must be incumbent on industry to reduce the amount of sugar in products, including comparable products in the European Union that are boxed in exactly the same way, but contain significantly different amounts of sugar and other ingredients. I also hope that if the Government are forthcoming with a fiscal solution, that is part of a much larger and comprehensive strategy of measures. I do not think anyone would try to argue that a sugar tax on its own is a silver bullet. I want food and drinks manufacturers to reduce sugar in their products, and we need to ensure that that happens.

I thank everyone who has spoken in the debate, and I hope the Minister will consider the many excellent contributions when the Government put the final touches to the childhood obesity strategy.

Specialist Neuromuscular Care and Treatments

Will Quince Excerpts

Tuesday 15th December 2015 Westminster Hall

[Ms Margaret Ritchie (South Down) (SDLP)]

It is a pleasure to serve under your chairmanship, Mr Brady. I congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing this debate on a vital issue that affects many young people throughout the UK.

As the right hon. Lady said, neuromuscular diseases come in many different forms. In fact, there are about 60 different types of muscular dystrophy and related neuromuscular conditions, which makes it difficult for the NHS to provide clear-cut statistics on the number of people affected by such diseases. However, research undertaken by Muscular Dystrophy UK suggests that out of every 1 million of the UK’s population, approximately 1,000 children and adults are affected by such muscle-wasting conditions. On that basis, we can estimate that some 70,000 of our constituents, of whom approximately 2,000 live in Northern Ireland, are affected by those conditions.

Another way of totalling the scale of the issue is to look at the admission rates of those with neuromuscular diseases to accident and emergency departments. Muscular Dystrophy UK undertook work on that issue and found that in Northern Ireland in 2011, 787 people with a neuromuscular condition were admitted to A&E departments requiring emergency treatment, at an estimated cost of £2.2 million. Those figures are broadly in line with the GB average. There were 28,000 emergency admissions in the UK, at a cost of £81 million. Relying on the emergency services to fill the gaps in treatment for people with such conditions robs people of their independence and costs the NHS much more than a well-designed system that helps people to manage their conditions and avoids emergencies.

I am sure everyone in this Chamber is in agreement on this issue and wants the best possible treatment and care to be provided to people living with the effects of this cruel disease. Unfortunately, we are not there yet. There is still much work to do—in particular, on an issue that the right hon. Lady already referred to: Duchenne muscular dystrophy and the need for Translarna to be commissioned by NICE and approved by its guidelines. It is important that that happens, because Translarna is already in use in France, Germany, Italy and Spain. Families in those countries can use it, but families here are waiting for it.

[Will Quince (Colchester) (Con)]

One of my constituents has two sons with Duchenne. Does the hon. Lady agree that it is deeply regrettable that they are considering moving to France and commuting back to work so that their sons have the vital access to those drugs?

[Ms Ritchie]

I thank the hon. Gentleman for his intervention. I agree. His point illustrates that we urgently need a decision from the Minister. I hope the Minister provides us with some welcome information on that issue. It is deeply regrettable that families will go through Christmas not knowing for sure whether the drug will be approved. In the new year, NICE’s decision must not be delayed further. We must end the difficult wait of those families and children.

In Northern Ireland, there has been a commitment for more adult neuromuscular nurse specialists and adult neuromuscular consultants. I share the hope that, when combined with increased care adviser support, the new specialists will begin to improve our currently overstretched services, although there are still valid concerns about how that can be carried out effectively in the context of broader reorganisation and funding scarcity. If we are to achieve the standard of care we all want, much more must be done to co-ordinate better and join up services to ensure patients with muscle-wasting conditions get the help they need efficiently and effectively.

Before I conclude, I want to mention one of my constituents, a lady called Michaela Hollywood, who is wheelchair-bound and was born with spinal muscular atrophy. She was born without ears and is permanently in a wheelchair. She is now 25 years old. She received a Points of Light award, and on Thursday last week she was with the Prime Minister when the Christmas tree lights were turned on in Downing Street. She is on the BBC’s list of the 100 most inspirational women. She received her undergraduate and master’s degrees from Ulster University, and she hopes to go back to do her PhD. She is a lady of immense capacity. She is a campaigner for young people like her with muscle-wasting conditions and, although she spends every day of her life in a wheelchair, she very much enjoys every one of those days because she is a constant campaigner with enormous zeal for life.

Michaela gave evidence to the all-party group on muscular dystrophy in the Northern Ireland Assembly for its report on specialist neuromuscular care. What she said is most important, because it highlights the need for joined-up Government thinking, whether here at Westminster and in the Department for Health or in the devolved Administrations. She said:

“There’s physiotherapy and hydrotherapy, trying just to cover everything. I do receive physiotherapy but it’s a tricky issue because when you’re under 18, with a neuromuscular condition, you have respiratory physio in the community; when you’re over 18 and in the community, with a neuromuscular condition, you’re with disability physios, even though you’re deemed as having a respiratory problem. So that I think is something that is a prime example of the disjointed care that we’re receiving. If we have one specialist multidisciplinary team…that would make things so much easier. If we had a physio that concentrated on neuromuscular diseases but also had experience within respiratory areas, that would make things easier. Also, if we had a cardiologist who pretty much had a good knowledge all round, that would help too.”

Michaela’s words make the case for a joined-up service better than any of us could, so I will end by simply reiterating her appeal for specialist multidisciplinary teams for the treatment of muscular dystrophy to be established. I call on NICE to make its decision on Translarna with the utmost urgency. I hope the Minister will give us some favourable answers to alleviate the distress that is felt by many people throughout the UK.