Group B Streptococcus (Newborn Babies)

Debate between Andrew Selous and Nadine Dorries

Thursday 7th November 2013 Commons Chamber

[Nadine Dorries]

Researchers stated:

“The most striking finding that has implications for clinical practice and policy is the low sensitivity of risk factor based screening, compared with PCR or culture tests in predicting maternal and neonatal GBS colonisation—”

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly commend my hon. Friend on bringing the issue before the House. I have a constituent who lost a child as a result of it, so it is something that I take seriously. Is my hon. Friend pleased, as I am, to see that Public Health England is now adopting gold standard enriched culture testing in its eight regional laboratories? Does she welcome that as a small advance in this important area?

[Nadine Dorries]

I welcome my hon. Friend’s intervention, and I will go on to talk about the gold standard culture medium.

The researchers continued that the sensitivity of such screening was

“below that which we considered to be a minimally acceptable sensitivity for our study—which calls into question the validity of the current UK policy. Moreover, consistent with previous evidence of practice variation, the risk factor-based screening policy was poorly adhered to, with one-third of women with indications for IAP not treated.”

Despite those authors and numerous others recommending routine screening as cost-effective in the UK, the UK national screening committee continues to recommend the risk-based approach.

Most countries that have national strategies against GBS infection offer routine antenatal testing for GBS. Those countries have seen the incidence of early onset disease fall dramatically, such as by more than 80% in the US and Spain. That compares favourably with the result of the risk-based approach in the UK under which, as I have said, the number of infections has increased. If we know that the risk-based strategy we are adopting is not working because infections are beginning to increase, yet countries such as Spain are seeing an 80% reduction, should we not consider the cost-effectiveness of moving to a system that we know will reduce the number of poorly babies in our intensive care units that have GBS-induced meningitis and other complications?

Studies show that testing for GBS in late pregnancy, as well as offering tests to women found to carry GBS or who have other recognised risk factors, is more cost-effective than the current risk-based strategy. A risk-based strategy is poor at predicting women who will be carrying GBS in labour, and therefore women for whom antibiotics in labour would potentially prevent devastating infections in their newborn babies.

Recently published research shows that although women want to be informed about GBS and offered testing for it during pregnancy, that is not happening. At less than £12, the tests are not that expensive, and the antibiotic recommended during labour if a woman is found to carry GBS in pregnancy is cheap and cost-effective. It is penicillin, which is shown to be exceptionally safe, as well as being a narrow-spectrum drug that is unlikely to cause greater resistance later.

Most NHS pathology services currently use culture media that are general purpose and identify GBS in only about 60% of carriers. At the request of the chief medical officer, Dame Sally Davies, the enriched culture medium test that my hon. Friend mentioned will be made available throughout England from 1 January 2014. That will identify about 90% of carriers, and it is the gold standard for that purpose, under Public Health England’s regional laboratory standard operating procedure. The results of the GBS test are about 85% predictive of carriage status for up to five weeks. It should be used to identify GBS carriage wherever there is an indication. These sensitive tests have not previously been widely available within the NHS when requested by the health professionals and pregnant women.

I have some key questions for the Minister. Will he use this debate as an opportunity to make a statement welcoming the gold standard enriched culture medium test for group B strep carriage, which is being made available from January 2014 and which can be used to assess carrier state if there is an indication? From this point on, how does the Minister plan to reduce the incidence of GBS infection in newborn babies when the current risk-based strategy, introduced in 2003, has been shown not to be effective? Is there a target rate for GBS infection in newborn babies? I have always derided targets, but in this case setting a target for the reduction of GBS infections may be a way to introduce routine testing.

Will the Minister confirm that the audit of practice suggested by the UK national screening committee to establish how well the new guidance is being implemented at a national level will study the actual practice taking place in maternity units, rather than simply being an audit of policies without any check on whether they are being applied in practice, because we know that these policies are not being put into practice in maternity units? What is the time scale for the feedback and advice to trusts about how they can further improve their adherence to the RCOG and National Institute for Health and Care Excellence guidelines on the prevention of neonatal GBS disease? What provision is being made for telling pregnant women about the risk of GBS infection in their babies? What provision is being made to educate relevant health professionals about the prevention of GBS in newborn babies and the forthcoming availability of the gold standard ECM test? Do midwives and practitioners in maternity units even know that this gold standard test is being introduced in 2014?

UK guidelines recommend that when GBS carriage is found by chance during a pregnancy, it should trigger the offer of antibiotic prophylaxis in labour. Why should a woman with unknown GBS carriage status be denied the opportunity to find out if her baby is at risk?

I would like to pay tribute to the tireless work of Group B Strep Support, the charity and campaign group that has been working to raise awareness of this issue and reduce the death toll. I also have a constituent who has sadly lost a baby to GBS. The group has been a great help to me in preparing for this debate following a meeting with my constituent. Ten years ago, my right hon. Friend the Prime Minister said in his Adjournment debate:

“Group B Strep Support’s aim, which I support, is for the routine test to be offered to all pregnant women, with those who are found to have GBS at the 35 to 37-week stage being automatically offered intravenous antibiotics.”

He said to the then Minister:

“I hope that the Minister will show great urgency over the issue”.—[Official Report, Date; Vol. 408, c. 267WH.]

My right hon. Friend supported the introduction of routine testing: I echo his sentiments exactly.

Health and Social Care (Re-committed) Bill

Debate between Andrew Selous and Nadine Dorries

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries]

My hon. Friend is not totally correct, because the whole purpose of the amendment is to separate out the financial situation. I shall come on to that in a moment. I disagree with my hon. Friend, and if she listens to the rest of the debate she will understand why. I do not believe that the place where an abortion was carried out is the right place for someone suffering from post-abortion distress to receive their counselling—a situation that many women suffering from post-abortion distress have told me about.

[Andrew Selous (South West Bedfordshire) (Con)]

I am grateful to my hon. Friend and parliamentary neighbour. May I for a second take the debate from the general to the particular? I think that she is on to something. I mentioned a 23-year-old constituent of mine who, having been to an abortion clinic, then went to a clinic such as my hon. Friend advocates. It was then her decision: she decided to change her mind, and today has a beautiful three-month-old daughter. She is pleased that she had the opportunity for that counselling, which no one forced her to take. That is why I think my hon. Friend is on to something.

[Nadine Dorries]

I hope that my hon. Friend is talking about the Crisis pregnancy centre in Dunstable, which I have visited along with many others. It does amazing work with young women.

--- Later in debate ---

[Nadine Dorries]

Well, I hope that the unions and the left-wing media will take my hon. Friend’s comments on board.

[Andrew Selous]

I wonder whether my hon. Friend will clarify something. It is my understanding that if she chooses to press any of her amendments to the vote, it will be amendment 1221. I wonder if that might be more acceptable to my hon. Friend the Member for Bracknell (Dr Lee) than amendment 1, which he may have been speaking about.

[Nadine Dorries]

The amendments are grouped, but when I spoke to the Table Office last night, I was told that I would speak to amendment 1 and that amendment 1 would be pressed to the vote. I hope that the Clerks will clarify that. [Interruption.] I will take advice from the Clerks, but when I spoke to the Clerk last night, I was told that it was amendment 1. [Interruption.] My hon. Friend the Member for South West Bedfordshire (Andrew Selous) is going to find out for me now.

On the offer, the amendment would provide space and time to talk and think for women who are feeling confused—that is all.

I now come to the financial arrangements between abortion clinics and counselling providers. If anybody in this House were to take out a mortgage today, the person who sold them the mortgage would have to refer them elsewhere for independent advice. If it was a husband and a wife, I believe that they would have to go to separate advisers, because they cannot both take advice about taking out the mortgage from the same person. I wonder why we feel it is appropriate that organisations that take £60 million a year of taxpayers’ money and are paid to carry out abortions give advice on the procedure.

Termination of Pregnancy (Information Provided)

Debate between Andrew Selous and Nadine Dorries

Tuesday 2nd November 2010 Commons Chamber

[Nadine Dorries (Mid Bedfordshire) (Con)]

Although the abortion figures for last year were slightly reduced by 3.2%, there were still 200,000 abortions carried out in the UK last year—572 per day. Abortion in this country is an industry from which a small number of organisations and individuals make vast amounts of money. No sensible person would condone this. In examining the legislative abortion procedures of European countries with far lower numbers than ours, it occurred to me that for those countries in which informed consent before an abortion takes place is enshrined in law—Germany, France, Belgium, Finland and others—the abortion rate was much lower. I have deliberately excluded countries with religious and cultural influences, such as Italy, Spain and Portugal from that analysis. It also appears to me that in those countries, the abortion procedure is a far kinder one, which takes much more account of the vulnerable position a woman might be in at the time of her request for an abortion and provides her with alternatives to consider and a cooling-down time in order to think, breathe and take stock of what is happening.

All those countries with good informed consent legislation had significantly lower than average daily abortion rates than the countries that do not have such informed consent legislation. Although a causal link is impossible to prove, these figures suggest that informed consent legislation might prove a good way of reducing Britain’s abortion figures. I think that all Members of all parties are agreed that we want to see that happen.

In this country, if a woman requests a termination from her GP, no questions are asked. I have spoken to numerous GPs and posed this question to them: “When a woman sits in your surgery and asks for a termination, what do you say?” The answer I frequently receive is that the GP does not say anything, but writes a referral letter. That is the process at the GP stage. A referral is made to a hospital or clinic and the abortion is performed, for the woman’s sake, as quickly as possible and without fuss.

Minimal counselling or no counselling is provided in some NHS hospitals and some clinics. Minimal counselling is provided by BPAS—the British Pregnancy Advisory Service—which carries out a large number of abortions on behalf of the NHS. However, BPAS carries out some counselling, but also carries out the abortion, so there is a clear conflict of interest there.

[Andrew Selous (South West Bedfordshire) (Con)]

I understand that the counselling provided by abortion providers is Government funded only if the abortion goes ahead. Does my hon. Friend share my concern about that?

[Nadine Dorries]

I am going to come to that very point a little later in my speech. It is one of the main concerns, mainly because no alternative counselling is provided to negate that option.

We all know that when it comes to abortion, the law is indeed an ass. It has no application whatever. We know that the law prohibits social termination—two doctors’ signatures are required—but none of that is ever taken into account. Abortion clinics freely admit that consent forms pile up in their offices, waiting for the second signature, long after the event has taken place.

A woman has an assumed right to choose. However, she apparently has no right whatever to any information on which to make that choice. If any of us were referred to a hospital today for a minor procedure such as an operation for an in-growing toenail, the procedure would be explained to us in detail. We would be made aware of the level of pain we might experience; we would be told exactly what would happen while we were under the anaesthetic; we would be given follow-up appointments to check on the progress of our healing; we would have our dressings changed and have checks for infection. A woman who has an abortion has none of that.

At the end of the day, the woman is discharged out on to the street and left to come to terms with the rollercoaster emotional journey of which she will still be in the midst. Before the woman received the procedure, she might have felt coerced, pressurised or bullied into the abortion. To her, it might have been a life or the beginning of a life—depending on her perspective. She might have had a seed of doubt, but once she was on the conveyor belt to the clinic, she might have felt helpless and unable to step off.

Make no mistake: abortion is not a medical procedure. It is not an in-growing toenail. Abortion is about the ending of a life, or a potential life. It is about a death which is final, and from which there is no going back. The abortion of a baby does not abort the seed of doubt or misgivings that may have been present at the time; that still remains.

Many consultant psychiatrists from the Royal College of Psychiatrists are becoming increasingly concerned about the number of women who are presenting with mental health issues directly linked to previous abortions. A major longitudinal 30-year survey published in The British Journal of Psychiatry in 2008 showed clearly—after adjustment for confounding variables—that women who had had abortions had rates of mental disorder 30% higher than women who had not. The Royal College of Psychiatrists said that, following its position statement on abortion and mental health,

“healthcare professionals who assess or refer women who are requesting an abortion should assess for mental health disorder and for risk factors that may be associated with its subsequent development”.

Nothing remotely like that happens. No consideration whatsoever is taken of the state of a mother’s mental health when she asks for an abortion. If she asks for an abortion, she is given one.

Given the disregard that we have for women seeking this procedure, I am surprised that that figure stands at only 30%. We push vulnerable women through a clinical procedure at great speed to end a life—or, as I said, a potential life—that is growing within them, and we wonder why only 30% have problems in later life. Those are the women who are diagnosed. They are the women who seek help, and whom we know about. We do not know about the others. Is it not time that we started to treat women a little better than this?

A5 to M1 Link

Debate between Andrew Selous and Nadine Dorries

Wednesday 30th June 2010 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

I am grateful to Mr Speaker for giving me the chance to raise with the Minister responsible for roads the vital need for the A5 to M1 link. When I made my maiden speech, on 2 July 2001, I stressed the urgent need for a bypass for Dunstable, Houghton Regis and the surrounding villages. I also stressed its importance to Leighton Buzzard as a business location. The need for a bypass in Dunstable is not new; indeed, the first mention of congestion in the town that I have been told about is in a 1924 newspaper article that talked about the traffic bottleneck in Dunstable. My predecessor, Sir David Madel, who was the Member for South West Bedfordshire for 31 years, from 1970 to 2001, also campaigned for a bypass for Dunstable throughout his time in Parliament.

Not long after my election, I presented another petition to the House, signed by 25,000 of my constituents—more than elected me in 2001—calling for the urgent need for a bypass to be addressed. I was therefore delighted when, in July 2003, the then Secretary of State for Transport—now the shadow Chancellor, the right hon. Member for Edinburgh South West (Mr Darling)—announced to the House that he was

“endorsing recommendations for improvements to some trunk roads of regional importance,”

one of which was

“a northern bypass for Dunstable”.—[Official Report, 9 July 2003; Vol. 408, c. 1177.]

I asked him when the Dunstable northern bypass would be built. In reply, he said:

“In the past five years, there have been long and detailed studies, but the time has now come when we need to get on and implement them, precisely to remove some of the inconvenience and congestion and to deliver the improved safety about which he is concerned.”—[Official Report, 9 July 2003; Vol. 408, c. 1195.]

I was therefore hugely disappointed when, at the end of the Parliament after which the then Secretary of State announced that the Dunstable northern bypass would be built, not a shovel had hit the ground.

It is a huge source of concern to me how long it takes for a new road to be built in this country. I understand that other European countries are able to build roads much more quickly. I understand that there is a much shorter delay between the announcement of a road being built and its completion in many of our competing neighbouring countries. One consequence of delay is that the cost escalates hugely, making even more demands on the public purse. The cost of the A5 to M1 link has virtually tripled since the first estimates back in 2003. I have spoken in the past of the near-Zimbabwean levels of inflation on major roads contracts. I understand that the Department insists on open book accounting, yet I cannot help believing that there must be cheaper ways for such roads to be built. I suggest that we need to take an urgent look at how genuine the competition is between road builders, to ensure that the Department and the taxpayer get real value for money in building new roads.

Sometimes I am tempted to think that the area that I represent has become, if not the land that time forgot, then the land that successive Governments have forgotten to build the necessary infrastructure in. In the north of Bedfordshire, the county town of Bedford seems to have all the bypasses that it needs. I had not even heard of the village of Ridgmont, to the north of my constituency, until I was told that it was to receive its own much- needed bypass. As I will demonstrate shortly, the need for a bypass to the north of Dunstable is overwhelming for the residents of Dunstable, Houghton Regis and the surrounding villages, but a bypass is also essential for Leighton Buzzard.

[Nadine Dorries (Mid Bedfordshire) (Con)]

My hon. Friend mentioned the village of Ridgmont. The bypass there has been gratefully received. Ridgmont is a village, and there are other villages in my constituency that will benefit hugely from the A5 to M1 link. Those villages will suffer from a lack of connectivity if the road to which he has referred is not built. Does he agree that it is imperative that the road should be built, not just for his constituency, but for the whole of Bedfordshire?

[Andrew Selous]

I am grateful for my hon. Friend’s support. The road will also benefit major towns such as Aylesbury, in providing fast direct access to the national motorway network.

I do not want Ministers or officials at the Department for Transport to think for one moment that the Luton-Dunstable busway will provide the answers to the problems of congestion, retail decline and lack of business growth in Dunstable and Houghton Regis. It will not. The only hope to secure economic regeneration to provide much needed jobs for my constituents and to provide much needed local housing is for the A5 to M1 link to be built urgently.

The need for the A5 to M1 link can be demonstrated by many examples of life in Dunstable. Dunstable high street has 56 empty shops in it because of the length of time it takes for shoppers to get into and out of the town centre. Some reductions in business rates have been granted as a result, which obviously means a loss of revenue to the Exchequer. During recent times of economic growth, every other area of Bedfordshire increased its level of employment between 2001 and 2008, but in South Bedfordshire there was a loss of 1,850 jobs—overwhelmingly due to congestion. Those figures are taken from the annual business inquiry data provided by the Central Bedfordshire council.

Major employers have closed down and left the area over the years and have not been replaced by sufficient numbers of new employers to provide the jobs that my constituents need today. Many of my constituents are forced to travel out of the area to find work, thus making congestion even worse.

Congestion is bad both for travellers going north-south on the A5 through Dunstable as well as for travellers heading east-west on the A505 through Dunstable. One story from a local shopkeeper illustrates this well. A customer was travelling east on the A505 along West street, trying to get to a shop in the Quadrant shopping centre in the middle of Dunstable. He was stuck in traffic as so often happens; he rang the shop keeper who left his shop, crossed the middle of Dunstable, gave him the goods as he was stuck in traffic in his car. That customer then turned round in the road, and drove out of Dunstable never to come and shop in the town again. How can the shopkeepers of the town I am proud to represent make a living when they are faced with an infrastructure deficit as bad as that?

The economic benefits of building this road have been estimated by both the Highways Agency and the East of England to be very significant. Central Bedfordshire council, with its private sector developers, also intends to build the Woodside industrial estate connection road from the new junction 11A, which will not require Department for Transport funds.