Baby Loss and Safe Staffing in Maternity Care

Angela Crawley Excerpts

Tuesday 25th October 2022 Westminster Hall

[Angela Crawley (Lanark and Hamilton East) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Hartlepool (Jill Mortimer) for bringing this important debate to Westminster Hall and for bravely sharing her experience. I also thank the hon. Member for Hexham (Guy Opperman). Sharing these experiences is what makes this House real to people. I know it is difficult to do so.

Today, I want to concentrate not on healthcare, which is devolved in Scotland, but on the professionals. Through my work in the APPG and on the Miscarriage Leave Bill, many have written to me to express their concerns and fears about returning to work after their own personal experiences of pregnancy loss. A swathe of healthcare professionals working in healthcare settings each and every day experience pregnancy loss themselves, and then return to work quite soon after to help to deliver another couple’s baby. It must truly be one of the most traumatic and devastating experiences to have to return to work after pregnancy loss, for anyone, but it must be especially devastating for these healthcare professionals.

Much of this debate is about safe staffing, and rightly so, because there is no more vulnerable time for any parent than through the pregnancy and at the birth of their own child. It is a time of fear and apprehension; a time when people ultimately place all of their trust and faith in healthcare professionals. I cannot imagine how triggering it must be for those healthcare professionals who have to return to work each and every day, and experience their own trauma time and again while supporting other parents to have their happy ever after. For some, that is not possible, which just reopens the trauma for those healthcare professionals.

The loss of a baby at any stage can be truly devastating for anyone, in any profession. That is why I have pushed repeatedly in the House for a basic minimum of three paid days leave for any individual who experiences pregnancy loss. Many people in this House have bravely shared their experiences. I do not particularly wish to go into each individual experience, but sharing experiences is so important because it reminds people that we are individuals, that we are human, and that we ourselves have an understanding of the pain and grief that come with pregnancy loss.

The Minister will no doubt tell me that there is provision for parents who experience pregnancy loss before 24 weeks in the form of sick leave, unpaid leave and other vehicles, but the fact is that there is no statutory provision. Last week, I met with the Chartered Institute of Personnel and Development, which informed me that, thankfully, there are whole sectors and industries that are introducing pregnancy loss policies. Sadly, however, no healthcare professions were among the list of organisations that are introducing such policies.

It is imperative that, regardless of sector or industry, when someone experiences pregnancy loss—there is no provision in law before 24 weeks—they are at least recognised and supported on their return to the workplace. The sad fact is that, for healthcare professionals, that is not the case. A third of employers say that they do not have a formal policy, and the CIPD notes that most smaller businesses feel that a formal policy is a luxury that they cannot afford. Without statutory provision, and without implementation in the healthcare profession itself, the reality is that day in, day out, more individuals will experience pregnancy loss and will have to return to work without the recognition of that loss. That is simply too much; it is simply a tragedy.

[Philip Davies (in the Chair)]

Order. I am sorry to cut the hon. Lady off during her speech.

Baby Loss Awareness Week

Angela Crawley Excerpts

Thursday 23rd September 2021 Commons Chamber

[Cherilyn Mackrory]

I thank my right hon. Friend for her intervention and kind words.

I entered Parliament and suddenly had the opportunity to speak with many people who had experienced the loss of a baby. Unlike me, many have no idea why their baby had died. As well as prevention of baby loss, which I will come to later, my focus in this place is on the care for bereaved families. The all-party group was instrumental in the creation of the Government-backed national bereavement care pathway, which seeks to improve the quality and consistency of bereavement care received by parents in NHS trusts in England after pregnancy or baby loss.

There are different experiences from place to place. While the Department of Health and Social Care strongly urges the trusts to take part in the pathway, mandating it and its nine standards would lead to greater time, funding and resources being made available to healthcare professionals to deliver this. Poor bereavement care, from the moment of diagnosis and the breaking of bad news, exacerbates the profound pain felt by parents. Although approaches to bereavement care in the UK have greatly improved in recent years, inconsistency still remains, often resulting in a postcode lottery for parents.

As of last month, all NHS trusts in England have either expressed interest in, or formally committed to, implementing the pathway within their hospitals and their services. Trusts require additional funding, however, to fully implement the standards, especially to ensure that every hospital has an appropriate bereavement suite, specialist staff and training.

As I mentioned earlier, the care that we received in Cornwall on the weekend that we lost Lily was second to none. However, while I was able to access bereavement counselling through my work, my husband has never been offered anything. It is my opinion that supporting partners and the wider family are not being looked after in the way that we would hope. Because the mother births the child, dads and supporting partners often feel the need to be “strong”—to be there for them. People often ask how mum is, but may not ask how dad is. That is not healthy. What about the wider family? Grandparents are grieving for their lost grandchild and wondering how best to support. Siblings are wondering what has happened.

My daughter was only four when we lost Lily. She knew I was pregnant and we tried to explain what had happened in an age-appropriate way. She seemed to accept this as children do and did not mention it again—until a couple of weeks ago. Completely out of the blue and without warning, she said, “Mummy, when I was four, you were going to have a baby but then didn’t.” Crikey! Wham! What do you do? On the hoof, I needed to explain calmly to my now almost seven-year-old what had happened. I do not know whether I explained it in the right way, but she knows now that, if there are questions, we are always here. I do not want it to be a spectre on her childhood to wonder what happened to her mystery sister. It reminded me that a child’s mind can often make up what they do not know, and we need to make sure that siblings and the wider bereaved family are cared for long after the event.

[Angela Crawley (Lanark and Hamilton East) (SNP)]

I commend the hon. Member for her bravery in speaking about such a personal and intimate matter. She speaks about partners and the wider family. There has never been a more important point about ensuring that both affected parents are able to take leave. Does she support my Miscarriage Leave Bill, which will ensure that both parents can take paid leave during this traumatic time?

[Cherilyn Mackrory]

The hon. Member and I have spoken about this issue. Since that conversation, I have taken her Bill to the Employment Minister, so I hope that we will hear more about it later in the year.

Despite our making good progress, more needs to be done if the Government’s ambition to halve baby deaths by 2025 is to be met. If the current trajectory of reducing stillbirths is maintained, England may be off meeting that 2025 ambition. The Health and Social Care Committee report noted:

“The improvements in rates of stillbirths and neonatal deaths are good but are not shared equally among all women and babies. Babies from minority ethnic or socioeconomically deprived backgrounds continue to be at significantly greater risk of perinatal death than their white or less deprived peers.”

Babies should not be at higher risk simply because of their parents’ postcode, ethnicity or income. I will let my APPG co-chair and Chair of the Select Committee speak to the findings of the report. However, it appears that health inequalities in maternity outcomes have been known about for more than 70 years, yet there are still no evidence-based interventions taking place to reduce the risks.

Continuity of carer could significantly improve outcomes for women from ethnic minorities and those living in deprived areas. Way back in 2010, the Marmot review proposed a strategy to address the social determinants of health through six policy objectives, with the highest priority objective being to give every child the best start in life. Marmot noted that in utero environments affect adult health. Maternal health—including stress, diet, drug and alcohol abuse, and tobacco use during pregnancy—has a significant influence on foetal and early brain development. Midwives have a key role in promoting public health. Individual needs and concerns can be better addressed when midwives know the woman and her family, and continuity of carer is a key enabler of that. This public health work is of most benefit to vulnerable and at-risk families, who may require more time and tailored resources. Additional work is required to address the needs of these groups, because they are simply more at risk.

As well as improving clinical outcomes for mothers and babies, continuity of carer models can also result in cost savings compared with traditional models of care, because there are fewer premature babies, so fewer neonatal cot days are required; the incremental cost per pre-term child surviving to 18 years compared with a term survivor is estimated at nearly £23,000, and most of the additional costs are likely to occur in the early years of a child’s life; there are fewer obstetric interventions, with women 10% less likely to have an instrumental birth; and there are fewer epidurals and so on.

--- Later in debate ---

[Angela Crawley (Lanark and Hamilton East) (SNP)]

I did not expect to be called to speak so early in the debate; thank you, Madam Deputy Speaker.

I again thank my friend, the hon. Member for Truro and Falmouth (Cherilyn Mackrory), for her bravery and for sharing her experience on the Floor of the House. It matters to the people at home to know that we politicians are also human beings, and that we also feel grief and loss.

Whether a pregnancy was planned or a surprise, that moment of seeing two lines on a pregnancy test stick will stay with many parents for a lifetime. Equally, for many who are trying to conceive, a faint one line or “not pregnant” will stay with them also, each and every time they receive it. Pregnancy can be a joyous, happy celebration for many. Perhaps that is why we often choose not to speak of the sadness and heartbreak when a pregnancy loss happens. Tragically, one in four pregnancies will end in miscarriage. The experience of miscarriage, along with the grief and loss associated with the miscarriage or stillbirth, will resonate for one too many parents. Every pregnancy loss is different, and there is no right or wrong way to feel about it. Sadly, many patients feel stigma. They feel a sense of shame or a failure that they could not conceive or, even when they can, that the pregnancy does not result in a happy birth.

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

My hon. Friend is making an excellent speech that resonates with so many of us who have suffered baby loss. Will she commend, with me, the campaign run by my constituent Louise Caldwell? She is campaigning for a dedicated miscarriage unit after having to give birth to her child who was sadly lost, not in a miscarriage way, and suffering real compounded trauma from having to be in the maternity wing of the hospital while other parents were celebrating and she was bereaved and her whole family were devastated? Will she also congratulate the Scottish Government on taking forward an initiative to have dedicated miscarriage wings?

[Angela Crawley]

I thank my hon. Friend for raising that very valid point. I commend Louise for her bravery and for making sure that the Scottish Government will adopt a new policy to prevent people in future from having to undergo that experience of happiness in among the sadness at that very tragic moment.

Many partners will blame themselves and often feel helpless in this situation. Thanks to the work of my hon. Friends the Members for North Ayrshire and Arran (Patricia Gibson) and for Glasgow East (David Linden), only last year bereavement legislation was introduced that entitles parents who lose a baby after 24 weeks to two weeks’ paid bereavement leave. However, there is currently no provision in place for parents who lose a baby before 24 weeks. Too many parents—mothers, fathers, partners and any parents who are facing this tragic incident—are forced to take sick leave or unpaid leave. Understandably, many do not wish to disclose these private and intimate details to their employer, especially in the early stages of pregnancy.

Grief is not an illness. In and of itself, it is a process that parents must go through. There is simply no timeline for grief. Every parent, regardless of whether the loss happens after 24 weeks or before, should be given the time to grieve that loss without a financial penalty. That is why I have introduced a private Member’s Bill that would allow parents who experience a miscarriage before 24 weeks to seek a minimum of three days’ paid leave. Some companies have already gone further, offering leave for seven to 14 days—an example that I hope many more employers will replicate and that I absolutely welcome. This compassion and recognition of the loss and the grief that comes with a miscarriage, whether in policy or in statute, would allow parents to approach their employer and seek a legal right to paid leave.

This traumatic life event will inevitably affect both parents differently. There is a cost associated with such a loss, as many parents opt to take unpaid or sick leave, so there is already a financial penalty for people up and down the country. Often an employer has no idea what the nature of their employee’s sickness is, or the ramifications for their business. Therefore, having a policy on this issue, or the right to take paid leave in statute, should not add any further burden to them. Rather, it would allow the conversation to take place where both employee and employer can understand the situation and hopefully seek to support their employee in the best way that they can. Many parents have spoken of feeling isolated and alone, without the opportunity to share their loss with colleagues for fear of the shame and stigma that have been associated with such a loss. Introducing a minimum of three days’ paid leave would not only give parents a chance to grieve and process their loss but show everyone that miscarriage is no one’s fault and help to break that stigma.

--- Later in debate ---

[Angela Crawley]

Does the right hon. Gentleman believe, as I do, that fathers, like mothers and like any parent, have the right to have a grieving process and should have the right to paid leave in order to do so?

[Jeremy Hunt]

I thank the hon. Lady for giving me a moment to recover. She makes a very powerful argument. Without committing to supporting her proposal, I would hope that all employers would listen to her speech and offer that leave voluntarily on compassionate grounds, because that is the responsible and kind thing to do.

I want, in my brief comments, to talk about another group of people less often talked about who also feel this grief—the doctors, nurses and midwives responsible for a child’s care. Some people have used the phrase “second victim” to describe the agonising sadness people feel when they are responsible for a child’s care and that child dies. When I was Health Secretary, many times I asked people working in hospitals what the biggest tragedy and professional shock they had ever had was, and they would often say that it related to the death of a child. Even more acute is when that death was caused by an error. Those doctors, nurses, midwives and frontline professionals, who go into their profession with the highest and noblest of motives, have to live with the fact that perhaps because of an ordinary human mistake—the kind of mistake that all of us can make—something really terrible happened.

We as politicians, and those in nearly every other profession, make mistakes the whole time—a media appearance goes wrong, a speech goes down badly, we lose an election, or whatever it is—but the consequence is not someone dying. Frontline health professionals have the courage to go into a profession where they are taking that risk every day. When those tragedies happen, those frontline professionals want nothing more than to be completely open, transparent and honest about what happened so that we can learn from the mistake and put in place processes and systems so that it never happens again. But, in truth, we make it practically impossible for them to do that. They are terrified about losing their job, about the Care Quality Commission, about being struck off the medical or nursing register, about the reputation of their unit, about the reputation of their hospital, and about lawyers, who get involved very quickly.

When I was Health Secretary—I do not think this has changed even now—every week I signed off a multimillion-pound payment to a family whose child was disabled for life because of medical error that the NHS accepted. Most weeks it happened twice. Overall, the cost of that compensation for medical error in the NHS is £2.4 billion a year. Just under half of that relates to maternity. We have got to the obscene situation where we pay more in compensation to families when something has gone wrong than on the entire cost of every doctor and every nurse working in maternity units up and down the country. Why is that? It is because of a simple problem that the Health and Social Care Committee—I am delighted to see members of the Committee in their places on both sides of the House—is urgently asking the Government to address.

If, because of a mistake, a child is born disabled, the parents quite understandably want financial support to deal with the unexpected costs that the family will face for the whole of that child’s life. However, under the law, the only way to get that compensation is if a court agrees that there was clinical negligence. Quite understandably, parents will fight to get that compensation and, also understandably, the doctors, nurses and midwives become defensive if they are accused of clinical negligence. It does not have to be that way. We need a system where people are entitled to compensation as soon as it is accepted that a mistake was made without the necessity to prove clinical negligence.

The country with the highest safety standards and the lowest number of baby deaths in Europe is Sweden, which has about half our level of baby deaths. In Sweden, compensation is given more quickly just on the basis of a mistake being made, with the result not that they pay more but that they pay massively less, because they have half the number of tragedies that we have. Surely those of us who are passionate about patient safety will support that, and those who are—as we all are—worried about baby deaths will support that. Even people in the Treasury should understand that the way to reduce the obscene compensation bill is to make it easier for families in those terrible situations to claim compensation. If we had the same maternity safety levels as Sweden, 1,000 more babies would survive every single year. Just think of the heartache and the transformation in the lives of families up and down the country were we to do that.

I turn briefly to the other recommendations in the Select Committee’s report, published in July. One of the most important recommendations relates to staffing. When it comes to medical error, if there are not enough staff on a ward, the likelihood of mistakes will self-evidently be higher. Eight out of 10 midwives say that there are not enough midwives on their shifts, and Health Education England—the Government’s own body—says that there is a shortage of just over 1,900 midwives across the system. NHS Providers thinks that there is a shortage of about 500 doctors in maternity units and the Royal College of Anaesthetists says that there is a shortage across the system of about 1,000 anaesthetists. The cost of putting that right is between £200 million and £350 million a year. That is a significant amount. The Government deserve credit for already agreeing to put in £95 million a year, but that additional cost is as nothing compared to the £2.4 billion that we are paying in compensation every year. I hope that the Government will agree to put right that staffing shortfall. They have said this week that they are considering that.

Training is another vital issue. It is so important for doctors, nurses and midwives to have the time to learn from things that go wrong and to improve systems, but they can do that only if there is protected time for training in their busy schedules. I commend Baby Lifeline for the fantastic, proven training that it does, which has saved many lives. It is led by the inspirational Judy Ledger, who was inspired to do what she does by her tragedies. The report also talks about more screening and health inequalities, both of which were mentioned by my hon. Friend the Member for Truro and Falmouth.

I finish with two brief points. First, it would be wrong to say that this is an NHS problem. It is a tragedy that happens in all countries all over the world, and this year the World Health Organisation has made maternal and newborn loss the theme of World Patient Safety Day. The WHO says that, every day across the world, 7,000 babies die and the majority of those deaths are preventable.

Finally, we should remember the tremendous progress that has been made. In the last decade, the number of neonatal deaths is down by 25% and the number of stillbirths is down 30%. I commend Jacqueline Dunkley-Bent and Matthew Jolly in NHS England, who are leading the maternity safety transformation programme, and the many doctors, nurses and midwives who are supporting them. I also commend charities such as Sands and the Lullaby Trust as well as many others. Most of all, I commend the families who have campaigned through thick and thin, including James Titcombe, remembering his son Joshua; Derek Richford, remembering his grandson Harry; Carl Hendrickson, remembering his son Chester and his wife Nittaya; and Richard Stanton and Rhiannon Davies, remembering their daughter Kate. There are many others. Five babies die every single day. This is our moment to put it right.

Draft Food and Feed (Chernobyl and Fukushima Restrictions) (EU Exit) Regulations 2019 Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019

Angela Crawley Excerpts

Thursday 14th March 2019 General Committees

[Angela Crawley (Lanark and Hamilton East) (SNP)]

I echo the sentiments of the hon. Member for Washington and Sunderland West. I agree that this is an example of why we should seek to extend article 50, and evidence of why it is required.

The draft regulations fix the inoperabilities in the retained EU legislation on special conditions for the import of food and feed that has been affected by nuclear accidents at Chernobyl in Ukraine and Fukushima in Japan that will arise as a consequence of the UK’s exit from the European Union. It replaces EU legislation, Council regulation (Euratom) 2016/52, and lays down the maximum permitted levels of radioactive contamination of food and feed following a nuclear accident or any other case of radiological emergency.

The draft regulations give UK-based authorities and bodies responsibility for this regulatory area in the future. What resources have the UK Government provided to those bodies to take on those new important roles? The draft regulations would see the UK authorities take on entirely new roles of expertise. What preparations have the Government made for that?

Draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019 Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019

Angela Crawley Excerpts

Thursday 14th March 2019 General Committees

[Angela Crawley (Lanark and Hamilton East) (SNP)]

I echo the sentiments of the hon. Member for Washington and Sunderland West. I agree that this is an example of why we should seek to extend article 50, and evidence of why it is required.

The draft regulations fix the inoperabilities in the retained EU legislation on special conditions for the import of food and feed that has been affected by nuclear accidents at Chernobyl in Ukraine and Fukushima in Japan that will arise as a consequence of the UK’s exit from the European Union. It replaces EU legislation, Council regulation (Euratom) 2016/52, and lays down the maximum permitted levels of radioactive contamination of food and feed following a nuclear accident or any other case of radiological emergency.

The draft regulations give UK-based authorities and bodies responsibility for this regulatory area in the future. What resources have the UK Government provided to those bodies to take on those new important roles? The draft regulations would see the UK authorities take on entirely new roles of expertise. What preparations have the Government made for that?

Cervical Cancer Smear Tests

Angela Crawley Excerpts

Monday 28th January 2019 Westminster Hall

[Angela Crawley (Lanark and Hamilton East) (SNP)]

It is a pleasure to serve under your chairmanship, Sir Roger. I am grateful to be able to speak in the debate. I thank the hon. Member for Warrington North (Helen Jones) for introducing it, and I welcome everyone in the Public Gallery. Natasha’s friends and family who are here have definitely brightened up the gallery and this debate, and we are grateful.

I pay tribute to Natasha Sale, a brave young woman who organised the petition that we are debating. As we heard, she was diagnosed with metastatic cervical cancer before passing away on new year’s eve last year—a 31-year-old woman who left behind four children. It is incredibly sad to hear that she never got to see this moment through, but I hope that, by having the debate, we pay tribute to her tenacity and her commitment to ensure that it was heard. On the petition webpage, she wrote:

“If I can do anything with my life I want to make this change happen, it’s too late for me but it’s not too late for the next generation of young ladies.”

That is a truly brave statement. I am only sorry that she could not make it to see the campaign debated on the Floor of the House. We are, however, very grateful to have all those present in the Public Gallery.

Natasha’s bravery and selflessness to the last in the face of that horrendous disease is truly humbling and should be commended by all. In doing so, we must also recognise the commitment of her family and friends who continued her endeavour to reach more than 100,000 signatures on the petition, which is a feat in itself. In raising awareness of cervical cancer through their campaign and by encouraging women to take smear tests, they have undoubtedly already saved lives.

Breaking the taboo is so important in the fight against cervical cancer. This debate should serve not only as a motivation for every young women who is scared to get regular check-ups and to see their GP, but as a reminder—I am sure it has reminded many of us present—never to be too busy to do the same.

Contributions from hon. Members in all parts of the House are most welcome, and it is always a pleasure to have men speak in these debates because, as the hon. Member for Darlington (Jenny Chapman) rightly pointed out, for too many years in this House such issues as this one have been seen as women’s issues. They are not women’s issues, because every man has a mother, a wife, a daughter or a sister, so the discussion should be had by everyone. It is therefore most welcome to have had those contributions.

I will summarise some of the contributions. The hon. Member for City of Chester (Christian Matheson) raised cases from his constituency and others, especially that of the young woman who, sadly, died around Christmas last year because she was denied access because she was under 25. That she is not here at this point is a great sadness. The hon. Member for Darlington highlighted how the debate should be part of everyone’s agenda, not only on behalf of their constituents but to raise awareness that it is not just a women’s issue. I also join the calls of the hon. Members for Warrington North and for Henley (John Howell) for the Government to keep the matter under review.

The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) brought a bit of light-heartedness to the debate. As harrowing and awful as this is, it is important to find a way to laugh. I found myself in a similar position and, up in stirrups, someone telling me, “Oh, that’s where I know you from”—easily the strangest time to be recognised, and a little bit weird. None the less, I had gone to have my smear test.

The hon. Members for Kingston upon Hull West and Hessle and for Rotherham (Sarah Champion), and my hon. Friend the Member for Livingston (Hannah Bardell) gave very personal contributions. The House is always richer when people share such experiences and give voice to the many more people who do not have a platform. I am grateful to each and every Member who shared in their contributions—they were deeply personal, but we appreciate their honesty and candour.

I also pay tribute to Jo’s Trust, especially because it has actively sought to ensure access to GP services. That is particularly important not only in England but in Scotland, so that people know they can access such services.

Cervical cancer is the most common cancer in women aged between 25 and 35 years old. I find myself in that bracket, so I use this opportunity to encourage every young woman in Scotland: please, have your smear test done if it has been a while or you have never done it. Now is absolutely the time, with about six women in Scotland diagnosed every week—please, do not be scared. Go and have that done. It is so important.

We know that smear tests are the best protection against that form of cancer. A test is not the most comfortable or nicest experience, but it has to be done, because when tests are done, they are estimated to save about 5,000 lives each and every year across the UK, and to prevent eight out of 10 cervical cancers from developing. Despite that remarkable fact, however, the most up-to-date figures show that, as we heard, only 73% of eligible women accept the offer of a test—but, ultimately, that means that 27% of eligible women do not, and they miss out on a potentially lifesaving trip to the doctor.

I have heard some of the reasons why people avoid participating in the tests, as the hon. Member for Warrington North also told us. The test might be said to be intrusive, offensive, scary or gross but, although it is not a pleasant experience, that is not a reason not to have it. While it is true there are more fun things than getting a smear test, the same can be said about a number of other routine check-ups. I do not particularly like going to the doctor or the dentist, but doing so is important.

Clearly, more work has to be done to encourage the take-up of screenings among certain groups of the population. As we heard, evidence shows lower participation in cervical screening among young women living in areas of deprivation, women with a learning or physical disability, black or minority ethnic women, and lesbian and bisexual women—the myth among those women, myself included, was that they should not have to have a smear test because they are sleeping with someone of the same gender. As my hon. Friend the Member for Livingston rightly highlighted, the test is also for those who are trans. It is easy to assume that this is a women’s issue, but it is an everyone issue.

In Scotland, we are working hard to ensure that all those at risk see the importance of attending cervical screenings through public awareness campaigns to tackle the fears that people might have about having a smear test. The contrast remains apparent between the least and most deprived areas, however: 78% of women who live in the least deprived areas attend their smear test, whereas only 67% took up the offer in the most deprived areas. Ultimately, those in the most deprived areas are least likely to attend. I hope the Minister recognises those figures and looks at what the Government can do to raise awareness in those areas. That proves that we have so much work left to do.

In Scotland, we are introducing tests for HPV within the routine smear test to allow for earlier detection and more effective treatment. Health Scotland has produced a toolkit to help GPs, practice nurses and practice staff to optimise uptake, reduce barriers and ensure that women make an informed choice about cervical screening. Despite those efforts, according to a recent study, 72% of young women said that they had delayed a test or never went for screening because they felt embarrassed. I do not know about anyone else, but I dread to think that the notion of “dying of embarrassment” could truly be the case. I hope we can do more so that young women know they should not feel embarrassed and ashamed. We must do more to encourage women to get further screening. If we break the taboo, we will save lives.

We should use the opportunity of World Cancer Day on 4 February to raise awareness and to encourage women to come forward. We should use the House as a platform not just to speak about Brexit—I am sorry to mention that word—but to tackle the issues that affect women so much.

Ovarian Cancer: Diagnosis and Treatment

Angela Crawley Excerpts

Tuesday 30th October 2018 Westminster Hall

[Angela Crawley (Lanark and Hamilton East) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate the hon. Member for North East Derbyshire (Lee Rowley) on securing the debate and on bravely speaking of his own experience and that of his mum, Linda. I am sorry to hear about the experience that his family have had in the past year and I wish Linda well.

I thank hon. Members on both sides of the Chamber for highlighting the issues faced by their constituents. They have talked about both the successes of the health service and the lessons that need to be learned for the future. Healthcare in Scotland is of course devolved to the Scottish Government, so I can only speak to that experience, but ovarian cancer is one of the most common types of cancer in women. It typically affects those who have been through the menopause, and more than 7,000 diagnoses are made each year across the UK. In Scotland, 350 women die of the disease each year. However, the survival rate for ovarian cancer is high compared with that for other types of cancer and, like other cancer survival rates, it increases with early detection.

One key issue with this disease is that awareness of the symptoms is still low among both GPs and the general population. As we have heard from both sides of the Chamber, more needs to be done to raise awareness of the early signs and to secure an early diagnosis. Most women with ovarian cancer are diagnosed when the disease has, unfortunately, reached an advanced stage.

In many regards, Scotland still leads the way on UK ovarian cancer diagnosis, but there is no denying that there is always more to do in this area. Scotland has improved its diagnostic pathway and the access to much-needed treatments. The SNP Government developed the Detect Cancer Early programme to improve survival rates through diagnosis and treatment at an earlier stage. Scotland has been able to tackle cancer through world-class scientific research. The Scottish Molecular Genetics Consortium uses DNA to detect a range of genetic disorders, including cancer. The Scottish Genomes Partnership is pioneering Scottish research in human genome discovery in four key research areas, of which cancer is one. That partnership involves the Universities of Edinburgh, Glasgow, Aberdeen and Dundee. However, although that research is saving lives, its funding is being slashed. The proportion of EU funds allocated to universities in the UK has already dropped and will continue to fall because of Brexit and the uncertainty about the future. Programmes such as those will collapse unless a post-Brexit Government are prepared to plug the funding gap.

In Scotland, the SNP wants to improve cancer care and treatment, which is one reason the Scottish Government are investing £100 million in their new cancer strategy. In addition to the SNP Government’s work on prevention and early detection, the strategy includes enhanced radiotherapy services through new technology, and recruitment drives to reduce waiting times and improve patient outcomes. The Scottish Government have outlined actions for end-of-life care needs through the “Strategic Framework for Action on Palliative and End of Life Care”, which encourages a culture of openness and dignity around dying and death.

In June, I was contacted by a constituent from Hamilton, Mr Gerard Murphy, who sadly lost his wife, Elizabeth, last year after a battle against late-diagnosed ovarian cancer. Mr Murphy expressed a lot of the sentiments articulated during this debate, calling for publicly funded awareness campaigns so that women and GPs know the symptoms to look out for, faster diagnosis so that women can start treatment earlier and have a greater chance of survival, and treatment in specialist centres such as the Beatson West of Scotland cancer centre, where Elizabeth was treated, in his words, “wonderfully well”. I am sure that Mr Murphy would welcome any advances for other families experiencing this disease.

We have heard calls from both sides of the Chamber for greater knowledge and awareness of the signs and greater investment in early diagnosis. This is something that we would like to tackle across the House. I hope that the Minister will pay heed to the comments that have been made.

Autism

Angela Crawley Excerpts

Thursday 29th March 2018 Commons Chamber

[Angela Crawley (Lanark and Hamilton East) (SNP)]

It is a pleasure to speak in this debate on a condition that affects more than 700,000 people in the UK but that is often misunderstood.

I welcome World Autism Awareness Week and the opportunity to have this debate in the Chamber. I thank all the contributors, and I will acknowledge each in turn, but I particularly thank the hon. Member for Strangford (Jim Shannon), who rightly outlined that some of the welfare changes have had a detrimental impact on those with autism. The hon. Member for Bristol West (Thangam Debbonaire) highlighted that this Parliament could benefit from being autism friendly, which would be a benefit to all.

I thank my hon. Friends the Members for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), for Glasgow South West (Chris Stephens) and for North Ayrshire and Arran (Patricia Gibson) for their initiatives in their local communities and for their carer-friendly and autism-friendly surgeries. I hope to be able to follow in their footsteps.

[Dame Cheryl Gillan]

The hon. Lady will be pleased to know that Parliament has been accredited as an autism-friendly destination, of which we are very proud. We want to try to maintain that across the board, so we are constantly keeping the administrative authorities up to their mettle so we retain that accreditation.

--- Later in debate ---

[Angela Crawley]

I was just about to champion the right hon. Lady and celebrate her championing of those with autism and her work with the APPG. Lastly, the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan), in one of today’s most valuable contributions, spoke of her son’s experience.

As we have heard, the National Autistic Society estimates that 16% of working-age people with autism are in full-time employment and only 32% are in any kind of paid work. Furthermore, 79% of people with autism are currently on benefits. One thing we could do in World Autism Awareness Week is consider how policies affect individuals with autism.

My constituent Macoist Fordyce, about whom I have spoken previously, has Asperger’s syndrome and recently applied for universal credit with the help of his mother, who felt compelled to highlight the treatment they both faced at their local jobcentre. I am not saying this to be political, as I simply want to inform the Government and give them an opportunity to address it, because that is exactly what this debate should do. Although my constituent had received an email at the time asking whether he had any physical disabilities, no consideration was given to what someone with autism may face. They were greeted by two advisers on arrival, who were behind a glass panel, knew nothing of Macoist’s autism and stated that he would meet a work coach on his next appointment. Mrs Fordyce tells me that she explained in detail how Asperger’s syndrome affected her son, including the difficulties involved in attending that initial appointment, but was informed that he would have to attend or his claim would not be processed.

Let us take a moment to think about how different and less stressful this situation could have been if the jobcentre staff had some training in autism awareness. Let us imagine the original appointment email had not just asked about physical disabilities but had asked whether there were any barriers that would prevent Macoist from attending. Let us imagine that on receiving the information that Macoist has Asperger’s syndrome, the jobcentre had sent through full details of what to expect at the appointment, including that a quiet room would be made available to try alleviate some of the anxieties he experienced. Let us imagine that the frontline advisers had read his application, in order to be aware of his disability, and then knew how to put in place the appropriate strategies to conduct the interview accordingly as they understood what my constituent might have had difficulty with, given that he had outlined that he had autism and that a neurodiversity toolkit is in place. I am sure Members will agree that Macoist and his mother could have had a more positive experience.

The “About Me” disability passport is an excellent idea that could certainly ease some of the issues faced by those with an autistic spectrum disorder. However, I question whether the Minister’s good intention in bringing forward this passport with access hosted on the websites of charities and other third sector organisations has actually come to fruition over the past year. I recognise that work is being done, but we can promote that work further and this is a prime opportunity to review those processes and make sure that we are doing this—certainly my constituent had never heard of it or come across it.

Mrs Fordyce reports that her son’s second appointment with the work coach was even more challenging. Again, no attempts were made to accommodate Macoist’s disabilities, resulting in a panic that might have been avoided if his first experience had been taken on board and referred to for the second meeting. The work coach was also unaware of Macoist’s autism, and was unaware that Mrs Fordyce was his appointee and refused to let her assist her son with his answers. No allowances were made for the challenges Macoist would face in completing his work commitment or holding down a position of employment, and they were told that he had to seek and be available for work or his claim would not be processed.

Sadly, the difficulties faced by my constituent in the welfare system are not confined to the jobcentre. On the work capability assessment, despite a phone call to check that Macoist would be seen at his 3 pm appointment and again checking on arrival at reception, at 4.20 pm Mrs Fordyce was called back to reception to be told that, after they had looked at Macoist’s assessment form, they had found there was no one with a specialised report of his assessment that would be able to do the assessment and that it would probably have to take place in a few weeks’ time.

In the course of my casework, I have submitted many complaints to both Independent Assessment Services and the Centre for Health and Disability Assessments. I have been told on many occasions that health professionals have to be trained and accredited experts approved by the Secretary of State, and it is not a requirement for them to be a specialist in any particular field. Perhaps simply expanding autism awareness training to those who work on a day-to-day basis in this area would be a starting point. This particular complaint has not yet been resolved, but it again highlights how the problems faced by those with autism in the social security system could easily be tackled by simply expanding on some of the brilliant initiatives and programmes that already exist.

Of course, in the Scottish Government’s work and in Northern Ireland there are many prime examples of areas where both the devolved nations and Administrations are doing things differently, and we can all learn from this across the board. On that basis, I ask the Minister simply to consider the work being done by the Scottish Government, and I recognise the work of the UK Government in this area. Many aims, strategies and initiatives to improve the lives of those with autistic spectrum disorder are already in place, but a key point to remember from this debate is that there is of course more that we can do. For an individual with autism, there is no benefit to the current system. I encourage the Minister to revisit the aims of the hidden impairments toolkit, the autism and neurodiversity toolkit and the “About Me” passport, and ensure that the targets are being met.

Support for Life-shortening Conditions

Angela Crawley Excerpts

Tuesday 7th June 2016 Westminster Hall

[Angela Crawley (Lanark and Hamilton East) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Percy, in your new appointment.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this debate and I apologise in advance that I may need to leave a little bit early to attend the Women and Equalities Committee.

The provision of support for children whose lives are shortened by illness is a difficult issue to discuss. No parent wants to think that their child will not reach full adulthood or that they will spend their whole life being ill. However, that is the reality for too many parents. Therefore, we must do all we can to support families with sick children, to allow them to make the most of their time together.

My own experience of this issue comes from supporting many families with a loved one who experienced a short life. Through the young carers service, I volunteered to support the families of children living short lives, including their siblings. Those families were brave and inspiring, triumphing over what was probably the saddest time of their lives. Those siblings overcame those periods and went on to be incredible young adults themselves.

I echo the sentiments of the hon. Member for Strangford (Jim Shannon), who thanked the medical professionals and practitioners, the organisations and the charities, in this area. They provide constant support and care throughout this sad experience and, in many cases, afterwards, as the families go through the bereavement process.

As we have already heard, the charity Together for Short Lives has estimated that 49,000 children and young people in the UK have life-shortening conditions. However, the charity itself admits that that number could fall short of the true number of children affected by these conditions. I echo the sentiments of the hon. Member for Torfaen (Nick Thomas-Symonds); he is no longer in his place, but he discussed the need for robust data collection to ensure that the support necessary for families is available and that we quantify that support in an adequate way. Although I recognise the challenges that all Governments face, for someone to have to explain to a family that they simply cannot support them in their time of need because of a funding issue is not sufficient; indeed, for those families, it is simply not good enough.

Investment in research is absolutely crucial to medical advancement, and it can also increase the life chances of many children and improve the experience of many families. The reality is that Governments, the NHS and local authorities are currently unable to budget sufficiently to ensure that there is enough money to meet the needs of these children because there is simply an unknown number of them. As I say, that goes back to the point made earlier about the need for correct data to ensure that adequate funds are provided. I put it to the Minister that this situation must be rectified so that we can adequately respond to the demand to close gaps in services and ensure that there is welfare provision for children in palliative care.

Funding is vital. Surveys have revealed that 89% of children’s hospices could be forced to reduce their services if their funding from Government was stopped, so I urge the Minister to consider the best way to support those valuable services, to ensure that there is continued funding for them; I hope that he will consider that issue.

The Scottish Government are committed to ensuring that people can access high-quality palliative care, regardless of their age, diagnosis, socioeconomic background or where they live. As part of that commitment, funding for children’s hospices has parity with that for adult hospices, and I hope that the UK Government will make the same commitment to provide such parity. The Scottish Government’s strategic framework encourages support and promotes the further development of holistic palliative care for those in the birth to 25 age group. I urge the UK Government to make the same commitment to children and young people across the UK.

I will touch briefly on the issue of welfare and the UK Government’s attitude to it. Many families who have children suffering from life-shortening illnesses will be hardest hit by the welfare reforms. At present, families with a disabled child in receipt of disability living allowance may be entitled to £60 per week. Under universal credit, that sum will be cut to £29 per week. In other words, the families of thousands of children will have their household budgets slashed at a time when they absolutely need such support.

Any parent of a child with a life-shortening illness wants to spend as much quality time as possible with their family. Instead, families affected by welfare changes will face substantial additional costs, as a result of having to pay for specialist aids and adaptations for their home, not to mention the additional visits to health services and the associated travel costs.

For many of the families across the UK who are caring for sick children, one of the greatest challenges that they face is accessing appropriate transport. We have already heard how vital it is that the Government consider the impact of their policy and ensure that mobility aid for families of children under the age of three is also in place, because we simply cannot discriminate on the basis of age. Those families need that vital support, but children under the age of three who have life-shortening conditions are currently ineligible to receive it. I hope that the Government will reconsider that.

A growing number of children within that age range require extra medical care, including palliative care. Some babies and their families have permanent wheelchairs and are unable to use them, or specialist buggies, without the necessary transport provision. Without specialist adapted vehicles, those families are unable to transport their young children to and from hospital, which obviously disrupts family life. It also means that families will miss out on making valued—in fact, cherished—memories with their children.

In closing, I must highlight that the burden of providing care for sick children can push families into poverty. In Scotland, and indeed in my constituency, 25% of children and young people with life-shortening illnesses live in the areas of highest deprivation. Providing equal access to sources of support is of paramount importance, to ensure that those children get the most out of their short lives. Helping them to achieve that is dependent on our giving as much support to their families as is required, so I urge the Government to take all measures necessary to provide that support as much as they can.

Health and Social Care

Angela Crawley Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Angela Crawley (Lanark and Hamilton East) (SNP)]

It is both a great honour and a privilege to have the opportunity to serve my area of Lanark and Hamilton East, and to have served as a councillor in my hometown of Hamilton. I will seek to return the faith of all those who voted, with hard work, dedication and complete commitment to uphold this duty of public service.

May we take this opportunity to recognise the talent of Charles Kennedy, who dedicated his life to politics? As a former law student at Glasgow University, I recognise Charles’s work as its rector. May I extend my sincere condolences to his family at this time?

May I also take this opportunity to pay my respects to my predecessor, Jim Hood, who served in Westminster from 1987, which, incidentally, is the year I was born? His courage to stand against his party over the Gulf and Iraq wars set him apart and showed his character and principles.

However, I stand here today inspired by great political women, including the remarkable and influential Winnie Ewing, whose Westminster victory in 1967 promoted the possibility that Scotland could prosper and flourish with the Scottish National party. Hamilton is also the birthplace of the late and wonderful Margo MacDonald. Margo and Winnie completely reset the rulebook and taught us that gender is irrelevant in life: when you have the will and the skill to succeed, you can.

My constituency is not just home; it is a colourful and vibrant place. It is innovative and industrious. It is both rural and urban, with a strong agricultural sector and deep respect for our mining history. There is much to champion about Lanark and Hamilton East, and yet still much to improve.

Growing up, I witnessed the poverty and deprivation in my local community, damp council houses and parents working hard yet struggling to make ends meet. As a teenager, I lost my mother to mental ill health. As a young carer, I know only too well about the need to protect our NHS. Most of all, I believe that this kind of desire to see change can be realised through politics and it must be realised through making a positive change. I am sure that everyone across these Benches will join me in that determination.

We must continue to invest in our vital services, health and wellbeing and education. I was lucky to have strong role models and to access education based on the ability to learn, not the ability to pay. I would like to ensure that all young people across these islands have that same opportunity.

Unfortunately, the story of poverty still echoes throughout many parts of my constituency today. Inequality and a lack of prospects for young people are crippling those who need support the most. We must ensure equality of opportunity, not only for young people but for everyone across all constituencies. Today, hard-working families up and down this country will be faced with a choice between putting food on their table and heating their homes. Let us just think about that: our reliance on food banks while committing billions of pounds on nuclear weapons is wholly unacceptable.

In my role as SNP spokesperson for equalities, women and children, I will continue to shine a light on our successes and highlight the areas that desperately need development. I am proud of our progress in recognising same-sex marriage across Scotland, England, Wales and now Ireland. When I marry my partner next year, I will celebrate the fact that marriage is truly equal, both in law and in life. I will continue to champion LGBT and black and minority ethnic rights, and to ensure that gender imbalance is addressed in our workplaces, in our boardrooms and in this Chamber.

Let us, this term, make history. Let us collaborate and work together to represent with compassion aspirational ideals and progressive politics. The people of Scotland voted loudly and clearly for an alternative to austerity. My team of 55 colleagues and I will work tirelessly with those on the Opposition Benches to ensure that we see an alternative to the damaging cuts to our public services.

I represent the Scottish National party. We are a party that will speak up for everyone with a shared interest in tackling inequality and poverty. Let us share in the spirited debate with respect and objectivity. Let us challenge constructively to achieve positive outcomes. Let us listen to the people and always act in their best interests, and in the interests of the many, not the few. Let us shape and strengthen the opportunities of future generations and our children. Let us promote potential over profit and invest in future generations, not nuclear weapons. Let us serve with honesty and transparency, but, most of all, let us serve.