Maternity Services

Baroness Gohir Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Gohir (CB)]

My Lords, I declare my interests as set out in the register, in particular that I am the CEO of the Muslim Women’s Network UK. In that role, I published a maternity report, Invisible: Maternity Experiences of Muslim Women from Racialised Minority Communities, in 2022. I thank the noble Baroness, Lady Taylor of Bolton, for securing this important debate because, despite the many research reports and inquiries that we have had, we are still waiting for a step change in the improvement of maternity care. I will focus my comments mostly on maternity disparities for minority-ethnic women, data training and accountability.

Data is crucial to really understand inequalities. However, when maternity data is often broken down by ethnicity, it is usually done so into broad groups such as black, Asian and white, which masks the inequalities among different subgroups; they then remain invisible and continue to have poor outcomes. For example, Arab women are rarely spoken about but the research that I conducted found that they have poor outcomes compared with other minority-ethnic groups. In the south Asian group, Bangladeshi women tend to have the poorest outcomes. Among black women, I found that black African women and mixed-race women tend to have the poorest outcomes.

I also have concerns about poor outcomes for women from, for example, eastern European backgrounds, so it is also important to break down the white group further. In this group, women with lower educational levels, single mothers and very young mothers—in other words, women who have less of a voice—are also likely to have poorer outcomes. Can the Minister say when the Government will have a detailed strategy that responds to the inequality experienced by each group?

One way of responding to inequalities more quickly rather than just waiting for datasets, which can take time to produce and analyse, is to use feedback from the complaints system. However, research—even hospital complaints data—often shows that there is a low level of complaints from particular groups, certainly minority-ethnic ones. Can the Minister say what action the Government are taking to ensure that families are aware of the complaints procedures? How will they have confidence in that service?

Given the poor experiences of minority-ethnic women, one would expect them to be overrepresented in maternity litigation data, which would help to indicate where the risks are for them. If they are underrepresented, it would indicate that they are not being compensated for the harms that are being caused to them. I decided to investigate this issue during my research so I put in a freedom of information request to NHS Resolution, the body that deals with claims of compensation on behalf of NHS England and which apparently works to resolve concerns and share learning and improvement. I was shocked to receive the following response in 2021:

“In terms of ethnicity breakdown, this information is not held as it is not recorded in our claims management system”.


This was astonishing given that ethnicity data is routinely collected by the NHS and is crucial for identifying inequalities between different groups. This is perhaps one of the clearest examples of systemic discrimination by the NHS.

I have since had letter exchanges with the CEO of NHS Resolution and asked for ethnicity data to be recorded. The response has been positive: I have been told that the data management systems are being upgraded now to record all protected characteristics. I have been informed that it may be a voluntary option, however, which is likely to result in low data capture. Yet this data can be pulled in from hospital records; it is routinely collected. I have also been informed that data and trends will be shared only internally for learning, so how will the public identify trends and hold the NHS to account?

I ask for assurances from the Minister. Will he ensure that NHS Resolution collects protected characteristic data from the hospital management systems, rather than on a voluntary basis, and that this information is made available to the public? This would help identify inequality among different groups for all types of medical negligence claims, not just maternity claims.

Next, on training, although workforce shortages will no doubt contribute to poor healthcare staff attitudes and poor maternity care, many maternity research report findings provide clear evidence that there exists among some midwives and obstetricians a culture of being desensitised to women’s pain and of having negative attitudes towards women, which is even more pronounced for women from racialised minority communities. How do the Government plan to address the issue of patient engagement and cultural competency training? Having served on a hospital board, I know that, if a maternity ward is short-staffed, staff will not have the time to undergo such training. Also, the UK has large numbers of doctors and nurses recruited from abroad. Their culture of patient care is likely to be different. Here I refer to non-medical aspects of patient care. Does the Minister agree that some kind of approved patient communication training should be mandatory for recruits from abroad?

Finally, have the Government pulled together the many recommendations made by numerous maternity reports, such as those from Birthrights and Five X More—including the one that I authored—to ensure that the recommendations are being implemented? The Government’s women’s health strategy does not adequately deal with many health inequalities for women—minority-ethnic women in particular—including maternity disparities. More needs to be done there; the strategy needs to be strengthened. I therefore urge the Government to appoint an independent maternity commissioner from outside the NHS to provide scrutiny and hold all agencies to account, which would benefit all women. We have commissioners for many other areas. In maternity services, too many babies and mothers are dying or ending up with poor outcomes, which can have lifelong consequences. Will the Minister agree to the appointment of a maternity commissioner?

King’s Speech

Baroness Gohir Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Gohir (CB)]

My Lords, I will focus on three areas in relation to the gracious Speech: children who are not in school; the quality of courses in higher education; and mental health inequalities.

I support having a register for children who are not in school. As the recent case of Sara Sharif highlighted, children being home-schooled drop off local authorities’ radar and become invisible. However, a register alone will not solve the problem of safeguarding the well-being and healthy development of children. Although many parents provide a stimulating and safe learning environment at home, not all do. For example, children with special educational needs may not receive the educational support that they require. Furthermore, the surge in online schooling that accelerated during the Covid pandemic poses additional risks to children. Who is monitoring the quality and content of these online courses?

Legislation should be strengthened to include: the establishment of a regularly updated register; the authority routinely to monitor children’s educational progress and well-being; and the power to scrutinise reasons for home-schooling and even relocating to a different jurisdiction, including overseas. For example, some girls from ethnic-minority communities could be at increased risk of female genital mutilation and forced marriage.

It is really important to understand the current situation and fully establish the facts. The Government should therefore publish the rates of home-schooled children over the past several years, the demographics, the hotspots and the reasons for home-schooling. No doubt some of the reasons may include bullying, mental health, subpar education or curriculum-related apprehensions. How do the Government propose to address these concerns? If they are not addressed, we will see a further rise in home-schooling.

Next, I want to address the quality of university courses. The Government want to tackle the growth of low-quality courses, apparently, but I am concerned about the criteria used to determine what these are; they might even take away opportunities from minority-ethnic students who are already disadvantaged in higher education. For example, the criteria might be the ability to be employed. Some students may live in areas where there is a lack of jobs or wages are low and may not have the means or the freedom to move away to a different locality. In some communities the burden of caring is much higher, which may hinder a student’s ability to move away or go into full-time employment. Some people study courses because they enjoy the subject and it may be a way for them to stay local, have some freedom from home life and socialise.

Finally, I want to talk about mental health. I too am disappointed that a mental health Bill was excluded from the King’s Speech. As has been mentioned several times already, a higher proportion of black and Asian people have poor mental health outcomes and they are more likely to be detained under the Mental Health Act. Under the Equality Act, health and social care providers have a legal duty to reduce inequalities between patients in terms of access to health services and the outcomes achieved. There is enough existing data and information telling us that minority-ethnic people are overrepresented in secondary care and underrepresented in primary care. If they get the care they need at an earlier stage, they are less likely to be detained.

We do not need to wait for a new Bill. The Government can act now, implement policies and put greater effort into the following: improving access to primary healthcare; increasing trust and confidence in mental health services; improving educational awareness in minority communities to recognise poor mental health symptoms and know how to get help; tackling the stigma associated with mental health, which may be greater in some communities; improving training and capacity so that mental health is not dismissed due to stereotypes; and improving the availability of culturally sensitive counselling rather than limiting treatment to medication only, the rate of which seems to be higher in ethnic-minority communities.

The final point I want to make is about people with autism, and I declare an interest here: I have a teenage son who has autism. He developed severe anxiety over the summer and also self-harmed. I had to take him to mental health professionals, and I was really appalled by the way he was treated. He was routinely dismissed, and more than once I was told, “Take him to an autism charity”. I then asked whether the health professionals had autism training; most had not. It makes a difference, because when I finally came across a doctor who understood autism, she understood that you can have autism and anxiety, which a lot of the other health professionals did not understand. I want to mention her by name: I thank Dr Lily Abedipour. Because of her, my son received the right treatment and is doing better than he was in the summer. So autism training matters; it makes a difference. I finish my contribution with a question to the Minister: when will all health professionals receive autism training according and appropriate to the needs of their roles?

General Medical Council: Internal Guidance

Baroness Gohir Excerpts

Tuesday 17th October 2023 Lords Chamber

[Lord Markham (Con)]

I can definitely confirm that we are taking it very seriously. The Secretary of State was clear in his speech at the recent party conference that it is vital that we recognise the importance of the different biological health needs. That means being clear about describing a woman as a woman. I apologise: the noble Baroness was quite right to pick me up on that point, but we are very clear that biological sex is absolutely vital in addressing people’s health needs. It is clear that we are addressing women as women and men as men.

[Baroness Gohir (CB)]

My Lords, under the Government’s watch there have been attempts to erase the word “woman” in various government departments and public bodies. One example is the NHS Race & Health Observatory, which the Government fund. I wrote to it last year and it said that it would address my concerns. What assurances can the Government give that all incidents anywhere where they have oversight have been addressed? Are there any central mechanisms where the public and staff can share concerns, because it is not feasible to report concerns to a line manager when it could result in bullying? Us women will not be erased.

[Lord Markham (Con)]

I absolutely agree. That is why, as I say, we could not be firmer in saying we want to make sure it is very clear in the NHS Constitution that we are referring to women as women—that has to be the absolute primary descriptor—and men as men. We could not be clearer on that, and I am very happy to take that up across government as well.

East Kent Maternity Services: Independent Investigation

Baroness Gohir Excerpts

Monday 24th October 2022 Lords Chamber

[Baroness Gohir (CB)]

My Lords, I thank noble Lords for being patient with me, as I am still learning the rules. I draw attention to my interests in the register. Given the continuous maternity concerns raised in this and many other reports, including by women’s groups, is it time to have a maternity commissioner? As the noble Baroness, Lady Merron, mentioned, what needs to happen to ensure that we get that change? Could the answer be a maternity commissioner who is independent and who then holds the Government to account?

[Lord Markham (Con)]

The noble Baroness is right to say that it is clear that we have not got it right to date, as shown by the fact that these instances have come up. We are taking the right steps with the Maternity Safety Support Programme that we have put in place, and its ability to put trusts into special measures—as I say, that has already been done on 23 occasions and it is being considered for another 10. I believe we have got those early warning indicators in place now, and trusts are being held to account. At the same time, we have to be open, to make sure that we continue to look at and review this, to see whether it has sufficient teeth and, dare I say, intelligence to properly identify these areas. If it does not manage to do that, we must make sure we put in something else, in addition to what is there already.

Cost of Living: Public Well-being

Baroness Gohir Excerpts

Thursday 20th October 2022 Lords Chamber

[Baroness Gohir (CB)]

I thank the noble Baroness, Lady Drake, for securing this really important debate, because some of the hidden and long-term impacts of the cost of living, such as how well-being is affected, have not been given sufficient attention, especially by this Government. I welcome the many calls to action and recommendations that have been made, including the one for a general election. That may be the favourite one today. Before I share my concerns, I draw attention to my interests set out in the register.

As already highlighted, because of the incredible financial hardship that people face in Britain today they are having to use food banks to make ends meet. It is not just people who receive benefits but those who are working, as the noble Lord, Lord Sikka, just highlighted—those workers who kept our country moving on the front line, including nurses and health workers who risked their lives for us. But now, because they cannot afford to feed their families, they are leaving the jobs they love and moving out of the NHS, resulting in a shortage of staff. That crisis is already happening. It means that we have not enough nurses on wards to look after patients; patients are therefore put at risk. The cost of living crisis is therefore impacting on the well-being of patients in our hospitals.

We are not going to see fewer patients going into hospitals; we are likely to see more people ending up in hospital because of the cost of living. When people starve themselves, they are not taking in the right levels of nutrients, which will weaken their immune systems. This means they are more likely to get sick and end up in hospital—and the pandemic is not yet over.

The cost of living crisis will also impact physical health in many other ways. To make money go further, families will opt to buy cheap food. This means more families will buy processed food, which is linked to diabetes. The number of people with diabetes will increase. Research shows that by 2030 one in 10 people will be living with diabetes, but that does not take into consideration the cost of living at the moment; the numbers are likely to be a lot greater. Diabetes is associated with kidney disease, heart disease and some cancers.

It is not just physical health that is affected and that we need to worry about; mental health will also worsen. Compared with men, women earn less and are more likely to work part-time. This means that they will increase their working hours or take on a second or third job. We know that is what the Government want—they have made that clear—but that is not right. Women will have less time for self-care and less time to spend with their children. Surely that will impact their mental health and that of their children.

Another impact of the cost of living is domestic abuse. We know that cases rose during the pandemic, and the cost of living will increase the risk of domestic and economic abuse. It will also mean that victims struggle to leave perpetrators because they will not be able to afford to, putting themselves and their children at risk of harm. Their mental health will also worsen.

It is clear from what we have heard today that people in Britain are surviving, not thriving. Is this the Britain we want? We are supposed to be a wealthy nation. We should not see people struggling; no one should be struggling. People on benefits are made to feel like a burden. We keep hearing about compassionate conservatism, but I feel that these are empty words. Compassion, kindness and empathy are the very principles that make this country great, but this Government have lost their way.

The Government are storing up physical and mental health problems for the future—problems likely to result in long-term unemployment and disabilities. I ask the Government: what is the plan to protect the health and well-being of the nation, threatened by the cost of living? What action will be taken to prevent health inequalities being further exacerbated? What will be done to reduce them?