Baby Loss and Safe Staffing in Maternity Care

Caroline Johnson Excerpts

Tuesday 25th October 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

First, I thank all the Members who have taken the time to attend the debate and those who have spoken so openly about their own, and their constituents’, experiences and concerns. I particularly thank my hon. Friend the Member for Hartlepool (Jill Mortimer) for securing the debate and enabling us to have this important conversation.

Let me take this opportunity to recognise the work of everyone who has been involved in Baby Loss Awareness Week. It is important that we make it easier to speak about pregnancy loss and enable people to have open conversations about their experiences, which in turn can help those who have experienced the tragic loss of a baby. I also take this opportunity to commend the work of the charities that provide excellent support to families experiencing baby loss, including all the members of the Baby Loss Awareness Alliance and the Lily Mae Foundation, which was mentioned by my hon. Friend the Member for Meriden (Saqib Bhatti).

As we take time to reflect, I want to acknowledge how difficult the loss of a baby is. Everyone’s grief will be different. It is a personal, individual process, which people will try to navigate in many different ways. Although it can be challenging to reflect on such tragic losses, this week provides an opportunity for people to remember, reflect, share and seek support and comfort from other people.

This is the seventh year in a row that a debate has been held to mark Baby Loss Awareness Week. I am honoured to take part as the new Parliamentary Under-Secretary of State at the Department of Health and Social Care and to work with everyone to continue making a difference in an area as vital as maternity and neonatal safety.

The independent review into maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust, as mentioned by my right hon. Friend the Member for North Thanet (Sir Roger Gale), was published last Wednesday. I take this opportunity to extend my condolences to the families who suffered due to the care they received and express my gratitude to the individuals who were instrumental in establishing the review and to the inquiry team for carrying out the review to such a high standard. The Government and I take the findings and recommendations of that report extremely seriously, and I am committed to preventing families from experiencing the same pain in the future.

Our maternity safety ambition, as mentioned by my hon. Friend the Member for Hartlepool, is to achieve half the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries in babies occurring soon after birth. Since 2010, the rate of stillbirths has reduced by 19.3%, the rate of neonatal mortality for babies born over 24 weeks gestational age has reduced by 36% and maternal mortality has reduced by 17%. However, it is important to note that there was an increase in the rate of stillbirths between 2020 and 2021. This increase occurred at the same time as the covid pandemic, and detailed work is going on to establish why that was the case. I reassure hon. Members that we remain committed to our maternity safety ambition.

Every woman giving birth has the right to a safe birth, and the Government and NHS England are committed to providing women with personalised and individual maternity care. The role of NHS staff in maternity services is critical to safe care for families, and I recognise all the great, hard work by teams across the country and thank them for it.

Members on both sides of the Chamber have talked about funding and workforce. NHS England has invested £127 million in bolstering the maternity workforce even further and in programmes to strengthen leadership and retention and provide capital for neonatal maternity care. We will keep that funding under review. That investment is on top of the £95 million investment made last year in the establishment of 1,200 more midwifery posts and 100 more consultant obstetrician posts. There are increasing numbers of midwifery and obs and gynae trainees.

I am grateful to the APPGs on maternity and on baby loss for producing their report into the maternity workforce, and I acknowledge the important themes in it. The hon. Member for Enfield North (Feryal Clark) raised the issue of retention. NHS England has established a nursing and midwifery retention programme, supporting organisations to assess themselves against a bundle of interventions aligned to the NHS people promise and it will use the outcomes to develop high-quality local retention improvement plans. In addition, in 2022-23 we made £50,000 available for each maternity unit in England to enhance retention and pastoral support activities.

[Bell Ribeiro-Addy]

Will the Minister give way?

[Dr Johnson]

I will not, because I have a lot of questions to get through in a really short time.

Many hon. Members talked about bereavement. In the difficult scenario of baby loss, we understand that bereavement care for women and families is critical. We continue to engage closely with the bereavement sector to assess what is needed to ensure that bereaved families and individuals receive the support that they need. This year we have provided £2.26 million of national funding to support trusts, expand the number of staff trained in bereavement care and directly support trusts to increase the number of days of specialist bereavement provision that families can access.

In the women’s health strategy, which hon. Members mentioned, published earlier this year, we discussed the introduction of pregnancy loss certificates for England. This will allow a non-statutory, voluntary scheme to enable parents who have experienced a pre-24 weeks pregnancy loss to record and receive a certificate to provide recognition of their baby’s potential life. The certificate will not be a legal document, but it will be an important acknowledgement of a life lost, and we hope that it will provide comfort and support by validating a loss.

We understand the impact of pregnancy and childbirth on mental health, especially for those affected by the loss of a baby, and we are committed to expanding and transforming our mental health services so that people can receive the support that they need when they need it.

As part of the NHS long-term plan, we are looking to improve the access to and quality of perinatal mental health care for mothers and their partners. Mental health services around England are being expanded to include new mental health hubs for new, expectant, or bereaved mothers. These will offer physical health checks and psychological therapy in one building.

[Guy Opperman]

I accept that my hon. Friend has many things to cover today. As a former Minister, may I advise her that she might want to be encouraged to write to everyone with detailed answers from civil servants to the points raised?

Does my hon. Friend agree on one key point—that the collation of data and the consistency of approach must be nationwide? While we have many wonderful trusts, that has to be driven by the NHS, for which she is a Minister.

[Dr Johnson]

I absolutely agree with my hon. Friend.

Going back to the issue of perinatal mental health, we have previously funded Sands, the stillbirth and neonatal death charity, to work with other baby loss charities and the royal colleges to produce and support the roll-out of a national bereavement care pathway to reduce the variation in the quality of bereavement care provided by the NHS and ensure that, wherever a woman and family are being cared for, they get a high standard of care. The pathway covers a range of circumstances of baby loss, including miscarriage. As of April this year, 78% of trusts in England had committed to adopting the nine national bereavement care pathway standards.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) talked about pre-eclampsia. NHS England is establishing maternal medicine clinics. These are specialist networks across the UK, which will manage pre-conception, antenatal, post-natal and medical issues in women, and reduce long-term morbidity, thereby improving outcomes for those women who have co-existing medical conditions.

My hon. Friend the Member for Macclesfield (David Rutley) spoke about the maternity unit in his constituency. I know that he is a doughty campaigner for that unit. I will write to him with further information on progress in that area.

The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) talked about the Scottish health service and how it is performing in relation to maternity care. It is, of course, a devolved issue in Scotland, but I was moved to hear about what is happening in areas of the north of Scotland near Elgin. I would encourage the devolved Scottish Administration to consider carefully what is going on there and to see what they can do to improve care. It seems unacceptable for women to travel 102 miles to give birth.

The NHS in England has a medical education reform programme, co-sponsored by NHS England and Health Education England, to direct investment for specialty training for population needs back towards smaller and rural hospitals. That programme entered its implementation phase in August 2022.

Hon. Friends mentioned The Lancet recommendations. While the pregnancy loss review will be published shortly, I am not in a position today to commit to what it is going to say, but we will consider it carefully.

[Feryal Clark]

I understand that the Minister is not in a position to comment on that review, but now that she has had the opportunity to review the recommendations from the East Kent investigation by Dr Kirkup, is she in a position to say whether the Government will accept those recommendations, or when the Government will announce whether they are going to accept them? They will have a nationwide impact.

[Dr Johnson]

I thank the hon. Lady for her question. We were both horrified by the East Kent report, which made for extremely difficult reading. We are carefully considering the review. The hon. Lady will appreciate that we are having a change of Prime Minister today and possibly a change of Minister too, so it is difficult for me to make any commitments at this stage, beyond that the Government will consider the matter carefully and further information will be provided in due course.

Let me conclude by making three broad points. First, we appreciate how difficult and distressing baby loss can be at any point in pregnancy and childbirth. I highlight again the importance of sharing experiences and coping mechanisms that may guide other families through their own bereavement. It is important to continue this conversation past this year’s campaign and, again, I thank my hon. Friends who shared deeply personal experiences.

Secondly, I touched on the important range of targeted programmes we are developing to better support families with their bereavement and ensure all families have access to the care they need and deserve, such as pregnancy loss certificates and the national bereavement care pathway. We understand how difficult baby loss can be, and families deserve compassionate and personalised care from their local health professionals.

Thirdly, we are committed to our maternity safety ambition to halve the 2010 rates of stillbirth, neonatal and maternal death, and brain injuries in babies occurring during or soon after birth. NHS England will consider the actions from both the Ockenden report and the East Kent report and map a coherent delivery plan for maternity that will be delivered through the maternity taskforce programme. We have also established a joint working group led by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to help deliver the plan as effectively as possible. I thank hon. Members for taking time to be here today and I thank everyone who took part in Baby Loss Awareness Week.

Covid-19 Vaccines: Safety

Caroline Johnson Excerpts

Monday 24th October 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) for his kind words regarding the covid vaccine programme, and for bringing this important and timely debate to the House. It is timely because we started the covid-19 boosters autumn scheme just a few weeks ago.

Before I respond to the points that have been made in the debate and try to answer all the questions posed by right hon. and hon. Members, I thank Members—particularly those on the Opposition Benches, including the hon. Members for Denton and Reddish (Andrew Gwynne) and for Coatbridge, Chryston and Bellshill (Steven Bonnar)—for their support for the vaccine scheme. I also thank each and every person in the country who has come forward for their jabs, as well as the tens of thousands of NHS staff and volunteers who made that happen.

My hon. Friend the Member for Carshalton and Wallington asked why the vaccine programme had worked so well. It worked so well because of the dedication and hard work of all who were involved in it—from the Government to the NHS, and from the volunteers to pharma. I was honoured to volunteer alongside people from my local area as young as 15 and as old as in their 80s. It was truly a community effort.

The take-up of the covid-19 vaccine has been huge, and over 151 million vaccines have been delivered in the UK, meaning that more than 90% of people aged 12 and over have received at least one dose and more than 40 million have received a booster or third dose. We have also made a great start to the autumn booster campaign. Since the start of the campaign on 5 September, more than 10 million people in England have stepped forward for their jabs.

Our safe and effective vaccines have underpinned the Government’s strategy for living with covid-19. They have allowed the economy and society to reopen, and the country’s ability to live with the virus in the future will continue to depend on deeper and broader population immunity. Critically, they have also reduced the pressure on the national health service and allowed us to start to tackle the elective care backlog.

Vaccines remain our biggest line of defence as we head into a challenging winter period. Vaccinated people are less likely to get seriously ill with covid-19 or seasonal flu, or to be admitted to hospital, and there is also evidence that they are less likely to pass the virus on to others. We know the covid vaccine has saved tens of thousands of lives—that is tens of thousands of mothers, fathers, husbands, wives, sisters, brothers, sons and daughters who are thankfully still with us.

[Andrew Bridgen]

Is the Minister aware that excess deaths run somewhere—there are two different sets of figures—between 18,000 and 25,000 this year alone?

[Dr Johnson]

I am referring to the covid vaccine, which has saved hundreds of thousands of lives. I take my hon. Friend’s point, but there is no evidence that those deaths were caused by the covid vaccine. Let me acknowledge and pass on my sympathies to the very small number of people for whom vaccines may not have worked as intended, and who may have suffered an adverse reaction from vaccines.

I turn to vaccine safety. All vaccines used in the UK covid-19 vaccine programme are safe. In the UK we have some of the highest safety standards in the world. The MHRA is globally recognised for high standards of quality, safety and medicines regulation. Each covid-19 vaccine candidate is assessed by teams of scientists and clinicians on a case-by-case basis. There are extensive checks and balances at every stage of vaccine development. It is only once each potential vaccine has met robust standards of effectiveness, safety and quality set by the MHRA that it will be approved for use.

It is also important to stress that the surveillance of vaccine safety and adverse reactions does not stop once a vaccine has been approved. The MHRA and the UK Health Security Agency constantly review a wide range of available data on the safety of vaccines, including UK and international reports of adverse reactions.

[Sir John Hayes]

People outside the House will not know that although the Minister has been in her job a relatively short time, she is a remarkably dedicated and diligent person. No Minister is more likely or determined than she is to get to the facts when looking at the international data. Will the Minister give the assurance that she will consider all the information available, including that international data, when she draws conclusions about the content of this debate and the cases that have been made by many of my constituents and others?

--- Later in debate ---

[Dr Johnson]

I thank my right hon. Friend for his kind words. I will, of course, look at all the evidence. He is aware of my experience as a clinician and he knows that I will look at the evidence-based medical process.

As part of the surveillance into currently used medicines and vaccines, the MHRA continues to review all the suspected adverse drug reaction reports—known as the yellow card reports—relating to covid vaccines, which right hon. and hon. Members have mentioned. Through the MHRA yellow card scheme, members of the public and healthcare professionals can report any suspected side effects. A comprehensive surveillance strategy alerts us to any unforeseen adverse reactions to the vaccine, to enable us to act swiftly when required.

In April 2021, we quickly responded to reports of extremely rare cases of concurrent thrombosis and thrombocytopenia following vaccination with the first dose of AstraZeneca. At that point, the Joint Committee on Vaccination and Immunisation advised that adults under 30 without underlying health issues should be offered an alternative vaccine to the AstraZeneca if one was available. That was later extended in May 2021 to adults under 40 without underlying health issues. The MHRA, as my hon. Friend the Member for North West Leicestershire (Andrew Bridgen) said, has undertaken a thorough review of UK reports of thrombosis and thrombocytopenia. While the estimated incident rate has increased over time as awareness of the condition increases across the healthcare system, the number of cases remains extremely low, given that more than 49 million doses of AstraZeneca covid-19 vaccine have been administered.

A number of colleagues asked about myocarditis. There is no evidence that people are at an increased risk of cardiac arrest in the days and weeks following the vaccine. The risk of getting myocarditis or pericarditis after the vaccine remains very low. A large study of 4 million vaccinated people in Denmark, published in the British Medical Journal, found that there were no deaths or diagnoses of heart failure in people who were diagnosed with myocarditis or pericarditis after being vaccinated.

In the highest-risk group, those aged 18 to 29, until the end of September this year there were 29 cases for every million second Pfizer doses and 68 cases for every million second Moderna doses given in the UK. The risk is much lower after a booster dose, and in other age groups the risk is lower still. However, it is worth remembering that catching covid-19 can significantly increase the risk of cardiac arrest and death, and the risk of developing myocarditis. There are an estimated 1,500 cases of myocarditis per million patients with covid—far greater than the risk of myocarditis following vaccination.

Let me turn now to some of the questions that have been asked. My hon. Friend the Member for Carshalton and Wallington asked about the inquiry and how people would be able to contribute to it. It will listen to and consider carefully the experiences of bereaved families and others who have suffered loss as a result of the pandemic. It will not consider individual cases; instead, listening to such accounts will inform its understanding of the impact of the pandemic and the response, and any lessons to be learned. Individuals will be able to engage through the inquiry’s listening exercise and the details of that will be brought forward in due course.

My hon. Friend the Member for Christchurch (Sir Christopher Chope) asked about informed consent. Indeed, I think that he produced the leaflet that provides the information that allows people to understand that the JCVI has recommended the vaccine because on balance it is beneficial to people; it is more likely to be of benefit to them than harm. Equally, however, each individual will be provided with information about the vaccine, as they are with all medical treatments, so that they know the benefits they can expect and the risk of side effects, however small, as well as what they are. As I say, he produced an example in the debate of a leaflet containing such information. What is important is that people are aware of the benefits and risks and can make informed decisions. Vaccination is not compulsory, but we are aware that it is of great benefit to the population and to individuals at risk of covid.

[Sir Christopher Chope]

What happens if somebody suffers a 50% disability as a result of having the vaccine, through an adverse reaction, or an unusual event? What do the Government do to help that person? They do not provide any compensation, or any special help through the health service, or a clinic, so what do they do?

[Dr Johnson]

My hon. Friend is talking about the vaccine damage payment scheme, which has been running since 1979 and provides a payment of up to £120,000—a tax-free lump sum, a one-off payment—for people who have been severely damaged by vaccines, on the balance of probabilities, which is determined when people apply. That does not prejudice any claim that they may have in a legal sense and they can still pursue a civil claim should they wish to do so. It has been asked whether there should be a separate scheme for covid, but of course it is right that all vaccines are treated in a similar fashion.

My hon. Friend the Member for Devizes (Danny Kruger) asked a few questions. He asked about the terms of reference of the inquiry being a matter for the chair, which indeed they are. He also asked whether I would commit the chair of the MHRA to meet specific people, but that is not for me to decide; it is up to the chair. My hon. Friend’s other question was about children’s vaccines. He is aware of my thoughts on that: it is important when we vaccinate children that the vaccines are of benefit to the child themselves. I am aware that when the vaccine was approved that was the decision made by all four chief medical officers and it is very important that the Government listen to and take medical advice. Since then, some things have changed. Natural immunity is more widespread and school disruption is no longer an issue. I understand that very shortly, at its next meeting, the JCVI will consider whether children’s vaccines should continue to be recommended, on the basis of the current situation. I think it is right that medical research is reviewed regularly as it becomes available and is taken into account.

The position of the MHRA remains that for most people the benefits of the covid-19 vaccine continue to outweigh the risks. The surveillance strategy is working, as we have discussed. We are able to respond quickly to ensure safe administration of all covid vaccines. I reiterate that the public should be very confident that all tests are completed to the very highest standards and that vaccines are safe.

Despite the progress we have made, we must not become complacent.

[Sir Christopher Chope]

Would the Minister be willing to address the all-party parliamentary group on covid-19 vaccine damage in a private meeting, so that she can hear at first hand some of the concerns that members have?

[Dr Johnson]

I thank my hon. Friend for that question. He will be aware of events today and I will at least have to see whether I remain in post before I potentially commit somebody else to such an event.

As I was saying, despite the progress we have made, we must not become complacent. We cannot risk an increase in serious illness, hospitalisations and deaths from covid. The UKHSA estimates that vaccinations had averted up to 128,000 deaths and 262,000 hospitalisations by the end of September 2021, and many more since then.

We must do everything in our power to protect those who are most vulnerable to the virus and keep pressure off the NHS in a tough winter period. Viruses such as covid-19 spread much more easily in winter when we socialise indoors. To protect those most at risk and help to reduce pressure on the NHS, we are delivering an autumn booster dose to those who are most in need of an extra layer of protection. Even if someone has had all of their jabs so far, and perhaps had covid too, they might still need an autumn booster to strengthen their protection. I encourage everyone who is eligible to come forward for their covid booster and seasonal flu jab today. To encourage vaccination against covid and flu and boost uptake, the NHS is making every effort to make it as convenient as possible for individuals to take up the offer, including offering both covid and flu vaccines at the same time, where possible, to reduce the number of appointments needed. Our NHS staff and volunteers are pulling out all the stops to deliver the next phase of the covid vaccine programme at speed once again, with more than 3,000 sites up and down the country involved.

The NHS was the first healthcare system in the world to deliver a covid-19 vaccine outside clinical trials, and it is now the first to deliver the new, variant-busting vaccine. Bivalent vaccines target two different strains of covid-19. They will give us a broader immunity and therefore potentially improve protection against variants of the virus. Whatever vaccine people receive in the autumn booster programme, they can be assured that it remains effective in preventing severe disease against all current variants and any potential future variants.

As I draw to a close, I thank my hon. Friend the Member for Carshalton and Wallington for bringing this important debate to the House at such an important time. The Government have already commissioned a public inquiry into the pandemic, and covid vaccines will be reviewed as part of that inquiry. There are no plans for an inquiry solely on vaccine safety. We face a tough winter ahead, and collectively we must do everything we can to protect those who are most vulnerable and to reduce pressure on the NHS. I encourage everyone who is eligible to step forward for their covid and flu vaccines as soon as they are able.

East Kent Maternity Services: Independent Investigation

Caroline Johnson Excerpts

Thursday 20th October 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

With permission, Mr Speaker, I will make a statement on the review into East Kent maternity services.

Few things could be as tragic as the death of a child, yet knowing that that death was “wholly avoidable” comes with its own unimaginable pain. It is thanks to the tireless efforts, courage and determination of families in east Kent that we have been able to shine a light on maternity failings in East Kent Hospitals University Trust. Dr Bill Kirkup’s report, published yesterday, contains some stark and upsetting findings. From examining over 200 births in that trust between 2009 and 2020, he found that, had care been given at nationally recognised standards, 45 babies might not have lost their lives, and many more families might not have experienced such distress at what should have been their time of joy. He also found a toxic culture within the trust, with a

“disturbing lack of kindness and compassion”

and victims’ families even blamed for their devastating losses. Before I say more, Mr Speaker, I want to say this: I am profoundly sorry to all the families affected. This should never have happened, and we will work tirelessly to put it right.

With the report having been published just yesterday, I am sure hon. Members will understand our need to carefully consider all of its details. I will be reviewing all the recommendations, and will issue a full response once I have had time to consider them. However, given the gravity of what the report reveals, I felt it was important to come to the House today and update colleagues on the steps we are already taking to improve maternity services in east Kent and across the country.

The report itself is a litany of failure that makes for very difficult reading. It details failures of team working, failures of professionalism, failures of compassion, failures to listen, failures after safety incidents, and ultimately a failure of leadership. The review heard about women and family members feeling patronised, ignored or told off, with one woman hearing from a doctor:

“Some parents just aren’t supposed to have children.”

Some people felt they were unimportant, or too much trouble. One woman was reportedly told by a staff member that they were sorry for her loss, but that her baby was dead, and that there were other babies who were still living who needed attending to. These kinds of failures showed up at every level of patient care, with no discernible improvement over the whole timeframe of the review. The trust failed to read the signals and missed every opportunity to put things right.

These are difficult things to hear, and especially hard because I know that so many of us have experienced for ourselves the brilliant care that NHS maternity services can offer. We must take nothing away from the hundreds of thousands of incredible people working day and night in maternity services across the country, yet we cannot pretend that the story of East Kent is a one-off. Reviews from Morecambe Bay and Shrewsbury and Telford paint a more disturbing picture. While they may be some of the most extreme examples—and we must hope that they are—they are certainly not isolated incidents. Colleagues will know that, just last month, Donna Ockenden began her independent review into maternity services at Nottingham University Hospitals NHS Trust.

We entrust the NHS with our care when we are at our most vulnerable. Everyone has the right to expect the same high-quality care, no matter who they are or where they live. We are already taking a number of steps to improve the quality of maternity care in East Kent and across the country. An intensive programme of maternity support was put in place at East Kent Hospitals University NHS Foundation Trust in September 2019, overseen by NHS England, the Kent and Medway integrated care system and the trust’s board. The trust has been allocated a maternity improvement adviser and an obstetric improvement adviser. We will also continue to ensure the highest standards at national level.

I am grateful to Dr Kirkup for the extensive recommendations in his report, but it is vital that they are not viewed in isolation. As Dr Kirkup said, since his Morecambe bay investigation in 2015,

“maternity services have been the subject of more significant policy initiatives than any other service”,

so his recommendations must be considered alongside existing work to improve maternity outcomes.

First, there is our independent working group. The group is one of the key immediate and essential actions from the Ockenden review and has begun its important work. The group, chaired by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, is advising the maternity transformation programme in England on how it can take forward the findings of both the Ockenden and the Kirkup reports. Next, our new maternity quality surveillance framework is a vital tool for proactively identifying problems in trusts, so that they can get support before serious issues arise. In March 2022, NHS England announced a £127 million funding boost for maternity services across England, to help ensure safer and more personalised care for women and their babies. Even with that essential work, we recognise that there is still a long way to go and much more work to be done to put things right.

In closing, I want to thank Dr Kirkup and his team. His experience has been invaluable, and I know that his approach of putting families first has been welcomed. I also know that hearing the accounts of families has been a harrowing experience at times, yet, as he said, it is difficult to imagine just how much harder it was for the families as they relived some of their darkest days. I am sure the whole House will join me in paying tribute to those families, whose tireless determination to find the truth and tell their stories has brought us to this important point. Nothing we do can bring back the children they have lost or fill the tragic void of a life never lived, but now we know their stories, we will listen, learn and act, so that no other family should ever experience such pain. I commend this statement to the House.

--- Later in debate ---

[Dr Johnson]

I thank the hon. Lady for her questions. The report paints a tragic and harrowing picture of poor maternity care at East Kent Hospitals. She talks about accountability. She will be aware that the chief executive and chairman of that trust board have changed, and that those new in their posts are working hard to ensure that things are turned around and improve.

The hon. Lady talked about funding and workforce. I understand why she did that, but if she reads Dr Kirkup’s report, it is clear that they were not causative factors in this case. This was about culture and workplace practice, not money and staffing levels. She also asked how that money has been spent. It has been spent on staffing, workforce and training. She also asked about culture change and how that will be measured. It is being looked at in several ways, particularly in terms of the outcomes, such as healthy babies and the mother’s experience of their care.

[Sir Roger Gale (North Thanet) (Con)]

Mr Speaker, first, thank you so much for facilitating this statement. You know that as not just the constituency Member of Parliament, but a father and a grandfather, this is a matter of profound importance to me personally. Can I welcome the Minister to the Dispatch Box for the first time and thank her for the tone of her remarks?

Nothing is going to bring back the children who were lost in the Margate unit. Nothing is going to erase the pain felt and continuing to be felt by the parents. I would like to commend them for the quiet dignity with which they have fought their cause under horrific circumstances for so long. I would also like, if I may, craving your indulgence, Mr Speaker, to thank Bill Kirkup and his team for the sensitivity with which they have handled this and listened to the harrowing stories from so many people—stories that should never have had to be told.

What we can do is to try to put this right, so that this never ever happens to another family again. It will come at a cost and, with a Treasury Minister on the Front Bench, I have to say that £33 million-worth of investment is now needed immediately in the maternity unit at Margate. What I would like to do at this stage is to ask my hon. Friend to tell me from the Dispatch Box that she is willing to bring her medical expertise, which is considerable, to Margate, and to come herself to see the unit, meet the staff and meet the new chief executive and the new chairman, who are determined to do their utmost to make amends and to do so as swiftly as possible.

[Dr Johnson]

I thank my right hon. Friend for his comments. I note that he has been a doughty campaigner on this issue, and I know how much it matters to him personally, as well as as a Member of Parliament. I would of course be happy to come to Margate to meet the staff he describes.

[Rosie Duffield (Canterbury) (Lab)]

I thank the Minister for her statement, Dr Kirkup and his team, and the families and staff who took part in the inquiry. It is clear that there has been an utterly toxic and dysfunctional culture within maternity services at the East Kent hospitals trust. It is shocking and disturbing, and made so much worse by the revelation that the trust tried to cover up these cases. Mothers were treated appallingly and babies died. I cannot comprehend what they have had to endure, and I am so angry on their behalf. How can the Minister assure my constituents that action leading to immediate change will not involve any of the staff and managers involved directly in these cases? And given that former staff and a governor have said publicly that they cannot recommend the service, how can MPs in East Kent tell our constituents that our maternity services are now safe?

[Dr Johnson]

I know that this is a matter on which the hon. Lady has been campaigning furiously on behalf of her constituents. I share her anger, and her shock when I read the report, at some of the cases and some of the ways in which patients have been spoken to during their time at their hospital. It is truly unforgivable.

On the question of safety, that was my first question when I read the report: are we sure that patients going in today to have their babies are safe to do so? So I met Anne Eden, the regional director of NHSE, yesterday to talk to her about safety, and I have been reassured about both quality and outcomes. On outcomes, I have been reassured that, looking at crude data, which I appreciate has not been published yet, the numbers of stillbirths and neonatal deaths over the last year or so have fallen substantially. On quality, it is doing a review, so each woman is contacted six weeks after her delivery to ask about her experiences, and where experiences have not been as they should be—although they are in almost all cases—that has been further investigated in each case.

[Damian Green (Ashford) (Con)]

This report is a terrible read, particularly, obviously, for bereaved parents, who have gone through untold anguish, including some at the William Harvey Hospital in my constituency. What makes me particularly angry is that this was going on for more than a decade under several different management regimes at the trust. Can the Minister give some reassurance to women in Ashford who are about to have a baby at the William Harvey that they will be treated safely and respectfully, and can she assure the House, looking further afield, that the terrible repeated examples of similar tragedies and scandals around the NHS are now at an end?

[Dr Johnson]

I know that my right hon. Friend shares the House’s desire to ensure that such events do not reoccur, and that his constituents are safe. He asked about failures over time. In fact, there were signs as early as 2010 that problems were being raised with the trust. The failure was not so much to find those problems, but that they were not properly dealt with when they were found. Yesterday, I received assurances from the regional director of NHS England, as I described a few moments ago, and I will meet her regularly to receive updates to ensure that the process is not just put in place but followed through.

[Clive Efford (Eltham) (Lab)]

The stories of the families are harrowing to read. I hear what the Minister says: that staff shortages cannot be used to excuse the poor practice that has taken place. None the less, it is disturbing that NHS England has abandoned its safety targets under the midwifery continuity of care model. When more midwives are leaving the profession than coming into it, as a matter of urgency to avoid such occurrences in other places, what are the Government going to do to turn around that loss of midwives?

--- Later in debate ---

[Dr Johnson]

NHS England has announced that it is investing an additional £127 million into the maternity system in the next year. That money will go towards the maternity workforce and improving neonatal care. In addition, £95 million was invested last year to support the establishment of more than 1,200 more midwifery posts and 100 more consultant obstetric posts. Work is already under way as part of the biggest nursing, midwifery and allied health care professional recruitment drive in decades. That will help us to increase the number of midwives in East Kent but also elsewhere.

[Helen Whately (Faversham and Mid Kent) (Con)]

I thank my hon. Friend for her statement, and particularly for the tone in which she made it. Dr Kirkup’s report is harrowing reading, but nothing compared with the harrowing experiences of the parents whose babies were severely injured at birth, stillborn, or lost in the days after they were born, particularly when so many of those incidents were avoidable. It is a shocking litany of clinical and management mistakes, missed opportunities, failures to take responsibility and an incomprehensible normalisation of baby death, despite all the efforts to improve safety since the Mid Staffs scandal. I ask my hon. Friend to put herself in the shoes of an expectant mum—I know that as a mum she will be able to do that, as well as from her experience as a clinician—and categorically assure me and all the parents to be who are soon to have babies in the East Kent trust, that the maternity units in those hospitals are safe for them to give birth?

While there are worthwhile sections on actions in the report—I commend Dr Kirkup for his report—it does not get to the bottom of the problem, which is truly one of accountability. Can my hon. Friend assure me that never again will a trust find reasons to excuse catastrophic outcomes, that never again can critical reports be dismissed as a “load of rubbish”, and that never again can staff blame patients for a hospital’s failings? How will she assure herself as a Minister—I know this is a difficult role—that every maternity unit in every hospital across the country is safe for mothers to give birth?

[Dr Johnson]

I know my hon. Friend has campaigned hard as both a Minister and a Back-Bench MP for safety in the national health service. On safety at the East Kent trust, we have already talked about the regional team there. There is also a maternity safety support team in the trust working actively on the ground to ensure that lessons are learned and services improved. I have been given some figures that demonstrate that the outcomes are improving. As I said earlier, steps are in place to ensure the quality of service and to feed back the quality of service to ensure that no woman is spoken to in the way described in the report.

From a wider perspective, we are looking at both the workforce as described but also at how we ensure that problems are not just picked up, but developed and followed through. We are also looking at the Kark report that looked at how managers are held responsible. We will talk more about that in due course.

[Rachel Hopkins (Luton South) (Lab)]

Many of my constituents have raised the point that black women in the UK are four times more likely to die in pregnancy and childbirth. Can the Minister explain what action is being taken to end that scandal?

--- Later in debate ---

[Dr Johnson]

From a wider perspective, the Government have a target of reducing stillbirths and neonatal deaths across the country and that, obviously, includes women of colour.

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

What was particularly shocking about the report, coming hard on the heels of Shrewsbury and Morecambe Bay, was the culture of cover-up that it revealed, the lack of empathy—extraordinarily—among staff and the fact that it took parents and grandparents such as Derek Richford to campaign to get the exposé. Does the Minister agree that, given that liveborn children were described as being stillborn so coroners could not investigate, it underlines yet again the need for my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, which was passed by the House three and a half years ago and gives powers to coroners to investigate stillbirths, to come into force at last? Will she go and speak to the Justice Secretary and liaise between the Departments to get that measure enacted straightaway to give some confidence to those parents who have been through these terrible experiences?

[Dr Johnson]

I understand my hon. Friend’s passion in this area. I am happy to meet him to discuss it further.

[Richard Foord (Tiverton and Honiton) (LD)]

We have seen several tragedies in health and social care services across the country. Both the Ockenden review earlier this year and this recent upsetting report by Dr Kirkup highlight serious multiple failings. It should go without saying that health outcomes should never be determined by location. We must tackle the inequalities that exist between rural and urban maternity services to ensure that people living in rural and coastal areas can access the same range of birthing methods and support. Will the Minister support the Maternity Services (Rural Areas) Bill introduced by my hon. Friend the Member for St Albans (Daisy Cooper) to end maternity service inequalities for people living in rural and coastal areas?

[Dr Johnson]

As a rural Member of Parliament, I understand the need for rural services to be just as good as those in more urban areas and to ensure that they are improved where they are not adequate. A medical education reform programme that is co-sponsored by NHS England and Health Education England is expected to direct investment for specialty training more towards area population need—to smaller and rural hospitals. The programme entered its implementation phase in August. Morecambe Bay, East Kent, James Paget and Shrewsbury and Telford are included in our current smaller hospitals list. I am not certain about the hospital in the hon. Member’s constituency, but I can find that information and write to him about it.

[James Morris (Halesowen and Rowley Regis) (Con)]

This is clearly a shocking and disturbing report. I found myself agreeing with the shadow Minister when she said that this represents a serious collective failure across our maternity services, because I know that it is not an isolated incident. Does the Minister agree that there is a role to be played by the Healthcare Safety Investigation Branch, which has set up a stream of work on maternity services? Could she redouble her efforts in conjunction with that body to ensure that we learn the lessons of the cultural failures in this case and that that learning is spread throughout the system? That is the only way we have an opportunity to ensure that these things do not happen again.

[Dr Johnson]

My hon. Friend will be aware that within HSIB the Government are establishing a new special health authority specifically for maternity investigations, with specialist expertise. This independent body will continue the work of HSIB from 2023. In the meantime, maternity investigations will continue without interruption until it is fully operational.

[Jim Shannon (Strangford) (DUP)]

First, I welcome the hon. Lady to her place. We are very pleased to have her expertise and knowledge in that role as Minister. This House will benefit from it. I would also like to express, on behalf of myself and my party, my sincere sympathies to all those who have lost loved ones. I think it is fair to say that we all have those families in our thoughts and prayers. Will the Minister outline what discussions have taken place with devolved health trusts in the devolved nations to share information and ensure UK-wide reform? It is clear that the pressures that led to this terrible scenario in Kent are ready to be replicated through the United Kingdom of Great Britain and Northern Ireland, as midwives battle with understaffed, unsupported and exhausted wards that are on the brink of life-and-death disasters. Through no fault of individuals, midwives will carry that all to their graves. I know the Minister is committed to making it better. How can we do that for all of this great United Kingdom of Great Britain and Northern Ireland?

[Dr Johnson]

It is, of course, important that information is shared across our great country, so that people in all areas of our nation get the best-quality care. Health is a devolved issue, but I will continue to work with Ministers from the devolved nations to ensure we share the lessons and learn from each other.

[Robert Courts (Witney) (Con)]

My constituent Helen Gittos, whose healthy full-term daughter Harriet died in 2014, said:

“Too often during pregnancy, in labour and afterwards, rather than being listened to, we were treated dismissively, contemptuously and without a desire for understanding. It is hard enough to come to terms with the death of a child; it is even harder when you are implicitly blamed for what happened.”

Will the Minister commit to ensuring the implementation of all five recommendations, to beginning the process of doing so by recess, and to making an oral statement to the House detailing what progress has been made, again by recess?

[Dr Johnson]

I know my hon. Friend shares my horror at the report and my horror at the way women and their families were treated at East Kent maternity hospitals. The report was published only yesterday. I will be considering it very, very carefully and will further update the House in due course.

East Kent Maternity Services: Independent Investigation

Caroline Johnson Excerpts

Wednesday 19th October 2022 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

I wish to inform the House that the independent review into maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust has today published its report, which can be found here:

https://www.gov.uk/government/publications/maternity-and-neonatal-services-in-east-kent-reading-the-signals-report

NHS England commissioned Dr Bill Kirkup CBE to undertake an independent review into maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust in February 2020, following concerns about the quality and outcomes of care. On behalf of the Government, I would like to thank Dr Kirkup, the families, and all those who contributed to the report.

The report details the poor maternity care that over 200 families received at East Kent Hospitals University NHS Foundation Trust between 2009 and 2020. The trust failed to provide safe care and treatment which resulted in avoidable harm for mothers and babies, causing tragedy and distress that no family should have to experience. I am profoundly sorry to all the families that have suffered and continue to suffer from these tragedies. I also wish to pay tribute to the families who have come forward to assist the review.

In line with the review team’s families first approach, I am pleased to hear that the families were able to see an advance copy of the report this morning ahead of the publication.

I, and the Government, take the findings and the recommendations from the report extremely seriously and I am committed to preventing families from experiencing the same pain in the future.

My Department along with NHS England has already established the independent working group, chaired by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. The independent working group will help guide the implementation and next steps of the immediate and essential actions from the Ockenden report and the recommendations from the East Kent report. The group has met twice to date, and the next meeting will focus on reviewing the recommendations for the East Kent report.

In March 2022, NHS England also announced a £127 million funding boost for maternity services across England that will help ensure safer and more personalised care for women and their babies.

I will be reviewing and considering all the recommendations from the report, and I will issue a full response once I have had time to consider the recommendations.

[HCWS329]

Covid-19 Vaccine Supply

Caroline Johnson Excerpts

Wednesday 12th October 2022 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

It is normal practice when a Government Department proposes to make a gift of a value exceeding £300,000, for the Department concerned to present to the House of Commons a minute giving particulars of the gift and explaining the circumstances; and to refrain from making the gift until 14 parliamentary sitting days after the issue of the minute, except in cases of special urgency.



I am writing to inform you that while Parliament was in recess the Department of Health and Social Care has started to donate approximately 30,000 doses of surplus covid vaccines to Barbados and Antigua & Barbuda. The combined value of these donations exceeds £300,000 and the donations will be accounted for as gifts since both countries are not eligible for official development assistance (ODA).

I want to take this opportunity to explain that we proceeded with these donations as a matter of urgency. The doses were surplus to the requirements of our domestic vaccination programme and were requested urgently by the recipient countries, including to vaccinate children before schools returned during September. Donating these doses with maximum available shelf life meant that they could be used rather than expiring and having to be destroyed.

The Permanent Secretary of the Department of Health and Social Care has written to the Chairs of the Public Accounts Committee and the Health and Social Care Committee to notify them of these gifts. This statement provides retrospective notification to the House of Commons.

HM Treasury has approved the decision.

[HCWS318]

Liver Disease and Liver Cancer: Diagnosis

Caroline Johnson Excerpts

Tuesday 11th October 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for securing a debate on this important issue. She has been a great advocate on this topic, and I share her commitment to tackling this serious disease. I also thank my hon. Friend the Member for Darlington (Peter Gibson) for his kind words and for sharing his family story and speaking about some of the personal, family impact of these terrible conditions.

It is a year ago this month that our colleague, Sir David Amess, was tragically taken from us. He had a huge interest in liver disease. He was the co-chair of the APPG for hepatology and did so much to raise awareness of this disease in Parliament. One of the many ways we can take forward his legacy is to improve the lives of those with liver disease. That is why, although the Minister responsible for this topic was unable to attend, I wanted to ensure that I took forward this important debate and updated hon. Members on the work we are doing.

Many have talked about the scale of the problem, so I will not go further into that, but I want to talk about what we will do to address it. First, the NHS plan will help us to do that. It recognises the importance of preventing avoidable liver disease through targeted policies to address alcohol consumption and obesity. Unfortunately, most people are diagnosed with liver disease at a late stage, when it is less treatable, and they are often diagnosed during an emergency hospital admission. It is for that reason that liver disease is often called the silent killer.

To help detect early signs of liver disease, NHS England has a number of trials in train. One is evaluating intelligent liver function tests. That is when patients get a normal liver function test, and the laboratory has a process in place, based on those results, to test the same sample further, not necessitating a further appointment, so we can work out which patients need further investigation and treatment.

The NHS health check for 40 to 74-year-olds also identifies people particularly at risk of alcoholic liver disease and refers them in for further treatment and investigation. On top of that, we have the fibroscans, which have been rolled out through community diagnostic centres. They help to identify fibrosis in the liver at a time when we can try to treat it and before it becomes worse. Last year’s spending review allocated £2.3 billion for diagnostics to increase the number of community diagnostic centres to at least 100 by March 2025. That will boost diagnostic capacity to diagnose liver disease and improve earlier diagnosis and health outcomes.

The hon. Member for Strangford (Jim Shannon) talked about education for children about alcohol. Education on alcohol is now a statutory component of relationships, sex and health education in England.

My hon. Friend the Member for Totnes (Anthony Mangnall) talked about a review of liver disease and liver care. That is taking place in 2022-23, and there should be a report after that. He and my hon. Friend the Member for Warrington South (Andy Carter) raised transplant care. I will ask the responsible Minister to write to them with further details about what is being done in that area.

The hon. Members for York Central (Rachael Maskell) and for Strangford said that many liver diseases can be prevented and are preventable, particularly in relation to alcohol, obesity and hepatitis, and I want to talk a little about what we are doing in those areas. Alcohol is the leading risk factor for liver disease, and identifying disease early in those at risk and supporting them to stop drinking is critical. If they stop drinking, that can halt or even reverse damage to the liver. People at risk of alcoholic liver disease are being identified and given early access to tests, to detect emerging liver disease through the health check and other means.

The NHS has also invested in the treatment of alcoholism: £27 million has been used to establish specialist alcohol care teams in hospitals with the highest rates of admissions related to alcohol dependence. Those specialist teams will help identify alcohol-dependent patients, start them on specialist alcohol treatment in hospital and support their transfer to community alcohol services.

Since April 2022, NHS England has introduced a measure known as commissioning for quality and innovation, which incentivises providers to improve earlier detection of liver disease for alcohol-dependent in-patients in acute and mental health services. We are also committed to increasing liver health investigations in community treatment settings. Through the drugs strategy, we are making the largest ever single increase in drug and alcohol treatment and recovery funding, with £780 million of additional investment over the next three years.

As hon. Members said, another major risk factor is obesity. Tackling obesity is a major priority for the Government. We have seen some important successes since 2016. The average sugar content of drinks subject to the soft drinks industry levy decreased by about 43% between 2015 and 2019. This month, regulations have been brought in about store placement of products that are high in fat, salt and sugar, so that they cannot be displayed in areas of the store that are attractive and available to children. There have also been the provisions set out in the Calorie Labelling (Out of Home Sector) (England) Regulations 2021 and an investment in further weight management services for people living with obesity.

I would like to turn to hepatitis B and C, which are also important risk factors for liver disease and primary liver cancer. Through the NHS hepatitis C virus elimination programme, we have reduced the number of people living with chronic hepatitis C virus infection in England by 37% since 2015. New treatment with direct-acting antivirals has massively improved the success of the treatment, with mortality from hepatitis infections falling by 35% since 2015. So that has already reaped rewards.

There is a new opt-out pilot programme of testing for HIV, hepatitis B and hepatitis C in emergency departments in areas of the country where HIV is most prevalent, which is a proven way of identifying new cases. During the first 100 days of the pilots in London, Blackpool, Brighton and Manchester, 328 people with hepatitis B were newly diagnosed, with 30 found to be lost to care. Each of them is an individual who will now be able to be treated effectively for the condition, which will reduce the risk of passing it on. Similarly, 137 people were newly diagnosed with hepatitis C, of whom 23 were found to be lost to care. Those are promising early results in just the first 100 days, and we now looking at what we can do to perhaps roll this programme out to other centres.

Many hon. Members talked about primary liver cancer, which has a tragic impact. As my hon. Friend the Member for Darlington said, the number of recorded deaths has more than doubled in the last two decades. Cancer Research UK statistics show that there are around 6,200 new cases diagnosed each year and, tragically, 5,800 deaths. Unfortunately, the five-year survival rate for people with liver cancer is poor, at only 13%, and that could be markedly improved by earlier diagnosis, as I mentioned.

To contribute to achieving a long-term plan ambition to diagnose 75% of cancers at an earlier stage by 2028, the NHS cancer programme has launched the early diagnosis liver programme. The programme aims to detect more liver cancers at an earlier stage, so that more patients can benefit from treatment. More people at a high risk of liver cancer are referred to six-monthly liver surveillance. The national cancer programme is working in partnership with the hepatitis C virus elimination programme to deliver 11 community liver health check pilots.

The pilots aim to support early detection and diagnosis of liver cancer by identifying and referring people with cirrhosis or advanced fibrosis into a liver surveillance pathway, and providing them with a peer supporter who can help and guide them through future appointments. The pilots will target people experiencing significant inequalities and those who disengage from the healthcare service, including homeless people, those with alcohol and substance addiction, sex workers, people in the justice system, disabled people and others. The hon. Member for Enfield North (Feryal Clark) mentioned the workforce; she will be interested to know that over the last five years there has been a 20% expansion in the number of consultant hepatologists.

This is an important debate on a very important issue. We have heard some heartfelt contributions about the pain that liver disease and liver cancer bring to so many people and their loved ones across the United Kingdom. This Government are determined to take action and to make the changes that are needed to tackle this deadly disease.

[Mr Clive Betts (in the Chair)]

Margaret Ferrier has one minute to wind up.

Access to GP Services and NHS Dentistry

Caroline Johnson Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting]

I wholeheartedly agree with my hon. Friend; it is the trend with this Government to seek division, sow division, pass the buck, devolve the blame and not take responsibility for anything. What Opposition Members would not give for just one day of being able to govern in the interests of the people in this country! This Government want to give the appearance of being in office but not governing at all. That is what is happening on their watch. If that is not bad enough, against a difficult economic backdrop, with scarce resources, not only is the way in which they manage and govern bad for patients, but it is squandering taxpayers’ money.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

rose—

[Wes Streeting]

I will give way in just a moment. The problems in general practice are storing up problems for the rest of the NHS; as we have heard, people are presenting in accident and emergency because they cannot see a GP. That failure is costing the taxpayer dearly. A GP appointment costs the NHS £39, but a visit to an urgent care centre costs it £77 and a visit to the emergency department costs it £359. The Government’s failure to invest in new GPs may be penny-wise but it is pound-foolish. It is wasting money and inconveniencing patients, and it is not the way to manage the NHS. One of my constituents wrote to me yesterday to say that if she wants a same-day appointment for her baby, her GP sends her to A&E. She wrote:

“I was sent to A&E to check a newborn baby’s suspected ingrown toenail that had no sign of infection. How is going to A&E for a non-urgent matter a good thing for anyone.”

Yet that is what our constituents are forced to do, because they cannot get a GP appointment. I hope the hon. Member for Sleaford and North Hykeham can give us some insight as to why.

[Dr Johnson]

As part of that, I suggest that the hon. Gentleman remembers that GPs take 10 years to train. He is right to say that we have been in government for 12 years, but most of the current GP shortage is because the previous Labour Government did not train those GPs at the time. One of the first things the Conservative Government did was to set in train the opening of five medical schools to increase the number of medical students. We had enough doctors but they do take 10 years to train. The reason I stood up to intervene on the hon. Gentleman was to say that one of the challenges that doctors—I refer to my entry in the Register of Members’ Financial Interests, as a doctor—and members of staff face is being abused in a surgery. I wonder whether he would like to apologise for some of the comments he has made on social media—

[Mr Speaker]

Order. Interventions are meant to be questions. I know that the hon. Member is down to speak. I would not want you to use up your speech now; I want you to save something for later.

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests. The debate is about GPs and dentists, and I will deal first with GPs. I pay tribute to the GPs who work in my constituency, and in particular those at the New Springwells practice and at Caythorpe and Ancaster medical practice, which have outstanding CQC ratings. I also pay tribute to the GPs who delivered the vaccine service. Not only did they work during covid with its challenges, but they delivered a vaccine service as well. They are a very hard-working, admirable group of people.

I agree with the Opposition that much of the overall problem with the NHS is a workforce problem. That is true. There are too many staff overall, and not enough of them are directly delivering or improving clinical care. We have expensive, very highly trained clinical decision makers being asked to do admin tasks that take them away from the clinical tasks that we are paying them for and which we need them to do. That contributes to our longer waiting times. So we need to increase the number of doctors.

The Opposition are making a big point about 12 years, but it takes 10 years to train a GP, and it takes longer than that to train a consultant. So, actually, the shortage was created during Labour’s time in government and we are trying to fix it. That is indeed why the number of medical schools has been increased by five. I am pleased that one of them is in Lincoln, just outside my constituency. It is training a new generation of doctors who will provide services locally—people predominantly stay where they train—which will help the people of Lincolnshire to have more access to doctors. However, the Government should go further. In the year when we had challenges with A-levels caused by covid and more people than expected got the grades required to get into medical school, places were exceptionally increased. There are challenges with that—only so many people can get around a bedside and a patient will be happy to have only so many people listen to their heart or feel a lump or bump or suchlike—but, nevertheless, it has been managed for one year, and I think that it could be managed for more. The best thing that the Government could do for the health service in that regard would be to massively increase the number of doctor places. At the moment, we are turning away keen, enthusiastic potential young doctors doing their A-levels because places are so oversubscribed, but then we find that we have a shortage. That surely cannot be right.

I turn to ease of access. The Secretary of State mentioned making it easier for people to be referred into secondary care, which of course is a good thing, but we need to ensure that training is in place for that. Since I became a consultant, we have seen the number of patients referred into secondary care increase rather rapidly—certainly in the department that I work in—but the quality of referrals has not always been right, and undoing an unnecessary referral can be more time-consuming than just seeing the patient. We need to be mindful of the need to have clinical decision makers doing what they need to do and, as such, if we are to broaden the scope of people making referrals, we need to ensure that either referrals are done with specific guidance or that training is provided so they are good-quality referrals, and not those that add to waiting lists.

On dentistry, we have heard much talk about children having whole-mouth teeth extractions. Clearly, that is a horrific thing to happen—it is unimaginable, really, that a child needs to come into hospital to have all their teeth removed. I look to the Minister to tell us what she doing about that, because it is not, as some have suggested, all the Government’s or the NHS’s problem. In part, it must be about diet, teeth brushing and dental care—whether the teeth are being properly looked after—as well as potentially fluoride enhancement of water and the availability of dentists. Several stages need to be looked at in a more holistic way to prevent these children from having to go through such an awful experience.

In Lincolnshire, NHS dental care is good, but the service’s availability is relatively poor. In the last two years, only 41% of adults in Lincolnshire have seen an NHS dentist, and less than a third of children saw an NHS dentist in the last year. The Minister will be aware that I had an Adjournment debate on the topic in October. I thank her for her engagement with me since and for her support in identifying potential solutions, as well as local dentists, the local dental committee, Professor Juster from the University of Lincoln and Health Education England for their time. They are just some of the people I have met to discuss Lincolnshire’s dental issues and how we can improve care.

The first thing to be solved is, of course, the dental contract. The contract was created by Labour in 2006, but I agree that we have had time and should probably have sorted it out by now. I raised that with the previous Secretary of State when I was on the Health and Social Care Committee in the previous Parliament. The contract pays for units of dental activity. There are three levels covering wide ranges of levels of care. Why Labour signed off on a contract that created such variability in both the value of a UDA and the amount of work required to be paid for one, I do not know, but it is human nature for someone to expect to be paid more if they have done more work, and that someone given the option of earning more for doing the same work will choose to do so. There, fundamentally, are the problems we have with the NHS contract. I look forward to hearing what the Minister is doing on that. I understand that she is in negotiations with dentists at the moment. I hope that she will be able to update the House on progress and that it will be good progress.

The second issue is geography. We know that our medical students predominantly stay where they train, and there is no dental school in the east midlands or in East Anglia. I am grateful to Health Education England and Ministers for discussions about solutions to this following my question at Prime Minister’s questions. There are a number of ways of resolving it. In the longer term, a dental school at Lincoln University would be a good way of ensuring that we have locally grown, locally trained dentists. The university is very supportive of that in the discussions, and indeed we have the support of all Greater Lincolnshire Members of Parliament for ensuring that this goes ahead.

I appreciate that it will take time to plan and deliver that, so in the meantime we need more dentists locally. The Minister and I have recently been talking about centres of dental development. The principle of a centre of dental development, which I would like to see in Sleaford, is that postgraduate training is delivered. It is attractive work for the sake of recruitment. People want to work at a centre because they get to deliver training and it is a more attractively remunerated job, but also, the postgraduate people being trained are immediately delivering care. Such a facility could be up and running within 18 months to two years and actively delivering care to my constituents, which is what I am looking for. I am particularly keen to see a centre located in Sleaford, because we have relatively few NHS dentists. We have great local schools, we have a fabulous community and we have great rail links, both north-south and east-west. What progress is the Minister making on these proposals?

Does the Minister have any update on what progress is being made on support for military families? I have a number of RAF bases, including RAF Cranwell, in my constituency. People who have moved around from place to place find that they have dropped off the list in one area and are struggling to get on to one in another. We have a covenant that says that we will ensure that people who are serving in our armed forces, and their families, are not disadvantaged, but clearly in this regard they are. I would be grateful for those updates from the Minister.

Health and Care Bill

Caroline Johnson Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I would like to draw Members’ attention to my entry in the Register of Members’ Financial International, and particularly, since these organisations have been mentioned, to state that I am a member of the British Medical Association and the Royal College of Paediatrics and Child Health.

The measure relating to amendment 92 was introduced in the context of the pandemic. The reason that the rules were brought in the first place was to protect women from coronavirus and to reduce its spread within society at a time when we did not have a vaccine. For me, this debate is not about ideology at all—it is not about the rights or wrongs of abortion, whether women should or should not be able to have abortions, whether or not life begins at birth, or anything of that nature. Society and Parliament have decreed that abortions may take place and that women should have the right to choose, and I support that. For me, this is a debate about women’s safety, particularly the safety of the most vulnerable and marginalised women and girls.

Previously, women would have attended a clinic and been given a tablet and another tablet to take a day or so later, and usually the bleeding would begin in the hours after the second tablet is taken. Under the new process, a woman or girl can speak to somebody on the telephone to arrange for the tablets to be delivered to her, or to be collected by her, and then take the tablets at home. It is very difficult for a clinician to tell whether the woman they are speaking to on the telephone is indeed pregnant. There are not necessarily visible signs of pregnancy below 10 weeks, and palpation of the abdomen would not be expected, so it is not clear to the clinician on the phone whether the woman is pregnant. Clearly, someone believes a woman when she says she is pregnant, but there is no way to be certain. In particular, there is no way to be certain of gestation. Although a woman may know when she has had sex and when her last period was, quite a number of women will bleed in the early stages of pregnancy, and some women mistake those early bleeds for a period, which means that women may believe that they are less pregnant than they are. If they go to a clinic, that can be determined, whereas over the telephone it cannot.

The NNDHP, which my hon. Friend the Member for Congleton (Fiona Bruce) mentioned, has found a number of examples since March 2020 of women who have had babies delivered quite significantly later in gestation; they had mid-term to late-term abortions believing that they were early in pregnancy when they were not. The examples included 12 babies who were born with signs of life, so the pregnancy would have been quite advanced. The women thought that they were at less than 10 weeks, or told the doctor that they were at less than 10 weeks, but they were not. In six of those cases, the woman giving birth was herself a child. One can only imagine the distress felt by these women and children when they take an abortion pill to deliver what they believe to be a foetus of less than 10 weeks and out comes a baby of up to 30 weeks’ gestation who may at that point have been alive. It is not rare to have side effects from these tablets. One in 17 women have to attend hospital and 36 women call 999 each month because of complications of taking these medicines at home.

If this measure had been introduced in a proper fashion rather than as part of the coronavirus regulations, we would have discussed it quite thoroughly and made it very clear that it should not apply to children. I do not think that many people in this House would think that a 14-year-old girl should be ringing up and receiving abortion medicines over the telephone, but that is indeed what the legislation allows. People may say that doctors would not do that, but we know that six of the children who delivered babies that they thought were at a much earlier stage were themselves under the age of 18.

[Steve Brine]

Surely the point is that this measure was brought in hastily in a pandemic. Therefore, if Members are not sure today, far from abstain, they should be returning to the status quo pre-pandemic. Then this Government can should consider the issue properly and seriously on its own and ask the House to make a decision.

[Dr Johnson]

I can only absolutely agree with my hon. Friend’s intervention.

I also want to talk about coercion, because we know that some women may be coerced into having an abortion.

[Dame Diana Johnson]

Before the hon. Lady moves on, I want to raise something with her. Obviously she has a clinical background, and she will know jolly well about the range of safeguarding measures that all clinicians, the royal colleges and all those involved in abortion care have to follow. She makes it sound as though no safeguards are in place. For instance, if a 14-year-old telephoned a clinician to seek advice around abortion, that clinician may well say, “I want to see you face to face.” There is nothing to stop that happening, and that may well be a proper safeguard that would carry on, irrespective of whether telemedicine carries on today.

[Dr Johnson]

With respect, the right hon. Lady makes my point for me, because that is right: there is nothing to stop that happening, and it may be that the doctor would say that they wanted to see the patient, but they do not have to do so. We know that abortions are being prescribed by telemedicine to children under the age of 18. If this measure had been looked at properly by the House as a single issue, rather than as this amendment to something else, we would have stipulated that children under the age of 18 should not be receiving abortions over the telephone without proper appointments, as I think they should and as the right hon. Lady, if I understand her correctly, also seems to be saying that they should.

We know that sometimes women and girls can be coerced into having abortions that they do not want, perhaps because the baby is of a gender or sex that the father does not want, perhaps because they are being abused, or perhaps they are being trafficked or sexually assaulted. It is very difficult for a woman to tell someone about that over the telephone, whereas if a woman is seen in clinic, she has that one-to-one opportunity.

[Jess Phillips]

Will the hon. Lady give way?

[Dr Johnson]

I am going to finish my point. In person, the woman has a one-to-one opportunity with that clinician and a chance to say, “Please can you help me?” Clinicians are alert to that opportunity to provide that help. It is true that if the woman receives the abortion by post, the problem of her being pregnant is solved, but the problem of her being abused is not. That is what can continue.

[Jess Phillips]

Will the hon. Lady give way?

[Dr Johnson]

No, I am going to continue. The other problem with giving tablets—[Interruption.] The hon. Lady spoke for 16 minutes, which is considerably more than a fair share, given the number of Members who want to speak, so I will keep going.

The other problem is who will take the tablets. If someone is prescribed something of such severity over the telephone, the clinician does not know who will take the tablets. Will they be taken by the woman speaking to the clinician on the telephone? Will they be given to somebody else? Are they going to be sold to somebody else? Is somebody else going to be forced to take them? The reality is that we do not know and we cannot know, and that is another safety issue.

I will summarise my concern by saying, as a woman— I have not had an abortion, but I guess in the future I could become pregnant and not want to be—if I were having an abortion, I would rather have the inconvenience of having to go to a clinic than the worry of knowing that some women are having abortions without going to a clinic. Essentially, for me this is an issue of whether we want to make things more convenient for the majority of women, or we want to protect the women who are the most vulnerable, the most marginalised and the most at risk.

[Mr Deputy Speaker (Mr Nigel Evans)]

I intend to call the Minister at 5 o’clock to give him 10 minutes to wind up. We have not got long, so will Members please keep their contributions as short as they can?

Elective Treatment

Caroline Johnson Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

The hon. Lady is of course right to talk about the importance of health inequalities. I hope that when she has had time to look at the plan she will see just how seriously the NHS and the Government take that. More broadly, I will have a lot more to say about tackling health inequalities shortly. Of course, the hon. Lady is right that there need to be alternatives to digital access for those who cannot easily access digital, be it through a web platform or the NHS app. There are alternatives in place, but I hope she agrees that for those who can use digital tools, we should make them part of the offering. The new “my planned care” service will be hugely important in providing more transparency than ever before, but also in helping people prepare for their surgical procedures. She may have heard me say earlier than one third of on-the-day cancellations of surgical procedures happen because people were not prepared.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I declare my interest as an NHS doctor and I echo much of what has been said by colleagues across the House about the workforce challenges.

As the Secretary of State said, covid has been a huge challenge to the NHS and it is a testament to NHS workers that cancer treatment was maintained at 94% of pre-pandemic levels throughout the pandemic and that 95% of people who needed cancer treatment started that within a month. However, I am sure the Secretary of State agrees that one month is a very long and frightening time to know that cancer is growing inside and that every day’s delay could be the day that costs your life. How does he intend to reduce that time and what will be his target from diagnosis to treatment?

[Sajid Javid]

I agree with my hon. Friend about the importance of the workforce. She is right to raise the importance of cancer care and to note that it has remained a huge priority for the NHS despite all the pressures of the pandemic. In the plan that we are publishing today, we have set out a number of cancer targets. They are all very ambitious with record amounts of investment. Once my hon. Friend has looked at the plan, I would be happy to discuss it further with her, either the cancer aspects or anything else.

Children’s Mental Health

Caroline Johnson Excerpts

Tuesday 8th February 2022 Commons Chamber

[Maggie Throup]

I will make progress because we are short of time and I want to give plenty of time for Back Benchers to contribute.

More than 420,000 children and young people were treated through NHS-commissioned mental health community services in 2020-21, which was almost 100,000 more than three years ago. The NHS children and young people’s mental health workforce has seen growth of 40% from 11,000 whole-time equivalents in 2019 to 15,486 whole-time equivalents in 2021.

Early intervention and mental wellbeing support in schools and colleges can prevent poor mental wellbeing from developing into mental illness. We remain committed to the proposals set out in the Green Paper to roll out mental health support teams based in schools and colleges and staffed by mental health professionals. There are now more than 280 teams set up or in training, with 183 of those teams operational and ready to support young people in around 3,000 schools and colleges. I am really pleased that we have been able to accelerate that programme to meet our original target a year early and then reach around 35% of pupils through 399 mental health support teams by 2023.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

A number of parents in my constituency have contacted me with worries about their children and how best they can support them. We know that parental support in the family can lead to great improvements in children’s mental health. What information is the Minister making available to parents on how best they can support their children when they are having difficulties with their health?

[Maggie Throup]

My hon. Friend makes a really good point, and I know that she has lots of experience on this issue from a clinician’s point of view. She is right to say that families play a very important role. In her absence, may I offer my hon. Friend a meeting with the Minister for Care and Mental Health, because she will be able to go into much more detail than I can at the Dispatch Box?