Social Care

Caroline Johnson Excerpts

Tuesday 25th February 2020 Commons Chamber

[Matt Hancock]

No, I do not recognise those figures because they are not the accurate representation of what is actually happening. There are many within that figure who are judged under legislation to need to pay for their own care, and they do. We have to start from a basis of fact and, frankly, until Labour Members start working on this from a basis of fact, it is very difficult to take their contributions seriously.

The critical thing is that, as life expectancy is increasing, more people are looking forward to ageing in comfort and dignity, and that is good news. Opposition Members may not like it. It is odd; they do not seem to want to think that life expectancy is going up. We have a duty to ensure that our social care system is equal to the task. There are many things we should be proud of in our social care system, although we would not have gathered that from the speech by the hon. Member for Worsley and Eccles South. Some 84% of providers of social care are rated as good or outstanding, and 90% of people who receive care are satisfied with its standard. The proportion of adults with learning disabilities living in their own home or with their family has increased every year since 2014-15. That is good news, which we should welcome.

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

Is my right hon. Friend not right to say that life expectancy is continuing to go up? We would expect it to slow down, because we are not all going to live forever. The key thing is not just how long we live for; it is how long we live a high-quality, healthy life for.

[Matt Hancock]

My hon. Friend is absolutely right, and that is the sort of analysis on which we can make decent policy progress, because it based on the facts, rather than on making things up.

--- Later in debate ---

[Jackie Doyle-Price]

The issue is that local authorities are commissioning care from local care providers and paying the rate that the individual resident is incurring. It is about what they are prepared to pay for that bill and not the local authorities paying living wages directly to employees. However, that is pushing the risk on to care providers, and we need to acknowledge that there will be workforce challenges for those providers. They will be competing more and more for people. While there is that downward pressure from local authorities on what they are prepared to pay and the upward pressure on wages, the risk is being borne by providers.

Part of the solution is also not just about who pays. We need to be a lot more imaginative about this. We all know that we will live longer—beyond 70—and that we will have more years in life in retirement. Just as we make plans for our pensions, we need to make provision for our homes and how we are going to live in old age. The simple fact is that our housing requirements when we are in our 40s and are raising a family are rather different from what we might require in our 90s. We know that falls are one of the biggest burdens on the NHS, so the fact that we are not encouraging people to make sensible lifestyle decisions about their homes is causing additional cost to the NHS, as well as, potentially, the need for more long-term residential care. One reason why we have that issue is that we have allowed, collectively over decades, so much wealth to be stored in our housing stock that we have encouraged people to behave in a way that makes them want to cling to it. I would like us to look more imaginatively at incentives through the tax system to encourage people to downsize and look at different ways of living. We want to use the planning system to encourage the development of retirement villages where people can purchase extra care.

[Dr Caroline Johnson]

Some people like to care for relatives at home, and it is not uncommon to create a small annexe within or adjacent to the property for an older relative to be cared for, but currently, the council tax system means that if that relative passes on, after that—within two years—people will be charged double the council tax for that part of their dwelling. Does my hon. Friend think that that is something that we can improve on and change to encourage people who wish to look after their relatives in their properties to do so?

[Jackie Doyle-Price]

I completely agree. That is exactly the kind of incentive that we should encourage. The longer that we can encourage people to live independently, the better their quality of life and the better it is for the taxpayer, because there will not be those ongoing bills. The point is exactly that as we live longer, we will spend many years in a condition of frailty, and that needs to be properly managed through the system.

Every parent, with the best will in the world, will wish to hand on as much of their assets to their offspring as possible, but that could also encourage behaviours that are bad for their health. I want my parents to realise the value of their assets rather than protect their inheritance for me. I am sure that most people would think that about their parents, but there is a lot we can do on the tax system and incentives to encourage families to manage those issues collectively and in a way that is good for people’s welfare as they become elderly and enables them to do more for their children.

It is high time that we tackled this issue. We should also not look at this entirely in isolation from the issues regarding working-age adults, which are also a major challenge for local authorities as they manage their finances in this area. We must look at the issue of people with learning disabilities and autism being increasingly placed in areas of long-term care. The issue is that, although we have been broadly successful in moving out people with learning disabilities through the transforming care programme, sadly the pipeline afforded by those people moving out has been filled by people with autism. The Government have to give a much clearer challenge to commissioners. When faced with people with complex needs, the first instinct should not be to put them in residential care. Too often we have seen how those kinds of placements do harm. We need to challenge local CCGs and NHS England to put much better care upstream by providing early diagnoses for people with autism and giving them the tools to protect themselves.

Maternity Services: East Kent

Caroline Johnson Excerpts

Thursday 13th February 2020 Commons Chamber

[Ms Dorries]

I fear that you will shout at me again, Mr Speaker, if I try to answer my hon. Friend’s question fully, because I agree with everything that she has said. Maternal deaths absolutely must become a never event, and we must focus on making pre-eclampsia and post-partum haemorrhage, which lead to such deaths, never events. I went to the first meeting of the APPG on baby loss and, as my hon. Friend knows, I am always happy to go and hear anything that anyone has to say about this issue that will help our work in trying to improve maternity standards[Official Report, 2 March 2020, Vol. 672, c. 4MC.].

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

I should mention at the start of my question that I work as a consultant paediatrician, and that I look after babies and have attended a number of deliveries. I would like to thank the Minister for being so thorough, robust and dedicated in ensuring that this situation improves and that babies are safely delivered throughout the country. In my practice, I have noticed that all baby deaths and adverse outcomes are thoroughly investigated locally, but in my experience this tends to be done just locally. The lessons might be shared internally, but they are not being shared with other hospitals down the road, where the same mistake might be made. I welcome what she is doing, but can she reassure me that those lessons will be shared nationally, so that everyone can benefit from the lessons that are learned, and that such sharing will be widespread so that future tragedies are prevented? Can she also reassure me that, when she sets up the Healthcare Safety Investigation Branch process, its culture is such that doctors, nurses and midwives are able to give full and free answers, and that we get the balance between accountability and blame just right?

Wuhan Coronavirus

Caroline Johnson Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

The hon. Lady makes an important point, especially in relation to communicating through, for instance, the Department for Education and schools to make sure that schools get the reassurance that they need. I pay tribute to the way the hon. Lady has conducted herself, given the number of cases in her constituency, and the impact on local health services. We have taken action urgently where contact tracing has shown that it needs to be taken, and we will take that proportionate action. I am also very keen to be able to provide reassurances to people that we are taking the action that is needed and that the threat to the public remains moderate, even as we have seen the increase in numbers.

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

In my local hospital, staff are being provided with specially fitted masks to ensure their safety when treating patients who may or may not have the coronavirus. Will the Secretary of State confirm that that is part of a wider package of ongoing policies and procedures in the NHS to keep our staff safe when treating these patients?

[Matt Hancock]

Yes, of course. Making sure that we have the equipment to keep our staff safe is a very important consideration—keeping medics safe is very important not only for them but for the public, because they provide such an important service.

NHS Funding Bill

Caroline Johnson Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

It seems to me that the NHS Funding Bill is really just the beginning. If the Government are serious about identifying specifically how much money they will commit to particular parts of the NHS budget, that is to be welcomed, and certainly any increase in any part of NHS spending is welcome. A 3.4% increase compared with what we have had during the very challenging period of the past three to four years is therefore very welcome. I believe that it actually is a floor, not a ceiling. I totally understand the interpretation, which I think is correct, of the money resolution, but that relates specifically to amendments to this Bill. My reading of the money resolution is that we can, in further Acts, expand and increase these amounts.

My real concern is trying to get to the bottom of how these figures have been arrived at. There has been an assumption that it is all about inflation and looking at comparative figures, but there are three pieces to this. What are the assumptions underlying the decisions that have come to these figures? What assumptions have been made about inflation, because Brexit has changed much since these figures were first arrived at? How are we looking at demand and need? Do the Government really understand what the unmet need is? Certainly, reports by the Public Accounts Committee indicate that the Government do not really have a grasp of that. That then leads me to question whether these are the right figures to do what everyone in this House wants, which is to meet the needs of all our citizens for good healthcare and, ultimately, good social care, which is not part of this Bill. I think the Government have missed a bit of an opportunity here. It would be helpful if they had set out how they will flex if the assumptions with regard to savings and efficiencies changed, if the inflation rate changed, or if demand changed. The bits missing from this Bill are a formula to calculate the increase and some honesty about the basis on which the Bill has been put together.

As we have heard, some specific promises have already been made in a five-year plan. We have said that mental health spending will go up by £2.3 billion, which is a 4.6% increase a year; that mental health spending for children and young people will grow faster as a part of that budget; and that there will be an increase in primary and community healthcare spend in the areas of highest health inequalities. But as yet we do not have any mechanism for an annual statement on exactly where we are on this spending. In addition to a formula that explains how we got to this magic figure, there should be an annual statement on these figures so that we can see how the 4.6% a year increase for mental health has actually been delivered and whether children and young people are actually getting the biggest chunk.

It has been said, quite rightly, that in this Bill we are looking at only part of our total health and care ecosystem. We must look at what we do about infrastructure—hospital—spending. The £2.8 billion hospital infrastructure promise in the spending review last year was very welcome, but, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out, what about the repairs? With regard to the training budget, the spending review refers to a 3.4% increase. Is that really going to cover it? How are we going to measure whether it is actually spent? The hon. Lady referred to the 1% increase in public health grant. Can that really be enough? For me, what is really needed is an annual report on all health spending. The biggest challenges to getting this right—I am not the first and I will not be the last to say it in this Chamber—are stopping the slippage from revenue budgets to capital budgets and the slippage that will inevitably occur if social care is not properly funded. We absolutely have to fix the social care challenge, and this Bill is not enough, and cannot stand alone, in terms of solving these issues.

This Bill is welcome, but it is in many ways a missed opportunity. We need to see the total picture. We need to have proper accounting. We need to have proper visibility of the numbers so that we as a House can demonstrate clearly to the great British people that we are delivering on what we have promised and what they need.

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

Does my hon. Friend accept that the purpose of the Bill is not to set out the absolute detail of every single possible thing that could happen over the next few years, but simply to provide assurance to the NHS in England of the minimum funding that it could possibly receive, and the massive increase that we are giving it, so that it can continue to plan for the future?

[Anne Marie Morris]

My hon. Friend is absolutely right that we should provide a long-term plan and a long-term budget. However, if we are to be honest with the public and with ourselves, we need to measure what we are doing and be clear and accountable to the public that what we have said we will spend delivers the outcome we have promised.

This is about openness, transparency and accountability, and that is the missed opportunity. It may well be that this sum is right and that the savings that have been promised can be made to enable it to be adequate, but there is some serious doubt about that. Without openness, honesty and the figures being reported on each year, we cannot put our hand on our heart and say that we are doing what we promised the British people we would do. There is a saying that what gets measured gets done, so let us measure this. Let us get to the crux of this spending and prove to the British people either that we have got it right or, if not, that we have a formula to get it right so that we can do what is right. We need a plan to monitor the10-year plan, which is great in ambition but needs to be properly scrutinised and properly monitored so that not just the Government and the Conservative party can be held accountable, but all of us in this House can be held accountable, because it is for all of us to get this right. It is not just down to the Government: it is for all of us to ensure that we deliver what people, frankly, need and deserve, and what we have promised.

Health and Social Care

Caroline Johnson Excerpts

Thursday 16th January 2020 Commons Chamber

[Jonathan Ashworth]

No, because we do not think it would work—it is not feasible. It is not just the Committee in the Lords that says that—plenty of think-tanks have said it is not feasible as well.

There is broad consensus about the principle of better integration between health and social care. We have long argued for it, and now the Government have come round to arguing for it as well. The Government are proposing an NHS Bill along the lines of what Simon Stevens of NHS England has proposed. We long warned that the Health and Social Care Act 2012, which was introduced by Andrew Lansley and supported by sitting many of the Ministers on the Front Bench, would not lead to the levels of integration and co-ordination of care that was needed but to a fragmented mess.

We also long warned that the compulsory competitive tendering provisions of the Act would lead to more contracts being handed to the private sector. About £9 billion-worth of contracts were handed to the private sector, despite the Secretary of State telling us that there would be no privatisation on his watch. If his Bill gets rid of those compulsory competitive tendering provisions—the so-called section 75 regulations—we would welcome that, but we want competitive tendering to be abolished completely. We do not want clinical services privatised. We do not want clinical services outsourced, such as pathology labs in London, as is happening on the Secretary of State’s watch. We do not want tinkering in the Bill: we want the Health and Social Care Act binned so that we can restore a universal public national health service. [Interruption.] The Secretary of State says that it is universal. He is clearly not aware of the rationing that is going on across the country because of austerity and the privatisation of the NHS that is his policy.

As I indicated in the debate on the Gracious Address before the election, we will work constructively with Ministers to ensure the speedy passage of the health service safety investigations Bill. We will look to strengthen the independence of medical examiners. We call on the Government to do more to roll out medical examiners across NHS trusts. It is disappointing that so far only about 50% of trusts have medical examiners. These are absolutely vital to improving patient safety, because we know that things do go wrong in the delivery of care. We have all been shocked by the revelations at Shrewsbury and Telford Hospital NHS Trust. This is the worst ever maternity scandal, with clinical malpractice apparently allowed to continue unchecked since the ’70s. It is absolutely horrific and astonishing. I cannot imagine the grief that the families affected must have had to endure. Will the Secretary of State update the House on what is happening at Shrewsbury and Telford? I appreciate that there was an Adjournment debate on that matter last night, but I think the House would appreciate his offering us some reflections on what is happening at Shrewsbury and Telford. Will he also commit to reinstating the maternity training fund to help to improve maternity safety in our hospitals?

I am sure that the Secretary of State will agree, more broadly, that the delivery of safe care depends on adequate staffing levels as well, so would he support enshrining safe staffing levels in legislation? We are short of 44,000 nurses in England. Community nurses have been cut by 6,000 since 2010. Learning disability nurses are being cut. Mental health nurses have been cut by 10%. Health visitor numbers are down. School nurses have been cut. We have been warning for years about the detrimental impact on safe care of these staffing shortages. That is why, for example, we fought the Government on the abolition of the training bursary. We welcome the fact that Ministers are now bringing back a partial version of the bursary in the form of a maintenance grant, but why not bring back the whole bursary? Without bringing back the whole bursary, many are sceptical that the Secretary of State will deliver on his commitment for 50,000 new nurses, because as quickly as—[Interruption.] Well, he is rather stretching the definition of the word “new”. He gave the impression in the general election campaign that there were going to be 50,000 new nurses, but that soon unravelled, because when he went on the media it turned out that he was including in his figures 19,000 nurses who already work in the national health service. I of course have some sympathy—

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

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I am afraid that on this occasion I will not, because many Members want to make maiden speeches. There is nothing worse for a Member waiting to make a maiden speech than seeing the time ticking down because Front Benchers are taking lots of interventions.

[Jonathan Ashworth]

I will tell you who was talking rubbish, Mr Deputy Speaker: the Secretary of State when he said at the general election that he was delivering 50,000 extra nurses. That is why he avoided Piers Morgan during the election campaign. I do not know why the Secretary of State avoided Piers Morgan—he is a pussycat. I went on Piers Morgan’s show every week; why did the Secretary of State not go on?

I will give way once more, and then if Members will indulge me, I will not give way again, because a lot of Members want to make their maiden speeches in the debate.

[Dr Caroline Johnson]

I am grateful to the hon. Gentleman for giving way. He is using a lot of statistics and figures, and he talked about the definition of “more” and “new”. I want to ask him about the 44,000 vacancies that he talked about. Is it not right that when the Health Committee looked at that, it found that 38,000 of those places were actually occupied by nurses who work on the bank because they choose that working model?

[Jonathan Ashworth]

As the hon. Lady knows from her work on the frontline in the NHS, the problem is that bank and agency staffing have contributed to many of the deficits that our trusts are dealing with. That is one of the problems with the way in which the workforce have been managed by the Government.

The Secretary of State says that his figures include 19,000 existing nurses. I have some sympathy for him, because we have been raising the issue of retention in the NHS for some time. That is why we were so vigorous in opposing the public sector pay cap, of which he was a great champion for many years as a Tory Minister, and it is why we were pleased that the Government got rid of it, following pressure from those on the Labour Front Bench. It is a laudable aim to improve retention in the NHS, but it is not the same as recruiting new nurses.

The Secretary of State expects to recruit 12,500 nurses internationally, while at the same time imposing a tax on those nurses through the immigration health surcharge, increasing it to more than £600 per family member per year of a nurse’s working visa. Does he really expect to recruit 12,500 nurses internationally while imposing this nurses’ tax on them?

The Secretary of State will also know that we are desperately short of nurses in the field of mental health services. We welcome the commitment to reform the Mental Health Act 1983, and we will work constructively with him on that, but we have had enough warm words and rhetoric on mental health services. It is now time to deliver the parity of esteem that patients deserve. We have a shortage of mental health beds, which means that too many people are sent hundreds of miles across the country to receive care, away from their family and friends, often in poor-quality private providers.

The Secretary of State likes to boast of hospital upgrades, but anyone who has been in a mental health trust, works in one or has visited one, as I have, knows that the mental health estate is, frankly, some of the worst estate in the NHS. It is unsafe. Mental health patients deserve so much better, yet there is still no credible plan in anything he has said to modernise and replace the 1,000 beds in old-style dormitory wards in mental health trusts across the country. Children are being particularly let down, with increasing rationing of mental health services and more than 130,000 referrals to specialist services turned down despite children showing signs of eating disorders, self-harm and abuse. Matters have become so desperate that there are even reports of GPs advising children to exaggerate problems, because otherwise they will not get any help. This is the chaos of the underfunded system, and it leads to an increasing number of children and young people presenting at A&E in mental health crisis. A&E is no place for someone in mental health crisis. This is a disgrace, and our mental health services now need investment.

That brings me to A&E more generally. The Secretary of State will say that there is increased demand on our A&E, and that is true. There is increased demand on our A&E because mental health services have been pushed to the brink; because years of cuts to social care are pushing more and more people to A&E; because public health prevention budgets have been hammered by years of cuts under this Conservative Government; because GP numbers in our communities have been cut and people cannot get appointments; because walk-in centres have closed under the Tories; and because pharmacies were cut back. More broadly, it is because decisions by this Government—whether it is their decisions on housing and universal credit or their cuts to children’s services, with Sure Start centres closing—and rising levels of poverty mean that health inequalities are widening. It all adds up to more people presenting at A&E because of 10 years of Tory austerity.

What is the Tories’ answer to the worst A&E performance figures on record? It is to scrap the four-hour A&E target. Abolishing the target will not magic away the problems in A&E. It will not suddenly fix a system that saw 100,000 people waiting on trolleys last December. That is why the president of the Royal College of Emergency Medicine said yesterday:

“Rather than focus on ways around the target, we need to get back to the business of delivering on it”.

But Ministers cannot get back to the business of delivering the target, because they will soon ask the House to approve legislation that will legally bake in the underfunding of our NHS. The NHS underfunding Bill effectively caps NHS spending way below the level that experts say our NHS will need. The last Labour Government did not need legislation to signal their support of and commitment to the NHS. The last Labour Government got on and delivered record investment in our NHS. They delivered a 6% increase in investment into the NHS, and they delivered the lowest waiting lists and the highest satisfaction ratings on record—and we did not need the gimmick of a Bill to do it. We got on and delivered it.

The Secretary of State is proposing a Bill that fails to reverse the £850 million of cuts to public health prevention services. This is at a time of rising drug deaths, rising presentations at A&E for alcohol abuse, rising STI infections and rising obesity among children. He is asking us to approve a Bill that does not reverse the raids on capital budgets or deal with the £6.5 billion backlog of repairs facing our hospitals, which has left hospitals with sewage pipes bursting, ceilings falling in and lifts not working. He is proposing a Bill that does not give the NHS the 4% uplift annually that many experts say it needs. That is why Labour has tabled an amendment today to give the NHS a 4% uplift, and every Tory MP who believes in the NHS should support it. The Secretary of State is enshrining in law four more years of underfunding of our national health service and four more years of capped expenditure in our national health service, but it does not have to be that way.

I congratulate the Government on securing election. I congratulate the Secretary of State and all the Ministers who have been reappointed to the Front Bench, and I pay tribute to my former shadow Ministers who lost their seat, Paula Sherriff and Julie Cooper. We will hold the Secretary of State to account. We will test him on whether he delivers 40 new hospitals, 50,000 new nurses and 6,000 new GPs. We will test him on whether he drives waiting lists down, as the Prime Minister promised yesterday. Where the Secretary of State is right, we will work constructively with him. Where he is wrong, we will argue our case forcefully.

The Secretary of State was elected on a promise to fix the NHS. With 4.5 million people on the waiting lists, 2.5 million people waiting beyond four hours in A&E and 34,000 people waiting beyond two months for cancer treatment, our constituents now expect him to fix the NHS. He could start by giving the NHS the level of investment it needs, which is a 4% uplift. He could start by voting for our amendment in the Division Lobby tonight.

--- Later in debate ---

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

It is an honour to speak on a Queen’s Speech that has set out such a fantastic programme for government, and from a Conservative majority Government. As a consultant paediatrician, it is particularly special for me to be able to speak in a debate on health.

I want to talk about the importance of engineers. My daddy is very fond of telling me that engineers have saved more people’s lives than doctors have; it will perhaps not surprise Members to know that daddy is an engineer. To some extent he is right, because improvements in water, sanitation, investigatory tools such as CT and MRI, and ventilating machines have saved many lives. That is why I am really pleased that the Government are bringing forward the medicines and medical devices Bill: it is by investing in research and increasing the number of people in clinical trials, and investing in research and development generally—the Government are committed to increasing investment in R and D to 2.4% of GDP—that we will be able to improve people’s lives. This is not all about increasing the NHS budget, although I am also pleased to see that we are giving the NHS its biggest ever cash injection, at £33 billion by 2023.

In my last minute, I want to talk about diagnostic centres. Grantham Hospital is very important to me and to my constituents, and to the constituents of my new neighbour, my hon. Friend the Member for Grantham and Stamford (Gareth Davies). I was pleased that earlier this week we were able to meet the Health Secretary to talk about the hospital’s future—a positive and excellent future, in a growing town.

As a doctor, I have seen a progressive move towards greater centralisation, with services becoming increasingly remote from the people whom they serve. That makes sense for low-volume, high-complexity work, because it improves outcomes for the patients who need such treatment, but it does not make sense for high-volume, low-complexity work, which should be delivered closer to home. I was pleased to hear the Health Secretary say essentially just that in his speech earlier today, when he suggested that diagnostics and investigations would move closer to home, which would mean a positive future for Grantham Hospital and the people there.

However, my first priority—and, no doubt, that of my hon. Friend the Member for Grantham and Stamford —is to ensure that the hospital’s A&E department reopens as a 24-hour, round-the-clock service. That is no more than my constituents deserve.

Batten Disease

Caroline Johnson Excerpts

Monday 22nd July 2019 Commons Chamber

[Seema Kennedy]

I thank the hon. Lady for her question. She has spoken to me and spoken in this House about Nicole and Jessica Rich. I agree that it is a highly effective treatment, but NICE sets the guidelines because it is made up of the independent experts and they are the ones responsible for the number of QALYs. However, as I have already said, it is constantly reviewing its guidelines in the light of the best available evidence. I have already reassured the House that I will make sure that I make contact with NHS England so that it is driving forward the process with BioMarin.

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

I have looked after a number of children with Batten disease in my career, and no one should underestimate the horrific nature of this condition with which a child develops apparently normally and then gets the horrific diagnosis that they will suffer neurodegeneration. I completely respect the importance of NICE being independent, and in general I do not get involved in these debates, but I believe I should do so in this one, because I actually think that NICE has this wrong. This drug does not make a little bit of difference—it does not have the effect of making someone die a couple of weeks later; it makes a phenomenal difference to the quality of life for these children. Yes, the trials have been short so far, but over a reasonable period it makes a massive difference, and I think we should do everything we can. I have heard the Minister say that she will ask the chief executive of NHS England to get BioMarin back round the table. How long will she give him to achieve that, and if he does not succeed, what will she herself do to ensure that these children get these drugs as soon as possible?

[Seema Kennedy]

I pay tribute to my hon. Friend for all the work she has done as a clinician. I can only say again—I know this is very disappointing for the House—that we have to rely on the NICE process to be independent. I hear what the House is saying about some people having doubts about the process, but, again, it is under review. NICE is internationally respected, and it has been going for 20 years. Yes, these are exceptionally difficult cases, but this is why, as custodians of NHS funds, we have to be very careful, because every pound we spend on one drug is a pound we cannot spend on another. I hear what my hon. Friend says about this being a life-changing drug, and I hope that BioMarin, NHSE and NICE will, and we would urge them to, carry on with their negotiations.

Children’s Palliative Care

Caroline Johnson Excerpts

Monday 1st July 2019 Commons Chamber

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

The subject of tonight’s debate is not an easy one to talk about, but it is very important. This evening, I am going to talk about the 49,000 children throughout the UK who have life-limiting conditions.

As a consultant paediatrician, I have looked after quite a number of these children over the years. I have been the person who has made that diagnosis, who has given that devastating news to families, who has looked after these families during various different points of the journey and, indeed, who has been there in those final minutes and hours. Through that time, I have watched as some of these families have just about managed, but others have really struggled to cope at all and have gone from crisis to crisis. For me as a paediatrician, the opportunity to be a politician gives me the chance to stand here and advocate for those families and for those children and to use this platform—this House—as a vehicle for change, and to make these treatments and the care that these children receive much better.

Children’s palliative care is not, as it is often misrepresented to be, only about the care that someone receives at the very end of their life: it is about improving the quality of their life while they are living with that life-limiting condition from the point of diagnosis. I shall take as an example a child with Batten disease. A child with Batten disease may present as apparently healthy, but they have a gene that will ultimately cause neuro-degeneration. So they will lose the skills that they had—the walking, the talking. Their skills will go backwards, until they become increasingly dependent on their families. Often, they die of chest infection.

The care for those families involves helping the child, the family and the siblings to understand the diagnosis and prognosis, providing support such as physiotherapy to keep the child mobile for as long as possible, providing home adaptions to train their parents in how to use things such as Mic-Key buttons, to provide tube-feeds and to use wheelchairs and hoists in the care of their children, and helping them with medical things such as seizure management, giving medication and speech therapy, as well as with how to navigate the benefits system, applications for a blue badge, education and when to move from mainstream into more specialist provision.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this matter to the House. There will not be a single elected representative who is not aware of someone who has been through this. Is she aware that the money that each children’s hospice has to spend each year to meet the needs of seriously ill children and their families has grown to an average of £3,681, which is a 4.5% increase between 2016-17 and 2018-19, faster than the rate of inflation, yet the funding has been cut or frozen for each of the last three years, leaving children’s hospices struggling to make ends meet? Does she share that concern, which we all have?

[Dr Johnson]

I thank the hon. Gentleman for his intervention. I do indeed share his concern and will come to some of those figures in a moment.

To return to the care that is provided during the palliative care process, finally, the care will indeed be about end of life care and bereavement counselling. Children’s hospices throughout the United Kingdom provide some of this fantastic care. They have specialist medical, nursing and other professional staff and volunteers, and I pay tribute to them, as I know other Members do, for their dedication and the fantastic work they do.

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

My hon. Friend is a great ambassador on this very important subject. I pay tribute to the Chestnut Tree House hospice, which does such a fantastic job in West Sussex. Does she acknowledge that, because of medical technological advances, many of these children will live for much longer than was anticipated many years ago, and for many of them this is about not care in a hospice but outreach care outside the hospice? It is therefore important that we have good support packages for the parents, including respite and care over a longer term, and that we are more imaginative in the way we build houses, so that children with life-limiting conditions can live in houses—perhaps new social house build—that reflect the increasing physical demands that they will have, so they can stay in their homes to be cared for appropriately?

[Dr Johnson]

I thank my hon. Friend for his intervention. He is indeed right. The demand for children’s hospice care is rising because there has been an increase in the number of children with life-limiting conditions and because those children are living longer and therefore require care for a longer period. The cost of providing that care is also increasing at a rate faster than inflation and faster than the money that the sector receives, which means that in some areas the money received has fallen in real terms.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

The hon. Lady and I work together closely on this issue as co-chairs of the all-party parliamentary group for children who need palliative care, and we hosted an incredibly moving discussion during Children’s Hospice Week at which we heard really powerful stories from parents who had recently lost children. I am sure she appreciates my concern that the hospice care that children receive is often needed not just at the end of their lives but throughout their lives in order to give them the best life possible in the time that they have, and that it is not funded on a sustainable footing. Children’s hospices must not be left to rely on the ability of local areas to fundraise for them. They must be put on a sustainable financial footing to give the children and their families the support that they need.

[Dr Johnson]

The hon. Lady is right. In fact, NHS and local authority funding represents just 21% nationally of the money that children’s hospices need. The rest is raised by charities, but for some hospices in less affluent areas, raising the additional money that is required can be very challenging.

I welcome the fact that the Government have made their end of life care choice commitment, which is really clear about the care support choices that children should have. In our roles as co-chairs of the all-party parliamentary group for children who need palliative care, the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and I carried out an inquiry last year to find out the extent to which this commitment was being met. We found that Ministers were at risk of failing to meet that commitment because of funding, as described, and because the quality of palliative care that children and families can receive is variable, depending on the area in which the child lives.

[David Linden (Glasgow East) (SNP)]

I am grateful to the hon. Lady for giving way, and I pay tribute to her expertise on this issue. Does she recognise that north of the border, in Scotland, the Scottish Government have recognised the need for parity of funding between adult care and children’s care, and that that is not the case in England? Will she join me in calling on the UK Government to look at the model in Scotland to see what a difference we have made and what has been delivered by, for example, CHAS—Children’s Hospices Across Scotland?

[Dr Johnson]

I thank the hon. Gentleman for that intervention. I am not familiar with the details of how hospices are funded in Scotland, but one of our report’s recommendations was that the grant for children’s hospices should be increased to £25 million. That is something that I repeat this evening.

On 27 December last year, we received a late Christmas present when Simon Stevens, the chief executive of NHS England, announced that £7 million of funding over the next five years would be available to children’s hospices each year in addition to the £11 million children’s hospice grant, if the clinical commissioning groups could provide match funding. I understand the benefits of match funding because it increases the engagement of the CCGs locally, but where CCGs are not providing the funding, it can lead to services not being provided properly in that area. Also, later, when the long-term plan was produced, the detail showed that this funding was not only for children’s hospices but for other palliative care services. This was recognised as useful for providing services for children in areas currently not covered by a hospice, but it could equally mean that the money might be diluted into other causes and not reach the children who need it.

Two weeks ago, as the hon. Member for Newcastle upon Tyne North said, we joined our secretariat, the excellent charity Together for Short Lives, which does much work in advocating for these children and their families, and we met parents and representatives from several hospice charities to discuss these issues further. One real concern to us at that time was that one of the charities, Acorns, which receives the most Government funding, was struggling to raise charitable donations in its area to cover costs and was consulting on closing one of its children’s hospices, in Walsall, meaning that families would have to travel much further for the care and support they needed. I know that that is something that no one in this House would want to see happen. Indeed, I have raised the issue with my hon. Friend the Minister for Care and my right hon. Friend the Prime Minister, both privately and in the House. I ask the Minister to raise the children’s hospice grant to £25 million a year and to ring-fence that money. It is a small amount within the NHS budget as a whole, but it would make a huge difference to children receiving hospice care and their families.

[Catherine McKinnell]

The hon. Lady is being generous with her time and is making an excellent speech. While she rightly makes the case for children’s hospices, does she agree that they are not the only vital care support that children and their families need? They also need care at home, which is often provided by charities such as the Rainbow Trust. It is a hugely important service, but CCGs and local authorities are too often not commissioning it, and one can only assume that that is due to funding restraints. Does she agree that local authorities and CCGs should be incentivised and supported to fund and make such services available?

[Dr Johnson]

I thank the hon. Lady for her intervention.

Turning to those who do not receive valuable hospice care, as a doctor I have seen too many families in crisis, struggling to cope with patchy provision or the lack of hospice or home care or respite. As children’s hospices are frequently set up by charities, their locations across the country have not been planned, so some families find themselves too far away from services to be able to use them. I want NHS England to review the provision of services to ensure that care is no longer patchy and no longer dependent on where a child lives. The hospices that I have spoken to have asked me to make the Minister and NHS England aware of how the funding cake is split. Hospices—both the well funded and the less well funded—feel that funding should be disbursed more fairly based on clinical need, so an examination of that situation would be helpful.

Another area on which I would be grateful for the Minister’s response is respite care or short breaks. For most people, an evening out requires a quick call to a friend or relative. If Mr Johnson and I want to go out for dinner, I just need to ask someone to come to our house for a few hours. I do not need to spend weeks planning to take the children away for several nights or a week at a time. I can pop out for a curry for two hours. For families whose children have many complex medical and physical needs, things are much more difficult. Short break provision is often patchy and inflexible. I might want a babysitter so that I can attend my brother’s wedding, but for someone whose child has complex needs, if the weekend on which respite care is available is not the same weekend, that may not be much help. Sadly, having got all the plans in place, respite care is all too often cancelled at short notice. In my time as a doctor, I have seen families pitch up at the hospital with their child, who has remained in an acute hospital bed for the weekend simply because, where else can they go?

I would like an army of help for families, not a patchwork system. I want each family to have the guarantee of short breaks and the opportunity to access trained care assistants who can be booked to come to the family home, like any other family can have if they want to go out for a meal or attend a sibling’s school play—Mr Speaker, you mentioned that your daughter Jemima was in a play recently, and I am sure that it went extremely well. Children with complex needs may have siblings, and the parents will want to be able to attend their plays. The Government should provide such a service through the NHS, and there should be a set amount of guaranteed free home respite care time per year, perhaps with additional subsidised capacity above that amount.

I know the Minister understands how important children’s palliative care is to children and families, and I know how hard she has worked and pushed for this issue in her Department. I know she understands the need for the Department to work with NHS England to review this provision and how it is spread across the country, and I hope she will be able to assist with the provision of respite care breaks so that these very vulnerable families find it easier to have short breaks and access to childcare, like any other family and any of us would want. Most importantly, I ask the Government to make sure that NHS England now honours the original announcement by recommitting to protecting the children’s hospice grant for the long term and by increasing it to the £25 million a year that is needed.

[The Minister for Care (Caroline Dinenage)]

I congratulate my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing a debate on this important matter. I particularly thank her for the fantastic work she does both as a medical professional—a paediatrician—and in her role as co-chair of the all-party parliamentary group for children who need palliative care, on which she has been a tenacious, passionate and very effective campaigner.

The APPG produced a report last year on children’s palliative care, to which the Government responded in full, and today we have an opportunity to pay tribute to the incredible work offered by children’s palliative care providers, many of which are hospices, in supporting some of our most poorly children and their families.

Children’s Hospice Week took place last month, and this year’s theme was “moments that matter.” As MPs, we are all very aware of the crucial role played by hospices in supporting and caring for our communities at a time of great need. I first became aware of that many years ago, when my mum was involved in fundraising to build the Naomi House children’s hospice near Winchester. In fact, she embroiled my whole family in a series of embarrassing fundraising activities to further her ends.

Since then, I have been privileged to visit Naomi House and, later, Jacksplace, a facility for young adults collocated on the site, to see for myself the incredible care and support they offer to very poorly children and their parents, both on site and more broadly in the community.

In my role as Minister for Care, I see how crucial palliative and end of life care services are for families in need. We know that many areas across the country are delivering excellent support and palliative care for children, but there is no room for any kind of geographical inconsistency, which is why it is crucial that more is done to challenge and support areas that are not providing it. That is why we have made children’s palliative and end of life care a priority in the NHS long-term plan, particularly in supporting children’s hospices.

NHS England’s hospices programme currently provides £12 million a year for children’s hospices, helping to provide care and support to children with life-limiting conditions and their families. I am delighted to announce, and my hon. Friend and other members of the all-party parliamentary group will be very pleased to hear, that NHS England has committed to increase the funding to £25 million by 2023-24. That will guarantee the additional £13 million for the children’s hospice grant. Clinical commissioning groups had been asked to provide match funding, but NHS England has now taken the decision to guarantee the investment after concerns were raised. As my hon. Friend said, match funding would not necessarily achieve the full investment anticipated.

I care very deeply for the hospice movement, and I hope this funding will provide it with full reassurance of the Government’s commitment to and support for its incredible work.

[Dr Caroline Johnson]

I thank the Minister for this fantastic announcement, and I know the money will make a phenomenal difference to the lives of the poorliest children in this country.

[Caroline Dinenage]

I thank my hon. Friend for that. She must take some of the credit, because it is her work, along with that of her co-chair of the all-party group, that has helped to secure these strong commitments from NHS England, so I wish to pay tribute to them this evening. But there is more. We know that children’s hospices are not evenly spaced throughout the country, so NHS England has also committed to undertake a needs assessment to understand whether additional investment, nationally or from clinical commissioning groups, is required where palliative care is provided by means other than hospices.

[Caroline Dinenage]

The hon. Lady has powerfully put her sentiments on the record, and I absolutely with them. In parallel with the announcements that NHS England has made on the much-welcomed investment, it is working to develop commissioning models specifically for children and young people with palliative care needs, to support CCGs. We know it can be difficult for some commissioners to meet the needs of this vulnerable group, and these models will help them overcome the challenge of delivering services for small and geographically spread groups of patients, whose conditions can fluctuate over the course of their lives. Together for Short Lives is involved in this important work, and I also wish to put on record my thanks to it for its continued support.

My hon. Friend mentioned Acorns hospices, which is currently consulting its staff on the closure of one of its children’s hospices at Walsall. I have been made aware that there is a financial aspect to this consultation, but there are other aspects to it, such as a reduction in the number of bed days used by in-patients. As I say, this is a consultation at this stage and I am hoping that the announcement of this money will help to make a difference to its decision.

In “Our Commitment to you for end of life care”, we set out what everyone should expect from their care at the end of life, and the actions being taking to make high quality and personalisation a reality for all in end of life care. The choice commitment is our strategy for end of life care, which, through the NHS mandate, NHS England is responsible for delivering through its national end of life care programme board, with all key system partners and stakeholders, including Together for Short Lives. This presents the best opportunity to continue to deliver the progress we all want to see and make the choice commitment a reality for both adults and children.

Looking to the future, the NHS long-term plan has set out a range of actions to drive improvement in end of life care and deliver the choice commitment. In addition to the £25 million of investment in children’s hospices announced today, the NHS long-term plan has made a number of commitments that will improve palliative and end of life care for children.

[Dr Caroline Johnson]

Along with the all-party group and Together for Short Lives, we have asked the Minister for three things this evening, and we appear to have received two of them—the extra money and the NHS England review. We will keep pushing for the third—respite care and an army of babysitters—but as Meat Loaf said, “Two out of three ain’t bad”.

[Caroline Dinenage]

As I said at the beginning, my hon. Friend is nothing if not utterly tenacious and passionate in her pursuit of this. I will talk about the short breaks now. She is absolutely right on this; I do not think families are necessarily looking for big long holidays, they just need short breaks, but for those need to be reliable and consistent. People need not to be let down at the last minute. That is the message I am getting loud and clear. Local authorities have a legal duty to commission short breaks, as established by the Breaks for Carers of Disabled Children Regulations 2011. Although the NHS role is not statutory and is a matter for NHS commissioners, the NHS may provide the clinical aspects of care to support such services, if appropriate.

According to the 2018 Together for Short Lives report, 84% of CCGs reported that they commissioned short breaks for children who need palliative care. That is an increase on the support in 2017, when it was 77%, but I recognise that we have much further to go. Parents desperately need short moments of respite and to know that their children will be well cared for at such times. The breaks also need to be reliable, and we will continue to work on that.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 18th June 2019 Commons Chamber

[Seema Kennedy]

A wide range of activity has been undertaken to help people to understand whether they need to pay for their NHS prescriptions, and I remind the House that 84% of NHS prescriptions are available for free. My Department and the DWP are working together to provide further clarity to universal credit, and hopefully we will be adding a universal credit tick box to the prescription form.

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

9. What steps he is taking to ensure that people can access Changing Places facilities when they use NHS services.

[The Minister for Care (Caroline Dinenage)]

Last year, I announced £2 million funding for NHS trusts in England to install Changing Places facilities in hospitals; this is now available for trusts to bid for. We estimate that 250,000 people in the UK cannot use standard accessible toilets, and the fund could help to install well over 100 more Changing Places facilities.

[Dr Johnson]

Many of the disabled children who use Changing Places facilities also have a life-limiting or life-threatening condition. I welcome the increase in Changing Places facilities, but in this national Children’s Hospice Week could I ask my hon. Friend to go further in protecting these vulnerable children by increasing the children’s hospice grants to £25 million to give them the financial security they need?

[Caroline Dinenage]

I am really pleased that my hon. Friend has mentioned that it is Children’s Hospice Week. It is a great opportunity to pay tribute to the incredible work that children’s hospices do up and down the country, supporting some of our most poorly children and their families. I thank my hon. Friend for the work that she does on the all-party parliamentary group for children who need palliative care. The short answer to her question is yes; the NHS will match fund CCGs that increase their investment in children’s palliative care, including hospices, by up to £7 million. That is increasing support to a total of £25 million a year by 2023-24.

Healthcare: East Midlands

Caroline Johnson Excerpts

Tuesday 30th April 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. In case hon. Members are not aware, I am a consultant paediatrician and work in the east midlands as a doctor during times that fit around my parliamentary commitments. I have worked in a number of hospitals around the east midlands: in Lincoln County Hospital, Mansfield Community Hospital, King’s Mill Hospital, and in both of the major Nottingham hospitals, Queen’s Medical Centre and Nottingham City Hospital. I have also worked at Doncaster hospital and I am now at Peterborough. I have a fairly wide experience of the different hospitals serving the east midlands population.

I was proud to hear last week that Peterborough has received a “good” rating from the Care Quality Commission. Not just that; the CQC will shortly return because the trust is not happy with “good”—it wants to receive an “outstanding”. It was somewhat displeased that the visitors focused on the areas they thought might be a problem, rather than on the areas we might have been able to showcase. The CQC will return to see the areas that it knew were very good already, to see whether we are entitled to see the “outstanding” mark. I hope that is achieved.

I congratulate the hon. Member for Lincoln (Karen Lee), my constituency neighbour, on achieving this hour-and-a-half debate. I was pleased to hear her welcome the extra money for the NHS, but disappointed to hear that she does not think it is enough, unlike the former Labour Health Secretary. We need to bear it in mind that a 3.4% average real-terms annual increase—£20 billion more—is a lot more money. I was also disappointed to hear about problems; it is easy to identify the problems and much more difficult to identify the solutions. Money is one of the solutions, but this is about much more than money.

I want to highlight some of the really good things going on in the east midlands. The hon. Lady correctly identified morale as one of the issues with the workforce. One of the things that affects workforce morale is people focusing on problems rather than on the areas in which excellent services are being delivered, which is the focus of most of my constituents—me and my family included—who receive excellent service from the hospitals in our area. The problem with low morale in the workforce is that it causes people to leave. When people leave we have more locum staff, which increases costs. Since less money is available, there is less ability to trial new things, so staff leave—and so the cycle continues. We need to reverse that, so I welcome the new routes into nursing, such as nursing apprenticeships, and the hard work we have done to increase the number of nurses who can train.

As a doctor, I am aware of shortages in medical staff, particularly in paediatrics, which is the area I work in. The University of Lincoln is opening a medical school in the hon. Lady’s constituency. That is a really good intervention. Students commonly stay to work in the area in which they trained, and that medical school will enable that to happen. The Government also need to look at remuneration. The remuneration of my junior medical colleagues is significantly lower in real terms than the remuneration I received as a junior doctor at the same grade.

I would be grateful if the Minister looked at issues with retirement. In my constituency, some GPs and other doctors retire earlier than they might wish to, because if they continued to work they would accrue very high pension contributions that they would not benefit from. If they continued to work but withdrew from the pension scheme, they would lose other benefits, such as death in service benefits. The Government should look at that.

In my rural constituency, once I have visited the GP it takes me 15 minutes to drive to a pharmacy in the nearby towns of Grantham or Sleaford with the prescription I have been given. Some patients at my surgery, including me, are entitled to have their prescriptions dispensed to them on site. How frustrating it is, though, for constituents who do not have that entitlement but would if they moved one house further down the street, not because they live in the wrong area but because they moved practice after they moved house. A constituent recently wrote to tell me that if someone moves into the area and then changes their GP, they are not entitled to dispensing services, but if they move GP and then move home, they are entitled to those services. That seems incongruous. GPs at dispensing practices receive a revenue increase, so they have both an incentive to provide an excellent one-stop service to their patients and a financial incentive to work in a rural area that offers such a dispensing service. I should be grateful if the Minister would look at that.

When I was first elected, I was terribly worried about East Midlands ambulance service. In the preceding few months, I had attended a number of incidents—just as an individual member of the public who had been driving past—where patients waited an inordinate amount of time for an ambulance. That was completely unacceptable, and one of those patients died, although I suspect that was not related to the time the ambulance took to arrive. That is why my first Prime Minister’s question, my first meeting with the Prime Minister and my first meeting with the Health Secretary were all about East Midlands ambulance service.

I was therefore pleased to go back and visit the ambulance service recently and hear how much has been done. The extra money that has been put in has produced 67 new ambulances, of which 27 are brand-new and additional as opposed to new-for-old replacements. The service’s response time for patients in the most acute need—the most unwell patients—has fallen by more than two minutes, which is a good success; we have to bear in mind the rural geography. I was also interested to hear about the research that is going on. Not all improvements in healthcare are delivered by money; some are delivered by research and improvements in knowledge and treatment. The East Midlands ambulance service has a research and audit department, which is looking at ways that the service can deliver better care to its patients; that is excellent.

A number of hon. Members mentioned the challenges of delivering healthcare in rural areas. Hon. Members may know about the joint work between Bishop Grosseteste University in Lincoln, United Lincolnshire Hospitals NHS Trust, Public Health England, Health Education England and others on launching a national centre in Lincoln to look at how we deliver better care to people in rural areas—that is its main focus. That is another attraction for people to come and work in the beautiful county of Lincolnshire. The centre will look at data, research and technology. I would love to have time to go into all the different things it can do to improve healthcare for my constituents and others, but time is short, so I will move on.

Let me touch on orthopaedic services at Grantham. People rightly are terribly concerned about the number of people who prepare for an operation—they build themselves up, take time off work and put plans in place for the care of those who are dependent on them—that is cancelled. We understand the reasons why that might happen, but ULHT has worked really hard on delivering better care. The fantastic Grantham Hospital—it has saved my husband’s life on two occasions—has a designated ward for orthopaedic surgery, which is only for what it calls “cold” operations. That is part of the “Getting It Right First Time” approach, looking at how we ensure that we get the very best care in orthopaedic surgery.

Trauma services have been moved to Lincoln. People might say, “Oh, that’s a dreadful cut,” but it means there are more people on hand in Lincoln to deliver more operations more effectively and more efficiently; more people get their operations done—fewer are cancelled—and there is a dedicated team of people in Grantham who are knowledgeable in orthopaedics and focused on delivering joint replacements and other non-urgent care. Overall, the service has improved massively. I congratulate ULHT and Grantham Hospital on the improvements they have delivered, and I wish they were being shouted about more publicly.

I also want to mention the A&E at Grantham Hospital. My husband, whom I love very much, has had his life saved twice at Grantham Hospital, so maintaining A&E services there and ensuring that people can access them is extremely important to me and my family, not least because we live very close by. I welcome the fact that the A&E will be reopened on a 24-hour basis soon, but I want soon to be now.

I have run out of time, but I thank the hon. Member for Lincoln for securing the debate and I hope to hear some good answers from the Minister.

Infant First Aid Training for Parents

Caroline Johnson Excerpts

Wednesday 3rd April 2019 Westminster Hall

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

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this important debate. She has been a champion of raising awareness to reduce avoidable deaths through working with the UK Sepsis Trust—sepsis is also a major killer of adults and children—and I am delighted that she has now lent her voice to the cause of infant first aid training for parents. As a paediatric consultant, this is an issue close to my heart.

My hon. Friend highlighted the alarmingly high number of cases where something could have been done to prevent a child’s death: 21% according to the Royal College of Paediatrics and Child Health. I should declare my membership of that organisation. Working on a children’s ward for the last 15 years, sadly I have seen far too many of those 21%. However, I have also seen children whose lives were saved by passing members of the public, as was described earlier in the case of Rowena, by doctors or health professionals, or by visiting family members who just happened to spot something and were able to help.

My hon. Friend the Member for Truro and Falmouth powerfully described a case of a child choking. As we approach Easter and then summer, mini-eggs and grapes are particular culprits. Advice should include how to manage a choking child, as well as simple measures to prevent choking. Chopping up grapes into little pieces, sitting down while eating and not running about with things in the mouth are helpful in preventing choking, but it can still happen to anybody, young or old, at any time. We should all know some of the manoeuvres that can help, such as the one my hon. Friend described in the case of the baby choking. The baby should be held face down across the adult’s legs, so that the baby’s head is lower than the adult’s knee, and blows should be applied to the baby’s back, between the shoulder blades.

That sort of information does not take long to learn, but can have a huge impact and can be responsible for saving somebody’s life. The information is already provided to a number of parents. I have delivered infant first aid to parents whose children have been in hospital. Each of the neonatal units that I worked on in the midlands provided first aid training to parents before they left hospital, in part because pre-term babies are more vulnerable when they have just left hospital and in part to provide parents with the confidence to manage very small babies when they go home, as was described by my hon. Friend the Member for Moray (Douglas Ross). Training is also provided routinely to parents who have had a child die in the past, but obviously we want to look at prevention.

The hon. Member for Belfast South (Emma Little Pengelly) talked about contact with health visitors and midwives. Evidence shows that parents are particularly receptive to messages about healthcare and first aid when they have just had their baby or when they are expecting their baby, as my hon. Friend the Member for Moray mentioned. That is a time before life becomes really busy, when one can reflect on the joy that is to come and be well prepared for it.

There are lots of opportunities for first aid training to be provided. There are antenatal classes, where training can be signposted or provided, as well as nurseries. I strongly believe that the practical advice should not just include what to do when things have gone wrong, but how to stop them going wrong in the first place. My hon. Friend the Member for Moray mentioned burns. I remember the case of a child who walked past a lit candle; it caught her dress and she got severe burns to her whole front. In that case her mum knew what to do—drop her to the floor, roll her over and stop the burning—and treated the situation appropriately, but even so the injury was severe and could have been prevented if the candle had not been left on such a low table.

Using seatbelts and car seats are among other simple measures that we know we should to do. One major cause of preventable deaths in children is drowning, so there should be simple advice about making sure that children are not left unsupervised around open water. I have seen this particularly in situations where there has been open water and a group of people, often at a big family event, where everybody is looking after the child but there is not one specific person watching to see that they do not end up in the water. At one of my children’s christenings, I was upstairs in a bedroom on the other side of the house when I saw from the window that a friend’s little boy had gone towards the small pond we had in the garden and that he was on his own. I ran downstairs and was fortunate that he had not gone into the pond by the time I got there. My husband was out with a digger the following day getting rid of the pond. It was not worth the risk, but if people have such ponds they need to be carefully managed. I have certainly seen children drown in those situations.

[Jim Shannon]

One thing that can be neglected in homes is fluids in cupboards. Years ago, when we were younger, fluids were kept in lemonade bottles and similar containers, and children did not realise that. I well remember when my second boy was very young—he was the one who everything seemed to happen to—he managed to get a gulp or two of Brasso. He had the shiniest backside that any child ever had, but that is by the way. It can easily happen that a fluid can be drunk or absorbed by a youngster. We need to take steps in our own homes to ensure that all fluids are under lock and key, wherever they may be.

[Dr Johnson]

I take the hon. Gentleman’s point about fluids. I noticed when I bought some washing detergent last week that the lids now have a clasp that is especially difficult to open, so children cannot consume those little bubbles. No one is ever perfect; I know that if I looked for hazards to my three children in my own home they would be there. So far, thank God, I have been lucky and I hope that will continue, but we can all do things to reduce risk.

I am glad that the Government are committed to ensuring that all early learning staff have first aid training, but it is time that they did the same for parents. Since 2016, all newly qualified level 2 and 3 early years staff must hold a current paediatric first aid or emergency paediatric first aid certificate. The Millie’s Mark quality scheme, which was commended by my hon. Friend the Member for Cheadle (Mary Robinson), was also launched in 2016. It requires childcare providers to train 100% of their staff in paediatric first aid, not just to have one trained person on site at any one time. The 300th nursery gained Millie’s Mark last summer, which was a cause for celebration, and I am proud those nurseries include Dappledown House Nursery and Appletree Corner Daycare in my constituency. My son’s nursery has offered parents first aid training in the last couple of months, so the message is getting out there and that needs to continue.

The efforts to provide safety in schools should now be matched to provide safety in the home. The time and financial investment needed to provide that is small. It costs £30 for two and a half hours of invaluable training on some of the most common causes of avoidable death, including choking, and ways of providing resuscitation. Providing preventive medicine is one of the best investments we can make. As well as avoiding tragedy, it takes pressure off our NHS services, which are facing ever-increasing demand. It is the right thing to do for both our children and our country, and I am glad to lend my support to this cause today.

--- Later in debate ---

[Julie Cooper]

I am grateful to the hon. Gentleman for that important intervention. I shall certainly speak with a loud voice about the subject in my constituency, and I encourage all Members to do the same.

The other point made by the hon. Member for Moray was that access is not easy. In preparation for this debate I checked up on access to training courses for my constituents and found that, even though I represent an urban community, it involves a 60-mile drive or a long train journey on a slow, rickety train line. That presents a massive barrier to my constituents accessing such training. I totally take the point that the hon. Gentleman makes, and I agree with him entirely.

The safety of our children is and always should be paramount, and it is therefore important that, in the event of an obvious health emergency, parents have at least a basic knowledge of first aid so that they can take action before professional help arrives—actions that might save the child’s life. The hon. Member for Truro and Falmouth made a strong point about how it is important that parents are trained to recognise the symptoms of what can be serious diseases, such as sepsis and meningitis. It would be useful if parents were equipped to recognise the symptoms before they decide whether to call 999 or take their child to hospital, because knowing how to spot the symptoms really does save lives.

First aid, as the term suggests, is the first medical attention that a person receives after an accident or during a medical emergency. Despite what many people have been led to believe, first aid does not have to be delivered by medical professionals—we have established that. A person’s chances of surviving a medical emergency are increased dramatically if a member of the community can respond with first aid immediately. What happens in the crucial minutes after someone dials 999 or the NHS’s 111 and before professional help arrives can be the difference between life and death. The British Red Cross reported that close to a quarter of infant deaths could have been prevented had there been a qualified first aider on hand, and who better to be trained than the parent?

[Dr Caroline Johnson]

A few weeks ago I was walking to a parliamentary event across the square, and I came across a man who was unconscious and not very well. When I called 999 for an ambulance, I noticed that the ambulance operators who answer the phone provide detailed and step-by-step advice to callers about what to do. That is a beneficial thing to note.

[Julie Cooper]

That is an important point. I have been on the receiving end of that with a family member, waiting for an ambulance and listening to instructions. Nevertheless, I appreciate that having the confidence to follow those instructions, particularly with a young child, might go a little beyond that.

This is about re-teaching people about what they think they know. There is a lot of so-called knowledge out there among people who think they know first aid, but that is often based on what they have seen in the media, which sometimes puts style before substance. In fact, procedures shown for dramatic effect often bear little resemblance to safe first aid. Furthermore, carrying out procedures without proper training might do more harm than good. First aid for babies is also vastly different from first aid for adults and other young children. Such important matters should be regarded as key parenting skills.

All parents, irrespective of their ability to pay, should have access to high-quality first aid training as a priority. Access to first aid training is about more than skills; it is also about building confidence and resilience. The British Red Cross surveyed a group of people it had trained in first aid, and asked whether they felt the training had contributed to their personal wellbeing. Three quarters of the respondents said it had made them more capable and more reliable in an emergency, and half said it had made them more determined and better at finding their way out of difficult situations.

Ahead of this debate, the British Red Cross shared with me the case of Leanne, a young mum from Swindon. When her baby, Maia, was six months old, Leanne took a baby first aid course with the British Red Cross. When Maia was 18 months old, she had a febrile seizure. Using knowledge from her first aid course, Leanne was able to save Maia’s life by instantly recognising the signs, taking steps to cool her down by removing her blanket, and placing her on the floor so that she did not injure herself during the seizure. After the seizure was over, Leanne further reduced Maia’s temperature by stripping her down to her vest, and she placed her in the infant recovery position. Leanne’s quick thinking saved Maia’s life before the paramedics arrived, and Maia is back to her playful, happy self. Leanne was able to do that only because she recognised the signs of a febrile seizure from her baby and child first aid course.

A seizure can be a terrifying and violent event for a parent to witness, especially when they do not understand what is happening. Febrile seizures are not unusual in babies and children between the ages of six months and three years. However, the Red Cross reports that, when questioned, 66% of parents had not been taught to recognise a febrile seizure, and 65% did not even know what one was. The baby and first aid course gave Leanne the knowledge and skills to act, but most importantly it also gave her the confidence. She said:

“I’m grateful that I had attended a baby and child first aid course which meant I knew what to look out for and how to deal with a febrile seizure.”

Because of her first aid knowledge, she felt calm and able to act for her daughter.

We have heard many examples of such events, and we are grateful to the hon. Member for Sleaford and North Hykeham (Dr Johnson) for sharing her expertise. People in the wider public often talk about MPs living in a bubble or ivory tower, but the hon. Lady’s expert and practical knowledge demonstrates yet again that Members of Parliament are in touch and know what is happening out there. As the hon. Member for Henley (John Howell) said, it is right and proper to use our position to spread that knowledge and champion causes such as this.

In 2014, Mumsnet sponsored 20 mums to take part in British Red Cross baby and infant first aid training. All the mums rated the training highly, and one said:

“I really enjoyed the course as every single thing discussed could easily relate to me and my children. All the videos of real-life scenarios really brought it home how easily these things could happen, but now I feel confident and that I could make a real difference to the outcome, and would feel so much more knowledgeable on what to do in an emergency situation.”

As we have heard, there are many different providers of first aid training for parents of infants. I specifically mentioned the British Red Cross, and other hon. Members have mentioned St John Ambulance, which offers first aid courses designed specifically for babies and children. There are also local providers, such as the one championed by the hon. Member for Truro and Falmouth. In addition, the NHS provides an online app to support parents with first aid for their infants. One parent said:

“Although you could read everything on the app and watch the videos for free, I think doing it in a class environment really makes you take it all in. It will also make you feel more confident if you were ever to need to help someone or your own child.”

As the Secretary of State for Health and Social Care often reminds us, technology in the NHS is helpful, but it is not a substitute for services delivered by real people. In terms of first aid provision for parents, such apps can be useful to reinforce training given in a class setting, but they should not be seen as a substitute.

[Dr Caroline Johnson]

The hon. Lady is generous in giving way. Does she agree that both technology and face-to-face contact have their benefits and can be combined? A “sim” dolly is an electronic version of a resuscitation dolly, and when supervised resuscitation is provided to a baby, it provides electronic feedback on whether compressions are deep or fast enough, as that can be measured electronically by the dummy itself.

[Julie Cooper]

I am grateful to the hon. Lady for her expertise in that technology, and such things can be used in combination with a class setting and training to support existing knowledge. I agree that, on specific occasions, such technology has an important role.

In terms of treatment, we lack consistency of provision and access. We have already spoken about distances to, and charges for, courses being a barrier for some parents. Shockingly, research by the Red Cross showed that 95% of parents did not know what to do when shown three examples of life-threatening medical emergencies. Surely it is time to ensure that training is available for every parent in every region. I take the point that we ought not to be prescriptive, but in leaving things to local providers, we must ensure that no one falls through the gaps and no parent is missed.

The Royal College of Paediatrics and Child Health has warned that UK infant mortality levels are among the highest in the developed world. There are many reasons for that, but cuts to local child services, community health projects, and community midwives and health visitors have undoubtedly not helped. It is clearly desirable to ensure that this important provision is adequately funded, but a significant proportion of deaths could be prevented by ensuring that all parents are equipped with important first aid skills.

Of course, a parent first aider is no replacement for a health visitor or paramedic, but they can be the first line of defence when it comes to helping their children live longer and healthier lives. Informed parents can prevent unnecessary trips to the GP and inappropriate hospital admissions, and it is a shame that despite the support that community and parent first aiders provide to the NHS and families, they are barely mentioned in the NHS long-term plan. That is important because if the Secretary of State is serious about making the NHS the best health service in the world, and about having an NHS that promotes health and wellbeing through a focus on prevention, the Government must make first aid in the community a priority. Equipping parents to look after their infants is a good and important step.

Will the Minister take action to ensure that universal first aid training forms part of the antenatal care available to parents? This is about providing families and communities with the skills to step forward in an emergency so that tragedies can be avoided. Learning such skills can be the difference between a life saved and a life lost.