Baby Loss Awareness Week

Caroline Johnson Excerpts

Tuesday 10th October 2017 Commons Chamber

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

I pay tribute to the bravery of the many people who have described very personal and moving experiences in the Chamber this evening. I have experienced this issue from a different angle, in a professional capacity. As a consultant paediatrician, I have been privileged to see many hundreds of babies come into the world. I can honestly say that the joy and the miracle of that event, in whatever circumstances, is not diminished by having seen it on numerous occasions.

As a junior doctor, one is fortunate to see many happy occasions when babies are born in good health and at full-term. As a consultant, one is called only when either the mum or the baby is in significant trouble. That might be when the baby is very premature, when the baby or mum is very sick—for example, following a road traffic accident or with sepsis, which we have heard about here before—or when the baby is, sadly, born without a heart rate.

I can remember occasions from my professional experience when I have had to give parents the news that nobody—I speak as a parent of three—ever wants to hear, and no doctor ever wants to give: that a baby or child is, sadly, going to die. I remember holding one particular infant in my arms, because his parents were not able to do so, as he passed away. There is no doubt that we need to do everything we can—NHS professionals work very hard every day—to make sure that that does not happen, but unfortunately it does. I welcome the Government’s target to reduce the incidence of stillbirth by 50% by 2030.

I want to talk about some of the changes that have been made during my career. I graduated as a doctor in 2001, and I worked as a consultant paediatrician in the NHS, particularly in neonatal care. A number of changes in neonatal care have led to improvements over this time. There has been an increasing centralisation of neonatal care, so that the smallest and sickest infants are cared for in areas of significant expertise. This has helped to reduce mortality, particularly for the smallest and sickest babies. It has also led to a need for transportation. A baby who is born in a small district general hospital may need to be transferred many miles—sometimes hundreds of miles—to a hospital that has the expertise to care for their particular problem. When I was a junior doctor, that meant the doctor who was on shift, such as me, getting into the back of a 999-called ambulance and taking the baby in an incubator to wherever they needed to go.

Over the past few years, that has changed considerably. We now have clinical networks and areas of the country are divided up into patches in which there is a dedicated clinical team, led by a consultant neonatologist, with nurses and doctors who have specialised in this area. In many cases, there is a dedicated ambulance, as well as helicopter transport, to come and retrieve babies from whichever hospital they are born in and to take them to such a centre of expertise. That has been a big improvement in the care we offer children during the time that I have been a doctor.

As was mentioned earlier, another thing we have done is to focus much more on the lessons that we can learn. As a doctor, the first infant I saw who died was a young boy whose death was, sadly, entirely preventable. There was an investigation and lessons have been learned, but that does not take away from the horror of the occasion. It was an awful experience for the family, and it was traumatic for everybody involved. As an introduction to being a junior doctor—although I took no responsibility for it all medically—it was very traumatic, as it was for everybody.

We now have regular meetings to look at the cases of children or infants who have died, suffered significant injury or become more unwell than we anticipated, and where any type of adverse event has occurred. Such cases are looked at in detail by a multidisciplinary team, which goes stepwise through the process from the child being conceived or being referred to hospital and asks what has happened, why it has happened, what could have been done better and what would have changed the outcome. Although we would like to prevent every case, the reality is that, while we will get closer to doing so, we will never prevent every death, in my view. We should, however, prevent every one that can be prevented, and I very much welcome the Minister’s statement about improving the way in which cases are reviewed and about making that a statutory requirement.

I welcome the contribution of my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) in relation to child bereavement leave. He is right to say that most employers, like him, are very flexible in dealing with people whose infant may be very unwell in hospital for several months at a time, but some are not, and that places an enormous pressure on such people. I also welcome the national bereavement care pathway. All the hospitals in which I have worked have had bereavement rooms and I think they provided good care to bereaved parents and families, although I know that that is not accepted as a universal statement.

Will the Minister look in detail at the evidence on group B streptococcal infections, and at any evidence relating to whether women should be screened for that in pregnancy?

The centralisation of tertiary neonatal services has been a good thing in making the survival outcomes for babies better. We are now focusing not just on survival but on improving the quality of life, particularly for pre-term infants, such as by improving ventilator settings so that their vision is improved and their lung function is better as they grow up. However, centralisation also has an impact on families. For example, for a baby born in my constituency, the nearest tertiary neonatal centre is Nottingham, and if it does not have a bed, they might be sent further afield to Sheffield, Leicester or Norwich. For people looking after older children at home—having to take them to school, for instance—trying to manage having a baby several hours’ journey away will have a huge impact on the family. It also has significant cost implications, and I not infrequently see parents, particularly in working families on low incomes, who are struggling with the financial implications of travelling to visit their desperately sick baby who is several hours away.

Overall, I think there have been many welcome announcements in this field today.

NHS Pay

Caroline Johnson Excerpts

Wednesday 13th September 2017 Commons Chamber

[Dr Whitford]

I totally thank the right hon. Gentleman for his intervention. That is absolutely the case. It has never been a negative—in fact it has always been a benefit—that we have attracted people who were a bit older to the role of student nurse. Perhaps they had another degree or a student loan to pay off, but they always had a bit more life experience under their belt.

As a very junior doctor in my first year, I remember what it was like when my hours alternated between 132 and 175, and I had no life that did not involve people who were dying or ill or who had been hit by a car. That is very difficult for a person who has just come out of uni, and who is used to going out for a pint and having parties. There is real advantage in training people who may have had a family and who have lived a bit of life. As the right hon. Member for North Norfolk (Norman Lamb) said, there are people who are attracted to nursing but who will not take it up because they will not put their family through it. We have seen that already with a 23% drop in applications.

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

As a fellow NHS consultant, I entirely agreed with the hon. Lady when she said that this was about not just the nurses, but the NHS as a team and the value of the whole package of care. One cannot work effectively without the other. Yes, there is a debt accrued in doing a nursing career, but the Health Secretary has proposed a new technical route into nursing, which will mean that people can get an apprenticeship in nursing, allowing them to work and earn throughout their training. Therefore, nurses will be able to qualify while working and supporting their families without accruing any debt.

[Dr Whitford]

I welcome the hon. Lady’s intervention. I definitely welcome other routes into nursing. Of course when I was a wee doctor, we had two routes: the enrolled nurse and the degree nurse. That disappeared with Nursing 2000, but we are now coming back to that discussion. I have no problem with that, but we will need degree nurses. We have nurses in very advanced practitioner roles, which means that they require a more academic design—a more balanced and weighing-up-the-evidence kind of approach. It is important that we do not make it that the only route most people can afford to follow is the healthcare assistant route. I welcome it, but I certainly would not like to see people limited by it. The Secretary of State tells us that this is not an issue, because we still have more applicants than places—as yet, according to the universities, the number of places has not expanded by very much—but what we do not know is the talent that exists among that 23%. It may be fine numerically, but if we are excluding people who might have been absolute leaders in the nursing profession and in the NHS then we are the poorer for it.

We know that 40,000 vacancies need filling, and the pay cap is definitely making it harder to fill them. Brexit is not exactly helping either. Everyone here knows that my other half is a German GP in our NHS who, 15 months on, still has no idea what our rights and opportunities will be. The pay cap is definitely contributing to that problem and it is time for it to go, but it must be funded, or else it will mean a cut in services, which will hurt not just patients, but staff, who will feel that they are damaging the very service in which they work, and they will feel guilty about that. As that service is cut and contracts, their working day and working life will get worse.

The Government often talk as if spending on public service staff is money wasted. It is as if we cannot afford that money because we need to get the debt down, but in actual fact money that is put out by public sector workers is irrigating the economy—the money is spent. Some of it comes back in income tax—20% of everything all of us spend comes back. Money disappears when it is pushed at the top. It goes into banks and offshore, and is therefore outside our economy. Money that is in our economy encouraging commerce and business is helping us to recover.

After the tragedies of this summer—from the terrorist attacks to Grenfell—people right across this Chamber have quite rightly praised NHS staff and emergency workers. Now is the time for us to show not just what we think of them, but how we value them.

Access to NHS Dentists

Caroline Johnson Excerpts

Tuesday 12th September 2017 Commons Chamber

[Judith Cummins]

I absolutely do.

Dental practices in working-class areas, facing spiralling overheads and a decline in their income, are struggling to stay afloat. In better-off areas, dental practices have been able to cushion themselves through extra revenue from privately paying patients. That extra income makes a difference. In working-class areas, the realities of life are hugely different. After many families have paid their rent or mortgage, covered day-to-day essentials and put food on the table, a visit to the dentist has now become one of life’s luxuries.

Research by the BDA supports that idea. Figures reveal that four in 10 patients have delayed a dental check-up because of fears about the high cost of treatment. That is understandable when we realise that the patient charge for treatment in the highest band—such as crowns or bridges—is £244.30. Working-class people, such as those in Bradford, are being hit the hardest. They have been abandoned by the Government, and they suffer failing oral health and chronic pain day in, day out. Worst of all, they are powerless to do anything about it because they find it difficult to access an NHS dentist. There is a clear human cost of poor dental health, which affects every part of a person’s day-to-day life.

The BBC spoke to a Mr Oldroyd during their investigations. Mr Oldroyd, a middle-aged man, has been trying to find an NHS dentist for four long years, during which he had suffered from chronic pain caused by his terrible tooth decay. He told reporters:

“The state of my teeth has made me depressed and I’ve literally begged to be taken on by an NHS dentist, but every time I’ve been turned away.”

Mr Oldroyd told reporters that his pain became so unbearable that, in the end, he resorted to self-extraction. He pulled out his own teeth. This is simply unthinkable. Mr Oldroyd believes that his poor dental health has contributed to him being out of work. As he puts it:

“The tops of my teeth are gone. I’m on benefits and trying to get a job, and when someone sees my teeth they just think I’m another waster.”

This crisis has been a long time in the coming. It has not crept up on the Government; it has been visible and in plain sight. The Government were put on notice when they came to power in 2010. There have been repeated warnings from dental professionals working in the sector, from within Parliament, and from the British Dental Association. All have warned that inaction is not an option, but sadly that is what we have seen.

It was not long ago that I, and many other Members, spent the afternoon right here in the Chamber in a Back-Bench business debate about health inequalities. During my remarks I set out a number of simple, uncontroversial steps that promised to improve access to NHS dentistry. First among those steps was to expedite reform of the NHS dental contract. Time and again when challenged about the reform of this contract, the Government have done little more than lay the blame at the door of the previous Labour Government. With respect, if that excuse was ever persuasive, it is now threadbare following seven years of a Conservative Government, two Conservative Prime Ministers and three general elections.

Reform of the contract is critical, as it promises to spend taxpayers’ money more effectively. The current dysfunctional contract sets quotas on patient numbers, fails to incentivise preventive work, including effective public information campaigns, and implicitly places an ever-growing reliance on dental practices to pursue private charging as a means of staying afloat. This Government are forcing dentists to make a terrible decision: either to stop providing NHS services altogether and go private, disregarding those who have less ability to pay, or to provide overstretched NHS dental treatment to their patients—or a combination of the both. That is a toxic choice for the dental profession.

Since first being elected in 2015, I have campaigned for more funding for Bradford. The city has among the worst oral health outcomes in the country, despite the hard work of local public health officials. We have received additional funding, to the credit of the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), but frustratingly this was only temporary. Despite my efforts, the Government still have not announced whether any permanent funding will be put in place. That is simply unacceptable. Official figures reveal that a five-year-old in Bradford is four and a half times more likely to suffer from tooth decay than a child in the Health Secretary’s constituency of South West Surrey. According to figures, a third of children in Bradford have not seen a dentist for more than two years. Children should be given a check-up every six months.

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

Will the hon. Lady give way?

[Judith Cummins]

I am really sorry; I cannot give way because of the time.

One of the most shocking figures reveals that the number of children admitted to hospital for tooth extractions has risen by a quarter over the past four years. Some may think that tooth extraction is simply a part of growing up—a rite of passage for children. Some may recount their own personal memories of visiting the dentist. If anyone still holds that sentimental view, they should pause for a moment and rethink. The tooth extractions I am speaking of, which have gone up by a quarter in the last four years, mostly involve a general anaesthetic. A recent freedom of information request to Bradford hospitals sets out the scale of the crisis. In the short period from April to December 2016, 190 children were admitted to hospital to undergo a tooth extraction under general anaesthetic. What was also shocking about this request was the hospital’s admission that those figures were not available prior to April 2016. The hospital did not consider that the procedure warranted reporting.

--- Later in debate ---

[Steve Brine]

I absolutely agree with the hon. Lady, and if she will bear with me, I will come on to that point.

[Dr Caroline Johnson]

As a doctor, I have seen the distressing circumstances in which children as young as two come in for teeth extractions. Children sometimes have all the milk teeth in their mouth extracted. Does my hon. Friend agree that there is more to preventing caries and such extractions than just dental treatment and having more dentists? The answer, particularly for the very youngest children, lies in extra education about oral care, as well as good diet and not drinking fizzy drinks and the like.

[Steve Brine]

Yes, there should be a package, and I will come on to mention one or two of those points. This is as much about self-care as it is about interaction with the dental profession.

To conclude the point I was making, at a regional level in the period to 30 June, the north of England saw the highest percentage of patients seen—56.8% of adults and 63% of children. Although these access numbers are encouraging, I know that the hon. Member for Bradford South will not be sitting there thinking, “That’s all okay, then.” I know that more needs to be done to reduce the remaining inequalities in access, including in areas such as Bradford South, which she represents, and NHS England is committed to improving the commissioning of primary care dentistry within the overall vision of the five year forward view.

There are a number of national and local initiatives in place or being developed that aim to increase access to NHS dentistry. Nationally, the Government remain committed to introducing the new NHS dental contract, which the hon. Lady rightly referred to often in her speech. It is absolutely crucial to improve the oral health of the population and increase access to NHS dentistry.

A new way of delivering care and paying dentists is being trialled in 75 high street dental practices. At the heart of the new approach is a prevention-focused clinical pathway. It includes offering patients oral health assessments and advice on diet and good oral hygiene, with follow-up appointments where necessary to provide preventive measures, such as fluoride varnish, that can help the prevention agenda. Importantly, and this is of most relevance in this debate, the new approach also aims to increase patient access by paying dentists for the number of patients cared for—let me restate that: cared for—not just for treatment delivered, as per the current NHS dental contract. Subject to the successful evaluation of the prototypes, decisions will be taken on wider adoption. The prototypes are being evaluated against a number of success criteria, but let me be clear that they will have to prove that they can increase dental access before we consider rolling them out as a new dental contract.

I appreciate that this is taking a long time. It is as frustrating for me as it is for right hon. and hon. Members and for the profession, but Members will understand that rolling out a new dental contract is complicated and complex. We have to make sure that it is right and that what we put in place is better than what was there before.

Contaminated Blood

Caroline Johnson Excerpts

Tuesday 11th July 2017 Commons Chamber

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

I wish to start by echoing what has been said by so many in paying tribute to the victims of this tragedy, their families and those many hon. Members who have campaigned tirelessly for such a long time to ensure that this public inquiry takes place. I also pay tribute to our Prime Minister who, after so many people have not, has listened to these concerns and has organised this full public inquiry.

As a doctor, I prescribe blood products—and that will be continuing every day—often for people who are not in the position to make decisions for themselves. I prescribe blood for babies who have been born very prematurely and for children who have cancer—people who are not in the position to make these decisions, just like the youngsters with haemophilia and other constituents who have been mentioned.

This is an issue of trust. It is important that when people go into hospital and receive treatment they are able to trust that the risk-benefit decision that is made with them or, if they are very small or very unwell, on their behalf, is made on the basis of all the known facts and all the available information. With the contaminated blood scandal, it appears that that was not the case. Despite the fact that people knew that HIV, hepatitis and hepatitis B were transmissible through blood products, that information was not made available to the people receiving such products. The bloods were not being properly screened, and even when, as I understand it, bloods were being screened elsewhere, these products were being used on people in the UK.

[Ms Esther McVey (Tatton) (Con)]

Trust is the key word—trust and faith, if people have that, in the inquiry. Every story is different. My constituent Barry Flynn is a twin. His twin is not here, but on his behalf he wants to be able to trust the inquiry. He wants the victims to be heard and to decide the remit, and he wants their evidence to be taken. Does my hon. Friend agree that that is the way to get trust?

[Dr Johnson]

Absolutely; the victims and their families have the right and deserve to know what happened. They deserve answers to their questions. They need to know when people knew that these blood products could be causing harm and, if those people did know, why the products were still given.

The House should be under no illusions—I am sure it will not be, after listening to many eloquent Members describe their constituents’ cases—about the suffering people have been through, losing their family members. There is a stigma that still exists today around many of these medical conditions, particularly HIV. Other people, such as victims’ wives and children, have been put at risk, and many others still suffer today from poor health.

I very much welcome the announcement of the public inquiry, which I hope will get to the bottom of all the issues. I hope that the victims receive the compensation they deserve.

Adult Social Care Funding

Caroline Johnson Excerpts

Thursday 6th July 2017 Commons Chamber

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

Improvements in medicine have enabled people to live longer, but we also want them to live more healthily. We know that investment in reducing loneliness, in improving activity and in treating conditions such as macular degeneration, which causes blindness, will help to reduce the need for social care. What is the Minister doing in this regard?

[Steve Brine]

Although I am not specifically the Minister with responsibility for care, I am the public health Minister and the primary care Minister. We have brought those two subjects together because we want to see a healthy population across the board. I am pleased that my hon. Friend has mentioned the Commission on Loneliness. It was probably set up before she entered this House; it was started by the late Member Jo Cox, who did some really good work that is rightly being taken forward in this Parliament.

NHS Shared Business Services

Caroline Johnson Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

I gently remind the hon. Gentleman that the last Government who had an active policy of increasing private sector market share in the NHS were the last Labour Government. This Government legislated to stop the Government nationally prioritising the private sector and made that a decision for individual doctors at a local level.

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

As a doctor, I understand the importance of ensuring that results and letters are reviewed in a timely manner. There will always be opportunity for error in any system relying on bits of paper being sent around. Hospitals such as Peterborough City hospital, where I have worked, provide results electronically, which is quicker, as well as having a back-up paper form, which provides for patient safety. Will the Secretary of State reassure us that good practice such as this is being rolled out elsewhere?

[Mr Hunt]

Absolutely. My hon. Friend is right to point out that we are in a different world from the world of 2011. The future is to transport patient records securely over electronic systems. It is much quicker and there is much less room for error, but we do need the back-up systems that she mentioned.

O’Neill Review

Caroline Johnson Excerpts

Tuesday 7th March 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Streeter. First, I thank my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for bringing this crucial issue forward for discussion. Keeping it in the spotlight is vital, to ensure that there is sufficient political will to carry forth the recommendations in the O’Neill report on antimicrobial resistance.

Having worked in the NHS as a consultant paediatrician, and having treated many patients with antibiotics, I have seen at first hand the work the NHS is doing to ensure that they are prescribed responsibly. I have also used the CRP test, which my hon. Friend the Member for Erewash (Maggie Throup) mentioned, many times. However, I would caution that the result of that test is only a small part of a much larger clinical picture, and we should be mindful that a normal result does not exclude serious infection.

Over the years of my clinical practice, many measures have come into force to ensure that the right antibiotic, appropriate for the infection and the patient, is used. One of those is limiting access to the newest antibiotics, and using them only in specific circumstances after discussions with the hospital’s consultant microbiologist. The measures have resulted in a more responsible use of antibiotics within the health service. However, as the O’Neill review identified, such stringent measures do not exist within veterinary medicine, and the use of antibiotics in farming accounts for about 40% of the UK’s consumption of antibiotics.

As a Member for a rural constituency and the wife of a farmer, I believe that minimising the growth of antimicrobial resistance through our agricultural practices is of great importance and must be tackled with the same vigour with which we have addressed the use of antibiotics in human medicine. The O’Neill review made a number of recommendations, including the responsible use of antibiotics in animals, restricting the use of antibiotics that are critical to human medicine, and disease prevention. An effective antibiotic monitoring system can have a huge impact on reducing the use of antibiotics, as shown by the implementation of such a system in the British meat poultry sector, which resulted in a 44% reduction from 2012 to 2015. Restricting the use in agriculture of antibiotics that are of the most critical importance to human medicine is vital to ensure their continued effectiveness. The Department of Health requires continued support to bolster the regulatory oversight of veterinary antibiotics, to ensure that they are used responsibly and to keep back the priority antibiotics.

Finally, we must support our farmers in methods to prevent disease by emphasising improvement in overall biosecurity and herd health, including through vaccination. It is important that we do our part to deal with antibiotic resistance, but we also need to recognise, as my right hon. Friend the Member for Tatton (Mr Osborne) said, that this issue can only really be solved with international co-operation and a push for awareness of the problem, not only at home but within the international community, to help develop the regulatory framework. Much talk is made of a cliff edge where drug-resistant bacteria will be able to defeat the entire arsenal of antibiotics, but we have already reached that cliff edge.