Sudden Unexplained Death in Childhood

Cat Smith Excerpts

Tuesday 17th January 2023 Westminster Hall

[Cat Smith (Lancaster and Fleetwood) (Lab)]

I congratulate the right hon. Member for Spelthorne (Kwasi Kwarteng) on starting the parliamentary conversation on this important issue. The fact that this is the first debate on the subject suggests to me that it is the beginning of a productive conversation.

I speak today on behalf of my constituent Alexander. On Friday I sat down with Alexander’s mum, Emily, and his dad, Darren, at their home in Lancaster. I also met his younger brother Freddie and baby sister Isabelle, who Alexander never got to meet because he died suddenly with an unexplained death on Boxing day 2021. He was three years old.

I will start my contribution by saying a little about Alexander. He was a happy, healthy three-year-old. He was doing well at nursery, and he loved Peter Rabbit and all things vehicles. He was a really loving big brother to Freddie, and he was really looking forward to meeting his new baby sister, as his mum was six months pregnant when he passed away. After a perfect Christmas day, Alexander appeared under the weather, and his mum took his brother Freddie out for a walk to give Alexander time to have a rest and a nap. Emily did not know that by the time she returned to the family home in Lancaster, her world would have changed forever.

Aside from a previous history of febrile seizures, there were no signs that Alexander was seriously ill or at risk of dying suddenly and unexpectedly. That is the reality of SUDC. It is sudden, and we currently do not know if there is any way to reduce the risk. There is no preparation and no warning, and families are left with little or no answer about why their child has died.

It would be very easy to use this debate to set out all the things that went wrong and could have been done better, but I want to talk about something that went really well. Emily and Darren were given a SUDC nurse, Jo Birch, who has been a real support to the family through a year that has been, quite frankly, horrific. This is something that is in place in Lancashire, but not everywhere. I take this opportunity to thank Jo for her work and share with the House her role. Jo is part of a nurse-led SUDC service. It is the first nurse-led SUCD service in the country—most are paediatric-led. The service began in 2008 and covers the whole of Lancashire. It follows each case through until the final stage of the process, which is the child death overview panel. For the first 10 years, the service was just two nurses working Monday to Friday, but since 2018 it has become a seven-day service. I am pleased to learn that there are now a couple of other nurse-led teams, although Lancashire remains the only one like it in the north of England.

Emily, Darren and their family ask the Government to do better by the families who are affected. They would like the Minister to take up the issue, as outlined by the hon. Member for Westmorland and Lonsdale (Tim Farron), of consistent national medical education on SUDC. Alexander’s parents feel that we particularly need to examine the links between febrile seizures and SUDC, as the limited research that exists suggests that there is an association. His parents were frequently told that such seizures were normal and he would grow out of them.

One thing that was very clear in my conversation with Alexander’s parents is that they never want any other family to have to go through what they have been through. They want to improve public information on SUDC, and that has to start with the information on the NHS website. I ask the Minister if he will encourage the NHS to urgently and immediately include appropriate information on SUDC on the NHS website. None of us can do anything to bring Alexander back, but we can all learn from his life and take action to ensure there is more research and more information on SUDC.

Finally, I want to say that Alexander is blessed to have a mummy like Emily and a daddy like Darren. Their love for their son shines through in all that they are doing in his memory. In his three years with us, Alexander touched the lives of so many people that he met, from his key workers and staff at the Lancaster University Pre-School Centre, to friends and neighbours. I thank all those constituents—there have been so many—who have written to me about today’s debate, asking me to attend and speak on behalf of Alexander.

Access to GP Services and NHS Dentistry

Cat Smith Excerpts

Tuesday 21st June 2022 Commons Chamber

[Cat Smith (Lancaster and Fleetwood) (Lab)]

It is a pleasure to follow the hon. Member for North East Bedfordshire (Richard Fuller). His points on planning resonated with me as a Lancashire MP. Where we see large expansions of housing that do not go hand in glove with expansions in GP practices, school places and public transport networks, it is hard to get buy-in from the current population in those areas for that expansion, with patients already struggling to get GP appointments.

When I was collecting my thoughts for this debate, I was worried that I might fall into the trap of talking about the huge number of constituents who get in touch with me daily about their frustrations with GPs and dentists, so I will begin by paying tribute to the GPs and dentists who work in my Lancaster and Fleetwood constituency. Having worked very closely with them for seven years, it is clear they are working to the best of their ability in a system that is, frankly, broken.

I will single out one GP in particular. It is always risky to start naming GPs because there will be someone I miss, but I pay tribute to Dr Mark Spencer. When he recognised the health inequalities, the differences in life expectancy and the increased number of cancers and other conditions among his patients in Fleetwood compared with patients in the rest of the borough of Wyre, he started an initiative called Healthier Fleetwood, which has the buy-in of our town, to promote healthier living and exercise. It is for that work that Healthier Fleetwood was awarded the Queen’s Award for Voluntary Service last month. I congratulate all the volunteers at Healthier Fleetwood and Dr Mark Spencer on having the initiative and foresight to do that. He established it because of those health inequalities, which are exacerbated when access to primary care is made difficult. The reality is that record numbers of people are waiting for care and waiting longer than ever before. When we say that people are waiting longer for care, it is important to remember that people are waiting in pain and in discomfort, and with conditions that become more severe and more difficult to treat.

Frankly, Tory mismanagement has left England with 4,500 fewer GPs than we had a decade ago. That is in stark contrast to what was promised in the 2019 Tory manifesto, which talked about 6,000 more GPs. Instead, we have 4,500 fewer. It is no wonder that patients are getting frustrated. Many of my constituents at the Lancaster end of my constituency started a Facebook group when they became frustrated with the telephone system of one medical practice in Lancaster. A lot of such issues are down to the fact that there is just not enough capacity to meet demand in that part of my constituency. My constituency feels like two stories. I get far more complaints and grumbles from the Lancaster end of my constituency about struggling to access GP appointments than I do at the Fleetwood end, and that is reflected in the number of GPs recruited.

When patients cannot access GP appointments, they are directed to urgent care or accident and emergency. That is financially illiterate. The cost of a GP appointment is roughly £39. If we direct someone to an urgent care centre, it is £77. If they end up at A&E, it is £359. By not funding and supporting primary care, and by not recruiting and retaining the GPs we need, it is costing the NHS more to deliver healthcare and making it more frustrating for my constituents.

Turning to dentistry, I spoke last week to a nursery teacher in my constituency who teaches a class of three and four-year-olds. They had been learning about dental hygiene and they were given a little toothbrush and toothpaste. She talked about their experiences of going to the dentist. She told me that hardly any of those three and four-year-olds had been to a dentist. That concerns me deeply, but it ties in with what I am getting in my mailbag as a constituency MP: constituents are struggling to get NHS dentists for their children. Adults, too, are struggling to get NHS dentists. One of the most obvious ways people fall out of having an NHS dentist is when they move house. I have many people who moved to live in my constituency from other parts of the country and tried to find an NHS dentist. Years and years later, they are still left waiting. I have examples of parents of school-age children who are still on NHS waiting lists to see an NHS dentist.

One of the most difficult advice surgery appointments I have ever had to sit through was when a constituent put on the table in front of me the teeth he had pulled out of his own mouth. That will, frankly, stay with me forever, but it should never have got to that point. As a result of that case, I have raised the issue of access to NHS dentistry many times in this Chamber, including at Prime Minister’s questions. Last year, 2,000 dentists quit the NHS.

The number of nought to 10-year-olds admitted to hospital for tooth extractions is going up. I looked up the statistics for my own area. There were 30 children in Lancaster and 40 children in Wyre under the age of 11 who had been admitted to hospital for tooth extractions. Of those children, 30 were five years old or younger. I have to say that we are getting something dreadfully wrong when it comes to NHS dentistry and access to NHS dentistry. If we do not get it right for children and babies, we are storing up a lifetime of health issues that will become more and more expensive to deal with and have a knock-on effect on wider health.

To wrap up, the Culture Secretary recently admitted that a decade of Conservative mismanagement had left our NHS “wanting and inadequate” before covid hit. It seems that the Conservatives are now breaking their promise to hire the GPs we need and they are overseeing an exodus of NHS dentists. Those who cannot afford to go private are resorting to DIY dentistry or are being left in pain. Frankly, the longer we give the Conservatives in office, the longer our constituents will wait in pain.

Childhood Cancer Outcomes

Cat Smith Excerpts

Tuesday 26th April 2022 Commons Chamber

[Ian Paisley (North Antrim) (DUP)]

I congratulate the hon. Member for Gosport (Dame Caroline Dinenage) on how she introduced this debate today. Many Members who have already spoken have become the voice for the voiceless in this debate. It is probably what Parliament should be for—to cry out for those who are most vulnerable, most needy and most deserving, yet do not have a voice.

Like many, I want to be the voice for one of my voiceless constituents today; I want to speak for Jake Oliver. Jake is four. He is currently in the haematology ward of the Royal Victoria Hospital for sick children, being looked after by some of the most magnificent staff in cancer services who deal with young people and children in particular.

Jake’s mum wrote to me, saying that she wanted me to speak in this debate because

“I honestly wouldn’t wish on any parent/family what we have been through in the past 19 months and continue to go through daily…Jake being so unwell and not getting a diagnosis quicker! 8 awful weeks before we knew he had cancer and at the age of 4. It breaks my heart to think my boy was so sick and didn’t know what was going on in his wee body…It took a further 6/7 days to stabilise him in hospital before we could begin biopsies….4 years old and he was basically being suffocated by a large mass surrounding his heart and lungs, cutting off his blood and air supply.”

I think we will hear many messages today from hospital beds and people’s homes about their little ones and how they need care. It is important that we recognise that every single effort has to be made to help these young people. Early diagnosis is clearly a key point.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

It strikes me that I have had a similar piece of correspondence from my constituents about their three-year-old son Alfie, who is undergoing treatment for leukaemia. Does the hon. Gentleman agree that awareness among GPs would go a long way to ensuring that these young people—my three-year-old constituent, and his four-year-old constituent—get treatment sooner that is perhaps less aggressive?

[Ian Paisley]

If Jake could speak today, he would say “Hear, hear!” to what the hon. Lady has just said, because early diagnosis has been key. As other hon. Members have said, waiting several months before the GP was able to get the child to A&E and then have them diagnosed is not appropriate. It is not the GP’s fault. More money has to be put into research. There has to be more awareness, more skills training and more discovery research done, so that these problems do not arise again and again. As the right hon. Member for Alyn and Deeside (Mark Tami) said earlier about his own little kid, if there had been greater awareness at the GP level, these things could have been avoided and we would have at least had an early diagnosis and earlier treatment.

The fragmented experience that many young people and their families are going through must be addressed. We have heard already from hon. Members on both sides of the House that the fragmented service is not good enough. Jake will not take the excuse that some of those issues had to be set aside because of covid. He will not accept that excuse and his parents will not accept that excuse—and rightly so. They will not accept the excuse that there are not enough resources and enough money being made available.

Some hon. Members will not like me making this point, but I will make it: we spend more on abortion services than on childhood cancer research. Hon. Members should think about that and the weight of that. Surely we should be putting resources into childhood cancer research to save the most vulnerable lives that are already with us. That is where the effort should be made.

I agree with the points and statement of the hon. Member for Gosport and with the strategy that we must outline and deliver urgently. Let us not have another debate in a few years’ time about the issue. Let us have a celebration that we have done something—that we have directed those resources, changed lives, and had the ability to encourage the research. Let us bring together the experts who we know are already out there so that little boys such as Jake and the little girls who have been mentioned know that the treatment will be made available and that the research will result in their lives being saved, so we will see a difference. Let us give Jake and other children across this kingdom a chance.

Covid-19: Impact on Social Work

Cat Smith Excerpts

Wednesday 23rd March 2022 Westminster Hall

[Cat Smith (Lancaster and Fleetwood) (Lab)]

I beg to move,

That this House has considered the impact of the covid-19 outbreak on social work.

It is a pleasure to serve under your chairmanship, Mr Robertson. World Social Work Day was on 15 March, so it is perhaps timely to hold a debate in this House on the issue of social work. May I begin by wishing social workers everywhere, particularly in my constituency of Lancaster and Fleetwood, a belated but very happy World Social Work Day?

I see from my casework, as I imagine many other Members do from theirs, the amazing work that social workers do to support our constituents. Social work is one of the lesser-understood parts of our social care sector. Social workers come into people’s lives at difficult and challenging times, and there can be a negative association with them. When social workers are in the headlines, that is often because the worst has happened. When the worst happens, that sadly often means that a child known to social services has died.

When Arthur Labinjo-Hughes was murdered by the very people who were supposed to love and care for him, that was national news. Everyone wanted to know what events had led to that tragic incident and how it could be prevented from ever happening again. Some people were asking why social services could not save him, and why they could not save Star Hobson, who was also killed by the people who were supposed to look after her.

Most of the time, social workers are not in the news. I know an awful lot about social workers. In fact, I was brought up by one. My dad is a retired social worker, but he spent many years working for Cumbria social services in probation, child protection and, latterly, in his longest stint, the youth offending team. Although there are probably many cases in which my dad supported individuals but perhaps did not manage to turn their lives around, I want to tell the anonymous story of a school friend of mine who was in contact with me a couple of years ago. She said, “Your dad was my social worker. I had fallen in with the wrong crowd, but your dad helped me turn my life around. Now I am a mum, I work, and I no longer have a criminal record. I managed to do that with the support of your dad.” The story of my school friend would never make a story in a local paper, let alone a national, but that is the kind of work that social workers do in lots of different sectors. In particular, such cases involve supporting young offenders to turn their lives around.

Every single day, social workers carry out their roles. They support people with learning difficulties and autistic people. They work with unaccompanied asylum-seeking children. They carry out assessments and reviews, protecting people’s liberties and best interests. Social workers are integral to upholding human rights and child protection, but we cannot ignore the sphere in which social workers work.

[David Linden (Glasgow East) (SNP)]

I am grateful to the hon. Member for securing the debate. Will she allow me to place on record my thanks to those on the frontline of social work in Glasgow? In particular, I pay tribute to the social work team in Easterhouse in the East community addiction team in Parkhead. Before covid-19, many of those social workers had an enormous workload, which has only been exacerbated by several lockdowns. Does the hon. Lady agree that it is important that we listen to the voice of social workers on further support from Government as we emerge from covid-19, as their workload has undoubtedly changed?

[Cat Smith]

I thank the hon. Member for making that point. As a frequent visitor to his constituency, I know that his social work team in Glasgow do an amazing job supporting his constituents, and he is right to say that the voice of social workers needs to be heard by Government.

I have spent a lot of time with social workers over the years, some of whom have gone on to be elected Members of the House and who were then able to provide a platform for social work issues, and I have huge respect for the Members of the House who come from a social work background. One of the first MPs I met, Hilton Dawson, was a social worker before being elected MP for Lancaster in 1997. After Parliament, he went to work at the British Association of Social Workers, where I worked with him before being elected to the House. There is probably quite a nice symmetry in that, but I suspect that he is probably watching and wondering why it has taken me so long to get a Westminster Hall debate on this important issue. Indeed, given that his most recent political activity was standing in the Hartlepool by-election for the North East party, he has certainly been on a political journey, too.

The British Association of Social Workers is the professional organisation for more than 22,000 social workers in the UK. Its annual survey was carried out at the end of 2021, and the results were published just a few weeks ago. Social workers are on the frontline. They know their own profession and what they need in order to be able to fulfil their statutory and non-statutory obligations to a high standard. The Government should be listening to them.

In the survey, the three biggest challenges facing the workforce were determined to be the demands of administrative tasks, workload demand and adequacy of staffing. Nearly 5,000 family social workers left the profession during 2021—up 16% compared with 2020. How can we trust that we are doing the best by social workers if they are leaving the profession in such numbers and trying to do their job without departments being fully staffed?

High workloads and staff shortages will lead to current staff burning out. In many professions, burnout at work means that someone drops the ball on a deadline and perhaps one or two deadlines are missed, but a burnt-out social worker can be a matter of life and death for a child. It is not the fault of that social worker; the issue is the environment in which they work. Social workers do their very best to support people, so Government must do their very best to support social workers.

The pandemic did not only affect child safeguarding. The challenges facing care homes were also a key focus, but Government failed to bring forward many solutions. They only issued guidance and let care homes make their own decisions about visitors and testing, and that caused a lot of upset. Social workers reported that they were unable to access care homes. Social workers have a key safeguarding role, and residents’ family members and social workers facing access restrictions only heightened the worry about what was going on inside care homes.

How were people coping with the changes? Many care home residents, especially those with illnesses such as dementia, would not have understood why their family members were not visiting. That was never the right approach. I appreciate that the confusion in a pandemic can lead to some rash and ill-thought-out decisions, but it must never be allowed to happen again. Upholding human rights is not an optional add-on; it is a fundamental part of our social care system and should never have been restricted.

The pandemic also had an impact on people with learning disabilities and autistic people. “Do not resuscitate” orders were being issued basis solely on a person’s learning disability. That is a national scandal. Does the Minister understand the distress that those orders will have caused people? People with learning disabilities have, for a variety of reasons, much poorer health outcomes than the population as a whole. Along with other vulnerable and marginalised groups, people with a learning disability and autistic people bore a disproportionate weight of the impact of covid-19, including a greater risk of death.

This cannot be looked at simply in the context of the pandemic, either. We know from scandals such as that involving Winterbourne View care home that people with learning disabilities and autistic people are not always treated in the way they should be. The British Association of Social Workers’ “Homes not Hospitals” group campaigns on this, so will the Minister agree to a meeting with that group to talk about what the Government can do to get people with learning disabilities and autistic people out of hospital and back into the communities where they belong?

Social workers join the profession because they care deeply about society and the people within it, but social workers can do their job properly only if the Government are giving them the resources to do so. There needs to be proper funding for local authorities so that councils can invest in preventive measures. The cuts to local authority budgets affect social work, but also sectors such as youth work. I have secured many debates in the House on youth work and I know that there is sometimes, in some places, a bit of a tension between the youth work profession and the social work profession but, particularly for children in care, a strong working relationship between youth workers and social workers can really make the difference for a young person’s life outcomes.

We do not know whether there will be another dangerous strain of covid-19 or a new virus altogether that may force us into more restrictions on the way we live our lives, but we have to learn the lessons from this pandemic. Social work and social workers must be at the heart of recovery. It is a profession that is often hidden until someone needs the support of a social worker, but it is work that we could not be without.

--- Later in debate ---

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am managing not to laugh; I will do my best.

I am grateful to the hon. Member for Lancaster and Fleetwood (Cat Smith) for securing today’s debate, which has been thoughtful and consensual. It is a worthy topic and I start by expressing my own gratitude to social workers for their outstanding work during these difficult times. They have continued to work tirelessly to support children, families, individuals and communities across a range of specialisms and services throughout the covid-19 pandemic.

I am grateful for the comprehensive and measured manner in which the hon. Member for Lancaster and Fleetwood outlined and opened the debate. It is a timely reminder to us all that, sadly, lives can be at risk when things go wrong, so it is vital that things do not go wrong and that social workers play a major role in helping to sort out people’s lives.

There are around 11,000 social workers registered with the Scottish Social Services Council. They are part of a social services workforce of over 209,000 people and are aligned to, but a different profession from, social care professions. Most work in local authority settings, across adults, children’s and justice social work. Registered social workers are also employed by the independent sector and may be self-employed independent social workers. They were all classed as key workers and admirably carried out their roles within the additional pressures of the pandemic climate. However, 77.7% of social workers interviewed by the British Association of Social Workers strongly agreed that working under lockdown had increased concerns around being able to safeguard children and adults. Concerns for the safety of women and children experiencing domestic abuse heightened over the pandemic. In some cases, lockdown and social distancing exacerbated already high-risk situations. It is deeply concerning that referrals to domestic abuse services increased during that period.

The Scottish Government are working tirelessly to ensure that frontline services continue to support adults and children experiencing gender-based violence, with £12 million allocated to tackle violence against women and girls. At the beginning of the pandemic, the Scottish Government allocated an additional £5.75 million to various organisations, including Women’s Aid and Rape Crisis Scotland, to support those providing frontline services to people experiencing the violence of domestic abuse, and to ensure that services could meet increased demand. Services, including national helplines, remained open during the pandemic, so that anyone who needed help could access them.

The Scottish Government have also committed to review the funding and commissioning of special services, with an additional twin focus on domestic and sexual abuse services. They recently launched the Delivering Equally Safe fund, inviting applications from public bodies and third-sector organisations. The fund provides up to £13 million a year from October last year to combat violence against women and girls.

Following the Scottish Government’s commitment in the 2020-21 programme for government, they published revised national guidance for child protection on 2 September. The guidance, which incorporates learning from child protection cases, supports improved cross-agency working and outcomes for children at risk. Local implementation of the guidance has been supported by a national group that is chaired by the deputy chief social work adviser. Chief officer groups oversee local public protection arrangements and the assessment and response to risk, vulnerability and protection across the 32 local partnerships.

The Coronavirus (Scotland) Act 2020 provisions were also developed to improve capacity and flexibility of local child protection processes and prioritisation of children at greatest risk. A local authority and Police Scotland data return, collected since April 2020, continues to be key to understanding how the pandemic is impacting on Scotland’s vulnerable children and young people.

While the Scottish Government have worked to protect social workers and those they serve, the UK Government’s requirements for mandatory vaccination of those working in care homes has forced valuable workers from the sector. The British Association of Social Workers issued a statement at the time warning of the dangers of the UK Government’s approach and expressing opposition. In my opinion, the UK Government should have followed the Scottish Government’s “educate and inform” approach to vaccination of care and social workers.

Social work relies very strongly on a human rights regime, which the Scottish Government have championed through working to enshrine the UN convention on the rights of the child and the UN convention on the rights of persons with disabilities in Scots law. The UK Government’s shameless attempt to prevent the enshrining of the UN convention on the rights of the child does nothing to protect the rights of children, and their plans to overhaul or overturn the Human Rights Act are a direct threat to social work, as has been highlighted in the British Association of Social Workers’ briefing. The UK Government should commit to supporting human rights and end their attacks on the Human Rights Act.

There can be no doubt that poverty is a driver of the need for social work interventions. As I have repeatedly called on the UK Government to make the £20 increase to universal credit and working tax credit permanent, it was disappointing that that was not done. The September cut to the £20 uplift has meant that millions of claimants suffered a £1,000-a-year cut, with only tapering to soften the blow. That cut is estimated to have pushed 60,000 people in Scotland into poverty, including 20,000 children.

[Cat Smith]

I am very much enjoying the hon. Gentleman’s contribution. I am glad he has raised the issue of poverty; that is one of the things I did not include in my contribution, but not because it is not important. Does he agree that it is important to understand the link between poverty and families needing support through social work, and that eradicating poverty would go a long way in easing many of the issues that we wish to address through social work?

[Martyn Day]

I agree entirely with the hon. Member. I am bringing my remarks to an end, and she has helped amplify my point, for which I am very grateful. On poverty, the British Association of Social Workers has commented in its briefing that

“it cannot be ignored that poverty will have wider repercussions, such as on social work.”

I will leave that thought as my final remark. I hope it helps focus the Minister’s response.

--- Later in debate ---

[Gillian Keegan]

My hon. Friend raises an important point that we will address as part of the White Paper, “People at the Heart of Care”. It is important that we equip local authorities with the skills and tools they need to commission well in the market and to get the balance right between paying a fair cost for care while making sure that they get value for money for taxpayers.

[Cat Smith]

I welcome quite a lot of what the Minister is saying, and I hope that I am not straying beyond her brief. The complex issue with social work, of course, is that it crosses many Government Departments. While she is talking about the recruitment and retention of social workers, I would like to invite her to put on record her thoughts about why, particularly in child protection, a social worker tends to burn out a lot faster. People tend to go into child protection and then progress to different parts of social work. Would she share her thoughts on why child protection in particular seems to lead to such quick burnout for social workers?

[Gillian Keegan]

The hon. Lady makes an excellent point. Anyone who has met social workers doing that vital job, particularly in child protection, has nothing but admiration for the job they do. It is an incredibly difficult job with incredibly difficult choices that are highly complex and have a massive impact on families and individuals. It is a highly stressful job, but we need to do more to support people in the workplace so that they can deal with their mental health, talk to people and share their experiences. There is no doubt that it is an incredibly difficult job and one that is done very well, but every day they face enormous challenges and big decisions.

Finally, last November we announced a review of leadership in health and social care, led by Sir Gordon Messenger. The review will report in early 2022 and is considering how to foster and replicate the best examples of leadership. Strong leadership in health and social care will help to ensure the best outcomes for our key priorities, including, most importantly, improved care for patients and service users. The review aims to ensure that the necessary leadership behaviours, strategies and qualities are developed to maximise these efforts. We all know that leadership is vital in these key professions.

The hon. Member for Lancaster and Fleetwood mentioned the work of the British Association of Social Workers and the “Homes not Hospitals” campaign to help more people to get the support that they need in their community, so that they can leave hospital. I completely agree with the desire to get more people out of hospital and getting the right care in the community. Indeed, we have an action plan, “Building the right support”, which we will be publishing in the not-too-distant future. I will be delighted to meet with representatives of the British Association of Social Workers to discuss this further.

Once again, I thank all hon. Members who have provided valuable contributions and insights today. It is important for the sector that we have this debate. We know, in our role as Members of Parliament, the work that we can do to highlight the fabulous work that people are doing. That does not always get highlighted, so this is a fantastic opportunity to highlight the complexity of the social work role and the variety of the role—the many different areas in which social workers provide vital support and the link to ensure that people get the right services from a load of different public services and get the wraparound care necessary for them.

The measures that I have set out today show that the Government are fully committed to supporting and developing the social work workforce—it is vital, and recognised as vital—as well as the wider health and social care sector. I thank everybody for their contributions and I look forward to continuing to work to celebrate this fantastic profession.

--- Later in debate ---

[Cat Smith]

Thank you, Mr Robertson. I had actually forgotten that I would get to wind up, but I will take the opportunity to thank all hon. Members for taking part in this important debate. I know that it will be reported on in various publications and read by social workers across the four nations of the United Kingdom, and I think that the contributions by the Members present will be appreciated. It is fair to say that social workers often feel invisible or unrecognised and that the only time they get the spotlight is when, sadly, things have gone horribly and tragically wrong. However, this has been an opportunity, so close to World Social Work Day, to highlight the good work that social workers do.

I thank the Minister for agreeing to meet with the “Homes not Hospitals” team at BASW. If she would not mind, I would be delighted if I could join her at that meeting.

[Gillian Keegan]

indicated assent.

[Cat Smith]

There has been such a lot of agreement and consensus in this debate, and it has been an absolute pleasure to hear so many positive things said about social workers right across the United Kingdom.

Question put and agreed to.

Resolved,

That this House has considered the impact of the covid-19 outbreak on social work.

Elective Care Recovery in England

Cat Smith Excerpts

Monday 7th February 2022 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend not only for his well-timed plug for his local hospital in Kettering but for his important point. The NHS and the Government have been getting on with improving things and trying to bring service levels back to pre-pandemic levels. Notwithstanding his comment about plans more broadly, it is important for us to have a clear long-term strategic approach to it, because the sums of money involved are significant. The waiting lists and the impact on those are significant. It is right to ensure that we have a clear plan and clear metrics to show how that public money will deliver the outcomes that we all want to see delivered and that those patients want to see.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

Waiting lists for joint replacements are at a record high. I have been contacted by dozens of constituents with arthritis who are waiting in a lot of pain. What can the Minister say specifically about joint replacements to the more than 600,000 people who are waiting for them nationally? Has he met Versus Arthritis about the issue?

[Edward Argar]

The hon. Lady makes an important point. Orthopaedic surgery, for want of a better way of putting it, is a hugely important part of the planned care and surgery that the NHS does. Although it does not have a direct impact on someone’s life chances in the same way that oncology does, it certainly affects their quality of life and their ability to enjoy it. I hope that I can give her some good news: I believe that I am due to meet Versus Arthritis, with which I have spoken in the past, later this week to discuss its work in this space and its ideas on how we can incorporate that in our work.

NHS England Funding: Announcement to Media

Cat Smith Excerpts

Monday 25th October 2021 Commons Chamber

[Edward Argar]

My hon. Friend makes an interesting and important point. These will be new diagnostic hubs, but he alludes to a central point. For example, there could be a hub in the car park of an existing hospital where these services are delivered to allow it to deliver them in a covid-free environment, rather than having the same front door for A&E or similar. We are working through the exact detail of how these new hubs will be delivered, but we will be looking at how they can potentially fit with existing services.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

Capital investment in our hospital estate is desperately needed at Royal Lancaster Infirmary—an incredibly old hospital site, which comes with its challenges. Does the Minister agree that closing two hospitals—Royal Lancaster Infirmary and Royal Preston Hospital—to make one new hospital is not creating a new hospital but is in fact a net loss of one hospital? He has a letter on his desk from me asking for a meeting to discuss the future of the hospital site at Royal Lancaster Infirmary. Does he agree that my constituents in Lancaster, which is a growing city, need to have a hospital that they can access?

[Edward Argar]

The hon. Lady will know that, while her local clinical commissioning group—her local health system—may well be considering various options, it has not put any particular option forward to me in that context. I look forward to seeing her letter, but I am certainly happy to meet her if that pre-empts my reply.

Independent Medicines and Medical Devices Safety Review

Cat Smith Excerpts

Thursday 8th July 2021 Commons Chamber

[Cat Smith (Lancaster and Fleetwood) (Lab) [V]]

As I am chair of the all-party parliamentary group on valproate and other anti-epileptic drugs in pregnancy, my comments are on that issue. However, I just want to note the harm done, the hurt caused and the justice needed for victims of surgical mesh and Primodos, who are in a similar position to those who have been harmed by sodium valproate.

One of the common threads that runs through all three campaigns is the way in which, more often than not, it is women who are the victims and it is women’s concerns that have been dismissed. Justice, frustratingly, always seems just out of reach.

One year on from the report’s publication, we really are not much further forward when it comes to sodium valproate. NHS England wrote recently to all women and girls aged 12 to 55 who are currently prescribed sodium valproate, reminding them of the risks of taking it while pregnant. That is a step in the right direction, but it has taken a year. One letter is not going to resolve the issue. The Government really must explain what further action will be taken and over what timescale.

Baroness Cumberlege’s report included nine general recommendations, in addition to a number of specific recommendations on sodium valproate. In January, the Minister provided the Government’s initial response to the recommendations. However, she only responded to the general recommendations and not the specific recommendations on sodium valproate. The Government have since stated on a number of occasions that they will respond in full later this year. Do the Government still plan to make a full response this year and will they address the report’s specific recommendations on sodium valproate?

I have a few brief comments about recommendations 3, 4, 5 and 9 of the report, before turning to the specific recommendations on sodium valproate. I would appreciate an update from the Minister.

Recommendation 3, which is for a new independent redress agency for those harmed by medicines and medical devices, has not been implemented, and it appears that the Government are unwilling to do so. May I express how hugely disappointing that is, given the avoidable harm that so many families have experienced? The case for an independent redress agency remains strong. Other countries have successfully set up an agency without such a mechanism, and people who have suffered avoidable harm following healthcare treatment have no option but to go to court, which is such a lengthy, expensive, confrontational and stressful process.

On recommendation 4, although the Government have stated that they are carefully considering a redress scheme for those harmed by sodium valproate, no further progress has been made. Again, I feel so disappointed, and I know that the families affected share that feeling. Patients who have suffered avoidable harm need help and support now, and actually we owe it to them. That may take the form of additional financial support, above and beyond that to which they are already entitled via welfare benefits and respite care. The frustrating thing is that many have already waited decades for help. What progress is being made to establish a redress scheme for those affected by sodium valproate?

On recommendation 5, again there has been no progress on establishing any specialist centres for those adversely affected by medicines taken during pregnancy. The Department of Health and Social Care appears to take the view that such centres are not needed. I therefore call on the Government to commit to introducing a network of such specialist centres, in recognition of the additional support and care that those affected require.

Recommendation 9 is that the Government should immediately set up a taskforce to implement the review’s recommendations. The Government have been quite clear that they have no plans to establish such a taskforce. The 14-person patient reference group that has been established had a series of meetings this year and will publish its findings shortly. I look forward to reading them, but the group is only able to provide feedback on proposals, whereas a taskforce would have been able to implement the recommendations. The Government really need to explain how they intend to keep patients fully involved as they move forward with full implementation of the report.

On the sodium valproate recommendations, the Government have not responded directly to any of these recommendations, and quite frankly they need to. More importantly, they need to implement them. On the recommendation that a clear process should be agreed to ensure that women can receive counselling related to their epilepsy treatment and contraception choices, at the moment it is a postcode lottery, so what progress is being made to ensure that women and girls with epilepsy have access to pre-conception counselling on epilepsy medicines and contraception?

On the recommendation that information should be collected to identify those already affected by exposure to valproate to ensure that they have access to diagnosis and support and plan their service provision, it is still not sufficient, especially without the redress scheme in place. May we have a response to that recommendation, please?

On the recommendation that a prospective registry should be established for all women on anti-epileptic drugs who become pregnant, and to include them in mandatory reporting of data relating to them and their children, such a registry could be expanded to collect data on paternal effects as well, but at the moment we are just looking at valproate. The valproate registry has been established, and it has been confirmed that other epilepsy medicines will be included, but that has not happened yet. It needs to be expanded to include those other epilepsy medicines as a matter of urgency, because we already know that anti-seizure medication is causing problems during pregnancy.

On the recommendation about stakeholders continuing to work with the patient groups to monitor and improve the pregnancy prevention plans and look at the next steps, all women and girls of childbearing potential have been written to, as I said at the start of my contribution, but we really need to do so much more to improve the PPP. It is important that a balance be found that allows women to make a choice about their treatment and care, while limiting the number of pregnancies exposed to sodium valproate and other harmful epilepsy medicines. May I ask the Minister what progress has been made in making improvements to the PPP?

The final recommendation on sodium valproate is:

“Clinicians should continue to follow guidance regarding prescribing of valproate and alternatives”.

Although further measures have been introduced to communicate the need for that, it is unclear—perhaps the Minister can shed some light—whether or not it is happening in practice, particularly given past concerns about the lack of communication with women and girls. That is a huge concern for me, as I know it is for many of the campaigners involved.

This is not the first time that I have raised the issue in the House. I put on record my thanks to my constituent Janet Williams and her fellow campaigner Emma Murphy for bringing the scandal to my attention in my first few weeks as an MP. Since then, I have learned so much about sodium valproate and epilepsy. I also put on record my thanks to Daniel Jennings from Epilepsy Action for his support in keeping me abreast of this and other issues that people with epilepsy face.

The challenges that women seeking pregnancy face while managing their epilepsy are not just about sodium valproate. Evidence shows that there are a number of other anti-epilepsy drugs that can cause preventable disabilities in babies when taken by their mothers. We must not forget the women impacted by other anti-epilepsy drugs. We cannot go on seeing history repeat itself. Anyone watching this debate who is in that situation might want to seek out the Epilepsy Society’s “Safe Mum, Safe Baby” campaign.

The Government need to consider funding research into safer epilepsy medicines so that babies will not be born with preventable disabilities caused by their mothers’ life-saving drugs. Some important progress has been made, but there are far too many areas in which we are still waiting for action and further response from the Government. It is deeply concerning that the Government have so far chosen not to respond to the specific recommendations on sodium valproate, because it took six months before they produced their initial response to the Cumberlege report, and after a further six months we are still waiting for their full reply.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Before we go any further, may I make an appeal to hon. Members who are speaking from home to remember that those who are here in the Chamber still have to get back to their constituencies this evening—and that usually that which can be said in 10 minutes can be said more effectively in five or six?

Women’s Health Strategy

Cat Smith Excerpts

Monday 8th March 2021 Commons Chamber

[Ms Dorries]

This call for evidence is going to last for 12 weeks, we are going to keep up the drumbeat consistently and it will be cross-departmental. I hope that other Ministers in other Departments will pick up part of the load along the way and use their contacts and access to charities and organisations. We are working strongly with journalists and other outlets to try to get the news over about what we are trying to achieve, our aims and objectives. My hon. Friend is absolutely right that working with charities, organisations, the third sector and all women, and their families and friends, across the UK is really important.[Official Report, 12 March 2021, Vol. 690, c. 6MC.] I ask her, as I have asked everybody else: if she knows of any particular organisations or charities that feel that they can contribute, she should encourage them to do so.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

For decades, women with epilepsy were prescribed sodium valproate and were told it was safe to take during pregnancy. It was not. Their babies were harmed, and women continued to be prescribed sodium valproate and babies continue to be harmed right to this day. The Minister in her statement paid lip service to the Cumberlege review, but this statement comes on the same day she has given me a written answer that I have here, where she said that she is not going to implement recommendation 3, which is about a redress agency for victims of sodium valproate. If this statement is meant to mean anything on International Women’s Day, can the Minister remember those women with epilepsy whose babies were harmed in the womb? Can we get a redress agency for the victims of sodium valproate?

[Ms Dorries]

Ever since sodium valproate was first licensed, the Medicines and Healthcare Products Regulatory Agency’s position has been clear: valproate should only be used in women of childbearing potential if no other medicine is effective or tolerated. The MHRA has kept sodium valproate under constant review. The national director for patient safety has recently set up a clinically led valproate safety implementation group to consider the range of issues relating to valproate and prescribing and to explore options to review and reduce prescribing. In terms of the redress agency, we have looked at that across the board as a result of the Cumberlege recommendations. A number of redress processes are available already, and we did not want to complicate the landscape any further. We feel that, with the MHRA and the national director for patient safety, we have a response to sodium valproate.

Covid-19: Vaccinations

Cat Smith Excerpts

Monday 11th January 2021 Commons Chamber

[Nadhim Zahawi]

My hon. Friend raises an important point. I commit to looking specifically at the point she raises. The NHS in England has done an incredible job, but of course some teams have outperformed others. We have to learn from the best and make sure we share that knowledge. If some teams need additional resource and help, we will do that. That is why we have the additional 80,000 people in the programme who are ready to help and ready to make sure we get the jabs into the arms of the most vulnerable people.

[Cat Smith (Lancaster and Fleetwood) (Lab) [V]]

For parts of Lancashire, the closest mass vaccination centre is more than 60 miles away in Manchester. The Minister has said that there will be more mass vaccination centres, so can he reassure my constituents that we will get a centre on the Fylde coast and in north Lancashire?

[Nadhim Zahawi]

The hon. Lady is right to highlight the issue of distance. No one in her constituency or anywhere else in England will be more than 10 miles away from a vaccination site.

DHSC Answers to Written Questions

Cat Smith Excerpts

Thursday 19th November 2020 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend, and I pay tribute to the officials in the Department, who are working hard to clear the backlog and do take this very seriously. As I say, we are trying to clear the older PQs first, and then get back up to the performance we had before. She is absolutely right to highlight the other methods of communication. I may not be the most technological Minister in this House, but we have been seeking to use every means we can to try to answer colleagues’ questions and to give them the information they need.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

In my time in this House, I have campaigned alongside women and families affected by sodium valproate. Many of the victims of this scandal have felt for decades that Governments have tried to push it under the carpet, so can the Minister understand the frustration and suspicion that these victims feel when written parliamentary questions about the Cumberlege review, which was published on 8 July, continue to take a long time to answer—and when those answers come, they are very poor—and their frustration that since July there has been no progress, beyond the apology in this House, in implementing that review? Can the Minister update the tens of thousands of victims of the Primodos, surgical mesh and sodium valproate scandals and assure them that their campaigns for justice remain high on his Department’s agenda?

[Edward Argar]

Again, I am grateful to the hon. Lady for the tone she adopts on what is actually a very sensitive and very important issue. I can reassure her that that issue does remain very high on the Department’s agenda. At risk of tempting fate, if she wishes either to write to me or to table a question to me, I will endeavour to get it answered very quickly so she has something on the record on that.