Strep A Treatments: Supply

Cat Smith Excerpts

Monday 19th December 2022 Commons Chamber

[Maria Caulfield]

We recognise that there are supply issues with pharmacies. That is why pharmacists have had the flexibility since before last week to adjust doses and preparations. Since Friday they have also been able to issue alternative antibiotics. I would say to the hon. Lady’s constituent to go back to her pharmacist, who will be able to give her an alternative supply.

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

Parents right across my constituency have been raising concerns with me about the rise in strep A cases. I spoke to a reception class teacher last week who told me that more than half the reception class were off with a variety of winter diseases, including strep A. Parents tell me that when they see the symptoms, they struggle to get a GP appointment because of the logjam in the primary care system. What steps is the Minister taking to make more GP appointments available so that parents are not left waiting?

[Maria Caulfield]

Where there has been an outbreak in a local area, many directors of public health are starting children in classes or in schools with known cases on prophylactic antibiotics, preventing strep A in the first place. If the hon. Lady has a case in her constituency, I urge her to talk to her director of public health; it is a clinical decision, but they may be able to start pupils in those classes on prophylactic doses.

Foetal Valproate Spectrum Disorder: Fatalities

Cat Smith Excerpts

Wednesday 7th December 2022 Commons Chamber

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

I congratulate the right hon. Member on securing this debate on such an important issue. She is touching on the issue of women currently taking sodium valproate when they are of child-bearing age and the number of pregnancies we are still seeing. While more needs to be done with GPs to ensure that these women understand the risks and that there are pregnancy prevention plans, does she agree that it is important to say that any women listening to our debate this evening should keep taking their medication until they have had that conversation with a GP, because sodium valproate is also a lifesaving drug?

[Caroline Nokes]

The hon. Lady is absolutely right, and I will come on to say that none of us is advocating that valproate be banned.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I congratulate my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on securing this important debate on fatalities relating to foetal valproate spectrum disorder. We all know the devastating effect that the drug can have during pregnancy, which is why we took seriously the recommendation in Baroness Cumberlege’s report. I have met the campaigners, Janet and Emma, when I was previously a Minister and since being reappointed—I can confirm that they are definitely not blacklisted by the Department. I look forward to meeting them again shortly to hear the concerns that they still have, which my right hon. Friend set out well this evening.

To reaffirm what the hon. Member for Lancaster and Fleetwood (Cat Smith) said, we all know that sodium valproate can be a highly effective drug that is used to manage and treat epilepsy as well as other disorders, such as bipolar disorder and migraines, often when many other medications do not work or have stopped working. It is absolutely right to say that if a woman is on sodium valproate, it is crucial that they do not stop that medication suddenly but discuss it with their GP.

We know that there are teratogenic side effects that mean that, if taken during pregnancy, sodium valproate can have harmful effects on a foetus and increase the risk of a child being born with physical defects and neurodevelopmental disorders. In relation to the point made by my right hon. Friend the Member for Romsey and Southampton North about possible death, I do not know about that specific case but I am happy to ask officials to go away and look at it, because that would be an important development.

The risk of birth defects following the use of sodium valproate is about 11%, but with a high maternal dose, the risk can increase to 24%. There are significant risks of taking that drug and effects on babies once they are born.

[Cat Smith]

I thank the Minister for the time that she makes available for the subject, which is much appreciated. While she is on the topic of the percentage risk of harm to the unborn baby, at that stage in pregnancy, many women and couples have a very much wanted pregnancy, which is perhaps planned for and longed for, but are suddenly advised by a doctor to terminate it. Does she agree that that tragedy needs to end? We need to come together to ensure that pregnancy prevention plans really work.

[Maria Caulfield]

I absolutely agree with the hon. Lady, and I will come on to some of the changes that are being made on that point. When I have met Janet and Emma, they have very much represented women who feel that those risks were not explained and that if they had known, they would have been on contraception or spoken to their team about stopping the medication before getting pregnant. Often, those are women with complex epilepsy for whom pregnancy is a difficult enough decision in the first place.

We have known for a long time that the drug should not be used by any woman or girl who can have children, unless they are in the proper pregnancy prevention programme. That is why, in 2018, the programme was introduced to reduce and prevent the number of pregnancies, which was high at the time, in women taking the drug. Being part of the programme means that women are supposed to have an annual review by a specialist, but I have concerns and have heard from campaigners that that does not always happen and is not always the case. There is also the valproate registry, which has now been created so that we can track every woman who is taking that medicine and ensure that the records of when they are prescribed it, when it is dispensed and what is happening to them are followed through, which has never happened before.

The programme is designed to make sure that, each year, those women have a discussion with their health team, so should they wish to become pregnant, they can get that advice there and then. When I was in this post previously, I had concerns about the overview of the register, the annual checks and some of the other safeguards around the dispensing and packaging of the drug, which have been touched on. That is why we have reviewed the programme.

I have met the MHRA, which has taken both campaigners’ and my concerns very seriously. It is looking at the programme, and it will be making an announcement shortly on stronger advice to GPs, but also to pharmacists, about some of the technical issues with dispensing medication, and on some safeguards we need in place so that women—once again, whether they mean to get pregnant or happen to get pregnant—have the advice they need and the reminder on the packaging when they pick up their medication.

The registry tracks all women in England who are taking the prescribed valproate, and it identifies if they become pregnant are accessing care for pregnancy. We can track pretty accurately when pregnancy happens, so we have a handle on how many women are getting pregnant while on the medication. I can reassure the House that the numbers are falling. They are still too high in my view, but they are falling. In the six-month period from April to September 2018 68 women prescribed valproate became pregnant, and from October 2021 to March 2022 that number fell to 17 women. That is still 17 women too many, although we are making progress in reducing that number of pregnancies, but that is why the MHRA is looking at further safeguards for prescribing and dispensing such medicine. It will be making that announcement fairly soon.

A national clinical audit is being undertaken by all community pharmacy contractors, as agreed with NHS England and the Pharmaceutical Services Negotiating Committee, which will measure adherence to current MHRA regulations. The audit will look at whether all patients are provided with a patient card and a patient guide every time the medicine is dispensed. It will also look at whether patients who are supposed to be getting a review every 12 months actually are, and what then happens to them if they are being signposted for additional advice.

I am appearing before the Health and Social Care Committee next week to go through the Cumberlege review on its anniversary and follow up on the progress that has been made. This week, I have met the new patient safety commissioner, Henrietta Hughes, who has also met Janet and Emma, and the issue of valproate is one of her key priorities in her first few weeks in post. I have discussed with her my concerns about its dispensing and packaging, and about the monitoring of women, including whether they are getting the advice they need for a planned pregnancy or, if they are not planning to get pregnant, whether they have had reliable advice and discussion about contraception. I plan to meet the patient safety commissioner on a regular basis to make sure that the measures in place are actually reducing the number of those pregnancies and providing women with the support and information they need.

The Department and the MHRA are consulting on a proposal that medicines containing sodium valproate should always be dispensed in the original manufacturer’s packaging. This would ensure that patients, particularly women and girls of child-bearing age, always receive the patient information leaflet about the medicine they are taking. We will shortly publish a response to that consultation, and we will keep Members updated.

To touch on the issue of redress, it was not one of the recommendations accepted in the original response to Baroness Cumberlege’s report. However, last year I was concerned about the issues, which my right hon. Friend the Member for Romsey and Southampton North raised, for women seeking legal advice and taking on the huge challenge of getting compensation. What we have done as an interim measure is to work with NHS Resolution to launch a claims gateway, so that individual women can go to NHS Resolution and get their individual case looked at and be provided with support if they want to make a claim, without having to go independently to solicitors and lawyers. That has only just started, and we are looking at how effective it is in helping women get access to some of the compensation they feel they need. However, in my conversations with the patient safety commissioner I have asked her to look at what a potential redress scheme could look like. I am not going to make commitments on that from the Dispatch Box because it is not necessarily my decision to make—that would have to be in discussion with the Chancellor—but I am keen to look at what a redress scheme would look like, and I will follow up on that with the patient safety commissioner and see what is possible. I hope I have been able to reassure colleagues.

[Cat Smith]

Will the Minister commit on the Floor of the House this evening that after she has had conversations with the commissioner about the possibilities of the scheme she will talk to the Chancellor or someone from his team about the recommendations and how they might be implemented?

[Maria Caulfield]

I have had those discussions about what a scheme could look like with the patient safety commissioner only this week. I will need to see the details, but I hope that reassures the House that I am listening to the concerns of parliamentarians and campaigners such as Emma and Janet, who represent a huge number of affected women. I understand the situation they are facing: they have lifetime costs for their children through no fault of the women or the children. They took that medication not realising the effect it could have. We now have that information, but we did not know it at the time. My commitment is that I am exploring options and will update the House on that later.

I want to reassure the House once again that we take very seriously the safety issues around this drug. It is an important drug in the management of epilepsy, and for some women it is the only way of managing their condition, but we need to make sure that women are aware of the implications of taking such a drug during pregnancy, that they are monitored annually to make sure those discussions are ongoing, and that every time their medicine is prescribed and dispensed that message is reinforced. We are reducing the numbers involved, which is great news, but we need to make sure they go even lower, and we need to look at how we support women who have been affected through no fault of their own.

We will be giving evidence at the Health and Social Care Committee next week. I think I am also meeting the hon. Member for Lancaster and Fleetwood shortly, and I am sure other parliamentary colleagues too. I just want to say that I want to support women who have been affected by taking sodium valproate and that we are in listening mode on what more we can do to support them and make sure the help they need and the support for their children are at the forefront of our minds.

Question put and agreed to.

Oral Answers to Questions

Cat Smith Excerpts

Thursday 21st October 2021 Commons Chamber

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

1. What recent discussions she has had with UK trade partners on inserting clauses on human rights into future trade deals.

[The Secretary of State for International Trade (Anne-Marie Trevelyan)]

I and my whole team would like to associate ourselves with the tributes to Sir David Amess that have been made this week. He was listed on the Order Paper for today’s oral questions and I have no doubt that he would have championed the export opportunities for Southend, our newest city.

The Government are clear that more trade will not come at the expense of human rights. The UK will continue to show global leadership in encouraging all states to uphold international rights obligations and to hold to account those who violate those rights. By having stronger economic relationships with partners, we have the opportunity to open discussions on a range of issues.

[Cat Smith]

I associate myself with the Secretary of State’s comments about our friend, Sir David. I welcome the Secretary of State to and congratulate her on her new position.

I note that the recent trade deal with New Zealand refers to indigenous people. Does the Secretary of State share my concern that when it comes to human rights it is important that we protect freedom of religion? Will she meet me to discuss further how UK trade deals can promote human rights and religious freedoms globally?

[Anne-Marie Trevelyan]

The hon. Lady is right: as we reach out, with our new ability to do free trade deals with our friends and allies, it is important to us to consider such important issues. For New Zealand, a chapter on indigenous peoples and their part in their nation’s future progress, in respect of both economic and wider issues, was very important and we were happy to work with New Zealand to include it. I would be happy to meet the hon. Lady to discuss more fully the particular area of freedom of religion, which I agree is extremely important and which the UK continues to champion around the world.

Oral Answers to Questions

Cat Smith Excerpts

Thursday 25th February 2021 Commons Chamber

[Tony Lloyd (Rochdale) (Lab)]

What recent discussions she has had with UK trade partners on inserting clauses on human rights in future trade deals.

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

What recent discussions she has had with UK trade partners on inserting clauses on human rights in future trade deals.

[Rachel Hopkins (Luton South) (Lab)]

What recent discussions she has had with UK trade partners on inserting clauses on human rights in future trade deals.

--- Later in debate ---

[Mr Jayawardena]

I certainly want to make sure that all Members across this House can trust this Government, but I say gently to the hon. Gentleman that Labour’s record on this is hypocritical and, sadly, it enabled antisemitism to be rife within its ranks. They turned a blind eye to terrible behaviour from countries that they like, like Venezuela, and the shadow Secretary of State even shared a platform with Hamas. So we will not be lectured by the Opposition on these issues.

[Cat Smith]

I last raised this issue on the Floor of the House on 19 November, and the Minister for Trade Policy told me to

“judge us on our deeds and not always on our words.”—[Official Report, 19 November 2020; Vol. 684, c. 455.]

So can I clarify, when it comes to human rights and Saudi air strikes in Yemen, that we should be judging the Government on the export licensing statistics published last month, which included the sale of £1.36 billion-worth of bombs and missiles to Saudi between July and September 2020—almost as much as the last 19 quarters put together?

[Mr Jayawardena]

We have a rigorous arms export control system in this country, one of the best in the world, and no arms will be exported that are inconsistent with the consolidated criteria, which were introduced in 2014.

Oral Answers to Questions

Cat Smith Excerpts

Thursday 19th November 2020 Commons Chamber

[Elizabeth Truss]

The answer to the hon. Gentleman is that we are seeking to roll over the Ghana deal, as we are other deals, but with Japan, we have gone through the process of producing a scoping assessments. [Interruption.] No, we were very clear that Japan was a deal that would go further and faster than the EU deal, alongside the new deals that we are negotiating with the US, Australia and New Zealand. There is a deal on the table for Ghana to agree to. It has already agreed to the same deal with the EU. There should be no block on Ghana being able to get tariff-free, quota-free access to the UK, and we are very happy to talk to its representatives at any time of the day or night.

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

What recent discussions she has had with UK trade partners on including provisions on human rights in future trade deals.

[The Minister for Trade Policy (Greg Hands)]

This Government have a strong history of promoting our values globally, including human rights. While our approach to agreements will vary between partners, our strong economic relationships allow us to have open discussions on a range of issues, including on human rights. We will not compromise our high standards in trade agreements.

[Cat Smith]

In September, the UN said that the Saudi airstrikes in Yemen had led to

“a consistent pattern of harms to civilians”

unlike our own Government who said in July that there was no such pattern and therefore it was lawful to resume arms exports. Can the Minister tell me how his Government have looked at the same evidence as the UN and arrived at such vastly different conclusions?

[Greg Hands]

May I remind the hon. Lady, as the Secretary of State said earlier in response to a question from the right hon. Member for Islington South and Finsbury (Emily Thornberry), that the UK has one of the most rigorous arms control regimes in the world? We follow the consolidated criteria at all times. On trade agreements, I ask her to judge us on our deeds and not always on our words. In terms of the trade agreements that we have rolled over, there has been no diminution of human rights clauses in any of those agreements.

Oral Answers to Questions

Cat Smith Excerpts

Thursday 8th October 2020 Commons Chamber

[Dehenna Davison (Bishop Auckland) (Con)]

What assessment she has made of the potential effect on farmers and food producers of the free trade agreement with Japan.

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

What steps she is taking to maintain the UK’s (a) food and (b) animal welfare standards in future free trade agreements.

[Rob Roberts (Delyn) (Con)]

What assessment she has made of the potential effect on farmers and food producers of the free trade agreement with Japan.

--- Later in debate ---

[Elizabeth Truss]

I hugely enjoyed my visit to Grange Hill farm with my hon. Friend. Our deal means that British beef going into Japan will have lower tariffs. We also announced last week that the first beef for 24 years was shipped from Britain to the United States. In the United States trade deal, we will seek to remove the 26% tariff on British beef so that we can get even more of that great product into that market.

[Cat Smith]

I have been contacted by many constituents who are concerned about the animal welfare standards in a US-UK trade deal. They ask me why the state of California can ban imports of products that do not meet its animal welfare standards but the UK Government are not willing to do the same.

[Elizabeth Truss]

We are absolutely clear that we are going to stand up for our high standards in any deal we strike, including with the United States, and make sure that the high standards our farmers operate to will not be undermined.

Gender Recognition Act Consultation

Cat Smith Excerpts

Thursday 24th September 2020 Commons Chamber

[Elizabeth Truss]

My hon. Friend is right that under the Equality Act 2010, service providers can restrict entry on the basis of biological sex. Of course, there are cases, such as women’s refuges and prisons, where that is an important issue.

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

It has taken the Government nearly three years to respond to this consultation and, in that time, the trans community have had their hopes raised and now dashed. If my inbox is reflective of the inboxes of other Members, the trans community feel bitterly let down by the Government’s actions this week. This has to be seen in a context of rising hate crimes, and the Government’s response—I will pull the Minster up on this—is not in line with what other nations are doing. We can look to Argentina or the Republic of Ireland, our near neighbour, which is doing things very differently. The Republic of Ireland has had a de-medicalised, self-determined system for gender recognition since 2015, and it is working. I urge the Minister to look again and not to let down the trans community, who are some of the most vulnerable constituents we represent in the House.

[Elizabeth Truss]

In my statement, I outlined the work we are doing to improve transgender healthcare. In all the research work and engagement we have done, that comes out as the No. 1 issue for transgender people. Focusing on improving those healthcare services is the way to help people lead better lives.

Japan Free Trade Agreement

Cat Smith Excerpts

Monday 14th September 2020 Commons Chamber

[Mr Speaker]

I am sorry about that. We are going to go to Cat Smith.

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

Once the details of this trade deal are published, the Japanese Parliament will get the opportunity to debate and vote on it. Will the Secretary of State be clear about whether parliamentarians in both Houses of this Parliament will get the same rights as our Japanese colleagues?

Oral Answers to Questions

Cat Smith Excerpts

Thursday 18th June 2020 Commons Chamber

[Elizabeth Truss]

I know that my hon. Friend is committed to Canada, having served as trade envoy and done a fantastic job. As part of our ambitious free trade agreement programme, we announced yesterday our intention to accede to the CPTPP, which is an advanced trade agreement covering chapters such as data and digital and goes far beyond what the EU has been willing to agree. Canada is one of the key players in the CPTPP, alongside countries such as Australia and New Zealand.

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

What discussions she has had with UK trade partners on maintaining environmental protection standards in future free trade agreements.

[Stephen Morgan (Portsmouth South) (Lab)]

What discussions she has had with UK trade partners on maintaining environmental protection standards in future free trade agreements.

[The Minister for Trade Policy (Greg Hands)]

The Government are committed to meeting their ambitious environmental objectives. We are exploring all options in the design of future trade and investment agreements, including environmental provisions within those, to ensure that we uphold the UK’s high environmental standards.

[Cat Smith]

Last year’s free trade agreement between Mexico, the US and Canada ran to 250 pages but failed to mention climate change or global emissions. What assurances can the Minister give the House that the free trade agreement being negotiated by his Government between the UK and the US will not make the same mistake and will put climate change at the heart of it?

[Greg Hands]

The hon. Lady raises a good question. The UK is absolutely committed to our international climate change agenda; that is one of our key objectives. We have not included that because the US is withdrawing from the Paris accord, which we regret. She mentioned the United States-Mexico-Canada Agreement. That agreement does include 30 pages of environmental commitments, including, for example, on sustainability, forestry, air quality, marine plastics, multilateral agreements and so on. There is plenty of potential for us to go further on the environment with our US trade agreement.