Oral Answers to Questions

Feryal Clark Excerpts

Tuesday 6th December 2022 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Feryal Clark (Enfield North) (Lab)]

Members on both sides of the House will have been shocked and appalled by the recent deaths of children from streptococcus A, and our thoughts are with all the families affected. Cases are on the rise, and as we head into winter it is vital for parents to be able to secure for their children the care that they so desperately need. The shortage of GPs means that too many are struggling to see a doctor, and now there are reports of shortages of antibiotics as well. What advice can the Secretary of State give parents whose children are exhibiting symptoms but who cannot obtain a GP appointment, and what assurances can he give on the supply and availability of antibiotics?

[Steve Barclay]

This is an important issue which I know is of concern to many families throughout the country, so I am pleased to be able to reassure the House about our response. While GPs are important in this regard, so are directors of public health, who are leading the response in respect of, for example, liaison with schools. We are seeing a peak in cases earlier than usual, which we believe is due to lower exposure during the pandemic, which in turn has led to lower immunity. There is no new strain, and that is one of the key points of reassurance, but the UK Health Security Agency has declared a national standard to improve the co-ordination of our response, including what is being done in schools.

NHS Staffing Levels

Feryal Clark Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing this important debate, and praise all the Members who have spoken this afternoon for their brilliant contributions.

The NHS is a cornerstone of communities up and down our country. It is the biggest employer in Europe and one of the biggest in the world, supporting the livelihoods of millions of British families. A publicly funded healthcare service that is free at the point of need is a lifeline for so many, and the people of this country are overwhelmingly proud of it. The pride and respect we have for the NHS means that it will always have people to stand up and defend it when things are going wrong.

However, the reality is that patients are finding it impossible to get a GP appointment due to chronic shortages of doctors, as we heard from my hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton). Stroke and heart attack victims are waiting an hour for an ambulance, and over 400,000 patients have been waiting more than a year for an operation. We have gone from an NHS that treated people well and on time to not just a winter crisis, but a year-round crisis, and an NHS that is understaffed and unable to deliver timely care.

The NHS is facing the greatest workforce crisis in its history. Right now, there are 132,000 vacancies across the NHS, and 165,000 in social care. We are short of 40,000 nurses, and we are losing midwives faster than we can recruit them. We are short of 12,000 hospital doctors, yet this summer, medical school places were cut by 30%, turning away thousands of straight-A students from training to become doctors when we need them more than ever. As we have heard again and again this afternoon, the consistent failure to train and retain the nurses and doctors our NHS needs has left staff overworked, overstretched and struggling to cope.

[Peter Dowd]

The Royal College of Physicians produced a short, medium and long-term plan for the NHS, specifically in relation to staffing. I was shocked to read that the measures to increase satisfaction and retention of current staff—getting the basics right—included access to hot food and drink, and rest facilities, at all hours of the day. The Royal College of Physicians putting that into a document shows how poor the situation is. Would my hon. Friend agree that the Government have to listen to that?

[Feryal Clark]

I wholehearted agree with my hon. Friend. With nurses already doing an average of £2,000 a year in overtime to make up shortages, the Government cannot rely on good will to get us through this crisis. They cannot afford to play politics and refuse to get around the negotiating table to avoid strike action.

It would be far too simplistic to suggest that pay is the sole cause of this crisis, as we have heard in this debate. Members who have spoken with NHS staff in their communities will know that the problems run far deeper than that. In this debate we have heard how staff are demoralised, burnt out and undervalued, and are working in poor conditions. Staff members are working harder than ever, but are unable to deliver the level of service they want for patients.

When I speak to NHS staff in my constituency of Enfield North, their passion and dedication is in no doubt whatsoever. One of the clear themes that came through in a local healthcare survey run over the summer was an appreciation in our community for the efforts of NHS staff. On a recent visit to Chase Farm urgent care centre, I saw at first hand the pride that staff had for the work they did, and their desire to deliver the best for patients, despite chronic shortages of staff and the most trying of circumstances. They are going above and beyond the call of duty.

We cannot keep relying on the good will of staff. We need to see their attitude matched by action from the Government. Staff need to know that they will not be hung out to dry and that help is there for them. What reassurance can the Minister give to staff, at places such as Chase Farm, that their cries for help will be heard? If the Minister believes that what we heard from the Chancellor is sufficient, then he is very much mistaken. I am pleased that, after long calls from the Back Benchers, the Chancellor has dragged his party into agreeing to an independent assessment of our NHS workforce needs, but does the Minister really expect that assessment to say that the NHS has the people it needs to deliver a safe standard of care for patients?

Talking will not cut it for NHS staff. We need a plan of action. I was pleased to hear from my hon. Friends the Members for Bradford West (Naz Shah) and for Barnsley East (Stephanie Peacock), who set out Labour’s plan so well. Labour’s plan will deliver the biggest expansion of medical school places in history, doubling the number to give the NHS the doctors it needs to get patients seen on time. It will also include an extra 10,000 nursing and midwifery places, helping to close the gap caused by the loss of 800 midwives in the NHS since the last election. Labour would double the number of district nurses qualifying each year and train 5,000 more health visitors. That would be funded by abolishing non-dom status, a move that brings in double the £1.6 billion investment that our NHS workforce needs. The Chancellor has described our plan as something that

“I very much hope the government adopts on the basis that smart governments always nick the best ideas of their opponents.”

Given that statement, I look forward the Minister bringing the plan forward as the Government’s own, sooner rather than later.

We know that getting more staff into the system will not, on its own, solve the problem. Our NHS has brilliant staff working in it already, and we must do more to give them the confidence to stay. The Government are simply not doing enough, and unless we improve retention, extra recruitment will not deliver the numbers we need. As we have heard, staff are leaving faster than we are recruiting. The scale of the crisis means that we cannot simply wait things out and hope it blows over. We need a plan and some action from the Government now. I look forward to the Minister telling us how they will deliver that.

Pancreatic Cancer Awareness Month

Feryal Clark Excerpts

Tuesday 8th November 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I start by thanking and paying tribute to the hon. Member for Strangford (Jim Shannon) for securing this morning’s debate to mark Pancreatic Cancer Awareness Month.

As other Members have done, I pay tribute to the brilliant work of Pancreatic Cancer UK. Such organisations are vital in raising awareness of this awful disease. I also praise the important contributions made by all Members, and thank them especially for sharing the touching stories of their constituents.

As we have heard throughout the debate, pancreatic cancer is the deadliest of the common cancers. It affects about 10,000 people a year across the UK, with three in five of those being diagnosed at a very late stage. More than half of those people will die within three months of diagnosis, only 7% will survive for more than five years, and 5% will survive for 10 years or longer. The figures are even worse in Northern Ireland, as we have heard.

In the North Central London integrated care board area, within which my constituency of Enfield North falls, 161 people were diagnosed with pancreatic cancer in 2020, and there were 153 deaths due to pancreatic cancer, so I sympathise profoundly with anyone who is affected by pancreatic cancer and with the family members of those who are suffering. Those statistics are shocking, but even more shocking is the fact that they have barely changed in the past 50 years, and that the UK ranks 29th of 33 countries with comparable data on five-year survival for people with pancreatic cancer.

One reason for the tragically low survival rates is the stage at which people are diagnosed, as was mentioned by the hon. Members for East Londonderry (Mr Campbell), for East Dunbartonshire (Amy Callaghan) and for Strangford, and other Members who contributed. Only 16% of people with pancreatic cancer are diagnosed at an early stage. For many, it is simply too late, so I would be grateful if the Minister outlined how the Government intend to improve the diagnosis of pancreatic cancer.

One thing we cannot ignore is the cancer backlog. Over the past decade, pancreatic cancer mortality rates have increased by a fifth. Waiting lists have risen to record levels and the proportion of people waiting less than 18 weeks for treatment is at its lowest in a decade. At the end of July 2020, waiting lists had risen to a record 6.8 million people, with almost 400,000 patients waiting more than a year. The Government are missing their target to eradicate the two-year wait, and analysis produced in May by Macmillan found that it could take more than five years to clear England’s cancer treatment backlog. For pancreatic cancer patients, that is simply not good enough. They cannot afford to wait.

Many Members have spoken about the workforce element, which underpins all the issues outlined in the debate. As was eloquently described by the hon. Member for Carshalton and Wallington (Elliot Colburn), without a robust workforce strategy, our NHS will simply not be in a place to provide the support that pancreatic cancer patients need, yet Ministers continue to ignore those calls—even calls from their own Chancellor, who is the former Chair of the Health and Social Care Committee. A recent report by the Committee said that the absence of a “serious effort” from the Government to tackle gaps in the cancer workforce is jeopardising earlier diagnosis, so I am keen to hear from the Minister what plans the Government have to ensure that staff are trained and retained sustainably, such that pancreatic cancer patients can always access care in a timely manner.

Labour has already set out its plans, pledging the biggest expansion of medical school places in history to give the NHS the doctors it needs so that patients can be seen on time. That commitment also includes creating 10,000 new nursing placements every year and training 5,000 new health visitors. Labour will also produce a long-term workforce plan for the NHS for the next five, 10 and 15 years to ensure that we do not find ourselves in this position again.

Members also mentioned the 10-year cancer plan. In February, the then Health Secretary announced a new war on cancer and launched a call for evidence to inform a new 10-year cancer plan for England. That call for evidence closed in April. We are now on our fourth Health Secretary since April, but there is still no sign of the plan. That is not good enough not just for those suffering with pancreatic cancer, but for those with all forms of cancer. Will the Minister set out exactly when we can expect this cancer plan? As we emerge from the pandemic, people living with pancreatic cancer need an NHS that has the time and resources to support them. It is about time that the Government delivered on that.

Oral Answers to Questions

Feryal Clark Excerpts

Tuesday 1st November 2022 Commons Chamber

[Steve Barclay]

I know that the hon. Lady has a lot of expertise in this area, and she raises a valid and important point. That is why, through the GP contract framework for 2020-21, we announced a number of new national retention schemes and continued support for existing schemes to retain more GPs. It is also why, at the other end, we are boosting training numbers, to get more GPs into the pipeline.

[Feryal Clark (Enfield North) (Lab)]

The Secretary of State says they are investing in GPs, but this Conservative Government have cut 4,700 GPs in the last decade. Patients are finding it impossible to get a GP appointment in the manner in which they want one. Seeing the same doctor for each appointment means better care for patients, but under the Tories, that is becoming rarer and rarer, much like seeing the same Health Secretary at the Dispatch Box. Even his own Chancellor wishes he had done more on the issue of continuity of care, so why is this Secretary of State not matching Labour’s ambition to bring back the family doctor?

[Steve Barclay]

First, as I have touched on, the number of GPs in training is up. The number of GP appointments is significantly up, because there is more patient demand, so they are seeing more patients. There is often in this House a real focus on GP appointments, and that is important, but it is about the skills of the primary care workforce as a whole. If one looks, for example, at the women’s health strategy, women want to be able to go to specialist services, not always requiring the GP. It is about looking at the primary care workforce as a whole, alongside the appointment of GPs.

World Menopause Day

Feryal Clark Excerpts

Thursday 27th October 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to the hon. Member for Swansea East (Carolyn Harris) and the right hon. Member for Romsey and Southampton North (Caroline Nokes) not just for securing today’s debate to mark World Menopause Day, but for being tireless champions of women. They have been pioneers and continued to make women’s voices heard at a time when, frankly, no one wanted to listen. The work that they have done already is beginning to change the lives of millions of women. On behalf of women my age, I thank them very much. I look forward to continuing to work with them and standing alongside them. I also thank all Members for their contributions to the debate.

As we have heard throughout the debate, too many women continue to suffer in silence and are afraid to break the taboo of speaking about menopause. Many have been misdiagnosed or simply ignored. It is a national scandal, and women, who make up 51% of our population, should not be made to put up with it. Having a frank and honest conversation in this House is a start, but when women cannot have frank and honest conversations with their own doctors, what hope do we have? From the consultation for the Government’s women’s health strategy, we know that 84% of women feel that their voices are not being heard when it comes to healthcare. That is simply not acceptable.

It is essential that women have confidence that the healthcare professionals treating them have the knowledge and understanding to provide quality healthcare. According to the charity Menopause Support, four in 10 British medical schools do not have menopause education on their curriculum, as we heard from the right hon. Member for South Northamptonshire (Dame Andrea Leadsom). Without changing that, we will continue with a generation of healthcare professionals who simply do not know what to do when it comes to menopause. We know the Government are trying to make headway on this issue, and I really welcome the commitment made in the women’s health strategy to improve education, particularly in primary care. I would be grateful if the Minister could clarify what discussions have been had with the General Medical Council to ensure that the proposed new medical licensing agreement makes specific reference to menopause. Furthermore, can he clarify what actions will be taken to upskill current staff, given the commitment in the women’s health strategy to lifelong learning?

We have heard today, as we have on several occasions in recent months, about the problems caused by the shortage of HRT. It should not be a luxury. It is not a “nice to have”. It is an essential part of treatment, recognised by the National Institute for Health and Care Excellence, that makes a real difference to the lives of women going through menopause.

When alarming problems with supply became apparent, it took a public outcry from women—as it often does with women’s health issues—for the Government to sit up and listen. Despite repeated warnings, nothing was done. Not only did that deepen problems in the supply chain, but it put a cost burden on many women who can ill afford it during a cost of living crisis.

Delaying changes to prescription charges meant that some women were left paying up to £200 more for HRT this year. For many, that is simply unsustainable. There have already been delays in delivering the Government’s commitment to a single annual prescription charge for HRT. Will the Minister confirm that there will be no more delays and that the commitment will be delivered in April 2023, as promised by numerous Ministers?

Issues of access are compounded for black and minority ethnic women, with 45% needing multiple GP appointments to establish they were experiencing symptoms of menopause or pre-menopause. That is a shocking statistic, which shows a system that far too often ignores women’s concerns. Given the now former Health Secretary’s decision to scrap the health inequalities White Paper, I would be grateful if the Minister would outline the specific steps being taken to address that disparity.

This issue adds to the growing pile of those the Government are just not doing enough on. We can have all the ambassadors, tsars, reviews and taskforces in the world, but they mean nothing if there is no tangible action to improve women’s lives. No more talking shops, Minister; we need action. If the Government think that the issue will go away and that women will put up and shut up, they are sorely mistaken. That is proven by today’s debate and by the voices of women in the media. Women from every party in this House, every corner of the country and every part of society are speaking up. They will not stop until their voices are heard and justice is done. I look forward to the Minister’s response to all the questions raised today.

Baby Loss and Safe Staffing in Maternity Care

Feryal Clark Excerpts

Tuesday 25th October 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies.

May I start by thanking the hon. Member for Hartlepool (Jill Mortimer) for securing this important debate? I also thank all Members for their deeply emotional, moving and important contributions to the debate, especially those who shared their personal experiences and the experiences of their constituents. By talking about these issues so openly, we work to remove the stigma that sometimes surrounds them. This debate and Baby Loss Awareness Week are vital for voices to be heard, and I praise the work of the over 100 charities that co-ordinate and support Baby Loss Awareness Week every year, particularly Sands.

Across the UK, thousands of parents experience the pain of baby loss every year. As we heard, one in four pregnancies ends in miscarriage, one in eight pregnancies is ectopic and 13 babies are stillborn or die shortly after birth every day. Just last week, we saw the publication of the report into the failings of East Kent maternity services, where up to 45 babies could have survived had they received better care—45 lives that were needlessly cut short and 45 families who were made to suffer the most devastating heartache. I am heartbroken for the families who suffer the loss of a baby. Those who suffer such tragedy must receive the physical and emotional support they need and so deserve. Yet, as we have heard this morning, so often they do not receive it.

My constituent Katie suffered a miscarriage in 2017, when she was 13 weeks pregnant. Immediately after receiving the news, she was told to go to another hospital, and her pregnancy folder was replaced with two sheets of paper entitled, “Your options after miscarriage”. She said that she was not treated with compassion by staff at the next hospital. After her operation, there was no follow-up, no aftercare and no information about what to do next. On returning to work, she discovered that her pay had been cut, as her employer did not class pregnancy loss before 24 weeks as a reason to receive sick pay. Katie was lucky enough to find herself pregnant again, but at every appointment she had to go through the details of her miscarriage time and time again. I worry that the trauma Katie went through is shared by many women across the country.

There is a pattern of avoidable harm in maternity units across our country. There were nearly 2,000 reported cases of avoidable harm at Shrewsbury and Telford Hospital NHS Trust. Half of maternity units in England are failing to meet safety standards. Pregnant women were turned away from maternity wards more than 400 times just last year.

Then there are the inequalities highlighted in the debate. I pay tribute to groups such as Five X More that do so much to highlight those disparities, and I thank my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for mentioning the important work they do. Stillbirth rates for black babies are twice as high as for white babies, and neonatal death rates are 45% higher. In the UK, black women are four times more likely to die in pregnancy or childbirth. A recent review by the NHS Race and Health Observatory found evidence of women from ethnic minority backgrounds experiencing

“stereotyping, disrespect, discrimination and cultural insensitivity”

when using maternity and neonatal healthcare services. Although I welcome some of the measures the Government have taken to address these problems, it is clear that so much more is still to be done.

As with the Government’s response to the investigation into East Kent maternity services last week, the women’s health strategy that was released about two months ago commits only to considering the recommendations of the pregnancy loss review expected later this year and the Lancet series on miscarriages. Considering further recommendations is not enough to reach the Government’s target of halving childbirth and neonatal deaths by 2025 and to provide the care that women need.

Underpinning all this across the NHS is the question of workforce, as we have heard from almost every Member this morning. More midwives are leaving the profession than are joining it. NHS England estimates that nearly 700 midwives have left in the past year—stressed, burned out and overworked. There is now a shortage of more than 2,000 midwives just in England. In a recent survey by Sands, almost one in 10 NHS trusts in England stated that they had no bereavement specialists in their maternity services—no services for parents who lose a child.

I thank all the members of the all-party parliamentary groups on baby loss and on maternity for the report they did on safe staffing in maternity services. It found that bereaved families are affected by staffing shortages, as stretched staff do not have the time to offer compassionate care, to understand what families’ needs are or to refer families to relevant services. We just do not have the staff to provide the good and safe care needed to prevent the avoidable loss of babies. Eight out of 10 midwives reported that they did not have enough staff on their shift to provide a safe service. Even the Chancellor agrees; last week, as co-chair of the all-party parliamentary group on baby loss, he signed the report, which describes maternity and neonatal services as

“understaffed, overstretched and letting down women, families and maternity staff”.

He went on to call for safe levels of staffing. So, as I asked in the main Chamber last week, will the Minister deliver on the Chancellor’s promise? Women, families and their babies deserve to be given the best standard of care to ensure the best possible outcomes. It is high time that the Government delivered that.

--- Later in debate ---

[Dr Johnson]

I absolutely agree with my hon. Friend.

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

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

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

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

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

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

[Feryal Clark]

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

[Dr Johnson]

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

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

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

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

Draft Water Fluoridation (Consultation) (England) Regulations 2022 Draft Health and Care Act 2022 (Further Consequential Amendments) Regulations 2022

Feryal Clark Excerpts

Monday 24th October 2022 General Committees

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Murray.

Poor oral health is far too common in 21st century Britain and, as is so often the case, it has the most significant impact on already vulnerable and disadvantaged people. Oral health has suffered from a chronic lack of investment, with a number of opportunities missed to make a serious impact on interventions. Those interventions have long since disappeared given the deep cuts made to public health budgets throughout the country, but one such measure that remains is putting fluoride in our water, which is an effective, evidence-based intervention on oral health—nothing more and nothing less. Given that fact, and the major health inequalities we face, we should actively pursue the rolling out of these schemes to the communities that would benefit the most.

When pursuing water fluoridation, it is vital that we start where communities are and bring them with us. I am therefore particularly pleased to see the emphasis the regulations place on the need for proactive engagement and consultation with local communities when the plans are rolled out. Given the mismatch of local authority and water-provider boundaries, the centralisation of the process is understandable, but it makes engagement even more important, as the Minister set out.

Given the regulations’ positive intention to improve oral health, where is the action to address the crisis of access to NHS dentistry? The Government spend on general practice in England has been cut by more than a third over the past decade, with the number of NHS dental practices in England falling by more than 1,200 in the five years prior to the pandemic. Tooth extraction remains the No. 1 cause of children being admitted to A&E. We welcome the regulations on fluoridation, but I gently remind the Minister that if we are to see progress on oral health, much more needs to be done.

On the second set of regulations, it is good to see the tidying up of the Health and Care Act 2022. I want to ask the Minister if it is correct that the regulations cover the statutory guidance on training for learning disabilities and autism?

[Will Quince]

I believe so, yes.

[Feryal Clark]

I just wanted to check, because the Minister mentioned virginity tests and hymenoplasty. I want to make clear our support for the change in that guidance on learning disability and autism training. The regulations are welcome, and their implementation is now a task for the Government.

Virginity testing and hymenoplasty are serious practices with no medical benefits that do not work in service of the goal they are supposedly pursuing. They are not medical practices; they are nothing more than abuse. Both practices are a violation of women’s and girls’ human rights. As the Royal College of Obstetricians and Gynaecologists has stated,

“Both are harmful practices that create and exacerbate social, cultural and political beliefs that a woman’s value is based on whether or not she is a virgin before marriage.”

Women need and deserve ownership of their sexual and reproductive health. It is our right. Those who deny women that right in any part of our country are criminal. They must not have the right to foster a child. We cannot and must not entrust the care of a child to anyone who has committed such a heinous crime. We welcome the regulations and support the measures.

East Kent Maternity Services: Independent Investigation

Feryal Clark Excerpts

Thursday 20th October 2022 Commons Chamber

[Feryal Clark (Enfield North) (Lab)]

I thank the Minister for advance sight of her statement. I thank Dr Bill Kirkup and his team for the report. Today marks another milestone for another group of families in their fight for justice. The heartbreak they must feel is unimaginable, and my thoughts remain with them during what must be an incredibly difficult time.

Sadly, this is another example of women’s voices not just being ignored but being silenced. When women in East Kent were told that they were to blame for their babies’ deaths, they were being told that their voices just did not matter. At a time when women are at their most vulnerable, they were let down by the very people they were relying on to keep them safe.

After responding to the Ockenden review of Shrewsbury and Telford, I find myself having to repeat something that I never thought I would need to say again at this Dispatch Box: no woman should ever face going into hospital to give birth not knowing whether she and her baby will come out alive—no one. It is not a case of a few bad apples. What happened at East Kent, as with what happened at Shrewsbury and Telford and at Morecambe Bay, was years of systemic negligence that cost lives. As we have heard, up to 45 babies could have survived had they received better care. That is 45 lives that were cut needlessly short and 45 families made to suffer the most devastating heartache.

Although I am heartbroken for the families that the review had to take place, it is vital that it did. Nobody who allowed this culture of neglect to set in should escape accountability. Such a review has been necessary again because, for too long, people turned a blind eye and tolerated the intolerable. That is why it cannot be allowed to sit on the Department’s shelf and gather dust. We must see action if we are to give women the care that they need and deserve.

There is a pattern of avoidable harm in maternity units across the country. There were nearly 2,000 reported cases of avoidable harm at Shrewsbury and Telford. Half of maternity units in England are failing to meet safety standards. Pregnant women were turned away from maternity wards more than 400 times last year. One in four women is unable to get the help they need when in labour. That is why it is important that the Government fully accept all the recommendations in Dr Kirkup’s review without delay.

This is a collective failure and we must all learn lessons from it. In the wake of the Ockenden review, the right hon. Member for Bromsgrove (Sajid Javid) announced an extra £127 million of funding for maternity services to help to deliver the reform that is clearly needed. Where is that money? Where has it been spent, what has it been spent on and how will its impact be measured?

Underpinning the issues in maternity care, and across the NHS, is the workforce. More midwives are leaving the profession than are joining, and there is now a shortage of more than 2,000 midwives in England. We just do not have the staff needed to provide good and safe care. Even the Chancellor agrees: last week, he signed a report as co-chair of the all-party parliamentary group on baby loss that describes maternity and neonatal services as

“understaffed, overstretched and letting down women, families and maternity staff”.

He went on to call for safe levels of staffing. Will the Minister deliver on the Chancellor’s promise?

The Government must provide the staff that maternity services desperately need to provide safe care across our NHS, as Labour has a plan to. All women are asking for is to have the confidence that they will be safe—that really is not much. It is high time that the Government delivered it.

Liver Disease and Liver Cancer: Diagnosis

Feryal Clark Excerpts

Tuesday 11th October 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for securing the debate and for her continued advocacy on this issue. I welcome the Minister to her place, and I look forward to many constructive discussions with her in the months ahead. I praise the contributions from the hon. Members for Darlington (Peter Gibson), for Totnes (Anthony Mangnall), for Strangford (Jim Shannon) and for Warrington South (Andy Carter), and from my hon. Friends the Members for Caerphilly (Wayne David) and for York Central (Rachael Maskell). I particularly thank the hon. Member for Darlington for sharing his personal experience. As the hon. Member for Strangford often reminds us at these debates, it is those personal experiences that remind us of the impact of what we are discussing.

Liver disease is increasing rapidly across the country, with deaths doubling over the past 20 years, as we have heard. Too often people with liver disease have little to no recognition of the condition, which is often asymptomatic in its early stages. As a result, as every hon. Member has set out tonight, diagnoses often come too late, with mortality rates from liver disease far outpacing those for other major conditions, such as diabetes or respiratory conditions, which have stabilised or improved over the past 40 years.

This is a condition that is only getting worse, with the 2020 covid-19 lockdowns seeing a 21% increase in alcohol-related liver disease deaths. We have heard tonight that the stats on liver cancer in particular are deeply concerning, with incidences rising by almost half in the past decade. With the poorest and most vulnerable in our society facing dire consequences from the cost of living crisis this winter, we are at real risk of seeing such a spike happen again. Given the serious inequalities we have already observed for liver disease patients, we know the devastating effects that that would have.

Statistics from the British Liver Trust show that prevalence of liver disease is four times higher in our most deprived communities than our most affluent. The most deprived patients are also expected to die a decade younger, as set out by my hon. Friend the Member for Caerphilly. This snapshot highlights the most glaring of inequalities. How can it be that, before we even look at the provision of services, people are facing such a glaring postcode lottery?

It is bitterly disappointing for liver disease patients, who are so badly affected, that the new Secretary of State for Health and Social Care has decided to scrap the health inequalities White Paper. Given the evidence we have heard from colleagues today, I look forward to hearing from the Minister how the Government plan to address this issue following that decision.

The picture for liver disease patients is deeply concerning, but when we look at the state of care and treatment services on offer, the situation gets even worse. Although, as we heard, access to specialist care improves survival rates by around 20%, provision of specialist liver disease services across the country is incredibly varied. Each year, thousands of patients are dying unnecessarily because they cannot access specialist services or because the services they can access are stretched to breaking point.

The rise in the prevalence of liver disease, combined with the shortage of specialist care, is compounding the crisis facing all parts of our NHS. More people are being admitted to hospital with no specialist care services available to them and no primary or social care capacity in their communities. We must break this all too common vicious cycle if our NHS is to have any chance to recover. The NHS desperately needs a workforce plan—something that has been called for consistently by not only Labour, but the cross-party Health and Social Care Committee. Can the Minister tell us what plans her Department has to address this issue facing all parts of our NHS?

As well as ensuring that we get the fundamentals such as workforce right, when it comes to liver disease, we should be learning from places where things are going right. Fortunately, my local integrated care system—North Central London—was categorised as green by the British Liver Trust survey, indicating that it has a fully effective pathway in place for the early detection and management of liver disease in primary care. Whether it is proactive case finding to identify those at high risk, GPs having the means to assess fibrosis, or effective management of patients, including referrals to secondary care where necessary, we know what effective care looks like, and we know what works.

I will conclude shortly. We need centres such as the North Central London integrated care system to exist not just in north London, but across the country. I urge the Minister to look at the positive examples of ICSs, such as North Central London, and see how the great work they are doing can be replicated more widely across the country. We know what works. We know we can do it. It is time for the Government to deliver.

Unavoidably Small Hospitals

Feryal Clark Excerpts

Tuesday 6th September 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is always a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Isle of Wight (Bob Seely) for securing this important debate. As we have heard, small and rural communities face a range of challenges when it comes to the provision of healthcare, so I am sure that his constituents will be grateful to him for putting the issues on the agenda today and for being a champion of their needs.

I also thank the hon. Members for Strangford (Jim Shannon), for Thirsk and Malton (Kevin Hollinrake), for Caithness, Sutherland and Easter Ross (Jamie Stone), for North Devon (Selaine Saxby) and for St Ives (Derek Thomas), and the right hon. Member for Richmond (Yorks) (Rishi Sunak) for their excellent contributions. I am delighted to see the right hon. Member for Richmond (Yorks) this morning, and am glad that he is enjoying his new-found freedom.

We should never think of the provision of accessible healthcare as a luxury but, as we have heard this morning, too many people across the UK face barrier after barrier to accessing even the most routine care. For too long, the drive towards economies of scale in the NHS has left many small and rural communities without the basic services they need. In the past 20 years, more than half of England’s hospitals have been closed or merged. The victims have too often been the smaller hospitals that provide healthcare to nearly half the population in areas that are frequently more remote, more deprived and have an older patient cohort than average.

Although the NHS has processes in place to recognise hospitals that are unavoidably small due to the remoteness of the communities they serve, they often do not go far enough. North Cumbria Integrated Care NHS Foundation Trust, which has received extra funding from the NHS, has patients who have been waiting more than six months to be discharged despite being medically fit to leave.

Sites falling outside the top eight sites identified by the NHS as in need of funding adjustments have not received any additional support. The consequence is not just that local patients receive a poorer service but that lives are put at risk. In Cornwall, we saw utterly shameful scenes when 87-year-old David Wakeley had to wait 15 hours for an ambulance in a makeshift shelter that his family constructed after he fell in his garden. In 21st-century Britain, no one should have to experience what David did, regardless of where they live.

We know the problems our NHS faces. Years of underfunding and poor staff recruitment and retention have caused universal challenges across the NHS, but the nature of small hospitals exacerbates those already pressing problems. Smaller hospitals are more likely to suffer from workforce issues—as all Members have said this morning—budget constraints and an inability to provide specialist services. As Members set out, the challenges of recruitment in remote communities leave smaller hospitals with the uncertainty of having to over-rely on locum staff. If hospitals do not have consistent and stable staffing levels, patients will not receive the standard of care they need.

The Government have had opportunities to put this right, but they have sadly fallen short every time. Nothing makes that clearer than the commitment in the 2019 Conservative manifesto to build 40 new hospitals. The hon. Member for North Devon said that she hoped her area would be one of those receiving one of the 40 hospitals, but I am sorry to say that nobody believes that cornerstone of the Conservative manifesto, because it contains not even a grain of truth. The policy has been such a failure that the National Audit Office is now stepping in to investigate the scheme and conduct a value-for-money review. When even the NAO does not believe the Government’s insistence that the commitment to build 40 entirely new hospitals can still be met, what confidence can patients have? Can the Minister tell us where the 40 new hospitals are or will be?

The reason that matters so much is that the Government’s blinkered focus on an unworkable, undeliverable policy is wasting precious time that could be spent on ensuring local services are able to provide people with the care they need in their community. There cannot be a blanket approach to the problems facing small hospitals; we must look at the entire health system for opportunities to relieve pressure and get services functioning. Care must be rooted in local communities to create trust and ensure that patients can build the relationships on which good community care relies. The introduction of integrated care systems is an ideal opportunity to do that and take a fresh look at the allocation of resources and at how we can maximise access for patients, particularly in small and rural areas. The Government must not waste this opportunity.

While I am talking about wasted opportunities, I would like to draw the Minister’s attention to the health disparities White Paper, which could be another crucial opportunity to look at inequality in care across the country and at issues facing isolated and deprived communities. We have been expecting the paper for months, so I would be grateful if the Minister could update us on where it is. We need to see progress on the paper, because patients in our small and rural communities cannot afford for the Government to waste this opportunity. This postcode lottery is putting lives at risk and it is time for it to end once and for all.

Finally, on a slightly more positive note, I wish the Minister all the best and good luck in today’s reshuffle. I hope she is returned to her place. Even though we may not agree on lots of things, I know she puts in more work than any of the other Ministers I have come across, so I wish her all the best.