NHS Dentistry

Fiona Bruce Excerpts

Tuesday 9th January 2024 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

One of the most important steps the Government can take to improve access to NHS dental care is to boost our workforce and train more dentists and dental professionals, in line with the Government’s NHS long-term workforce plan, which has a clear reference to dental training as a priority. I will focus in particular on the importance of training dental professionals, who support dentists in many important ways. The workforce plan recognises that we must ensure that the skills of our whole dental workforce are utilised, by supporting dental hygienists, dental therapists, dental nurses and others to provide additional care, freeing up more time for dentists and increasing overall dental care and provision. I will focus on the importance of that and what the Government are doing to prioritise it.

I digress briefly by saying that in my own professional background as a solicitor—I refer to my entry in the Register of Members’ Financial Interests—I know how vital it is that our support staff are there to help the qualified solicitors do our job. We could not work without them and without their expertise, often honed over many years and in particular specialised areas. The same applies to the dental profession.

I applaud and commend all those who work in the profession and support dentists. I welcome the Secretary of State’s statement that we must empower them to take on even more responsibility—not because it is a burden, but because I can see how those working in professional environments find their work increasingly fulfilling the more responsibility they are trained to take on. I support her statement that we should do that and ensure that those staff are qualified, competent and indemnified.

Turning to the NHS long-term workforce plan in particular, while it is commendable that dentistry training places have a target and the Government are working to expand places by 24% by 2028-29, I particularly applaud the focus on increasing training places for dental therapy and hygiene professionals by 28% in the same period, adding hundreds more professionals to our dental workforce. That work is not just looking to the future, but is happening now: in the past year, NHS England has made an investment in postgraduate dental specialty training, focused on areas currently underserviced by existing provision, which will improve access to specialist dental services.

As the plan states:

“We recognise the important contribution to dental care that the wider dental workforce makes, including dental nurses. While training of dental nurses is largely the responsibility of dental practices, we will work with dental practices and other stakeholders to support the wider dental workforce to meet NHS service delivery plans for dentistry.”

It is heartening to note that

“the Plan aims to deliver 15% of dental activity through dental therapists and dental hygienists, as opposed to the current estimate of 5%.”

That has to be a positive target to work to. In addition, the plan focuses on the

“national Return to Therapy programme…being developed to enable dental therapists working as hygienists to fulfil their full scope of practice”,

and states that

“NHS England is reforming contractual arrangements to encourage more dentists back into NHS practice and to make it easier for therapists and hygienists to provide NHS care”.

I will move on to the consultation that the Government held on making better use of the whole dental workforce, supporting dental hygienists and therapists to provide additional care to patients. I know the Secretary of State has said that the Government will shortly set out the outcome of the consultation. I urge them to do so and to take particular note of any contributions to that consultation from dental hygienists, therapists or nurses. They have so much to offer through their work at the coalface on the challenges that we all recognise in ensuring that everyone can see a dentist quickly and receive the treatment they need to keep themselves healthy and well. Dental care is an essential part of the NHS and should continue to be so for the future.

New Hospitals

Fiona Bruce Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

As I set out in my statement, the place of Kettering in the new hospital programme is secure. That is in large part a result of my hon. Friend’s campaigning. He has raised this issue with me on a very regular basis and shown me at first hand the issues at Kettering. He has championed investment in Kettering General Hospital, and today’s announcement is a very positive day for the staff and patients of Kettering.

[Fiona Bruce (Congleton) (Con)]

On behalf of my constituents, particularly in Middlewich and Sandbach, I warmly welcome the excellent news on the rebuild of Leighton Hospital. I thank Ministers for responding to the determined local campaigning on this, commendably led by my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) and also involving my hon. and learned Friend the Member for Eddisbury (Edward Timpson) and my hon. Friend the Member for Macclesfield (David Rutley). Without wanting to detract from that, could I again ask the Secretary of State to look at Congleton War Memorial Hospital? Will he meet me to discuss how the services and facilities there can be expanded and modernised? There is capacity for the site to serve the residents of Congleton, where demand is increasing, as house building has increased in the area.

[Steve Barclay]

I know that my hon. Friend has championed this investment in her health system. She is right that it serves a number of constituencies and is part of the wider system transformation that I set out, with other investments such as in diagnostic centres and surgical hubs. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), who leads on primary care, has been looking at the specific issue of new housing and how we can get the right level of contribution from new housing to local health facilities. I know that he will be happy to discuss that with her.

Health and Care Bill

Fiona Bruce Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Dr Allin-Khan]

I thank my hon. Friend for his intervention. There are widely held variations in views across the House, but I stand by the principle that everyone should have access to safe and timely healthcare, and that scrapping telemedical abortion services would drastically reduce access to a service that is incredibly important for women, and, as I have said, would simply increase the number of later-term abortions, which can have physical and mental impacts on the mother herself.

As for Lords amendments 85 to 88, it is disappointing to see the Government going against their own ambitions and targets. The consultation referred to in Lords amendment 83 would be on a statutory “polluter pays” scheme to make tobacco manufacturers fund measures to reduce smoking prevalence and improve public health. Smoking is responsible for half the difference in life expectancy between the richest and the poorest in society. Will the Minister please explain why we are still waiting to see the Government’s tobacco control plan, which we were promised by the end of 2021? The Government need to stop kicking public health matters into the long grass. They say that they recognise the stark health inequalities associated with tobacco use, but delays will do nothing to level the playing field and eradicate health disparities.

Ministers need to make sure they listen to the Lords, whose amendments go a long way towards eradicating the vast health inequalities that exist across society today. Rather than wasting time trying to overturn the changes, Ministers should now focus relentlessly on bringing waiting times down.

[Fiona Bruce (Congleton) (Con)]

I rise to speak to Lords amendment 92 and the Government motion to disagree, and to the amendment in lieu. A few months ago, in my role as the co-chair of the all-party parliamentary pro-life group, I wrote to the Health Secretary, supported by more than 60 parliamentarians—not an insignificant number—urging him to discontinue the temporary provision to allow for the taking of both sets of abortion pills at home. We said that we were deeply concerned about reports that taking both sets of abortion pills at home without direct medical supervision had led to a number of deeply concerning, unacceptable health and safety risks to women and girls in this country. These included a lack of basic checks by abortion providers before sending abortion pills, and the occurrence of severe complications and later-term abortions due to the lack of in-person assessment. We were also, notably, concerned about the greater risk of coercion by a partner or family member where the doctor does not see the woman in person.

--- Later in debate ---

[Fiona Bruce]

Please let me continue. I am sure the hon. Lady will have put in to speak. I thank Health Ministers for listening, and for recently cancelling this temporary emergency provision from August, fully in accordance with the Government’s intention at the outset of the covid pandemic, which was that the measure would be temporary. To delve a little deeper into the issues and concerns, having no in-clinic assessment means that gestational age is, and can only be, an estimate. Many women cannot be sure that they are within the legal—and, I presume, safe—limit of nine weeks and six days for taking such pills. Indeed, several women who have needed hospital treatment after taking an at-home abortion pill were clearly many weeks over that limit.

[Alec Shelbrooke]

Will my hon. Friend give way?

[Fiona Bruce]

I feel that I must be fair, and I have said that I will not take interventions—

[Alec Shelbrooke]

Just on this point?

[Fiona Bruce]

All right.

[Alec Shelbrooke]

I am genuinely grateful to my hon. Friend, and I am not intending to speak in the debate. I know that she has deeply held beliefs, which I respect very much. She is giving examples and details. Can she give data referring to the examples she is giving? I have been struck by the fact that in this debate, I have heard a lot of anecdotal evidence that has not been backed up by any reference to data, and I think that data is important for this debate.

[Fiona Bruce]

Yes; the organisation Right to Life, which is the secretariat to the all-party parliamentary pro-life group, has collated such data. Freedom of information data analysis also shows that one in 17 women taking abortion pills requires hospital treatment. That means that more than 14,000 women have been treated in hospital following the approval of pills-by-post abortion. A similar study of FOI data in February 2021 showed that every month, 495 women attended hospital with complications arising from abortion pills, and that 365 of them required hospital treatment. Thirty-six women every month are making 999 calls—that is more than one a day—seeking medical assistance because they are concerned about complications arising from taking abortion pills.

Women, especially vulnerable women, deserve the care and attention given in an in-person meeting with an experienced clinician before making such an important decision. Indeed, 74% of GPs have indicated concerns about women finding it distressing to terminate a pregnancy themselves at home. More than 600 medics signed an open letter to the Prime Minister in May 2021 calling for an end to pills-by-post abortion, and a clear majority—70%—of the respondents to the Government’s consultation on this subject said that the temporary measure of pills-by-post abortion should end.

However, whatever one’s views on abortion, the Government very recently made a decision to cease the authorisation of these pills from August this year, due to this being a temporary covid provision that was never intended to outlast the covid pandemic period. The Government—our Health Ministers—have made an informed, carefully considered, evidence-based decision. We should respect that, but once more, those pressing for an even more easily available abortion regime in this country are not willing to accept it. Instead, they are seeking to make a serious change to the law through an amendment, as is frequently their practice. That gives us far too little time to debate such fundamental issues. There is too little opportunity for us parliamentarians to scrutinise this serious issue, which is literally a matter of life and death. Whatever our views on abortion, that is simply wrong. I urge colleagues to vote against this proposal to make at-home abortion pills permanently available.

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

I come to this Bill rather late, so I pay tribute to my hon. Friend the Member for Central Ayrshire (Dr Whitford), who did most of the heavy lifting on it for the SNP. I have turned up for the fag end of the process. I hope the House will oblige me by listening to a few general comments before I address the Lords amendments.

Overall, this Bill is a missed opportunity for England to go back to a unified service, similar to the one we have in Scotland. Whatever system we have, I am sure each of us on these islands would wish to extend our gratitude and thanks to the staff who delivered such a focused patient care service in difficult times, throughout the pandemic. I also acknowledge the Government’s progress on recognising the need for consent from the devolved nations; that should have been included in the Bill from the get-go. Still, better late than never.

As we know, health is mainly a devolved matter. Following discussions with the UK Government, the Scottish Government were able to bring forward a legislative consent motion in December, further to which, in the light of securing acceptable amendments, the Scottish Government recommended consent to the Secretary of State’s power to transfer or delegate functions under clauses 88 to 94.

The UK Government made amendments to introduce two new clauses to the Bill—on hymenoplasty offences in Scotland, and on information about payments, et cetera, to persons in the healthcare sector—that also require legislative consent. The Scottish Government are content to recommend that the Scottish Parliament grants that consent.

In summary, the SNP supports Lords amendments 66 and 109 on the Health Services Safety Investigations Body to protect safe spaces and reduce any future harm to patients. These amendments largely rehash some of the amendments we tabled at previous stages, and I welcome the Government’s acceptance of the Lords amendment to remove coroners’ access in this regard.

A key health driver on which we can make a big difference is encouraging people to stop smoking, which is one of the best things people can do at any time of life. We support Lords amendments 85 to 88 on a tobacco products statutory scheme for the regulation of the prices and profits of tobacco manufacturers and importers, and they would require the Secretary of State to carry out a consultation on the scheme.

Although I understand that the Minister does not wish to prejudge the options for England’s tobacco control plan, we should remember that these would be UK-wide measures, and public health and smoking cessation are devolved to Scotland. The Scottish Government’s programme for government committed to a refreshed tobacco action plan built on the pillars of prevention, protection and cessation to achieve their target of lowering Scotland’s smoking rate to 5% or lower by 2034, which would put tobacco out of sight and out of mind for future generations. These Lords amendments, particularly on the “polluter pays” charge, would be beneficial in that regard, and Scotland’s progress should not be held back by decisions in this place.

In conclusion, I draw Members’ attention to the Cancer Research briefing:

“Implementing a ‘Smokefree Fund’ would require tobacco manufacturers to pay for the harm caused by tobacco but without letting them influence how the money is spent. It would provide much-needed investment in evidence-based measures such as public education campaigns and Stop Smoking Services, without further squeezing the public purse.”

Who could argue with that?

--- Later in debate ---

[Jess Phillips]

I totally agree with my right hon. Friend. Actually, if people are against telemedicine for abortion, they might have very strongly held views about not liking telemedicine for anything. By that virtue, they should be against it for everything. For all the people who are desperately worried about vulnerable women—victims of domestic abuse and victims of sexual violence—not being able to access healthcare, I say come on and join me. They are absolutely right: there is zero availability of most mental health support. There is zero chance of getting a GP appointment any time soon, but somehow, people are against telemedicine only on this issue.

Often in debates, we do not stand up to seek to convince others. That only happens when there is a free vote—when actually the debate is really important. To people who are unsure, I say that I understand it—I totally get it—especially if they do not necessarily have so much skin in the game have but a huge load of emails in their inbox. The reality is that if they are not sure, they should either try to be convinced by the debate and the evidence, or they should simply abstain on the issue.

This is not particularly difficult for me. As I have said, I am not a dispassionate sort. I have stood in this House before and said that I have had an abortion. I do not feel devastated by that fact. I think we need to be clear about this. In this place, we only deal in hard cases, because they tell the argument much better. One thing I would say about when I had an abortion is that the worst process of having an abortion is the waiting. I had made the decision about what I was going to do with my body. I had made it the second that I saw I was pregnant on a pregnancy test, because I am an adult woman, completely capable of handling my own body and knowing my own mind, and that is how we should treat every woman in this country.

[Fiona Bruce]

On that point about adult women, and the point about the number of professional organisations that have been quoted, as if there were universal support for the continuation of telemedicine, I will mention two organisations, with particular reference to young people. The National Network of Designated Healthcare Professionals for Children, NHS doctors and nurses who work in the area of children’s safeguarding, has welcomed the Government’s decision to end the provision, and the Royal College of Paediatrics and Child Health recently released a statement:

“Children and young people under the age of 18 and Looked after Children up to the age of 25 must be offered and actively encouraged to take up a face-to-face appointment to assess gestation, support their holistic needs and assess any safeguarding issues as part of the pathway for early medical abortions.”

[Jess Phillips]

I could not agree more. People should absolutely be able to access a face-to-face appointment where they want and need one, and there is not a single thing in the legislation that would prevent that. I go back to this idea: “If you don’t like abortion, don’t have one. No one’s forcing you.” This is exactly the same. No one is forcing anybody to take through the procedure at home; it is a choice that we should allow adult women to make.

When I made that choice, after I made it I had to wait another eight weeks. It was some time ago, long before the pill was even necessarily widely available. I had made the decision, and I did not feel sad about it. I did not feel bad about it. I had made the decision on behalf of my son, who had only just been born—although, actually, I do not even need an excuse. I did not want to have a baby, having just had one, and it is perfectly well within my gift to make that decision. The argument is often made about all the children who have been lost because of women like me, but my younger son, Danny, would not exist if that baby had been born, so we end up equal, and he is a cracker of a kid.

The reality is that I had to wait, and I started to feel pregnant. I started to feel unwell, I started to feel tired and it started to affect my work. That was horrendous for me, knowing that I was not going to go ahead with it—not horrendous because of guilt, but because it made me feel sick and it made me feel that people had expectations of me. I had to hide it. I could not tell people I was pregnant; I had to hide that fact from people at work and other places, because I had to wait. Had I been able, at the four-week point when I found out I was pregnant, to just stay in my house and ring up, it would have been a far better situation for me.

People do not want to think about me, but rather obsess about the difficult cases, not the vast majority who are adult women and should be trusted to take medication in their own homes. We are treating those women as if they are going to get a methadone allowance from a surgery, as if they cannot be trusted when they say, “Actually, I’d prefer to stay at home and not maybe have a miscarriage on the bus on the way home because I live in a rural community.”

If people want to hear about the hard cases, I am currently handling one. It is the case of a young woman who has been sexually exploited since she was 13 years old. She is 23 now. She has had 10 years of being raped repeatedly, pretty much every weekend of her life, by multiple men, and it continues. Obviously, she falls pregnant—well, she does not fall pregnant; she is raped and then she gets pregnant. She has very little trust in agencies and in the police, and she is right to have so little trust. She has been failed time and again. Without the opportunity of telemedical abortion, I have no idea how she would cope. It is a vital service for people who really need it.

I ask hon. Members to vote Aye on Government amendment (a) in lieu of Lords amendment 92, or, if they are not sure, to abstain. Adult women can be trusted to decide what they want to do with their health, and any other vote would suggest otherwise.

Abortion Services Commissioning: Northern Ireland

Fiona Bruce Excerpts

Tuesday 14th December 2021 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

It is a pleasure to follow the hon. Member for Upper Bann (Carla Lockhart), my co-chair on the pro-life all-party parliamentary group. I commend her for her informed and sensitive speech and for all that she does to be a voice for the unborn in this place.

I rise to speak in this debate to support the right of the Northern Ireland Assembly, representing the people of Northern Ireland, to determine the way forward on abortion—a matter devolved there for some 100 years. I will also highlight the problems arising from the 2020 and 2021 regulations.

I agree that this is a sensitive matter; it is one of fundamental importance in terms of the lives of the unborn, respecting the wishes of the people of Northern Ireland, and respect for the long standing Sewell convention of devolution—that the UK Parliament does not normally legislate in respect of devolved matters without the consent of the devolved legislature. Before I move on to the particular problems of the 2020 and 2021 regulations, I will first refer to two other issues: the Secondary Legislation Scrutiny Committee and the House of Lords Select Committee on the Constitution Abortion (Northern Ireland) Regulations 2021. There were multiple submissions to the Secondary Legislation Scrutiny Committee earlier this year as it considered the Abortion (Northern Ireland) Regulations 2021. Those submissions illustrated the worrying damage that imposing such changes could inflict on the Union. I will quote just one, which says that the Secretary of State’s new powers would

“give him complete control of policies related to abortion and education in Northern Ireland, which are devolved matters. They will take away from the people of Northern Ireland any power to affect any abortion policy the Westminster government choose to impose”,

and that,

“given the current unrest in the province, these measures could do untold damage to the already fragile Northern Ireland Assembly and the Good Friday Agreement.”

Those are profound implications.

I turn to the House of Lords Select Committee on the Constitution, which published a report on the Abortion (Northern Ireland) Regulations 2021 in April highlighting several constitutional issues arising from the regulations. The Committee stated:

“The 2021 Regulations raise an important issue concerning devolved competence. On the one hand the Secretary of State cites a statutory duty, arising from section 9 of the 2019 Act, to make the 2020 and 2021 Regulations… On the other hand, one of the governing parties in the Northern Ireland Executive opposes the Regulations as an unwarranted interference with the devolution arrangements… The prospect of different laws on abortion operating in Northern Ireland would cause substantial legal and political difficulties, and risk undermining the devolution arrangements. We urge the Government and the Northern Ireland Executive to adopt a more constructive approach to resolve this matter.”

I agree.

I now turn in detail to the problems arising from the 2021 and 2020 regulations. Some of these points have been touched on, very eloquently, before; forgive me, Mr Pritchard, if I touch on them again. They are worth repeating. The 2020 regulations allowed the Westminster Government to introduce a completely new abortion framework to Northern Ireland—even broader than the already extremely permissive regulations applicable here. For example, the regulations allow for an abortion, without the need for any ground or reason to be given, for any pregnancy up to 12 weeks. That, effectively, permits sex-selective abortion, as it is now possible to tell the sex of an unborn child between seven and 10 weeks.

Government Ministers here have repeatedly stated that sex selection is not a lawful ground for the termination of pregnancy. When sex-selective abortion was debated in Westminster in 2015, a Minister described it as an “abhorrent practice”. In permitting abortion on demand up to 12 weeks, the regulations go far beyond the law in Great Britain. Indeed, they are even more permissive than required by the CEDAW report, which I will come on to shortly.

The 2021 regulations are even broader, as they deal not only with abortion but with wider issues such as sex education. However, no formal consultation has taken place on the regulations. The Government relied on a mere six-week consultation on the 2020 regulations—six weeks that ran during the general election campaign of 2019 and in the lead-up to Christmas that year.

Then there is the question of the cost of implementing this new framework for abortion in Northern Ireland, which is shrouded in confusion. There was no impact assessment for the 2020 regulations. It appears that the UK Government—the Minister may correct me—have given no indication of how costs will be borne, arguing that this is a matter for the Department of Health in Northern Ireland. However, the Department of Health in Northern Ireland considers this funding to be a matter for the UK Government.

There is the further legal point of controversy as to whether the obligations in the Northern Ireland (Executive Formation etc) Act 2019 were a one-off, so that the 2020 regulations met them, which is the view of the former Attorney General for Northern Ireland, John Larkin QC, or whether those obligations are continuing, which I understand is the view of the Government.

It is critical to remind ourselves, as colleagues have done, that the minor UN CEDAW committee was not the UN speaking as a whole, which was often the impression that we were given when we were discussing the Northern Ireland (Executive Formation etc) Act 2019. Those discussions were far too brief. I remember one important debate on the Bill, on 18 July, that lasted just one hour. On another occasion, if I remember correctly—and I stand to be corrected—we were asked to look at House of Lords amendments in just 17 minutes, which was totally inadequate for the consideration of such important legislation.

That CEDAW committee was not the UN speaking as a whole and, as we have heard, its recommendations are neither binding nor international law. That has been specifically confirmed by the Northern Ireland Office itself in its explanatory memorandum to the Abortion (Northern Ireland) Regulations 2021, which states, with reference to paragraphs 85 and 86 of the CEDAW report:

“In particular, those recommendations are not binding and do not constitute international obligations.”

The whole premise on which we passed the 2019 Act was false.

On the basis of those non-binding recommendations, the Government seek, through the 2021 regulations, to give the Secretary of State sweeping powers to direct not just Ministers but civil servants and health bodies in Northern Ireland to implement a broad abortion framework. That is a far wider group of people and bodies than envisaged by the Northern Ireland Act 1998, which allows the Secretary of State to give direction to Ministers or a Northern Ireland Department only in certain circumstances, namely,

“for the purpose of giving effect to any international obligations”

—and we have agreed today, I hope, that the CEDAW recommendations were not international obligations—or for the purpose of

“safeguarding the interests of defence or national security or of protecting public safety or public order”.

The wide-ranging powers given to the Secretary of State by the 2020 and 2021 regulations cannot be justified on any of those grounds.

I turn now to commissioning. There is no reference to what services might be commissioned in either the 2020 or the 2021 regulations. The regulations are now, as Mr Pritchard has said, the subject of a pending court decision, which makes for a further legal complication. The requirement to commission services under the direction of the Secretary of State may disappear if that legal challenge is successful, leaving a legal loophole. What is particularly concerning about the commissioning, however, is that the regulations do not include any proposed inspection arrangements for premises conducting abortions, whether NHS or private. It would appear that the Northern Ireland Regulation and Quality Improvement Authority has no powers to inspect any premises to compare with those of the Care Quality Commission in England. If that is the case, that omission is doubly concerning when we consider recent reports by the CQC of abortion clinics in England. In the last few weeks, a British Pregnancy Advisory Service clinic in Middlesbrough was rated inadequate after inspectors found that medicines were not stored safely and that systems to protect people from abuse were not “effective”, while a Doncaster BPAS clinic was put into special measures following an inspection. It is essential that proper provision for the inspection and regulation of abortion services is in place in Northern Ireland.

As mentioned, abortion remains a devolved matter that rests with the competency of the Northern Ireland Assembly. The Northern Ireland (Executive Formation and Exercise of Functions) Act 2019—which, in section 9, includes the order-making power under which the regulations were created—was imposed on Northern Ireland at the behest of parliamentarians from other parts of the UK. No Northern Ireland MP in Westminster supported the passing of that Act.

The Northern Ireland Assembly have been up and running for some time. It not only has the legislative competency to act on abortion-related matters but, as we have heard, it is in the process of doing so through the Severe Foetal Impairment Abortion (Amendment) Bill. Respect for the competencies of that Assembly and the devolution settlement surely dictates that all other abortion matters should be determined by the Assembly, particularly since abortion has been a devolved matter for so long.

The Severe Foetal Impairment Abortion (Amendment) Bill seeks to address the discriminatory nature of abortion law implemented in Northern Ireland under regulation 7 of the 2020 regulations, which permits abortion up to birth on the grounds of disability. It is a matter of increasing concern across the UK in terms of its discriminatory aspect, as we heard in the House only two weeks ago in a debate on the proposed Down’s syndrome Bill.

Application of regulation 7 would very much go against the progressive tide of thinking in that respect. The fact that abortion up to birth for serious foetal disability is already in effect in GB is no reason to implement it in Northern Ireland—particularly as it is now considered to be deeply concerning and ill-defined legislation. I know that because my son was born with a club foot. I do not consider that to be a serious disability. We have seen it corrected; no one looking at my son today would know that he had been born with that disability.

Even the CEDAW report on which the regulations rely stated:

“In cases of severe fetal impairment, the Committee aligns itself”

with the UN

“Committee on the Rights of Persons with Disabilities in the condemnation of sex selective and disability selective abortions, both stemming from…negative stereotypes and prejudices towards women and persons with disabilities.”

With great sadness, I conclude that imposing the ill-thought-through and hurried-through regulations would demonstrate a profound lack of respect for the people of Northern Ireland and their elected representatives. As I have repeatedly said in this House—I refer to my remarks on 8 July, 18 July and 9 September 2019, and on 8 January 2020—the hurried handling of the issue of abortion, which is a devolved policy area, and the Northern Ireland (Executive Formation) Act and the subsequent introduction of regulations has been, in my opinion, unconstitutional, undemocratic, legally incoherent and utterly disrespectful to the people of Northern Ireland.

[Mark Pritchard (in the Chair)]

I ask the hon. Member for Strangford (Jim Shannon) to wind up at about 3.38 pm, to allow the Front-Bench Members 10 minutes each.

Dignity in Dying

Fiona Bruce Excerpts

Wednesday 8th December 2021 Commons Chamber

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

I express my thanks to Mr Speaker for granting this Adjournment debate.

Assisted dying is an immensely sensitive and emotive issue of conscience over which each of us individually, as Members of this place, must wrestle, and which this House will have to address collectively before much longer. In my role as co-chair of the all-party parliamentary group for choice at the end of life—I have the pleasure of co-chairing it with the hon. Member for Bristol South (Karin Smyth) in this House—I have had discussions with many colleagues, including the Prime Minister, and I know how seriously this issue is taken. I know that many colleagues are yet to come to a firm conclusion on it. I respect that position. I respect it not least because I have completely changed my mind on this issue since I arrived in the House of Commons. After listening to many constituents in my office in Sutton Coldfield, often with tears of solidarity in my eyes, as with inordinate sadness they have told me of the painful and undignified death of someone they loved, I have concluded that I want the law changed to benefit my constituents, to benefit those who I love, and possibly, indeed, to benefit myself.

Our constituents are, according to every single opinion poll over the past three decades, in strong support of this change in the law. I remind the House that the Bill introduced by the noble Lady Meacher in the other place, which has recently commanded their lordships’ support and builds on the consensus so painstakingly and skilfully assembled over many years by Lord Falconer, sets out that those who are within six months of the end of their life and who, in the opinion of two doctors and a High Court judge, have reached the decision independently and in sound mind that they wish to end their life to avoid the often undignified and extraordinary suffering that would otherwise assail them, should be able to do so.

[Fiona Bruce (Congleton) (Con)]

Is it not extremely difficult to assess when a life will end? Is that not one of the challenges that we have with regard to this proposal of a timed end to a life?

[Mr Mitchell]

My hon. Friend is right, but I used to be a junior social security Minister, and I know that social security law means that the Government—society—already have a way of determining a period six months before the end of someone’s life. We can of course reflect on this, and on whether there is a better way of doing it, but that facility in fact already exists.

Health and Care Bill

Fiona Bruce Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I would like to speak to new clause 31 in my name, which would reduce the upper gestational limit for abortion in most cases to 22 weeks gestation. This time limit amendment would replace the current 24-week time limit for abortions on the ground where there is a greater risk of injury to the physical or mental health of a pregnant woman or any of her children of proceeding with the pregnancy, under section 1(1)(a) of the Abortion Act 1967. The current 24-week limit law is based on an outdated understanding of the viability of premature babies, and it needs to be updated.

[Sir Edward Leigh (Gainsborough) (Con)]

Is it not absurd that in one ward of a hospital doctors can be fighting to save the life of a 22-week gestation baby while arguably, under the law, a 24-week baby can be aborted? That is ridiculous, and whatever anyone’s views on abortion, this is now the time to review this law, which is based on outdated technology and medical practices.

[Fiona Bruce]

My right hon. Friend makes exactly the right point.

Our law needs to be updated. The current 24-week limit was set over 30 years ago, in 1990. That legislation removed the previous time limit of 28 weeks. In 1990, 24 weeks was considered the point of viability outside the womb, but the scientific advances in those 31 years have been enormous. The latest guidance from the British Association of Perinatal Medicine establishes 22 weeks gestation to be the point of viability and enables doctors to intervene to save premature babies from 22 weeks. A study from a neonatal intensive care unit in London found that survival rates for babies born at 22 and 23 weeks gestation went from zero in the period from 1981 to 1985 to 19% in the period from 1986 to 1990, and then up to 54% in the years from 1996 to 2000. We would no doubt find that the figures had increased substantially since then, were those figures available. Just in the past few weeks, we have seen the incredible story from the American state of Alabama of the birth of a baby boy at just 21 weeks old. Weighing just 14.8 ounces, Curtis Means needs oxygen support and a feeding tube, but he is in good health. New clause 31 is a probing amendment, so I will not be pressing it to a vote on this occasion. However, I would welcome the Minister’s views and I look forward to a greater debate on this issue.

I also want to take a few moments to give my support to new clause 51, in the name of the hon. Member for Upper Bann (Carla Lockhart), which would clarify that abortion on the ground of the sex of the foetus is illegal. This relates to the truly awful exploitative practice whereby women can be pressurised into abortions based on the sex of their unborn child. I also support new clause 52, also in the name of the hon. Member for Upper Bann, which seeks to bring parity to the law in equalising time limits on abortions that take place on the ground of disability, so that they would be equal to the limits on most other abortions. The current law permits abortions up to birth if the baby is deemed likely to be born seriously handicapped. This is interpreted to include entirely non-fatal disabilities such as Down’s syndrome and easily surgically rectifiable conditions such as cleft palate and club foot. One of my sons was born with club foot, and I know how rectifiable it is. The law is plainly inconsistent with the disability discrimination legislation that applies after birth, and it sends a dreadful message to people who are living and thriving with disabilities about how little their lives are valued under abortion law. Again, I look forward to hearing the Minister’s views.

[Madam Deputy Speaker (Dame Rosie Winterton)]

In order to try to get as many people in as possible, I am going to put on a three-minute time limit.

Hospital Building Programme

Fiona Bruce Excerpts

Wednesday 3rd November 2021 Westminster Hall

[Dr Mullan]

My hon. Friend is absolutely right, and what he has said is typical of people who live in the area, who have also experienced their children being born at that hospital and receiving excellent care there.

[Fiona Bruce (Congleton) (Con)]

Speaking as a neighbouring constituency MP whose family has also made great and beneficial use of Leighton over many years, I strongly support my hon. Friend’s campaign for additional resources and support for Leighton. I very much respect him for that effective campaign, which I know has strong support across our constituencies.

My hon. Friend has spoken about the number of people who seek services from Leighton at the present time. Does he agree that that number is not going to diminish: it is going to increase, due to the additional numbers of houses that are being built in our areas? I note, for example, Northwich, where there is a huge amount of house building on the former ICI site, Middlewich in my constituency and Sandbach. Altogether, in recent years, thousands of new houses have been built for people who will want to look for support from Leighton.

[Dr Mullan]

My hon. Friend is absolutely right. One of the great things about the plans for the new site is that they take into account those future projected increases in population. I do not know what we will do if the resources are not there to do that.

Going back to staffing, we have more nurses and doctors and more staff overall working in the NHS than ever before, but it remains a huge undertaking for the Government to continue to work on recruitment and retention to staff new facilities. I know a lot of the media and campaigning by Opposition parties has focused on pay. While it is important, my experience is that fixing staff shortages would be the priority for most staff. The obstacles for further recruitment will not simply be solved by higher pay; the challenges are more complicated than that.

Of course, buildings and facilities matter, but we have to remember that the material used to build Leighton was expected to last only 30 years. It might seem odd to us now to create a major public facility with that sort of life span, but that is the reality.

Covid-19: Vaccination of Children

Fiona Bruce Excerpts

Tuesday 21st September 2021 Westminster Hall

[Miriam Cates (Penistone and Stocksbridge) (Con)]

I beg to move,

That this House has considered the vaccination of children against covid-19.

It is a pleasure to serve under your chairmanship, Dame Angela. I thank the Backbench Business Committee for granting this important debate, and draw Members’ attention to the three e-petitions that relate to this topic, which have amassed more than 100,000 signatures between them.

Vaccination has transformed public health over the last two centuries. As a science teacher, I remember teaching students about the amazing work of Edward Jenner, who famously developed the smallpox inoculation. Two hundred and fifty years later, vaccinations have again ridden to our rescue with the rapid development and roll-out of covid vaccines across the UK. The phenomenal success of the vaccination programme can be seen clearly in the data. Of the 51,000 covid-related deaths from January to July this year, 76% were of unvaccinated people, and a further 14% had received only a single dose. Just 59 deaths—0.1%—were of double-vaccinated adults with no other risk factors, and 92% of adults now have covid antibodies.

Those figures are a ringing endorsement of the Joint Committee on Vaccination and Immunisation’s strategy to recommend vaccination based on the medical benefits and risks to the individuals concerned. The Government have repeatedly defended both this strategy and the independence of the JCVI, and resisted calls to prioritise the vaccination of teachers or police officers over those at higher risk of serious illness. That was the right approach, and the UK has led the world in falling rates of deaths and hospitalisations.

It was therefore surprising, to say the least, when the Government put political pressure on the JCVI to quickly reach a decision about the vaccination of children. On 3 September 2021, the JCVI announced that it was unable to recommend the mass vaccination of healthy 12 to 15-year-olds. The reason was that, although there are marginal health benefits of covid vaccination to children based on the known risks of the vaccine, there is considerable uncertainty regarding the magnitude of the potential harms, such as the long-term effects of myocarditis.

Paediatrician and JCVI member Adam Finn wrote in The Sunday Times that a high proportion of myocarditis patients showed

“significant changes of the heart. It is perfectly possible that these changes will resolve completely over time. But it is also possible that they may evolve into longer-term changes.

Until three to six months have passed, this remains uncertain, as does what impact on health any persistent changes may have.”

According to the JCVI, for every 1 million healthy children vaccinated, two intensive care unit admissions will be prevented, and three to 17 cases of myocarditis caused. With two doses, that rises to between 15 and 51 cases—finely balanced, indeed.

There is no rush to roll out the vaccine to children. We know that children are not at risk from covid; teachers are no more at risk than the rest of the population; the vast majority of vulnerable adults have been vaccinated; over half of children already have antibodies; and there is no evidence that schools drive transmission.

[Fiona Bruce (Congleton) (Con)]

My hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates) is making an excellent speech, and she is quite right that the Government’s vaccination roll-out programme has been very positive. However, does she share my concerns about the message it sends out regarding parental authority if children as young as 12 are allowed to challenge their parents’ decision regarding their vaccination?

[Miriam Cates]

I agree with my hon. Friend: there are some very difficult issues around parental consent and the vaccine, and whether any child can know enough about the potential benefits and risks. This is going to be a very difficult question for schools, health authorities and parents. I will say more about that later on.

Covid-19

Fiona Bruce Excerpts

Monday 22nd February 2021 Commons Chamber

[Fiona Bruce (Congleton) (Con) [V]]

I would like to highlight the impact of covid-19 on the mental health of farmers and their families. A recent study by the Farm Safety Foundation found that 88% of young farmers now rate mental health as the biggest problem faced by farmers today, up from 82% in 2018—this is a hidden problem. Cheshire agricultural chaplaincy has also seen a worrying marked rise in levels of poor mental health.

Financial concerns, exacerbated by the pandemic, and the stress induced by them have had a significant impact on the mental health of farmers. Food market destabilisation affecting goods such as potatoes, high-end meat and milk due to the collapse of the hospitality sector last year continues to have knock-on effects. There are instances of farming businesses feeling pressurised by banks that are questioning their serviceability and removing overdraft facilities. This has placed severe stress on farmers.

With regard to social separation, lockdowns have exacerbated an already lonesome industry. Those who live and farm alone have been isolated from family and friends, as well as from the wider agricultural community, whose members normally meet regularly and encourage one another throughout the year, including at county shows or market sales.

For many, farming is an isolated existence, but in other farming families there can be up to three generations living on the same site. As with many walks of life, marital pressures have increased exponentially as a result of lockdowns, with the added pressures for many of home schooling. In some farming families, children have been kept at home for almost a year, as there is a real fear of them bringing covid-19 home and spreading it throughout the family. That is especially stressful for farmers, because the nature of their work means that if they or their other staff contract covid, taking sick leave is not an option.

The pandemic has also highlighted existing labour shortages for farmers, particularly in the light of ongoing concerns about the European labour market, aside from Brexit. Some workers come to farms for two or three months in a normal period, providing significant help for farmers, but due to the cost of obtaining a test to travel, the need for quarantining and the uncertainty about being able to return home if lockdown restrictions change, many workers have become wary of travelling to the UK, causing uncertainty for farmers.

These stresses facing the industry will extend long after the virus has gone, so the importance of providing support for farmers and those in the wider agricultural sector, and for those who support them, such as chaplaincies and the Royal Agricultural Benevolent Institution, has never been greater.

Healthcare Support Services: Conception to Age Two

Fiona Bruce Excerpts

Tuesday 15th December 2020 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

It is always a pleasure to follow my friend, the hon. Member for Strangford (Jim Shannon). I commend my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) not only on securing this debate and on her excellent speech, but on the many years of work that she has undertaken in support of nought to three-year-olds. I very much support that.

The Early Intervention Foundation’s new report, “Planning early childhood services in 2020,” states:

“It is difficult to think of a more effective way in which the government might realise its vision to ‘level up’ Britain and ensure equality of opportunity than through ensuring access to high-quality local family services which start in maternity and run throughout childhood.”

It goes on to say:

“There is a logical case for more holistic and joined-up approaches to delivering area-based family services, which respond to concerns about a lack of service integration and artificial service boundaries.”

Recently, in making the levelling-up fund announcement, the Chancellor spoke about the opportunity to upgrade the centres of our communities:

“This is about funding the infrastructure of everyday life”—[Official Report, 25 November 2020; Vol. 684, c. 831.]

As vulnerable children and their families struggle with isolation, relationship conflict, poverty, addiction, death and many other problems during this pandemic, we need now more than ever to strengthen our community infrastructure so that every family needing support can access it locally and easily, when they need to. Many of us here are aware that the most pressured point in family life is often when the children are aged nought to three.

It will come as no surprise to colleagues that I want to use the rest of the two short minutes I have today to talk about family hubs. To put it bluntly, family hubs’ time has come. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) made an excellent speech in which he said that sometimes it is difficult to find something new to say about something one has been speaking about for years, but I should say that family hubs are local centres that ensure that families with children and young people can receive help to overcome a range of difficulties, and get the face-to-face support that, as we have heard this morning, is so necessary.

Recently, calls for progress in supporting family hubs have grown louder. The Children’s Commissioner wrote in July:

“Some parents may want help to find work, or deal with the new strains on their relationship, or on their mental health, that can come with having a baby—and those stressful issues may also be making it harder for them to give their young children the loving attention they need. The Hubs would also have these more targeted services—including perinatal and infant mental health teams, JobCentre advisors, Speech and Language Therapists and housing teams—co-located within the service.”

Recently, family law practitioners have got on the case as they see far too many—40%, in fact—separating couples using fractious court proceedings to determine child contact and residency. Last month, the Family Solutions Group concluded that

“Crucially, the Family Hub…could provide the signposting and gateway to the range of other direct support services for children which are so sadly lacking at present.”

Thankfully, the Government are now on the same page. Their manifesto commitment says that they will

“champion Family Hubs to serve vulnerable families with the intensive, integrated support they need to care for children – from the early years and throughout their lives.”

Recently, the Family Hubs Network was established to share best practice and drive the family hubs movement across the country. The movement is characterised by an understanding of the importance of early help and provision; by a relational approach, adopted by everyone who works in the hub; and by a whole-family approach, so that families have somewhere they know they can go to get information, advice or guidance. Parents can get help for difficulties in their own relationships, and there can be integrated health and public health priorities, including health visiting and maternity, with social services and, if necessary, troubled families programmes.

This month, the Department for Education is taking the first steps in establishing a national centre for family hubs, which will not only develop the evidence base but share good practice on how best to support families in the early years. There is no time to lose.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the right hon. Member for South Northamptonshire (Andrea Leadsom) for securing the debate. I know that her passion for this subject runs deep and has done for some considerable time, and she always speaks with great authority. That is why I was so pleased that the Prime Minister appointed her to lead the review. I am really looking forward to the results of that come the new year, because as so many right hon. and hon. Members have said, the time for change is here. Being able to deliver for families over those first 1,001 days is a responsibility that we should all share; we need to make sure that we not only speak about it, but actually deliver it.

I would also like to thank all hon. Members present, starting with my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton)—or, as I now like to refer to him, the hon. Member for health visiting, that very unsung part of our health ecosystem. I thank the hon. Member for Glasgow Central (Alison Thewliss), and commend her on the work that she does with her APPG on breastfeeding, which is such an important start to life. I also thank my hon. Friend the Member for family hubs, or for Congleton (Fiona Bruce), and the hon. Member for Strangford (Jim Shannon), who looks after the strength of the family in this place. Finally, I thank my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) for her plea for continuity of caring, but also for the fine work she does with the APPG on baby loss. I am following in some big shoes: those of my hon. Friend the Member for Colchester (Will Quince), of the former Member for Eddisbury, and of my hon. Friend the Member for Banbury (Victoria Prentis).

There is such power in this room for change, and it is both right and important that the Government have a care for the nation’s health. Just as we say about retirement, we should be investing in our health from the beginning: from early years through to older age. It must start from conception to be as effective as it can be. The period between conception and the age of two is absolutely critical in a child’s development, as we have heard. It is during this time that the important foundations are laid, creating that strong and healthy start that can see children through their life: to school, to work, to parenthood, and to better parenting themselves, as my right hon. Friend the Member for South Northamptonshire said, which very much struck me. This is a cycle that we really do need to get right.

Thankfully, most babies do have a fantastic start in life. They benefit from the support of loving parents and carers, as well as dedicated early years professionals. However, there are unacceptable variations across the country, both in different parts of the country and within regions, and both in terms of geography and population groups. We know that just over 66% of children in Bolton achieve a good level of development at age two to two and a half, but that rises to over 93% for a child born in Cambridgeshire. That differential should be unacceptable to us. Risk factors, often family based or socioeconomic, make our children—they are all our children—more vulnerable to poorer outcomes going forward.

The coronavirus has created enormous pressure, not only on services but on individuals. For many new parents, coronavirus has meant feeling isolated and losing that support mechanism, and my heart goes out to them. I think it was the hon. Member for Strangford who spoke about the importance of just meeting friends; just being able to have that little bit of “Does your baby do this? My baby does that.” They do not come with a manual, and I remember all four of mine, all under five at the same time, all being completely different: they all had completely different eating habits, and so on. Very often, I could not work out why. I thought, “I did a proper job before I had these children. Why on earth is this so difficult?” Some days, it was a real achievement to get the breakfast pots washed and go out with my pants on the right way around.

[Fiona Bruce]

The Minister is making such an important point. Does she agree that we so often undervalue how important mothering, parenthood and ensuring children have that best start in life is? As a society, we should value that much more highly, because it is not an easy job.

[Jo Churchill]

I agree wholeheartedly with my hon. Friend. We are in a different time as regards parenting. Many couples choose that the father will stay at home. Often they do an excellent job at raising their children, as that part of the family unit. It is about communicating, sharing responsibility, and the services that wrap around families. My hon. Friend the Member for East Worthing and Shoreham used a lovely phrase when he talked about supporting, not supplanting, parents: holding hands to make sure that there is help there when someone struggles with breastfeeding or to understand the right thing to help a child sleep, or when there might be conflict in the house and they reach out. I take the point made by my hon. Friend the Member for Truro and Falmouth about a trusted carer giving people signposting. I asked my sister, who recently became a grandparent, what the most challenging thing was, and she said it was definitely the isolation and separation, which did not even allow her to hold her new granddaughter for six weeks after her birth.

--- Later in debate ---

[Fiona Bruce]

I thank the Minister for that comment. Will she also comment on the point made by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) about the need for a dedicated Minister for families, ideally at Cabinet level? Within just a few minutes we have referred to many different Government Departments—the Department for Education, the Department of Health and Social Care, the Ministry of Housing, Communities and Local Government and others—all looking at family hubs. There needs to be one Minister who can really pull the thinking together and drive it forward.

[Jo Churchill]

I know that the Education Secretary has been given a leadership role for families, and £2.5 million to research and develop best practice on how we integrate family services. I know that my hon. Friend the Member for East Worthing and Shoreham has often called for a families Minister, and in the last Parliament my hon. Friend the Member for Congleton also made such a plea. Joined-up cross-Government working in many areas is always a challenge. I leave the plea of my hon. Friend the Member for East Worthing and Shoreham resting there. It is something else that will probably come out in the review.

The Department is taking important steps to improve the healthcare outcomes of babies and young children to give them the best start in life, including the most ambitious childhood obesity plan in the world. The Minister for Mental Health, Suicide Prevention and Patient Safety has done a lot of work on transforming children’s mental health and maternity services to identify those mothers and members of the broader family who are struggling. We also have a world-leading immunisation programme, which I will come back to.

All those policies are informed by the guiding principle of prevention, which I totally agree is better than cure. We want to identify and treat problems from the earliest stage and help parents to care for their children, change and improve behaviours, and protect against preventable diseases. We know that if parents and babies are well supported in the vital period from conception to age two, they are set up for a lifetime of better mental and physical health. Attachments, stimulation and foundations really are the backbone of their lives. While my right hon. Friend the Member for South Northamptonshire was talking, I thought of it as an emotional reservoir on which we can spend our lifetime drawing to ensure that we live healthier and more sustainable lives.

We are doing everything we can to help the NHS to improve outcomes for babies and children, and we are building that into the NHS long-term plan. The pandemic has made the public rely on new methods of accessing childcare. Information has been accessed from conduits such as 111 to an extent that we have never seen before. I am keen to explore how that can be used further to support parents and children going forward.

We are embracing opportunities presented by technology and pleased that the personal child health record, better known as the red book, is being digitised and made available. There are enormous opportunities here. We are also making sure that the modernisation of the healthy child programme is universal and personalised in response to every child’s needs. We remain committed to improving perinatal health. My hon. Friend the Minister for Patient Safety, Suicide Prevention and Mental Health is making sure this is at the top of her agenda.

I ask Members to encourage parents in their constituencies to ensure that their children are vaccinated. As my hon. Friend the Member for East Worthing and Shoreham said, vaccination rates are falling, and we lost the World Health Organisation status for measles. It is vital that parents use the free vaccination service to protect their children from measles. The actual disease is much worse than the second it takes to get vaccinated. I would really like us all to push to make sure that we regain the WHO status. The flu vaccination programme rolled out to school-aged children has been a phenomenal success this year, but if parents are worried about anything to do with vaccinations, they should go to their GP or a health professional and ask questions.

Before I finish, I will quickly comment on support bubbles. I hear my right hon. Friend the Member for South Northamptonshire. In all tiers, single adult households can form a bubble, and we have expanded this provision because we understand the pressure that they are under. Specifically, households containing a child with only one adult, and adult households with a child under one, or a disabled child under five who requires continuous care, can now also form a support bubble. In addition, households with one or more people who have a disability and require continuous care, as long as there is no more than one other individual over 18 who does not have a disability, can also form a support bubble. As my right hon. Friend knows, it is a challenge in the current pandemic to make sure that we balance the safety of everybody with access to support, in this case for young parents or perhaps people with needs arising from terminal illness.

The Duchess of Cambridge’s report was mentioned by several hon. Members. I am keen to understand whether the five recommendations are woven into the review, when it finally comes to us in January.

I recognise the impact of domestic violence on families. It has been incredibly difficult, and it is unseen. I pay tribute to the Under-Secretary of State for the Home Department, my hon. Friend the Member for Louth and Horncastle (Victoria Atkins), for her work in this space and on the Landmark Domestic Abuse Bill. We all need to be aware of the issue, and highlighting services and support for families is key.

On that note, I hand over to my right hon. Friend the Member for South Northamptonshire. I look forward to receiving the review in the new year and discussing the outcomes with her.