IVF Provision

Debate between Hannah Bardell and Maria Caulfield

Tuesday 24th October 2023 Westminster Hall

[Maria Caulfield]

As the hon. Lady will know, it was only last year that we published the women’s health strategy. IVF was front and centre of that—the first year priority. Getting that information is the first step, and then we are able to look at the ICBs that are not offering the required level of service, have those conversations about why and have a step change to improve the offer. That is just one tool in our box to fulfil our ambition to end the postcode lottery for fertility treatment across England.

Colleagues have also raised the issue of lack of information about IVF, both for the public and healthcare professionals. We are working closely with NHS England to update the NHS website to make IVF more prominent, and also with the royal colleges to improve the awareness of IVF across healthcare professions. One area we are dealing with is that of add-ons, which the hon. Member for Pontypridd (Alex Davies-Jones) and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) addressed. As part of our discussions with the HFEA, it now has the add-on rating system, so that people can see what percentage difference an add-on would make and make an informed choice about whether they want to do that as part of their IVF treatment.

I have also just received the HFEA’s report about modernising the legislation, with particular regard to its regulatory powers. That will cover the provision of add-ons, and I hope to be able to respond to the report as quickly as possible. We are making really big changes to some of the issues that have been holding back IVF for a long time. I know that for many people this is not quick enough, but I reassure hon. Members that progress is being made.

For female same-sex couples and same-sex couples across the board, I know that this is a really important matter. I took the position that it was unacceptable for female same-sex couples to shoulder an additional financial burden to access NHS-funded fertility treatment. On the transparency toolkit now on the gov.uk website, we can easily see which parts of the country are asking for six cycles of self-funded insemination, for instance. In Cambridgeshire and Peterborough it is 12 cycles, in Bristol and north Somerset it is 10. As the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) said, that is exactly the information we need so that we can tackle the issue head-on and directly with the ICBs. Indeed, one of our key commitments in the women’s health strategy was to remove this injustice once and for all. We were hoping to do that completely in the first year; it will in fact take us a little longer, but it will not take us 10 years.

[Hannah Bardell]

It is certainly comforting to hear that, but I urge the Minister to supercharge that work, so that female same-sex couples and, indeed, the trans community can make sure they can access that. Will the Minister say something about surrogacy, because I know that across the UK—though, again, we have somewhat better standards and access in Scotland—there are still major challenges, legal and otherwise, for male same-sex couples accessing surrogacy?

[Maria Caulfield]

The Law Commission has recently produced a report on changes to surrogacy, which we are in the process of responding to. It will address some of the issues raised today. The Government’s position is to abolish the requirement for female same-sex couples to undergo six cycles of self-funded treatment before they can access NHS-funded treatment. We have been clear that the NHS-funded pathway should now offer six cycles of artificial insemination followed by IVF to female same-sex couples, giving everyone access to NHS-funded fertility services. Some ICBs are doing that already, but others have delayed implementation, and that is what we want to focus on now. We are clear that that needs to be urgently addressed, because same-sex couples’ expectations have rightly been raised and the service has not met them swiftly enough. I take that on board from the debate today and reassure colleagues that that is a priority.

To accelerate action, NHS England is developing advice to assist ICBs. I hope they will be able to share that soon. I will share that with the House as soon as it is available. When it is published, we expect ICBs to update their local policies. There should be no further delay and no waiting for NICE guidelines when they are published next year. ICBs must urgently address all local inequalities in access to fertility treatment. There is a reason that IVF was made a priority in the women’s health strategy and a reason it was a priority in the first year.

Our health service pioneered the use of IVF in the 1970s. It is a great British invention that should be available to every couple who want to start a family, because the Government back women and families and the accessibility of IVF to those who need it. I look forward to the hon. Member for Jarrow continuing to hold my feet to the fire until we have delivered the change—deliver it we must.

Birth Trauma

Debate between Hannah Bardell and Maria Caulfield

Thursday 19th October 2023 Commons Chamber

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

I, too, congratulate my hon. Friend the Member for Stafford (Theo Clarke) on her courageous speech, in which she described the birth of her daughter and the terrifying experience that she had. It is good to hear that she received such great support from her NHS team, but concerning to hear of her negative experiences—and as a former Minister for maternity services, I know that they were not isolated and that many others will have had similar experiences. My hon. Friend is a tireless advocate for women who have suffered birth trauma, and I pay tribute to her for the work that she has done and, I am sure, will continue to do.

I also congratulate Members on both sides of the House who have shared their personal experiences and those of their constituents, including my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), who does so much in the area of baby loss, and who I am sure will speak in the next debate. The hon. Member for North Shropshire (Helen Morgan) talked about her experience of a caesarean section, and I want to reassure her that we are trying to move away from terms such as “normal” and “natural” to the term “a safe birth”, whether that refers to a “natural” birth or a C-section. I have been working with the hon. Member for Canterbury (Rosie Duffield) on the East Kent inquiry and its recommendations, and have met many of her constituents who also shared their traumatic experiences about the care they had received.

I thank my hon. Friend the Member for Moray (Douglas Ross) for sharing his experience as a partner, and also for pointing out that many of these issues apply to all four nations of the United Kingdom. I respond as the Minister for services in England but, obviously, I work closely with devolved colleagues to try to ensure a consistent service across the country.

I have listened very carefully to the contributions and pay tribute to everyone for their courage in sharing their stories. Before this debate, I was pleased to meet my hon. Friend the Member for Stafford to talk about the issues she has raised and to share with her the many pieces of work that the Government are already starting, after they were shared by women across the call for evidence on the women’s health strategy and by meeting many women across the country to discuss maternity services. We clearly need to do much more in this space, but I will also share some of the progress we are making.

I salute the work of the newly established all-party parliamentary group on birth trauma, chaired by my hon. Friend, which is showcasing an issue that very few people like to talk about. She discussed breaking the taboo, because even women who have been through birth trauma are often very reluctant to talk about this difficult subject, but the issue affects thousands of women. We can see from the response in the Gallery how important it is that we break the taboo and talk about these issues, both to prevent birth trauma and to manage the consequences when it happens.

I commend the work of charities such as the Birth Trauma Association and the many campaigners who are here today. It is important that we highlight this issue, because many women going through pregnancy do not realise some of the choices that are available to try to prevent birth trauma in the first place.

Birth trauma and injury take a toll on women, both physically and mentally, and greater awareness from the public and healthcare professionals is crucial to preventing birth trauma and mitigating its impact on women’s lives. We have heard a number of examples of compassionate care, which is essential both in reducing and preventing injury and in helping women and their families to cope with the impact of injury when it happens.

[Hannah Bardell (Livingston) (SNP)]

I am sorry that I was not able to be here for the speeches, but will the Minister join me in commending health practitioners such as Stephanie Milne, who runs Physio Village in my Livingston constituency? She does mummy MOTs, and she talks a lot about birth trauma and how her work supports women who have been through birth trauma. Does the Minister agree that the NHS can do more to help women through such post-natal healthcare support?

[Maria Caulfield]

I absolutely pay tribute to them. We have heard some great examples of work happening around the country, but the point has also been made that it is not consistently available to everyone. Those examples show why compassionate care is a key part of the work we are taking forward, particularly in relation to Bill Kirkup’s report on maternity and neonatal services in east Kent, which was published last year. Dr Kirkup rightly emphasised the need for compassionate care and a change in culture as well as a change in practice for women throughout their pregnancy, labour and post-natal period.

Compassion, kindness and understanding all require women and their families to be treated as individuals and to be heard. That is something we heard strongly in our call for evidence on the women’s health strategy, to which we had over 100,000 responses. That is why birth trauma is mentioned in the strategy, and I will talk about that further.

As part of this, we have to recognise that the PTSD, psychological trauma or depression that a mother may experience also have to be supported. Just delivering a safe birth is not enough. Wearing my other hat as the mental health Minister, it is why new mums are a high-risk group in the suicide prevention strategy. It is a shocking statistic that the leading cause of death in new mums is suicide, but it is a very vulnerable time in a woman’s life. They are often isolated from work colleagues if they are on maternity leave and, if they are a first-time mum, they will not have a support network of other mums. We hear all over the place on social media what a wonderful time it should be in a mother’s life, that they should be blooming with a new child, but the reality can be very different. We have heard that today, whether it is issues around breastfeeding, not sleeping or just feeling isolated. On top of that, birth trauma can cause difficulties in not being able to drive and with being in pain—there is a whole raft of issues.

Through the work we are doing on maternity and focusing on new mums as a high-risk priority group in mental health, we are trying to drive forward changes to support women better.

I am pleased to have the opportunity to update the House on the wider progress we are making to improve outcomes in pregnancy. I fully understand the importance of preventing perineal trauma during childbirth. We have to be honest that we cannot always prevent it. I am not a midwife, but there are risk factors such as a larger baby, a smaller cervix or a long birth that mean trauma and injury will sometimes happen. There is no doubt that we need to do more to reduce the incidence of perineal trauma but, if it happens, we need to manage it in a much better way.

That is why I am pleased that NHS England has this week published a national service specification for perinatal pelvic health services, which it aims to roll out across England by March 2024 in order to end the postcode lottery of services. The specification states that the services will work with maternity units across England to implement the obstetric anal sphincter injury care bundle developed by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives.

As my hon. Friend the Member for Stafford said, getting the specification rolled out across the country is an early success for the APPG. I am confident that this new guidance, which will be implemented across maternity units, will reduce the rate of anal sphincter injuries resulting from labour and vaginal births and help to manage such injuries in a much better way when they happen.

The introduction of these services will broaden the core service offer of pelvic health beyond the existing NICE and RCOG guidelines on care for obstetric anal sphincter injuries. The services will make sure that all pregnant women get the advice and support they need to prevent and identify pelvic health problems, and that those who do have problems are offered conservative treatment options before surgery is considered, in line with NICE guidelines.

We all know the crucial role that midwives play in recognising women who are suffering perinatal mental illness, including by taking a trauma-informed approach to care. To support this, NHS England is refreshing its core competency framework for perinatal mental health. The shadow Minister touched on this, and I reassure her that, by the early part of next year, every integrated care system in England—I cannot comment on what is happening in Labour-run Wales—will have a fully working maternal mental health service to support mothers experiencing moderate, severe or complex mental health difficulties.

It is true that the number of women accessing perinatal mental health services has risen by almost 50% over two years, but that is good news because we want women to come forward. The challenge for the Government in England is being able to meet that demand. For too long, women have suffered in silence and isolation. When they come forward, we need to have the services to support them. This demonstrates that mental health services are more important than ever before.

A number of colleagues have identified the issue of inequalities in maternity care, and we know that some women, particularly Asian, black and working-class women, are experiencing poorer mental health and poorer outcomes in maternity across the board. That is why we continue to fight to introduce NHS equity and equality action plans across the country. I am proud of the progress we are making on developing resources, and I pay particular tribute to the maternity disparities taskforce, which is working with organisations to deliver this as quickly as possible.

A number of issues were raised in the debate and, touching on birth trauma in the women’s health strategy, we will fairly soon be updating our year 2 strategy and setting out our priorities. I will let Members know about that as soon as possible.

There is a lot we could talk about in this space, and I pay tribute once again to my hon. Friend the Member for Stafford and all colleagues who have shared their experience. I reiterate that this is a priority for the Government. We are seeing change, but more change needs to happen.

Hormone Pregnancy Tests

Debate between Hannah Bardell and Maria Caulfield

Thursday 7th September 2023 Commons Chamber

[Maria Caulfield]

I hear my right hon. Friend and, as I said, I will come on to that specifically towards the end of my remarks.

There were further evidence reviews. Hon. Members have touched on the evidence from Heneghan et al., and from Brown et al. in 2018. Those were looked at, and again there was no evidence of causality found in those reviews.

[Hannah Bardell]

Will the Minister give way?

[Maria Caulfield]

I will, but I need to make some progress on addressing the points made.

[Hannah Bardell]

Causality is one of the key issues here, because it is very difficult to prove. The only way it can be proven is if those tests were done on pregnant women, and we all know that would be utterly ridiculous and absurd. However, we do know that there was association, and the bar has been set so high that it has become impossible for people to get justice. That responsibility lies at the door of the Government. Thalidomide campaigners were able to settle with the company. We need to look at how we can make that happen for Primodos campaigners, but the Government also need to look at lowering the bar.

[Maria Caulfield]

I take the hon. Lady’s point that causality is a high bar. I am just going through the fact that there have been a number of reviews of the evidence so far. Baroness Cumberlege, when she set out the remit for her review, also stated from the outset that she would not be able to touch on causality for many of those reasons. There have been a number of reviews of the evidence, but I hear from right hon. and hon. Members some concerns that those reviews still have not got to the bottom of the issues that the families and those affected by Primodos feel that they have faced.

On the next steps, I have heard hon. Members. I heard my right hon. Friend the Member for Chipping Barnet (Theresa Villiers), who was clear about the drug being taken even after evidence had emerged. I heard from my hon. Friend the Member for Stourbridge (Suzanne Webb) about the effect on her constituent Helen and her family. I heard from my right hon. Friend the Member for North East Somerset (Sir Jacob Rees-Mogg) about his experience in Government and why these things often take so long. And, of course, I heard my right hon. Friend the Member for Maidenhead (Mrs May), who set up the Cumberlege review in the first place. My hon. Friend the Member for Leigh (James Grundy) has lobbied me hard outside this place on behalf of his constituent Marie Lyon and the many others who have been affected.

Now that we are in between the first and—potentially—second court cases, I am keen to meet and get to the bottom of right hon. and hon. Members’ concerns.

--- Later in debate ---

[Maria Caulfield]

Finger pointing is not exactly effective. As I set out at the beginning of my remarks, we have accepted the majority of those recommendations. We could not accept the Primodos ones while there was an ongoing court case. I have given my commitment from the Dispatch Box to review the outstanding recommendations in relation to Primodos, because I want to get to the bottom of this once and for all and provide justice for the families. I have heard from Members across the House about their concerns and the outstanding recommendations of the Cumberlege review, and my commitment is to look at those now.

[Hannah Bardell]

It seems to me that we are caught up in a quagmire of bureaucracy. We have had the Cumberlege review. We know what the results are. The Government said incessantly that they would not address the Primodos matter because of the court case. We now know that the court case was, in some respects, flawed, because the complainants and victims were not able to take their case forward as their information was withheld by the legal firm. As the right hon. Member for Kingston and Surbiton (Ed Davey) said, they are now being treated in a hostile manner by the Government by being told that they will be sued for over £10 million if they take another case forward. That is an utterly preposterous situation. If the Minister really wants to get to the bottom of it, she needs to implement fully the Cumberlege review and ignore the nonsense that has gone on in the courts.

[Maria Caulfield]

I do not want to test your patience, Mr Deputy Speaker, because I know that I am over time, but I have made the commitment to review the Cumberlege recommendations for Primodos patients. For those who have been affected by sodium valproate and mesh, we are making huge progress. Only this week, we introduced a statutory instrument so that sodium valproate can only be dispensed in the manufacturer’s original packaging. We have the pregnancy prevention programme, which is drastically reducing the number of babies born to those taking sodium valproate. We are installing the registry, so that women on sodium valproate are better cared for and not taking that medication. Now that 11 August has passed and the claim was not followed up, I am looking at the Primodos recommendations as well. My commitment is to come back to the House and update Members on the progress on those matters.

Oral Answers to Questions

Debate between Hannah Bardell and Maria Caulfield

Wednesday 12th July 2023 Commons Chamber

[Maria Caulfield]

I reassure the hon. Lady that work is going on in that space. My ministerial colleagues from the Department for Work and Pensions are looking at this, and will be updating the House shortly.

[Hannah Bardell (Livingston) (SNP)]

6. What steps the Government is taking to help tackle (a) gender and (b) racial inequality in the workplace.

Oral Answers to Questions

Debate between Hannah Bardell and Maria Caulfield

Tuesday 1st November 2022 Commons Chamber

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

I thank my hon. Friend for his suggestion. We are committed to boosting the mental health workforce, and I am happy to meet him to discuss his suggestions.

[Hannah Bardell (Livingston) (SNP)]

My constituent Wilma Ord and her daughter Kirsteen are victims of the Primodos hormone pregnancy drug. Will the Minister update me on where the Government are in getting justice and compensation for the affected families? Many people have died. Will she meet me and other families and representatives from the campaign group to get justice for these families? They have waited far too long.

Cumberlege Report

Debate between Hannah Bardell and Maria Caulfield

Thursday 3rd February 2022 Westminster Hall

[Maria Caulfield]

Valproate should not be being used on women or girls able to have children, unless they have a pregnancy prevention programme in place. That is to ensure that patients are fully aware, if they need to take sodium valproate, of the effect on any potential pregnancy. The NHS also commissioned the paediatric neurosciences clinical reference group to support the development of pathways for care services, specifically to improve patient support and co-ordination on the pathway for sodium valproate.

Mechanisms are therefore being set up for those women and girls who need to take sodium valproate. I think my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) pointed out that, in other settings, a huge amount of work is done to ensure that those women do not get pregnant. Also, a multidisciplinary expert group with experience in responding to exposure has been established. It will report its recommendations to NHS England in March this year. We will follow up on those recommendations, but a piece of work is being done specifically on sodium valproate, which will help to prevent such problems in the future.

Recommendation 6 was on MHRA reform. The review highlighted the need for the regulatory agency to undergo substantial revision, in particular on adverse event reporting and patient engagement. As many Members said, instances were flagged many times by many different people—the women themselves, MPs in this place, charities and other bodies—but people did not listen, although the MHRA has a duty to do so.

The MHRA has now initiated a substantial programme of work to improve how it listens and responds to patients and the public, developing a much more responsive system for adverse event reporting and supporting timely and robust decisions involving patient safety. It has been consulting on a new regime for medical devices that makes patient safety, engagement and transparency more prominent.

To strengthen its commitment to patient engagement, the MHRA recently established an enhanced customer service centre to make it easier for patients to express concerns, whether about medicine or devices that are being used. The MHRA has also appointed a chief safety officer, Dr Alison Cave, who will lead its ongoing commitment to the recommendations.

On setting up a database to collect details of all implantations of devices, which is recommendation 7, we have already legislated for that through the Medicines and Medical Devices Act 2021. The Act created a power for the Secretary of State to regulate for the establishment of a UK-wide medical device information system. Alongside developing those regulations, more than £11 million has been set aside for the work, involving partners across the healthcare system to scope, test and cost options for that workstream.

On transparency for payments, which I think was raised by the hon. Member for Chesham and Amersham (Sarah Green), who spoke about the conflicts of interest between doctors and pharmaceutical companies or providers of surgical mesh, recommendation 8a highlights the need for greater transparency for payments made to doctors. The recommendation calls for a register of doctors’ interests and for recognised and accredited specialisms to be held by the General Medical Council.

As the Government set out in our response to the review, we agree that lists of doctors’ interests should be publicly available. We continue to hold the view that that information will be most accessible to patients if it is published by healthcare providers rather than by the GMC. We are taking that measure forward and it should be in place by July this year.

We are also working with professional healthcare regulators to be clear that all regulated health professionals—not just doctors—must declare their interests, and that that information must be published by their employers. That approach will give not just women but all patients the reassurance that there are no interests involved in clinical decisions made about their care. We are working with the Care Quality Commission and equivalent organisations, and with the devolved Administrations, to ensure that implementation is monitored and that there is local accountability.

Recommendation 8b touches on the mandatory reporting of the industry. It calls for the pharmaceutical and medical devices industries to establish payments made to teaching hospitals, research institutions and individual clinicians. On 24 January this year—just a few days ago—an amendment to the Health and Care Bill was tabled to give the Government the power to deliver on that important recommendation. That legislation will, I hope, come into law fairly soon. The amendment will enable the Secretary of State to make regulations requiring companies to report information about their payments to the healthcare sector. That measure will benefit patients, who will see payments made to their doctors or hospitals, and it will build on proactive initiatives by healthcare regulators and the industry.

I very much take on board Members’ feeling that it took too long to acknowledge the problems that those women have faced, whether because of mesh implants, sodium valproate or Primodos. Although this may not be of any reassurance for women who have already been affected, we now have measures in place to flag problems in the system. For maternity care and clinical negligence, for example, we have an early notification system so patterns of events around neonatal care and foetal abnormalities are picked up at an earlier stage, to get on top of the causes quickly. We are seeing improvements in maternal and neonatal outcomes as a result of that early warning notification system

We very much recognise that such problems did happen in the past, but measures are being put in place to make sure that they do not happen in the future. I certainly want to make sure that the women affected are getting the care and support that they need. I very much take on board the points raised by hon. Members. I am very happy to keep Members updated on progress. I meet Baroness Cumberlege regularly to address the issues raised in her report.

I reassure colleagues that many of these issues will feature in the women’s health strategy, which we will publish shortly. The women’s health ambassador, the patient safety commissioner and I will be working hand in glove to make sure that women’s voices are heard in relation to their healthcare, and that we end the pattern of women feeling that they are not being listened to, that they are palmed off, and that their concerns are not taken seriously.

[Hannah Bardell]

Does the Minister recognise that this is not only about compensation, but about exposing the failures so that they never happen again? Eighteen members of the Primodos support group have died in the past two years. That gives an idea of just how long people have waited. They should not have to wait any longer. Those who have died will never see justice.

[Maria Caulfield]

I absolutely take that point—that is the crux of the matter. For too long in the health service, there was no duty of candour. The health service did not acknowledge when mistakes were made. That is changing; there is now a duty to declare when a mistake has happened. There is also support for staff. I cannot remember who mentioned the whistleblower on Primodos, but there is protection for whistleblowers now. There are freedom to speak up guardians to support whistleblowers in the workplace, and the Care Quality Commission is happy to take notification from patients and staff if there are worries about unsafe patient care. That will trigger an unannounced inspection to look at the data. It is all about creating a culture of learning in the NHS, rather than one of blame that pits patients against clinicians—that is what we want to change. That is how we learn from the mistakes of the past and prevent mistakes in the future.