Women’s Health

Jess Brown-Fuller Excerpts

Thursday 27th February 2025 Westminster Hall

[Jess Brown-Fuller (Chichester) (LD)]

It is lovely to see you in the Chair, Dr Huq, and I welcome the Minister to her place. I thank the hon. Member for Hastings and Rye (Helena Dollimore) for securing this important and timely debate, and for giving a passionate and well-informed opening speech.

Women’s health has been overlooked for far too long, and today’s discussion is an opportunity to highlight the urgent action needed to address the crisis in women’s health, with International Women’s Day due to be celebrated next week. The Fawcett Society found that nearly two thirds of women in the UK believe that their health concerns are not taken seriously, and more than half have had negative experiences with healthcare professionals. I start this speech feeling very frustrated, because during the debate I have had a message from one of my good friends who was ignored two years ago when she had pain in her leg, and she has just texted to tell me that she will now have to undergo a course of chemotherapy and extremely evasive treatment so that she can retain her ability to walk. My friend is in her early 20s—she was ignored, so I am very cross.

This is not just a health issue; it is an economic issue, as has been mentioned. The UK loses 150 million working days every year due to women’s poor health and inadequate support. If we want a healthier, more productive society, we must take action to close the gender gap in healthcare. During a drop-in surgery that I ran in my Chichester constituency, a woman told me that when her daughter started experiencing extremely painful periods, with pain outside of her period, all she could do was cry at the thought of her having to go through the same painful process with healthcare professionals that she had been through herself to get a diagnosis for endometriosis, which took that lady nine years.

Gynaecological waiting lists have more than doubled since 2020, which is the biggest increase of any medical speciality. At the end of last year, 755,000 women were waiting for treatment. Behind every number is a woman experiencing chronic pain, worsening mental health and a disrupted daily life. One in four women with a gynaecological condition will end up in A&E because they could not access the care that they needed in time, yet the NHS is failing to prioritise these urgent needs. The Royal College of Obstetricians and Gynaecologists has been clear: the system needs a complete overhaul so that gynaecological care is given the attention it deserves.

An example is St Richard’s hospital in my constituency, which does not have a specific gynaecological ward. That means that women who have gynaecological issues or have received treatment are placed across several other wards. That could negatively impact their treatment as it makes it more difficult for them to receive urgent specialised support in emergencies. Also, as the hon. Member for Luton North (Sarah Owen) said, clinicians do not have to do gynaecological training as part of their mandatory training.

Delays in female cancer care are alarming. Between April 2021 and March 2024, 2,980 people waited over 104 days to start treatment on the 62-day urgent suspected breast cancer referral route. My hon. Friend the Member for Bath (Wera Hobhouse) noted that younger women have a much worse prognosis, due to a lack of breast cancer screening before they are 50. For ovarian cancer, the average wait from GP referral to treatment is 69 days. That is one of the longest delays for any cancer. These prolonged waits are not just unacceptable—they have life-altering consequences.

For generations, women’s pain, particularly in maternity care, has been dismissed. That has created a crisis of confidence in NHS maternity services. Several investigations have revealed fundamental flaws in our maternity care and how it is delivered across England. A Care Quality Commission inspection of 131 maternity units found that 65% of them were not safe for a woman to give birth in, and studies show that one fifth of all causes of stillbirth are potentially preventable.

The CQC has also warned of a normalisation of serious harm in maternity care. That cannot continue. I held a debate on maternity services earlier this week, calling for the Government to fully implement the recommendations of the Ockenden report. That is urgently needed to reform the maternity care sector for the better.

In 2024, the Patient Safety Commissioner estimated that 10,000 women in England had experienced harm as a result of vaginal mesh implants, although campaigning groups argue that the true figure could actually be closer to 40,000. One woman in my constituency asked me to go to her home because she does not leave it; she is a victim of the mesh scandal and she is totally isolated from her community because of it.

I am a member of the First Do No Harm APPG, which builds support and raises awareness of the recommendations of the 2020 Independent Medicines and Medical Devices Safety Review, and I was really glad to hear the contribution from the hon. Member for Washington and Gateshead South (Mrs Hodgson), who talked about the women living in poverty, isolation and pain, who are so often dismissed by the professionals. The review found that those suffering adverse effects from medical treatments including vaginal mesh found a system that was

“disjointed, siloed, unresponsive and defensive.”

So many of those women are still waiting for compensation. It is a national scandal and a grave injustice. I appreciate all the work that the hon. Member is doing with the APPG.

The Liberal Democrats would ensure that medical scandals that have disproportionately harmed women in the past can never be repeated, including through the introduction of a statutory duty of candour for public officials. We believe that every woman deserves high-quality, safe and accessible healthcare. We would try to tackle the maternity care crisis by addressing chronic understaffing, improving retention and modernising outdated facilities. We will continue to press the Government to expand access to screening for conditions such as breast cancer and cervical cancer. We would also make a serious commitment to investing in women’s health research.

For too long, the gender gap in medical knowledge has left women without the answers or the treatments that they need. Faster diagnoses and better treatment pathways for women’s cancers and gynaecological conditions must be a priority for this Government, not an afterthought, because this is not just about healthcare; it is about basic dignity, fairness and justice. Women should not have to fight to be heard when it comes to their own bodies. It is time to put women’s health front and centre of the NHS.

Maternity Services

Jess Brown-Fuller Excerpts

Tuesday 25th February 2025 Westminster Hall

[Jess Brown-Fuller (Chichester) (LD)]

I beg to move,

That this House has considered maternity services.

It is an honour to serve under your chairmanship, Sir Christopher. I thank all the Members in attendance for their interest in this important topic and the Backbench Business Committee for allocating time to debate maternity services in England.

On average, a baby is born in England every 56 seconds, over 1,500 babies each day, most of them delivered in an NHS setting with the help and support of a maternity department or at home with an NHS community midwife by their side. That is over 500,000 babies every year. I contributed to that statistic in 2014 and 2019 when I gave birth to my children at St Richard’s hospital in Chichester. Two very different births that I will not spend my valuable time in this debate reflecting on, because there are far more important voices that need to be heard and considered. A person is at their most vulnerable moment when they or their partner go into labour. We put our health, safety, and the safety of our unborn child into the hands of professionals who work in that setting—the midwives, obstetricians, anaesthetists, and neonatologists—to support us in the safe delivery of our child and get us all home safe. And in the majority of births that is the case.

However, several investigations have revealed fundamental flaws in how maternity care is delivered across England. A Care Quality Commission inspection of 131 maternity units found that 65% were not safe for women to give birth in, with studies showing that one fifth of all causes of stillbirth are potentially preventable. The Ockenden report, led by Donna Ockenden, investigated the maternity services at the Shrewsbury and Telford Hospital NHS Trust, but it also highlighted the flaws in maternity care across England. The report laid out immediate and essential actions which are key to reforming maternity services and ensuring that every mother and baby receive the care they deserve and should expect. In her report Donna reflected that sometimes that spotlight can feel harsh to staff on the front line, who are doing their very best in what are often extremely challenging circumstances.

In conversation with midwives and others working in the maternity care sector, I recognise that each one I spoke to entered the profession as a the result of a calling, vocation, or passion for supporting mothers to bring their babies into the world. They are frontline NHS staff who often go above and beyond the call of duty to support and care for their patients in those extraordinary hours and days. Midwives in particular spend significant time with expectant mothers, supporting them through all stages of pregnancy and birth. They see women at their most vulnerable. They act as therapists, teachers, friends and maternal figures. Yet across the country, staffing levels are inadequate. In 2023, midwives and support workers worked over 100,000 hours of unpaid overtime every week. The pressure and stress on them is immense and this leads to burnout, absenteeism, high staff turnover and the loss of experienced professionals from the field, and that ultimately puts patient safety at risk.

[Jeremy Hunt (Godalming and Ash) (Con)]

I congratulate the hon. Lady on bringing forward this debate and the excellent and persuasive way that she is making her case. On burnout, does she agree that one of the biggest issues is that when a tragedy happens, midwives and obstetricians often feel that if they speak out the risk is that they or their institution will get sued, or that they could get fired from their jobs? Does she agree that litigation reform to try and change the rules of the game, so that people are able to be open when they think they have made a mistake and learn from those mistakes, is one of the most important ways that we could improve the record on patient safety, which is as much a concern to her as it is to me?

[Jess Brown-Fuller]

I agree wholeheartedly that we need to change the way that we do litigation, because NHS trusts often argue that they want to learn and grow from poor experiences, but the litigation system means that they rarely have the opportunity to do so, because everybody is so afraid to speak out. We need to change that culture within maternity services and the NHS as a whole.

As a country, we are training more midwives than ever before, yet retention remains a problem and the pandemic exacerbated an already difficult situation, with highly trained midwives with families or caring responsibilities leaving the profession too soon.

[Dr Al Pinkerton (Surrey Heath) (LD)]

I congratulate my hon. Friend on bringing this debate here today. Frimley Park hospital in my constituency received an outstanding report from the Care Quality Commission in 2023, but it none the less identified that inadequate staffing remains one of the highest risks on the maternity register. That has daily implications; many midwives reported, for example, that daily checks were often incomplete, handovers were interrupted and not standardised, and mandatory training was often not completed.

Does my hon. Friend agree that to ensure high-quality maternity care, from admission to discharge, requires not only stringent oversight by trust boards, but far greater care for staff in the setting of the hospital, providing safe spaces where conversations can be had, handovers can take place, and nurses can rest? In that way, we will both retain and also hopefully recruit more of our vital nursing staff.

[Jess Brown-Fuller]

My hon. Friend is absolutely right; the key to providing strong maternity services that benefit both the staff and the patients is making sure that there is a full workforce so that they can do not just the “need to haves”, but the “nice to haves” in a maternity department, which can make such a difference to patients’ experiences when they are going through that service.

The retention issue that we have directly impacts training. Newly qualified and inexperienced midwives need experienced mentors, but if seasoned professionals leave, the next generation lacks the support necessary to transition into leadership roles. Midwives and other maternity staff must train together at every level to be fully equipped for every situation, and ensure that concerns can be escalated effectively. That is why the Ockenden report and the Royal College of Midwives seek a commitment to including midwives in the long-term workforce plan.

In 2017, bursaries for student nurses and midwives were ended, with the Royal College of Midwives warning that that decision threatened the future of our maternity services in England. It has led to one third of midwifery students having debts exceeding £40,000, with 80% of them knowing someone who has dropped out of their course due to financial hardship. Many also take on additional jobs to afford their studies, which detracts from their vital training. To mitigate those pressures on trainee midwives, I encourage the Government to explore alternative routes to support midwifery and nursing students, which have been laid out by the Royal College of Midwives, through new funding options or a scheme where student debt is forgiven after a defined period of service in the NHS.

A similar funding issue affects apprenticeship schemes in midwifery. Despite receiving overwhelmingly positive feedback from trusts across the country regarding the apprenticeship route, many trusts cannot afford to offer those positions due to a lack of backfill funds, so trusts often hand back their apprenticeship levy, as the scheme is undeliverable. I hope the Minister will work with her colleagues in the Department for Education to address this fundamental flaw in the delivery of level 6 and level 7 apprenticeships, which have proven to deliver the midwives of the future.

In preparing for today’s debate, I was invited to my local maternity unit at St Richard’s hospital in Chichester, where as I mentioned I had both of my children. University Hospitals Sussex had its maternity services inspected by the CQC in September 2021, which found all hospitals across the trust to be inadequate or requiring improvement. Although there has not been a formal inspection since, the trust assures me that all actions from the CQC have been completed, with the majority of the Ockenden immediate and essential actions implemented. However, to fully implement all the IEAs will require funding, which currently the trust does not have.

St Richard’s hospital confidently tells me that it is now fully staffed for the first time in a long time, and the director of maternity services is keen to look at how she can further improve patient experience and communication. I know Members across the House are keen to work with their NHS trusts constructively to ensure the best outcomes possible for their constituents. I was reassured by the senior leadership team, those working in the department, and the new parents on the ward, who I had the pleasure of congratulating. Introducing tiny babies to the world was probably the best moment of my recess—it was very bizarre for those parents when the MP walked in and said, “Can I say hello?” I am pleased that the trust is taking seriously its responsibility to provide a much improved service.

It would be a missed opportunity if I, as the chair of the all-party parliamentary group for infant feeding, did not mention how we could do much more as a society to support mothers to breastfeed, if they choose to. The UK’s breastfeeding rates are among the lowest in the world. Only 1% of mothers exclusively breastfeed at six months, despite the World Health Organisation recommending exclusive breastfeeding for this period and continuation, alongside nutritious foods, for up to two years. Some 44% of mothers surveyed wished that they had breastfed for longer and would have done so if they had received better and more tailored support. New mothers need time, expertise and evidence-based information to make informed decisions on their feeding choices, and maternity services play a key role in establishing a feeding plan that works for mother and baby before they go home. But, across the country, community midwifery and health visiting services have been vaporised, so support is patchy and often delivered by volunteers or midwives in their spare time. I hope that the Government will support improved community services such as milk support groups, to give all women, regardless of their feeding choices, somewhere to turn when they need support.

I will take this opportunity, perhaps selfishly, to get on record the name of one of the coolest kids I ever met. Benedict Henry Goodfellow was an absolute dude—[Interruption.] I am not going to cry—and I am proud to call his mum, Steph, one of my close friends and the strongest woman I know. This debate is so important to me because Bendy needed 24-hour care since birth after a case of extreme birth trauma left him with devastating neurological damage. Bendy was loved by everyone who came into contact with him until he died, aged 10. The experience left Steph traumatised and profoundly changed. Bendy was born nearly 30 years ago and yet Steph and Ben’s story is just as relevant today. It should not be.

I am immensely grateful to Donna Ockenden for putting me in touch with families from across the country—including from Leeds, Nottingham, Shrewsbury and Sussex—ahead of this debate to hear their personal experiences of failures in maternity care.

[Katie White (Leeds North West) (Lab)]

As I am the Member for Leeds North West, the hon. Member may have spoken to my constituents, Dan and Fiona, who tragically lost their baby Aliona after only 27 minutes. Despite the fact that the inquest found a number of gross failings, the figures for Leeds, which came out only last night, are horrifying. Does the hon. Member agree that there are grounds for an independent review of maternity services in Leeds?

[Jess Brown-Fuller]

The hon. Member is absolutely right to raise the case of Dan and Fiona. I was lucky enough to have them give up their time to share their heartbreaking story with me. They are at the forefront of the fight for an independent inquiry in Leeds. The Secretary of State for Health and Social Care said that he would look at whether there is cause for an investigation but those families are still waiting to find out if that will go ahead.

I met with families like Dan and Fiona to ensure that the questions I ask the Minister today are the questions that those families would ask if they had the opportunity. I cannot begin to imagine how exhausting it is to relive the moments that their lives changed forever, over and over again, in the pursuit of better outcomes for the next family. I will include a number of their questions to the Minister in my closing remarks, but I reflect that the families who were able to share their experiences with me were, overwhelmingly, white, middle class, often highly educated and that many had medical backgrounds or academic careers before going through this trauma. Lord Darzi’s report found that black women are almost three times as likely to die in childbirth as white women and that neonatal mortality in the most deprived areas is more than double that in the least deprived. Who speaks up for those families? Who ensures transparency and accountability for those with a fundamental distrust of the medical profession, or those who have learning disabilities, or English as their second language, because those people are not supported in navigating the complex systems that are in place?

Negligence claims in obstetrics account for just 13% of the volume of litigation received by NHS Resolution in 2023-24 but cost over £1 billion every year—nearly 60% of the total cost of clinical negligence claims. Beyond financial costs, those failures carry a devastating human toll. If we truly invest in our maternity services, in both professionals and facilities, more than money is saved; lives are saved.

In conclusion, I would like to ask the following questions of the Minister. First, the previous Government were supportive of the Ockenden review, and previous health Ministers had made assurances that maternity services were going to get the support they desperately needed. I know the Secretary of State for Health is supportive of the Ockenden review and has met many bereaved parents since the general election. He has assured those parents that fixing maternity is a priority for the Government, and that actions would be outlined publicly before Christmas 2024. He came back shortly after Christmas saying they needed more time. That response is now two months overdue. Can the Minister assure me that those families will hear an update in the near future?

Do the Government support all the Ockenden report’s immediate and essential actions arising from the review into the Shrewsbury and Telford trust? How will the Government ensure that all integrated care boards and trusts across the UK implement all the actions? What support will be provided to the trusts to achieve that, and prevent a postcode lottery of maternity care?

If those IEAs are implemented, what will be the Government’s measure of success? We currently have no national data regarding preventable deaths. It is the charitable sector that has determined that more than 800 baby deaths a year could have been prevented. One of the IEAs is a long-term plan to secure a safe maternity workforce and improve training. Can we expect to see maternity care professionals, including neonatologists, obstetricians and anaesthetists, included alongside midwifery colleagues in the refresh of the 10-year workforce plan for the NHS?

An overriding theme in my conversations with bereaved parents was the CQC’s hesitancy to prosecute. Cases were often supported in the first instance, but families were then informed, just days before the three-year statute of limitations expired, that the CQC would no longer be seeking a prosecution, with the families having no time to appeal that decision. Does the Minister believe that a three-year statute of limitations is appropriate when families dealing with bereavement are often not even considering a case in the first 12 months?

Does the Minister have any concerns about the CQC’s ability as a regulator? Or does she agree with the parents that there is a reluctance to prosecute by the leadership of CQC when there have been failures in patient care? Does the Minister support calls from Sands and Tommy’s charities for all triage phonelines to be recorded, as currently they are not?

Finally, parents repeatedly reported to me that the bereavement care they received felt like a tick-box exercise, with a lot of focus on the mother and a lack of communication and support for the father, when both have suffered that bereavement. Does the Minister agree that communication could be vastly improved across maternity services in all cases, so that both parents have the opportunity to understand what happened in those most vulnerable hours?

I would like to finish by thanking every Member who has come to talk about this important issue. I also thank Donna Ockenden and all who contributed to the creation of the review. My greatest thanks go to all the families who gave up their time to share their stories with me, reminding me that those babies were people, not statistics. They are loved, they are missed, and they deserved better.

--- Later in debate ---

[Jess Brown-Fuller]

I thank all Members from across the House for their constructive approach to the debate. It is clearly an area where there is passion in all parts of the House. I thank the Minister for her replies to the questions, and I am sure that a lot of Members will be writing follow-up letters to Baroness Merron asking for further detail on particular areas. I will forgive the Minister for her “crack on and deliver” pun.

The Minister mentioned that lessons are learned from every tragic event. I will finish by saying that the parents I spoke to did not feel like lessons were being learned from their tragic events, because nobody was asking them what had happened. If just one thing comes out of this debate, let us send this message to all NHS trusts and ICBs: “When there are tragic events, please don’t cover them up. Please contact the parents, because they want to talk to you and they want to make it better for parents in the future and the babies that we lost too soon.”

Question put and agreed to.

Resolved,

That this House has considered maternity services.

National Cancer Plan

Jess Brown-Fuller Excerpts

Tuesday 4th February 2025 Commons Chamber

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

[Jess Brown-Fuller (Chichester) (LD)]

Nearly every family has a cancer story, whether it is a personal fight or that of a loved one. A 10-year plan from the Government is a welcome step, as the previous Government broke their promise to implement a 10-year cancer strategy that would have made a real difference to patients. We on the Liberal Democrat Benches are very proud that our cancer campaigner, my hon. Friend the Member for Wokingham (Clive Jones), secured from the Government a commitment to introduce such a plan.

Testing for cancer, diagnosing and starting treatment quickly reduces stress and anxiety. Also, if the cancer is caught early, it is more likely to be treated successfully. Yet the target of 85% of people receiving their diagnosis and starting treatment within 62 days of an urgent referral has not been met since December 2015. In my constituency, one third of cases fall short of that target and 1,000 families lose a loved one every year to this cruel disease.

Lord Darzi’s review laid out very clearly that the UK has appreciably higher cancer mortality rates than other countries and that more than 30% of patients are waiting longer than 31 days for radical radiotherapy. A quarter of England’s 280 radiotherapy machines are now operating beyond their recommended 10-year lifespan, and in some areas, such as West Sussex, there is no access to radiotherapy at all. That is why we welcomed the £70 million investment announced in October to start to replace the older radiotherapy machines.

Will the Minister confirm whether there will be further rounds of funding to keep pace with available radiotherapy technology? Will he look to support those at the mercy of a postcode lottery by ensuring that radiotherapy is available in all areas? What is the expected timeline for reversing the damage done by the previous Government, and when can all patients expect to start their treatment within the 62-day urgent referral target?

[Andrew Gwynne]

One reason we think a national cancer plan is so important is precisely to get the investment in the areas we need so that we can tackle those health inequalities. There are very real inequalities when it comes to the diagnosis of cancer and, more importantly, the treatment and therefore the outcomes. I am really keen that we focus on that in the plan, to ensure that all parts of the country achieve the best outcomes for people who have been diagnosed with cancer.

Part of the plan is the roll-out of community diagnostic centres so that we can get diagnosis much earlier. That then puts greater pressure on getting people through the front door for treatment, so that is why, as part of the recovery plan that the Prime Minister and the Health Secretary announced, we are seeking to get more people treated more quickly on those treatment pathways. Hopefully, that will get the desired outcomes we want. It is a commitment that we will seek to restore the national health service to its constitutional standards. That is a priority of this Government.

On radiotherapy machines, the £70 million investment will fund about 25 or so machines. The criteria for evaluating bids are the age of the machine, the proportion of machines aged over seven years, and the performance against the 31-day standard for radiotherapy, with poorer performers prioritised. On future rounds of funding, the cancer plan will feed into spending reviews and future Budgets. It is our priority to ensure that we reach the cancer targets, so hopefully we can make the case to the Treasury for future investment in further years.

Hospice and Palliative Care

Jess Brown-Fuller Excerpts

Monday 13th January 2025 Commons Chamber

[Jess Brown-Fuller (Chichester) (LD)]

I thank my hon. Friend the Member for Wimbledon (Mr Kohler) for securing today’s important debate, and all hon. Members for approaching the conversation with the compassion and thoughtfulness that this topic deserves.

Examples shared across the House show that hospices are a vital part of our healthcare system. They provide outstanding care for patients approaching the end of their lives, offering dignity, comfort and support to families, and they are often driven by hundreds of volunteers, alongside the paid staff. Hospices will play a key role in meeting this Government’s objective to move care from hospitals to the community. This debate is very timely, given that the front pages of the newspapers are reporting today that half a million people were left languishing on trolleys in A&E and in corridors in 2024 because there were not enough beds to admit them.

Hospices, such as the extraordinary St Wilfrid’s in my constituency of Chichester, are the cornerstone of community care. I was blown away during my recent visit to St Wilfrid’s, and I am not ashamed to admit that I was brought to tears by the accounts of the family members, patients and staff I met that day. I applaud the hon. Member for Stoke-on-Trent South (Dr Gardner) for her show of emotion, because it is an emotive topic. St Wilfrid’s provides comfort and compassion to patients and their families during life’s most challenging moments—both directly in the calm and idyllic surroundings of the hospice and out in the community, providing palliative care for 300 people in the comfort of their own homes. It is St Wilfrid’s belief that everybody should be afforded a good death, and it strives to ensure that there is beauty in every day for patients and their loved ones, yet its service is being crippled by rising costs and a lack of sufficient Government support.

Hospices are in the process of setting their upcoming budgets, and many are having to make difficult long-term decisions to cut palliative care because they lack a long-term solution to address the growing financial strain. As the hon. Member for North Herefordshire (Ellie Chowns) mentioned, it is all well and good being able to say you have a lovely car park when you do not have any nurses to park in it. Only 17% of the overall cost of St Wilfrid’s hospice is currently covered by NHS grant funding—well below the minimum requirement across the country.

One of the biggest components of hospice costs is the salary of their expert clinical and other staff. Hospices are trying to match NHS salary increases to ensure that staff can afford to stay with them, and to remain competitive. In addition, they are now burdened with paying increased national insurance contributions, whereas direct NHS providers are exempt. For St Wilfrid’s, the rise in national insurance contributions will cost an additional £210,000, which is a significant financial burden. Although we Liberal Democrats and hospices alike welcomed the capital investment announcement in December 2024, that funding does not address the challenges of day-to-day spend, so there is still a vast gulf between rising expenses and available income. As the hon. Member for Birmingham Erdington (Paulette Hamilton) said, the funding must be the start, not the end.

Hospice UK has warned that around 300 hospice in-patient beds—14% of the total—are currently closed or out of use due to a lack of funding and chronic staff shortages, meaning that fewer patients are able to access the end of life care that they need at one of the most vulnerable times in their lives.

My hon. Friend the Member for Twickenham (Munira Wilson) mentioned the Marie Curie report, as did other Members across the House, which stated that one in four people who need hospice care cannot currently get it. The term “bed blocking” is not one I am particularly comfortable with, but if adequate palliative care is unavailable in the community or in a hospice, those people will remain stuck in hospital, and those hospitals cannot provide the expert care that a hospice can. Our hospices are ready and willing to take on those patients, but they need the support of this Government to do so.

As my hon. Friend the Member for Wimbledon (Mr Kohler), who brought forward this debate, said, people do not want to die in hospital. They want to die at home or in a specialised setting such as a hospice. That is why the Liberal Democrats are calling for hospices to be exempted from the rise in national insurance contributions. This targeted measure would provide immediate relief for a sector that is struggling under the weight of rising costs, and prevent further reductions in capacity or even closures.

We must think long term. Hospices need a sustainable funding model that guarantees they can continue their vital work of providing care for patients, supporting families and easing the pressure on the NHS. Hospices must also be a part of the conversation in the Government’s upcoming 10-year plan for the NHS, and that must include sustainable hospice funding reform. Examples from across the House today showed a shared recognition of the importance of hospice care. Now we need the Government to match that recognition with action for the patients, for the families and for a health service that depends on hospices.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

Oral Answers to Questions

Jess Brown-Fuller Excerpts

Tuesday 7th January 2025 Commons Chamber

[Andrew Gwynne]

Attempting to exploit people with addictions is reprehensible. Free drug and alcohol treatment is available in every part of the country and I urge anyone who is struggling right now to visit the NHS addiction website. The Care Quality Commission has said that it could take legal action against companies misusing its logo, and Google has said it would remove search listings from these companies. I am more than happy to meet my hon. Friend to see what more we can do to stop this outrageous activity.

[Jess Brown-Fuller (Chichester) (LD)]

Social prescribing is one of the primary care services provided for drug and alcohol addiction, and it also supports the Government’s aim of moving from cure to prevention, which is why I was shocked to hear that a primary care network in my constituency is reviewing its social prescribing offering across the Chichester district and proposing to remove it entirely. Does the Minister agree that social prescribing is a key pillar of our primary care services, and does the money used need to be ringfenced to protect that service across the country?

[Andrew Gwynne]

Social prescribing is one of the tools, and it is an important one in addressing public health concerns in each of our constituencies. This Government are committed to ensuring that we get those shifts from sickness to prevention. We will be ensuring that local areas have public health funding in reasonable time. We are about to announce, in due course, this year’s allocations. We need to make sure that local systems maximise the use of their money, and that certainly includes social prescribing.

NHS Backlog

Jess Brown-Fuller Excerpts

Monday 6th January 2025 Commons Chamber

[Jess Brown-Fuller (Chichester) (LD)]

I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for introducing this important debate on our first day back after Christmas. I also thank all hon. Members from across the House who have contributed to the debate, and specifically the hon. Members for Runnymede and Weybridge (Dr Spencer), for Ashford (Sojan Joseph) and for Bury St Edmunds and Stowmarket (Peter Prinsley), who always bring really valuable contributions because of their background and current professions; it is very much appreciated when talking about the NHS.

My hon. Friend the Member for North Shropshire highlighted in her opening remarks that backlogs are not just about NHS waiting lists, but that there are also problems with mental health backlogs, handover delays, A&E waits, poor access to dentistry, GP appointments, cancer treatment waiting times and staff that are being driven from the NHS because they cannot provide the care they want to give.

Our healthcare system remains the No. 1 issue that I am contacted about. It is not unreasonable for my constituents and people across the country to expect to receive the care they need when and where they need it. I doubt there are many people who have not been affected or know somebody who has been affected by NHS backlogs. Indeed my dad struggled for months to get a face-to-face GP appointment for what he believed was a return of a hiatus hernia. By the time he saw his GP and was referred, the oesophageal cancer that he had was so progressed that palliative care was the only option for him and he passed away shortly after being diagnosed in 2021.

When I asked my constituents to get in touch with examples of personal experiences of the NHS backlogs, I was inundated with emails from people across Chichester, and I will share some of those with the House.

I have Jane, who was at high risk of bowel cancer due to living with ulcerative colitis. She is meant to see her consultant every six months but has not had an appointment since 2019, despite her GP trying on her behalf on multiple occasions. She has no idea if the polyps discovered in 2017 have turned cancerous and is living in constant fear of her health deteriorating further.

Ian got in touch after waiting over a year to receive a scan after he experienced extreme chest pain. The scan revealed heart disease, but the lack of any follow-up appointments has left him anxious and uncertain about his health.

I will also mention a good friend of mine, Rylee, who noticed irregular bruising and a physical change on the back of their leg in 2021 and was finding it harder to walk. After visiting the GP, who sent an urgent referral to the hospital, Rylee waited for months only to discover when chasing the hospital that the referral had gone to the wrong place. They then got added to the waiting list and were told the wait would be between 40 and 50 weeks. We are four years on from the initial changes to Rylee’s leg, and they are finally being treated by leading specialists as Rylee can no longer walk unaided. Amputation of their leg is now being considered. If Rylee had been seen within the expected window of an urgent referral, they would not be facing the prospect of losing their leg in their mid-20s.

These are just a few examples of what is a much larger picture of the NHS, with caring and compassionate staff working within it who are overstretched and overburdened and, as my hon. Friend the Member for North Shropshire said, who cannot provide the care they desperately want to because of a system that cannot meet the demand.

The Liberal Democrats recognise that this is an inherited problem; indeed, the key NHS waiting times standards have not been met for some years. The number of patients waiting longer than four hours in A&E rose consistently between 2015 and 2020. The 62-day waiting time for standard cancer treatment has not been met in recent years, and the consultant-led treatment target in England of 18 weeks has not been met in 2016.

The last Conservative Government left emergency care in a deep crisis. The Darzi review stated that 800 working days were lost every day to handover delays in 2024. Last winter, ambulances across England collectively spent a total of 112 years waiting outside hospitals to hand patients over. In 2024, more than 1 million patients faced waits of more than 12 hours in A&E. The Liberal Democrats welcome new investment in the NHS, but instead of spending money firefighting crisis after crisis, we would invest to save taxpayers’ money in the long run. We would do that by investing in the front door and the back door: in primary care, with GPs and dentists, and by reforming social care.

Some of my constituents would like it noted that they will not be counted on any statistics regarding backlogs, because they cannot get a GP appointment to even get on the backlog list. That is why the Liberal Democrats are calling for everyone to have the right to see their GP within seven days, or 24 hours if it is urgent, with a 24/7 booking system to end the 8 am phone-call lottery to get an appointment. We would also ensure that everybody over the age of 70 and those with a long-term condition have access to a named GP.

We would fix the back door and address the social care crisis now, rather than spending another three years commissioning a report that will find out what we already know: social care is in urgent need of reform. The Darzi review showed that inadequate social care accounts for 13% of hospital bed occupancy, meaning that people who desperately want to get home cannot because of the lack of social care packages available and that others deteriorate at home, because they cannot access the social care they need. In the past year, more than half of all requests for social care were unsuccessful. We would strengthen our emergency services to reduce excessive handover delays by increasing the number of staffed hospital beds and calling for a qualified clinician in every A&E waiting room to ensure that any deteriorating conditions are picked up on to prevent tragic avoidable incidents.

I once again thank the hon. Friend the Member for North Shropshire for bringing forward this incredibly important debate, and I thank those Members who contributed to a conversation that matters to my constituents in Chichester and to people across the country.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Minister.

Winter Preparedness

Jess Brown-Fuller Excerpts

Wednesday 18th December 2024 Commons Chamber

[Karin Smyth]

I am very pleased to reiterate that safety is the watchword for winter, as it is all year round, and to stress that that is why NHS England wrote about it today. I commend my hon. Friend for meeting her constituents locally, and I urge all Members to do the same. We are getting some fantastic ideas from staff and from patients about how to reform and change the system for the long term.

[Jess Brown-Fuller (Chichester) (LD)]

One in four people trying to contact their GPs last month were unable to get a same-day appointment, and one in 20 could not get through to their GPs at all. We know that these people end up in A&Es up and down the country, and that hospitals are already buckling under the strain. What is the Minister doing to improve support for GPs and frontline services during this winter crisis, especially while they navigate the challenges of the employer NICs rises?

[Karin Smyth]

I refer back to what I said in my statement about how we are supporting the system. We absolutely understand the importance of primary care, and of using 111 to make sure that people are directed towards getting the right care in the right place. We know that the system is under pressure, and we will continue to do all we can to support it in the longer term, as well as in the short term.

Lobular Breast Cancer

Jess Brown-Fuller Excerpts

Tuesday 10th December 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a real pleasure to serve under your chairship, Ms Vaz. I add my thanks to all hon. Members for their contributions and to my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes). First let me say how sorry I am to hear about her friend. Those are very precious friendships and I think my hon. Friend articulated that well today. My deepest sympathies to Heather’s loved ones who are with us today and to her wider family group. It is a really difficult time and this is a very recent bereavement to be talking about. My hon. Friend has used her voice as a parliamentarian to good effect, as she always does, and I congratulate her on doing that. I hope I can go some way to answering the questions she raised at the end of her speech. If I do not and she is not satisfied, I will make sure officials get back to her on the specifics.

I also echo the words of the hon. Member for Hinckley and Bosworth (Dr Evans) about hon. Members raising their personal experiences and the importance of support from partners and wider family members for people who are going through diagnosis, treatment and sadly, often, death.

We know that too many cancer patients are being failed. They are waiting too long for life-saving treatments and receiving a diagnosis too late. As my right hon. and learned Friend the Prime Minister reiterated last week, we have inherited a broken NHS but it is not beyond repair. We know it needs to be fixed and there is not a single solution. To ensure that more people survive cancer, including lobular breast cancer, we have to take a multi-pronged approach—catching it earlier so more treatments are available, raising awareness of its specific symptoms, and investing in equipment and research, as many hon. Members have raised today. All those actions are part of our plan to put the NHS on the road to recovery.

As we have heard today, according to Cancer Research UK lobular breast cancer is the second most common type of breast cancer. Also known as lobular carcinoma, it impacts the lives of many—around 15 in every 100 breast cancers are invasive lobular. Treatments for lobular breast cancer are broadly similar to those for other breast cancers. Surgery and radiotherapy are effective for most patients with primary invasive types, meaning those which have not spread to other parts of the body. Systemic therapy such as chemotherapy, hormonal treatment, targeted therapy or immunotherapy are usually offered based on the stage at which the NHS catches that cancer.

Another factor which can determine clinicians’ decisions on the best treatment option is how the cancer has spread or developed in each patient’s case and we understand that is different for different patients. Sadly my understanding is that when cancer is growing in more than one location, as is more common in lobular breast cancer, treatment is more challenging. The same is true when a cancer has spread to other parts of the body. To improve outcomes in such challenging cases, NHS England funded an audit into both primary and metastatic breast cancer that has spread. The scoping for this audit began in October 2022 and the results were published in September this year. NHS England are hopeful that the results will help to improve the consistency of treatments offered, as well as stimulate improvements.

We know that for far too many women, lobular breast cancer is diagnosed at a later stage, which means that treatment options are more limited. The key to improving survival must lie in raising awareness, and early detection and diagnosis. I am not sure I can do it as well as the shadow Minister, but I want to use this opportunity to raise awareness of the fact that not all breast cancers form a firm lump. I think he articulated really well what women should be looking for. Lobular breast cancer patients are more likely to have thickened areas of breast tissue. Possible symptoms include an area of swelling, a change in the nipple or a change in the skin, such as dimpling. I encourage everyone to check their breasts regularly and to consult their GP straightaway if they have any concerns. While more people are surviving breast cancer than ever before, we know that lobular breast cancers can be particularly hard to detect.

Another measure to support earlier diagnosis of breast cancer is screening before people notice symptoms. Our screening programme sends women their first invitation at the age of 50. To support detection, the NHS carries out approximately 2.1 million breast cancer screens each year in hospitals and mobile screening vans, usually in convenient community locations, but—this is a really shocking figure that I learned recently in another debate in Westminster Hall, which shows how important it is that Members raise these issues—take-up of breast cancer screening is currently below 70%. That is worryingly low, and we are determined to improve it. Every effort that hon. Members here and people listening to this debate can make to improve that take-up rate will help save lives. If someone is eligible for screening, they should come forward and take up that important offer.

Unfortunately, even for those women who come forward for a mammogram, we know that lobular breast cancer can be more difficult to catch than other types of breast cancer. We have heard some shocking stories and examples today. To ensure that women survive, we need to be relentless in researching every possible avenue of treatment and diagnosis. Examples of innovation supported by my Department include £1.3 million invested in a Bristol-based FAST MRI project, which will determine whether different types of scans can help detect cancer in a cost-effective manner. The FAST MRI project focuses on an abbreviated MRI, which is a shortened version of a breast MRI. This type of imaging can help to detect the most aggressive forms of breast cancer sometimes missed by screening through mammography, including lobular breast cancer.

My Department is also working closely with UK Research and Innovation and the Medical Research Council. These bodies are responsible for studies that look to understand the basic mechanisms of disease. Combined, they spend £125 million on cancer research each year. My officials also meet regularly with partners to discuss a wide range of our research investments and ways to stimulate new proposals. These include those for lobular breast cancers.

Through the National Institute for Health and Care Research, my Department will continue to encourage and welcome applications for new research in this area. I hope this addresses the shadow Minister’s point, but funds for research are still available through the NIHR. Funds are awarded through open competition informed by expert peer review, with active involvement of patients and the public. The Department and NIHR also advise the campaign on the Lobular Moon Shot Project. It has already contracted £29 million, which I think is the figure the shadow Minister referred to, to the Institute of Cancer Research and its partner at the Royal Marsden. This proposal included work on lobular breast cancer. I hope I have addressed that point, but if I have not, then please let me know.

We know that we must do more to rise to the growing challenge that cancers including lobular breast cancer represent, but for our efforts in detecting and understanding this complicated disease to be effective, we need to back fundamental reform in the health service. That is why we have launched the biggest national conversation about the future of the NHS since its birth to shape the 10-year plan. We need suggestions from hon. Members on how to go further in preventing cancer where we can. I urge everyone to visit the website change.nhs.uk to do so.

[Jess Brown-Fuller (Chichester) (LD)]

The risk of all breast cancers in women is reduced by 4.3% for every 12 months of breastfeeding, but the UK has one of the lowest breastfeeding rates in the western world: only 1% of children are still exclusively breastfed at six months. Does the Minister agree that community initiatives to encourage women to breastfeed for longer support the Government’s mission to reduce the risk of breast cancers and improve health outcomes overall?

[Karin Smyth]

I thank the hon. Lady for that really important point. She highlights another important issue affecting the health of women and children, and I agree with her.

My hon. Friend the Member for Dulwich and West Norwood spoke about women’s health overall, which is an important priority for this Government, as are these forms of cancer and the wider preventive agenda. That is another point that can be made on the change.nhs.uk website, which I will keep plugging. The issues that have been raised on it by the public and staff are really interesting and informative.

My right hon. Friend the Secretary of State has been clear that there should be a national cancer plan. The hon. Member for Wokingham (Clive Jones) made helpful points about that opportunity. I will not take up his invitation for a meeting; his point would be better made by being inputted into the process with the organisations he is in touch with. That would help to shape the national cancer plan, which we can all buy into as a country. The plan will include more details about how to improve outcomes for all tumour types, including lobular breast cancer, and ensure that patients have access to the latest treatments and technology. We are now in discussions about what form that plan should take and what its relationship with the 10-year health plan and the Government’s wider health missions should be. We will provide updates on that in due course.

I thank my hon. Friend the Member for Dulwich and West Norwood for bringing this important matter to the House.

Infant Formula Regulations

Jess Brown-Fuller Excerpts

Wednesday 13th November 2024 Commons Chamber

[Chris Webb (Blackpool South) (Lab)]

I am grateful to have secured my first Adjournment debate on an issue that affects so many families in my constituency and across the country: the cost of infant formula and the regulations that govern its sale.

The infant formula market is rightly highly regulated, and should remain so. Regulations have a key role in supporting public health goals and breastfeeding. However, not all parents can or want to breastfeed, and recent stats show that 95% of babies in the UK have had some formula by the age of nine months. As the father of a nine-month-old baby, I know how emotionally charged and difficult it is to navigate infant feeding. The infancy period is crucial for a child’s development. In their first year, they will triple their birth weight, and the foundations of their health are determined for the rest of their life. It is vital that parents have access to safe and affordable food during infancy. The fact that, for too many families, that is not the reality is a public health crisis.

Recent data from YouGov shows that one in four mothers are struggling to afford formula milk. Over the past two years, the price of the cheapest brand of formula has risen by 45%, with an average price hike across all brands of 25%. Those increases are putting immense pressure on families.

[Jess Brown-Fuller (Chichester) (LD)]

I thank the hon. Member for bringing forward this important debate and allowing me to intervene briefly. A recent Competition and Markets Authority report highlighted the insufficient marketing regulations in the formula industry, which enable brands to exploit vulnerable parents by presenting their products as distinct or superior, despite all formulas being required to meet the same nutritional standards, whether the box costs £7 or £14. Does he agree that an NHS-branded formula in plain packaging could be considered? It could be sold at cost price. That would give those families who choose not to, or who cannot, breastfeed confidence that their decision is best for their child, regardless of the cost.

[Chris Webb]

I completely agree, and I will come to that later in my speech. I look forward to working with the hon. Lady and other members of the all-party parliamentary group on infant feeding when it is established in the coming weeks.

In my constituency alone, where child poverty has increased by 30% in the past year, 12,500 children are going without enough food each day. Formula is an essential product for many, but the average tub now costs a staggering £14.50, so many parents are resorting to extreme and unsafe measures to feed their babies. A black market has sprung up for infant milk, and it is one of the most commonly shoplifted items. Rather than working to reduce its cost, some supermarkets have resorted to locking formula in cages or attaching security tags to it. Certain stores have even gone as far as to prevent customers from entering unless admitted by staff—that is happening in convenience stores across my constituency.

We are seeing something that should be unthinkable in modern Britain: formula foraging. I regularly read heartbreaking posts on local forums from parents begging for baby milk to tide them over until the next payday—they are in utter despair—but by seeking out cheap or free milk online, they risk feeding their babies a product that could be out of date or already opened and potentially laden with bacteria. Studies have shown that the inability to afford formula can lead to unsafe feeding practices such as skipping feeds, ignoring expiry dates, and over-diluting powdered formula or bulking it out using unapproved alternative foods such as porridge, all of which can harm an infant’s health.

New NHS England figures show a worrying rise in childhood malnutrition. Up to 47% of hospitalised children are at risk of undernourishment. Last year, admissions for malnutrition at Blackpool teaching hospitals had almost doubled on the previous year. Gastroenteritis has become an alarmingly common illness in infants, with many now suffering more than one episode a year. In Blackpool, hospital admissions for under-ones with gastrointestinal problems are almost triple the national average. Dehydration—a common complication of gastroenteritis—is a particularly serious risk, and it is exacerbated by parents’ inability to access or properly prepare formula. Parents should not be forced into those dangerous choices when they are simply trying to feed their babies. This scandal demands the urgent attention of the House.

Income Tax (Charge)

Jess Brown-Fuller Excerpts

Tuesday 5th November 2024 Commons Chamber

[Jess Brown-Fuller (Chichester) (LD)]

I start by recognising that this Government face an enormous challenge in clearing up the mess of a decade of Conservative mismanagement in this country, and that failure is nowhere more apparent than in our NHS and care sector. Every day, thousands of patients across the country face agonisingly long waits, often in severe pain, just to see a GP or get an appointment with a dentist.

Yesterday, I met a constituent whose 45-year-old husband—a well-loved, energetic and creative man—never regained consciousness after being left in the A&E waiting room of my local hospital for six hours after suffering a brain haemorrhage. James Palmer-Bullock leaves behind three wonderful children, a loving wife and a devastated community. His wife’s request to me was to ensure that no family ever suffers the same neglect again. I hope the Secretary of State will meet me to discuss the experience that my constituent faced and what can be done to prevent it in future.

New funding for day-to-day spend in the NHS is welcomed across this House, and it is desperately needed if we are ever to address the crisis in the NHS. However, there is no point in pouring money into a leaky bucket if that money does not get where it needs to go.

[Bradley Thomas (Bromsgrove) (Con)]

It is not just public services that we need to focus on: the third sector provides vital services that many of our constituents rely on, particularly children’s hospices. I would like to highlight to the House the Acorns children’s hospice in my constituency, which provides vital support to many local families in a really acute moment of need. In 2019, NHS England decided to increase the children’s hospice grant—

[Madam Deputy Speaker (Caroline Nokes)]

Order. That intervention was far too long.

[Jess Brown-Fuller]

I thank the hon. Member for his intervention. He will be pleased to know that I am going to mention hospices later in my speech.

To fix the NHS, we must fix both the front and the back door. Taking the pressure off secondary care can only be achieved by properly funding primary care. That is why the decision to increase employer’s national insurance contributions is a significant mistake, as it risks worsening the crisis in the NHS and care sector. Increasing that rate will drive up GP surgery costs, significantly raising the annual expense of GP practices. Those practices are not eligible for the employment allowance that protects our small employers, so surgeries in Chichester and across the country will bear the full weight of that rise—a burden that they and my constituents simply cannot afford. Surgeries such as Southbourne surgery, Langley House surgery and Selsey medical practice have already reached out to me with concerns about their ability to continue providing services amid those financial challenges. They all agree that this increase will directly undermine patient access and care.

Charities have long suffered the burden of failing statutory services. Chichester boasts some of the most amazing charitable organisations, and one of the great pleasures of my role is to spend time with the people at the heart of those organisations. Charities such as Stonepillow, which works to prevent homelessness in our area, face an increase in costs of £125,000. I also visited St Wilfrid’s hospice after the Budget announcement—an incredible hospice that provides palliative care for hundreds of people every year, both in the hospice and in the community. It now faces an increased bill of £175,000—money that it needs to find annually, with only 17% of its annual budget covered by the NHS. I urge the Government to consider exempting the health and social care sector from the national insurance rise, so that the Treasury is not giving with one hand and taking with the other.