Stillbirth Certification

Jim Shannon Excerpts

Wednesday 31st October 2012 Westminster Hall

[Chris Heaton-Harris (Daventry) (Con)]

It is a pleasure to serve under your chairmanship for the first time, Mr Owen. I hope that you will be as gentle with me as are the other Chairmen whom I have served under in Westminster Hall. I thank the House for giving me the opportunity to talk about stillbirth certification.

On 18 May 2011, I led a Westminster Hall debate on the sensitive and emotive subject of stillbirth. I explained back then that I had wanted to raise the subject ever since a couple of my best friends had a stillborn child. The way in which they and other parents of stillborn children are treated is simply not good enough for a modern developed country.

Seventeen babies are stillborn or die shortly after birth every single day in the United Kingdom, and the stillbirth rate has not changed in a decade. That number is way too high. I have been told that approximately 30% of stillbirths remain completely unexplained and that lots of different factors play into the deaths of the remaining 70%. I know that the Minister who will reply to the debate is concerned that the UK is slipping down the league table of developed nations in this regard. According to a study published last year in The Lancet, the UK has one of the worst records for stillbirths, ranking 33rd out of 35 high-income nations. Although it is important to acknowledge that all women are vulnerable, we need to work out why women in our nation may be at a higher risk of stillbirth and what we can do to change that fact.

There are some troubling regional differences in the percentage rates of stillbirth across the United Kingdom. How can we explain the 33% difference between the incidence of stillbirth in the south-west, which has the lowest rates, and the east midlands, of which my constituency is a part, which has the highest?

I have had discussions with people who point out that in recent years, Britain has become one of the unhealthiest nations in Europe. We are the most obese nation in Europe and we have the heaviest drinkers. As life expectancy has increased, more British women are also waiting until later in life to become first-time mothers. All those could be contributing factors to the horrid statistic that I read out earlier.

I could not let this occasion go by without asking the Minister what research is being done into the reasons behind our high stillbirth rate. Why is there so much regional variation? More than anything, I want the Minister to assure me and those in the Chamber that the Government have an ongoing commitment to reduce the number of stillborn children throughout the United Kingdom, to talk about this subject more and to spread best practice. What will the Minister do to ensure the spread of best practice? There are many hospitals across the United Kingdom that have fantastic practice in this area, but, equally, there are those where best practice is desperately needed. Eventually, I hope that fewer parents will suffer this terrible fate. I was personally delighted by the announcement by the Department of Health, on 16 May, of the Government’s maternity pledges, which include the pledge to provide more NHS support to women who have suffered a stillbirth.

I do not intend to go over much of the territory that we covered in the debate last year, but wish instead to concentrate on one particular area—the certification of stillborn children. Without a doubt the passing of the Still-Birth (Definition) Act 1992 was a breakthrough and had huge significance for parents. From the passing of that Act, a baby who was born dead at or after 24 completed weeks of pregnancy was recognised in law as an individual. It required that the baby’s death be registered in person by one or both parents at a register office within six weeks of the baby’s birth and it stated that a stillbirth certificate be issued.

Since I raised this subject in May 2011, I have been contacted by hundreds of families who have suffered the terrible anguish of stillbirth. Many of them have shared their stories with me, and I am in awe of how some of those parents have dealt with the worst of all possible situations.

A number of themes have started to fall together around the whole subject of stillbirth. Indeed, many parents had issues that were individual in their nature. If they had complaints about their treatment, they tended to sort them out for themselves. However, there was one very distinguishable theme that came out of my many conversations and e-mails—how to help parents grieve and eventually to move on. I believe that something simple can and should be done in that regard.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this matter to Westminster Hall. It is something that affects many people across all the constituencies in the United Kingdom. Does he agree that as things stand, the parents are not able to get the closure that they so desperately need? Although nothing can ease the pain, even to acknowledge that there was life in the first place would give a sense of closure to the family. It is a small thing but it could be of great comfort to a grieving family.

[Chris Heaton-Harris]

Yes, I do agree, and I shall come on to that point in the next couple of minutes. Certainly, that applies to a number of the parents to whom I have been speaking. Although no one will ever be able to give them back their baby, they almost feel as though the state is cheating them. It is as if their baby was never in existence. Having a birth and death certificate might help them get over that point in their grief so that they can move on.

[Jim Shannon]

The issue for parents is coming to terms with the emotional trauma that they have been through. Having a certificate will mean a terrible lot to those people, and that is what we are trying to achieve.

[Chris Heaton-Harris]

That is my intention in raising this debate today. However, this is about not just the certification element, which I hope the Minister will answer, but the need for more awareness of all the issues around stillbirth and neo-natal care.

Having the flexibility for parents to be able to choose to have a birth and death certificate for babies born after 24 completed weeks of pregnancy but showing no signs of life, would massively help a large number of parents in their grief and show that the state recognises that they had a wonderful child. As some parents would be distressed at the possibility of having to go down that route, I wonder whether we could have a more flexible system whereby parents have the choice of a formal birth certificate, a stillbirth certificate issued by the hospital or—if they so choose—nothing. In modern society, we have the ability and sensibility to deal with the matter of certification, which is important to most of the parents to whom I have spoken because it is a simple process of formally naming their deceased baby.

Over the course of my time in this place, I have raised the matter of stillbirth certification a number of times. However, on each occasion I have received a similar reply from the Department of Health. One reply said:

“The registration of stillbirths and live births serve different purposes.”

It helps Departments collect statistical data and

“enables us to monitor the causes of stillbirth.”

Another reply said:

“Different state benefits are available to parents depending on whether a child was live-born or stillborn, so it is important to be able to distinguish one certificate from another.”

I completely understand the need for the state and the Department to be able to collect these important data for use in research. In fact, I am keen to encourage the Department to do more. However, I simply cannot understand why in 2012, with all the modern technology that we have at our disposal, we cannot, in a sophisticated way, collect all the data that are required and issue birth and death certificates when they are requested by parents.

Winterbourne View

Jim Shannon Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

I have tried to be clear on my views on what has been happening—it has been going on for years. As I have said, the fact that someone is sent 200 miles away from home creates the conditions in which abuse is more likely than if they are in their own community. I want that to end—I want to be as clear as I can that that is a national scandal that needs to be brought to an end.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his comments. I also watched the “Panorama” programme last night and was horrified. According to the local council and the Minister, changes have been made. Will he confirm that the lessons learned will be conveyed to the devolved Administrations in Scotland, Wales and Northern Ireland to ensure that this terrible abuse never happens again anywhere in the UK?

[Norman Lamb]

The hon. Gentleman makes an essential point. Wherever people are, they must be protected from potential abuse and benefit from high standards of care. I will give him my absolute assurance that we will work closely with the devolved Administrations to ensure that people receive that benefit, wherever they are in the UK.

Mental Health (Approval Functions) Bill

Jim Shannon Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

Yes, I can confirm that that is the case. The Secretary of State spoke to the relevant Health Ministers this morning. I hope that that gives the hon. Gentleman reassurance.

[Jim Shannon (Strangford) (DUP)]

Following on from what the hon. Member for Arfon (Hywel Williams) has asked, may I ask the Minister, in relation to Northern Ireland, what investigations have taken place to ensure that no one was detained illegally, and whether there are likely to be challenges from people who have been sectioned? I am afraid that they might have reason to claim against the Government for that purpose, given that no legislation was in place. Please excuse the condition of my voice, by the way.

[Norman Lamb]

I am grateful to the hon. Gentleman for that intervention, but I am afraid that I struggled slightly to hear all the points that he was making. Perhaps the best way of dealing with all this is to ensure that I respond in writing to all his questions. I can also assure him that the Secretary of State spoke to the Northern Irish Minister yesterday and briefed them fully on the situation. There is good liaison there.

Our current assessment is that about 2,000 doctors were not approved properly in line with the provisions of the 1983 Act, and that those doctors have participated in the detention of between 4,000 and 5,000 of the patients currently detained in NHS or independent sector hospitals. There are two important points that I would like to make clear now. First, the decision to detain a patient under the Mental Health Act is primarily a clinical one. There is no suggestion, and no reason to believe, that the irregularity of the approval process for these doctors has resulted in any clinically inappropriate decision being made, whether the decision was to detain or not to detain. Nor is there any suggestion that the doctors approved by mental health trusts are anything other than entirely properly qualified to make these recommendations.

All the proper clinical processes were gone through when these patients were detained. There is no reason why the irregular approval process should have led to anyone being in hospital who should not be—or vice versa—and no patients have suffered because of this. The doctors had no reason to think that they had not been properly approved; they acted in total good faith and in the interests of the patients throughout this period. As of Friday last week, the SHAs concerned had corrected their procedures and all the doctors involved had been properly approved. I hope that that addresses the question raised by the hon. Member for Wolverhampton North East (Emma Reynolds).

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 23rd October 2012 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

My hon. Friend makes an extremely good point. This is all about giving power to patients. Personal budgets have already been very successful in social care, and there are pilots under way in health care; the indications are that they are proving very successful.

[Jim Shannon (Strangford) (DUP)]

The NHS has a responsibility for all patients in ill health, especially those who are elderly. Is the Minister aware of the information released last week that 3,000 general practitioners have drawn up a list of 7,000 patients who have less than a year to live—in other words, whose level of care is in question? Will the Minister condemn that list and take every possible step to ensure that every patient gets NHS care, irrespective of age?

[Norman Lamb]

The whole purpose of that approach is to ensure that patients get appropriate care at the end of their life. There is very strong consensus supporting that approach, including on the part of Marie Curie Cancer Care and Age UK. It is really important that all GPs and others involved in the care of people at the end of their life engage fully with the patient and the patient’s loved ones. That is the right approach.

Oral Health Services

Jim Shannon Excerpts

Wednesday 17th October 2012 Commons Chamber

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I am pleased to have this opportunity to raise the question of oral health in the UK. Oral health is given far too little attention, in terms of what practitioners can bring to improving a population’s general health, as well as how it can be used to prevent the development of disease. Rather like opticians, our dentists are undervalued, in terms of what they can bring to the table to help to improve our nation’s health. Perhaps it is because dentists are not the most popular group in society—although I suspect that they are outdone by politicians. Why is going to the dentist not seen as a pleasurable experience? I will leave that to others to judge, but although going to the dentist may not be pleasurable, it is absolutely essential, and good practice starts right at the beginning, with the emergence of milk teeth.

Here in the UK we can be proud of many of our successes in achieving a good quality of oral health. The UK is one of the top-performing countries for oral health in Europe, but there is still much we can do. In fact, a recent joint report by Wrigley and GlaxoSmithKline suggests that Britons love their teeth and take very good care of them compared with our European neighbours. More Britons have more of their natural teeth than people in any other European country, and since the 1980s Britain has cut its decayed, missing and filled teeth score by two thirds. That is an impressive step, but there is certainly still room for improvement—I should explain, Mr Speaker, that Wrigley is based in my constituency.

I recently attended the launch of the report and listened with great interest to Professor Ken Eaton talking in detail about the work that has been going on across Europe looking at patterns of dental health. Other speakers included Dr Nigel Carter from the British Dental Health Foundation and Juliette Reeves, a dental hygienist and nutritionist with over 30 years’ experience. All the speakers set out clearly the importance of dental checks in the early identification of a number of diseases, particularly cancers, which we know are growing in prevalence, mouth cancers in particular. There has been a 48% increase in mouth cancers in the last 12 years. Early identification can make all the difference, in terms of the treatment required and the survivability of the patient. Dental health problems can also be indicative of other diseases, such as diabetes. All those issues are easily picked up during a dental health check. One of the good things in the new contract for NHS dentistry is that it recognises the importance of prevention. This will be challenging for some in the profession to implement, as they will have to change the way in which they work, but most dentists will learn to accept that prevention should be a priority.

The report’s evidence showed that although a majority of us in the UK keep to the suggested practice of brushing twice a day, only half of us brush for two minutes or longer—the rest of us just whizz around and hope that is sufficient—and that almost two thirds of us eat or drink between brushing and going to bed at night. There is clearly space to improve our personal oral hygiene practices, and there is scope for policy and campaigns to achieve that.

Personal oral hygiene is essential. Dental disease is completely preventable, and so, therefore, are those occasionally uncomfortable visits to the dentist when invasive treatment is necessary. These diseases constitute a significant public health problem across the UK and Europe. I cannot stress strongly enough that prevention is the key, and it needs to be encouraged. Many will say that the treatment is expensive. Yes, it can be, but when set against the money saved by regular dental checks reducing the likelihood of more complex treatment, the expense looks like good value for families. The prevention of debilitating diseases will certainly reduce the social and economic costs for the country and the individual.

Curative dental care is a significant economic burden across Europe, with spending close to €9 billion. In the UK, the cost is substantial. An estimated 0.5% of gross domestic product was spent on oral health care services in 2010, and that figure is rising. Expenditure on treatment for oral diseases often exceeds that for other diseases, including cancer, heart disease, stroke and dementia, yet the simple fact is that the causes of most oral diseases in the UK are preventable through cost-effective measures that would ultimately save the taxpayer money. Brushing, flossing, using mouthwash and chewing sugar-free gum—a much-maligned practice that is actually quite effective—could all be more effectively promoted to help to keep dental costs down in Britain, and the sharing of good practice should be encouraged.

Policy needs to be designed and implemented to improve research into oral health promtion. There is currently a lack of comparable data across Europe, although the report goes some considerable way towards addressing that problem. To tackle the burden of oral disease we also need to consider taking action in various ways, some of which have been suggested in the report on the state of oral health in Europe, which I hope the Minister has had an opportunity to read. The report suggests the need to address increasing oral health inequalities, improve the data and knowledge base and support the development of the dental work force.

We should be proud that Britain is a high achiever when it comes to oral health in Europe, but there is certainly room for improvement. Despite our successes, oral diseases remain a burden for much of the population, and the economic impacts are significant. There needs to be a greater focus on prevention rather than treatment, and improvements in education and awareness are also needed.

I am proud that we have the Peninsula dental school in Plymouth. I was asked by my local media why I had chosen oral health as the subject for this debate when so many other issues could have been raised. That was a good question. Having the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), here to respond is of course a good reason. There is also the small question of the ballot for Adjournment debates. MPs often put in for a number of debates over the Session, and we cannot tell which one will be lucky enough to come out of the ballot. I was lucky on this occasion.

Also, one of the first major campaigns that I was involved with when I was first elected to Parliament was to get a dental school sited in Plymouth. I remember fighting tooth and nail—the pun is intended—for that, alongside my former colleague, Linda Gilroy, and experts such as Sir John Tooke. It was during that campaign that I began to understand just how important good dental health is, and how essential it is that we train our dentists and technicians to the highest standards. My subsequent involvement in the all-party parliamentary group on dentistry, which is chaired so well by the hon. Member for Mole Valley (Sir Paul Beresford), has maintained my interest in the subject.

The groundbreaking training offered by Peninsula in Plymouth closely links the trainee dentists and technicians to local communities that have historically had very low levels of contact with dentists, and it is making a difference. This was one of the strong points of the case we made for a dental school in Plymouth.

We have an excellent community development team at the dental school who ensure that the training includes opportunities to go out into these communities, taking dentistry to “places it has never gone before”. Some of the projects included highlighting the impact of high-sugar drinks for professional rugby players at Plymouth Albion; making mouth guards for them; offering oral health advice to local schools; and letting children enjoy and play in a clinical environment to make it less scary. The dental school also works alongside experts to support people with drug and alcohol abuse issues, and is certainly doing some excellent work around oral cancer and smoking cessation with young adults and teenagers.

There continues to be concern about access to dentists in some parts of the country. In Plymouth, we have good months and bad months. Since the start of 2012, however, improvements have been made, with an additional 6,500 NHS places coming on stream in our city. This is possible in part because the graduate dentists from the dental school are staying in the area—yet another reason why we so wanted a dental school in Plymouth. I was pleased that the then Labour Government recognised the importance of dental training—unlike the last Tory Government, who closed dental schools.

There continues to be an issue about the cost of dental care and treatment for many families, particularly in the recession. That cost is still not easily met by some families.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way and for bringing this matter to the House for discussion. Oral health is a big issue right across the whole of the United Kingdom. In Northern Ireland, some plans have been mooted to introduce fluoridation in the water. That has been resisted by the Northern Ireland Assembly and resisted by the population of Northern Ireland. A new consultation process has started, but it will again be resisted. Does the hon. Lady feel that the best way of addressing tooth decay is, as she has already indicated, by regular brushing and diet, and not by fluoridation of the water?

[Alison Seabeck]

I know that the hon. Gentleman feels strongly about this issue. I feel equally strongly about it, but I disagree wholeheartedly with him, not least because a lot of toothpaste has fluoride in it in any case. Neither of my daughters, now 30 and 26—they will probably kill me for revealing their ages—has any fillings, and they have lived in an area with full fluoridation. They have had no side-effects at all either.

[Jim Shannon]

The hon. Lady is generous in allowing me to intervene again. There are statistics and information showing that fluoridation of water leads to osteoporosis and other diseases. Is it not important to be careful before pursuing a policy that could affect people’s health negatively rather than help them?

[Alison Seabeck]

I understand the hon. Gentleman’s concerns, and I am sure the population in his area will continue to have that debate, but I am convinced by the data and information that I have seen that, on balance, fluoridation of the water is a good thing. I was intending to touch on it later, but I shall now skip around it.

I will come back to the issue of families and the cost of dental care. Brushing teeth from an early age is certainly something we should all be doing; it has no significant cost and has positive outcomes. Dental treatment can be expensive, so a dental contract that focuses on prevention, works with people identified as having a higher risk of dental decay and takes a more risk-based approach—patient by patient—could lead to some families spending less on their visits to the dentist each year. That would obviously be a good thing for those families. Those people who have no visible issues of tooth decay—an increasing number in the UK, thanks in part to fluoridation—do not need a service focused on drill and fill. They need a system that rewards dentists for the preventive work they do, which should lead overall to less expensive treatments.

The wider use of expert dental hygienists to monitor and advise patients as well as to carry out treatments could have a significant benefit, although there will be some dental practices—these issues have been raised—that are not currently suitable and do not have enough space to accommodate the additional clinics. Some of the proposed changes could be problematic for them. I would welcome an update from the Minister about whether he is picking up concerns from some of the pilots as to whether or not this is an issue. The result of the contract pilots will be crucial when it comes to deciding whether the patient, as well as the dentist, benefits from the change in emphasis. The wider health benefits of preventive work will also save the NHS money, if other health problems are caught early. Preventive work can save lives, which is obviously hugely important.

I urge the Minister to consider whether, as well as the pilot schemes, further public information campaigns are needed to make the general public aware of the growing number of oral cancers that are linked to smoking and alcohol consumption—particularly among young women—and the importance of brushing babies’ first teeth. It should be emphasised that dental care can be preventive, rather than something that we all have to suffer when we have toothache.

I know that companies such as Wrigley run their own campaigns linked to their products and support wider campaigns such as Keeping Britain Smiling, but, given the massive cost to the NHS of poor dental health and linked ill health, the Government also have a role to play. I hope that the Minister will not only take on board the concerns raised by me and by others, but will tell me about the steps that are currently being taken, and about those that may be planned. I invite him to come down to Plymouth, visit the dental school and look at some of the outreach work that it is doing in deprived communities, because I think that there are some very good lessons to be learnt.

We should all speak to and lobby our health commissioners to ensure that those who are involved in the new health commissioning system understand what dentists can contribute to an overall reduction in poor health and the early identification of health problems. I hope that the Minister will note that plea.

Rickets

Jim Shannon Excerpts

Tuesday 4th September 2012 Westminster Hall

[Kate Green (Stretford and Urmston) (Lab)]

I am very pleased to have been given the opportunity of and time for this debate and to introduce it with you in the Chair, Mr Hollobone. I start by acknowledging two Manchester GPs, Dr Hans-Christian Raabe and Dr Avril Danczak, who came to see me some months ago to draw my attention to the shocking rise in the incidence of rickets in this country over the past 15 years. A written answer that I received on 9 November 2011 contained figures showing that the number of reported cases of rickets had risen from 183 in 1995-96 to 762 in 2010-11. Earlier this year, it was reported that the chief medical officers of the UK had contacted health professionals to highlight the need for vitamin D supplements for at-risk groups. Therefore, the issue is clearly one of concern. I welcome the steps that the Government have taken so far to deal with it, but more needs to be done.

Rickets is a disease that affects the growing of bone in children and is associated with moderate vitamin D insufficiency. It is mainly characterised by deformed bones, bone pain, convulsions and delayed development, particularly in relation to height rather than weight. Current Government guidance is that most people can get all the vitamin D that they need by eating a healthy balanced diet and getting some sun. However, it is not at all clear that that advice is adequate. The national diet and nutrition survey found that 90% of people in the UK do not get enough vitamin D from their diets, and there is widespread confusion in the public mind about what constitutes an appropriate amount of exposure to sunshine.

Certain groups have particularly high levels of vitamin D deficiency. They include pregnant and breastfeeding women and their babies, young children, elderly people, those who are not exposed to much sun—perhaps because they cannot get out of the house or because they cover up their skin for cultural reasons—and people with darker skin pigmentations, such as those of African, African-Caribbean or Asian origin. Levels of air pollution may also have an impact on sunshine exposure levels, and there is certainly a gradient of rising incidence of vitamin D deficiency as we move north across the UK, so it is clearly a concern in the north-west region, where my constituency is located. When one member of a family has a vitamin D deficiency, it is also likely to be replicated among siblings and children.

It is therefore clear that steps need to be taken to deal with vitamin D deficiency in quite large sections of the population. I am pleased that the Scientific Advisory Committee on Nutrition is examining the issue, but it is not due to report until 2014, and it is likely that any recommendations made by the committee could take time to implement in any event. However, there are things that can and should be done now, not least in terms of informing and educating the public and health professionals.

A recent study by the clinical effectiveness unit at Stockport NHS Foundation Trust highlighted a quite surprising lack of awareness among health professionals about vitamin D. That study, across eight acute and six primary care trusts in the north-west, found quite poor knowledge among midwives and health visitors surveyed. Only 24% of health visitors and just 11% of midwives reported having had training in vitamin D supplementation. As a result, they felt less confident in discussing vitamin D with pregnant women and mothers, vitamin D was poorly promoted at the booking of appointments and 90% of the women were not provided with information about vitamin D. However, the study found that where trusts had good policies or expert personnel in place, staff reported greater confidence in discussing vitamin D and more women received verbal and written advice.

Last year, my hon. Friend the Member for Bolton South East (Yasmin Qureshi) hosted an event in Parliament, in conjunction with the Proprietary Association of Great Britain—the UK trade association for manufacturers of over-the-counter medicines and food supplements—at which it was suggested that doctors, nurses and pharmacists receive very little nutritional training at undergraduate level and that there is no obligation for health professionals to undertake such training once in practice. Therefore, I would like first to ask the Minister to comment on the steps that the Government are taking or planning to improve training, awareness and knowledge among health care professionals. I would also like to ask what steps are being taken to raise awareness among the wider pool of professionals working with families and children, and what discussions the Minister and colleagues in the Department may have had with Ministers in the Department for Education to ensure that staff in schools, Sure Start workers, child care professionals and so on are aware of the importance of vitamin D.

There are also concerns about financial incentives. I have looked at the quality and outcomes framework for GPs, and there is a lack of a clear financial incentive for GPs to address their patients’ nutritional needs. Will the Minister say what steps are being taken to develop the quality and outcomes framework to focus more GP attention on nutrition and vitamin D intake, and how she expects that that framework will be kept under review?

I come now to the question of vitamin supplements, which the Department of Health recommends for at-risk groups—the groups I mentioned in my opening remarks—and which are available free of charge to certain low-income families via the Healthy Start programme. However, that targeted approach has resulted in only very limited uptake, which unpublished PCT data suggest could be as low as 2% to 4%. Clearly, many at-risk families are missing out on the recommended vitamin D supplements; and although some families may obtain supplements, from over-the-counter sources, that can be expensive and the dosage may be inappropriate. I would be interested in the Government’s attitude to allowing food supplement manufacturers greater freedom to develop and market a wider range of vitamin D products, targeted at different population groups. I would also welcome the Minister’s view on how the European Food Safety Authority might make it easier for manufacturers to make legitimate claims about the role of vitamin D in good bone health.

I particularly hope that the Minister will consider a report published online, on 21 August, by the British Medical Journal that considers an initiative by the Heart of Birmingham PCT to provide universal vitamin D supplementation to all children from the age of two weeks to five years and to all pregnant and breastfeeding women. That provision of supplements was supported by a programme of continuing professional education of health staff, including GPs, health visitors, midwives, pharmacists, paediatricians and obstetricians and by a public communications campaign. In that initiative, uptake of vitamin D supplements rose year on year to reach 17% among children and pregnant women. That was still low, but considerably higher than the 2% to 4% achieved under Healthy Start. Public awareness of vitamin D also rose from just over 60% to nearly 90%, and a 59% fall was recorded in the number of cases of vitamin D deficiency.

Clearly, there are some important lessons to be learned from the Birmingham initiative. Although some problems were experienced with distribution through the NHS supply chain, limited opening hours at pharmacies and so on, and with the availability of trained staff, the initiative was very successful overall in reaching a considerable number of families who might be at particular risk of vitamin D deficiency by virtue of ethnicity, skin pigmentation or lifestyle, but would not be eligible for free supplements.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to Westminster Hall today. I am of an age group, and others in the House may be of a similar age, that can remember that when we went out to play at school lunchtime, the milk was on the table when we came in. Is there a role for the Department of Health in the education of children to ensure that children’s health is better monitored and supervised?

[Kate Green]

I absolutely agree with the hon. Gentleman. Health professionals, and other professionals from across different disciplines, have pointed to the absence of a holistic approach that draws different practitioners and professionals together to ensure that the message is promoted and the education of children and families is pursued coherently.

The absence of trained staff was certainly seen as a factor that limited the effectiveness of the Birmingham initiative, but overall it was very successful in improving vitamin D uptake in families who would have been at risk. I am keen to invite the Minister to look carefully at the Birmingham experience. Is she willing to analyse the costs and benefits of a universal approach based on the study’s findings?

On food fortification, relatively few foods are naturally rich in vitamin D, and consumption of many of those that are, such as full-fat dairy products, eggs and oily fish, has fallen in recent years. Yet in the UK, we fortify relatively few foods, such as margarine, some processed cheeses and breakfast cereals. We do not fortify milk, which has been fortified in Canada and the US for many years. Finland, Jordan and the Irish Republic have all taken recent steps to introduce food fortification. Will the Minister indicate the Government’s attitude to statutory food fortification? There seems to be scope for a more robust approach. Can she confirm whether the work of the Scientific Advisory Committee on Nutrition will look at the experience of other countries? Will the committee’s report reflect an analysis of the effectiveness of food fortification measures in those countries?

Finally, there appears to be scope to make greater use of the public health outcomes framework, to focus attention on vitamin D. I looked at the framework, and, with the exception of some quite vague indicators on diet and hip fractures, there appears to be nothing specific to highlight the need for action to tackle vitamin D deficiency and its consequences, including the risk of rickets. I welcome the Government’s focus on public health, but we must ensure that the framework and the new health structures being put in place more widely achieve the best possible outcomes.

This is a crucial and, I have to say, challenging time of transition. We are settling into the new public health infrastructure against a backdrop of far-reaching changes in the NHS more widely. Although I appreciate that the public health outcomes framework will be kept under regular review, I would like very specific and early attention to be given to the issue in the framework and by the new health and wellbeing boards. I would welcome the Minister’s comments on that.

[Jim Shannon]

I thank the hon. Lady for giving way again. She is being very gracious. Is she aware of the statistics and figures that show a greater problem in the United Kingdom—England, Wales, Scotland and Northern Ireland—with not only rickets, but osteoporosis, from the lack of vitamin D? Is there a need not only for a pilot programme, such as the one she mentioned in Birmingham, but for a programme for the whole UK, working with all the regions?

[Kate Green]

The hon. Gentleman is quite right. The impact of vitamin D deficiency is felt in not only rickets and diseases in children, but osteoporosis and other diseases. Vitamin D deficiency inhibits the absorption of calcium, for example, which is important for bone health and growth.

Professionals have identified the lack of joined-up advice—for example, telling a woman recovering from a cancer operation and having chemotherapy that there could be an impact on her bone health and the steps that she could take to address it. It is right that professionals have expressed an interest in the development of a strategic approach, both geographically and across health conditions. Perhaps the Minister will comment on how the Government might react to that.

Rickets is a largely preventable disease that many of us thought had been left firmly in the past. Its resurgence is not in question, yet the distress and pain it causes are preventable, and we know what steps we need to take. What is more, the solutions are mainly systemic—within the control of public policy and health care practice. Although I acknowledge that some gaps in the evidence remain, the importance of vitamin D for at-risk groups—children, pregnant women and mothers—has been understood for many decades, as has the need for effective supplementation where intake is inadequate. There is therefore no need to delay working on and developing appropriate systems and a programme of public and professional education to maximise vitamin D intake. I hope that today’s debate raises public and professional awareness of the issue.

National Health Service

Jim Shannon Excerpts

Monday 16th July 2012 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I am extremely grateful for the opportunity to speak in this debate. The NHS is clearly important to all of us. I have seen it personally because I have had a number of operations and through my working life in the hospice movement, where I saw how the care that is provided is so important to the families we were looking after. Clearly, the dedication of the staff is great and I pay tribute to them.

Listening to the Opposition today, it is hard to take them seriously. We can see from their actions in Wales what they would do with the NHS if they were in power. They have cut the budget, resulting in an increase of 51% in the number of patients waiting to start treatment and an increase of 156% in the number of those waiting for more than 26 weeks. All the bad news from the Opposition is therefore difficult to swallow.

I will give a couple of examples from my area. I recently met some GPs and clinicians to talk about the work they are doing to redesign musculoskeletal services. They have brought in innovative ways of ensuring that the patient knows exactly what will happen to them. Clinicians across primary care, community services and secondary care are working together to ensure that the patient has a clear understanding of the care that they will receive. They use map displays, which show a clear pathway, offer educational content for GPs to ensure that patients get the highest standard of care, and ensure that information is available for the patient.

I am proud to say that on Friday, one of the surgeries in my constituency will open a new well-being centre, which will provide a place where health care, social care and the third sector can come together to provide better ways to improve health and well-being in the town.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman share the concerns of many Members, as I believe he does, over the closure of surgical units for children in the middle counties of England? If so, what is he doing to prevent it in his constituency?

[Stuart Andrew]

The hon. Gentleman pre-empts the next part of my speech and I am grateful to him for that.

As this is a health debate, I am sure that my right hon. Friend the Secretary of State would expect me to talk about the safe and sustainable review of children’s heart units. Like other Members, I have received a number of e-mails from various organisations today. One of them said that some MPs should seek to reignite the debate and that I should think about the children because if I had children, I would move heaven and earth to ensure that the service was the very best. Frankly, throughout the campaign on children’s heart units, I have only ever thought about the children. Of course I want the very best service for them, as do the right hon. and hon. Members from all parts of the House who have worked on the campaign. I have always accepted that there is a need for change. That is why I want to discuss a few related points this evening. I know that I will have an opportunity to raise it in greater detail tomorrow, but it is important that I speak about it tonight.

Access and travel times are incredibly important to the families who use children’s heart services. Logical health planning surely dictates that services should be based according to where the population lies. The British Congenital Cardiac Association states:

“Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”

Adult Social Care

Jim Shannon Excerpts

Monday 16th July 2012 Commons Chamber

[Paul Burstow]

On the proposals for portability of assessment and guaranteed continuity of care, the LGA is certainly aware and has been engaged in the consultations that we undertook last year as part of our preparations for the White Paper. It did not, of course, negotiate line by line the text of the White Paper, but it has the opportunity, as does everyone else, to participate now in the scrutiny of the draft Bill that we introduced. I hope the LGA will do so. We wish to engage with the LGA on these issues.

Integration is an important part of these reforms. Too often, people feel bounced around the system. What we do for the first time in the White Paper is set out a number of important steps towards more integration of the two existing systems.

[Jim Shannon (Strangford) (DUP)]

The Minister has used the term “integration” several times. In Northern Ireland we have an integrated health and social care system, which is working extremely well. I am conscious that that is very different from the position on the mainland. Are there lessons from the integrated system in Northern Ireland that could be applied here? We have done it well in Northern Ireland. Perhaps the example could be used here.

[Paul Burstow]

From my own limited study of the system and from visits that I have made over the years, one of the conclusions that I would draw, which is at the heart of our reforms as well, relates to culture and collaborative behaviour across the various parts of the system. That has been essential to delivering genuinely integrated care in some parts of Northern Ireland. I believe it is essential to delivering genuinely integrated care in England as well.

I mentioned earlier that end-of-life care was an omission from the Labour Government’s last White Paper. It has not been omitted from ours. We are doubling the budget of the pilots that we have instituted to test the patient funding mechanisms and to make sure that we have the necessary data to understand the benefits of a free social care system at end of life. We want to make it clear that we see the merits of such a change, and it is why we want to make sure that we have the information on which we can base the final decision.

Our goal is to shift the focus of the system to prevention and early intervention, not to wait for the system to stutter into life when a crisis strikes. We want to make it easier for people to plan and prepare, both to avoid and reduce the need for care and to meet the need for care in the first place. Last week we laid out a reform agenda of universal information and advice, national eligibility, deferred payments, integration of health, housing and social care, better transition for children to adult services, and support for carers. Together those constitute the most comprehensive overhaul of adult social care in 60 years, and they are a contrast to the motion before us, which adds nothing, says nothing about how change will be paid for, and says all that it can to scare people about the current system.

Rather like 13 years of a Labour Government, today’s motion gets us nowhere. That is why we are investing an extra £300 million in the system to support change, and why I urge my right hon. and hon. Friends to vote against the motion.

Violence against Health Workers

Jim Shannon Excerpts

Tuesday 3rd July 2012 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

Our national health service employs more than 1.7 million people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners, 400,000 nurses and 25,000 ambulance staff, as well as an army of other health care workers. Only the Wal-Mart supermarket chain, Indian Railways and the Chinese People’s Liberation Army directly employ more people.

On average, our health service deals with 1 million patients every 36 hours. That is about 500 people a minute or eight people a second. As those figures suggest, the size and volume of the NHS means that literally millions of interactions between patients and staff occur every single day. In the vast majority of cases, these interactions are positive and result in successful outcomes for patients and staff alike, which is why, simply put, the NHS is one of the best health care models on the planet. But sadly, things sometimes go wrong for patients and badly wrong for staff. The superb staff who provide such sterling service to the public can find themselves the victims of violence while working on our behalf to provide those very services. The purpose of this debate is to highlight this wrong and seek support from the Government for righting it.

The NHS management service’s latest statistics reveal more than 150 reported physical assaults on health care staff per day—and that is before verbal assault is taken into consideration. According to the latest 2010-11 NHS survey, 7% of NHS staff had been victims of assault in the previous 12 months. The Royal College of Nursing’s research reveals further troubling statistics, with almost 11% of those surveyed having been assaulted at work in the previous two years and more than 60% of all respondents having suffered verbal abuse at work. Indeed, one respondent commented that

“verbal abuse seems to just be accepted as part of our work”.

That is totally indefensible.

In Northern Lincolnshire and Goole hospital trust, which serves the Scunthorpe area, there were 13.1 assaults per 1,000 members of staff in 2009-10. Although that figure is below the national yearly average of 16.8 per 1,000, it is still far too high. One assault against any person simply trying to do their job in any profession, never mind people who routinely save lives every day, is completely unacceptable.

Two weeks ago, I joined a local ambulance crew for five hours of their 12-hour shift, and I was hugely impressed by the professionalism of the paramedic team and the staff at Scunthorpe general’s accident and emergency department. Patients were treated with great skill, care and dignity, which is exactly as it should be, but I was shocked to learn that the fantastic paramedic I was with had gone to a house call about a year ago and was seriously assaulted by the man he had gone to help. He was chased around the house by the man, who violently and persistently assaulted him. The assault was so bad that it resulted in his being off work for six months.

I received today this e-mail from a staff nurse at Scunthorpe general hospital:

“I understand that you are taking part in an adjournment debate tonight on the above subject. I was assaulted by a patient in January this year. With colleagues I went to clean up a patient that…had attacked a nurse earlier in the day and no one felt able to approach him since. I was subjected to a violent attack which meant I was on sick leave for three months. I have had intensive physiotherapy and still attend physio regularly. I suffered a needlestick injury while trying to sedate the patient and will be tested for blood borne viruses in the next few weeks. During the time I was off work and, for some time since, I have been in constant pain, I had limited use of my right arm and restricted movement of my neck. I could not hold a pen to write or brush my teeth. Everyday tasks took hours and I became depressed and withdrawn. Even now I am unable to perform all my duties as a nurse. Yet, mine was not a serious injury. I have made considerable improvement but will always have some level of pain and restriction of movement.”

She goes on to thank us for raising this issue in Parliament.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this issue to the Chamber, and I wish to associate myself with his comments. In Northern Ireland, including in my constituency and in particular the Ulster hospital, there have been several attacks on accident and emergency personnel and ambulances. It is not specific to Scunthorpe but happens across the UK. Would better co-ordination between the hospital authorities, ambulance and emergency personnel and the police be a way of addressing some of these issues?

[Nic Dakin]

I thank the hon. Gentleman for his comments. He reminds us that, sadly, the problem affects people across the nations of the United Kingdom. I will come to the issue he raises later, but I want now to quote the final comments of the nurse who wrote to me:

“You can have no idea what it means to have this problem recognised and debated. I do not expect to be compensated in monetary terms for the pain I have suffered or the possibility that I may not be able to work to retirement age but I do want to see measures put in place to effectively protect staff who are expected to deal with difficult and violent patients.”

The costs of such assaults are multi-fold. There is the cost to the NHS of care for the victim, the cost to the NHS of the health worker’s absence from work and the possible loss of an employee if recovery is not complete. Added to that is the potentially devastating impact on the health worker’s own health and well-being, with further strain on family, friends and the wider community. I would like to pay tribute to all the fantastic people working in the NHS, including the people and organisations working hard to prevent such violence from taking place against health workers. Northern Lincolnshire and Goole Hospitals NHS Trust has launched an e-petition to heighten public awareness of the issue. The fact that the trust has recognised it in this way is to be applauded, but there is much more to be done. That is why the trust’s partnership approach, working with Unison and others to find ways of practically addressing the issue, is to be welcomed.

NHS Employers—part of the partnership for occupational safety and health in health care—is also actively involved in raising the issue of violence and aggression against staff, and is looking at how it can be managed, working hard to help create healthy and productive workplaces. Work is also under way—led by NHS Protect, with input from the Royal College of Nursing and others—to look at preventing and managing physical assaults on staff which result from a patient’s underlying medical condition, such as dementia. Many physical assaults result from a patient’s underlying clinical condition, but rather than ignoring this, steps can be taken to reduce the risks. Work to take these positive initiatives forward needs to be systematically supported and funded if it is to bring real change and reduce the risk to health workers from such patients.

All these initiatives are positive and to be welcomed. However, I want to highlight a number of concerns raised with me by the Royal College of Nursing, Unison and others. I am keen for the Minister—who I know is committed to ensuring that the Government do their best in this area—to say in his response what practical steps the Government are taking to address those concerns. The Government have funded work by the Design Council with a limited number of A and E units to reduce violence through design solutions. That is to be welcomed. How will the work be evaluated, and how will any improvements to the safety of staff and patients in such units be shared and implemented more widely? With the end of Secretary of State directions, which required NHS trusts to have measures in place to protect staff, how will it be possible to ensure that all provider services meet standards similar to those currently set under Secretary of State directions? They include access to a local security management specialist, training on conflict resolution, central reporting of physical assaults and a requirement to follow policies and guidance—for example, lone working guidance—published by NHS Protect.

Lone working nurses and health care workers absolutely need protection. They often form an invisible work force. Many health workers already work alone with limited, if any, back-up or support. The quite proper policy direction of providing more services in the community means that more health workers are likely to find themselves in potentially vulnerable situations as sole workers. How will Government ensure that there are systems in place to minimise risk and protect the work force?

Full consideration needs to be given to the possible impact of changes in health care delivery combined with efficiency savings on the likelihood of risk of violence against staff. In particular, a risk assessment of the impact of closing units, lengthening A and E waiting times and staff shortages needs to be undertaken and the effects mitigated. That needs to be recognised. In this climate of cost-cutting and austerity, how can we be certain that such measures will be put in place to reduce the risks to staff? Staff who report incidents need more support from their employers and the police. They need feedback after they have reported incidents, and they need to know what action is being taken to prevent any reoccurrence. Lack of feedback and support can lead to under-reporting of incidents and reduced morale.

I welcome the fact that pressure from Unison has resulted in a change to the code for Crown prosecutors to increase the number of prosecutions for assaults on public servants. The closer working relationship between NHS local security management specialists and trade union safety representatives has been a positive development. NHS Protect has also agreed protocols with the police and the Crown Prosecution Service. Under the memorandum of understanding with the Association of Chief Police Officers, the police are committed to progressing all cases of violence and abuse against NHS staff as a priority. The Crown Prosecution Service has also made a commitment to

“work with the police to ensure that these cases are treated with the seriousness that they deserve and encourage a robust charging policy”.

It is crucial that that should lead to a more consistent approach by police forces to following up the perpetrators of either physical or verbal abuse. RCN research suggests that police follow-ups are sometimes inconsistent around the country. Some forces follow up complaints robustly and work closely with local hospitals, but others appear reluctant to get involved in procedures, especially when the incident involves a patient with an underlying mental health condition. Such incidents in particular need more close examination, as a significant number of physical assaults on health workers are by patients with underlying mental health problems. How can the Government ensure that the memorandum of understanding between ACPO, the CPS and NHS Protect will be consistently and effectively implemented?

The reporting and investigation of assaults also need to be properly addressed. According to the RCN survey, although only about 11% had suffered physical abuse at work, 74% of the incidents they recalled were never reported to the police. Staff need to be confident that they will be supported by their employers and the police. They need to be given the confidence always to report assaults. There needs to be a culture of trust that, when reported, such assaults will be taken seriously and fully investigated, with proper support given to the victims. Proper feedback and support in the reporting process will help to keep up morale in the NHS work force and reassure staff that they should not expect to be put in danger while carrying out their duties on behalf of all of us.

In this age of austerity, budgets are being squeezed, and organisations that protect workers are being asked to do important jobs with a lot less funding. For example, the Health and Safety Executive, which plays an important role in keeping people safe at work, has had its work force reduced by a third in the last 10 years, with the number of inspections that it carries out falling from 75,000 to 23,000 a year. That could lead to the real danger of worker safety being jeopardised, which makes it even more important for NHS employers to take completely seriously the need to protect their work force and minimise the risk of attack from patients. Health and safety is not red tape; health and safety saves lives.

Worryingly, the cuts in NHS and local authority budgets and in the Health and Safety Executive are in danger of combining with the confusion caused by the NHS reforms to cause local security management specialists to become increasingly reliant on safety representatives to help them to identify those work areas in which NHS staff will be most at risk. Many local security management specialists used to work with primary care trusts. With the abolition of PCTs, there is a possible danger of confusion and uncertainty about their role in the workplaces that they cover. How will the Government ensure that the risk inherent in the changes does not lead to more health care workers finding themselves in situations in which their personal safety is put at risk?

Every single person should be able to go to work without the fear of physical harm. I strongly back Unison’s calls for a zero-tolerance approach to safeguarding NHS staff. Everyone needs to work together with a clear and persistent focus to make sure that all staff can carry out their work free from the fear and the threat of physical or verbal assault. When individuals are found guilty of attacks on health care workers, that should inform the sentencing and be treated with the utmost seriousness.

As Julian Corlett, Unison branch secretary for Scunthorpe general hospital, wrote to me:

“Violence directed at health workers is never acceptable and is not part of the contract of employment. We must dispel the myth that violence in the NHS is inevitable, or unpredictable and therefore uncontrollable. It therefore remains our key objective to see a significant and sustained reduction in the number of violent incidents directed at NHS staffs across the country, with more prosecutions and severe sanctions for those perpetrating such violence. There has to be the presumption that those committing these offences are more likely to face prosecution than not if we are to see sustained reductions in the figures anytime soon.”

Julian speaks from experience with great passion and clarity; his words will echo round this Chamber and in the world outside it. We should be vigilant and proactive in ensuring the safety of those who work within the NHS. In the words of the children’s laureate, Michael Rosen, on the 60th anniversary of the NHS, we must do all we can to protect the

“hands that touch us first...and the hands that touch us last”.

Community Hospitals (North-East)

Jim Shannon Excerpts

Wednesday 20th June 2012 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman explain why some Members, when they are outside the House, support petitions to retain hospitals and community services, but in the House vote to stop them?

[Mr Deputy Speaker]

Order. I allowed the intervention, but I am not sure what the connection is between the north-east and Northern Ireland.