Social Care

Lilian Greenwood Excerpts

Tuesday 25th February 2020 Commons Chamber

[Barbara Keeley]

My hon. Friend is right. I will come to the causes, because it is important to mention them.

The 15-minute care visit reduces the giving of care by care staff to a series of physical tasks, rather than the staff being able to see a person with their own interests, desires and opinions. It really strips them of the time to do the job they want to do. I pay tribute to all care staff, who go above and beyond in their jobs to improve the lives of the people they support. Without them, our social care system would not work, but they do not get the pay and recognition that they deserve.

Care staff, who provide essential practical and emotional support to some of the most vulnerable people in society, are among the most poorly paid workers. The average hourly pay for care staff is below the rate paid in most UK supermarkets. On average, care staff are paid less than cleaners and healthcare assistants in the NHS, and this has led to a vacancy rate of 122,000 care jobs and a turnover rate of 33%. Now the Government are planning to make the situation worse by turning away people who want to come to this country to work in social care. One in seven care workers is from outside the UK, but the average care worker earns £10,000 a year less than the Government’s immigration salary threshold, so will the Secretary of State tell us just how he thinks he is going to be able to fill the large number of vacancies in the social care workforce?

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is making a powerful speech. Does she share my concern that poor pay and conditions mean not only that these workers are exploited, but that there is a high degree of turnover and a lack of investment in training and development, which in themselves have a significant impact on the quality of care that is delivered to some of our most vulnerable residents?

[Barbara Keeley]

Once again, I absolutely agree. My hon. Friend is right to emphasise that point.

Last week I met home care support workers in my constituency who are campaigning to be paid a real living wage, and they told me about their struggles to manage financially. One staff member talked of working 90 hours for four consecutive weeks at an effective rate of £6.10 an hour. Others talked about being bitten or punched, yet still they continue to do the support job that they love. I pay tribute to their commitment; in the case of social care, doing a rewarding job does not pay the bills.

NHS Funding Bill

Lilian Greenwood Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

The hon. Gentleman is absolutely right that the three years without an Administration in Northern Ireland have led to all sorts of difficulties. I have already spoken to my new Northern Ireland counterpart twice and offered all the support that we can give. The extra funding will help an awful lot, but it is sadly true that there are over 10,000 people waiting more than a year for a procedure in Northern Ireland. The number in Wales—run by the Labour party—is over 4,000, and the number in England is just over 1,000. We have to make sure that we get the very best treatment across the whole of the UK. Even though I am responsible for the NHS in England, I am also the UK Health Secretary. For instance, on the public health emergencies that we have been talking about recently, we have to engage across all four nations and make sure that the Northern Irish health system improves, as do the Welsh system—which is in a terrible state in many places, despite the amazing effort of the staff who work in it—and the problems that we well know about in the Scottish system.

[Lilian Greenwood (Nottingham South) (Lab)]

The Secretary of State has set out many commitments relating to what he wants to deliver with the extra funding in the Bill. However, the funding in the Bill is purely in cash terms. Will he make a commitment here and now that if inflation rises, such that £33.9 billion does not equal £20.5 billion in real terms and therefore does not deliver the real-terms increase that he has promised, he will exceed the amounts that are set out in the Bill?

[Matt Hancock]

We are already exceeding those amounts with the additional funding that I mentioned to do with training and capital, both of which are critical. Of course the budget is set out in cash terms: cash is what the NHS spends. Part of what the NHS has to do is make sure that it spends the money getting the best possible value for money. I am acutely aware that, while we are spending £33.9 billion extra and the total budget is almost £150 billion, every single pound of that is taxpayers’ money. We have to be acutely aware of the value we get from it.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

In the recent election, the issue of the NHS was frequently debated in the media. Our constituents often say things like, “Can’t you take the party politics out of it?” I completely understand why they feel that way, but the truth is that our parties do not always agree about NHS funding, and there is good reason for that.

I obviously welcome the extra funding set out in the Bill for the national health service, but I worry that it is rather more about presentation than dealing with the very real needs of our constituents and the health service that they rely on. I cannot help wondering whether the cash increase of £33.9 billion is preferred to the real-terms increase of £20.5 billion just because it sounds like more, when actually it is potentially exactly the same, but not necessarily.

My constituents just want to be sure that high-quality services will be there when they and their family need them. For many of them, their experience of using the health service in recent years tells them that it is under real and rising pressure. They tell me that it is increasingly difficult to get an appointment to see their GP, that they have been waiting a long time to see a specialist or that their much-needed operation has been cancelled. They ask for my help when they cannot access the mental health support they need or when an elderly parent is not getting the social care they need to enable them to stay in their own home. NHS staff tell me that they are working under intolerable pressure, that there are too many vacancies and that too many colleagues are off sick or leaving the service altogether as a result of workplace stress. My conversations with my constituents are no doubt similar to those of other Members across the House, and my concerns echo many of those already described in the debate.

Of course, the funding in the Bill is welcome, but it is simply not enough, and my hon. Friend the Member for Leicester South (Jonathan Ashworth) set out precisely why. One of the reasons why funding is so badly needed and why this is not enough is that the system has been allowed to get into a state of crisis. My hon. Friend has been tireless in challenging the Government on these issues, and unfortunately the symptoms of recent under-investment are there for everyone to see.

Health Ministers may not believe my hon. Friend, but here is what doctors in the NHS say. The British Medical Association’s briefing for today’s debate tells us:

“A decade of underfunding… has led to a serious deterioration in the NHS’s ability to provide safe and effective care to patients”.

It notes that the A&E waiting time target has been missed for 53 months in a row, having not been met since July 2015; that the proportion of A&E patients seen within four hours is the lowest on record; that there are over 4.42 million people waiting for elective treatment; that in November 2019 there were 145,800 delayed days due to delayed transfers of care; and that 78% of doctors say that NHS resources are inadequate, which “significantly affects” the “quality and safety” of patient services. If Ministers will not listen to Opposition Members, I hope they will listen to the doctors working in our national health service.

This is also not enough money because we have a growing population, and people are living longer. The development of medical science means that new procedures and treatments are becoming possible, and those developments generate additional pressures on the system. The national health service needs real-term funding increases every year just to stand still, and the lack of sufficient extra resources in recent years has added to those pressures. There is a gap to fill.

The problem has already been made worse by wider changes to Government policy, and a number of Members have made reference to this. The policy of austerity has led to deep cuts in funding for a whole range of local services, and in particular social care, which puts additional pressure on the national health service. That investment in social care needs to be not only forthcoming but properly and fairly distributed on the basis of need, and it must be sustainable. I heard from Nottingham City Council about the fact that so much of the funding is provided on a single-year basis, and it is non-recurrent grant funding. Unless that changes, the council cannot make the best use of the money available. Adding a precept on to council tax means that places with a lower tax base—those with the greatest levels of deprivation and need—receive the least available funding.

I am concerned that this extra funding is not sufficient and will not allow us to catch up, particularly if there is not investment in social care. I am also concerned that it is expressed in cash terms, because that leaves the NHS with a lack of certainty about what funding will be available in real terms and therefore what can actually be delivered. I am disappointed that the Secretary of State would not commit to providing additional funds to ensure that the £20.5 billion in real terms will definitely be delivered.

I want to briefly touch on mental health. I welcome the commitment that mental health funding will grow at a faster rate than the overall NHS budget, but how will the Secretary of State ensure that the funding set out in the Bill goes where it is required and leads to increased investment in mental health in every local area? How will he address the urgent shortages in the mental health workforce? Workforce issues are the largest risk to the delivery of the NHS long-term plan, and the challenges are especially acute in mental health.

Finally, I want to turn to the issue of capital funding, which many Members have mentioned. Many parts of the NHS estate need extra investment. I remember visiting the Meadows Health Centre in my constituency and hearing from patients, GPs and staff how a relatively small amount invested in their building had made a big difference to the services they are able to provide. I want to focus on the needs of Nottingham University Hospitals NHS Trust, which is one of the biggest and busiest acute teaching trusts in the country and a big centre for specialist services in the east midlands. It has a leading university teaching hospital, a regional trauma centre, cancer centre and heart centre and is one of the most research-active trusts outside of London, Oxford and Cambridge. We are really proud of our hospitals and grateful to our dedicated and caring staff, but there is huge concern about the fabric of our three hospital sites.

NUH was included in the list of 21 trusts that will be allocated a share of £100 million seed funding, but that was announced in September, and the trust still does not know how much it will receive. There is no certainty, even once it has drawn up those plans, that they will be funded and delivered. That future funding may help us, but £1 billion of capital funding is needed to provide new and refurbished facilities, and our trust has the highest critical infrastructure risk in the entire NHS outside of London, adding up to £104 million. I have previously raised with Ministers the concerns that the city hospital still has coal-fired boilers, which are both polluting and totally inadequate. Some £24 million over two years is needed to replace those boilers—when will that funding come forward? I raise that yet again and hope to get an answer.

The hospital trust has made a number of priority requests for funding needed to ensure the quality of patient care, including £10 million, or £22 million over two years, for the redesign and partial consolidation of the maternity and neonatal service, since many Nottinghamshire mums and premature babies are currently sent to other places to be treated; increased paediatric intensive care capacity; ward renewals; and funding for backlog maintenance. We need that capital investment, and we need certainty, not just in this year but in future years.

[Several hon. Members rose—]

Acquired Brain Injury

Lilian Greenwood Excerpts

Tuesday 2nd July 2019 Westminster Hall

[Chris Bryant]

There are specific issues that affect children. It is a profound source of depression to me as a Labour Member and a socialist that a child from a poorer background is four times more likely to suffer a brain injury before the age of five than a child from a wealthy background. We need to look at all the elements that lead to that, because prevention is far better than cure. I have spoken in other debates about issues that relate particularly to education, including the importance of schools having as full an understanding as possible of how brain injury can affect a child. All the statistics now indicate that every primary school class in this country has at least one child who has had a significant brain injury, although many of them may be undiagnosed. That is an issue for every single school in the country, and I do not think that we have fully taken it on board yet.

The experience of having had a brain injury often includes the sense of being pushed from pillar to post in the health system and in the organisations that the state provides. An element of that is inevitable, because something fundamentally chaotic is being brought into an ordered system. That is how it feels to the individual, too: they knew what their life was, and then suddenly—nearly always completely out of the blue—something has happened to radically change their life and their family’s lives, perhaps permanently. All too often, however, families have to fight for every single bit of support from the national health service, the local authority, the education system or wherever.

If there is one thing that I hope will come out of all the work that we have done in the all-party group, it is that we can change that feeling of having to fight for every single element. So many patients have told me, “If I could devote all my energy to getting my brain better, rather than fighting for support, I would be a useful and fully functioning member of society. I would dearly love to be that person again.” If there were any way in which all the arms of the state could fully recognise that factor, that would be something that we should dearly hope for.

The charity Sue Ryder does an awful lot of work with people who have had brain injuries and other neurological conditions. It reckons that 15,000 people who have had acquired brain injuries are now in generalist older people’s care homes, which are probably not the places to get the right support, but are the only places available. Sue Ryder is aware of at least 515 people who are placed out of area, a long way from home, which means that all the support systems that they might have through family, friends and so on are simply not available or are extremely expensive because of the travel.

We really have to do far better. The Minister is very good on the subject—I have talked to her several times—but the tendency in the NHS and in Government circles is to put a positive gloss on everything and stress all the good things that have happened. I understand that, but we are still a long way from achieving what we all want, and what the people we are talking about deserve.

The national clinical audit of specialist rehabilitation produced a report earlier this year—it has not yet been discussed in Parliament—on all the specialist rehabilitation around the country. Somebody who has had a major traumatic brain injury, or a brain injury caused by factors such as carbon monoxide poisoning, may at first need four or five people to feed them, clothe them, wash them and provide all the basics of their daily life. However, effective neuro-rehabilitation over a sustained period can and often does mean that they need just one person—or, in an ideal world, it gives them back the independent life that they had before, in as large a measure as possible.

The good news from the report is that the rehabilitation prescription that the all-party group has discussed is being steadily rolled out across the whole country. That means that patients and their families can say, “This is what we know we should be getting—we want to make sure that we are getting it.”

[Lilian Greenwood (Nottingham South) (Lab)]

I congratulate my hon. Friend on securing the debate and on his speech. Does he share my concern that neuro-rehabilitation in the UK is particularly limited for children? There is just one option for in-patient neuro-rehabilitation and post-hospital discharge, which is run by the Children’s Trust in Surrey. Should not every region have a paediatric neuro-rehabilitation pathway, rather than the patchy and underfunded set of services that we have at the moment?

[Chris Bryant]

My hon. Friend is absolutely right. Indeed, I know of a case that makes that point extremely keenly, where a young lad ended up having to go from south Wales to Surrey. Obviously in south Wales we love visits to Surrey, but it is a phenomenal cost for the family to have to visit their child there every week because it is the only facility in England and Wales. There is also an emotional cost in being a long way away and not being able to see their child every day. We really need a string of these paediatric services across the whole country.

One of the great successes that the Government have introduced in the past few years is the major trauma centres, which are now saving many more lives—at least 800 more a year. People who would have died of brain injuries are now alive. However, the national clinical audit has found that only 40% of those who were assessed at the major trauma centres as needing in-patient rehabilitation actually got it. That means that across England and Wales we are probably about 330 beds short. We have to strive to get those beds and make sure that nobody fails to get the in-patient rehabilitation that they need, not least because rehabilitation works. According to the audit, 94% of those who got the rehabilitation that they needed ended up able to live far more independent lives.

The net saving to the public purse from rehabilitation is significant. Extrapolated over a patient’s lifetime—in many cases it is quite young people who have had brain injuries—the average net lifetime saving from rehabilitation amounted to just over £500,000 per patient. That means that the total savings that would be generated from just this one-year cohort of patients alone was £582 million.

Investing in the 330 beds that are needed, which might cost somewhere in the region of £50 million, would generate an enormous return for the public purse. Leaving aside the finances, there is also a moral imperative. If we can not only save people’s lives but give them back as much quality of life as is humanly possible—if we can do that medically—we should do that as a society.

The other thing that I want to say about finances concerns the injury cost recovery scheme, which is a little-known aspect of the national health service. We always say that the NHS is free, and that is true. However, under the injury cost recovery scheme, local hospitals and ambulance services can reclaim an element of the cost when an individual has had an insurance claim met. The scheme was last reviewed in 2003, but in 2018-19 the sum total brought in by all the hospitals and ambulance trusts in England, Wales and Northern Ireland was £200 million, which is not an insignificant amount of money. In April, the amount that hospitals and ambulance services can charge was increased by the annual health and community services inflation measure, which meant that for in-patient care they can now claim £891 a day and for out-patients £725 a day. However, these amounts are capped at £5,381 a week and £53,278 in total.

These amounts need to be reviewed. There is no reason why hospitals in the NHS should not be able to claim a significantly higher amount when there are significant insurance claims. The extra money would not come out of the money won by the individual; it would come out of the money paid in legal and other costs. The average cost for in-patient care for somebody who has had a brain injury runs to something like £16,000 a week, yet the maximum that the NHS can claim from insurance companies is just £5,381 a week.

A regulatory impact assessment in 2006—the last one conducted by the Government—said that the cost to the NHS then was £170 million to £190 million. I reckon that in this financial year the figure would be more like £440 million, so yet again we have another means to find additional resources to put into these services.

I want to end with the experience in south Wales. I recognise that the Minister is not responsible for that, but a large number of people in south Wales, including constituents of mine and of other south Wales MPs, end up using English health services because we do not yet have a major trauma centre in Wales; there will be one and I hope that it will be very successful. I hope that the Minister will accept that one thing that was slightly left out of the equation when the major trauma centres network was set up was how to integrate fully neuro-rehabilitation—good, strong rehabilitation—and the whole pathway from ultra-acute or hyper-acute services all the way through to care in the community and patients returning to their home. Such integration was slightly forgotten and left to one side, which is why a quarter of major trauma centres in England still do not have a neuro-rehabilitation consultant.

I say to my colleagues in Wales: let us not make the same mistake in Wales. When the major trauma centre opens in Wales, I want to make sure that we have a fully functioning neuro-rehabilitation centre alongside it, so that every single patient who is assessed as being in need of in-patient neuro-rehabilitation will receive it and will continue to receive it for as long as they need it, so that they can return to full health. That should also apply to children and teenagers.

I say that because in the end, although I am not as religious as I used to be, I always have this little thing running through my mind, and I apologise if it sounds too religious or pious for some. Jesus said something about his having come to give people “life in all its fullness”. The sadness for me is that we are managing to save people’s lives but are then unable to give them life back in all its fullness. That is what the NHS should be about in this regard, because otherwise there is a cruelty, if all we do is save somebody’s life but do not give them life in all its fullness.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell, and to follow so many fine speeches. Like my hon. Friend the Member for Darlington (Jenny Chapman), I am not an expert on acquired brain injury, but I recently met Dr Emily Bennett, who is a consultant clinical psychologist in paediatric neuro-psychology at Nottingham Children’s Hospital. She has provided me with some briefing on the subject, which I would like to share.

As many Members have said, acquired brain injury is an under-recognised, hidden condition, yet it can impact on every aspect of a person’s life. As has been mentioned, 40,000 children and young people report to hospital with an ABI every year, but it is very likely that many thousands more have a mild brain injury that goes completely undetected. That can be associated with a range of cognitive, behavioural and emotional symptoms that can impact on education, health and relationships. It is important that we do more work on that.

We need to address neuro-rehabilitation specifically for young people. An ABI affects their brain when it is still developing and can have a temporary or permanent effect on their functioning. Sometimes it can be forgotten during a young person’s development and their time in school that they have a brain injury. It is important that specialist services follow up with children, particularly at key transitions. Children have a long life ahead of them, so work done in the early years to improve their outcomes can have a long impact through their childhood and adulthood.

An acquired brain injury in childhood can impact on school engagement, attendance and achievement. It can result in young people being more vulnerable to exclusions from school and being involved in the youth justice system. Obviously it can affect their job prospects and further education. It can impact on their mental health and self-esteem, lead to isolation and poor participation, and increase care demands for families.

I have already highlighted the patchy nature of neuro-rehabilitation services. I am pleased that in Nottingham Children’s Hospital, which is a regional centre for neuro-sciences and a major trauma centre for the east midlands, we are fortunate to have a multidisciplinary paediatric neuro-rehabilitation team known as the BRILL team—Brain Injury Living Life. However, that does not mean that everything is perfect, even in our region. There is a desperate need for dedicated rehab beds, follow-up clinics and more neuro-psychological support.

Before closing, I want to ask the Minister a couple of questions. What is being done to ensure that children’s services are better developed and that families are not faced with a postcode lottery as to whether their child receives neuro-rehabilitation? Will the Minister commit to a national review of those services, including those for children and young people? Is there an assurance that the number of rehabilitation beds for children and young people will be reviewed? Will the Government commit to ensuring that children as well as adults leave hospital with a rehabilitation prescription? Will the Minister agree to organise meetings between Departments? As my hon. Friend the Member for Blaydon (Liz Twist) said, the links between health and education are really important in making sure that children are well supported. Will the Government invest in and support research so that we better understand the long-term impact of a childhood acquired brain injury? Such questions will help us to move forward.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 7th May 2019 Commons Chamber

[Matt Hancock]

I am grateful to the hon. Gentleman for raising that point. He did not raise the individual case with me in advance, but I can see the point he is making. The public health Minister, who is responsible for cancer policy, will be very happy to meet him.

[Lilian Greenwood (Nottingham South) (Lab)]

3. What recent assessment he has made of trends in the level of workforce vacancies throughout the NHS.

[The Minister for Health (Stephen Hammond)]

The NHS employs more staff than at any time in its 70-year history. Posts may be vacant for a variety of reasons, including maternity and career breaks. The latest data shows that as of December 2018 about 80% of nursing vacancies and 85% of medical vacancies are filled by a combination of bank and agency staff.

[Lilian Greenwood]

Recent data from NHS Digital shows that there are 720 fewer GPs in the east midlands than just two years ago. According to NHS England, each month thousands of people wait more than four weeks for a face-to-face GP appointment in Nottingham. In January, 3,206 people had to wait more than 28 days between making the appointment and seeing their doctor. Ultimately, that is leaving the GPs we do have overwhelmed and overworked. I know myself that it is creating huge pressures on the emergency department at Queen’s Medical Centre. What is the Minister going to do to change that system?

[Stephen Hammond]

The NHS long-term plan will set out vital strategic frameworks to ensure that the needs for the next 10 years are met. The hon. Lady will know that we are training an extra 5,000 GPs to work in primary care and general practice. If she writes to me about the specifics of the numbers she mentioned in respect of Nottingham, I will be happy to respond.

Eurotunnel: Payment

Lilian Greenwood Excerpts

Monday 4th March 2019 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

The Secretary of State for Transport may have ducked today’s questions, but I am pretty sure that my Committee will still require his answers. If there is a Brexit deal or, indeed, if there is no Brexit, how much of our taxpayers’ £33 million do the Government expect to recover from Eurotunnel?

[Matt Hancock]

Of course, the medicines are going on these boats that we are procuring and that makes this a serious health matter. The hon. Lady is perfectly within her rights to ask these sorts of questions. The truth is that the £33 million is the maximum figure. It may not be as high as that, but we have been clear about the full exposure.

NHS Long-term Plan

Lilian Greenwood Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is dead right. There is a whole chapter in the plan on using new technologies not only to improve care but to make care more convenient. He has been a doughty campaigner for the use of technology in health services. His trip to my local hospital to understand these issues went down incredibly well locally, and I hope he keeps pushing us to do the best we can.

[Lilian Greenwood (Nottingham South) (Lab)]

How can it possibly make sense that, when the Health Secretary is targeting much needed support towards areas of high deprivation, the Secretary of State for Housing, Communities and Local Government is cutting funding for social care and public health, and cutting deepest in cities such as Nottingham with high levels of poverty? Is that not actively undermining the Health Secretary’s stated ambition to improve health and reduce inequality?

[Matt Hancock]

In debates on the future of our nation’s healthcare, we should always start with the facts, and the fact is that social care funding is going up. It went up by £240 million this year, and it is going up next year, too.

Baby Loss Awareness Week

Lilian Greenwood Excerpts

Tuesday 9th October 2018 Commons Chamber

[Antoinette Sandbach (Eddisbury) (Con)]

I beg to move,

That this House has considered baby loss awareness week 2018.

I rise to open today’s debate on Baby Loss Awareness Week, and if you, Madam Deputy Speaker, or others wish to read the account of Fiona Crack and her husband about their daughter Willow that is on the BBC site today, you will understand why this debate has continuing endurance and relevance. I am also extremely grateful to my colleagues and the charities that have worked with us on the all-party parliamentary group on baby loss. I want to use my time to highlight some of the successes, to describe how we can ensure that we build on them and to mention a couple of areas where we must focus our efforts more closely as they have become areas of concern.

Looking back over the past year, I am proud of the higher profile of parental bereavement issues. Whereas before many people felt that they did not know how to approach the subject or what to say, we are increasingly seeing people coming forward and offering words of sympathy, kindness and condolence, and the 60 charities working in this field have produced an excellent video, which is available on YouTube under the title “Baby Loss Awareness Week”. Members of the public and anybody watching this debate can watch and see how to approach and discuss the subject.

This change has come about because of a slow and steady change in how we in this country treat those who have lost a child. All of those involved in Baby Loss Awareness Week can be proud of this change, from those of us in this place today to the fantastic charities and voluntary groups, such as Sands, the Lullaby Trust and the 60 other charities that have been involved in the initiative. In addition, doctors, nurses and midwives on the frontline have been changing attitudes during the past few years.

It is not just attitudes that have changed in the past year, but policy. I am delighted that the past year has seen two major policy shifts: the implementation of a pilot of the national bereavement care pathway; and the passage of the Parental Bereavement Act 2018 into law. I am sure that my hon. Friend the Member for Colchester (Will Quince) will want to discuss that Act in more detail, and I pay tribute to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for his able stewardship in taking the Bill through Parliament. This is a significant step in ensuring that those who lose a child can mourn their loss while knowing that they have a period of paid parental leave from their employment. It marks the introduction of a new benefit such as has not been seen in this country for many decades, and I welcome the progress that the Government have made on that.

I want to spend a little longer concentrating on the national bereavement care pathway. Good care cannot remove parents’ pain and grief, but it can help them through this devastating time. In contrast, poor care can significantly add to their distress. The national bereavement care pathway sets out to deliver that good quality care and it was designed to address the previous postcode lottery in quality of care. The first wave of pilots was launched this time last year, during Baby Loss Awareness Week 2017. Eleven trusts were joined by 21 more when the second wave started in April of this year. This week, we take another step forward, as all the documents, tools and resources are being made publicly available for the first time. The national bereavement care pathway is paving the way for excellent care after pregnancy and baby loss. It aims to improve the quality of bereavement care experienced by parents and families at all stages. That includes miscarriage, stillbirth, neonatal death, molar and ectopic pregnancy, termination of pregnancy due to foetal abnormality, and sudden and unexpected death in infants of up to 12 months. This bereavement care pathway provides healthcare professionals with detailed guidance, training programmes, staff resources and simplified paperwork so that they can provide high-quality bereavement care when families need it most.

We are lucky because an evaluation of the first wave of pilots has taken place, and the results have been really positive. Parents have responded overwhelmingly positively, considering what they went through at the time. Some 95% of parents surveyed agreed that the hospital was a caring and supportive environment; 98% of parents agreed that they were treated with respect; 90% felt that they were provided with information that was easy to understand; 92% felt that the decisions they made in hospital were the right ones at the time; and 96% felt that they were communicated with sensitively. That is so important, because that shows that there has been a huge change in advice and support. I think my hon. Friend the Member for Banbury (Victoria Prentis) will be talking about the less encouraging statistics for areas that have not been able to roll out the pathway.

It is not only parents but medical professionals who feel the difference. At the beginning of the pilot, medical professionals were interviewed and asked what was preventing the delivery of the best possible quality bereavement care. One said that

“people were in their own little bubbles. There wasn’t much sharing, nothing was passed around as a standard.”

Medical staff also identified a lack of staff training, poor bereavement suite facilities, complex paperwork, long delays in getting post-mortem results back, staff not knowing how to communicate with parents about their loss, and different levels of awareness or knowledge between departments at the same hospital. The evaluation shows that significant progress is being made on a number of those concerns. Some 77% of the professionals who are aware of the pathway agree that, overall, bereavement care has improved in their NHS trust during the period of the pilot. That is something that our national health service can be really proud of, because it represents a significant change. Two thirds of professionals who are aware of the pathway agree that it has helped to raise the profile of effective bereavement care in their trust. The proportion of health professionals who feel prepared to communicate with bereaved parents, able to discuss bad news with parents and supported to deliver good-quality bereavement care has increased. If this were an exam, the student would have passed with flying colours.

The testimony of one parent who was involved in the pilot says it all:

“There was a doctor who was really, really helpful with me. It was such a shock and took such a long time for me to process why and how this happened; I must have gone in about five times, where she had to sit me down and tell me the same thing again and again. It was never too much trouble for her, and I needed that. Having patience with someone is really, really important—because you might have said it five or six times but I need you to say it again. She’s a doctor, she’s a very busy woman but she always made time to speak to me.”

This kind of care, and this kindness in care, is so important for parents in that position. They are going through the worst experience of their lives, and they are not always thinking straight. They are guaranteed to be sleep deprived and distraught. The kindness of a doctor or the concern of a midwife can be the first small building block on the road to recovery.

However, despite these successes and others, which I am sure colleagues from across the House will mention, we must continue with our work. In the most recent year for which figures are available, 5,500 babies were stillborn or died within 28 days of birth in the UK. Some of our European neighbours have managed to cut perinatal mortality rates by up to half, which shows there is still more to do. I welcome the Government’s target of halving perinatal mortality rates in the UK by 2025.

One thing I am becoming increasingly concerned about is the rising number of child death cases in hospitals. Although I am pleased that the light of transparency is being shone into these hospitals, I cannot help being concerned by the number of such cases in the last year. Shrewsbury and Telford Hospital NHS Trust has been the subject of horrific news, with the investigation into maternity care expanding to more than 100 cases. Likewise, in my own area, the Countess of Chester Hospital is the subject of a criminal investigation amid allegations that a member of medical staff was involved in 17 deaths and 15 non-fatal collapses. More broadly, a recent study found that the baby death rate was 10% higher than expected for a maternity unit.

Just last week, we saw the news from Wales that Cwm Taf University Health Board may have failed to properly investigate historical cases of stillbirth and neonatal deaths in its maternity units. I know that that case—the most recent—is devolved, and there will be things that the Minister cannot say while investigations are ongoing, but I would be grateful if he reassured the House about the steps that are being taken to address these specific issues, and what plans he has to ensure that when such issues arise in the future, there is a plan in place to support affected parents and ensure that the investigation is as quick and thorough as possible.

[Lilian Greenwood (Nottingham South) (Lab)]

The hon. Lady is speaking with great authority on this issue, as she always does. Does she agree that one thing the Government could do in this area, particularly when it comes to stillbirth, is to extend the power of coroners to investigate stillbirths of full-term babies? We have discussed that previously, and it is the subject of a private Member’s Bill. Does she think that that would help in the investigation, and therefore the prevention, of unnecessary deaths?

[Antoinette Sandbach]

I know that across the House there is a great interest in the need for coroners’ investigations, and I believe that the hon. Member for East Worthing and Shoreham (Tim Loughton) will be introducing a private Member’s Bill. I think that the idea has support from the Government. It is incredibly important for parents to give consent to post-mortems—that can be a very sensitive area, particularly for parents from ethnic minority backgrounds—because very often, medical findings assist with the research to discover the causes of stillbirth and neonatal death. The hon. Lady makes a very good point.

In closing, I hope that colleagues will recognise that this year has been one of significant policy wins.

--- Later in debate ---

[Will Quince]

I thank my hon. Friend for raising those very good points, which are entirely valid. His points about support, both in hospital and post-hospital, and about the support available to fathers, are very important and I shall come on to them in a moment.

Just before we move on to the debate proper, I want to talk a bit about my right hon. Friend the Member for South West Surrey (Mr Hunt), because we have not had a chance since his elevation to the position of Foreign Secretary to praise him for the work he did on these matters when he was Health Secretary. From the beginning, we also felt supported by Ben Gummer—I think I am allowed to call him that now, as he is the former Member for Ipswich; he encouraged us to set up the all-party parliamentary group. However, the former Health and Social Care Secretary, now Foreign Secretary, could not have been more supportive, and we felt from the very beginning that we were pushing against an open door. He knew that the issue needed to be addressed, and he threw the full weight of the Department behind it. I thank him on the behalf of the APPG, and I know that all the charities feel the same way. He was hugely supportive and continues to be so.

We produced a video for Baby Loss Awareness Week, which is live now, and my right hon. Friend features in it, showing how passionate he is about tackling this issue. I also want to say how much the rest of the APPG and I are looking forward to working with the new Secretary of State for Health and Social Care, my right hon. Friend the Member for West Suffolk (Matt Hancock), who has already reached out to me and other members of the APPG, as have his special advisers, to continue that work, which they recognise is important.

Several colleagues have already referenced the hugely important work done by charities up and down the country. That includes both big charities such as Sands, which is marking its 40th anniversary this year, the Lullaby Trust, the Mariposa Trust, Tamba and so many others and small charities that provide support locally. The support that they provide to parents at the most difficult time in their lives is so valuable, and I thank everyone who works in and volunteers for those charities.

[Lilian Greenwood]

The hon. Gentleman is making a powerful contribution, as he always does, and I congratulate him and all the members of the APPG on their work. Will he join me in congratulating a local Nottinghamshire charity called Forever Stars? Not only is it doing fantastic work supporting parents who have lost a child, but it has managed to raise £300,000 to create two new bereavement suites at the two Nottingham hospitals over the past year. I know that that has already been touched on in the debate, but it makes such a difference to parents who have experienced the loss of a child when they have somewhere suitable to be with their baby and deal with the aftermath of a terrible situation.

[Will Quince]

I thank the hon. Lady for her intervention. I will absolutely thank and pay tribute to that charity. In so many cases, bereaved parents want to do something to make a difference and to provide a legacy for or mark the life of their child, however short, and raising money to support our NHS or to provide support for bereaved parents is hugely worth while. If I heard the hon. Lady right, an incredible £300,000 was raised: I pay tribute to the work that parents across the country do to raise such sums, which support the NHS in providing world-class facilities. I will discuss this further in a bit, but although we do have world-class facilities and bereavement suites some of our hospitals do not have them, which is an issue in and of itself.

I have thanked charities, but it is also important to thank the clinicians and support staff within the NHS who work so hard in this area. They really are heroes, and their work is incredible. Midwives do an incredible job, because although they are so often there at the best time in someone’s life—when a child is born—they are sometimes sadly also there at the very worst time in someone’s life. Their ability to, in effect, wear both hats and provide that caring, compassionate, empathetic support is a credit to them. We really do have world-class staff in our NHS.

I also thank all the clinicians who are working so hard on the national bereavement care pathway. Numerous colleagues have mentioned it already, and it is important to reference the progress made so far. I do not want this to be a back-patting debate, because I will move on to some areas where the Government could do more, but we have achieved quite a lot in just over three years. The first, and probably most significant, achievement was the Government’s commitment to reduce stillbirth and neonatal death by 20% by 2020 and by half by 2025. I note that that target has been moved forward—I think the target three years ago was 2030—thanks to the work of the Secretary of State for Health and Social Care, Health Ministers and clinicians. Having spoken to the Department and to clinicians up and down the country, I understand that those targets are realistic and achievable and that we are on track to achieve them, which is quite incredible.

However, it is important to note that even if we achieve the target of reducing stillbirth and neonatal death by 50%, that still means that around 2,000 or 2,500 babies are dying in the UK every single year and that a similar number of families will be going through a horrific personal tragedy, so we must ensure that we have world-class support. That is why the national care bereavement pathway, which I think it is fair to say was a concept initially drawn up based on the APPG’s work with charities, is game changing. The pathway is game changing, because what we had and continue to have across our NHS is world-class bereavement care, but it can be found only in pockets. It is not consistent across the NHS.

A particular hospital trust may have one or perhaps even two specialist bereavement suites and one, two or maybe more specialist bereavement-trained midwives or gynaecological counsellors, and all sorts of charities may be supporting bereaved parents within that hospital trust. In other hospitals, however, there may be no bereavement suite and perhaps just one or even no specialist bereavement-trained midwives or gynaecological counsellors. That is an issue, so a national bereavement care pathway that provides consistent, compassionate, empathetic care and support across our NHS, whichever hospital one visits, is so important.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 24th July 2018 Commons Chamber

[Matt Hancock]

I pay tribute to the work that my right hon. Friend has done over many years making the case for his hospital, which I have heard loud and clear. I always enjoy visiting Harlow, especially when I am his guest. I hear the case that he puts and look forward to visiting soon.

[Lilian Greenwood (Nottingham South) (Lab)]

T3. Last month, a constituent contacted me about the care of her adult son who needed to be admitted to hospital under the Mental Health Act 2007. She was told that no beds were available anywhere in the country. The following day, a bed was identified but when, after three hours’ wait, the ambulance had not arrived, the bed was filled by another patient. Three days later, he was finally admitted to hospital. The head of mental health at Nottingham City Council told me that this is not an infrequent occurrence. Secretary of State, how is this an acceptable standard of mental healthcare?

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Clearly, the sequence of events that the hon. Lady has outlined is completely unacceptable. We have obviously set out clear expectations on NHS England to commission sufficient beds to enable local placements where possible and specialist care where a more acute service is required. It is up to NHS England to ensure that sufficient services are commissioned and I will readily take up that case with NHS England.

Learning Disabilities Mortality Review

Lilian Greenwood Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

My hon. Friend is right to say that this is the first time in the world that such a review has been done. We are the first to have a learning from deaths programme and a Healthcare Safety Investigation Branch, so we take such things incredibly seriously. The whole point of the learning disabilities mortality reviews is that the information will be disseminated to local trusts so that they can make plans to avoid such disastrous, tragic incidents happening in the future.

[Lilian Greenwood (Nottingham South) (Lab)]

The gap in life expectancy for people with learning disabilities is deeply troubling. Last week, and at Health questions earlier, the House discussed cancer screening and the need to improve screening opportunities. The Minister will know that screening participation rates among people with learning disabilities are far below those for the general population. What specific actions is she taking to address that gap?

[Caroline Dinenage]

The hon. Lady is right to raise the inequalities of diagnosis of conditions and illnesses for which catching them early can mean the difference between life and death. That is why we have introduced annual health checks for people with learning disabilities. They mark a huge step forward and will help to reduce recognised health inequalities and ensure that reasonably adjusted care needs are much better communicated to other NHS partners.

Bowel Cancer Screening

Lilian Greenwood Excerpts

Tuesday 1st May 2018 Westminster Hall

[Nick Thomas-Symonds]

I am pleased to hear the good news that the hon. Lady’s sister was able to recover well. Of course Members across the House should look to support those campaigners. I am in favour of consistency across the UK. One of the great things about devolution is learning from best practice in different parts of the United Kingdom, and people in Northern Ireland absolutely should benefit too.

There are other differences in testing. In England and Scotland, people aged over 75 can obtain a screening test by calling a free bowel cancer helpline. In England, a one-off bowel scope screening is promised for those aged 55, but only around half of areas currently offer that. Will the Minister update us on how progress towards all areas being covered can be sped up?

As I indicated in answer to the hon. Member for Eastbourne, there is cross-party support for reviewing the age at which testing starts. I ask the UK Government and all the devolved Governments to look at and keep under review the age at which screening begins—that is crucial—and the sensitivity of the tests that are used. It seems to me that reducing the screening age, which many Members have pointed out, and increasing the sensitivity of tests are the two uniting themes.

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is making a powerful argument. Like him, I lost my mother to bowel cancer when she was only 53—an age I am now approaching. Does he have evidence on whether there should be a lower screening age at least for those of us with a family history of bowel cancer, even if the screening programme cannot be extended to everyone under 60 or 55?

[Nick Thomas-Symonds]

I absolutely agree. Although we all want a blanket reduction in the screening age across the United Kingdom, there are a number of risk factors for bowel cancer, one of which is family history, and we certainly need to look at having flexibility around the country so that screening can be done earlier where those risk factors are present.

The charities Bowel Cancer UK and Beating Bowel Cancer seek an optimal screening programme for men and women from 50 to 74. They rightly point out the importance of early diagnosis and the real opportunity to reduce the number of people who die from this awful disease.