Trends in Excess Deaths

Maria Caulfield Excerpts

Friday 20th October 2023 Commons Chamber

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

I congratulate the hon. Member for North West Leicestershire (Andrew Bridgen) on securing this important debate. I only have five minutes of this 30-minute debate to respond. I will try to cover all the points if I can.

Can I start by acknowledging that the hon. Member is correct that we have seen an increase in excess deaths in the last year? However, I disagree with his analysis, because the causes that he refers to simply do not bear out the statistics that we have. There has been a combination of factors contributing to the increase in excess deaths, including, in the last year, high flu prevalence, the ongoing challenges of covid-19, a strep A outbreak and conditions such as heart disease, which he touched on, diabetes and cancer. Because we had had virtually a lockdown of routine health services over a two-year period, many people are now coming forward with increased morbidity and mortality as a result.

I will start with winter flu. The number of positive tests last year peaked at 31.8%, the highest figure seen in the last six years. Interim analysis from the UKHSA indicates that the number of deaths in England associated with flu was far higher than pre-pandemic levels, so the excess deaths due to flu last winter are, sadly, part of the answer.

The hon. Member touched on the independent body, the ONS. Its figures show that the leading cause of death in England is still dementia, which accounts for about 10% of all deaths. It also looks at the cause of excess deaths. If we look at the figures as of June this year, the top three causes of excess deaths are respiratory illnesses, dementia and ischaemic heart disease, which is often caused by an increase in cholesterol, smoking or not having a blood pressure check. There are a number of reasons, and they are often chronic conditions that people have had for years, or in some cases for decades; they are not acute illnesses.

In the three minutes I have left to respond, I will touch on some of the points that the hon. Member made. First, on the importance of vaccination, it is very easy to say that there is a prevalence of high rates of covid vaccination in people who have died. That is correct: when 93.6% of the population have had at least one dose of the vaccine, there will be a high rate of vaccination in excess deaths. That is different from causality. I completely agree with the hon. Member that there is a high prevalence rate, but that is not the same as saying that vaccination is the cause of those deaths.

The Office for National Statistics has looked at this, and those who have been vaccinated have generally had a lower all-cause mortality rate than unvaccinated people since the introduction of the booster in 2021. A recent study in Singapore looked at unvaccinated patients who had recovered from covid, and showed that those patients had a 56% higher risk of cardiac complications a year later than those who were vaccinated. There is conflicting data on this issue, and I am not necessarily disagreeing with the hon. Member, but I think we need to have a robust conversation about it, not to assume that one side necessarily has all the answers.

I will touch on a couple of points that the hon. Member made about vaccine safety. The regulator has been taking account of those who report adverse events, and I encourage anyone who has had a side effect from any of the vaccines to use the yellow card system and report it to their GP. When those side effects have been reported, the MHRA has taken action. In April 2021, the MHRA reacted to rare cases of concurrent thrombosis and thrombocytopenia following the AZ vaccine, which resulted in adults under 30 not being offered that vaccine. In May 2021, that was increased to adults under 40. With regard to the mRNA vaccine specifically, following reports of a link between covid vaccines and myocarditis, the Commission on Human Medicines conducted an independent review in June 2021, which found that the incidence of that side effect was rare: between one and two cases per 100,000. When there are concerns, we absolutely must investigate them. There is no doubt about that.

We had a debate earlier this afternoon about those who have experienced rare side effects from the vaccine. We do have the vaccine damage payment scheme, which offers a payment of £120,000 if that is shown to be—

Pregnancy Loss Review Recommendations: Implementation

Maria Caulfield Excerpts

Thursday 19th October 2023 Written Statements

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

I wish to inform the House of our progress in implementing the recommendations of the pregnancy loss review following Baby Loss Awareness Week last week.

The sensitive handling and storage of pregnancy loss remains—We have begun a review of the guidance on the sensitive handling of pregnancy remains and the Human Tissue Authority will make any necessary updates by March 2024. The Department of Health and Social Care is working to develop specifications for a bespoke receptacle to ensure foetal remains can be collected and stored with dignity by February 2024. Scoping work is also under way to map the provision of cold storage facilities to avoid needing to temporarily store pregnancy remains at home.

Recurrent miscarriage—The Tommy’s Miscarriage Centre at Birmingham Women and Children’s Hospital will be launching a three-month pilot to assess the effectiveness of a graded model of sporadic or recurrent miscarriage that brings forward support to before a third miscarriage. The results of the pilot will be considered in due course.

Bereavement care—NHS England will commence a compliance survey of the estates, including early pregnancy facilities, starting by spring 2024. NHS England will also review the “Health Building Note” for maternity care facilities to update best practice guidance on the design of new and existing facilities, including access to appropriate facilities for women and families who suffer bereavement at any stage of pregnancy.

Education, training, and information—The Department of Health and Social Care is working with stakeholders to develop new information resources, based on best practice examples, for primary and secondary healthcare settings, including a poster on “what to do if you have pain or bleeding during pregnancy”.

Early Pregnancy Assessment Units—Work with commissioners of NHS 111, ambulance services and trusts will look at the direct booking of appointments with early pregnancy assessment units so that patients with complications can be sent direct. A review of the current directory of services, which allows women to find their closest service, will ensure that local information is kept up to date.

Baby loss certificates—In July, I announced that we would be rolling out the baby loss certificate service in October. Following testing phases with over 1,000 families who have experienced pregnancy loss, I have commissioned an enhanced service specification to improve the application process and ensure the proper protection of this sensitive service, including strengthening the method of second parent verification. We are working at pace to put in place additional verification and the certificates will be available as soon as possible.

In addition to the progress being made, we have established a pregnancy loss ministerial oversight group, and the first meeting will take place this month to ensure actions are on track to progress work on the priority recommendations.

I will continue to update on our work, including on the remaining medium and long-term recommendations, via written ministerial statements.

[HCWS1076]

Black History Month

Maria Caulfield Excerpts

Thursday 19th October 2023 Commons Chamber

[The Minister for Women (Maria Caulfield)]

I am grateful to be able to contribute to this Adjournment debate to mark Black History Month. I congratulate the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) on what has been a marathon afternoon for us both. It is lovely to finish the afternoon by responding to such an important debate.

As Minister for Women, I was pleased to see that one of this year’s themes for Black History Month is “celebrating sisters”. That gives us a chance to recognise the important contribution that black British women have made in the story of this nation. From individuals such as Mary Seacole, a trailblazing nurse who served during the Crimean war, to women from the Windrush generation who helped rebuild this country after the second world war, these pioneering women fought for civil rights and equality, playing an essential role in shaping the diverse and inclusive nation we are today.

As a Government, we are committed to ensuring that Black History Month is, as the hon. Lady said, not a once-a-year event and that schools are equipped to teach black history all year round. How our past is taught is crucial to ensuring that every pupil, regardless of their background, feels a sense of belonging to this country. We also want to celebrate the fact that our country is more diverse than ever before. According to the 2021 census, 18% of people in England and Wales are now from an ethnic minority group, compared with just 14% in 2011. Integration is also increasing, with the mixed- ethnicity population in England increasing by 40% in 10 years; 2.4 million households are now multi-ethnic.

[Abena Oppong-Asare]

According to some of the latest data, contained in a report produced recently by the newspaper the Voice in conjunction with Cambridge University, although we are seeing more diversity, especially in communities, there are concerns about the way people feel. May I urge the Minister to look at the report and think about what action can be taken in that regard?

[Maria Caulfield]

I have not seen the report, but I shall be happy to look at it, because the question of how people feel is important, in terms of both their experience and how it shapes their future.

It would of course be naive to say that tolerance and inclusion are the universal experiences of everyone who lives here, which is why, in July 2020, the then Prime Minister established the Commission on Race and Ethnic Disparities. We published our response to the Commission, “Inclusive Britain”, in March last year. That response sets out a groundbreaking action plan to level up the country, with three clear aims: to build a stronger sense of trust and fairness in our institutions—the hon. Lady touched on that, in relation to maternal health in particular —to promote equality of opportunity, encouraging aspiration and empowering individuals to reach their full potential; and to encourage and instil a sense of belonging to a multi-ethnic United Kingdom that celebrates its differences while embracing the values that unite us all.

The landmark “Inclusive Britain” strategy sets out 74 actions to tackle entrenched ethnic disparities in health, education, employment, policing and criminal justice. The strategy aims to increase trust and fairness, promote equality of opportunity, nurture agency, and foster a greater sense of belonging and inclusion. In April we published an update for Parliament, setting out the excellent progress we had made in delivering our ambitious strategy. This is a cross-Government approach, and we have delivered a number of changes already. There is new guidance from employers on how to use positive action in the workplace. We have published our ambitious schools White Paper, and provided targeted support for pupils who need it the most. We have established an Inclusion at Work panel to promote fairness in the workplace, and we are improving the stop and search process through new training for police officers. All of that will make a difference to the lives of black communities. Eighteen months on, we have already completed more than half those 74 actions, and we are proud to be delivering on our promises to all our citizens.

[Abena Oppong-Asare]

I appreciate that the Government are taking steps to try to address this issue, but given that this is the 75th year of the Windrush generation, I should like to hear more about what they are going to do for, in particular, those who have contributed so much to the NHS, have worked in Transport for London, and have helped our public sectors in general. They are being massively left behind, and the compensation scheme has not moved forward at all.

[Maria Caulfield]

The hon. Lady raised that point in her speech. We want to make sure that this is a fair scheme. The Home Office has reduced the time taken to allocate a claim for a substantive casework consideration from 18 months to less than five months. However, I fully understand the points that the hon. Lady has made, and I am happy to raise them with Home Office colleagues, because we fully understand the frustration and the upset that has been caused.

[Abena Oppong-Asare]

It is great that the case workload has been reduced, although it needs to be speeded up. However, I want to ask about the Wendy Williams review, which has been in place for some time. Is the Minister able to give us any firm commitments on its full implementation and any timescales applying to that?

[Maria Caulfield]

I am not able to give a firm commitment from the Dispatch Box this afternoon, but I can update the hon. Lady, and I shall be happy to write to her with some firm timelines after the debate.

I understand that Windrush is a particularly sensitive area, but I reassure the hon. Lady that we are making progress across the board, particularly on the school curriculum. Our model history curriculum will help pupils to understand the complex nature of British history and their place within it.

The hon. Lady touched on maternal health, and the evidence and statistics show that women from black, Asian and working-class backgrounds have poorer maternity outcomes, which is why I am so pleased that we set up the maternity disparities taskforce. My co-chair Wendy Olayiwola is a trailblazing black woman, and she follows the fantastic Professor Jacqueline Dunkley-Bent, who transformed how maternity services respond to black women in particular.

We established the taskforce in February 2022 to tackle disparities for mothers and babies, and our work is currently focused on pre-conception health and wellbeing because our understanding is that disparities are often bedded in by the time a woman is pregnant. The way to reduce those disparities is to ensure that women have help and support before getting pregnant, as that is the best way to ensure a safe outcome during pregnancy and birth.

The taskforce met in September, just a few weeks ago, and we are bringing together experts from across the health system, including some of the charities that the hon. Lady talked about, to explore and consider interventions. We are looking at setting up a pre-conception toolkit, and those charities, including Five X More, are feeding in what they think will make the greatest difference for women across the board. We know from their testimony that previous poor experience of healthcare services often prevents black women from engaging with healthcare services in future. It is important that we break down those barriers and change black women’s experience of NHS services.

Our Online Safety Bill will soon become law, allowing us to hold social media companies to account in clamping down on online racist abuse. This is just a taste of the work we have done and will continue to do to make sure the inclusive Britain commitments are implemented.

The hon. Lady touched on a meeting back in 2022. I was not the Minister at the time, but I am happy to follow up and let her know the outcomes. If it has not been actioned since that meeting, I will follow it up.

I am grateful for the points raised by the hon. Lady throughout this debate. I share some of her concerns, particularly on maternity services, and we are committed to trying to transform the statistics to make sure that black and Asian women in particular, have better maternity outcomes.

Across the board, the Government are committed to continuing to work towards a society in which every individual, regardless of their background, has the opportunity to succeed. We are not there yet, as the hon. Lady so eloquently pointed out, but I have every confidence that the decisive action we are taking as part of our inclusive Britain strategy will help us to achieve that goal.

Question put and agreed to.

Baby Loss Awareness Week

Maria Caulfield Excerpts

Thursday 19th October 2023 Commons Chamber

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

I start by thanking the hon. Members for North Shropshire (Helen Morgan) and for Sheffield, Hallam (Olivia Blake). I know the hon. Member for Sheffield, Hallam could not be here this afternoon, but she has done a huge amount of work over the last 12 months, since the last debate. I also thank my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), who is the co-chair. This is a fantastic example of cross-party working on such an important issue to women, but also to men, up and down the country. I pay tribute to the work that those on the all-party parliamentary group do. They are tireless campaigners for improving support for all families who go through the heartbreak of losing a baby.

This is the 21st Baby Loss Awareness Week and the eighth consecutive year that this House has held a debate to mark it. I am proud, once again, to be able to applaud all campaigners, charities and clinicians who mark Baby Loss Awareness Week. I will use my time this afternoon to provide an update on the progress we have made since the debate last year and on pregnancy loss in particular.

Before I do, I want to touch on the comments by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), who is my constituency neighbour as well. I want to apologise because, while we have delivered most of the changes in his Act, we still have not published the consultation on coronial investigations into stillbirths. I know from speaking to Bill Kirkup and Donna Ockenden that they are very supportive of coronial investigations into stillbirths. I have met many parents who have suffered the horrendous experience of losing a baby and who are very supportive of this change. I was hoping to come to the Dispatch Box and be able to make a positive announcement. Unfortunately, I cannot do so this afternoon, but I can assure him that I will personally follow this up after the debate. I hope that, in a very short period of time, we will be able to make a positive announcement for him.

The loss of a baby is, tragically, a common outcome. We are improving rates. Stillbirth rates have reduced by 23% and neonatal mortality rates for babies born over 24 weeks’ gestation have reduced by 30%, but that is no consolation to those parents who experience baby loss when it does happen. We know that, too often, when baby loss occurs, the experience of parents and families is not what it should be. That is why the independent pregnancy loss review published its report in July, and the Government are supporting the recommendations in that report to make sure that every trust offers a consistent, compassionate service. The review made it clear that baby loss is too often treated as a clinical event, with emotional support failing or falling short in a number of areas. That is why it is so important that we reintroduce compassion as an element throughout the experience.

Let me take one example that was shown in the pregnancy loss review. I was horrified to read stories of women miscarrying at home and storing their baby’s remains in their fridge in a Tupperware container because they were waiting days for their early pregnancy loss unit to reopen. The review put it down in black and white that major improvements are needed and that is why we are supporting the recommendations.

The review made 73 recommendations for change within the NHS and wider society, and we have already started action on many of those. The first was touched on by the SNP spokesperson, the hon. Member for North Ayrshire and Arran (Patricia Gibson): the use of baby loss certificates for babies who are born before 24 weeks, who currently cannot be registered. We announced in July that we would be rolling out baby loss certificates. They will be retrospective. There is no time limit on applying for them. They will be voluntary, so parents do not have to apply for one if they do not feel that they wish to. We are going through service user testing with families to ensure that the system we set up works for them. Following testing, there has been some service specification that we need to improve to ensure that the process runs smoothly. It will be run on the gov.uk website. Once we have those safeguards in place for both parents to be able to register on a certificate, we will announce the roll-out date formally to this place. It is important that parents who want to acknowledge the loss of their baby before 24 weeks are able to do so.

We also looked at the sensitive disposal of a baby after pregnancy loss, many instances of which happen at home rather than in hospital or clinical settings. It is important that women have access to proper collection facilities, so we have taken on board the recommendation on creating a bespoke receptacle to ensure that foetal remains can be collected and stored with due dignity. To do that we have been engaging with charities, women and healthcare professionals and we aim to finalise a specification by February. We are also working with the Human Tissue Authority to review and update its guidelines by March next year. NHS England is also consulting on a clear pathway to ensure that women can always have access to cold storage in NHS facilities, too.

We have also heard from women about the difficulty they often experience in getting help during a miscarriage. In partnership with NHS England, we are exploring how 111 and ambulance services can block-book appointments with early pregnancy assessment units, so that women in need can be directed straight to them if necessary; rather than going to A&E or other healthcare professionals, they can go straight to those units, where care can be provided with dignity and privacy. The review also proposes introducing graded care for women who suffer one, two or more miscarriages; the shadow Minister touched on that issue. We have taken on board those recommendations because currently, women have to suffer three miscarriages often before they get help.

Tommy’s miscarriage centre at the women’s hospital in Birmingham has launched a three-month pilot of that graded model, so that after one miscarriage assessments can be delivered. I have been to the unit to see the amazing work it does and I am looking forward to its results. It will look at that graded model and be able to present to us the difference that that will make to women experiencing baby loss. That will help to prevent further pregnancy losses in future.

Another recommendation made by the pregnancy loss review concerns the fact that families are often forced to grieve in public spaces. I want to be clear about this. Very often, the pregnancy facilities are inadequate. My hon. Friend the Member for Truro and Falmouth talked about the Daisy centre that is available in her area; it was not available when she tragically had to go through her experience. In many places, clinics, units and buildings are not able to meet women’s needs. Therefore, NHS England is surveying pregnancy facilities and will report back by the spring to ensure we can invest in those facilities to improve the outcome and experience for women and their families. We also need to improve bereavement support for both women and their families. That is another key area we are looking at.

Members touched on the number of midwives there are. I am pleased that in Cornwall there is a waiting list for training but across England there has been an increase in the number of midwives: there are 14.2% more than in 2010. We are engaging in a number of routes into midwifery. We have the degree apprenticeship now but we also have the nurse conversion course, which is popular with nurses who perhaps want to work in midwifery instead of nursing. Those routes are not just getting more midwives into practice but retaining them. That is a key element to be able to deliver all the asks in the pregnancy loss review.

We are also looking at how we support people in the workplace. It is important that women and families who experience baby loss are able to take the time off that they need. As a first step, the Department has signed the miscarriage association pregnancy loss pledge and we encourage other organisations to do so.

We could cover a number of issues that were raised in the debate. I just want to be clear with the House about all the issues that have been raised. With the ongoing maternity inquiries, we have set up a national oversight board so that we can pull together all the recommendations and findings, whether from Donna Ockenden, Bill Kirkup or other inquiries that have happened in the past, and make sure that every single maternity unit across England is responding to them, whether they are relevant to their units’ experience or not. We want consistent, good maternity care across the board, whether that is the Birthrate Plus model for making sure there are more midwives on units, making sure the capital framework of the unit is able to help support women who lose their babies, or ensuring that the culture of change that Bill Kirkup touched on so much in his review is rolled out, so that women have a compassionate experience when they go through the devastating loss of a baby.

It is our duty to support families who experience the devastating loss of a baby, and this Government remain committed to implementing all the independent pregnancy loss review’s recommendations. At the debate next year, I hope that my hon. Friend the Member for East Worthing and Shoreham will have a more positive comment to make and we will have addressed his concerns in detail, but also that we will have taken a step forward on many of the issues raised today and on some of the work we have started with the pregnancy loss review.

Birth Trauma

Maria Caulfield Excerpts

Thursday 19th October 2023 Commons Chamber

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

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

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

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

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

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

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

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

[Hannah Bardell (Livingston) (SNP)]

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

[Maria Caulfield]

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

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

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

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

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

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

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

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

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

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

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

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

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

Clinical Negligence Claims

Maria Caulfield Excerpts

Monday 18th September 2023 Written Statements

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

On 15 September, the Government response to the consultation on fixed recoverable costs in lower damages clinical negligence claims was published on www.gov.uk.

The rising costs of clinical negligence claims are of great concern to the Government. Costs have more than quadrupled in the last 16 years, with legal costs comprising a notable proportion of this rise. Claimant legal costs have risen sharply in lower damages claims—claims valued up to and including £25,000—and are often disproportionate to the value of those claims. These costs are funded from the core NHS budget and use resources that could otherwise have been spent on patient care.

The length of the legal process can also be disproportionate given the relative straightforwardness of many claims at this level, meaning that people who have been harmed are waiting longer to receive compensation.

The consultation response sets out a way forward for these lower damages claims: a set of fixed legal costs and a new streamlined process. Our aim is to facilitate faster resolution for claimants and defendants at a lower, more proportionate cost than under the current system for these claims. The scheme would only affect the amount of legal costs that claimant lawyers can recover from defendants following a successful claim, not the compensation that a claimant could receive.

We also believe that these reforms will achieve significant cost savings and make an important contribution towards addressing the overall rise in clinical negligence costs. The Department’s modelling indicates that introducing these reforms could realise cashflow savings to the NHS in England of around £500 million over a decade. These reforms would apply to care provided by NHS, non-profit and private healthcare providers in England and Wales, but would not apply in Scotland or Northern Ireland.

The responses to our 2022 consultation on introducing fixed costs in ‘lower value’ clinical negligence claims have been vital in helping us shape these reforms and informed some changes to the original proposals, in particular around strengthening the safeguards we have in place to protect claimants’ access to justice.

Alongside the response, I have launched a further consultation focusing on the specific issue of disbursements under the fixed recoverable costs scheme, inviting views on a proposed way forward on disbursements for all claims in the scheme. That further consultation will run for six weeks, ending on 27 October 2023. I welcome views from all interested parties on those proposals.

We will work with the Civil Procedure Rule Committee to ensure the smooth delivery of these reforms. Subject to agreement, the Government expect that legislation will be in place to implement the reforms by April 2024.

[HCWS1031]

World Sepsis Day

Maria Caulfield Excerpts

Wednesday 13th September 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Fovargue. I start by thanking the hon. Member for Neath (Christina Rees) for introducing this important debate, which is taking place on World Sepsis Day; for her work as chair of the all-party parliamentary group; and especially for her tribute to Dame Cheryl Gillan, who did so much work in this space. I am sure that Dame Cheryl would have been delighted by the way the all-party parliamentary group has been taken forward under the leadership of the hon. Lady.

I was touched by how she shared her personal experience of sepsis because I think that will highlight to people listening or watching how difficult it sometimes is to diagnose sepsis and the very many circumstances in which sepsis can present. Sepsis is a devastating condition and, while many people who develop sepsis survive, every death is tragic. Patients rightly expect it to be recognised and treated promptly because very often they are feeling so poorly that they are not necessarily in a position to raise concerns themselves. Even as the hon. Member for Neath pointed out, just becoming unwell with sepsis has long-term consequences and it can take many months to recover from an episode. She put that extremely eloquently.

The many interventions have moved us all. Many of us will know people who have become worryingly ill or have died from sepsis. It is especially heartbreaking when the family of someone who has died from sepsis feel that more could have been done to save them. Those cases are hard to hear, but it is important for us to listen and learn at all levels of Government, from officials through to frontline clinical staff.

As has been mentioned, we have all been moved to hear about Martha Mills who was 13 when she tragically died from sepsis despite concerns being raised by her family about her care. On what would have been Martha’s 16th birthday last week, her mother spoke about her death and the need for patients and families to be listened to when they think that something is wrong. I echo the words of the hon. Member for Neath. We need to encourage more people to ask that question: could it be sepsis?

I am pleased to add my support to the announcement made by the Health Secretary that the NHS will be exploring the introduction of Martha’s rule in the United Kingdom. The Secretary of State is meeting Martha’s family later today and is looking at how this could be implemented. I am sure he will be updating the House and I am happy to update Members on the follow-up from that meeting and the work that is being done to look at this.

We anticipate that Martha’s rule will be similar to a system in Queensland, Australia, known as Ryan’s rule, which is a three-step process allowing patients and families to request a clinical review of a patient’s condition if they are deteriorating. Such a system would build on initiatives already being tested in the UK, including the Call 4 Concern scheme introduced in the Royal Berkshire Hospital. Evidence from the scheme suggests that patients and their families find it useful, and that it can make a real difference in outcomes for patient care.

[Rachael Maskell]

In the light of the fact that people suffering from sepsis can rapidly deteriorate, will the Minister ensure that a review of a patient could also be undertaken really quickly, without it becoming a bureaucratic process?

[Maria Caulfield]

Absolutely. That is the point: if families want a review, it needs to be done as quickly as possible. If we are going to look at Martha’s law, those processes will need to be looked at. It must not become bureaucratic to make a request. It must be a really practical process that makes a difference.

Sepsis is not a single disease and it cannot be diagnosed with a single test. It varies in presentation depending on the source of infection and the individual. I pay tribute to the UK Sepsis Trust, which today has reiterated the signs and symptoms for people to look out for, including: fatigue; not passing urine; breathlessness; skin being discoloured, which is particularly important for ethnically diverse communities, because the skin colour may be different in different communities; fits and shakes; confusion; and shivers. All those symptoms are signs of potential sepsis, so it is really important that people understand to look out for them. We will never fully eliminate the risk of sepsis or other forms of acute deterioration, but we must do everything we can to ensure that clinicians and other NHS staff working on the frontline can recognise a very sick patient.

As many Members know, 100% of ambulance trusts and 99% of acute trusts in England screen for sepsis using the national early warning score or NEW score, which is carried out in clinical care. Following recommendations from the Academy of Medical Royal Colleges and the National Institute of Health and Care Excellence, we are working to update national guidance on sepsis. I very much take the point made by the hon. Member for Neath about the importance of ensuring that that information is all in step and aligned with guidance across the board, so that there is one clear narrative about recognition of sepsis and the targeted use of appropriate treatment.

Research is key to improving outcomes the detection of sepsis and finding more effective treatments. We are committed to driving the evidence base to improve our understanding, and the Department is providing funding of over £1 billion a year through the National Institute of Health and Care Research to drive forward research studies in these areas. Since 2017, the national institute has funded 14 research projects on sepsis, with a combined total funding value of £27 million, but further applications will be welcomed, so if there people out there want to undertake research studies, please encourage them to come forward and put in applications.

It is important that I touch on antimicrobial resistance, as the issue is inextricably linked to sepsis. It is critical that we conserve our antibiotics so that if an infection occurs, they remain as effective as possible when they are really needed, including for sepsis. In line with the asks of the declaration, the Government are delivering a five-year national action plan and a 20-year vision to contain and control antimicrobial resistance by 2040.

I am pleased to say that we are working collectively, across the UK, with our counterparts in Northern Ireland, Scotland and Wales on that antimicrobial resistance national action plan. Hon. Members have touched on international collaboration, because no country or Government can tackle this issue alone. A study published last year by the Global Research on Antimicrobial Resistance Project shows that resistance was associated with the deaths of 4.95 million people worldwide, and many of those cases will be because of sepsis related to antimicrobial resistance. By working together with international partners, we can protect ourselves and help to treat sepsis more quickly and easily.

World Sepsis Day is an important reminder that there is more work to be done. In recognition of that and as a reminder of the importance of the issue, the Department is lit up in pink today. Once again, I thank the hon. Member for Neath. I am happy to meet her and anyone she wants to bring with her, because there is still work to be done. We have made great progress, and she is touched on work that is being done, including on Martha’s rule, but I am happy to meet her and the APPG to ensure that, by next World Sepsis Day, we have made further progress with this significant condition.

Question put and agreed to.

PANS and PANDAS

Maria Caulfield Excerpts

Tuesday 12th September 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Dowd, and to respond to this debate. To be clear, I can respond only on healthcare services in England, and not on behalf of Ministers in Scotland, Wales and Northern Ireland, because health is a devolved issue. I can, however, give a commitment to hon. Members that I am happy to work with colleagues in the devolved nations on this very important issue.

I welcome the shadow Minister, the hon. Member for Erith and Thamesmead (Abena Oppong-Asare), to her place. It is slightly disappointing that she chose to be so political—I thought we had quite a good cross-party consensus in this debate. I thank the hon. Member for North East Fife (Wendy Chamberlain) for providing the opportunity to raise awareness of paediatric acute-onset neuropsychiatric syndrome, or PANS, and paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, known as PANDAS.

We have heard from Members how important the issue is. I thank them for describing the experiences of their constituents and the issues that they have faced. I recently met the chair of the all-party parliamentary group on PANS and PANDAS, my hon. Friend the Member for Aberconwy (Robin Millar), to discuss the lack of guidance on diagnosis, treatment and assessment for children who suffer from either of those conditions, and about the lack of awareness across the medical profession in all parts of the health service. I absolutely agree that we need more research and evidence to improve our understanding of the conditions and to better support the families affected.

[Sir Julian Lewis (New Forest East) (Con)]

The Minister will have heard the excellent speech made by my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about taking it on himself to send leaflets to his GPs to raise awareness. Does the Department have a mechanism for alerting all GPs to these conditions, which seem to be relatively unknown? If so, could GPs be encouraged by her Department to consider prescribing amoxicillin or a similar antibiotic at a very early stage, because that seems to be an almost risk-free option?

[Maria Caulfield]

The Department does not regularly write to GPs because the NHS is operationally independent, but NHS England does and we can certainly speak to NHS England colleagues. They send out regular bulletins on a range of issues to GPs, so I will speak to my primary care colleagues to see whether that is possible. We do not have enough information at the moment about how many children in the UK are affected by PANS and PANDAS. In the US, scientists have suggested that the prevalence there could be as high as one in 200 children.

We have specifically talked about the United Kingdom and England today. Although there is a classification now by the World Health Organisation, very few countries issue guidance on the diagnosis, treatment, assessment and management of PANS/PANDAS, because the scientific evidence is so sparse. When I met my hon. Friend the Member for Aberconwy, we talked about how we can get that evidence base so that we can issue guidance to primary and secondary care providers. We know that symptoms tend to come on suddenly.

We heard from my hon. Friend the Member for North Devon (Selaine Saxby) about the example of Jack and the difference that a diagnosis made. It is often following an infection that children who are healthy and developmentally on track suddenly start exhibiting OCD or other neuropsychiatric symptoms. The hon. Member for Brentford and Isleworth (Ruth Cadbury) is correct that very often a course of antibiotics can improve and tackle some of the symptoms that parents say can change a child overnight such that they can no longer attend school and are suddenly plagued by anxiety and other neurological symptoms.

PANS and PANDAS require a clinical diagnosis based on specific signs and symptoms observed by a clinician. There are currently no lab tests or biomarkers that specifically diagnose those conditions. There is also an element of excluding other diagnoses in the process of diagnosing PANS and PANDAS. That means other illnesses or diseases are considered first rather than assuming it could be PANS and PANDAS.

Although there are currently no national or European clinical guidelines on assessment, investigations or diagnosis, a multidisciplinary team referral often helps speed the process up. That is why we need our primary care colleagues to be aware that this could be the cause of symptoms and to get those referrals in as quickly as possible.

[Ruth Cadbury]

I thank the Minister for her response. She mentions the fact that there is no lab test that can diagnose PANS/PANDAS, but is that not true for other neurological conditions that I mentioned, such as ME and some of the ongoing conditions that people are experiencing from long covid? Sometimes a lab test does not exist because of the nature of what caused the symptoms. Perhaps the medical profession and NHS England need to think slightly outside the box in their search for answers.

[Maria Caulfield]

I absolutely agree with the hon. Lady. NHS England has been happy to work on such issues with the working group. It is embarking on work to roll out a nationwide surveillance study designed to identify the signs and symptoms because, again, it is probably unlikely that we will reach a definitive test that will ever give us a diagnosis, and it is about matching symptoms with a diagnostic criteria. NHS England has committed to doing that, and the Department is happy to support it in its work.

There is the issue about how quickly antibiotics should be prescribed and dispensed, but while one antibiotic may work for one child, it may not work for another, and it is sometimes a case of trial and error before the appropriate treatment is found. Although there is an evidence base for the treatment of symptoms, such as obsessions, compulsions and tics, it is recommended that children and families affected should be offered evidence-based treatments. That is why we absolutely need to build that research base to provide evidence-based guidance to clinicians, whether they are in primary or secondary care. At the moment, NICE says that it does not have the evidence base to put that guidance together, whether that relates to psychological treatments or to medications such as antibiotics. The commitment I can give today is to push and work with the working group, organisations and Members in this place to try to develop that research base.

[Robin Millar]

I have been struck by a couple of things in the debate—one is the cross-party consensus, but another is the uniform distress that Members have relayed. On the point the Minister just made about whether treatment is psychiatric or medical, one of the key points is that PANS/PANDAS is often confused as being psychiatric when it is an infection that has proven susceptible to treatment with antibiotics. That is the kind of basic step forward that we are hoping for today.

[Maria Caulfield]

I absolutely agree. I acknowledge that while the symptoms mimic a mental illness, there is very often a physical cause for those developments. That is why we need to build that evidence base with research to back the guidance that we can give to clinicians who, as colleagues have said, may not be aware of the condition or how to manage it.

Training on PANS is now included in the Royal College of Paediatrics and Child Health curriculum. In April 2021, the British Paediatric Neurology Association issued a consensus statement with the faculty of child and adolescent psychiatry at the Royal College of Psychiatrists. Following concerns about variation in how it was being interpreted across the UK, the new PANS PANDAS working group, as we have heard today, which is being supported by NHS England, issued a statement recommending the development of appropriate service models and pathways back in February. I am keen that we support the working group in its important work bringing the key organisations together so that we can get that consensus out to clinicians in the field.

The work that the working group has done highlights that all children presenting with acute onset neuropsychiatric symptoms should receive a full medical evaluation and signposts clinicians to existing international peer review treatment guidelines. As I have said, while NICE currently has no plans to issue guidance, should the evidence base develop further, and should there be an opportunity to do that, we would look to update clinical policy. NHS England would then consider the development of care pathways for those living with PANS/PANDAS. The key is building that evidence research base.

We have the evidence to sufficiently demonstrate that PANS and PANDAS are discrete disease entities. I hope that answers the question by the hon. Member for North East Fife on whether we recognise that. We absolutely do, but we do not have the evidence and research base on assessment, diagnosis, treatment and management. However, the Department is funding research into rare diseases through the National Institute for Health and Care Research, which is spending over £1 billion a year every year on research particularly into rarer conditions. It welcomes funding applications for research into any aspect of human health, which would include PANS and PANDAS. Applications are subject to peer review and judged in open competition, with awards made on the basis of importance to the topics of patients, health and care services.

The National Institute for Health and Care Research does not just provide funding; it will also provide guidance, whether for academics, clinicians, researchers, the working group, charities or any other organisation. I am happy to organise introductory meetings with the National Institute for Health and Care Research. It has met other groups to explore the types of research it would support and that would build an evidence base. I strongly encourage researchers with an interest in this area to come forward with proposals so that we can develop that evidence base and make real inroads.

Other countries are not necessarily leading the way. Not many countries have international guidance on the issue. I cannot remember which hon. Member referred to this, but the UK and the devolved nations have an opportunity to take a lead, build that evidence base and develop guidance on that basis.

I assure colleagues that I am committed to ensuring that those with PANS and PANDAS get the care they need. We need more high-quality research into these conditions. That is the only way we can get better outcomes for patients. I am happy to meet both the APPG and the working group to take this forwards, because there is an opportunity to develop our knowledge, increase awareness and ultimately to have better outcomes for those children affected.

Suicide Prevention Update

Maria Caulfield Excerpts

Monday 11th September 2023 Written Statements

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

Every suicide is a tragedy with devasting impacts on individuals, loved ones and communities. Today we are publishing a new National Suicide Prevention Strategy for England, which refreshes the national strategy for England that was published in 2012.

The strategy considers the latest evidence collected through our mental health call for evidence and discussions with experts, including those who have experienced the suicide of a loved one, academics, those who work within suicide prevention and the Government’s National Suicide Prevention Strategy Advisory Group.

I am incredibly grateful to everybody who took the time to provide feedback to ensure that the new strategy reflects the most pressing challenges and opportunities.

The result is a new cross-Government and cross-sector strategy for the next five years, with a core message that suicide prevention is everybody’s business. Over the next five years, we intend to reduce the suicide rate—with initial reductions in half this time. The strategy also sets out measures to improve support for people who have self-harmed and those bereaved by suicide.

Together, this strategy lays out over 100 concrete actions across national Government Departments, the NHS, local government, employers, the voluntary sector and many others. It includes new priority areas of action, such as improving online safety, addressing the links between suicide and factors such as gambling and domestic abuse, and combating different methods of suicide.

We have already provided funding to improve access to crisis support and support the voluntary sector to deliver suicide prevention activity including:

The £10 million from 2023 to 2025 to support non-profit organisations to meet the increased demand seen in recent years and support a range of diverse and innovative activity that can prevent suicides, including targeting groups of concern identified in this strategy.

Over £2.3 billion more a year for mental health services by March 2024 compared to 2018-19 , with £57 million specifically for suicide prevention and suicide bereavement services.

The £150 million capital investment made available to urgent and emergency care mental health pathways, including mental health ambulances, crisis cafes, children and young people’s places of safety and new mental health assessment spaces.

We will continue to review progress and update actions to prevent as many suicides as possible. I look forward to continuing to work with members of this House, the National Suicide Prevention Strategy Advisory group and colleagues across the NHS, local government and the voluntary sector to deliver on our ambition to reduce suicides.

I will deposit a copy of the strategy in the Libraries of both Houses.

[HCWS1012]

Hormone Pregnancy Tests

Maria Caulfield Excerpts

Thursday 7th September 2023 Commons Chamber

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

I thank the hon. Member for Bolton South East (Yasmin Qureshi) for securing the debate and all right hon. and hon. Members who have taken part in it. We cannot help but be moved by the many cases that have been brought forward this afternoon. This is the first time I have been able to speak either in this Chamber or in Westminster Hall on Primodos because, as many Members have said, there were legal proceedings that ended in May. The claimants had until 11 August to make an application for permission to appeal, which they did not do in that time, so today is my first opportunity since that legal action to speak on it. A second claim is being issued by those who believe that they were harmed by hormone pregnancy tests, against Bayer/Schering. That claim was stayed pending the outcome of the first case and, given that the first claim was struck out by the court, there are now discussions regarding the next steps with that claim. However, I am free to speak today on the issues that we have discussed in the debate.

I want to be clear, as a Minister who is responsible for patient safety, that the patient safety element is the most pressing and important part of my role. Baroness Cumberlege is also a constituent of mine, so hon. Members can be assured that she lobbies outside Parliament as well as inside.

Baroness Cumberlege conducted a review, and the Government have accepted and made progress on most of those recommendations. As has been said, an apology was issued by Government Ministers at the time when they responded to that report. We have appointed an independent Patient Safety Commissioner, and Henrietta Hughes is doing an outstanding job holding the Government to account.

I will touch on the issues around redress in just a moment. We have set up the mesh centres for those affected by pelvic mesh; I meet regularly with those female campaigners to hear their feedback on the effectiveness of those centres, and there is work going on to review that. The MHRA itself is revising its practice as a result of Baroness Cumberlege’s report.

[Dame Angela Eagle]

I think the Minister for her generosity in giving way, but this sounds like a typical civil service-drafted speech, if I may say so, mentioning everything but the issue we are talking about. We are not talking about mesh; we are talking about Primodos, and we want to hear about redress. Can she now please address those points?

[Maria Caulfield]

I can show the hon. Lady my remarks—they are on the back of this paper, and I have been writing them down during this debate. I am only two minutes into my speech and I am addressing some of the points that were made. I will of course come on to Primodos as well.

It is important to recognise that we did take those issues in Baroness Cumberlege’s review seriously. We could not look at the issue around Primodos at that time because of the legal case, which I have touched on, but there have been some reviews. My hon. Friend the Member for Mid Norfolk (George Freeman) was here just before this debate. In his time as Minister for Life Sciences, he took the campaigns and the evidence around Primodos so seriously that he set up the expert review in 2014 to look at the evidence that was in place. I hear very loudly this afternoon some concerns about that expert working group and that maybe evidence was either misinterpreted or not looked at, but that expert working group did look at the evidence at that time and also issued a public call for evidence.

[Sir Mike Penning]

The so-called expert group changed the remit that it was given, with no recourse, as I understand it, to any Minister for permission to do so. It changed the terms of what it was supposed to look at, which is not what it was asked to do in the first place.

[Maria Caulfield]

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

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

[Hannah Bardell]

Will the Minister give way?

[Maria Caulfield]

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

[Hannah Bardell]

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

[Maria Caulfield]

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

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

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

[Mrs May]

I wonder whether the Minister might clarify one point about the second court case. The Government were a party to the first court case; that was the argument that they used for being unable to come to a decision. Are the Government a party to the second court case? If not, the second court case seems to me irrelevant.

[Maria Caulfield]

I will come to that in a minute. We are in between cases, and I want to make progress while we do not have a live case. Discussions are ongoing at the moment.

I am the Minister with responsibility for patient safety, and on this matter, I, rather than officials, wrote my speech. We all know that tragic events and accidents can happen, but I am weary of meeting families up and down the country who are victims of the injustice in the health service at the moment. I and the Secretary of State met the families at the Countess of Chester Hospital only last week. I met the families from Tees, Esk and Wear valleys, whose young children died by suicide. I met, as you will know, Mr Deputy Speaker, the families whose children died in east Kent, where there was an inquiry. I met Janet and Emma, the sodium valproate campaigners from In-FACT—the Independent Fetal Anti-convulsant Trust—and the women who lead the mesh campaign. I hear day in, day out about the injustice that many have to face, and about the fight to get answers to basic questions when things go wrong.

I am very happy to say from the Dispatch Box that I will meet the all-party parliamentary group, the hon. Member for Bolton South East, and other hon. Members who have taken part in the debate. I am very happy to commit to a meeting with my hon. Friend the Member for Leigh and with Marie Lyon, as well as with any other families who wish to meet, to discuss the Primodos case. If there are concerns that evidence was left out or not scrutinised, or that evidence in previous reviews is disputed, I am very happy to look again at that evidence and to leave no stone unturned until we absolutely get to the facts of the matter.

The right hon. Member for Kingston and Surbiton (Ed Davey) mentioned the letter that has gone out to those taking part in court cases. I do not want people to be in a position where they feel that they cannot get justice simply because they cannot afford to, so I commit to looking at that matter and addressing the points that he made as soon as I get to the Department.

I do not want to come back to the Dispatch Box to discuss the issues around Primodos on an ongoing basis. If patients feel that there has been an injustice, and that there is evidence to support that, I am very happy to look at it again. There may be future court cases, as my right hon. Friend the Member for Maidenhead said, but we are at a point where we can look at that now.

[Mrs May]

I am sorry; I did not say that there may be future court cases. The Minister herself referred to a second court case, and I asked a simple question about whether the Government would be a party to that case. I am grateful, and I am sure that the families will be grateful, that the Minister has opened the door to sitting down with and hearing directly from the families and campaigners. She says that she is prepared to look at any evidence that comes forward. The Cumberlege review is the evidence; it sets it out very clearly. That is all the Government need.

[Maria Caulfield]

To be specific on that point, the Government are involved in a second claim. We are not sure whether that claim will go forward—discussions about that are ongoing. As the appeal timed out on 11 August, I am happy to commit today to looking at the evidence and the Cumberlege review. Baroness Cumberlege is my constituent, and I am sure she will be pushing me for that.

[Ed Davey]

To follow on from the point made by the right hon. Member for Maidenhead (Mrs May), the Cumberlege review has concluded. There are recommendations. Is the Minister saying from the Dispatch Box that the Government are not accepting those recommendations? We want to hear that they are going to implement those recommendations, not hear more evidence—implement them!

[Maria Caulfield]

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

[Hannah Bardell]

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

[Maria Caulfield]

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

--- Later in debate ---

[Maria Caulfield]

Will the hon. Lady give way?

[Yasmin Qureshi]

We want to sit down with the Minister, and we want her to say to us, “This is what we are going to do about the Primodos case.” We do not want the Minister to tell us the problems. We want a system of redress right now—that is what we want from the Minister—and I hope that when we have that meeting, she and her officials will present to us the practical action they are going to take so that all the people who have been suffering for decades and decades actually get justice. We want her to tell us not about what has happened before or about the court cases, but about the actions she will take based on what the Cumberlege review said. [Interruption.] The Minister is muttering, but in the past it has sometimes taken us months and months to get a meeting with Ministers. I am glad that she has reassured us, and I hope that we will get a meeting in the next couple of weeks and that her and her officials will present a concrete plan for how to get redress for the victims. [Interruption.]

[Yasmin Qureshi]

I am sorry; I did not realise the Minister was asking to intervene. I give way.

[Maria Caulfield]

I just wanted to reiterate that I have pledged to meet the APPG and all its members. I have also pledged to look at the recommendations specifically in relation to Primodos. I think it is important to meet the families and the APPG, so that we can make progress on this issue.

[Yasmin Qureshi]

I thank the Minister for that intervention. I look forward to meeting her and her officials, and to a great scheme that will help the victims of Primodos. I remind her that if we do not get our meeting, or if we do not get a satisfactory result, we will be back again—all of us. We have been fighting for the past 10 or 12 years, and we will continue to fight this campaign, because the whole House is united behind it. I hope we will get positive news at our next meeting.

Question put and agreed to.

Resolved,

That this House notes that children were born with serious deformities due to the hormone pregnancy test drug Primodos, which was taken by expectant mothers between 1953 and 1975; further notes that official warnings were not issued about Primodos until eight years after the first reports indicated possible dangers; observes that the report by the Commission on Human Medicines’ Expert Working Group on Hormone Pregnancy Tests in 2017 was inconsistent with other academic reports; notes that the Independent Medicines and Medical Devices Safety Review, First do no harm, found that Primodos caused avoidable harm; further notes that the Government has refused to acknowledge the recommendations by the Independent Medicines and Medical Devices Safety Review relating to Primodos families; and calls on the Government to fully implement the recommendations in the Independent Medicines and Medica al Devices Safety Review and to set up a redress fund for families affected by Primodos.